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1.  A paper that changed my practice: S McKenzie. Cough but is it asthma? Arch Dis Child 1994;70:1–2 
Most doctors can identify key papers that have influenced their approach to the management of a particular clinical problem, although sometimes the gestation period of this effect can be very prolonged. In this short review I discuss the effects of a seminal paper by Sheila Mackenzie from the early 1990s on my current approach to the diagnosis and management of chronic cough in children.
doi:10.1136/adc.2006.104430
PMCID: PMC2083138  PMID: 17185449
3.  Arch Dis Child 2000 Volume 83 No 2 
doi:10.1136/adc.83.2.0
PMCID: PMC1718437
4.  Arch Dis Child 2000 Volume 82 No 5 
doi:10.1136/adc.82.5.0
PMCID: PMC1718343
5.  The accuracy of references in paediatric journals 
Archives of Disease in Childhood  2001;85(6):497-498.
We analysed the reference error rate of four paediatric journals. The overall rate was 29.7%. Individual rates were as follows: Acta Paediatr 36%, Arch Dis Child 22%, J Pediatr 29%, Pediatrics 32%; the rate of major errors was 1%, 1%, 2%, and 4%, respectively.


doi:10.1136/adc.85.6.497
PMCID: PMC1719006  PMID: 11719341
6.  The needs of children whose mothers have HIV infection 
Archives of Disease in Childhood  1997;77(6):483-487.



AIM—To ascertain the psychological, social, and educational needs of children born to mothers with HIV infection.
METHODS—Review of case records of 120 children and 86mothers.
RESULTS—The cohort of 120 children were born to 92 women, and followed up for a median duration of 48 months (mean (SD) 51.1 (34.1), range 0.3-132). Sixteen children were infected with HIV, 15 were of indeterminate status, and 89 uninfected. Eighty one children (68%) were cared for by their birth mother, of whom 52% were single women and 23 (38% of 61) known to have symptomatic HIV disease. Twenty five mothers of 32 children had died; the child's mean (SD) age at maternal death was 66.9 months (37.7) (range 4-128). Compared with uninfected children, more infected children knew of their mother's diagnosis (31% v 5%) and mothers were also more likely to disclose their own illness to educational authorities (77% v 13%). A larger proportion of infected children had special educational needs (69% v 13%). Only 33 children (28%) were known not to be receiving any support from the voluntary or statutory agencies.
CONCLUSION—The results highlight the multiple needs of children living with maternal HIV infection, which require dedicated resources and commitment from health, education, and social work agencies and the voluntary sector. We propose the model of chronic illness as the standard of care for these children.


PMCID: PMC1717407  PMID: 9496179
7.  Familial erythrophagocytic reticulosis. Complete response to combination chemotherapy. 
Archives of Disease in Childhood  1984;59(2):173-175.
Two infants with familial erythrophagocytic reticulosis attained a durable complete remission after combination chemotherapy including intrathecal methotrexate. Though both later died, neither child had definitive evidence of tumour at necropsy.
PMCID: PMC1628480  PMID: 6546659
8.  CORRECTIONS 
Archives of Disease in Childhood  2003;88(10):946-947.
doi:10.1136/adc.88.10.946-c
PMCID: PMC1719330
9.  Corrections 
doi:10.1136/adc.2010.170118
PMCID: PMC3859681
10.  [No title available] 
PMCID: PMC2083867
11.  CORRECTIONS 
doi:10.1136/adc.88.1.93
PMCID: PMC1719286
12.  CORRECTION 
doi:10.1136/adc.86.6.455-a
PMCID: PMC1763007
13.  Dr Silverman comments 
PMCID: PMC1628773
14.  Relationship between adiposity and cognitive performance in 9-10 year old children in south India 
Archives of disease in childhood  2013;99(2):126-134.
Background
Studies in high-income countries have shown inverse associations between adiposity and cognitive performance in children. We aimed to examine the relationship between adiposity and cognitive function in Indian children.
Methods
At a mean age of 9.7 years, height, weight, triceps and subscapular skinfold thicknesses and waist circumference were recorded for 540 children born in Mysore, India. Body fat percentage was estimated using bio-impedance. Cognitive function was assessed using 3 core tests from the Kaufman Assessment Battery for children-II edition and additional tests measuring learning, short-term memory, reasoning, verbal and visuo-spatial abilities, attention and concentration. Data on the parents’ socio-economic status, education, occupation and income were collected.
Results
According to WHO definitions, 3.5% of the children were overweight/obese (BMI>+1SD) and 27% underweight (BMI<−2SD). Compared to normal children, overweight/obese children scored higher in tests of learning/long-term retrieval, reasoning and verbal ability (unadjusted p<0.05 for all). All the cognitive test scores increased with increase in BMI and skinfold thickness, (unadjusted β=0.10 to 0.20 SD; p<0.05 for all). The effects, though attenuated, remained mainly significant after adjustment for age, sex and socio-economic factors. Similar associations were found for waist circumference and percentage body fat.
Conclusions
In this Indian population, in which obesity was uncommon, greater adiposity predicted higher cognitive ability. These associations were only partly explained by socio-economic factors. Our findings suggest that better nutrition is associated with better cognitive function, and that inverse associations between adiposity and cognitive function in high-income countries reflect confounding by socio-economic factors.
doi:10.1136/archdischild-2013-304478
PMCID: PMC3982043  PMID: 24146284
Adiposity; Children; Cognitive function; India; Birth cohort
15.  Season of Birth in a Nationwide Cohort of Coeliac Disease Patients 
Background and objective
Genetic factors alone cannot explain the risk of developing coeliac disease (CD). Children born in summer months are likely to be weaned and introduced to gluten during winter when viral infections are more frequent. Earlier studies on birth season and CD are limited in sample size and results are contradictory.
Method
Case-control study. We used biopsy reports from all 28 Swedish pathology departments to identify individuals with CD, defined as small intestinal villous atrophy (n=29,096). The government agency Statistics Sweden then identified 144,522 controls matched for gender, age, calendar year and county. Through conditional logistic regression we examined the association between summer birth (March-August) and later CD diagnosis (outcome measure).
Results
Some 54.10% of individuals with CD vs. 52.75% of controls were born in the summer months. Summer birth was hence associated with a small increased risk of later CD (Odds ratio: 1.06; 95%CI=1.03–1.08; p<0.0001). Stratifying CD patients according to age at diagnosis, we found the highest OR in those diagnosed before age 2 years (OR=1.17; 95%CI=1.10–1.26), while summer birth was not associated with a CD diagnosis in later childhood (age 2–18 years: OR=1.02; 95%CI=0.97–1.08), but had a marginal effect on the risk of CD in adulthood (age ≥18years: OR=1.04; 95%CI=1.01–1.07).
Conclusions
In this study, summer birth was associated with an increased risk of later CD, but the excess risk was small, and general infectious disease exposure early in life is unlikely to be a major cause of CD.
doi:10.1136/archdischild-2012-302360
PMCID: PMC3560933  PMID: 23172784
celiac; coeliac; epidemiology; risk factors; seasons; viral infection
16.  IMPROVING ACCESS TO CARE FOR CHILDREN WITH MENTAL DISORDERS: A GLOBAL PERSPECTIVE 
Archives of disease in childhood  2013;98(5):323-327.
Developmental disabilities, emotional disorders, and disruptive behaviour disorders are the leading mental health related causes of the global burden of disease in children aged below ten years. This article aims to address the treatment gap for child mental disorders through synthesizing three bodies of evidence: the global evidence base on the treatment of these priority disorders; the barriers to implementation of this knowledge; and the innovative approaches taken to address these barriers and improve access to care. Our focus is on low resource settings, which are mostly found in low and middle income countries (LMIC). Despite the evidence base on the burden of child mental disorders and their long-term consequences, and the recent mhGAP guidelines which testify to the effectiveness of a range of pharmacological and psychosocial interventions for these disorders, the vast majority of children in LMIC do not have access to these interventions. We identify three major barriers to implementation of efficacious treatments: the lack of evidence on delivery of the treatments; the low levels of detection of child mental disorders; and the shortage of skilled child mental health professionals. The evidence base on implementation, although weak, supports the use of screening measures for detection of probable disorders, coupled with a second stage diagnostic assessment, and the use of non-specialist workers in community and school settings for the delivery of psychosocial interventions. The most viable strategy to address the treatment gap is through empowerment of existing human resources who are most intimately concerned with child care, including parents, through innovative technologies such as mobile health, with the necessary skills for the detection and treatment of child mental disorders.
doi:10.1136/archdischild-2012-302079
PMCID: PMC3672840  PMID: 23476001
17.  Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study 
Archives of disease in childhood  2012;97(7):610-616.
Objective
To examine whether delivery by caesarean section is a risk factor for childhood obesity.
Design
Prospective pre-birth cohort study (Project Viva).
Setting
Eight outpatient multi-specialty practices based in the Boston, Massachusetts area.
Participants
We recruited women during early pregnancy between 1999 and 2002, and followed their children after birth. We included 1255 children with body composition measured at 3 years of age.
Main outcome measures
Body mass index (BMI) z-score, obesity (BMI for age and sex ≥ 95th percentile), and sum of triceps + subscapular skinfold thicknesses, at 3 years of age.
Results
284 children (22.6 percent) were delivered by caesarean section. At age 3, 15.7% of children delivered by caesarean section were obese, compared with 7.5% of children born vaginally. In multivariable logistic and linear regression models adjusting for maternal pre-pregnancy BMI, birth weight, and other covariates, birth by caesarean section was associated with a higher odds of obesity at age 3 (OR 2.10, 95%CI 1.36 to 3.23), higher mean BMI z-score (0.20 units, 95% CI 0.07 to 0.33), and higher sum of triceps + subscapular skinfold thicknesses (0.94 mm, 95% CI 0.36 to 1.51).
Conclusions
Infants delivered by caesarean section may be at increased risk of childhood obesity. Further studies are needed to confirm our findings and to explore mechanisms underlying this association.
doi:10.1136/archdischild-2011-301141
PMCID: PMC3784307  PMID: 22623615
18.  Does maternal feeding restriction lead to childhood obesity in a prospective cohort study? 
Archives of disease in childhood  2010;96(3):265-269.
Background
Some studies show that greater parental control over children’s eating habits predicts later obesity, but it is unclear whether parents are reacting to infants who are already overweight.
Objective
To examine the longitudinal association between maternal feeding restriction at age 1 and body mass index (BMI) at age 3 and the extent to which the association is explained by weight for length (WFL) at age 1.
Methods
We studied 837 mother–infant pairs from a prospective cohort study. The main exposure was maternal feeding restriction at age 1, defined as agreeing or strongly agreeing with the following question: “I have to be careful not to feed my child too much.” We ran multivariable linear regression models before and after adjusting for WFL at age 1. All models were adjusted for parental and child sociodemographic characteristics.
Results
100 (12.0%) mothers reported feeding restriction at age 1. Mean (SD) WFL z-score at age 1 was 0.32 (1.01), and BMI z-score at age 3 was 0.43 (1.01). Maternal feeding restriction at age 1 was associated with higher BMI z-score at age 3 before (β 0.26 (95% CI 0.05 to 0.48)) but not after (β 0.00 (95% CI −0.17 to 0.18)) adjusting for WFL z-score at age 1. Each unit of WFL z-score at age 1 was associated with an increment of 0.57 BMI z-score units at age 3 (95% CI 0.51 to 0.62).
Conclusions
We found that maternal feeding restriction was associated with children having a higher BMI at age 3 before, but not after, adjusting for WFL at age 1. One potential reason may be that parents restrict the food intake of infants who are already overweight.
doi:10.1136/adc.2009.175240
PMCID: PMC3703750  PMID: 21081589
19.  Fetal head circumference growth in children with specific language impairment 
Objective
To characterise fetal brain growth in children with specific language impairment (SLI).
Design
A nested case–control study.
Setting
Perth, Western Australia.
Participants
Thirty children meeting criteria for SLI at age 10 years were individually matched with a typically developing comparison child on sex, non-verbal ability, fetal gestational age, maternal age at conception, smoking and alcohol intake during pregnancy.
Main outcome measures
Occipitofrontal head circumference (HC) was measured using ultrasonography at approximately 18 weeks gestation. Femur length provided a measure of fetal length. Occipitofrontal HC was measured at birth and at the 1-year postnatal follow-up using a precise paper tape measure, while crown-heel length acted as an index of body length at both time points. Raw data were transformed to z-scores using reference norms.
Results
The SLI group had a significantly smaller mean HC than the typically developing comparison children at birth, but there was no group difference at 18 weeks gestation or at the 1-year postnatal follow-up. Individual analyses found that 12 SLI children had an HC z-score less than −1 at birth, with three of these cases meeting criteria for microcephaly. There was no group difference in the indices of overall body size at any time point.
Conclusions
Children with SLI are more likely to have a small HC at birth but not at 18 weeks gestation or infancy, suggesting growth asynchrony in brain development during the second half of pregnancy.
doi:10.1136/adc.2009.180331
PMCID: PMC3704335  PMID: 20921240
20.  Mothers’ experiences of bottle-feeding: a systematic review of qualitative and quantitative studies 
Archives of disease in childhood  2009;94(8):596-601.
Objective
Most babies receive at least some formula milk. Variations in formula-feeding practices can have both short- and long-term health consequences. We systematically reviewed the literature on parents’ experiences of bottle-feeding to understand how formula-feeding decisions are made.
Methods
We systematically searched for and appraised relevant English-language papers identified by searching 12 electronic databases, reference lists and related articles and by contacting first authors of included papers. We analysed and synthesised the included studies using a combination of narrative and thematic approaches. Consensus on the final inclusion, interpretation and synthesis of studies was reached across the research team.
Results
Six qualitative studies and 17 quantitative studies (involving 13,263 participants) were included. Despite wide differences in study design, context, focus and quality, several consistent themes emerged. Mothers who bottle-fed their babies experienced negative emotions such as guilt, anger, worry, uncertainty and a sense of failure. Mothers reported receiving little information on bottle-feeding and did not feel empowered to make decisions. Mistakes in preparation of bottle-feeds were common. No studies examined how mothers made decisions about the frequency or quantity of bottle-feeds.
Conclusions
Inadequate information and support for mothers who decide to bottle-feed may put the health of their babies at risk. While it is important to promote breastfeeding, it is also necessary to ensure that the needs of bottle-feeding mothers are met.
doi:10.1136/adc.2008.151910
PMCID: PMC3697301  PMID: 19602520
Infant feeding; formula milk; experiences; qualitative methods; systematic review
21.  Monitoring head size and growth using the new UK-World Health Organization growth standard 
Archives of disease in childhood  2011;96(4):386-388.
In order to assess the extent to which children in the United Kingdom (UK) will follow the UK-WHO head circumference standard, we used head circumference data from the Southampton Women’s Survey (SWS; n=3159) and the Avon Longitudinal Study of Parents and Children (ALSPAC; n=15,208) in children age 0-36 months, converted into z-scores using both the UK-WHO or UK1990 references. Rapid head growth was defined as crossing upwards through 2 major centile bands (1.33 SD). The UK-WHO standard identified many more infants with heads above the 98th centile compared to the UK1990 reference (UK-WHO 6% to 16% of infants at various ages, UK1990 1% to 4%). Rapid head growth in the first 6 to 9 months was also much more common using the UK-WHO standard (UK-WHO: 14.6% to 15.3%; UK1990: 4.8% to 5.1%). Practitioners should be aware of these findings to avoid unnecessary referrals.
doi:10.1136/adc.2010.200030
PMCID: PMC3685130  PMID: 21285227
ALSPAC; head circumference; growth charts; macrocephaly; microcephaly; hydrocephalus
22.  Folic acid supplements in pregnancy and early childhood respiratory health 
Archives of disease in childhood  2008;94(3):180-184.
Background
Folate supplementation is recommended for pregnant women to reduce the risk of congenital malformations. Maternal intake of folate supplements during pregnancy might also influence childhood immune phenotypes via epigenetic mechanisms.
Objective
To investigate the relationship between folate supplements in pregnancy and risk of lower respiratory tract infections and wheeze in children through 18 months of age.
Methods
In the Norwegian Mother and Child Cohort Study, questionnaire data collected at several time points in pregnancy and after birth, from 32,077 children born between 2000 and 2005, were used to assess effects of folate supplements during pregnancy on respiratory outcomes up to 18 months of age, accounting for other supplements in pregnancy and supplementation in infancy.
Results
Folate supplements in the first trimester were associated with increased risk of wheeze and respiratory tract infections up to 18 months of age. Adjusting for exposure later in pregnancy and in infancy, the relative risk of wheeze for children exposed to folic acid supplements in the first trimester was 1.06 (95% confidence interval: 1.03, 1.10), for lower respiratory tract infections the relative risk was 1.09 (95% confidence interval: 1.02, 1.15), and for hospitalizations for lower respiratory tract infections the relative risk was 1.24 (95% confidence interval: 1.09, 1.41).
Conclusions
Folic acid supplements in pregnancy were associated with a slightly increased risk of wheeze and lower respiratory tract infections up to 18 months of age. Results support possible epigenetic influences of methyl donors in maternal diet during pregnancy on respiratory health in children.
doi:10.1136/adc.2008.142448
PMCID: PMC3612898  PMID: 19052032
Dietary Supplements; Folic acid; Pregnancy; Respiratory Tract Infections; Wheezing
23.  Predicting mortality for paediatric inpatients where malaria is uncommon 
Archives of disease in childhood  2012;97(10):889-894.
Objective
As the proportion of children living low malaria transmission areas in sub-Saharan Africa increases, approaches for identifying non-malarial severe illness need to be evaluated to improve child outcomes.
Design
As a prospective cohort study, we identified febrile paediatric inpatients, recorded data using Integrated Management of Childhood Illness (IMCI) criteria, and collected diagnostic specimens.
Setting
Tertiary referral centre, northern Tanzania.
Results
Of 466 participants with known outcome, median age was 1.4 years (range 2 months–13.0 years), 200 (42.9%) were female, 11 (2.4%) had malaria and 34 (7.3%) died. Inpatient death was associated with: Capillary refill >3 s (OR 9.0, 95% CI 3.0 to 26.7), inability to breastfeed or drink (OR 8.9, 95% CI 4.0 to 19.6), stiff neck (OR 7.0, 95% CI 2.8 to 17.6), lethargy (OR 5.2, 95% CI 2.5 to 10.6), skin pinch >2 s (OR 4.8, 95% CI 1.9 to 12.3), respiratory difficulty (OR 4.0, 95% CI 1.9 to 8.2), generalised lymphadenopathy (OR 3.6, 95% CI 1.6 to 8.3) and oral candidiasis (OR 3.4, 95% CI 1.4 to 8.3). BCS <5 (OR 27.2, p<0.001) and severe wasting (OR 6.9, p<0.001) were independently associated with inpatient death.
Conclusions
In a low malaria transmission setting, IMCI criteria performed well for predicting inpatient death from non-malarial illness. Laboratory results were not as useful in predicting death, underscoring the importance of clinical examination in assessing prognosis. Healthcare workers should consider local malaria epidemiology as malaria over-diagnosis in children may delay potentially life-saving interventions in areas where malaria is uncommon.
doi:10.1136/archdischild-2012-301812
PMCID: PMC3508729  PMID: 22872067
24.  Perinatal interventions and survival in resource-poor settings: which work, which don’t, which have the jury out? 
Archives of disease in childhood  2010;95(12):1039-1046.
Perinatal conditions make the largest contribution to the burden of disease in low-income countries. Although postneonatal mortality rates have declined, stillbirth and early neonatal mortality rates remain high in many countries in Africa and Asia, and there is a concentration of mortality around the time of birth. Our article begins by considering differences in the interpretation of ‘intervention’ to improve perinatal survival. We identify three types of intervention: a single action, a collection of actions delivered in a package and a broader social or system approach. We use this classification to summarise the findings of recent systematic reviews and meta-analyses. After describing the growing evidence base for the effectiveness of community-based perinatal care, we discuss current concerns about integration: of women’s and children’s health programmes, of community-based and institutional care, and of formal and informal sector human resources. We end with some thoughts on the complexity of choices confronting women and their families in low-income countries, particularly in view of the growth in non-government and private sector healthcare.
doi:10.1136/adc.2009.179366
PMCID: PMC3428881  PMID: 20980274
25.  Infant feeding practice and childhood cognitive performance in South India 
Archives of disease in childhood  2009;95(5):347-354.
Aim
Several studies have suggested a beneficial effect of infant breast-feeding on childhood cognitive function. Our main objective was to examine whether duration of breast-feeding and age at introduction of complementary foods are related to cognitive performance in 9-10 year old school going children in South-India.
Methods
We examined 514 children from the Mysore Parthenon birth cohort for whom breast-feeding duration (6 categories from <3 to ≥18 months) and age at introduction of complementary foods (4 categories from <4 to ≥6 months) were collected at the 1st, 2nd and 3rd year annual follow-up visits. Their cognitive function was assessed at a mean age of 9.7 years using 3 core tests from the Kaufman Assessment Battery for children and additional tests measuring long-term retrieval/storage, attention and concentration, visuo-spatial and verbal abilities.
Results
All the children were initially breast-fed. The mode for duration of breast-feeding was 12-17 months (45.7%) and for age at introduction of complementary foods 4 months (37.1%). There were no associations between longer duration of breast-feeding, or age of introduction of complementary foods, and cognitive function at 9-10 years, either unadjusted or after adjustment for age, sex, gestation, birth size, maternal age, parity, socio-economic status, parents’ attained schooling, and rural/urban residence.
Conclusions
Within this cohort, in which prolonged breast-feeding was the norm (90% breast-fed ≥6 months and 65% breast-fed for ≥12 months), there was no evidence suggesting a beneficial effect of longer duration of breast-feeding on later cognitive ability.
doi:10.1136/adc.2009.165159
PMCID: PMC3428883  PMID: 19946010
Breast-feeding; Complementary foods; Children; Cognitive performance; India

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