Sunday, June 17, 2007

Pediatric Grand Rounds 2:5



Welcome to volume two, number five of Pediatric Grand Rounds. The order of presentation is not by rank but follows a logical thread, trying to give every post its best neighbourhood possible. Last is certainly not least. But of course I begin with my favorite.

Intensive emotions

This editor's pick has not been picked but has picked me. A strong piece of writing, flowing directly from heart, unbraked by case shift key, after a long sleepless night shift in a pediatric intensive care unit. Sasha Cornell at Girl MD tells us how it feels living the myth of sisyphus in a sad reality of dying children.

The same sisyphus feelings, in a setting that could not be more different, are evoked by Tara C. Smith at Aetiology, telling us that Sierra Leone takes one step forward banning marriage at age eleven ... and a half step back in still allowing female genital mutilation in girls what often causes death by sepsis. More than half a step back, I sisyphously would say.

In face of such drama, our problems here seem to be luxury: Stress caused by too much work and by kids who refuse to comply. Stacey B. Stryer at her Revolution Health blog tells us why parents often behave like kids and what can be done against adult temper tantrums.

For our next section we take a step back to intensive care...

Starting life too early

Neonatal Doc has found himself in the midst of the heat fueled by advocates of all kind with fixed opinions about resuscitation of preemies with very low gestational age and with Down Syndrome. The answers to such questions cannot be easy, and there are still the parents who have their own opinions.

Sextuplets have a very difficult start, and their chance of having a normal life depends mainly on gestational age and weight at birth. Judy at Tiggers don't Jump gives an accurate but chilling clinical assessment of the prospects of two sets of sextuplets that were born recently.

Parents of preemies are often told not to worry and that all will be just normal. Stacy of The Preemie Experiment, in response to a reader question, says that some neonatologists and the mass media whitewash the facts and that parents should be told the inconvenient truth about the consequences of prematurity.

Now let's turn to the nutrition that is supposed to be the most natural for newborns...

Breastfeeding

We still are at intensive care, though. Laura at Adventures in Juggling is a nurse in such a unit, and she constantly needs to be all things to all patients and their families. But then suddenly she discovers that she is two in one simultaneously: a breastfeeding saboteur and a breastfeeding tyrant!

Even with a baby born on term there may be problems. Christina at A Mommy Story tells us about the double frustration of having a first baby who refused the breast and a second one who never can get enough milk.

The Lactivist presents a carnival about the importance of fathers in breastfeeding and Black Breastfeeding Blog addresses the fact that black mothers get less accurate advice for breastfeeding than white mothers.

Breastfeeding makes babies grow, they become toddlers, then kids, and then ...

Growing older

Even chronically ill children, thanks to a better medicine, survive more and more and reach adult age. As positive as this is, it raises new problems, as Clark Bartram at Unintelligent Design points out: They grow out of the pediatric domain where they have got best care, and this transitioning care makes them lose what had worked best for them. A serious downside of medical success.

In coming of age, ill and healthy makes just one difference. Gender makes another, and not a small one. Boys do it their own way: Men do not cry and seeing a doctor is sissy. Nancy L. Brown at Healthline discusses why teen boys are reluctant to seek healthcare and what can be done about it.

And girls do it their way, too. Sandy at Junkfood Science, as ever, has fresh food for critical thinking. Public health messages, in her opinion, do more harm than benefit when they hit the wrong target. She links to a piece with shocking pictures of girls misled towards anorexia. Warning: Visiting pro ano sites puts you at risk of an eating disorder, as far as I remember a study. This said: Click by and make your own opinion!

Another girl issue is brought up by Signout at Scienceblogs: Children having children. Abortion sucks - I admit this title made me hesitate at first because I do not agree with most people who publicly claim that abortion sucks even if I personally find that abortion sucks. But then I realized that it was posted at one of the Scienceblogs (on the unintelligent design side) and I was not surprised to be told things that suck even more than abortion.

We are already in the midst of our next section, and we got more...

Hot topics

The Autism Omnibus hearings have begun (background: the Thiomersal controversy), a flood of legal cases of families blaming vaccines to have caused autism in their children. Orac at Respectful Insolence gives an excellent and comprehensive overview of this issue, warning from a tsunami of pseudo-science spilling over the proven facts: When you don't have scientific evidence, tug on the heartstrings!

Treatment Online, in Perspectives on Autism «Epidemic», points out that the definitions of this disease have expanded, thus increasing the number of cases by (over)diagnosis.

Book author Arthur Allen has noticed that the anti vaccination zeitgeist has reached Hollywood meanwhile, spreading mercury fears even more.

When quackery issues hit the mass media, other topics that ought to be hot are in danger of being forgotten. Primary immunodeficiency is such a case, presented by Bertalan Mesko at Scienceroll. He makes himself an advocate of giving babies a chance to survive. An effort that is worth being supported.

Neurofibromatosis, a rare tumor in children, is another such case. Walter at Highlight Health reviews a conference that just has been held about the subject. The sad story is that the funds for research against this disease have been heavily cut. If you want this to be changed, feel free to click the donation link at the bottom of Neurofibromatosis and The Children's Tumor Foundation.

In hot debates, the two dimensions of our next section often intermingle...

Fantasy and reality

Chris Chatham at Developing Intelligence presents fascinating research outcomes about the blur between fantasy and reality in children. The crucial points are: What did I say? What did I hear? What did I do? What did I watch others to do? Research tells us what is prone to be intermingled (and what is not) when we recall our childhood.

Expectations are another important domain of fantasy, and Bryan at Parenting Solved shows us the outcome of a human experiment that takes place all the time in his clinic: It depends on parental expectations, more than on reality, when parents say baby is better or not. And often mummy and daddy do not agree.

Life should not always be hard and serious. So enjoy our next section...

Quirky research

Let me present you two more favorites of mine. Both take up an issue that I have covered in my own blog - laughter (in June) and robot doll (in May), and it is interesting to see how a different angle of view or new sources add more knowledge and insight to a subject.

Shinga at Breath Spa for Kids wonders if you just can make your kids giggle to get them rid of eczema. This is no joke! She presents outcomes of Japanese studies that seem to support such a view, but in her opinion the studies are more fun than the outcomes. What she finds no fun at all is the poor provision of allergy services in her country. Read what she has to tell us about Laughter, Children, Babies and Eczema.

I just have learned that Robota, the Swiss robot doll, has got a British pal called Kaspar. Medgadget presents this little Pinocchio-like robot that is designed to teach autistic children social skills. Medgadget is quite optimistic about the benefits of such a robot. Just click by and form your own opinion!

Dr. Rob at Musings of a Distractible Mind comments on a toddler robot that has been developed by - oh, again these funny Japanese - scientists. Its purpose: a better understanding of human toddlers. Should we laugh or should we cry? Don't miss Rob's witty comments.

Now it is time to get back to the real purpose of medical science. This brings us to the last, small but very important section...

Health tips

Dr. Steven Parker at WebMD blog gives parents top 10 tips for a safe and healthy summer. Number ten I like most: Give your kids ice-cream. Check out if you know the nine others, they are very important!

But be aware that some health tips conflict with others. Dr. Gwenn at Pediatrics Now muses on the relative risks and possible shortcomings of various summer tips for children in no good deed goes unpunished. Her very thoughtful post is a must read for all who care for kids' health and safety.

Acknowledgements

This edition has been made possible by Clark and Shinga. What they do for Pediatric Grand Rounds is really great and cannot be valued highly enough. I am also indebted to all who submitted posts and, on behalf of our next host, to all who regularly submit to PGR. And thank you all, you members of the PGR family who link to PGR editions where your post has been included, and my special thanks go to the Friends of Pediatric Grand Rounds who link to us without having been included - too numerous to bee mentioned here.

This concludes PGR 2:5. It has been a pleasure to read and compile all these great posts. I hope you enjoyed my presentation. Look up the hosting schedule for future editions of Pediatric Grand Rounds. PGR 2:6 will be hosted by Shinga July 1, 2007 (submit here).

Photo credit: flickr.com/photos/o_caritas/512838893/

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