Paediatric Grand Rounds 1:12 Is Up
Next host is the ever entertaining Kim on October 8, 2006 at Emergiblog.
[p]rofessionals involved in the care of children with OM should be aware that OM not only affects physical functioning but also general well-being of the child and its family. These outcomes should therefore be included in the evaluation of the child with otitis media both in the clinical and research setting.Well established risk factors for OM include respiratory tract infections and environmental exposure to tobacco smoke such as parental smoking at home. However, researchers suggest that traffic-related air pollutants contribute to OM. The authors decided to assess the relationship between traffic-related air pollution and OM in two birth cohorts, one in the Netherlands and another in Munich, Germany.
These findings indicate an association between exposure to traffic-related air pollutants and the incidence of otitis media. ..The strong evidence linking otitis media with ETS exposure and the similarities between ETS and ambient air pollution add further support to our findings. The specific air pollutants that affect respiratory infections have not been clearly identified, although some evidence suggests that NO2 and coarse particles may be especially active in this regard...Additionally, the mechanism by which air pollution may lead to otitis media is not known. Air pollution exposure may result in a more severe or persistent infection—for example, by decreasing mucociliary clearance...-making progression to otitis media more likely.The authors argue that it is important to identify preventable risk factors such as exposure to air pollution for OM, because they have significant implications for health care costs. They stress that because air pollution is not usually considered a risk factor for OM, its associated costs for the health impact and cost–benefit assessments tend to be disregarded. The authors further conclude:
Given the ubiquitous nature of air pollution exposure and the importance of otitis media to children's health, these findings have significant public health implications.Children can't be expected to breathe through gas masks to protect them from traffic pollution. It would be useful to have a research model that would examine how much protection they obtain from the filtering that comes with, e.g., nose-breathing.
we are deeply concerned at the escalating incidence of childhood depression and children’s behavioural and developmental conditions. We believe this is largely due to a lack of understanding, on the part of both politicians and the general public, of the realities and subtleties of child development.However, I'm not entirely sure that it is due to "a lack of understanding". A wholesome way of eating and a regular lifestyle with time spent with other people - these are not matters that require subtle understanding. I know parents who are only too aware that their working hours take them away from their children and (through stress and tiredness) have an impact on the quality of time that they do spend together. Hectoring all parents in this manner will wash over some of those who need the advice and may alienate those who are already acting in their children's best interests. These Vera Lynn statements (Dr. Crippen defines this as something so self-evidently right that is beyond criticism) smacks of truthiness.
Since children’s brains are still developing, they cannot adjust – as full-grown adults can – to the effects of ever more rapid technological and cultural change. They still need what developing human beings have always needed, including real food (as opposed to processed “junk”), real play (as opposed to sedentary, screen-based entertainment), first-hand experience of the world they live in and regular interaction with the real-life significant adults in their lives.
[T]he quality by which a person purports to know something emotionally or instinctively, without regard to evidence or to what the person might conclude from intellectual examination.I agree that children's mental health and development are complex socio-cultural problems and that we need a discussion on matters of public policy. However, a lot of money is already being spent on services that are not achieving much in the way of outcomes (e.g., Sure Start). And there are some health issues that are not in the control of parents, such as the contribution of traffic particulates to asthma, poorer lung function and recurrent ear infections. Too many children live in poor housing conditions. Both of these need to be part of any discussion about child development. And any discussion should involve parents, not alienate them.
Only 3% of the sample felt their smoking status was not the pediatrician's business, 89% stated they believe it is an important part of a pediatrician's job to ask about their smoking status, and 8% stated it wouldn't matter if the pediatrician asked...Among 187 smokers, 177 (95%) would appreciate or feel okay about the physician's concern if advised to quit and 57% reported wanting some kind of smoking cessation help from the pediatrician's office.
[stress has] many mechanisms, but among the most prominent are the manifestations of physiological stress responses as a result of living and working conditions, inter-personal conflict, as well as the sense of control of one’s environment and optimism/pessimism toward the future. "Allostatic load" refers to the cost of adaptation to a stressful environment, which elicits repeated and sometimes prolonged adaptive responses ("allostasis") that preserve homeostasis in the short run but can cause wear- and-tear on the body and brain...We have powerful ways of modulating the harmful output of the stress response systems that include belief systems and behaviors. An important quote attributed to Dr. McEwen is, "We must also remember that the biggest problems for the human race in the future are those associated with our own behavior and misbehavior and the impact of the social and physical environment on our bodies and brains."
I hope you don’t grow up to be a demanding, screaming adult patient.Sticking with cuts, Scalpel introduces us to Zen and the art of laceration repair. He establishes a calm environment and leads children to relax with breathing control. From some of the accounts in PGR, it seems as if parents would benefit from learning these techniques.
Those are called “wimps”.
When you are a big boy, you might want to join the Marine Corps. They have an excellent program in self-discipline.
Lord knows you won’t learn any from your parents.
Parents who are stressed, either psychologically, emotionally, financially, or physically, have the potential to view their child's symptoms through the amplifier of their own state. Physicians who understand their parents and have a good rapport with them, can help find help for parents when they are distressed. It's good for the parent, and it's good for the child.Doctors in the UK are now so accustomed to being 'educated' by journalists and patients coming in to see them, clutching the latest newspaper article about mis-diagnoses and new treatments, that some of them are listening to current affairs programmes that will give them a jump-start on the medical news of the day. Dr. Jest had food for thought when he heard about a proposal to improve teenagers' IQ by dosing them with Omega 3. He proposes a novel method for Truant Officers to enforce compliance in the 'naughty' children who don't attend for their daily dose. But he does wonder if supplements are the best approach to addressing emotional and behavioural problems that may be diet-related.
My kids’ pediatrician was always so encouraging. So sweet to me. He always brought up issues I worried about and was too embarrassed or ashamed to bring up myself, such as her constant crying (colic?) And how to deal with that without losing my mind.This anecdote is a reminder that it is best for children when the parents have strong social support, but that paediatricians, family doctors, specialists and healthcare workers can make a difference to children's health and development, sometimes in the simplest ways, by encouraging or reassuring nervous parents. It might be an obvious non-pharma intervention of the sort that Clark Bartram wants bloggers to write about, but it is, nonetheless, powerful and long-lasting.
...our doc never failed to tell me i was doing a great job with her...looking back as i grew up over the years...i saw that he didn't have to treat all his moms this way, but he knew i was young and he took the extra time with me.
he didn't know it at the time, but he was the only encouragement i ever had.
Buteyko's theory relating to carbon dioxide levels and airway calibre is an attractive one, and has some basis in evidence from experimental studies. However, it is not known whether altering breathing patterns can raise carbon dioxide levels significantly, and there is currently insufficient evidence to confirm that this is the mechanism behind any effect that BBT may exert.They conclude that further research is necessary to establish the effectiveness of the Buteyko Method and to validate the mechanism of action.
This article reviews the available evidence supporting the hypothesis and concludes that although attractive, there is currently insufficient evidence to attribute the benefits of breathing retraining to this mechanism.Hypocapnia and asthma: a mechanism for breathing retraining. Bruton, A. and Holgate, S.T. (2005). Chest, 127 (5), 1808-11.
At present...no reliable conclusions can be drawn concerning the use of breathing exercises for asthma in clinical practice. However trends for improvement, notably in quality of life measurements, are encouraging and further studies including full descriptions of treatment methods and outcome measurements are required.Breathing exercises for asthma. Cochrane Database Syst Rev., 2004;(1):CD001277. Holloway, E. & Ram, F.S..
Every Saturday on my own blog I will write about non-pharmaceutical interventions that have improved the lives of pediatric patients. I ask that every medical blogger would do the same with a focus within their own realm of expertise. But why limit it to just the docs? I am also calling for blogging patients and family members of patients to write about how a member of the medical community has helped them or their loved one without pulling out a prescription pad. For every post in the blogosphere about drug company conspiracies and doctors who keep people ill only to make more money, I want to see two discussing the benefit that society has reaped from non-drug contributions from docs, nurses, therapists, or any other practitioner of modern medicine.CB has kicked this off with an interesting entry about newborn jaundice and his recommendation for increased breast-feeding and the right sort of light.
The numbers of deaths from food allergy are small and not all are preventable. Allan Colver believes that the increasing prescription of emergency prophylaxis to children fuels anxiety rather than saving lives, but Jonathan Hourihane argues that there are no data to show that prescription of autoinjectors increases anxiety and their provision, as part of an integrated care plan, is justified.I found this discussion useful. I would write more (of course) but my left arm is playing up and I need to ice it.