Paediatric pain and its assessment and management are challenging for medical professionals, especially in an urgent care environment. Patients in a paediatric emergency room (PER) often undergo painful procedures which are an additional source of distress, anxiety, and pain. Paediatric procedural pain is often underestimated and neglected because of various myths, beliefs, and difficulties in its evaluation and treatment. However, it is very different from other origins of pain as it can be preventable. It is known that neonates and children can feel pain and that it has long-term effects that last through childhood into adulthood. There are a variety of pain assessment tools for children and they should be chosen according to the patient’s age, developmental stage, communication skills, and medical condition. Psychological factors such as PER environment, preprocedural preparation, and parental involvement should also be considered. There are proven methods to reduce a patient’s pain and anxiety during different procedures in PER. Distraction techniques such as music, videogames, virtual reality, or simple talk about movies, friends, or hobbies as well as cutaneous stimulation, vibration, cooling sprays, or devices are effective to alleviate procedural pain and anxiety. A choice of distraction technique should be individualized, selecting children who could benefit from nonpharmacological pain treatment methods or tools. Nonpharmacological pain management may reduce dosage of pain medication or exclude pharmacological pain management. Most nonpharmacological treatment methods are cheap, easily accessible, and safe to use on every child, so it should always be a first choice when planning a patient’s care. The aim of this review is to provide a summary of paediatric pain features, along with their physiology, assessment, management, and to highlight the importance and efficacy of nonpharmacological pain management in an urgent paediatric care setting.

Neonatal diabetes, characterized by hyperglycemia within the first 6 months of life, is a rare disorder primarily caused by monogenic mutations, exhibiting diverse clinical manifestations. KCNJ11 and ABCC8 pathogenic variants account for most permanent neonatal diabetes cases. We report a case of a 2-day-old presenting with hyperglycemia and later diagnosed with a KCNJ11 pathogenic variant. The male newborn was born in the 35th week of pregnancy. Capillary glucose levels started to rise at the 36th hour of life. A continuous infusion of insulin was started at the 96th hour of life. The need for insulin remained constant. Genetic analysis confirmed a heterozygous pathogenic KCNJ11 gene variant NM_000525.4:c.175G > A p.(Val59Met) via Sanger sequencing (conducted at The Exeter Genomics Laboratory). This variant is associated with neonatal diabetes and a high likelihood of DEND (developmental delay, epilepsy, neonatal diabetes) syndrome. Glibenclamide therapy was started at the age of 57 days. Follow-up visits with the neurology and endocrinology teams showed good glycemic control with glibenclamide, a slight delay in motor development, and no epilepsy. Despite the rarity of genetic neonatal diabetes, it should be considered in infants with persistent hyperglycemia. In some cases, diabetes can be successfully managed with oral sulphonylurea agents, so rapid genetic testing and initiation of appropriate medication are extremely important because they significantly improve quality of life as well as general outcomes.

Objectives: Congenital epulis (CE) is a rare benign tumour typically arising from the alveolar ridge and more frequently observed in female neonates. The report highlights its potential impact on neonatal breathing and feeding, emphasizing the importance of early recognition and management. Case presentation: We present a case of a female neonate with a giant CE detected on prenatal ultrasound. After the birth the lesion interfered with feeding, while respiratory function remained unaffected. Three masses were surgically dissected from the maxillary mucosa and the neonate successfully transitioned to oral feeding within the first week. Histopathological examination revealed a granular cell tumour with negative immunoreactivity for S100. Conclusions: The case underlines the significance of prenatal diagnosis, collaborative multidisciplinary planning, and, when indicated, the application of the EXIT procedure for congenital orofacial tumours with potential airway obstruction. Early recognition and integrated care can substantially improve neonatal prognosis.