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In the end, the only surprise was the lack of altercation, confrontation, heated exchange and counterpoint. Her approach taciturn yet deferential, his initial resistance to sharing the code melting like butter on San Antonio July tarmac in minutes. She could, in fact, almost sense contrition. ‘Why had no one asked before?’ nagged at first, but once she had the answers, she only looked forward.
Age of consent
There is consensus that a prerequisite for recruitment to paediatric research requires both parental consent and child assent, consent protecting and assent acknowledging autonomy respectively. This philosophy is now deeply embedded after a welcome, rapid transition from lip service to essential provided there is capacity and understanding. Whether decisions around participation would be endorsed by non-capacious children enrolled into an RCT as adults (or whose mothers were enrolled during pregnancy) is unknown In this context. Nike Franke and colleagues in Auckland, New Zealand explore this in an intriguing qualitative follow-up of the ACTORDS trial in which women likely to deliver prematurely were randomised to one or more antenatal doses of corticosteroids, interviews gauging feelings around the process itself and follow-up visits. The findings make for very intriguing reading. See page 209
Consumption: the sequel
Tuberculosis (TB), ‘the old captain’,1 remains a major scourge of health systems in low- and middle-income countries. The main aim of treatment is survival, but, rather paradoxically, there has been to date no pooled data on long term lung function in children. Yao Long Yeu and colleagues in Darwin, Australia assess this overlooked deficit in a meta-analysis of TB trials for which pre and post pulmonary function data (FVC and FEV1) were available – and find, soberingly, significant deterioration. The implications for follow-up are patently clear, interventions beyond rehabilitation less so. What this superb work tells us is that these children can’t be discharged once the last dose of isoniazid has been swallowed. See page 188
Fading away
It’s only in the recent past that avoiding restrictive eating disorder (ARFID) has been recognised as an entity quite separate to anorexia nervosa in that the preoccupation is not with weight. Textures seem an important determinant and there is an association with autistic spectrum disorders, but these alone do not fully explain the often extreme selectivity in diet. Sarah Schimansky and colleagues in Bristol, UK examine the inherent risks of micronutrient and vitamin deficiencies particularly with respect to blindness and the potential interventions. See page 181
Lockers – 1
The way we practice, even the way we are, reflect to an extent, our forebearers’experiences, interpretation and writing. Sometimes we’re guided by data, at other times tradition marinaded with gut feeling takes over as pilot. One area where both sources are needed, is the perennially sensitive one of what is now called, factitious or induced illness (FII), formerly Munchausen’s or (in the case children) Munchausen’s by Proxy. The phenotype (and I use the term very broadly) involves a mental health disorder where parents feign physical or psychological illness in their children, interfere with their medical tests or inflict injuries. The main gain seems to be attention through the sick role and the concept is, literally, as old as the original Munchausen himself. Eugen-Matthias Strehle (Newcastle, UK) describes the evolution of the syndrome and eponym from its 18th century roots in a wonderfully etched Voices from History. See page 253
Lockers – 2
In a historically-related vein, the world has moved on from the (not very distant past) hospital practice of preventing parents staying with their children overnight on the ward. How this could ever have been the case is baffling, but, there’s more. Aside from allowing them ‘access’ what about sustenance. One aspect of the original proposed European charter for children in hospital some 40 years ago was the provision of meals for parents of inpatients. For whatever reason, this never became statute and hospitals, therefore, able to make their own decisions. As Helen Hare’s Viewpoint suggests, in some countries this nettle has been grasped, in others not confronted. See page 251
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Contributors -
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
Linked Articles
- Viewpoint
- Original research
- Review
- Voices from history
- Global child health