Sunday, July 02, 2006

Paediatric Grand Rounds 1:6

Photo mosaic reads Paediatric Grand Rounds 1:6Guilt, desperation, fear and magical thinking can be powerful forces in decisions about children's healthcare and their well-being. So can resourcefulness, compassion, love and the intellectual challenge of caring for children whose lives present a rich mosaic of their own needs and circumstances that are determined by others.

Neonatal Doc gently confronts us with a tough question: when is failing to resuscitate a premature baby tantamount to age discrimination? Or an example of negative views of disability? On the latter point, Angry Doc of Singapore is miffed by the guilt-trip Wyeth use to promote vaccination. However, he is confused and angry about the implications of a politically-correct objection to the advertising campaign and wonders where that would leave public health education.

The blogosphere was aflame with discussions of the recent New York Times article about an aggressive public health campaign in support of breast-feeding. It's hard to avoid the feeling that the shock tactics obscured the educational material. Dr. Sarah of Good Enough Mummy strongly objects to the spin of the rebuttal piece by that presents an unmitigatedly negative view of breast feeding. Disease Proof emphasises that breast milk is nutritionally, immunologically and developmentally superior. Meanwhile, Amka wonders if we should do more to support public breast feeding.

After a trip down memory lane to the snake-pit-resembling Grand Rounds of his student days, Dr. Jest contemplates a contemporary snake pit in the form of a potential measles epidemic and the media treatment of a group of pro-vaccination doctors. After recent experiences of a substantial increase in workload and parental alarm caused by an outbreak of a comparatively trivial illness, he wonders about the impact of something that is considerably more than an inconvenience.

The irrepressible Flea is the quintessence of resilience as he urges us to ignore disarmingly dangerous advice and continues his campaign to keep non-emergent patients out of the ED. Recent events at work have prompted Dust in the Wind to think about the letter that she would like to hand to parents when they arrive in the Emergency Department with their child, What not to say.

Does Dr. Megan dream of a similar letter that addresses, What not to do? In The World According to Megan, we learn that some parents have a cavalier approach to administering antibiotics to children, and unerring confidence in the rightness of their actions. Meanwhile, the incredulous paediatrician has a spinning head and a mass of concerns that is not addressed by ad libitum amoxicillin.

Awesome Mom recalls a time when advice from her son's specialists undermined her confidence in her decisions, judgments and actions. She is grateful to her paediatrician who took time to listen to her fears and made her feel competent again.

A lot of factors play a part in parents' decision-making when their children are desperately ill. But with a heavy heart, Orac knows that the reality of illness is stronger than magical thinking. Sometimes, we want a happy ending but it just isn't going to happen. A surprising number of PGRphiles name The Princess Bride as one of their favourite films or make regular references to it. When VitaminK MD quotes the Dread Pirate Roberts, "Life isn't fair, princess, and anyone who tells you differently is trying to sell you something", we are in for a moving account of just how unfair life can be.

Matthew Baldwin of Defective Yeti writes with skill and humour about his many interests, and his life with his wife (aka, The Queen) and his son (aka, The Squirrelly). In an unexpected post, we discover what it was like for this family to discover that The Squirrelly has a diagnosis of Autistic Spectrum Disorder (ASD). Read through to the end to discover the surprising link between love and horseradish.

Matthew mentions his concerns about the availability of appropriate resources and schools for children with ASD or similar disorders. Clark Bartram of Unintelligent Design gives us a horrifying glimpse into the practices of one school in New York that uses extreme measures that amount to state-funded child abuse.

It is easy to agree on some common features that harm or promote the development of children. Building a better brain argues that science supports the need for social policies to support strong, stable relationships between children and key figures in their lives. Stress and negative life events do play a significant role in children's well-being, even being implicated in asthma exacerbations. However, the UK experience of social interventions is dispiriting. An evaluation of programmes that exist to boost children's welfare through improving parenting skills and creating a secure and happy home environment indicates that they may be disadvantaging some of the children who need them most.

Have you ever paused in the midst of your childcare chaos to wonder how blind parents cope with the same situations? Well, Charv tells us what it is like for her as a blind, stay-at-home mother to care for three young children without resorting to bells or tagging - yet.

Tagging teenagers has a lot of support in some of the UK press. Dr. Jest knows that one sure sign that he is in for a rough few minutes is if a shoe-gazey teenager turns up for an appointment, flanked by both parents. Is this similarly true in other countries? girl MD continues her occasional series about classic parent phone calls: this one is about an indelicate teenage problem that definitely did not require ED attendance.

The Granola sounds like she was a smart teenager. She traces the origins of her scepticism about alternative medicine to her teenage encounter with a chiropractor who seems to have been playing a cynical numbers game.

Finally, an interesting corollary of the truism that children outgrow shoes and clothes quickly: have you ever thought that the same is true of pacemakers? Dr Hsien-Hsien Lei looks at early research into biological pacemakers that would be maintenance-free.

This is the 12 week check-up and Clark Bartram's baby is bouncing with vitality and developing well. You can consult both the hosting schedule and earlier editions in the Paediatric Grand Rounds archive.

The next Paediatric Grand Rounds is scheduled for July 16 and your host is Dr. Sethi of Pediatrics Info.

I'd like to thank all of the contributors who have so generously shared their posts with me. I look forward to seeing you in future editions of Paediatric Grand Rounds.

For more information about the images used in the illustration, click on it or visit the detail on Flickr.


Blogger neonataldoc said...

Good job, Shinga. I'm impressed with how big this has become so fast!

9:07 pm  
Anonymous Anonymous said...

Char originally sent in a post about the problems she has encountered with breastfeeding support. Why was it not included? It was very informative. AND as someone who can take a smidgen of credit in helping her get it off to a good start with her third child.... I'm a little saddened to see it wasn't used... sigh...
Beautiful job getting the GR up, but saddened to not see my friend/clients' original post.

3:49 pm  
Anonymous Dr Sethi said...

Hello Bloggers!
The Pediatric Grand Rounds will be up at my website - on 16th July.
Its nice to see so many Pediatric Bloggers and other med-bloggers blogging about Pediatrics.
Please do contribute to the Grand round by submitting whats new in the Pediatrics . The real life stories, patient interactions, poems , verses are the ones i am looking for
Please post a link on your site asking for submissions and giving my link

Dr Sidharth Sethi
MBBS,MD Pediatrics

10:19 am  
Anonymous Dr Sidharth Sethi said...

You can post your submissions for the next pediatric grand rounds at
Dr Sidharth Sethi

8:41 am  

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