The Centers for Disease Control and Prevention (CDC) now recommends a Covid -19 vaccine for children ages 5 and older. Johns Hopkins Medicine encourages all families to have eligible children vaccinated with the Covid - 19 vaccine. Currently, Pfizer's vaccine is the only approved Covid-19 vaccine for children and its side effects are still the same in children. Children might notice pain at the injection site (upper arm), and could feel more tired than usual. Headache, achy muscles or joints, and even fever and chills are also possible and these side effects are usually temporary and generally clear up with 48 hours.
This review1, listing all the pros and cons of covid vaccinations for children, is to be welcomed but the authors have omitted some important questions on the downside. They rightly state that a large proportion of children might already be immune and point to waning immunity after vaccinations, suggesting that primary infection at young age with boosting exposure over time might be a better strategy. But they do not cite recent evidence that people who are first vaccinated then exposed afterwards, appear to mount brisk IgG response to the spike protein since this is already in their immune memory, but may fail to mount the broader response associated with natural infection, including N-antibodies2. For those children (>75%) already immune, there is no significant benefit to vaccination with an emergency use authorised product. For otherwise healthy children who are not yet immune, they can obtain this by natural infection over the months ahead, at minimal risk to themselves or to the vaccinated adults around them.
Under the heading ‘Long-term safety’, the authors rightly quote concerns of possible ongoing effects of myocarditis, but they make no mention of any other potential as yet unknown effects of these novel technologies. If there are effects on T-cell function, then there is risk for autoimmune diseases3 and also for potential cancer cells4 to pass unchecked. There are also no adequate animal reproductive studies and the nanoparticles have been shown b...
This review1, listing all the pros and cons of covid vaccinations for children, is to be welcomed but the authors have omitted some important questions on the downside. They rightly state that a large proportion of children might already be immune and point to waning immunity after vaccinations, suggesting that primary infection at young age with boosting exposure over time might be a better strategy. But they do not cite recent evidence that people who are first vaccinated then exposed afterwards, appear to mount brisk IgG response to the spike protein since this is already in their immune memory, but may fail to mount the broader response associated with natural infection, including N-antibodies2. For those children (>75%) already immune, there is no significant benefit to vaccination with an emergency use authorised product. For otherwise healthy children who are not yet immune, they can obtain this by natural infection over the months ahead, at minimal risk to themselves or to the vaccinated adults around them.
Under the heading ‘Long-term safety’, the authors rightly quote concerns of possible ongoing effects of myocarditis, but they make no mention of any other potential as yet unknown effects of these novel technologies. If there are effects on T-cell function, then there is risk for autoimmune diseases3 and also for potential cancer cells4 to pass unchecked. There are also no adequate animal reproductive studies and the nanoparticles have been shown by Pfizer to concentrate in the ovaries and testes5 in rats. These more theoretical risks may be of less concern to adults, particularly those a relatively high risk from covid. But for children, with their whole lives ahead of them, we absolutely must remember the maxim, ‘First do no harm’.
Most importantly, the authors state that, ‘Subjecting children to potential risk of vaccine adverse effects to drive indirect effects with little or no direct benefit might be ethically questionable’. I would contest that is unethical to ask children to take a vaccine to boost herd immunity or to offset political decisions such as school closures, at a stage when the drug trials have still to be completed. Policy makers would do well to re-read the Universal Declaration on Bioethics and Human Rights6 and to follow the authors’ guidance to ‘weigh up the risks and benefits with caution and to proceed with care’.
1. Zimmermann P, Pittet LF, Finn A, et al. Should children be vaccinated against COVID-19? Archives of Disease in Childhood Published Online First: 03 November 2021. https://doi.org/10.1136/archdischild-2021-323040
2. UK Health Security Agency. COVID-19 vaccine surveillance report Week 44 https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
3. Ishay Y, Kenig A, Tsemach-Toren T, et al. Autoimmune phenomena following SARS-CoV-2 vaccination. Int Immunopharmacol. 2021;99:107970. https://doi.org/10.1016/j.intimp.2021.107970
4. Jiang, H, Mei, Y-F. SARS–CoV–2 Spike Impairs DNA Damage Repair and Inhibits V(D)J Recombination In Vitro. Viruses 2021, 13, 2056. https://doi.org/10.3390/v13102056
5. Pfizer biodistribution data. https://www.naturalnews.com/files/Pfizer-bio-distribution-confidential-d...
6. Universal Declaration on Bioethics and Human Rights (2005). http://portal.unesco.org/en/ev.php-URL_ID=31058&URL_DO=DO_TOPIC&URL_SECT...
I read with great interest the article by Haisma et al. that reports on fecal calprotectin instability.(1) The authors are to be commended on their study. However, some points deserve comment.
The authors tested the stability of calprotectin after the stool was homogenized. The clinical relevance of this is unclear since what is important is the stability of calprotectin in stool after collection and before analysis. The studies that have evaluated fecal calprotectin stability in this situation are in alignment; calprotectin is stable in unprocessed stool at room temperature for at least 3 days with some studies suggesting up to a week (for review see D’Amico et al.).(2)
No support is provided for the statement by Haisma et al. that calprotectin instability in stool samples sent by mail may lead to errors in treat-to-target strategies. Indeed, the literature says otherwise.
1. Haisma SM, van Rheenen PF, Wagenmakers L, Muller Kobold A. Calprotectin instability may lead to undertreatment in children with IBD. Arch Dis Child. 2020;105:996-8 doi: 10.1136/archdischild-2018-316584 [published Online First: 2019/01/19].
2. D'Amico F, Rubin DT, Kotze PG, et al. International consensus on methodological issues in standardization of fecal calprotectin measurement in inflammatory bowel diseases. United European Gastroenterol J. 2021;9:451-60 doi: 10.1002/ueg2.12069 [published Online First: 2021/05/08].
Thank you for your Rapid Response to our publication, ‘Language in 2-year-old children born preterm and term: a cohort study’ in the Archives of Disease in Childhood. We appreciate the opportunity to provide clarity on the points you raised.
Infants in this study were recruited one to two weeks following birth as it was part of a larger longitudinal cohort study aimed at understanding early neurobehavioural and brain development. Medical staff recommended that infants were not approached if the infants were medically unstable or parents had previously requested not to be approached regarding research studies at this early stage.
Due to the size of the sample, we did not perform subgroup analysis by gestational age at birth within the preterm cohort. We appreciate that the distribution of gestational age at birth is of interest, and provide this in the table below
Thank you for your Rapid Response to our publication, ‘Language in 2-year-old children born preterm and term: a cohort study’ in the Archives of Disease in Childhood. We appreciate the opportunity to provide clarity on the points you raised.
Infants in this study were recruited one to two weeks following birth as it was part of a larger longitudinal cohort study aimed at understanding early neurobehavioural and brain development. Medical staff recommended that infants were not approached if the infants were medically unstable or parents had previously requested not to be approached regarding research studies at this early stage.
Due to the size of the sample, we did not perform subgroup analysis by gestational age at birth within the preterm cohort. We appreciate that the distribution of gestational age at birth is of interest, and provide this in the table below
Gestational age in completed weeks
Number of children
Percent of very preterm group
23
1
0.75%
24
4
2.99%
25
9
6.72%
26
26
19.40%
27
31
23.13%
28
28
20.90%
29
35
26.12%
Due to the size of the sample, we were restricted as to the number of predictors that could be robustly examined. We agree that in future papers with larger cohorts, family history of language disorder would be a predictor of interest.
Thank you again for your interest, and we hope that our responses are helpful in the interpretation of our results.
Yours sincerely,
Dr Katherine Sanchez, Professor Alicia Spittle, and Professor Angela Morgan
Let us not forget the not insignificant number of children who present to their GP within a day of discharge from hospital with their parents reporting they cannot or will not swallow the unpalatable liquid. The cost of GP time, community pharmacy time and prescribing a second, more palatable, antibiotic all adds up and needs to be taken into consideration.
England and Tuthill deserve congratulation for highlighting the need to review the accuracy of drug information on the web. It is encouraging to see an apparent improvement in the quality of online information since we considered this question (Akram et al, 2007) but difficulties in study design would appear to limit the application of these findings. When online information for families is being rated it is important to distinguish between websites geared to the lay reader and those designed for professional reference, which may not be designed specifically to be readable and accessible.
A more ‘lay person’ centred methodology would also suggest that there is more to accuracy of patient information than a ‘correct’ listing of side effects found in a formulary written for prescribers. In line with General Medical Council guidance on consent (GMC, 2020, Para 23), families need information that correctly highlights common side effects and high risk rare events. A website may miss some, less severe, rare side effects and include some side effects that are not recorded in the formulary without necessarily reducing accuracy in a clinically meaningful way.
In this important and topical area for clinical research authors would do well to use established methodologies. For example DISCERN (Charnock et al, 1999) still provides a valuable basis for rating the quality of information.
Akram G, Thomson AH, Boyter A, Morton MJS.
Characterisation and evaluat...
England and Tuthill deserve congratulation for highlighting the need to review the accuracy of drug information on the web. It is encouraging to see an apparent improvement in the quality of online information since we considered this question (Akram et al, 2007) but difficulties in study design would appear to limit the application of these findings. When online information for families is being rated it is important to distinguish between websites geared to the lay reader and those designed for professional reference, which may not be designed specifically to be readable and accessible.
A more ‘lay person’ centred methodology would also suggest that there is more to accuracy of patient information than a ‘correct’ listing of side effects found in a formulary written for prescribers. In line with General Medical Council guidance on consent (GMC, 2020, Para 23), families need information that correctly highlights common side effects and high risk rare events. A website may miss some, less severe, rare side effects and include some side effects that are not recorded in the formulary without necessarily reducing accuracy in a clinically meaningful way.
In this important and topical area for clinical research authors would do well to use established methodologies. For example DISCERN (Charnock et al, 1999) still provides a valuable basis for rating the quality of information.
Akram G, Thomson AH, Boyter A, Morton MJS.
Characterisation and evaluation of UK websites on attention deficit hyperactivity disorder. 2008. Archives of Disease in Childhood 93(8):695-700.
doi:10.1136/adc.2007.130708
Charnock D, Sheppard S, Needham G, et al. DISCERN: an instrument for judging the quality of written consumer health information on treatment choices, 1999. J Epidemiol Community Health 53:105–111
We welcome this article by Heyman et al (2021) in last weeks Archives of Diseases in Childhood in particular the explanation of 'functional tic-like attack disorder'. In our community CAMHS in Bedfordshire, we too have noticed an increase in referrals or enquiries asking about medication and management of tics in young girls. In some cases the tics have started since lockdown in girls who are already being seen by CAMHS for other mental health issues such as anxiety or Autistic Spectrum Disorder. Although most of our patients report an increase in motor tics, we have also been made aware of vocal tics increasing. Normally the tics include noises such as clearing of the thorat or high pitched noises.
In February this year we also cofacilitated a local support group for parents with children with Tourettes Syndrome (Beds, Herts and Bucks Parent Tourette Syndrome Group) with a view to understanding how they were coping in the pandemic. We were surprised to see that so many of the attendess had daughters with Tics and Tourettes and almost all said their daughters struggled with increase in anxiety and worsening of tics. It was interesting to hear that a number of boys with Tourettes coped better as there was lack of pressure from going to school and they were allowed more time with online gaming, although those with associated ADHD understandably struggled being confined to their homes. We would agree that the tics serve some sort of function in that it is an...
We welcome this article by Heyman et al (2021) in last weeks Archives of Diseases in Childhood in particular the explanation of 'functional tic-like attack disorder'. In our community CAMHS in Bedfordshire, we too have noticed an increase in referrals or enquiries asking about medication and management of tics in young girls. In some cases the tics have started since lockdown in girls who are already being seen by CAMHS for other mental health issues such as anxiety or Autistic Spectrum Disorder. Although most of our patients report an increase in motor tics, we have also been made aware of vocal tics increasing. Normally the tics include noises such as clearing of the thorat or high pitched noises.
In February this year we also cofacilitated a local support group for parents with children with Tourettes Syndrome (Beds, Herts and Bucks Parent Tourette Syndrome Group) with a view to understanding how they were coping in the pandemic. We were surprised to see that so many of the attendess had daughters with Tics and Tourettes and almost all said their daughters struggled with increase in anxiety and worsening of tics. It was interesting to hear that a number of boys with Tourettes coped better as there was lack of pressure from going to school and they were allowed more time with online gaming, although those with associated ADHD understandably struggled being confined to their homes. We would agree that the tics serve some sort of function in that it is an expression of anxiety. We would be very cautious about prescribing of medication such as strong antipsychotics in this client group. We have seen that families are grateful for the functional explanation and also encouragemet of the young person to express herself either in therapy or creatively via writing or the arts. We would encourage other services to use functional tic disorder as an explanation and first line psychological management as opposed to rushing in with medication. The hope is that as we get closer to some sort of normality with easing of lockdown, the increase in tics will start to decrease. We also encourage clinicans to signpost affected families to local parent support groups which can be an invaluable source of support.
Thanks fir a simple but powerful effective piece.. It shows the human factors that motivate healthcare workers, cause parents barriers and makes a powerful point:
Children are our patients, not parents .
I submitted this response below and see that it has not been published and have had no response to indicate why this would be so. My email address has changed from jamie.houston@nhs.net .
In discussion with colleagues from across Scotland, no significant increase in numbers of infants of Abusive Head Trauma have been referred to medical child protection services was noted during 2020.
My original eLetter was submitted on 08 Jul 2020:
I share concerns about the impact of Covid, and note that we have seen an increase in NAI referrals over recent months (but not AHT). Given that the number of cases in this institution was so low in previous years, I wonder if there has been a change in referral patterns with GOSH admitting more general PICU cases than usual. Has there been an impact from other PICUs in London that were caring for adults during the peak?
Any new, sudden onset of tics or "tic-like" attacks should prompt consideration of Sydenham's chorea. The typical age range for Sydenham's chorea is 5-15yrs, with females more commonly affected, especially in adolescence, which fits with the group described [https://doi.org/10.1016/j.pediatrneurol.2009.11.015].
Neuropsychiatric signs, such as emotional lability, obsessive-compulsive signs, anxiety, and attention deficit often precede the chorea but may mistakenly lead to a presumption of a functional disorder. It can be difficult for non-specialists to distinguish different kinds of involuntary movements, and this may explain why delayed diagnosis is common in Sydenham's chorea [http://www.dx.doi.org/10.1136/archdischild-2015-308693].
The importance of establishing Sydenham's chorea as a cause is of course so that appropriate treatment can be given, including antibiotics and medication to control the chorea, but also to diagnose and treat co-existing rheumatic heart disease.
The Centers for Disease Control and Prevention (CDC) now recommends a Covid -19 vaccine for children ages 5 and older. Johns Hopkins Medicine encourages all families to have eligible children vaccinated with the Covid - 19 vaccine. Currently, Pfizer's vaccine is the only approved Covid-19 vaccine for children and its side effects are still the same in children. Children might notice pain at the injection site (upper arm), and could feel more tired than usual. Headache, achy muscles or joints, and even fever and chills are also possible and these side effects are usually temporary and generally clear up with 48 hours.
This review1, listing all the pros and cons of covid vaccinations for children, is to be welcomed but the authors have omitted some important questions on the downside. They rightly state that a large proportion of children might already be immune and point to waning immunity after vaccinations, suggesting that primary infection at young age with boosting exposure over time might be a better strategy. But they do not cite recent evidence that people who are first vaccinated then exposed afterwards, appear to mount brisk IgG response to the spike protein since this is already in their immune memory, but may fail to mount the broader response associated with natural infection, including N-antibodies2. For those children (>75%) already immune, there is no significant benefit to vaccination with an emergency use authorised product. For otherwise healthy children who are not yet immune, they can obtain this by natural infection over the months ahead, at minimal risk to themselves or to the vaccinated adults around them.
Show MoreUnder the heading ‘Long-term safety’, the authors rightly quote concerns of possible ongoing effects of myocarditis, but they make no mention of any other potential as yet unknown effects of these novel technologies. If there are effects on T-cell function, then there is risk for autoimmune diseases3 and also for potential cancer cells4 to pass unchecked. There are also no adequate animal reproductive studies and the nanoparticles have been shown b...
I read with great interest the article by Haisma et al. that reports on fecal calprotectin instability.(1) The authors are to be commended on their study. However, some points deserve comment.
The authors tested the stability of calprotectin after the stool was homogenized. The clinical relevance of this is unclear since what is important is the stability of calprotectin in stool after collection and before analysis. The studies that have evaluated fecal calprotectin stability in this situation are in alignment; calprotectin is stable in unprocessed stool at room temperature for at least 3 days with some studies suggesting up to a week (for review see D’Amico et al.).(2)
No support is provided for the statement by Haisma et al. that calprotectin instability in stool samples sent by mail may lead to errors in treat-to-target strategies. Indeed, the literature says otherwise.
1. Haisma SM, van Rheenen PF, Wagenmakers L, Muller Kobold A. Calprotectin instability may lead to undertreatment in children with IBD. Arch Dis Child. 2020;105:996-8 doi: 10.1136/archdischild-2018-316584 [published Online First: 2019/01/19].
2. D'Amico F, Rubin DT, Kotze PG, et al. International consensus on methodological issues in standardization of fecal calprotectin measurement in inflammatory bowel diseases. United European Gastroenterol J. 2021;9:451-60 doi: 10.1002/ueg2.12069 [published Online First: 2021/05/08].
Dear Dr Howells,
Thank you for your Rapid Response to our publication, ‘Language in 2-year-old children born preterm and term: a cohort study’ in the Archives of Disease in Childhood. We appreciate the opportunity to provide clarity on the points you raised.
Gestational age in completed weeks
Number of children
Percent of very preterm group
23
1
0.75%
Let us not forget the not insignificant number of children who present to their GP within a day of discharge from hospital with their parents reporting they cannot or will not swallow the unpalatable liquid. The cost of GP time, community pharmacy time and prescribing a second, more palatable, antibiotic all adds up and needs to be taken into consideration.
England and Tuthill deserve congratulation for highlighting the need to review the accuracy of drug information on the web. It is encouraging to see an apparent improvement in the quality of online information since we considered this question (Akram et al, 2007) but difficulties in study design would appear to limit the application of these findings. When online information for families is being rated it is important to distinguish between websites geared to the lay reader and those designed for professional reference, which may not be designed specifically to be readable and accessible.
A more ‘lay person’ centred methodology would also suggest that there is more to accuracy of patient information than a ‘correct’ listing of side effects found in a formulary written for prescribers. In line with General Medical Council guidance on consent (GMC, 2020, Para 23), families need information that correctly highlights common side effects and high risk rare events. A website may miss some, less severe, rare side effects and include some side effects that are not recorded in the formulary without necessarily reducing accuracy in a clinically meaningful way.
In this important and topical area for clinical research authors would do well to use established methodologies. For example DISCERN (Charnock et al, 1999) still provides a valuable basis for rating the quality of information.
Akram G, Thomson AH, Boyter A, Morton MJS.
Show MoreCharacterisation and evaluat...
We welcome this article by Heyman et al (2021) in last weeks Archives of Diseases in Childhood in particular the explanation of 'functional tic-like attack disorder'. In our community CAMHS in Bedfordshire, we too have noticed an increase in referrals or enquiries asking about medication and management of tics in young girls. In some cases the tics have started since lockdown in girls who are already being seen by CAMHS for other mental health issues such as anxiety or Autistic Spectrum Disorder. Although most of our patients report an increase in motor tics, we have also been made aware of vocal tics increasing. Normally the tics include noises such as clearing of the thorat or high pitched noises.
Show MoreIn February this year we also cofacilitated a local support group for parents with children with Tourettes Syndrome (Beds, Herts and Bucks Parent Tourette Syndrome Group) with a view to understanding how they were coping in the pandemic. We were surprised to see that so many of the attendess had daughters with Tics and Tourettes and almost all said their daughters struggled with increase in anxiety and worsening of tics. It was interesting to hear that a number of boys with Tourettes coped better as there was lack of pressure from going to school and they were allowed more time with online gaming, although those with associated ADHD understandably struggled being confined to their homes. We would agree that the tics serve some sort of function in that it is an...
Dear Anon
Thanks fir a simple but powerful effective piece.. It shows the human factors that motivate healthcare workers, cause parents barriers and makes a powerful point:
Children are our patients, not parents .
I submitted this response below and see that it has not been published and have had no response to indicate why this would be so. My email address has changed from jamie.houston@nhs.net .
In discussion with colleagues from across Scotland, no significant increase in numbers of infants of Abusive Head Trauma have been referred to medical child protection services was noted during 2020.
My original eLetter was submitted on 08 Jul 2020:
I share concerns about the impact of Covid, and note that we have seen an increase in NAI referrals over recent months (but not AHT). Given that the number of cases in this institution was so low in previous years, I wonder if there has been a change in referral patterns with GOSH admitting more general PICU cases than usual. Has there been an impact from other PICUs in London that were caring for adults during the peak?
Any new, sudden onset of tics or "tic-like" attacks should prompt consideration of Sydenham's chorea. The typical age range for Sydenham's chorea is 5-15yrs, with females more commonly affected, especially in adolescence, which fits with the group described [https://doi.org/10.1016/j.pediatrneurol.2009.11.015].
Neuropsychiatric signs, such as emotional lability, obsessive-compulsive signs, anxiety, and attention deficit often precede the chorea but may mistakenly lead to a presumption of a functional disorder. It can be difficult for non-specialists to distinguish different kinds of involuntary movements, and this may explain why delayed diagnosis is common in Sydenham's chorea [http://www.dx.doi.org/10.1136/archdischild-2015-308693].
The importance of establishing Sydenham's chorea as a cause is of course so that appropriate treatment can be given, including antibiotics and medication to control the chorea, but also to diagnose and treat co-existing rheumatic heart disease.
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