Showing papers in "Archives of Disease in Childhood in 2002"
TL;DR: The available literature shows consistently increased levels of psychological morbidity among refugee children, especially post-traumatic stress disorder, depression, and anxiety disorders, and it is argued that much primary prevention can be undertaken in the school context.
Abstract: The UK is facing a major increase in the number of people seeking asylum each year, of whom approximately a quarter are children. The stressors to which refugees are exposed are described in three stages: (1) while in their country of origin; (2) during their flight to safety; and (3) when having to settle in a country of refuge. The evidence concerning the impact of displacement on children's mental health is reviewed and a framework for conceptualising the risk factors is proposed. The available literature shows consistently increased levels of psychological morbidity among refugee children, especially post-traumatic stress disorder, depression, and anxiety disorders. The principles underlying the delivery of mental health care for these children are also considered. It is argued that much primary prevention can be undertaken in the school context. Some key aspects of British immigration law are examined and the tension between the law and the best interests of the child principle is discussed. There is particular concern for the plight of unaccompanied children. Attention to the mental health needs of this vulnerable group is urgently required.
478 citations
TL;DR: Most of the skeletal mass in lumbar spine and total body is reached before the end of the second decade, with a slight increase thereafter, and this study provides reference values for bone density and body composition measured with DXA for children and young adults.
Abstract: Aims: To obtain normative data on bone mineral density and body composition measured with dual energy x ray absorptiometry (DXA) from early childhood to young adulthood.
Methods: Cross sectional results from 444 healthy white volunteers (4–20 years) in the Netherlands were combined with the results from 198 children who agreed to participate in the follow up study approximately four years later. DXA (Lunar, DPXL) of lumbar spine and total body was performed to assess bone density and body composition.
Results: Bone density and lean body mass (LBM) increased with age. Maximal increase in bone density and LBM occurred around the age of 13 years in girls and approximately two years later in boys. Bone density of total body and lumbar spine showed an ongoing slight increase in the third decade. Mean fat percentage in boys remained at 10.5% throughout childhood, but increased in girls.
Conclusions: Most of the skeletal mass in lumbar spine and total body is reached before the end of the second decade, with a slight increase thereafter. This study provides reference values for bone density and body composition measured with DXA for children and young adults.
349 citations
TL;DR: The frequency of acute adrenal crisis was greater than expected as the majority of these patients were treated with ICS doses supported by British Guidelines on Asthma Management, and fluticasone, the least prescribed and most recently introduced ICS, was associated with 94% of the cases.
Abstract: Background: Until recently, only two cases of acute adrenal crisis associated with inhaled corticosteroids (ICS) had been reported worldwide. We identified four additional cases and sought to survey the frequency of this side effect in the United Kingdom. Methods: Questionnaires were sent to all consultant paediatricians and adult endocrinologists registered in a UK medical directory, asking whether they had encountered asthmatic patients with acute adrenal crisis associated with ICS. Those responding positively completed a more detailed questionnaire. Diagnosis was confirmed by symptoms/signs and abnormal hypothalamic-pituitary-adrenal axis function test results. Results: From an initial 2912 questionnaires, 33 patients met the diagnostic criteria (28 children, five adults). Twenty-three children had acute hypoglycaemia (13 with decreased levels of consciousness or coma; nine with coma and convulsions; one with coma, convulsions and death); five had insidious onset of symptoms. Four adults had insidious onset of symptoms; one had hypoglycaemia and convulsions. Of the 33 patients treated with 500–2000 μg/day ICS, 30 (91%) had received fluticasone, one (3%) fluticasone and budesonide, and two (6%) beclomethasone. Conclusions: The frequency of acute adrenal crisis was greater than expected as the majority of these patients were treated with ICS doses supported by British Guidelines on Asthma Management. Despite being the least prescribed and most recently introduced ICS, fluticasone was associated with 94% of the cases. We therefore advise that the licensed dosage of fluticasone for children, 400 μg/day, should not be exceeded unless the patient is being supervised by a physician with experience in problematic asthma. We would also emphasise that until adrenal function has been assessed patients receiving high dose ICS should not have this therapy abruptly terminated as this could precipitate adrenal crisis.
319 citations
TL;DR: There is a high probability that parents will encounter elaborate antivaccination material on the world wide web and factual refutational strategies alone are unlikely to counter the highly rhetorical appeals that shape these sites.
Abstract: Aims: To determine the likelihood of finding an antivaccination site on the world wide web and to characterise their explicit claims and rhetorical appeals. Methods: Using “vaccination” and “immunisation”, examining the first 10 sites displayed on seven leading search engines. Detailed examination of content of 100 antivaccination sites found on Google. Results: 43% of websites were antivaccination (all of the first 10 on Google). Main rhetorical appeals involve themes of the scientific veracity of antivaccination argument; rapport with parents seeking to protect their children from harm; and alleged collusion between doctors, the pharmaceutical industry, and government to deny vaccine harm. Conclusions: There is a high probability that parents will encounter elaborate antivaccination material on the world wide web. Factual refutational strategies alone are unlikely to counter the highly rhetorical appeals that shape these sites.
302 citations
TL;DR: It is suggested that children living in areas of high atmospheric pollution are at risk of developing vitamin D deficiency rickets and should be offered vitamin D supplements.
Abstract: Aims: To compare the vitamin D status of 34 children, 9–24 months old, living in an area of Delhi renowned for high levels of atmospheric pollution (Mori Gate), with a comparable age matched group of children from a less polluted (Gurgaon) area of the city. Methods: Serum concentrations of calcium, alkaline phosphatase (ALP), parathyroid hormone (PTH), 25-hydroxyvitamin D (25(OH)D), and 1,25-dihydroxyvitamin D (1,25(OH) 2 D) were measured. Haze scores, regarded as a surrogate marker of solar UVB radiation reaching ground level, were measured in both areas. Results: Mean 25(OH)D of children in the Mori Gate area was 12.4 (7) ng/ml, compared with 27.1 (7) ng/ml in children living in the Gurgaon area (p Conclusion: We suggest that children living in areas of high atmospheric pollution are at risk of developing vitamin D deficiency rickets and should be offered vitamin D supplements.
294 citations
TL;DR: Exclusive breast feeding seems to have a preventive effect on the early development of allergic disease—that is, asthma, atopic dermatitis, and suspected allergic rhinitis, up to 2 years of age.
Abstract: Aims: To investigate the effect of breast feeding on allergic disease in infants up to 2 years of age.
Methods: A birth cohort of 4089 infants was followed prospectively in Stockholm, Sweden. Information about various exposures was obtained by parental questionnaires when the infants were 2 months old, and about allergic symptoms and feeding at 1 and 2 years of age. Duration of exclusive and partial breast feeding was assessed separately. Symptom related definitions of various allergic diseases were used. Odds ratios (OR) and 95% confidence intervals (CI) were estimated in a multiple logistic regression model. Adjustments were made for potential confounders.
Results: Children exclusively breast fed during four months or more exhibited less asthma (7.7% v 12%, ORadj = 0.7, 95% CI 0.5 to 0.8), less atopic dermatitis (24% v 27%, ORadj = 0.8, 95% CI 0.7 to 1.0), and less suspected allergic rhinitis (6.5% v 9%, ORadj = 0.7, 95% CI 0.5 to 1.0) by 2 years of age. There was a significant risk reduction for asthma related to partial breast feeding during six months or more (ORadj = 0.7, 95% CI 0.5 to 0.9). Three or more of five possible allergic disorders—asthma, suspected allergic rhinitis, atopic dermatitis, food allergy related symptoms, and suspected allergic respiratory symptoms after exposure to pets or pollen—were found in 6.5% of the children. Exclusive breast feeding prevented children from having multiple allergic disease (ORadj = 0.7, 95% CI 0.5 to 0.9) during the first two years of life.
Conclusion: Exclusive breast feeding seems to have a preventive effect on the early development of allergic disease—that is, asthma, atopic dermatitis, and suspected allergic rhinitis, up to 2 years of age. This protective effect was also evident for multiple allergic disease.
263 citations
TL;DR: Disodium pamidronate (APD) was given as monthly intravenous infusions to 28 children and adolescents with severe OI or a milder form of the disease, but with spinal compression fractures to find an effective symptomatic treatment.
Abstract: Aim: To find an effective symptomatic treatment for osteogenesis imperfecta (OI). Methods: In a prospective observational study disodium pamidronate (APD) was given as monthly intravenous infusions to 28 children and adolescents (aged 0.6–18 years) with severe OI or a milder form of the disease, but with spinal compression fractures. Results: During treatment for 2–9 years, dual energy x ray absorptiometry measurements of the total body and of the lumbar spine showed a gradual increase in bone density. All bone metabolism variables in serum (alkaline phosphatase, osteocalcin, procollagen 1 C-terminal peptide, collagen 1 teleopeptide) and urine (deoxypyridinoline) indicated that there was a decrease in bone turnover. All patients experienced beneficial effects and the younger patients reported a major improvement in wellbeing, pain, and mobility without significant side effects. Vertebral remodelling was also seen. Conclusions: APD seems to be an efficient symptomatic treatment for children and adolescents with OI.
257 citations
TL;DR: If 5% of the child population have food allergy, the risk that a food allergy child will die from a food allergic reaction is about 1 in 800 000 per year, and the food allergic child with asthma may be at higher risk.
Abstract: Aims: To discover the incidence of fatal and severe allergic reactions to food in a large population of children.
Methods: A retrospective search for fatalities in children 0–15 years from 1990 to February 1998, primarily of death certification at offices of national statistics. A prospective survey of fatal and severe reactions from March 1998 to February 2000, primarily through the British Paediatric Surveillance Unit. Main outcome measures were deaths and severe reactions. A case was deemed severe if one or more of the following criteria was met: cardiorespiratory arrest; need for inotropic support; fluid bolus >20 ml/kg; more than one dose of epinephrine; more than one dose of nebulised bronchodilator. A case was deemed near fatal if intubation was necessary.
Results: The UK under 16 population is 13 million. Over the past 10 years, eight children died (incidence of 0.006 deaths per 100 000 children 0–15 years per year). Milk caused four of the deaths. No child under 13 died from peanut allergy. Two children died despite receiving early epinephrine before admission to hospital; one child with a mild food allergic reaction died from epinephrine overdose. Over the past two years, there were six near fatal reactions (none caused by peanut) and 49 severe ones (10 caused by peanut), yielding incidences of 0.02 and 0.19 per 100 000 children 0–15 years per year respectively. Coexisting asthma is more strongly associated with a severe reaction than the severity of previous reactions.
Conclusions: If 5% of the child population have food allergy, the risk that a food allergic child will die from a food allergic reaction is about 1 in 800 000 per year. The food allergic child with asthma may be at higher risk. Prescribing an epinephrine autoinjector requires a careful balance of advantages and disadvantages.
225 citations
TL;DR: The growth charts show that European boys with DS are taller than corresponding American boys, whereas European girls with DS, although being lighter, have similar height to corresponding American girls.
Abstract: Background: Growth in children with Down’s syndrome (DS) differs markedly from that of normal children. The use of DS specific growth charts is important for diagnosis of associated diseases, such as coeliac disease and hypothyroidism, which may further impair growth. Aims: To present Swedish DS specific growth charts. Methods: The growth charts are based on a combination of longitudinal and cross sectional data from 4832 examinations of 354 individuals with DS (203 males, 151 females), born in 1970‐97. Results: Mean birth length was 48 cm in both sexes. Final height, 161.5 cm for males and 147.5 cm for females, was reached at relatively young ages, 16 and 15 years, respectively. Mean birth weight was 3.0 kg for boys and 2.9 kg for girls. A body mass index (BMI) >25 kg/m 2 at 18 years of age was observed in 31% of the males and 36% of the females. Head growth was impaired, resulting in a SDS for head circumference of -0.5 (Swedish standard) at birth decreasing to -2.0 at 4 years of age. Conclusion: Despite growth retardation the difference in height between the sexes is the same as that found in healthy individuals. Even though puberty appears somewhat early, the charts show that DS individuals have a decreased pubertal growth rate. Our growth charts show that European boys with DS are taller than corresponding American boys, whereas European girls with DS, although being lighter, have similar height to corresponding American girls.
211 citations
TL;DR: These are the first reported obese, white cases from the UK to present with type 2 diabetes mellitus associated with significant obesity, and it is believed this clinical scenario will become more prevalent given the epidemic of childhood obesity in this country.
Abstract: We report four white adolescents aged 13 to 15 years (three females, one male) from the south and west region of England who presented with type 2 diabetes mellitus associated with significant obesity (body mass index more than +3SDS) in the past two years. Although these are the first reported obese, white cases from the UK to present with diabetes, we believe this clinical scenario will become more prevalent given the epidemic of childhood obesity in this country.
209 citations
TL;DR: The group concluded that for most clinical purposes the UK90 reference is superior and for many measures is the only usable reference that can be recommended, while the original Tanner–Whitehouse and the Gairdner–Pearson charts are no longer reliable for use at any age.
Abstract: Since the introduction of new growth charts in the mid 1990s, there has been confusion about which charts should be used, with many districts using more than one version. Because of this uncertainty, an expert working party, the Growth Reference Review Group, was convened by the Royal College of Paediatrics and Child Health to provide guidance on the validity and comparability of the different charts currently in use. This paper describes the technical background to the construction and evaluation of growth charts and outlines the group's findings on the validity of each growth reference in relation to contemporary British children. The group concluded that for most clinical purposes the UK90 reference is superior and for many measures is the only usable reference that can be recommended, while the original Tanner–Whitehouse and the Gairdner–Pearson charts are no longer reliable for use at any age. After the age of 2 the revised Buckler–Tanner references are still suitable for assessing height. There are presently no reliable head circumference reference charts for use beyond infancy. The group propose that apart from refinements of chart design and layout, the new UK90 reference should now be "frozen", with any future revisions only undertaken after careful planning and widespread consultation
TL;DR: Paediatricians should be aware of the potential of PTS in all children who are at risk of DVT, including patients with malignancy, congenital heart disease, and children who have had previous CVLs, even in the absence of documented acute DVT.
Abstract: Post-thrombotic syndrome (PTS) is a potentially disabling complication occurring in up to 67% of adult patients following deep venous thrombosis (DVT). PTS has recently been recognised in children. We present three cases of symptomatic PTS in children, which occurred following the use of central venous lines (CVLs). In two cases, no symptoms of acute thrombosis were noted. The cases highlight the clinical presentation of this syndrome. A review of the literature revealed two reports describing PTS occurring in children following DVT with an estimated incidence of 7-12%. It is concluded that PTS is an important complication of DVT in children. The clinical findings of pain, swelling, and brawny induration are similar to adult patients. The effect on growing limbs is not known. Paediatricians should be aware of the potential of PTS in all children who are at risk of DVT, including patients with malignancy, congenital heart disease, and children who have had previous CVLs, even in the absence of documented acute DVT.
TL;DR: A renewed public health campaign is required in the UK to address the continuing problem of vitamin D deficiency in Asian families and the incidence, aetiology, prevention, and treatment of symptomatic vitamin D deficiencies in childhood are considered.
Abstract: Vitamin D has steroid hormonal effects which can produce clinical symptoms and signs unrelated to calcium homoeostasis. Its deficiency has been implicated as a risk factor for diabetes, ischaemic heart disease, and tuberculosis in Asians. In this review, the incidence, aetiology, prevention, and treatment of symptomatic vitamin D deficiency in childhood are considered. A renewed public health campaign is required in the UK to address the continuing problem of vitamin D deficiency in Asian families.
TL;DR: A clinical guideline for the diagnosis and treatment of Kawasaki disease in the UK based on the best available evidence to date is proposed, and areas of practice where evidence is anecdotal or based on retrospective data are highlighted.
Abstract: This article proposes a clinical guideline for the diagnosis and treatment of Kawasaki disease in the UK based on the best available evidence to date, and highlights areas of practice where evidence is anecdotal or based on retrospective data. Future research as proposed by the London Kawasaki Disease Research Group is outlined, and clinicians are invited to prospectively enrol their suspected cases into this collaborative research project.
TL;DR: Peripheral thyroid hormones (T3, T4, and TSH are moderately increased in obese children; weight reduction leads to a long term decrease in the peripheral thyroid hormones but not in TSH.
Abstract: Background: Little is known about changes in thyroid function in obese children. An influence of leptin on thyroid hormone synthesis has been proposed. Aims: To examine thyroid function and leptin concentrations in obese children. Methods: Triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), and leptin were measured in 118 obese children (aged 4.5–16 years); thyroid function was also determined in 107 healthy children of normal weight. T3, T4, and TSH were analysed in 55 obese children who had achieved weight reduction and in 13 obese children who had not achieved weight reduction after one year based on normal energy diet. Results: TSH, T3, and T4 were significantly higher in obese children compared to those of normal weight. Twelve per cent of the obese children had TSH, 15% had T3, and 11% had T4 concentrations above the twofold standard deviation of normal weight children. The degree of overweight correlated with T3, T4, and TSH. Thyroid hormones did not correlate significantly with leptin. A reduction in overweight showed a significant decrease in T3, T4, and leptin serum concentrations, but there was no significant change in TSH. Conclusion: Peripheral thyroid hormones (T3, T4) and TSH are moderately increased in obese children; weight reduction leads to a long term decrease in the peripheral thyroid hormones but not in TSH. There is no necessity to treat the increased serum TSH.
TL;DR: Paediatric obesity is now common in the UK, as in other developed countries, and a literature search was conducted and evidence based answers to five frequently answered questions sought.
Abstract: Paediatric obesity is now common in the UK, as in other developed countries. A literature search was conducted and evidence based answers to five frequently answered questions sought. Recommendations for diagnosis are given. Although there is no conclusive evidence that the condition is preventable, a number of treatment approaches are promising.
TL;DR: Data suggest that learning disorder, attention deficit, and dyspraxia in children who survive VLBW do not correlate with conventional markers of perinatal brain injury, and may be related to global brain growth and the development of key structures, such as the caudate nuclei and hippocampal formations.
Abstract: abnormalities. Methods: A total of 87 children (aged 15-16 years) with a history of VLBW (<1500 g) and eight age matched full term controls have been studied with detailed magnetic resonance brain scans. Volume measurements of the caudate nuclei and hippocampal formations were made. Results: Scans in 42.5% of the children showed evidence of perinatal brain injury. There was no sig- nificant difference in IQ, dyspraxia, or attention deficit between children with qualitatively normal and abnormal scans. However, quantitative volumetric analysis showed that children with a low IQ had smaller volume measurements for the right caudate nucleus and left hippocampus, and a smaller hip- pocampal ratio (left volume:right volume) than those with normal IQ. Conclusion: Data suggest that learning disorder, attention deficit, and dyspraxia in children who sur- vive VLBW do not correlate with conventional markers of perinatal brain injury, and may be related to global brain growth and the development of key structures, such as the caudate nuclei and hippocam- pal formations.
TL;DR: The evidence suggests that family and parenting interventions for juvenile delinquents and their families have beneficial effects on reducing time spent in institutions and their criminal activity.
Abstract: Aims: To determine whether family and parenting interventions benefit children and adolescents with conduct disorder and delinquency.
Methods: Meta-analysis of eight randomised controlled trials involving 749 children and adolescents (aged 10–17 years) with conduct disorder and/or delinquency. Criminality, academic performance, future employment, problem behaviour, family functioning, parental mental health, and peer relations were evaluated.
Results: Family and parenting interventions significantly reduced the time spent by juvenile delinquents in institutions (weighted mean difference 51.34 days). There was also a significant reduction in the risk of a juvenile delinquent being rearrested (relative risk 0.66) and in their rate of subsequent arrests at 1–3 years (standardised mean difference -0.56).
Conclusions: The evidence suggests that family and parenting interventions for juvenile delinquents and their families have beneficial effects on reducing time spent in institutions and their criminal activity. In addition to the obvious benefit to the participant and their family, this may result in a cost saving for society.
TL;DR: The neonatal arterial switch operation with combined circulatory arrest and low flow bypass is associated with parent reported long term behavioural impairment, but not with self reported general reduction in quality of life.
Abstract: Aims: To evaluate behavioural outcome and quality of life in children aged 8–14 years after neonatal arterial switch operation for transposition of the great arteries.
Methods: Sixty children operated as neonates with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass were evaluated at age 7.9–14.3 years by the Child Behaviour Checklist (CBCL) and the Inventory for the Assessment of the Quality of Life in Children and Adolescents (IQCL).
Results: Parent reported behavioural outcome on all CBCL problem and competence scores was worse, whereas quality of life on self reported IQCL scores was not reduced compared to the normal population. On multivariate analysis, severe preoperative hypoxia was related to parent reported social problems; peri- and postoperative cardiocirculatory insufficiency was associated with internalising, externalising, attention, and total behavioural problems. Reduced expressive language was associated with total behavioural problems, and poor academic achievement was related to parent reported deficits in school performance. Impaired neurological status and reduced endurance capacity both predicted self reported stress by illness.
Conclusions: The neonatal arterial switch operation with combined circulatory arrest and low flow bypass is associated with parent reported long term behavioural impairment, but not with self reported general reduction in quality of life. This discrepancy may be a result of different perception of illness. In our experience, increased risk of long term psychosocial maladjustment after neonatal corrective cardiac surgery is related to the presence of neurological impairment and reduced endurance capacity.
TL;DR: Investigating humoral immunodeficiency, particularly pneumococcal polysaccharide antibody deficiency, and autoimmune phenomena in a cohort of patients with 22q11.2 deletion found normal T cell function and immunoglobulin levels do not exclude poor specific antibody responses.
Abstract: Background: Although severe T cell immunodeficiency in DiGeorge anomaly is rare, previous studies of humoral function in these patients have found no antibody abnormalities but have not examined the response to polysaccharide antigens. Isolated cases of autoimmunity have been reported. Several patients with 22q11.2 deletion attending our immunology clinic suffered recurrent sinopulmonary infection or autoimmune phenomena.
Aims: To investigate humoral immunodeficiency, particularly pneumococcal polysaccharide antibody deficiency, and autoimmune phenomena in a cohort of patients with 22q11.2 deletion.
Methods: A history of severe or recurrent infection and autoimmune symptoms were noted. Lymphocyte subsets, immunoglobulins, IgG subclasses, specific vaccine antibodies, and autoantibodies were measured. Subjects were vaccinated with appropriate antigens as indicated.
Results: Of 32 patients identified, 26 (81%) had severe or recurrent infection, of which 13 (50%) had abnormal serum immunoglobulin measurements and 11/20 ≥4 years old (55%) had an abnormal response to pneumococcal polysaccharide. Ten of 30 patients (33%) had autoimmune phenomena; six (20%) were symptomatic.
Conclusions: Humoral immunodeficiency is more common than previously recognised in patients with 22q11.2 deletion. Normal T cell function and immunoglobulin levels do not exclude poor specific antibody responses. Patients should be referred for formal immunological assessment of cellular and humoral immune function.
TL;DR: The purpose of this review is to examine the current evidence for linking GC to adverse growth and bone health in childhood disorders that commonly require GC therapy.
Abstract: An examination of current evidence
Glucocorticoids (GC) are important regulators of diverse physiological systems and are often used in the treatment of a number of chronic inflammatory, autoimmune, and neoplastic diseases. It is estimated that 10% of children may require some form of GC at some point in their childhood.1 Impairment of childhood growth with an approximate cortisone dose of 1.5 mg/kg/day was first described over 40 years ago; osteopenia in children receiving a prednisolone dose of less than 0.16 mg/kg/day has also been reported.2,3 The maintenance of growth and bone health is a complex process that can be influenced not only by drugs, but also by the nutritional status of the patient and the underlying disease process. The purpose of this review is to examine the current evidence for linking GC to adverse growth and bone health in childhood disorders that commonly require GC therapy.
Loss of bone and deterioration in short term growth are dependent on the type and dose of GC and occur most prominently over the first six months of treatment.4–6 Although it is generally believed that GC affect trabecular bone more than cortical bone, a recent study of fractures in children following steroid exposure as part of acute lymphoblastic leukaemia (ALL) treatment showed a high incidence of cortical bone involvement, suggesting that the disease process may interact with GC usage in influencing site of bone loss.7,8
GC have a suppressive effect on osteoblastogenesis in the bone marrow and promote the apoptosis of osteoblasts and osteocytes, thus leading to decreased bone formation.9 Accumulation of apoptotic osteocytes may also explain the so called “osteonecrosis”, also known as aseptic or avascular necrosis. There is some evidence to suggest that GC may also increase bone resorption by extending the lifespan of …
TL;DR: It is recommended that a screening programme should be instituted to detect coeliac disease in children with diabetes mellitus and where possible children themselves, should be fully involved at all stages of the screening, diagnostic, and treatment process.
Abstract: The average prevalence of coeliac disease among children with diabetes mellitus in 26 reports was 4.5% (0.97-16.4%). Malabsorption, unstable diabetes, and growth failure, indicate that coeliac disease may be present. Even those who are apparently asymptomatic may have subtle complaints indicative of coeliac disease if a careful history is taken. Ill health may only be recognised in retrospect following the benefits conferred by a gluten free diet. For these reasons it is recommended that a screening programme should be instituted to detect coeliac disease in these children. Parents and where possible children themselves, should be fully involved at all stages of the screening, diagnostic, and treatment process.
TL;DR: Patients with MCD have higher bacterial loads than previously determined with quantitative culture methods and maximum load is highest in those who die, as well as in patients that died.
Abstract: Aims: To determine bacterial loads in meningococcal disease (MCD), their relation with disease severity, and the factors which determine bacterial load.
Methods: Meningococcal DNA quantification was performed by the Taqman PCR method on admission and sequential blood samples from patients with MCD. Disease severity was assessed using the Glasgow Septicaemia Prognostic Score (GMSPS, range 0–15, severe disease ≥8).
Results: Median admission bacterial load was 1.6 x 106 DNA copies/ml of blood (range 2.2 x 104 to 1.6 x 108). Bacterial load was significantly higher in patients with severe (8.4 x 106) compared to milder disease (1.1 x 106, p = 0.018). This difference was greater in septicaemic patients (median 1.6 x 107 versus 9.2 x 105, p < 0.001). Bacterial loads were significantly higher in patients that died (p = 0.017). Admission bacterial load was independent of the duration of clinical symptoms prior to admission, with no difference between the duration of symptoms in mild or severe cases (median, 10.5 and 11 hours respectively). Bacterial loads were independent of DNA elimination rates following treatment.
Conclusion: Patients with MCD have higher bacterial loads than previously determined with quantitative culture methods. Admission bacterial load is significantly higher in patients with severe disease (GMSPS ≥8) and maximum load is highest in those who die. Bacterial load is independent of the duration of clinical symptoms or the decline in DNA load.
TL;DR: Renal ultrasound findings are neither sensitive nor specific for VUR in children with a first UTI in children under 5 years of age admitted with their first episode of urinary tract infection over a two year period.
Abstract: Aims: To determine the sensitivity, specificity, and predictive values of renal ultrasound findings for vesicoureteral reflux (VUR). Methods: Retrospective review of the ultrasound and voiding cystourethrogram (VCUG) results of 162 children under 5 years of age admitted with their first episode of urinary tract infection (UTI) over a two year period. Ultrasound findings were considered suggestive of VUR if “dilatation of the pelvi-calyces”, “dilatation of the ureters”, or “dilatation of the collecting system” of one or both kidneys was reported. Results: A total of 162 patients were eligible for inclusion (median age 85 days; 71 (44%) were female). The prevalence of VUR was 22%. Ultrasound findings were positive for VUR in 14 of 35 patients with confirmed VUR on VCUG, and positive in 30 of 127 patients without VUR on VCUG. Of 21 patients who had a normal ultrasound but showed VUR on VCUG, 14 had grade II reflux, five grade III reflux, and two grade IV reflux. The sensitivity and specificity of ultrasound in suggesting VUR were 40% and 76%, respectively. The positive predictive value of ultrasound in suggesting VUR was 32%; the negative predictive value was 82%. Conclusion: Renal ultrasound findings are neither sensitive nor specific for VUR in children with a first UTI.
TL;DR: Survition in cerebral palsy varies according to the severity and number of functional disabilities and by birth weight, but among low birth weight children, survival declined steadily from 1966 to 1989 after allowing for disability.
Abstract: Background: Cerebral palsy presents with a range of severity of cognitive, motor, and sensory disabilities, which might affect survival. Aims: To quantify the effects of motor, cognitive, and sensory disabilities, year of birth, birth weight, and gestational age on survival in cerebral palsy. Methods: A cohort of children with cerebral palsy born between 1966 and 1989 to mothers resident in a defined geographical region was subdivided into early impairment (EICP: cerebral insult prenatally or within 28 days of birth) or late impairment (LICP: insult at least 28 days after birth). Deaths are notified by the National Health Service Central Register. Birth and disability details were obtained from clinical records. Survival analyses were carried out. Results: Severe motor disability was associated with a 30 year survival of 42% and severe cognitive disability with a 30 year survival of 62%. Severe visual disability was associated with a 30 year survival of 38%, but the association of survival with hearing disability was weak. EICP had better survival than LICP but the difference was not significant after allowing for severity of functional disabilities. Normal birth weight infants (≥2500 g) showed no birth cohort effect, but the 10 year survival of low birth weight ( Conclusions: Survival in cerebral palsy varies according to the severity and number of functional disabilities and by birth weight. Among low birth weight children, survival declined steadily from 1966 to 1989 after allowing for disability. The disabilities reported do not capture all the factors affecting survival of preterm infants.
TL;DR: Results support the potentially beneficial effects of both diet and physical training in obese children, and further and longer term evaluation of such programmes is required.
Abstract: Aims: To evaluate effects of a low energy diet, with or without strength training, on blood lipid profile in obese children
Methods: Eighty two obese children were enrolled into a six week dietary programme, and were randomly allocated to a training group or a non-training group The training group underwent regular exercise sessions with emphasis on strength training
Results: Height increased significantly, with a non-significant reduction in body mass index Fat free mass increased significantly in the training group Serum total cholesterol was significantly reduced in both groups The LDL:HDL ratio significantly decreased in the training group
Conclusion: Results support the potentially beneficial effects of both diet and physical training Further and longer term evaluation of such programmes is required
TL;DR: The intervention was more effective at improving some aspects of the children’s mental health, notably conduct problems, than the no intervention control condition, and had a short term impact on social dysfunction among parents.
Abstract: Aims: To assess the effectiveness of a parenting programme, delivered by health visitors in primary care, in improving the mental health of children and their parents among a representative general practice population.
Methods: Parents of children aged 2–8 years who scored in the upper 50% on a behaviour inventory were randomised to the Webster-Stratton 10 week parenting programme delivered by trained health visitors, or no intervention. Main outcome measures were the Eyberg Child Behaviour Inventory and the Goodman Strengths and Difficulties Questionnaire to measure child behaviour, and the General Health Questionnaire, Abidin's Parenting Stress Index, and Rosenberg's Self Esteem Scale to measure parents' mental health. These outcomes were measured before and immediately after the intervention, and at six months follow up.
Results: The intervention was more effective at improving some aspects of the children's mental health, notably conduct problems, than the no intervention control condition. The Goodman conduct problem score was reduced at immediate and six month follow up, and the Eyberg Child Behaviour Inventory was reduced at six months. The intervention also had a short term impact on social dysfunction among parents. These benefits were seen among families with children scoring in the clinical range for behaviour problems and also among children scoring in the non-clinical (normal) range.
Conclusion: This intervention could make a useful contribution to the prevention of child behaviour problems and to mental health promotion in primary care.
TL;DR: A significant proportion of parents have access to the internet and use it to find information about their child’s medical condition and the parents who discuss what they find with the clinic doctor are in the minority.
Abstract: Aims: (1) To establish how many parents of children seen in paediatric outpatient departments use the internet to find information about their child’s medical condition. (2) To ascertain what information is sought and found, and what proportion of all parents had access to the internet at home or elsewhere.
Methods: Over a six week period in 2000, parents of children attending general paediatric outpatient clinics in the district general hospital in Bath and in the 10 associated community hospitals, were asked to complete a questionnaire survery.
Results: Of the 577 questionnaires distributed, 485 were returned, a response rate of 84%. A total of 332 (69%) families owned a computer and 248 (51%) had internet access; 107 (22%) had looked on the internet for information about the problem for which their child was being seen in clinic that day. Parents who knew their child’s diagnosis were more likely to have used the internet than those who named their child’s symptoms only. A health professional had suggested that parents seek information on the internet in 6% of cases. These parents were more likely to use the internet than parents to whom this had not been suggested (67% v 20%, p < 0.001). Eighty nine (84%) parents who had used the internet prior to this clinic appointment found it useful. Thirty six (34%) parents had discussed or were planning to discuss the information they had found with their doctors.
Conclusion: A significant proportion of parents have access to the internet and use it to find information about their child’s medical condition. The parents who discuss what they find with the clinic doctor are in the minority. Doctors should be prepared to ask parents about their information needs and discuss use of the internet.
TL;DR: The prevalence and secular trend of congenital anomalies in Glasgow is described with special reference to secular trends, and underlying contributing factors include changes in case ascertainment, antenatal screening, and diagnostic methods.
Abstract: Aim: To describe the epidemiology of congenital anomalies in Glasgow with special reference to secular trends.
Methods: The prevalence of congenital anomalies was determined retrospectively in 233 777 births using the Glasgow Register of Congenital Anomalies for the period 1980–97.
Results: The total prevalence of congenital anomalies was 324 per 10 000 births, declining by just over a third from 382 per 10 000 births in 1980 to 238 per 10 000 births in 1997. The categories of defects with the highest prevalence were congenital heart disease (50 per 10 000 births), anomalies of limbs (49 per 10 000 births), and digestive system anomalies (47 per 10 000 births). Prevalence in most categories of anomaly declined, including those of the ear (-88%), congenital heart disease (-69%), anomalies of integument (-67%), nervous system anomalies (-61%), anomalies of limb (-54%), and urogenital (including renal) anomalies (-31%). By contrast, there was a significant upward trend for chromosomal anomalies (+50%).
Conclusions: Despite the decline in the prevalence of many types of congenital anomaly, around 2.5% of all births in Glasgow were still associated with these disorders in 1997. In attempting to explain the prevalence and secular trend of congenital anomalies in Glasgow, underlying contributing factors require to be considered. These include changes in case ascertainment, antenatal screening, and diagnostic methods.
TL;DR: A wide range of suspected ADRs are associated with fatalities in children, and anticonvulsants were associated with the greatest number of reports of fatalities and hepatotoxicity in particular.
Abstract: Aim: To determine the nature and number of suspected adverse drug reactions (ADRs) associated with fatal outcomes in children reported through the yellow card scheme. Methods: All reports of suspected ADRs with a fatal outcome in children received by the UK Committee on Safety of Medicines through its Yellow Card Scheme from 1964 until December 2000 were reviewed. Reports associated with vaccines and overdose were excluded. The medicine, date of the report, diagnosis, ADR, and the age of the child were analysed. No formal causality assessment was performed. Results: There were 331 deaths with 390 suspected medicines reported for children aged 16 years or less. Medicines most frequently mentioned were anticonvulsants (65 deaths), cytotoxics (34 deaths), anaesthetic agents (30 deaths), and antibiotics (29 deaths). The individual drug most frequently mentioned was sodium valproate (31 deaths). The nature of the reported ADRs were diverse, with hepatic failure the most frequent. In the past decade, there has been an increase in both the total number of suspected ADRs reported in children and the number of reports with a fatal outcome. Conclusions: A wide range of suspected ADRs are associated with fatalities in children. Anticonvulsants were associated with the greatest number of reports of fatalities and hepatotoxicity in particular.