BMJ  2007;334 (9 June), doi:10.1136/bmj.39237.605150.47

Editor's Choice

Editor's choice

About children . . . and more

I am never surprised by what children can learn, nor am I surprised when they perform better than or as well as adults. This week Ian Jones and colleagues show that children aged 13-14 years can compress the chest (as part of acquiring resuscitation skills) as well as adults (doi: 10.1136/bmj.39167.459028.DE). Children aged 9-10 were not able to compress the chest sufficiently strongly, but they could position their hands correctly and press at the right rate. Optimistic about their results, the researchers say that the younger children could show adults the technique even if they can't do it themselves. But they do admit that emotional factors may affect the rescuer's performance, as would the need to provide rescue breaths. Lives would be saved, no doubt, but I worry about the effect that a dramatic episode of engaging in successful or unsuccessful real life cardiopulmonary resuscitation could have on a child's emotions.

Unfortunately not all children are able to learn new skills as quickly as others. For example, although most children with epilepsy have no learning difficulties, some do. Some of the difficulty is due to the effects of antiepileptic drugs on behaviour and cognition. In particular, phenobarbital has been much maligned and is hardly ever used in developed countries. However, its use is widespread in developing countries because it is cheap and effective, and WHO has recommended it for many years. Some experts believe that children in the developing world (be they South Asian, African, or Chinese) are immune to its side effects on behaviour and cognition or are not bothered by them. These experts will be pleased by a trial from Bangladesh that shows that the behavioural side effects of phenobarbital are no worse than those of carbamazepine (doi: 10.1136/bmj.39022.436389.BE).

This trial has limitations, as Emilio Perucca points out in an editorial (doi: 10.1136/bmj.39065.460208.80). It uses an open label design, does not have sufficient power to detect potentially important differences in seizure outcome and behavioural problems, and does not report on drug concentrations (a useful measure of compliance). More children were lost to follow-up in the phenobarbital group, and this group had fewer girls—in whom behavioural problems were common. The controversy about phenobarbital will go on, while I wait for a convincing explanation from neurologists in the developed world who recommend its use in the developing world but will not use it on their own patients.

This week's issue contains yet more about children. Parents of children with congenital heart disease will be able to compare the performance of specialist children's heart centres in the United Kingdom before making a decision on treatment (doi: 10.1136/bmj.39234.662384.DB). Pfizer has to face criminal charges in Nigeria over a trial it conducted on children with meningitis (doi: 10.1136/bmj.39237.658171.DB). And you could learn more about using radioimaging to investigate hip pain in a well child (doi: 10.1136/bmj.39188.515741.47).

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Relevant Articles

Treatment of epilepsy in developing countries

Emilio Perucca
BMJ 2007 334: 1175-1176. [Extract] [Full Text] [PDF]

Nigeria files criminal charges against Pfizer

Jeanne Lenzer
BMJ 2007 334: 1181. [Extract] [Full Text] [PDF]

Website gives survival rates for congenital heart disease centres

Andrew Cole
BMJ 2007 334: 1187. [Extract] [Full Text] [PDF]

Investigating hip pain in a well child

A Gough-Palmer and K McHugh
BMJ 2007 334: 1216-1217. [Extract] [Full Text] [PDF]

Side effects of phenobarbital and carbamazepine in childhood epilepsy: randomised controlled trial

Selina H Banu, Moshrat Jahan, Umme Kulsum Koli, Saadia Ferdousi, Naila Z Khan, and Brian Neville
BMJ 2007 334: 1207. [Abstract] [Full Text] [PDF]

At what age can schoolchildren provide effective chest compressions? An observational study from the Heartstart UK schools training programme

Ian Jones, Richard Whitfield, Michael Colquhoun, Douglas Chamberlain, Norman Vetter, and Robert Newcombe
BMJ 2007 334: 1201. [Abstract] [Full Text] [PDF]

Rapid Responses:

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Is modern medical science immoral?

BM Hegde
bmj.com, 9 Jun 2007 [Full text]

Depth and width of analysis

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