Which is the best drug today to use in children in status epilepticus after intravenous benzodiazepine? The EcLiPSE trial, conducted in 30 Emergency Departments in the UK, has tried to answer this question. Children (age 6 mo to 18 y) with status epilepticus were randomly injected (intravenously) with either 40 mg/kg of levetiracetam over 5 minutes (n=152) or 20 mg/kg phenytoin over 20 minutes (n=134). Levetiracetam was effective in aborting convulsive status in 70% and phenytoin in 64%. One child had life-threatening adverse effect (hypotension, increase in focal seizure, and decreased consciousness) after phenytoin. Agitation was observed in 8% of children who received levetiracetam and 3% of those who received phenytoin.

This trial is the first adequately-powered randomized controlled trial to compare two second line drugs in status epilepticus. However, it was an open label trial since blinding in a pragmatic clinical setting was considered difficult. Further only clinical impression of cessation of convulsive status was taken as an end-point, without EEG confirmation. Within these limitations, it appears that intravenous levetiracetam is non-inferior to phenytoin as a second-line agent after benzodiazepene in pediatric status epilepticus. (Lancet. 2019 Apr 17. doi: 10.1016/S0140-6736(19)30724-X)

Leeds in the UK has become the first in the country to note a downswing in obesity rates in children. Over 4 years, the rates of obesity fell from 11.5% to 10.5% in 2016-17. In the rest of the UK, rates hover around 28%, and all cities have shown either static or rising trends.

How did they do it? The credit probably goes to a charity called HENRY (Health Exercise Nutrition for the Really Young). Since 2008, they have been running training programs for parents and professionals who handle child care centers and nurseries. Parents were trained in authoritative and not authoritarian parenting. Authoritarian parents make children follow strict rules. Permissive parents allow children to call all the shots. Authoritative parents have clear limits but give children healthy choices and allow some decision-making by them.

The classes encouraged healthy snacking, eating as a family, and cooking food from scratch. There was also an active local campaign to reduce sugar and increase activities, especially through dance. (BBC News 1 May 2019)

A novel method to treat Attention deficit hyperactivity disorder (ADHD) has been recently approved by the FDA. This device is a trigeminal nerve stimulator that is placed attached via a wire to a patch placed over the eyebrow. It was approved after a trial in children between 7-14 years in whom it was administered nightly for 8 weeks. Significant improvements were seen on the ADHD-IV Rating Scale (P<0.0001) and parent-completed Conners Global Index (P<0.0001), as well as the majority of scales on the parent-completed Behavior Rating Inventory of Executive Functioning (BRIEF). Improvements were also noted on the computerized Attention Network Task (ANT) Incongruent Reaction Time (P=0.006), suggesting that trigeminal nerve stimulation has positive effects on response inhibition.

While the exact mechanism of its action is not yet known, neuroimaging studies have shown that electronic trigeminal nerve stimulation increases activity in the brain regions that are known to be important in regulating attention, emotion and behavior. It may take upto 4 weeks for effects to become obvious. (FDA News 19 April 2019; https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-first-medical-device-treatment-adhd)

Helicopter parents are those who hover over their children to make sure nothing goes wrong. In the US, there is currently a debate as to the problems and benefits of this kind of overparenting. Examples of helicopter parenting include a mother who won’t let her 17-year-old son catch the bus to school on his own, constantly badgering the school to make sure their child is in a specific class the following year, parents rushing to school to deliver items such as forgotten lunches or assignments, and parents believing that, regardless of effort, their child must be rewarded. While this excessive monitoring of children is rampant in India, it is relatively new in the US. Excessive parenting is believed to reduce self-esteem and a lower ability to show leadership, especially in adolescents.

However, a recent book "Love, Money and Parenting: How Economics Explains the Way We Raise Our Kids" by economists　Matthias Doepke　of Northwestern University and　Fabrizio Zilibotti　of Yale argues that it is the difficult job market that has resulted in this kind of intensive parenting as these children are more likely to get a college degree or stable job.