D Tuthill

Stuttering and bilingualism

5 years were, respectively, 0.67 (0.25 to 1.9) and 0.45 (0.12 to 1.7), and 0.46 and 0.47, respectively, after adjustment for BMI. In the older age group, scar presence had a significant additional protective effect against fever: mean days of fever per month was 1.6 in children with a scar and 2.7 in those without (p = 0.04). Our findings suggest that the presence of a BCG scar is associated with immunological differences in children, and it is the presence of a scar rather than its absolute size that is of more importance. Two further studies are planned to delineate the natural evolution of the scar and to determine whether revaccination of children without a scar confers additional benefits.

E-cigarette liquid ingestion: a fast growing accidental issue in children

Electronic nicotine delivery systems (ENDS), commonly known as e-cigarettes, are products that vaporise nicotine-containing liquid.1 The emergence of e-cigarettes as an alternative to smoking tobacco products has raised many issues regarding their safe use among adult users and death has been reported occasionally from overdoses. However, there are few data regarding the risk of e-liquid exposure and its outcome in children. We explored the effects of e-liquid exposure in the paediatric population from an analysis of all telephone …

G59(P) What parents think of climbing up a milk ladder

Background Cows’ milk allergy is common, occurring in up to 2% of infants. To facilitate oral tolerance, the reintroduction of baked milk initially, followed by progressively “rawer” forms is recommended. Many “Milk Ladders” exist guiding clinicians in this including: the St Bartholomew’s (Bart’s), BSACI (British Society of Allergy and Clinical Immunology), Cardiff (REACH Team), and MAP (Milk Allergy in Primary care) ones. Aim To compare parents’ views and preferences on four milk ladders. Methods A pilot questionnaire was devised and tried for clarity; minor revisions were made. The final version had 9 questions: the first seven questions assessed aspects including layout and practicality through questions such as, ‘How clear do you think the language and layout is?’, and ‘How clear is it when to progress to the next step of the ladder?’. All of these 7 questions were scored by the parents out of a possible high score of 5, giving a possible total score of 35. Two further questions assessed parental understanding in using the ladder, through questions that asked at which stage of ladder items such as yoghurt and milk would be on. The questionnaire was distributed to Parents/Guardians of children of any age on the Wards and Outpatients Departments; each participant was given two randomly allocated ladders to assess. SPSS was used for data analysis. Results 150 questionnaires were distributed and 123 returned with 11 non-responders and 16 incomplete. Participants reviewed 252 Milk Ladders.Abstract G59(P) Table 1 Milk ladder review A one-way Welch ANOVA assessed the mean questionnaire scores with these being statistically significantly different (p < 0.0005) between the groups. The BSACI ladder scored worse than the other three ladders, whilst Cardiff scored higher than the Bart’s ladder. Conclusion Parents found all milk ladders helpful, preferring aspects such as a boxed layout and fewer stages. Overall the Cardiff Milk Ladder was found easiest to use. This preliminary study has highlighted the need for further research on Milk Ladders.

G256(P) Good news! Resuscitation knowledge is improving

Aims Early intervention in acutely unwell children reduces morbidity and mortality. Previous studies have demonstrated inadequate resuscitation knowledge in UK and New Zealand. Since the national implementation of resuscitation courses, e.g. Advanced Paediatric Life Support in 1992, studies have demonstrated improved knowledge. We aimed to ascertain the current knowledge of paediatric staff, by telephone questionnaire interviews. Methods Data on resuscitation training, position, background and level of experience was collected. A 9-part questionnaire was devised based on our previous audit of theoretical scenarios to assess resuscitation knowledge of common paediatric emergencies. These included weight and endotracheal tube estimations for children of different ages, interosseous route as a method of intravascular access and fluid resuscitation in septic shock amongst others. Answers were validated against current resuscitation guidelines and a maximum score of 17 was possible. Participants completed the questionnaire by phone or in person where possible. Results 54 paediatric staff from 8 hospitals completed the questionnaire. Overall, participants scored higher than the 1993 UK and 1998 New Zealand cohorts, bar the estimation of endotracheal tube sizing. Those with non-specialist training posts, less experience and no paediatric postgraduate qualifications had significantly lower mean scores. Conclusions Overall paediatric resuscitation knowledge has improved since the introduction of national resuscitation courses.Abstract G256(P) Table 1 % correct answers by cohortsAbstract G256(P) Table 2 Overall scores by paediatric posts, experience and post-graduate qualifications

Hypoallergenic formulae for cow's milk protein intolerance – the huge variation in prescribing practice across wales

Introduction Cows milk protein (CMP) intolerance affects 2–3% of all infants and generally resolves in the first 3 to 4 years of life. A maternal CMP free diet is indicated for those breast feeding. European guidelines state ‘Infants with cows milk protein allergy who are not breast fed should receive a dietary product with highly reduced allergenicity based on “extensively” hydrolysed protein or, in selected cases, a product based on an amino acid mixture’.1 Only about 10% of infants with CMPI require an AAF; for example, those with failure of EHF or anaphylaxis. The vast majority of these Hypoallergenic formulae are prescribed for CMPI with only a few cases for intestinal failure. Aim We wished to study prescribing practices for such formulae throughout Wales. Methods. Data on prescribing practices for Hypoallergenic Formulae throughout Wales were obtained from NHS Wales Prescribing Services for 2009 and analysed by the 22 Local Health Board areas. Results There were 26 971 prescriptions for specialty formula in Wales in 2009: lactose-free 7886, soya 5001, and 14 084 hypoallergenic formula-EHF 9442 and AAF 4642. The average percentage for the hypoallergenic formula prescriptions was EHF 67% and AAF 33%. However there was a huge variation between areas with the percentage of prescriptions for EHF ranging from 40–92% and AAF ranging from 8 to 60%. Only 1/22 areas had a prescribing rate for AAF of 10% or less. Conclusion There is an eightfold variation in the prescribing of AAF within Wales which is unlikely to be due to patient variation. European guidelines are not being followed in most areas. This may have considerable clinical and financial implications.

Feeding infants and young children: does doctor know best?: Abstract G86 Table 1

Background Dietary adequacy in infants and young children affects their current growth and health as well as their risk of adult onset diseases. Recognising the lifelong importance of nutrition, the Department of Health (DH) and Food Standards Agency (FSA) have devised guidelines for optimal nutrition in childhood. Are paediatricians aware of them? Aim To audit paediatricians’ awareness of these current national feeding guidelines for infancy and early childhood. Methods A questionnaire was devised by a multidisciplinary group to audit paediatricians’ knowledge of these national guidelines. The questions were based on: breastfeeding, introduction of cows milk, management of cows milk protein (CMP) allergy and vitamin supplementation. The guidelines recommend extensively hydrolysed protein formulas as alternatives for CMP allergy as soya milk contains phytoestrogens and can cause cross reactivity. Rice milk is to be avoided due to its arsenic content. The last question reflected the recent FSA publication on the nutritional equivalence of organic and non-organic food. Results 110 paediatricians participated (Consultants: 40, Middle grades: 27, FY1-ST3: 43). The table below shows the percentage (%) of correct answers by groups. Abstract G86 Table 1 Guideline recommendation audited Consultants Middle grades FY1-ST3 Exclusive breastfeeding for 4-6 months 88 93 67 Cows milk as main milk source after 1 year 95 81 60 Alternative “formula milk” for CMP allergy avoid soya milk as 1st line alternative avoid rice milk 80 81 84 53 59 51 Vitamin supplements for all children aged 1-4 years 28 22 28 Organic food nutritionally equal to non- 80 74 70 Conclusion DH guidelines on exclusive breastfeeding and cows milk introduction are widely acknowledged. Most recognise extensive hydrolysates as superior to soya but many are unaware about rice milks’ arsenic content. Respondents show poor awareness of vitamin supplementation advice for children. Many are informed of organic foods equivalent nutrient content.

Coeliac disease occurs in Asian children living in Wales

Coeliac disease is often thought of as a disease of Mediterranean and Irish aetiology and not occurring in the Asian community. However, previous studies have highlighted areas in northern India where coeliac disease is prevalent. In the UK coeliac disease affects approximately 1% of the population and is frequently under-diagnosed throughout all population groups. The aim of the present study was to determine the detection of coeliac disease amongst the Asian childhood population residing in mid and southeast Wales. All cases of children diagnosed as having coeliac disease between 1990 and 2006 were assessed. Cases from the whole of mid and southeast Wales were identified from histological and serological records and clinic letters. All cases were endoscopically diagnosed at the Children’s Hospital for Wales. The Registrar General’s census data were used to estimate the childhood population. A total of ninety-nine children were diagnosed as having coeliac disease (ninety-four Caucasian; five Asian). According to 2001 census data 358 846 children aged <17 years were resident within mid and southeast Wales (342 579 Caucasian children; 6664 Asian children).

The increasing diagnosis of coeliac disease since the introduction of anti-TTG testing

Coeliac disease (CD) is a lifelong intolerance to gluten that affects approximately 1% of the UK population. It remains vastly underdiagnosed, with only approximately 10% of all cases being diagnosed. Research carried out at the University Hospital of Wales between 1983 and 1998 has shown an increase in the incidence of diagnosed childhood CD in South Glamorgan following the introduction of serological testing (antigliadin and anti-endomysial) in 1990. The aim of the present study was to determine the incidence of diagnosed childhood CD within South Glamorgan between 1999 and 2007 and the effect of the introduction of anti-tissue transglutaminase (antitTG) testing in 2004. CD incidence rates were calculated for cases diagnosed in the area of South Glamorgan between 1999 and 2007. Mean incidence rates were calculated for each 4-year interval. Population information was taken from the Registrar General’s mid-year estimates of childhood population residing in South Glamorgan. A total of fifty children aged <16 years were identified as residing in the area of Cardiff and the Vale of Glamorgan; thirty-six were diagnosed between 1999 and 2006. The total childhood population decreased slightly from 96 553 in 1999 to 89 630 in 2006.