2 Paeds in a Pod
Show Notes — Episode 83
Knife Crime, Febrile Infants, and What's Caught My Eye
Released: May 2026 | Runtime: ~20 minutes
In this episode, Ian covers what's caught his eye in the paediatric literature this fortnight. The main story looks at a landmark national review of child deaths from knife wounds in England — and what it means for those of us working in paediatric emergency and urgent care. He then turns to new data on febrile infants aged 29 to 60 days and the evolving evidence base around risk stratification in that notoriously tricky age group. The episode closes with three quick picks from this fortnight's journal sweep: point-of-care lung ultrasound for pneumonia, reframing conversations about paediatric palliative care, and a flag for the new Surviving Sepsis Campaign paediatric guidelines — which we'll be coming back to in a dedicated episode soon.
Main Story 1 — Knife Crime Deaths in Children in England (2019–2024)
Knife-related deaths in children and young people represent one of the most pressing — and most inequitable — public health challenges in England today. This month, Roberts and colleagues published a review using the National Child Mortality Database covering every child under 18 who died of a knife wound between April 2019 and March 2024.
The headline findings:
145 children died over the five-year period — roughly one every two weeks
Mean age at death was 14.4 years; 90% were male
Black or Black British children died at a rate more than 13 times higher than white children when corrected for population size
Children in the most deprived areas of England had over 7 times the risk of death compared with those in the least deprived areas
60% of children died before reaching hospital
Of those who reached hospital, 57% underwent a thoracotomy — reflecting the severity of injuries sustained
Injuries to the chest and neck were responsible for 76% of fatal wounds
75% of children had been known to social services prior to their death
58% had experienced domestic violence and abuse
51% had documented neurodiversity or mental health concerns
Why this matters for paediatric practice: These were not invisible children. The vast majority were known to statutory services. For clinicians working in paediatric emergency and urgent care, this paper is a reminder that every child who comes through our doors carries a history — and that our role extends beyond the presenting complaint. It also raises important questions about pre-hospital intervention, penetrating trauma training in paediatric settings, and the role of the ED as a potential point of early intervention for children at risk.
Knife injuries are not confined to major urban centres — the data show deaths distributed across all regions of England.
Reference: Roberts T, Odd D, Coveney J, et al. Emergency Medicine Journal. Published April 2026. https://doi.org/10.1136/emermed-2025-215154
Main Story 2 — Bacteraemia and Bacterial Meningitis in Low-Risk Febrile Infants Aged 29–60 Days
The febrile infant aged 29 to 60 days occupies some of the most uncomfortable clinical territory in paediatric emergency medicine. Too old for the automatic full-septic-screen approach applied under 28 days, but too young to rely on clinical examination alone. This paper from Burstein, Xie, and Kuppermann — published in JAMA Pediatrics — examines how the updated PECARN (Pediatric Emergency Care Applied Research Network) febrile infant rule performs in an international sample.
What the PECARN rule involves: The rule uses a combination of clinical and laboratory parameters to stratify infants into low, intermediate, and higher risk for invasive bacterial infection (bacteraemia and bacterial meningitis). Key components include temperature, urinalysis findings, absolute neutrophil count, procalcitonin, and — where indicated — CSF analysis.
Why this paper matters: The original PECARN derivation and validation studies were predominantly North American. This international validation is an important step in understanding how the rule performs across different healthcare systems, bacterial epidemiology, and rates of prior antibiotic exposure. The full data are behind a paywall, but the publication itself signals continued maturation of the evidence base.
For UK practice: NICE guidance for this age group tends towards more liberal investigation. Whether structured risk stratification tools like PECARN could safely reduce lumbar punctures and admissions in a subset of genuinely low-risk infants is an active and important question for UK paediatric emergency practice.
Key learning point: Know the PECARN framework. Know its components. And watch this space — this is a field moving quickly.
Reference: Burstein B, Xie J, Kuppermann N. JAMA Pediatrics. Published April 2026. https://doi.org/10.1001/jamapediatrics.2026.0971
What's Caught My Eye
1. Point-of-Care Lung Ultrasound for Paediatric Pneumonia
A review in Pediatric Emergency Care summarising the diagnostic performance of bedside lung ultrasound (LUS) for pneumonia in children. Multiple meta-analyses demonstrate sensitivity up to 94% and specificity up to 96% — at least comparable to chest X-ray, often better, and without the radiation burden or logistical delay.
The key caveat: distinguishing bacterial consolidation from viral illness or asthma on ultrasound requires training and careful clinical correlation. Overlapping sonographic appearances are common and the technique is operator-dependent.
For anyone working in paediatric ED or acute settings who hasn't yet developed confident POCUS skills for respiratory presentations — this is the evidence base saying it's worth the investment.
Reference: Marzook N. Pediatric Emergency Care. Vol 42(5):391–399. Published April 2026. https://doi.org/10.1097/PEC.0000000000003533
2. Shifting the Narrative Around Paediatric Palliative Care
Stewart and colleagues at Evelina London Children's Hospital, writing in BMJ Paediatrics Open, have produced a thoughtful narrative review examining why paediatric palliative care referral happens late — and what we can do about it.
The central argument: the words "palliative care" carry such strong associations with dying that clinicians often delay conversations for fear of undermining hope, and families often hear "giving up" where clinicians intend "additional support." Crucially, directly debunking this myth — saying "palliative care isn't just about end-of-life" — can backfire by activating the very association you're trying to dispel.
What works better, the authors argue, is replacing the narrative rather than fighting it. Lead with what palliative care actually looks like — coordinated, holistic, life-enhancing support that runs alongside active treatment from the point of diagnosis. The paper offers a useful metaphor: palliative care is the umbrella, not the rain. You reach for it before the storm, not once you're soaked.
A practical, communication-focused paper with something genuinely useful for anyone — trainee or consultant — who has ever felt uncomfortable raising that conversation.
Reference: Stewart CE, Vare C, Kerr-Elliott T, et al. BMJ Paediatrics Open. Vol 10(1). Published April 2026. https://doi.org/10.1136/bmjpo-2025-004413
3. Surviving Sepsis Campaign Paediatric Guidelines 2026 — Flag
The 2026 update to the Surviving Sepsis Campaign international guidelines for paediatric sepsis and septic shock is out. A panel of 68 international experts produced 61 statements — including 20 new recommendations and 13 updates from the 2020 version. Of note: only three of the 61 recommendations are based on high or moderate quality evidence.
We'll be covering this in full in an upcoming episode. For now — get it on your reading list.
Reference: Weiss SL, Peters MJ, et al. Pediatric Critical Care Medicine. Vol 27(4):379–434. Published March 2026. https://doi.org/10.1097/PCC.0000000000003927
Key Takeaways
The knife crime mortality data are a call to action for every clinician working with children — clinically, in terms of safeguarding awareness, and as advocates for the children most at risk
PECARN febrile infant risk stratification is maturing internationally — if your department doesn't use a structured approach for the 29–60 day febrile infant, now is the time to revisit
Point-of-care lung ultrasound for paediatric pneumonia has strong diagnostic performance — sensitivity and specificity both exceed 90% in meta-analyses, and the skill is worth developing
When introducing paediatric palliative care, replace the narrative rather than debunking it — lead with what it is, not what it isn't
The new Surviving Sepsis Campaign guidelines are out — full episode coming soon
References
All articles retrieved from PubMed. Based on articles retrieved from PubMed:
Roberts T, Odd D, Coveney J, et...
UK