Sunday, July 01, 2007

Paediatric Grand Rounds 2:6

Paediatric Grand Rounds in Shop Sign Letters
What with the floods, the bombing attempts in my local area, and the shrill warnings that the UK is on critical alert for terrorist events, a number of households are probably taking the time to go through emergency planning dilemmas and review contingency plans with their children. Matthew Baldwin of Defective Yeti is a menace to tidy desktops: he too often causes the rapid nasal dumping of whatever I'm drinking over a keyboard, monitor and surrounding area. He turns the everyday into, well, Photo Finish.
Squiggle's daycare was creating emergency kits for each child. One of the things they asked the parents to supply was pictures of themselves. That way, if there was a natural disaster, and the child was separated from his caregivers, he could at least find comfort in seeing them in a photograph.
I'd like a headcount of those of you who think that your children would find this comforting in the event of such a contingency. The importance of having proper emergency provisions is highlighted by Orac who reproduces a battery advertisement that tells the story of how fumbling about during a blackout almost led to a situation where: I poured a death potion for my sick baby!

We might be tempted towards DIY diagnosis under emergency conditions. Find out why Judy of Tiggers don't Jump says I hope they were just waiting for the pediatrician's office to open. On the topic of unsettling search terms and the information that you might expect to receive from Dr Google, Kevin, M.D. chronicles: The Google Health Advisory Council: Outrage. While we are on the topic, how strong is this advisory group on the subject of paediatric healthcare?

Parents wanting to comfort and help their children and advocate for them during medical visits is a strong theme for this PGR. Jen is one of the alpha-girls of Unique But Not Alone. I think that we are all familiar with the situation where a child just trips on air and, in no uncertain terms, lets you know, "It hurts so bad." It is just so much more fraught when both parent and child are veterans of many procedures.
I kept thinking, “I know it hurts. Let me help you kid!” My frustration with the situation and not really being able to make it feel better, made me a lot less patient and my tone was at best witchy. I reminded myself to keep it together, though.
Catherine of Charming BB was a little apprehensive when she met up with a new paediatrician for her son. There were a few reservations and a little awkardness on both sides. Find out why mutual respect and good manners really do oil the wheels of many potentially fraught situations: So, How's It Going?
He didn't say: "You are a crazy pain in the ass parent." And I didn't say: "Wish you guys had caught this disease earlier."
Girl MD of girl MD gives a lyrical and poignant account of Ondine's curse; a condition that had taken some time to diagnose.
before this night, i did not know the extent of their journey together, this young boy and his mother. as it became clear that he would sleep soundly, the tension drained from her face.

Stacy of The Preemie Experiment is a staunch advocate for her daughter, Paige. However, Stacy was taken aback when Paige, who has mild CP, announced: Mommy, I need a wheelchair. When the parental/medical impression of "She looks good to me" contrasts with a child protesting that she is in pain:
Being honest here... I don't know what to do when Paige utters this statement.
Neonatal Doc was watching a professional fishing tournament in which the fish were returned to the water when it triggered a train of thought. Given the complexity of caring for current premature babies, he considers that medical research has so far not developed an artificial placenta and wonders if it represents a natural physical and ethical Barrier.
Sometimes we wish we could throw a tiny baby back into the uterus to grow some more, but it obviously doesn't work that way with humans.
Dr Clark Bartram of Unintelligent Design gives a fascinating account of the dramatic medical progress of diabetic mothers and Willy Wonka Wombs.
The abnormally low, and potentially quite dangerous, blood sugar arises from spending roughly 9 months in the Willy Wonka womb of an uncontrolled diabetic mother...

Prior to 1922, when cow insulin was first given to a human with diabetes, there was no hope for young diabetics. They rarely lived long enough to bear children and diabetic women with child were counseled to terminate their pregnancies. Insulin, and more importantly the ability to make a lot of it, was irrefutably one of the biggest advancements in modern medicine...
Walter of Highlight Health reports more common in utero exposures: Second-hand Smoke Exposure Linked to Psychological Problems in Children.
Researchers found that children whose mothers had been exposed to tobacco smoke either by smoking or exposure to second-hand smoke when they were pregnant had more symptoms of ADHD and conduct disorder than children whose mothers did not experience smoke exposure.
Christian Bachmann of Med Journal Watch summarises the debate about whether it is in utero or social influences that have an impact on intelligence scores: What the birth order IQ study tells us. I enjoyed his conflict of interest:
I am a firstborn of seven siblings which may influence my view of this study.
I wonder if the impact of social order could be overcome by appropriate branding. Dr Bryan Vartabedian of Parenting Solved has a remarkable account of contemporary childhood in The Wall St Journal and Baby Branding.

Of course, this is the sort of post that I typically associate with GI specialist Dr Vartabedian. A Really Close Look at a Dirty Diaper, or, to be more accurate, a year's worth. Be careful about when you look at it, but there is an interesting discussion of a paper that reports fascinating material about GI tract colonisation and the role of microbiota in extracting nutrients from food.
By applying sophisticated genetic analysis to samples of a year's worth baby poop...researchers have now developed a detailed picture of how these bacteria come and go in the intestinal tract during a child's first year of life.
Moving on to older children, Medgadget has taken a robust attitude on a controversial topic: Video Game Addiction: We Don't Care.
Why? Because it's pretty clear there are those who spend way more time interacting with screens and virtual worlds than is healthy, and apparently have a hard time doing otherwise. However, getting on board with the addiction classification opens up a scary scenario where parents of loner overweight kids can sue Capcom for the results of their bad parenting.
How many "loner overweight" kids are stressed? Treatment Online covers recent discussions: Stress Effects Children's Social Skill, Academic Success. I doubt that anyone is surprised by this but I wish that there were an obvious and practical remedy.
[R]esearchers found that children who have elevated amounts of stress tend to demonstrate lower social skills than classmates without as much stress. They also found that active participation by parents in their child’s academic life results in positive performance in both the long and short term.
They also discuss The Alleged Risks of Psychotherapies; this is not directly about child psychotherapies but it did raise questions for me as to the extent of the evidence-base that exists for them.

Sandy Szwarc of Junk Food Science gives us her usual commonsense take on the topic of diet and related issues in children. She reports that Fitnessgrams (fit report cards) are being implemented in increasing numbers of school systems in the U.S. They claim that academic performance is dependent upon fitness -- Sandy takes a look at those claims and the evidence in: Take home message from school: Kids, spend as little time reading as possible. Sandy also takes a cool-headed look at yet another another diet claimed to be effective for children and teens that is riddled with the assumptions and errors common to most weight-loss studies. Figure Flaws — Did this diet really work?

Dr Scott of Just Practicing is familiar with both inundation, overwhelm and false promises. He has a startling announcement, he's had Enough.
The government has done NOTHING for healthcare after Katrina...Forgive me for playing the martyr, but I feel like I've been caring for the children of Waveland and Bay St Louis on my own back and on my own dime. I can't do it by myself anymore, and if no one is coming to help, it can longer be my problem.
The second part of PGR reflects events in the UK and US.

Vaccination, MMR and autism

I should explain that while you have the Autism Omnibus hearings in the US these issues are coming up for us again in the UK because the General Medical Council is holding hearings in the matter of Dr Andrew Wakfield and two of his previous colleagues, in July. The UK's self-styled leading nutritionist Patrick Holford recently asked: Was Dr. Andrew Wakefield Right About the Link Between Autism, the Gut, Allergy and the MMR Vaccine?. He purported to give an overview:
If you are not sure, then please read on to find out what we know about autism, the gut, vaccinations and what food has to do with it.
We do not know any of that: the science has been well and truly exposed. At best, Patrick Holford is outdated in his knowledge and it is past time that he updated it. Something he had ample opportunity to do before repeating these beliefs in recently published books.

Patrick Holford depends upon Wakefield's work to justify some of his entrepreneurial and charitable endeavours. He owes it to the people who rely upon him to revise his acceptance of Wakefield's science and findings. And people are guided by Patrick Holford when it comes to MMR. Petition signatory 4797 credits Patrick Holford with her daughter's decision not to vaccinate her children:
Thank God my daughter used her judgement and did not have the MMR for her children. She based her decision on extensive research, most particularly 'What Doctors Don't Tell You' and Patrick Holford.
Patrick Holford owes it to that woman to put together a better overview of the research that purports to find a link between MMR and autism: he may even owe it to her that he should strongly reconsider his position on a number of important matters.

The following posts address various aspects of Wakefield and the MMR debacle and how Wakefield's work and that of others has spawned some dubious treatment programmes for autism.
Patrick Holford and Dr Andrew Wakefield's Discredited Findings: Part 1
Kevin Leitch on Andrew Wakefield and the death of the MMR debacle
Mike Stanton on Patrick Holford and his unusual views on vaccination, MMR and autism
Patrick Holford Claims Remarkable Benefits for Homeopathic Vaccinations
Holford Watch: Holford believes Secretin is "Worth considering" as an autism treatment; however, there is no evidence that this treatment is effective and
Holford is sceptical about off-label prescribing, but thinks that secretin for autism is "Worth considering"
Patrick Holford alias Doctor Knock aka Holt Senior

Courtesy of the Autism Omnibus, there have been many fascinating posts about similar issues in US blogs. Autism Diva has done an outstanding job of blogging the Autism Omnibus Hearings and her summaries of the testimony are well worth reading. If you want to learn about measles from a world authority on the topic, however, I have to single out Omnibus hearing: Griffin.
if you have the slightest inclination to get an understanding of the natural history of measles and how the wild-type virus is so different from the vaccine strain virus, and if you'd like details on how the vaccine virus was developed and what the limitations are on culturing vaccine strain and wild-type strain in a laboratory setting, if you'd like to know about what happens to children who catch the wild-type measles and do just fine for 7 to 10 years when they develope subacute sclerosingpanencephalitis or SSPE...
Arthur Allen has provided interesting coverage of the Autism Omnibus, both on his own blog and for Slate. Fombonne was one of the experts who testified in the case of Michelle Cedillo. It was both sad and enlightening to learn of Fombonne's interpretation of the Painful home videos in the autism/vaccines trial.
It’s common that parents, especially first-time parents don’t pick up such abnormalities. And they should not blame themselves for that. But with hindsight you do see these very clear patterns.
The ever-reliable Orac has posted one of the most accessible explanations of PCR that I've seen and explains just why the expert testimony should discredit some of the widely-propagated beliefs about the claims that the MMR measles strain has been identified in gut samples. The difference between real scientists and crank scientists:
If the evidence presented in the Autism Omnibus doesn't put the final stake in the heart of the misbegotten "MMR causes autism" pseudoscience, truly there is no hope for reason and science.
Prometheus of A Photon in the Darkness was intrigued by Generation Rescue's claim that their survey shows that vaccination causes autism. Prometheus has looked at the figures and sums it up: Survey Says....Nothing!!!
Well, actually, it doesn't really show that vaccines cause autism, what it shows is that vaccines cause "neurological disorders", loosely defined as autism (or autistic spectrum disorder) and/or ADD/ADHD.

Except that it really doesn't show that, either.
Kevin Leitch addresses the issue, What will change? It seems that the answer is, very little. People who thought that there was little science to support the MMR-mercury-autism hypothesis have probably just been strengthened in that by the array of world-class experts and their commentaries. People who believed in the link already have refreshed their crop of conspiracy theories. Kevin concludes with an allusion to Swift:
You cannot reason someone out of a belief they did not reason themselves into.
Dr Bryan Vartabedian of Parenting Solved is our next PGR host for Sunday July 15.

Clark Bartram is looking for hosts for future PGRs. You can consult both the hosting schedule and earlier editions in the Paediatric Grand Rounds archive. Please sign-up. Pretty please...PGR

Please host PGR written in shop sign letters

Labels: ,


Blogger concerned heart said...

There is plenty of research showing that older paternal age in one generation or another causes the new/non-familial genetic changes that produce autoimmune disorders, autism, schizophrenia and type 1 diabetes, cancers and various other disorders. It can be older maternal grandfathers at the mother's birth. One needs to sift through the 50 years of research on paternal age, sperm stem cell DNA mutations, and various genetic disorders. Average paternal age has risen greatly and so has genetic disease. If there is a political decision not to look at the paternal age effect it does not mean that it is not biological there.

4:08 pm  
Blogger Leatherwood said...

This comment has been removed by a blog administrator.

3:30 am  
Blogger Shinga said...

The relevance of age is certainly an intriguing research area.

11:19 am  
Blogger Iron-Man said...

Most fat kids have emotional problems and/or bad parents.

5:31 am  

Post a Comment

Links to this post:

Create a Link

<< Home