Simon Lenton

Therapeutic clowning in paediatric practice

Over the past 30 years, there has been much research into the health benefits of humour and laughter. Although often viewed very positively, rigorous evaluation of the therapeutic effect of clowning is complex. Clowning is a multi-modal intervention, which may have an impact on medical conditions, procedures, family functioning and health care teams. Clowns help children to adapt to their hospital surroundings and can distract from, and demystify, painful or frightening procedures through ‘doses of fun’ to complement traditional clinical interventions. This paper provides a review of the paediatric literature and reveals studies looking at the effect of clown interventions on various practical procedures and individual medical conditions, and the effects of clowning within clinical teams.

Sustainable development, human induced global climate change, and the health of children

In this short article we introduce the concept of sustainable development and its significance to child health using climate change as an example. Environmental issues, in the long term, are as important to childrens health as smoking, accidents, and poor parenting are in the short term, yet have hitherto had little publicity or discussion within paediatric circles. What is happening to childrens health in the world? In the developed world cardiovascular disease, diabetes, cancer, and dental disease are all on the increase, while in the developing world malnutrition, infectious disease, and injuries are still rife. At present, inequalities of health and wealth—both within and between nations—appear to be increasing,1 with an adverse impact on childrens health. The Ottawa charter for health promotion states that the fundamental conditions for health are peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity.2 The evidence for the connections among the environment, the economy, and social change are compelling and any change within one inevitably affects the others. For the first time in history, the economic activity of the human population has become so vast that it is beginning to change the gaseous composition of the lower and middle atmospheres. This is now called human induced global climate change (HIGCC), which in turn will have a significant impact on a future generation of children. There seems no doubt that climate change is a genuine phenomenon.3 The main cause of climate change is the greenhouse effect, which is related to the massive increase in use of fossil fuels with consequent liberation of CO2 into the atmosphere. Before man started burning oil and coal and gas, the atmosphere contained about 280 parts CO2 per million—now the figure is about 360 ppm. Methane concentrations are now more than …

Improving the practice of child death overview panels: a paediatric perspective

Objective In England, every death in childhood is reviewed by a local multidisciplinary Child Death Overview Panel (CDOP) with the intention of understanding causation and implementing interventions to reduce future deaths. This study aimed to establish how well panels work from the perspective of the paediatricians involved and to ascertain whether they deliver good value and identify areas for improvement. Design A questionnaire was sent to every CDOP paediatrician in the country (n=93). Questions focused on the quality of CDOP case discussions as well as examples of effective and significant recommendations. Responses were analysed using simple quantitative and qualitative methods. Results 84/93 (90%) of the paediatricians responded. Among the respondents, 60 (71%) believe that investment in CDOPs is offering good value, 73 (87%) feel that case discussions are rigorous and consistent and over 90% believe that the correct issues are emerging from discussions. However, responders noted many areas for improvement: 40 (48%) suggested devolving the discussion of specialist deaths (eg, neonates) to hospital-based review meetings or holding themed meetings with invited specialists, 11 (13%) suggested filtering out cases where learning is unlikely before full CDOP meetings and 13 (15%) called for national integration and analysis of data. Conclusions In this time of economic austerity it is vital that the CDOPs add value to the invested resources. Although CDOP paediatricians feel that panels are working well, there is scope for improvement through enhancing relationships with commissioning bodies, aggregate review and analysis of CDOP data at a national level and consideration of specialist and/or network review of certain categories of deaths such as cardiac surgery, oncology and neonates.

Public health approaches to safer cycling for children based on developmental and physiological readiness: implications for practice

Introduction Cyclists have a high mortality and morbidity per mile travelled compared with car occupants, a figure that is likely to increase if campaigns to increase active travel are successful. Concerns about safety is the leading factor limiting cycling for children. Objective This review brings together a paediatric perspective based on the developmental readiness of children and young people and a public health approach to reducing injuries, to produce a practical agenda for improving the safety of cycling for children. Method Selective literature review. Results While most sports realise the importance of practice and training to create mastery of the game, similar thinking has not been consistently applied to cycling proficiency, so many children do not have an opportunity to master cycling before riding on the roads. Conclusions The aim should be to minimise road traffic injuries involving children and young people in ways that create cobenefits for other members of society, increasing opportunities for active travel, reducing air pollution, creating more green space to play and reducing dependence on motor vehicles. Changes in legislation are required now to enable younger children to cycle on pavements while learning to ride and improvements in road design to separate cyclists from motor vehicles especially routes to school for older children.

Cross-reporting of animal abuse

SIR, — We welcome the news item entitled ‘Call for cross-reporting of animal abuse and domestic violence’( VR , May 26, 2007, vol 160, p 712). In the absence of good epidemiological studies demonstrating the degree of overlap between domestic violence, child abuse and animal abuse it is

Changes in guidance for prescription of controlled drugs

The Shipman inquiry concluded that there were several shortcomings in the management system for controlled drugs (http://www.the-shipman-inquiry.org.uk/home.asp). As a result, changes to prescribing and dispensing of controlled drugs are being introduced. We are concerned that the implications, and possibly unintended consequences, of the new guidance have not been widely recognised or publicised to paediatricians and child psychiatrists. We first became aware of changes to prescribing policy after several phone calls …