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  1. HARVEY MARCOVITCH, Editor in chief

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    Arch Dis Child 2000 Volume 83 No 6

    The Children Act—a judge replies

    In March, two of our contributors stated with some vigour that the Children Act was failing those severely abused orand neglected children.1-1 This is a grave allegation to make against the law which governs how the courts protect children. We were not surprised, therefore, to receive an equally forthright rebuttal from a senior judge (page 463)—more particularly since she had been the Law Commissioner responsible for the reforms in family law, of which the Children Act was a key part. We hope readers from outside the jurisdiction will also find the dialogue useful as it raises matters of principle beyond that of the specific item of legislation under contention. Key messages are that social workers lack resources and support; families should not be separated without due process of law; legal proceedings must move faster; and adoption procedures need improving. Drs Wynne and Speight, authors of the original polemic, add that we need a lobby for the rights of abused children and they reiterate their objection to the unqualified statement, in this context, that “children are generally best looked after within the family . . .”.

    References

    1. 1-1.

    Prescribing—cause for concern

    One day before writing this piece, the British press featured a story of a newborn baby who had died after allegedly being prescribed and administered a tenfold excess dose of a necessary medication. All experienced clinicians have experienced errors, hopefully without sequelae. This month we publish an audit from a large Scottish Hospital looking at its mandatory medication error reporting system (page 492). The overall rate was one per 662 admissions, ranging from nearly one in 100 in the paediatric intensive care unit, to one in 2500 in the surgical ward unit. Doctors, nurses, and pharmacists were all responsible and double checking was not foolproof. Given the newspaper report mentioned above, I was alarmed to read that fifteen incidents involved a tenfold error, five of them caused by incorrect setting of an infusion pump. Fortunately, 96% of errors were deemed minor—no harm likely and even the five more serious mistakes did not lead to long term damage.

    Alarmingly, parents were not told about half of the events—no longer acceptable in these days of openness and shared management. The authors note that reluctance to acknowledge mistakes openly may result in system failures going undetected. They describe the remedial steps they have put in place. Anyone looking for something important to audit in their own unit might reasonably follow these authors' example.

    Prescribing off licence

    It's one thing to get the right dose but what if manufacturers can't or won't declare what it should be? We have previously looked at unlicensed and off-label prescribing in newborns.3-2 This month we look at what happens to children in general practices in the Midlands of England and the environs of Paris (pages 498 and 502). Off-label prescribing is widespread, the French being more cavalier than the puritanical inhabitants of Nottinghamshire and Derbyshire. The latter used licensed medicines, but at an off-label dose nearly 10% of the time. The largest groups were antibiotics, anti-asthmatic drugs, and emollients. The first tended to be prescribed at too low a dose and the second too high (inhaled steroids) or too low (chromoglycate). The 10 unlicensed preparations sound pretty benign—steroid cream diluted by a community pharmacist and a non standard formulation of white soft paraffin and liquid paraffin.

    The French group were office based paediatricians rather than general practitioners and might not have been indicative of their counterparts in that they belonged to a self motivated educational programme. English readers will be pleased to have their prejudices confirmed by learning that the fourth most commonly prescribed items were paracetamol (acetaminophen) suppositories. Ninety nine of 2522 prescriptions were unlicensed, consisting mostly of nose drops used for coryza, some of which contained epinephrine (adrenaline) or steroids. The largest “off-label” group was for antibiotic eye drops—all of which were so classified as the French formulary contains no listing for eye drops with paediatric doses. Both sets of authors call for a better regulatory process. Dr Chalumeau and colleagues draw attention to the US FDA regulations which contain both legal obligations and financial incentives for paediatric drug evaluation. They add that EU guidelines have not improved drugs labelling and they call for compulsory regulation.

    References

    1. 3-2.

    And now for something completely different

    Those who adhere to the Western calendar will note it is nearly the end of the year. Some believe it is nearly the beginning of the real millennium. Traditionally, our great uncle the BMJ, normally so straight laced, considers it's time to lift up its skirts and prance around a bit. Perhaps paediatricians aren't amusing enough, but we have done our best to gather together at the end of this month's ADC a selection of the quirky, dotty, gently satirical, and completely daft. I also claim to have included the first New Yorker cartoon to appear in the pages of the journal. It carries a profound message, so note well: all submissions in 2001 which the editors deem pretentious will receive a copy. You have been warned.

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    • REFEREES 2000

      In addition to members of the Editorial Board, the following reviewed one or more papers for Archives of Disease in Childhood from 1 September 1999 to 31 August 2000. Thanks are extended to all reviewers.
       

      Dr Mario AbinumDr Majd Abu HarbDr Ishaq Abu-Arafeh
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