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clippings

Indian Pediatr 2012;49: 934

Clippings


Gaurav Gupta

Email: drgaurav@charakclinics.com

 

Gut feeling better predictor of serious infection than clinical examination (BMJ 2012;345:e6144).


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’.  


Background TV a threat to kids (Pediatrics 2012;130:1)


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.

Probiotics for babies may not fight allergies later (J Allergy Clin Immunol 2012, DOI: 10.1016/j.jaci.2012.07.018)


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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