Charles Essex

Hyperbaric oxygen and cerebral palsy: no proven benefit and potentially harmful

Any good paediatrician will point out to the parents of a child with cerebral palsy (CP) that their childs brain damage is fixed and cannot be altered. This is not being over pessimistic but simply honest. The paediatrician then suggests a variety of treatments/therapies aimed at maximizing the childs potential. However, it is understandable if parents still go on to seek treatments which they hope can alter their childs condition. Such treatments include conductive education, cranial osteopathy, and hyperbaric oxygen (HBO) – to name a few. This article seeks to review available information on the use of HBO in the treatment of children with CP.

Children have rights to medicines

Editor—If a medicine was restricted to certain racial groups or to one sex on the basis of information from studies limited to these groups there would be an understandable outcry. Yet one group of the population—children—is denied access to treatment on this basis. This unacceptable situation persists because children have no vote, no spending power, and little voice. John Wardens article on the report by the …

The death of childhood

A series of three programmes on Channel 4 recently tackled the emotive subject of child abuse. Dr Charles Essex reflects on whether anything has been learnt Sometimes a single word can evoke a memory for a whole nation–Thalidomide, Dunblane, Cleveland. But are those memories correct? In 1987 child sexual abuse seemed to have reached epidemic proportions in a small part of the north east of England. The paediatricians and social workers seemed to be zealots–children who turned up at hospital with minor unrelated symptoms were diagnosed as having been sexually abused, with reflex anal dilatation as the sole criterion, and were taken into care. Death of Childhood examined two high profile situations of child …

Type 2 tracheal agenesis without tracheoesophageal fistula

Tracheal agenesis is a potentially lethal congenital anomaly first described by Payne in 1900. It can occur in isolation or in association with tracheoesophageal (TO) or bronchoesophageal (BO) fistula, cardiovascular anomalies, limb deformities, vertebral anomalies and gastrointestinal tract abnormalities. There are 47 reported cases of tracheal agenesis up to 1989; 45 of these were associated with TO fistula. Another 15 cases of tracheal agenesis have been reported since then, and all have been associated with TO fistula. We report only the third case of type 2 tracheal agenesis without TO fistula.

Developmental delay or failure to arrive

limited by puberty. Another similarity is the cerebral immaturity suggested by electroencephalography. As some children with ADHD, without seizures, degenerative conditions, or focal neurologic signs show abnormalities such as Rolandic spikes in a routine EEGs, the inclusion of EEGs in ADHD diagnostics seem essential to the identification of this subgroup. The EEG is the indicator of the need for specific testing, further evaluation and, perhaps, adequate therapy. Not performing routine EEG could result in the oversight of subclinical epileptic discharges in a considerable number of children with ADHD. We suggest that the update of practice parameters for the assessment and treatment of children with ADHD until puberty should include EEG, regardless of the lack of a prior history of overt seizures or other obvious neurological conditions.

Consultants could give patients a letter summarising their consultation.

EDITOR—Burkey et al state that patients in outpatient clinics value a clear message when they are being discharged, being given written and verbal information about their condition, and knowing that their general practitioner has this information.1 I suggest that one way to address these is to write to the patient or the parents. After every consultation I write only one letter, to the parent(s), with a copy to other parties. This includes (examples in brackets) whether I have discharged the …

Problems with sharing clinical data in routine referral letters

Adams’s article raises two important problems.1 Firstly, in general terms, the requirement for clinicians from all fields to offer patients copies of letters written about them to other health professionals was stated in the NHS Plan in 2000, to be implemented in April 2004.2 The experience of Adam’s patients shows that 10 …

Head circumference needs to be measured

SIR–Murray and Jackson’s genetics update fails to mention the three most important prerequisites of microcephaly. First, the head circumference needs to be measured. Second, it needs to be measured accurately. Third, it needs to be plotted accurately. Children’s heights and weights are often measured, but by comparison head circumferences are the poor relation. Head circumferences are notoriously badly measured and badly plotted. I frequently test students and trainees in my clinic by getting them to measure a child’s head circumferences. Most have never done it before; almost none have been taught how to do it. I see head circumference measurements recorded in the hospital records that would indicate that the infant’s head had shrunk if they were correct compared to previous measurements. A colleague and I did an audit of children on the waiting list for brain magnetic resonance imaging (MRI). Half of them had not had their head circumference measured. Hopefully, we encourage trainees and students that the principles of making a diagnosis are ‘history and examination’. Yet an MRI costing, say £1000 (including anaesthetic and interpretation by a neuroradiologist), was requested before using a £1.50 tape measure. The authors say that microcephaly is defined as ‘... a significant decrease in head circumference.’ Surely the head circumference does not decrease, rather it fails to grow at the normal rate and so falls away significantly from its original position on the centile chart.

Clinician managers don't want to know.

I do not believe the NHS will change in my lifetime, despite the report into Mid Staffordshire Trust.1 The surprise should be how long the problem has taken to come to light and that only this trust and …

Unofficial Secrets: Child Sexual Abuse: the Cleveland Case and Child Sexual Abuse: Whose Problem? Reflections from Cleveland

Mention Cleveland, and doctors of a certain generation will probably frown and ask, “Wasn’t that where paediatricians overdiagnosed child abuse?” Doctors with an interest in child protection, which should include all doctors but unfortunately doesn’t even include all paediatricians, will know that the vast majority of children in Cleveland who were taken into care in the summer of 1987 had probably been sexually abused. So why the perception that the paediatricians got it wrong? They were not helped by a public inquiry and report chaired by Elizabeth Butler-Sloss, who later remarked, on whether the children were abused, “It was not my job to find out.” Fortunately the journalist Beatrix Campbell did try to find out. It …