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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 . . .”.


  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.


  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.

Supplementary materials

  • 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
    Dr Dominic AcoletDr Tony E AdesDr Christoph Aebi
    Professor P J AggettDr Jag S AhluwaliaDr Anthony K. Akobeng
    Mr Tim AlbertDr Grethe AlbrektsenDr John Alexander
    Dr Mazin AlfahamDr Fernando Alvez GonzalezDr Rod Amos
    Dr Gavin AndersonDr Mary AnthonyDr Richard Appleton
    Dr L Nick J ArcherDr Simone Arden-HolmesDr A Arena
    Dr Peter ArkwrightDr Renu AryaDr Mark R Ashton
    Dr D J AthertonProfessor Jane T AtkinsProfessor Stephanie A Atkinson
    Professor Jeanette AtkinsonDr I AuchterlonieProfessor Albert Aynsley-Green
    Mr AF AzmyDr Denis AzzopardiDr Christopher J Bacon
    Dr Trevor BaglinDr Edward James BakerDr Alastair J Baker
    Dr Ian M Balfour-LynnDr Colin BallDr Ami Ballin
    Professor David J P BarkerDr Denis BarkerProfessor Donald Barltrop
    Dr Nick BarnesDr Rosemary A BarnesDr Timothy Barrett
    Dr Peter W BarryProfessor Kim BartlettDr J Harry Baumer
    Dr Martin C O BaxDr Adam Baxter-JonesDr Sue Beath
    Dr R Mark BeattieDr Jack O BeattieDr Alison Bedford Russell
    Dr Frank BellDr Michael BensonDr Valerie Beral
    Dr Stefan BergDr A BertottoDr Viviane Bertrand
    Dr Peter R BettsDr David BeverleyDr Walter Beyer
    Professor Vinny K BhutaniProfessor Zulfiqar Ahmed BhuttaProfessor Nick Bishop
    Dr W Michael BissetDr T BistritzerDr Maria Bitner-Glindzicz
    Dr Peter S BlairDr Mats BlennowDr Orna Blondheim
    Dr M BobakDr Antonio BoccazziDr Sandy Bohin
    Dr Paula Bolton-MaggsProfessor Ian W BoothDr Robert Booy
    Dr Nico A BosDr Stuart BoydDr Bernard Brabin
    Mr Jeffrey BrainDr Claire BramleyDr A M Breckenridge
    Dr Caroline Breese-HallDr Joseph BrittoDr J Trevor Brocklebank
    Dr Peter BrocklehurstDr Paul A BroganProfessor Charles G D Brook
    Dr Edward G BrooksDr Raymond BrownDr Martin J Brueton
    Professor B BrunekreefDr Frank BrusDr Peter D Bull
    Dr Frances Bu'LockDr Mike BurchMr David M Burge
    Dr David BurgnerProfessor Peter BurneyDr Michael L Burr
    Dr Martin BurtonDr Andrew BushDr R Butler
    Dr Pamela A CairnsDr S A CalvertDr Andrew J Cant
    Dr Robert G CarpenterDr Robert CarrDr Lucinda J Carr
    Dr Fabrice CarratDr Roy Carr-HillDr Enitan D Carrol
    Dr Marco CarrozzoDr Dennis CarsonDr Patrick H T Cartlidge
    Dr Helen CartyDr David CassonDr P R Cavanagh
    Dr Tapia CeballosSir Iain ChalmersDr Lee G Chan
    Dr Janet ChaplaisDr Stephen ChapmanDr Charlie P J Charlton
    Dr Tim CheethamDr Phil A J ChetcutiProfessor Malcolm Chiswick
    Professor Imti ChoonaraProfessor R D ChristiansenDr Deborah Christie
    Mr D I ClarkDr Penny ClarkDr Graham Clayden
    Dr Peter E ClaytonDr Jill Clayton-SmithDr Maureen Cleary
    Dr G Mac CochraneProfessor Tim J ColeDr Trevor R P Cole
    Dr Peter ColeDr Jane CollinsDr John Collins
    Dr G J ConnettDr Stephen P ConwayDr Nancy R Cook
    Dr Derek CookProfessor Richard W I CookeDr Richard J Cooke
    Dr Robert CoombsMr J J CorkeryDr M Cosgrove
    Mr Aidan CosgroveDr Malcolm G CoulthardDr Jon Couriel
    Dr Fiona J CowanDr Brian CraigDr Suzanne Crowley
    Dr Steven CunninghamDr Nigel CurtisDr Geoff Cusik
    Dr William A M CuttingDr Giuliano Da VillaDr Mark Dalzell
    Dr Hans DanielsDr Brian DarlowDr V K Das
    Mr Mark DavenportProfessor Tim J DavidProfessor David P Davies
    Dr Hugh DaviesDr Pamela A DaviesProfessor Peter S W Davies
    Dr E Graham DaviesDr Helena DaviesDr Graham Davies
    Dr Paul M DavisDr Peter D O DavisDr Suzanne Davison
    Dr Katy DavisonDr Carmen L De CuntoDr Ronald de Groot
    Dr R A de LemosDr Linda S de VriesDr Ester de Vries
    Dr Peter R DearDr Geoff D DebelleDr DM Demers
    Dr Graham DerrickDr Sanjeev A DeshpandeDr Sean Devane
    Dr Carol A DezateuxDr Anil DhawanMiss H K Dhillon
    Dr David F DickinsonMr James A S DicksonDr Javier Diez-Domingo
    Dr Carolyn DiGuiseppiProfessor Mike J DillonDr Gabriel Dimitriou
    Dr R DinwiddieDr Patricia DiotDr Marjorie Dixon
    Dr Simon DobsonDr P DobsonDr Keith Dodd
    Professor John A DodgeDr Cora DohertyDr Malcolm D C Donaldson
    Professor Dian DonnaiProfessor S P DonnanDr I M Doughty
    Dr Iolo J M DoullProfessor Lex W DoyleDr Eddie Doyle
    Professor Brendan DrummDr S W D'SouzaDr David A Ducker
    Dr Matthias DuerkenProfessor David B DungerProfessor Peter M Dunn
    Dr D DutkaDr Philippa EasterbrookProfessor Tim Eden
    Dr Julie EdgeProfessor David EdwardsDr Philippe A Eigenmann
    Dr Christine EiserDr David EllimanMr Martin Elliot
    Dr A S El-RadhiDr D Mary EminsonDr Anthony J B Emmerson
    Dr Alan M EmondDr Jean EmonsDr A H Enk
    Dr Ben EssexDr Margaret J EvansDr Geoffrey Evans
    Dr Nicholas J EvansDr Mark L EverardDr Andrew Ewer
    Dr Vineta FellmanDr Alan C FentonDr Theo Fenton
    Dr Fabrizio FerrariDr Mary FewtrellProfessor David J Field
    Professor Alistair R FielderDr Alain FischerDr Margaret Fitzpatrick
    Professor Peter FlemingDr Helen J FoleyDr Annabel B M Foot
    Dr Rodney P K FordDr Gillian ForrestDr J Forster
    Professor Kevin ForsythDr K R ForwardDr Helen E Foster
    Dr Peter FowlieMr David FrankDr Alan E Fryer
    Dr Susumu FurukawaDr Albert GarcíaDr Janet M Gardner-Medwin
    Dr E J GarlandProfessor Elana GarraldaDr H R Gaskins
    Dr A R GatradDr E J A GerritsenDr Diana Gibb
    Dr Brenda GibsonDr Alan GibsonDr Neil Gibson
    Dr Ruth GilbertDr Brian GillDr A Bryan Gill
    Dr J E GillespieDr G GladmanProfessor Frances P Glascoe
    Dr Philip L GlickDr James GnanapragasamDr John Goddard
    Dr Michael GoldacreProfessor Jean GoldingDr N Golitsina
    Dr Michael GoodacreDr Judith GoodshipDr Siobhan Gormally
    Dr Paul GovaertDr J Clive GrahamDr S M Granthem-McGregor
    Dr Elizabeth GrayDr Victor E GrechDr Anne Green
    Dr Stuart H GreenProfessor Anne GreenoughDr J W Gregory
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    Dr Peter GroneckDr Tari HaahtelaDr Parviz Habibi
    Dr Dino HadzicDr Judith HaleDr Michael Hall
    Professor David M B HallDr Georgina W HallProfessor Henry Halliday
    Dr Patricia HamiltonDr W HandrickDr Ian Hann
    Dr K N HaqueDr John I HarperProfessor C Anthony Hart
    Dr Gary HartnollProfessor David HarveyDr Mark Hatherill
    Dr Jane HawdonDr Debbie HawesDr Joanna T Hawthorne
    Professor George B HaycockDr F G HaydenDr David Heaf
    Dr Paul HeathProfessor Peter J HelmsProfessor Henderson-Smart
    Dr M HerbertDr Dean HessDr Edmund Hey
    Professor Peter D HillDr Peter HindleyDr Peter Hindmarsh
    Dr Michael F HirdMiss Rowena HitchcockDr P Hoare
    Dr Christopher J HobbsMr Anthony HockleyDr Donald Hodge
    Professor Hilary HoeyDr Barbara HollandDr Philip C Holland
    Professor Jeff HollyDr E Wren HoskynsDr Robert W Hostoffer
    Dr Brian HoustonDr Alan HoustonProfessor J G R Howie
    Dr Ian HuggonProfessor Ieuan HughesDr Helen Hughes
    Dr David HughesProfessor Sir David HullDr Sally Hulton
    Dr A Stewart HunterDr Mark HunterDr Susan Huson
    Dr John IrvingProfessor David IsaacsDr Hiroki Isomura
    Dr Kevin IvesDr Tsuyoshi IwasakiDr Anoo Jain
    Dr C JakobsProfessor Stephen JarvisDr Ian G Jefferson
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    Mr Nigel JonesProfessor Elizabeth F JuniperDr Anthony Kaiser
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    Mrs Sue KefflerDr Deirdre A KellyDr Yvonne J Kelly
    Dr A Wilf R KelsallDr Alison KempDr Stephen T Kempley
    Dr Colin R KennedyProfessor Jan L L KimpenDr SE Kinsey
    Dr Jeremy M W KirkDr Harriett KitzmanDr Nigel Klein
    Professor Jerome kleinProfessor Martin E KlineDr L M Koenig
    Dr P KonigDr Ron KooijmanDr Sailesh Kotecha
    Dr Ilya KovarDr Rashmi KumarDr Nathan Kuppermann
    Dr Necdet KuyucuDr Dominic P KwiatkowskiDr Phillipa Kyle
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    Dr R LakshmanDr William LambDr Anthony D Lander
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    Professor Ann Le CouteurDr Howard LeeDr Christoph Lees Harris
    Dr Eric LegiusDr Eugene LeibovitzDr Warren Lenney
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    Professor Malcolm I LeveneDr Franciscio Leyva-CobiánDr Seah Lim
    Dr Nehama LinderProfessor Otwin LinderkampDr Tom Lissauer
    Dr J M LittlewoodDr Ben W LloydProfessor David Lloyd
    Professor Robert LockeDr Stuart LoganDr D J Lovell
    Professor Margaret LynchDr Andrew J LyonDr Ian MacConachie
    Dr Roderick MacFaulDr Duncan MacraeDr R John Madar
    Dr Andrew R MagnayDr Dermot MaherDr Mike Makris
    Dr Gunilla MalmProfessor Jillian R MannDr Nicholas P Mann
    Dr Adnan ManzurDr Michael MarkiewiczProfessor Neil Marlow
    Dr Elaine MarlowProfessor A M MarmontDr Mike Mars
    Dr Michael J MarshDr Tom MarshallProfessor J C Marshall
    Dr Rob MartinDr Ahmed MassoudDr Ruth C Mathews
    Dr Heather MaxwellDr Jan McColmDr Moira McDonnell
    Dr Pat McGrathDr Mary McGrawDr Bill McGuire
    Dr Kieran McHughProfessor Neil McIntoshDr Mike McKendrick
    Dr Sheila A McKenzieDr Patricia A McKinneyDr Karen A McLeod
    Dr M Tony McShaneProfessor Sir Roy MeadowDr Nigel Meadows
    Dr Judith MeekDr P W Dirk MeerstadtDr Dirk Mentzer
    Dr Jussi MertsolaDr Colin A MichieProfessor Giorgina Mieli-Vergani
    Dr Heather J MilburnProfessor Peter J MillaDr Elizabeth Miller
    Dr Mark MillerDr S MillershipDr David Milligan
    Professor Anthony D MilnerDr Robert A MinnsDr Christopher Mitchell
    Dr Ed A MitchellDr Sally MittonDr Jacqueline Mok
    Dr James MoorcraftMr A T MooreDr Imogen Morgan
    Mr D MorganDr Bruce J MorlandDr Ruth Morley
    Professor Colin J MorleyDr Richard MortonDr Jenny Moseley
    Dr Celia MossProfessor Martin G MottDr Robert Moy
    Professor Miranda MugfordDr M Zulf MughalDr Richard H Mupanemunda
    Dr Simon MurchDr I A MurdochDr Craig Murdoch
    Dr Deborah Murdoch-EatonDr Anna MurphyDr Mike F G Murphy
    Ms Julia MurrayDr Kirsi MustonenDr Simon Nadel
    Dr Richard NaeyeDr A B NaficyDr Keigo Natakani
    Dr Dilip NathanDr Tim NealDr Simon J Newell
    Professor P C NgDr Richard M NichollDr Angus Nicoll
    Dr Hans E NielsenDr Maarten W NijstenDr Titus Ninan
    Dr Hanna NohynekDr Vas NovelliProfessor Frank Oberklaid
    Dr Christopher O'CallaghanDr Amanda Ogilvy-StuartDr Shyuuhei Ogita
    Dr Richard OliverProfessor Richard E OlverDr William Olver
    Dr I Ostman-SmithDr S K ParikhDr Gareth Parry
    Dr Leena PatelDr James Y PatonMr Michael Paynton
    Dr Ian PeartProfessor Ammon B PeckProfessor Heikki Peltola
    Dr Daniel J PennyDr Juliet PenriceProfessor A Percy
    Dr Mike J PetersDr Stavros PetrouProfessor P O D Pharoah
    Dr Jeffrey PhelanDr A G S PhilipDr Barbara Phillips
    Dr Michael PikeDr Alison PikeDr Andrew J Pollard
    Professor Leon PolnayDr Anne-Louise PonsonbyProfessor C Potter
    Dr Chris PowerDr G PratsProfessor Michael Preece
    Dr Michael PrendergastDr Ursula PretzlikProfessor John F Price
    Dr D A PriceDr Robert A PrimhakDr Sue Protheroe
    Dr Jonathan PuntDr John W L PuntisDr Michael W Quinn
    Dr Shakeel A QureshiDr Andrew RafflesDr Mary Ramsay
    Professor M B RankeDr Richard ReadingDr William Reardon
    Dr Andrew N RedingtonDr Aileen OB RedmondDr M M Reid
    Dr John J ReillyDr Elizabet ReizensteinProfessor Graham J Reynolds
    Mr Peter RichardsDr Martin RichardsonDr Sam Richmond
    Dr Chris RiddochDr F Andrew I RiordanProfessor R A Risdon
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    Dr Bengt RobertsonMs Lesley RobertsonProfessor R O Robinson
    Dr Peter RobinsonDr M J RobinsonProfessor Leslie L Robison
    Miss W Joan RobsonProfessor Roberto J RonaDr Elhasid Ronit
    Dr Stephen J RoseDr Lewis RosenbloomDr Eric Rosenthal
    Dr Simon RothDr SH RoussounisDr Judith Rowen
    Dr Peter T RuddDr Gary RuizDr Martin Runciman
    Dr J Alison RushforthDr Glynn RussellDr Robert Ian Ross Russell
    Professor Nick RutterDr Steve RyanDr George W Rylance
    Dr Berthold RzanyDr Eeva SaloDr Alison Salt
    Dr Barry SampsonDr Martin SamuelsDr Camille de San Lazaro
    Dr Ian R SandersonProfessor Bhupinder SandhuProfessor J M Saudubray
    Dr Sureyya SavasanDr Rayfel SchneiderDr Susanne Schweitzer-Krantz
    Professor Gunnar SedinDr Reinhard SegerDr Tom Sensky
    Professor Graham R SerjeantDr Gurleen SharlandDr Peta Sharples
    Dr Ben J ShawDr Nicholas J ShawDr Alison G Shefler
    Dr J P H ShieldDr S D ShorvonDr Sheila Shribman
    Dr Anupam SibalProfessor Jo SibertProfessor D Sidi
    Professor Michael SilvermanDr Karen SilversDr M Sinaasappel
    Dr Surjit SinghDr Kuldeep SinghDr Sunil Sinha
    Dr H SintonenProfessor Wolfgang G SippellDr S M Skevington
    Dr Jonathan SkinnerDr Roderick SkinnerProfessor David Skuse
    Dr Roger SmithDr Michael F SmithDr Alan Smyth
    Dr M R SoodDr Christina SoonProfessor David P Southall
    Dr B SpeidelDr A Nigel P SpeightDr David Spencer
    Professor Nick J SpencerDr Gavin SpickettDr Henry A Spiller
    Professor Lewis SpitzDr Charles StackDr Richard G Stanhope
    Dr Lori J StarkProfessor Alan SteinDr Ben J Stenson
    Professor Terence StephensonProfessor John B P StephensonDr Michael C G Stevens
    Dr David W StevensDr Anne StewartDr Sarah Stewart-Brown
    Dr Charles A StillerDr Janet StocksDr Mark Stoeckle
    Dr Barbara J StollDr David StoneProfessor Gregory Stores
    Dr David StrachanProfessor Stephan StrobelDr A Graham Stuart
    Dr Oliver F W StumperDr Peter R StutchfieldDr N V Subhedar
    Dr Sadao SugaDr Peter B SullivanDr Ian Sullivan
    Dr Maurice SuperDr Robert SurteesDr Cecille Svanes
    Professor Kathy SylvaDr D N K SymonDr Rashmin Tamhne
    Professor K L TanProfessor M Stuart TannerDr M J Tarlow
    Professor William Tarnow-MordiDr Robert C TaskerDr Chris J Taylor
    Dr David W TeeleDr Sudhin Thayyil-SudhanDr Adrian Thomas
    Dr Julian E ThomasDr Mark R ThomasDr Neil Thomas
    Dr Ros ThomasDr Michael E ThompsonDr Mirin A Thompson
    Dr Anne ThomsonDr Michael A ThomsonDr E Trend
    Dr J H TrippDr Annet TroelstraProfessor David Tudehope
    Dr Robert TullohDr Kjell TullusDr Dino Vaira
    Dr Niels H ValeriusDr Christopher VallisDr A Van Rie
    Dr Vivienne H van SomerenDr Guy Van VlietDr William Van't Hoff
    Dr Eftyhia VardasProfessor Alessandro VenturaProfessor Julian L Verbov
    Dr Chris VerityDr Kate Verrier JonesDr Russell M Viner
    Dr G N VolansDr Kurt von SiebenthalDr A J Vora
    Dr Linda D VossDr Michael P WailooDr J K H Wales
    Dr Neil WalkerDr Valerie WalkerDr Brian Walker
    Professor John A Walker-SmithMr S WallDr Sheila J Wallace
    Dr W Hamish B WallaceDr P C WallerDr Martin P Ward Platt
    Dr Michael E WardDr Charles WardropProfessor John O Warner
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    Dr Nicola WilsonDr Neil WilsonDr David C Wilson
    Dr Joachim WoelfleProfessor Fenella WojnarowskaDr Andrew Wolf
    Professor Dieter F H WolkeDr K C WongDr A J Wood
    Dr M R WorkmanDr J Ed WraithDr John Wright
    Dr Jen-Tien WungProfessor John WyattDr Jonathan Wyllie
    Dr Jane M WynneDr Janet YassaDr Robert Yates
    Dr Tetsushi YoshikawaDr Duncan YoungDr C Bill Yoxall
    Professor Victor YuProfessor W YuleDr M Yunge
    Dr Hussain R YusufDr Zenobia ZaiwallaDr Fred Zepp
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