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Logo of archdischArchives of Disease in ChildhoodVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Arch Dis Child. 2007 April; 92(Suppl1): A75–A79.
PMCID: PMC2066114


Child public health

G/THUR/PUB1 How should we tackle obesity in the really young?

L. Edmunds1, B. Mulley2, M. Rudolf2. 1University of Teesside, Middlesbrough, UK; 2Leeds Primary Care Trust, Leeds, UK

AimsTo obtain the views of health visitors and mothers of obese infants in order to inform the development of interventions targeting obesity in infancy.

MethodsThree focus groups with health visitors (n = 39) and nine in‐depth interviews with a purposeful sample of mothers (n = 8) were conducted in Northern England. Analyses were iterative and thematic, using a Grounded Theory approach. Triangulation within findings was sought.

ResultsHealth visitors commented on how few obese children they saw in practice, but were very concerned about not deterring parents when cases arose. They perceived excess weight as the converse of failure to thrive, and thought accurate weaning leaflets, clear referral guidelines, a de‐stigmatising approach, clarity on different practices and best practices and resources would aid them. Mothers felt they could identify when their children gained excessive weight and were more concerned when the child had other health issues. Mothers considered health visitors lacked understanding of the complexity of rearing an obese child. They wanted better listening and communication skills with an appropriate balance between being empathic and practical help without being patronising. Both groups felt that intervention should occur beyond 3 months of age and growth charts were a good starting point for exploring the problem.

ConclusionsHealth visitors and mothers identified a clear need for professionals to receive training and resources to tackle obesity in the very young. The perceived needs were different with some agreement on when and how.

G/THUR/PUB2 Further evidence for acquired undescended testicle in the UK and its incompatibility with current recommendations in the Hall Report

J. Martin. Child Health Department. Herefordshire Primary Care NHS Trust, Hereford, UK

AimThe 4th edition of the Hall Report (Hall DMB. Health for all children. Oxford: Oxford University Press; 2003:167) does not expect undiagnosed undescended testicles at the age of 5 years or subsequently to be seen if its advice for diagnosis is carried out. We examine whether that recommendation can be relied upon.

MethodA retrospective audit was performed of 228 boys who underwent orchidopexy between January 1992 and December 2003 at a hospital in the UK. During that time, 10 048 boys were born at the hospital. Child health records, hospital records and some GP records were used.

ResultsA total of 103 boys (45%) were treated before their 5th birthday and 125 (55%) were treated after the age of 5; 93 orchidopexies were performed as a result of diagnosis made at birth or 6 weeks, but 83 were undertaken in boys documented as having scrotally placed testes both at birth and 6 weeks. A further 21 had documentation for scrotal testes either at birth (14) or at 6 weeks (7) but not both. The records of the remaining 31 are either missing or did not yield the information required largely because the Parent Held Child Record was introduced after their time. The literature was reviewed, and the results found to concur with those of other papers, in particular with a recent study from the Netherlands, which led to a new classification of undescended testis drawing attention to “acquired undescended testicle”. The progressive nature of this entity was seen from review of the case notes.

ConclusionThe natural history of acquired undescended testis means that recommendations as set out in the Hall Report “that no further check after six weeks need be made if the testes are ‘well down' at that stage” cannot be successful.

G/THUR/PUB3 Increasing incidence of breastfeeding malnutrition in neonates: new challenge for community care

V. Kudumula, Y. Akinsoji, T. Solola, M. Suresh‐Babu, M. Lewins. Lincoln County Hospital, Lincoln, UK

AimsTo ascertain the incidence of babies readmitted with weight loss >10% of birth weight and hypernatraemic dehydration. To identify major contributing factors for the increasing incidence and formulate strategies to reduce the incidence of the problem.

MethodsRetrospective study of babies admitted to the ward with weight loss >10% of birth weight over a period of 15 months (June 2005 to September 2006). Data were collected by reviewing maternal and babies' notes.

ResultsForty nine out of 129 (38%) neonates readmitted to the ward met our inclusion criteria. The incidence of babies that presented with loss of >10% birth weight was 1.1/100 deliveries. Mean age at admission was 6.8 (range: 3–14) days. Mean weight loss was 13.2% (range: 10–20%) of birth weight. 14 babies (incidence 3.1/1000 deliveries) had hypernatraemia (range 150–160 mmol/l). 13 babies had a high urea (range: 7–32.9 mmol/l). Maternal age ranged from 21 to 46 years (37% were 30–34 years, 22% were 35–39 years and 10% over 40 years). 28/49 (57%) were primiparous. Postnatal complications were documented in 16% of mothers (14% had significant postpartum haemorrhage). None of the babies were septic or had congenital problems. Mean and median length of stay in postnatal ward, after delivery, was 2 (range: 0.5–7) days. All the babies (100%) were exclusively breastfed at home before readmission. Significantly, 12% of mothers decided to bottle feed their babies immediately after admission, which increased to 24% at the time of discharge. Median length of stay in hospital was 2 days (range: 2 hours to 5 days). All babies (100%) were discharged home without any complications and with a clear follow‐up plan.

Conclusion and RecommendationsOur study reported very high incidence of babies admitted with breastfeeding malnutrition and hypernatraemic dehydration. We recommend early and frequent weighing of the babies (3rd and 5th day of life) for early identification and prevention of serious complications. Continuous education of parents about the signs of successful breastfeeding is necessary. We identified at risk mothers. We also noted a significant number of mothers (24%) changed from breastfeeding to bottle feeding because of this problem. Extra effort must be taken on the ward to encourage the mothers to continue breastfeeding.

G/THUR/PUB4 Tackling health inequalities: does community paediatrics contribute to reducing health inequalities by reaching out to deprived children?

F. Rahman, V. Maharaj, L. Adamson. Derby City PCT, Derby, UK

AimTo demonstrate that community paediatrics seeks to reverse the inverse care law by providing a service preferentially accessed by children likely to be affected by deprivation as measured by the index of multiple deprivation 2004.

MethodWe mapped the activity data of a community paediatric service for financial year 05/06 against deprivation quintiles (postcode link to IMD 2004) and compared it against data for the entire child population aged 0–16 years in the area covered by the service. Quintiles 1&2 are the most deprived and these children have a higher risk of health inequalities due to deprivation.

ResultsProportions of children in lowest two quintiles: service contacts compared with entire population covered by the service (see table).

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Abstract G/THUR/PUB4

ConclusionThe majority of contacts with our service are for children in the two most deprived quintiles. The proportion of deprived children seen by our service is significantly greater than the proportion of deprived children in the population covered by the service. These children are traditionally “hard to reach” and even though they access emergency services frequently, their use of preventive and specialist services is often relatively low. It is important for children's services to demonstrate that they are accessible to and used by deprived children and families. Future inspections of children's services will focus on these children, and we suggest that such mapping would be a useful measure of service accessibility to socioeconomically vulnerable families.

G/THUR/PUB5 Tackling the social class gap in infant mortality: findings from the Department of Health's review of the infant mortality health inequalities target

M. Korkodilos, M. Rae, R. Earwicker, A. Bhoopal, R. Anderson, S. Graves, Y. Fagun. Department of Health, London, UK

BackgroundThe infant mortality element of the Department of Health's (DH) health inequalities Public Service Agreement (PSA) target is by 2010, to reduce by at least 10 per cent the gap in mortality between routine and manual (R&M) groups and the population as a whole in children under 1 year.

AimsTo identify how the DH can help secure delivery of the infant mortality aspect of the health inequalities PSA target and narrow the infant mortality gap.

MethodsThis was achieved through data analysis, fieldwork visits and modelling the effect of interventions on reducing the “gap”.

ResultsData analysis. The infant mortality rate among the R&M group (5.9 per 1000) was 19% higher than in the total population in 2002–4 (4.9 per 1000). There were 9032 infant deaths in England in 2002–4, 3631 (40%) were in the R&M group. A reduction of 800–900 deaths in the R&M group over the target period to 2009–11 is needed to meet the target if current trends in overall infant mortality continue. Fieldwork visits. The visits identified five challenges to delivering the target: no recognition of the target; services not fully delivering to the target group; lack of leadership and systems to support delivery; lack of knowledge and understanding of the target; poor handling and use of data and gaps in the evidence base. Interventions. Modelling identified four evidence‐based interventions that have the biggest contribution to reducing the “gap”, reducing teenage pregnancies, targeted interventions to reduce sudden unexpected deaths in infancy, smoking and obesity in the R&M group.

ConclusionsThe infant mortality target is challenging. The results of the review can help narrow the gap and contribute to meeting the target. The DH has developed an implementation plan of actions to meet this challenge.

G/THUR/PUB6 Meeting the health needs of children in residential care: 10 years on

B. Sands, E. Fillmore. Nottingham University Hospitals Trust, Nottingham, UK

IntroductionChildren in residential care continue to present a challenge to agencies to meet their high level of need. In 1992 a joint venture between social services and health set up a team of professionals to produce a high quality, coordinated service which assesses, in partnership with young people, their health needs and ensures they are met. A report was published in 1996.

AimTen years on we have looked to see if our health team input to the residential homes has improved identification of physical and mental health needs, uptake of health promoting activities and improvement in health‐seeking behaviour.

MethodWe audited the healthcare plans for all the children in residential care over one year. We looked at the fields identified in the Health Lifestyle Questionnaire 10 years earlier and compared with 2006 data.

ResultsThirty eight healthcare plans were analysed with the age range 12–17 years (mean age 15, male: female 22:16). (In 1996 39 health questionnaires were completed with the age range 9–16 years (mean age 14, male: female 28:11).) Nutrition was discussed in 89% of cases with 85% young people having a reasonable diet and 70% given dietary advice. (10 years ago, 90% had not eaten any fruit or vegetables in the last week.) Exercise was discussed with 80% young people. 50% of health assessments took place at a leisure centre with a fitness assessment. 65% young people took up the free gym pass and 42% young people were shown to have used the facilities at least once per week for one year. Mental health was discussed with 95% young people of whom 30% reported low mood and self‐harming behaviour. In 73% cases residential care workers reported a concern and 96% of young people about whom there were concerns were discussed in CAMHS consultations. (10 years ago 75% young people had significant anxiety and 44% showed clinical depression, with no clear pathway for referral or management.) 21% young people were non‐smokers (as compared to 10% non‐smokers in 1996). Drugs and alcohol were discussed with 90% young people of whom 85% were given appropriate information. Sexual health was discussed with 89%. (No documented discussion of drugs and sexual health in 1996.)

ConclusionThe input from our health team has contributed to the improvement in meeting the health needs of young people in residential care.

G/THUR/PUB7 Looked after children: meeting their health needs

M. Salama, D. Low, D. McAndrew. Sandwell and West Birmingham NHS Trust, West Midlands, UK

BackgroundA regional audit in 2004 against the Department of Health guidelines Promoting the Health of Looked after Children (LAC) demonstrated a fragmented and poor quality service. Funding was obtained to set up a dedicated team and we devised a multiagency pathway for these children.

AimsTo evaluate the health needs of LAC and assess the how effective our care pathway has been in identifying and meeting the health needs of these children.

MethodsThis is a retrospective audit of all the initial assessments this service carried out from 2004–6. We collected data from our database on the following: Demographic factors; Parental factors; Physical and mental health; Education; Development; Immunisations; Dental and visual health and surveillance; Alcohol and drug use and health action plans following assessment. These were analysed using Microsoft Excel software. We also audited the timing of reassessment and fulfilment of health plans.

ResultsOf 262 children there were two peaks of influx into care, the neonatal period and adolescence. 35% of children had been exposed to domestic violence, 20% to alcoholic parents, 25% to parents who took drugs and 21% to a parent with a mental illness. In 20% of cases either the social worker or foster carer was not present at initial assessment. 46% of children had a chronic medical condition and 3 teenagers needed antenatal or postnatal care. 12% had visual problems, 13% had dental problems and 29% had outstanding immunisations. Educational deficits were highlighted with half having difficulty at school and almost a third not attending regularly. There were mental health concerns in 27%, behavioural problems in 23% as well a higher than average rate of smoking, drinking and drug use in adolescents. The assessment identified 30% needing routine vision checks, 32% needing routine dental checks and 32% needing onward referral. Looking at our reassessments we initially were only carrying out 46% of our reassessments in time but this has improved to 74% and better. Similarly now the majority of our health action plans have been actioned.

ConclusionThe audit has confirmed that these children are complex and have multiple physical and mental health needs in addition to a variety of other problems. We are able to show that with dedicated resources and a multiagency care pathway we are better able to meet the health needs of these children.

G/THUR/PUB8 A pilot national clinical dataset for community paediatrics to support service delivery, planning, Hospital Episode Statistics and Joint Area Reviews requirements

F. Rahman1, C. Ni Bhrolchain2, M. Blair3. 1Derby City PCT, Derby, UK; 2Wirral Hospital Trust, The Wirral, UK; 3Imperial College, London, UK

AimsTo pilot a possible clinical dataset for UK community paediatricians.

BackgroundThere is currently no agreed minimum data set for children treated outside hospital. This makes analysing activity, outcomes and reference costs impossible. A data set already in use in one of the authors' services was piloted nationally to test its feasibility as a national dataset.

MethodA data collection sheet and coding key, with sample coded clinical scenarios, were circulated to all members of the British Association of Community Child Health (BACCH) with the Newsletter in Spring 2006. Members were asked to each collect and code 20 cases and to return them centrally for analysis. The returned sheets were analysed using Excel.

ResultsNine doctors from 4 services submitted 172 cases. All grades of staff contributed. The data quality was excellent. The whole range of community paediatrics from audiology to substance abuse clinics was reflected. 74% of referrals came from health, 2% each from education and social services, 1% from self/parent and 21% were unspecified. Reasons for referral were special educational needs (SEN) (34%), behaviour (32%), general/physical (18%) adoption/fostering (2%),school attendance (1%), sexual abuse (1%) and unspecified (12%). 20% of cases had a second problem. A broad range of ethnicities (10) and the entire age range (0–19 years) were seen. 45% of children fell into at least one vulnerable category: 37% SEN, 3% youth offending team, 2% looked after, 1% children in need, 1% on child protection register. Contact types were clinic (86%), multidisciplinary meetings (12%),and telephone (2%). First diagnosis was mental health (29%), physical (28%), learning (24%), psychosocial 2%, normal (1%), unspecified (16%). A second diagnosis was present in 46% of cases and a third in 12%. Time spent per contact ranged from 10 minutes to 120 minutes. Two workshops at the BACCH ASM 2006 confirmed that participants would support the introduction of a similar dataset nationally as lack of time and perceived complexity had previously deterred them.

ConclusionThis small pilot shows that community paediatricians could collect reliable data if they had an agreed national dataset to work with. The BACCH dataset could be the basis for the national dataset. In particular it would support HES and the new JARS emphasis on vulnerable children.

G/THUR/PUB9 How often and why do parents choose to treat their children with complementary medicines?

M. Blair1, A. Lorenc2, N. Gully2, K. Mitchell2, P. Fox2, N. Robinson2. 1Imperial College, London, UK; 2Thames Valley University, London, UK

AimTo determine the prevalence and determinants of complementary medicine (CM) use in a multi‐ethnic paediatric outpatient population with particular reference to parental health beliefs.

MethodsParent‐completed standardised questionnaire survey incorporating the standardised beliefs in medicines questionnaire (BMQ) and multidimensional health locus of control scales (MHLC). Population and setting; consecutive sample of parents attending paediatric general and subspecialist outpatient clinics in a North West London hospital during September to December 2005.

Results339 parents were approached, of whom 243 agreed to participate (72%). Parents' use of CM for their children in this multi‐ethnic population was higher than expected at 37% for a variety of conditions (gastrointestinal, infection, skin and psychological symptoms were commonest) Four treatments accounted for 82% use: homeopathy (30%) herbal medicine (28%), osteopathy (14%) and aromatherapy (10%) Parental CM use (p<0.001) and education (p<0.01) and the child's health status (p<0.05) were the most significant predictors of CM use. There were no significant differences in use between ethnic groups. The main reason for using CM was word of mouth (65%), the main source of information was friends and family (51%). 88% of CM was bought over the counter and 53% of CM use was not reported to their doctor. Parents using CM for their children had significantly stronger beliefs in the overuse of conventional medicine (BMQ) than non‐users (p = 0.013) but did not differ in their MHLC scales.

ConclusionsThis study demonstrates that CM use in children is higher than previously estimated in the UK and is influenced by parental health beliefs. Paediatricians need to acknowledge parental reluctance to report CM use and the range of beliefs that inform parents' decision‐making process.

G/THUR/PUB10 Primary care experiences of different ethnic groups and the risk of pneumonia or of being hospitalised with pneumonia in children in New Zealand

D. Emery1, C. Grant1, G. Coster1, T. Milne1, E. Robinson1, C. Forrest2. 1University of Auckland, Auckland, New Zealand; 2Bloomberg School of Public Health, Baltimore, USA

AimsHospitalisation rates for pneumonia in New Zealand are high, especially for Pacific and indigenous Maori children. Pneumonia hospitalisation rates are reducible with utilisation of quality primary care. In 2001 New Zealand restructured its primary health system to improve access and quality. This study aimed to determine to what extent ethnicity contributes to variability in primary care experiences and in the risk of developing and being hospitalisation with pneumonia.

MethodsCase control study with 1 case and 2 control groups of children <5 years old. Cases were children hospitalised with pneumonia. Controls were children seen with pneumonia in the Emergency Department, but not hospitalised, and a random sample of well children from the community. Data were collected by interview with caregiver and general practice manager and review of primary and secondary care records. Caregiver satisfaction was measured using questions from the General Practice Assessment Survey.

ResultsFeatures of primary care describing access and comprehensiveness were not associated with risk of pneumonia or being hospitalised with pneumonia. Maori and European/other caregivers did not differ in assessment of the family doctor, except for greater overall satisfaction for Maori caregivers (OR 1.90, 95% CI 1.08–3.34). Pacific caregivers were less satisfied with the family doctor than European/other for access (OR = 0.32, 95% CI 0.18–0.58), receptionist (OR = 0.47, 95% CI 0.27–0.84), continuity (OR = 0.35, 95% CI 0.18–0.67), communication (OR = 0.31, 95% CI 0.15–0.61), interpersonal care (OR = 0.48, 95% CI 0.27–0.83) and patient knowledge (OR = 0.22, 95% CI 0.11–0.46). Odds ratios adjusted for socioeconomic status.

ConclusionObjective measures of access to primary care were similar for those who developed pneumonia or were hospitalised with pneumonia. When assessing caregiver satisfaction with primary care Pacific caregivers reported greater dissatisfaction compared with European/other, irrespective of socioeconomic status.

G/THUR/PUB11 Taking the “ouch” out of childhood immunisations: what is the evidence?

L. Whiteford, J. Tyrrell. Royal United Hospital, Bath, UK

AimsTo identify and critically appraise the published evidence which has investigated ways of reducing the pain and distress associated with childhood immunisations.

MethodsA literature search was performed using PubMed. The following limits: English; human; all child 0–18 years, were applied. The MESH terms “child” or “children” or “pediatric” or “paediatric” were combined with “acute pain” or “procedural pain” or “analgesia” and with “immunisation” or “vaccination”, to search for relevant papers. Links to related papers were explored. Identified studies were reviewed and analysed using methodology checklist 2 from SIGN 50: A guideline developer's handbook.

ResultsNineteen studies were identified and reviewed. Three of these (2 RCTs and 1 survey) looked at different brands of vaccine and found different levels of pain with the same level of immunogenicity. Two RCTs compared subcutaneous and intramuscular injection and found that intramuscular injection was associated with less pain and less reactogenicity. Oral sucrose solution was studied in 3 RCTs in infants and found to significantly reduce crying times and distress associated with immunisation. Four RCTs looked at topical local anaesthetic cream and 1 at vapocoolant spray, all of them found significantly lower levels of pain compared with a placebo. Five studies (4 RCTs and 1 observational study) looked at pyschological interventions and found that distraction and patient taught coping strategies could significantly reduce pain. These were supported by a cochrane systematic review which found that distraction, hypnosis and combined cognitive‐behavioural techniques all reduce needle‐related procedural pain and distress.

ConclusionsImmunisation is the commonest painful procedure that most children will undergo. In the current UK immunisation schedule children receive 12 injections by the time they are 5 years old. There is good evidence that the pain and distress can be reduced by considering the brand of vaccine used, using the intramuscular rather than subcutaneous route and incorporating psychological interventions. Oral sucrose solution in infants and topical local anaesthetics in older children do reduce pain in immunisation. The question is whether we should be using them routinely.

G/THUR/PUB12 Relationships between socioeconomic status and cognitive outcome in children with traumatic brain injury and non‐injured control children

D. Pauldhas1, H. Miller1, R. McCarter1, H. Cooke2, A. Currran1, B. Hameed1, P. Sharples1. 1Frenchay Hospital, Bristol, UK; 2SW Public Health Observatory, Bristol, UK

IntroductionChildren from areas of socioeconomic deprivation are at greater risk of dying from traumatic brain injury (TBI) than those from affluent areas. However, few data exist concerning the relation between socioeconomic status and outcome in TBI survivors.

Aims(1) To investigate the relationship between socioeconomic status and cognitive outcome in TBI children. (2) To compare the relationship with that seen in non‐injured controls.

MethodsProspective cohort study. Study subjects were TBI children aged [less-than-or-eq, slant]16 years admitted to the Regional Neuroscience Centre. Controls were non‐injured children matched for age, sex and socioeconomic status. TBI severity was classified by admission Glasgow Coma Score (GCS) as severe (GCS 3–8), moderate (GCS 9–12) and mild (GCS 13–15). Socioeconomic status was assessed using the Income Deprivation Affecting Children Indices (IDACI) of the Index of Multiple Deprivation (2004). Subjects' postcodes were converted into super output areas and an IDACI assigned to each area. Cognitive outcome was assessed using the Wechsler Intelligence Scale for Children‐III; the Children's Memory Scale; and the Test of Everyday Attention in Children.

Results106 TBI children and 41 controls were studied. There was no difference in age between TBI subjects (mean 11.4 years) and controls (mean 11.5 years). In TBI children at 1 month post‐injury there was a significant relationship between IDACI and Verbal IQ (VIQ) (p<0.001), Performance IQ (PIQ) (p = 0.007), General Memory Index (GMI) (p = 0.005) and measures of attention (Map Mission, p = 0.003; Score, p = 0.008; Opposite/Opposite Worlds, p = 0.004). At 12 months post‐TBI there was a significant relationship between IDACI and VIQ (p = 0.001), GMI (p = 0.002) and some measures of attention (Map Mission, p = 0.001); but not between IDACI and PIQ (p = 0.203), or other attentional measures (p>0.05 for all). In control children there was no correlation between IDACI and measures of cognition (p>0.05 for all).

ConclusionThere is a significant correlation between socioeconomic status and cognitive outcome after TBI, which is not seen in controls. These data are consistent with recent evidence that environmental enrichment may improve outcome after brain injury. We suggest rehabilitation therapy post‐TBI should be particularly targeted on children from areas of socioeconomic deprivation.

G/THUR/PUB13 Safe journey home? A survey of child transport practices on discharge following delivery

E. Clark, D. Charispoulou, M. Blair. Northwick Park Hospital, NWLH NHS Trust, UK

AimsIn light of the awareness of the new legislation regarding the use of car restraints in children, we wanted to observe current practice in the use of appropriate car seats for newborn babies leaving hospital.

MethodsA questionnaire was designed to look at how parents were intending to take their newborn babies home from the postnatal ward. The questionnaire identified mode of transport, where the baby would be placed and reasons for not using a car seat if needed. A convenience sample of parents completed the questionnaire at the time of the postnatal baby check with the help of the neonatal SHO as necessary, prior to discharge from the postnatal ward.

ResultsA total of 101 questionnaires were completed in a 2‐week period between December 2005 and January 2006. The majority, 72%, of families were travelling home by car and the other 28% by taxi/cab. No‐one was travelling home by bus, train or on foot. Where the baby would be placed varied between the 2 modes of transport. Only 51% of the 101 intended to go home in a car seat. The main reason given for not using a car seat in a taxi was that there was not one available in the taxi. Of those going home by car 29% did not have a car seat available: 43% of these did not know it was needed and 29% had not got round to buying one yet. A total of 20% of those questioned did not know that a car seat was needed for a baby to travel home by car/taxi.

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Abstract G/THUR/PUB13

Conclusions49% of babies are leaving the postnatal ward in a vehicle with no car seat. Interventions to improve this figure should centre around educating antenatally about the requirements of car seats for babies and to make car seats available for those travelling home this way. We aim to repeat this questionnaire December 2006 to January 2007 following implementation of our proposed interventions and to report the findings.

G/THUR/PUB14 Will new restraint laws reduce severe seat belt injuries in children in the UK?

K. Reeve, Y. Zurynski, E. Elliott. University of Sydney, Australian Paediatric Surveillance Unit, Sydney, NSW, Australia

AimsTo systematically review legislation, policy, and practice regarding child restraints and serious seatbelt injuries in children.

MethodsWe searched Medline, the Cochrane Library, and the internet for sites associated with road safety, using the terms lap belt, seat belt, child restraint, legislation and injuries. We reviewed 394 titles, 126 abstracts, 35 full text articles and 36 websites. We found only 1 systematic review related to incentives to use booster seats. Most data on restraint safety came from simulated crash tests and injury surveillance databases.

ResultsDespite wearing seat belts, children involved in motor vehicle accidents sustain significant, sometimes fatal, injuries. In 2005, 27 children aged 0–11 years were killed and 299 were seriously injured in cars in the UK. Inappropriate restraint choice or misuse increases the risk of injury and death. Recent changes to UK child restraint legislation make it mandatory for children up to 12 years of age (or 135 cm) to travel in dedicated child restraints. Compared with adult seat belts, correct use of booster seats reduces injury by 59% and death by 28%. In the UK more than 90% of children use either seat belts or child restraints, but 70% of child restraints are not properly fitted. The Department for Transport maintains a passenger casualty database in the UK but there is no surveillance of restraint‐related injuries. Australian and Canadian paediatric surveillance units collect data prospectively on severe seat belt injuries, which have been used to guide education and policy.

ConclusionsUK Government initiatives such as the National Service Framework and Road Safety Strategy (Tomorrow's Roads‐Safer for Everyone) target improved child safety through injury prevention. It will be important to assess the impact of new child restraint legislation in the UK on severe seat belt injuries in children which, although rare, are preventable. A study through the British Paediatric Surveillance Unit is a possible option.

G/THUR/PUB15 Enhanced surveillance of meticillin‐resistant Staphylococcus aureus bacteraemia in children less than 16 years in the UK and Ireland, June 2006–November 2007

C. Goodall1, A. Johnson1, M. Sharland2. 1Health Protection Agency, London, UK; 2St George's Hospital Medical School, London, UK

IntroductionSurveillance was undertaken to determine the incidence of meticillin‐resistant Staphylococcus aureus (MRSA) bacteraemia in children, and to define the demographic and clinical features of cases, particularly the proportion of cases that are healthcare‐associated or community‐associated.

MethodsCases of MRSA bacteraemia in children were ascertained from paediatricians reporting to the British Paediatric Surveillance Unit and via routine voluntary reporting from hospital microbiologists to the Health Protection Agency, and/or isolates referred to National Staphylococcal Reference laboratories for strain characterisation.

ResultsTo date, 111 notifications of MRSA bacteraemia have been received from the BPSU over 17 months; 63 have so far been confirmed as cases with 20 questionnaires outstanding. 69 isolates have been received by the HPA Staphylococcal Reference Laboratory and voluntary routine reporting from hospital microbiologists has identified 103 cases; 10 cases were confirmed by all 3 reporting routes. Of the 63 confirmed cases notified by paediatricians, 50 (79%) were submitted by paediatricians in England, 5 (8%) from Scotland, and 4 (6%) from Ireland. BPSU reports were concentrated in children less than 1 year (73%), with 44% of reported cases seen in those less than 1 month old. Clinical information submitted with questionnaires indicated that the majority of children were premature (28/63) and were resident in SCBU/NICU or PICU units at the time of diagnosis. Typing of isolates has indicated that strains associated with the healthcare setting (particularly EMRSA‐15) are most prevalent within this group.

ConclusionThese data should inform policy to reduce the burden of invasive infection with MRSA in children.

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Group