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Indian Pediatr 2012;49: 934
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Clippings |
Gaurav Gupta
Email:
drgaurav@charakclinics.com
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Gut feeling better predictor of serious infection than clinical
examination (BMJ 2012;345:e6144).
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A gut feeling that a child is sicker than he or she appears can be an
even more powerful predictor of serious infection than the clinical
exam, according to an observational study of 3890 children published
September 25 in the BMJ. In the Belgian study, 3369 children and
adolescents aged 0 to 16 years were clinically assessed as having a
nonsevere illness on the basis of a clinical impression that included
history, observation, and clinical examination. However, 6 children
(0.2%) were subsequently admitted to the hospital for 24 hours or longer
with a serious infection, such as pneumonia, pyelonephritis, viral or
bacterial meningitis, or sepsis. Acting on their gut feeling had the
potential to prevent two of the six cases being missed. But that would
also have come at the cost of 44 false alarms. Intuition that something
was wrong despite the clinical assessment of non-severe illness
substantially increased the risk of serious illness, they report. The
clinical sign most strongly associated with gut feeling was a history of
convulsions. The children’s appearance, pattern of breathing, and level
of drowsiness were also significant but were less likely to provoke a
gut feeling than parental concern. Weight loss and urinary symptoms were
also independently associated with gut feeling. Less experienced doctors
were more likely to experience a gut feeling than more experienced
doctors, noted the authors. The diagnostic power of gut feeling,
however, was no better in experienced physicians than in those without
experience. The analyses in the study may not thoroughly explain what
constitutes a gut feeling and how it may vary from one clinician to
another, note the authors. Although the nuances of gut feelings need to
be worked out in future research, they should not be ignored in clinical
settings, the authors write. Having a gut feeling that something is
wrong should make three things mandatory: the carrying out of a full and
careful examination, seeking advice from more experienced clinicians…,
and providing the parent with carefully worded advice to act as a
‘safety net’.
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Background TV a threat to kids (Pediatrics 2012;130:1)
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According to the first national estimate of background television
exposure, young children in the US spend nearly as much time around a
switched-on television as they do in school! Between eight months and
eight years, kids spend an average of 232 minutes a day with the TV
droning on in the background, researchers found. Add to that the 80
minutes of active watching that previous studies have found, and there’s
a total of just over five hours of daily interaction with the electronic
babysitter. The results are based on nationally representative telephone
interviews with close to 1500 parents, who reported their child’s
activities over the past 24 hours and whether there was a TV on in the
background. The effects of screen time on developing brains and minds
are not well understood, but researchers say concerning findings are
emerging. Children spend less time playing with friends and interacting
with parents when a TV is clamouring in the background than when there
is no such distraction. For infants and toddlers, studies suggest the
din from a TV may slow down language development. They may catch up, but
it’s a concern that requires more research.
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Probiotics for babies may not fight allergies
later (J Allergy Clin Immunol 2012, DOI:
10.1016/j.jaci.2012.07.018)
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Kindergartners who were given probiotics supplements as infants
were no less likely to suffer from allergies than other kids in
a new study from Australia. Based on what’s known so far, it may
be that only certain probiotics are helpful for certain kids -
but even then, the benefit seems very modest. The 123 kids in
this study, were part of a clinical trial as infants, when
researchers randomly assigned them to take a supplement
containing Lactobacillus acidophilus or a placebo every
day for the first six months of life. All of the babies were
considered to be at increased risk of allergies because their
mothers suffered from them. This latest report finds no effects
at the age of five. Of 66 kids who had received the probiotic in
infancy, 44% had some type of allergy or asthma, compared with
38% of 57 kids who got the placebo. The findings are somewhat
surprising, because some studies have found that probiotics may
help curb certain kids’ long-term risk of eczema. But the bottom
line is that even in the positive studies, the benefits of
probiotics seem small.
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