135 e-Letters

  • Re:A different view of studies with deferred consent
    Kerry Woolfall

    The author makes an interesting point about the current legislation and automatic inclusion of data in trials where prior informed consent is not possible.

    EU legislation focuses on when research without prior consent (RWPC) can occur and the need to obtain consent for continued participation, but does not cover the options for use of data collected prior to consent. The exception to this is where consent is not pr...

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  • A different view of studies with deferred consent
    Anthony M Kaiser

    Thank you for outlining so clearly the current basis for "deferred consent" studies and suggesting good practice in dealing with the issues it raises. Unfortunately I believe that the current practice is the worst of possible worlds: not only do we submit vulnerable subjects to interventions without the expression of their/their parents' autonomy (ie consent), but also we risk losing any data obtained because we retrospect...

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  • Re: Toe walking in infancy
    Arnab Seal

    We agree that baby walkers and door suspenders can be associated with transient toe walking and delayed walking, which usually would correct spontaneously relatively quickly once the children stop using the device. The use of such devices should be strongly discouraged as part of normal parenting practice. Enquiry regarding inappropriate use of either of these devices in a toddler who has tip toe gait on independent or sup...

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  • Not all petechial rashes require admission.
    Robin D Marlow

    This was succinct and helpful article. However as a paediatric emergency doctor I would query the phrase "There is still a risk of meningococcal disease even when blood tests are normal; therefore, admit all children for 4-6 hours with hourly observations". It may seem pedantic, but this is not what NICE says. The pathway states "Assess clinical progress (vital signs) and carry out observations at least hourly over t...

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  • Toe walking in infancy
    Siddika S. Yalcin
    I read with interest Sivaramakrishnan et al's structured approach to a child with toe walking [1]. Various levels of contexts such as parenting, maternal education, poverty and social networks interact with each other and with genetic expression to create long-lasting consequences for development [2,3]. Sometimes, single or isolated negative environmental factors may make a major contribution to developmental problems with most n...
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  • The Wiggle Sign
    Stephen M Mullen

    Dear Editor, We were interested to read the article by Parige and Power entitled, 'A chest x-ray that doesn't look right'. (Archives of Disease in Childhood - Education and Practice Edition 2014; 99: 72). This article described extravasation of TPN from a PICC line resulting in a pleural effusion. Our attention was drawn to the initial 'check x-ray' which identified what we refer to locally as the "wiggle sign". The "wigg...

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  • There is an association between herpes simplex encephalitis and anti-NMDAR antibodies
    Rebecca A. Brooks

    We read with interest the review by Le Doare et al. discussing the presentation and management of neonatal and childhood herpes simplex encephalitis (HSE). The article nicely outlines the importance of timely treatment of this potentially catastrophic infection. The authors have provided practical advice that is applicable for many of the challenges that clinicians might be faced with.

    Although they mentioned...

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  • Properly randomised trial of tongue tie division is needed!
    Nigel Mercer

    The paper cites various studies but in only one is the placebo effect studied it seems and it found that almost half the mothers said that feeding was improved. The inference is that almost 50% of the treated children did not require the procedure and so have been subjected to a surgical procedure on one of the most sensitive organs in the body un- necessarily.

    Until the placebo effect is fully investigated in t...

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  • Prenatal and neonatal paracetamol (acetaminophen) may increase the risk for ADHD and asthma.
    Inge Axelsson

    Dr. Catherine Williams argues against and Dr. Damian Roland for using antipyretics in feverish children (Arch Dis Child Educ Pract Ed 2014;99:158-159) but they do not mention that paracetamol may be a risk factor for ADHD and asthma.

    In the last two years, an animal study1, two cohort studies2 3, and an ecologic study4 have presented evidence for an increased risk of disturbed neuropsychiatric development after...

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  • Re: Viable alternatives to Toddler Taming
    Deborah Shanks

    Dear Ellen,

    Thank you for your letter and the many alternative recommended books, it is a fascinating topic. My opinions were mainly personal and parenting styles are a personal choice and differ greatly. I would however wish to reply firstly to your comments on the 'controlled crying' technique. This is not 'prolonged, unrelieved stress', it is a well researched technique of managing sleep behaviours where the...

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