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Palatal tremor (or palatal myoclonus) is a rare movement disorder affecting the soft palate. The essential, or idiopathic form, usually affects children aged between 6 and 9 years and resolves spontaneously after between 3 months and 5 years. There is involuntary rhythmic jerking of the soft palate in an otherwise neurologically normal child, and clicking in the ears audible to the child and to an observer with, or sometimes without, a stethoscope. In Barcelona (Developmental Medicine and Child Neurology 2006;48:982–4) four children were treated with piracetam and all lost the palatal tremor within a month of starting treatment at doses between 100 and 300 mg/kg/day. One child relapsed on stopping treatment but responded to a further course.
There is a suggestion that periodontal disease in pregnancy might increase the risks of preterm birth, preeclampsia and low birthweight. Now a multicentre trial in the USA (New England Journal of Medicine 2006;355:1885–94; see also editorial, ibid: 1925–7) has shown that treatment of periodontal disease is successful in dental terms but probably does not improve obstetric outcomes. A total of 823 women with periodontal disease were randomised to be treated with scaling and root planing, with monthly tooth polishing and oral hygiene instruction, either before 21 weeks gestation or after the birth. Treatment improved the periodontal disease but had no significant effect on measured obstetric or neonatal outcomes. The writers of the editorial, however, speculate that treatment of periodontal disease might reduce the risks of late miscarriage, early stillbirth, or early (before 32 weeks) preterm birth and that it might be more effective given before pregnancy. On the other hand it might have no effect on the pregnancy at all.
The many advantages of breast feeding for mother and child do not include enhancement of the child's intelligence. That is the message from a study based on data from the US national longitudinal survey of youth, 1979 (BMJ 2006;333:945–8; see also editorial, ibid: 929–30). The unadjusted data showed an increase of about 4 points in children's IQ associated with breast feeding. Higher maternal IQ accounted for over 70% of this effect and full adjustment for maternal IQ, maternal education, socioeconomic status, and other biological, behavioural and environmental factors reduced the effect of breast feeding on children's IQ to a non‐significant increase of half a point. A sibling pairs analysis of the data in this study and a meta‐analysis of data from previously published studies supported the conclusion that breast feeding, in itself, does not have a significant effect on a child's intelligence.
In Malawi chloroquine treatment of Plasmodium falciparum malaria was stopped in 1993 because of parasite resistance and since then standard treatment has been with sulfadoxine and pyrimethamine. After the switch the prevalence of the parasite chloroquine resistance gene declined, reaching zero in 2001. Now a randomised trial (New England Journal of Medicine 2006;355:1959–66; see also Perspective, ibid: 1956–7) has shown that chloroquine is again effective. A total of 210 children with uncomplicated P falciparum malaria were randomised to treatment with chloroquine or sulfadoxine‐pyrimethamine. The rates of treatment failure were 1/80 (chloroquine) vs 71/87 (sulfadoxine‐pyrimethamine). Despite the return of chloroquine sensitivity these researchers warn against using chloroquine as monotherapy in Malawi because the high prevalence of chloroquine resistance in surrounding countries suggests that its use would rapidly be followed by the reintroduction of resistant parasites.
New vasopressin antagonists may prove useful in the treatment of euvolaemic or hypervolaemic hyponatraemia. Two studies in adults have been reported in a single paper (New England Journal of Medicine 2006;355:2099–112; see also editorial, ibid: 2146–8). Most of the 448 patients had chronic heart failure or hepatic cirrhosis but a significant proportion had the syndrome of inappropriate antidiuretic hormone secretion. Randomisation was to tolvaptan, an oral selective vasopressin V2 receptor blocker that is said to promote excretion of solute‐free water, or placebo. Serum sodium concentrations at 4 days and 30 days were higher in the tolvaptan group and a greater proportion (48% vs 12% at 4 days and 56% vs 25% at 30 days) of patients in that group achieved normal concentrations. Correction of hyponatraemia was accompanied by clinical improvements, including improvements in cognitive function. Hyponatraemia recurred within a week of stopping treatment. If the benefits in adults are confirmed paediatric studies will no doubt follow.
Britain has one of the highest teenage pregnancy rates in Europe. A national strategy for England was implemented in 1999 with the aims of halving the rate by 2010 and increasing the educational, training and employment opportunities for teenage parents. The four components of the strategy are a media campaign, coordination of relevant national and local agencies, better sex education and improved access to sexual health services, and support for teenage parents to continue with, or return to, education, training or work. Data from 148 local authorities (Lancet 2006; 368:1879–86; see also Comment, ibid: 1846–8) show that between 1994–98 and 1999–2003 teenage (<18 years) conceptions decreased by 3.2%, teenage abortions increased by 7.5%, and births to teenagers decreased by 10.6%. The changes were greater in deprived and rural areas and areas with lower educational attainment. Areas with poor services and poor access but with greater strategy funding had more change. The authors of this paper interpret the data as providing limited evidence that the national strategy is having an effect but the Lancet commentators are not fully convinced.
In the last 3 or 4 years the possibility has been broached that some of the increase in asthma prevalence might be connected to increased exposure of children to chlorination by‐products in indoor swimming pools. Increases in school swimming lessons, higher water temperatures, overpopulation of pools and energy‐conscious restrictions on pool ventilation may have contributed to increases in concentrations of these by‐products in the air over and around indoor pools. Now an ecological study (Occup Environ Med 2007;64:37–46) has shown an association between childhood asthma prevalence and indoor swimming pool availability using data from the International Study of Asthma and Allergies in Childhood (ISAAC). This latter study included over 90000 6–7 year old children and almost 190000 13–14 year old children in 21 European countries. The prevalence of asthma in children was related to the number of indoor chlorinated swimming pools. An increase of one pool per 100000 population was associated with a 2.7% increase in “ever asthma” in the older age group and a 1.5% increase in the younger age group. No similar association was found for other atopic diseases and the results were not influenced by altitude, climate or GDP per capita.