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Children Act—more harm than good?
In this issue, two paediatricians experienced in dealing with child abuse argue that the law, as enshrined in the 1990 Children Act is failing those whom it was designed to help. Before the Act became law, seriously abused children could quickly be removed from danger and placed in a permanently safe environment. This is no longer the case, argue Speight and Wynne (page 192) following pressure from parents' rights groups, some social workers, and the Cleveland debacle (an inquiry into an apparent rapid rise in incidence of child sexual abuse in one area of the UK).
Speight and Wynne claim the courts may be slow, unnecessarily wasteful in the use of “experts”, and biased towards keeping children within abusive or neglectful families; social service departments may shrink from the expense of court action; parents' responsibilities are regarded as secondary to their rights. The authors call for the act to be examined critically and challenge the Royal College of Paediatrics and Child Health to give a lead.
Bin the growth charts?
Yet again a systematic review takes a long accepted fact and turns it into a mirage. This time the target is the value of growth monitoring. I had assumed that several forests must have disappeared to provide research publications on this topic. If so, it has been an ecological tragedy as Garner et al (page 197) could find only two satisfactory trials, neither of which was particularly encouraging. In his commentary, Professor Davies sorrowfully concludes that, in the developed world at least, the ritual may indeed be redundant. However, he doubts that it will be abandoned overnight so pleads that it should be done properly and studied further.
Do you know your children's birth weight?
Even if frequent measurements are a waste of time, the very first one surely sticks in the mind. How many times, in the delivery room, have you been asked for this information virtually before the cord has been tied? Yet it appears all is not so clear cut. O'Sullivan and colleagues (page 202) asked the question of parents of 649 schoolchildren in Newcastle upon Tyne. After disposing of obsolete imperial measures, they found that some parents could get it wrong by as much as 1390 g. One in 10 respondents were more than 200 g adrift. Age of the child and social class had no significant effect. The authors conclude that the overall error is sufficiently small not to interfere seriously with epidemiological research. Although there is nothing like a primary source, this journal expects to continue to receive papers based on recall by questionnaire. It isn't only the bother of obtaining records; many NHS Trusts, like mine, even if they don't have a reputation for losing casenotes, may charge researchers for their retrieval. Long live the parent held child health record.
Another SIDS theory bites the dust
About five years ago, this journal was plagued by a correspondent obsessed with the belief that there was a conspiracy between the government and manufacturers of cot mattresses. He considered that toxic gases released from statutory fire retardants could be fatal when inhaled (and inhalation was more likely when a baby was prone or overwrapped). Although medical researchers were never convinced, the UK public was hyped up by a popular television programme, which alleged that high levels of antimony—a component of fire retardants—had been found in the livers of SIDS victims.
A group in Dublin has revisited this story and concluded that any such difference in antimony concentrations reflects differences in the timing of collection of samples postmortem (page 244). The lesson to be learned is wider than the particular issue addressed by the paper: no matter what the investigation, data can be dangerously contaminated unless experimental technique is scrupulous and controls handled no differently from subjects. By the way, authors' failure to observe these elementary rules is a frequent reason for papers being rejected by ADC.
RSD—another mystery unsolved
Paediatricians find it hard enough to cope with the vagaries of chronic fatigue syndrome (CFS/ME). Paediatric rheumatologists have similar crosses to bear; one is fibromyalgia (or is that the same thing?) and the other is reflex sympathetic dystrophy. Like all such aetiologically and pathologically confusing conditions it doesn't even have the decency to stick to one name, having been refashioned as chronic regional pain syndrome type 1. A group of paediatric rheumatologists and physiotherapists from Liverpool have reviewed the clinical course of 46 patients (page 231). Mean time to diagnosis was long, investigations multiple, treatment variable, recovery delayed, and relapse frequent. One lesson, like that with CFS/ME (and routine growth monitoring for that matter), is that medical awareness might spare unfortunate sufferers unnecessary treatment and investigation.