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Lucina had supposed that young children might be reluctant to wear glasses. Observations in Reading, however, suggest that she was wrong (Eye1998;12:173–8). Children under age 8 years accepted spectacles well and acceptance was related to the social environment and the comments of other children rather than improvement in vision. Rude comments were apparently rare in this age group but were perhaps more likely at around the time of school entry—that might not be a good time to supply spectacles for the first time.
In a US/UK study (New England Journal of Medicine1998:338:1572–6) 409 babies with birth weights less than 1251 g and less than 31 weeks’ gestation were randomly assigned to wear goggles that reduced visible light by 97% and ultraviolet light by 100%, or no goggles. There was no effect on the incidence of retinopathy of prematurity (ROP) (goggles 54%, controls 58%). An editorialist (Ibid: 1620–1) accepts that this proves that light does not cause ROP but asks whether the goggles might help once ROP has begun to develop.
Two girls aged 6 and 8 years developed multiple tender pink or violaceous nodules or papules on the soles of their feet after ballet classes (Pediatric Dermatology1998;15:97–102). They had palmoplantar eccrine hidradenitis (otherwise known as idiopathic planter hidradenitis, neutrophilic eccrine hydradenitis, recurrent palmoplantar hidradenitis in children, or idiopathic palmoplantar hidradenitis). The condition has only been recognised in the past 10 years. It comes on after running, dancing, or walking, and usually affects both feet although it may be unilateral and the palms are sometimes involved. Histology shows neutrophilic infiltration round the sweat glands. No treatment is proved to be effective but the lesions usually resolve spontaneously in about a week although they may recur.
A leading article in the British Journal of Surgery(1998:85:580–1) comes out against skull x rays for children with blunt head injury unless non-accidental injury is suspected, or there is a penetrating injury or a depressed fracture. Otherwise a skull x ray does not contribute anything useful to the care of the child. The author acknowledges, however, that there could still be legal complications if, for instance, a child is sent home from the emergency department without x ray and is subsequently found to have an intracranial bleed. The probability though, is that the courts would support a practice accepted by the profession.
A US national study of compensation claims for acute encephalopathy after measles vaccination (Pediatrics1998;101:383–7) identified 48 cases with a clustering around 8–9 days after vaccination. The probable incidence, however, was about one in 1.5 million children vaccinated.
Crops such as peas, maize, and potatoes are susceptible to fungal infections. One way of combatting such infections might be to spray the crops with a bacterium, Burkholderia cepacia, and firms in the USA and Canada would like to do just that (New Scientist 1998;23 May:5). The trouble is that B cepacia can be lethal to people with cystic fibrosis and, although the firms claim that their strain is non-pathogenic, British and American microbiologists have pointed out that the bacterium is capable of mutation and its safety is in considerable doubt. It seems unlikely that the plan will get past the regulatory agencies but the whole story gives Lucina that sinking feeling.
Self injurious behaviour is a striking and strange phenomenon. Lucina suspects that most paediatricians might link it with Lesch-Nyhan syndrome but might be hard pressed to complete the list of 15 other syndromes included in a recent review (British Journal of Psychiatry 1998;172:385–8). The full list includes the following syndromes; Lesch-Nyhan, Rett, Aicardi, Joubert, Brachmann de-Lange, Prader-Willi, Smith-Magenis, Oculocerebrorenal of Lowe, FG syndrome, fragile X, Klinefelter, tuberous sclerosis, Noonan, Rubinstein-Taybi, untreated phenylketonuria, and ring chromosome 22. Non-syndromal causes included autism and bipolar affective disorder and self injury may be associated with violence and severe learning disorder (Ibid: 381–4). New approaches to drug treatment include opiate antagonists, dopamine D1 antagonists, and agents affecting serotonin turnover (Ibid: 389–94). Psychological interventions may be beneficial even at low levels of cognitive functioning (Ibid: 395–400).
In 1966 a peculiar pattern of eczema, characterised by exudation and crusting around the nostrils, ears, and scalp, with the later appearance of a generalised fine papular rash, was described in Jamaican children and called infective dermatitis (ID). In 1990 all of 14 children with ID were found to be seropositive for human T lymphotrophic virus type 1 (HTLV-1). Now a further study in Jamaica of 50 children with ID and 35 with atopic dermatitis (Archives of Dermatology1998:134:439–44. See also editorial Ibid: 487–8) has confirmed the association with HTLV-1 (seropositivity, ID 100%, atopic dermatitis 14%). Further characteristics of ID were lymphadenopathy, raised immunoglobulin levels, activated T cells with high rates of HLA-DR antigen positivity, high CD4 and CD8 cell counts, and raised CD4:CD8 ratio. Whether these children will later develop adult T cell leukaemia/lymphoma is not known.
A live attenuated influenza vaccine given intranasally to 15–71 month old American children (New England Journal of Medicine 1998;338:1405–12) had an efficacy of 89% after one dose and 94% after two doses. There was a 30% drop in episodes of febrile otitis media in vaccinated children. The researchers imply that more widespread vaccination of children might be indicated but an editorialist (Ibid: 1459–61) favours caution in that respect.