EVIDENCE-BASED CHILD HEALTH: A COCHRANE REVIEW JOURNALEvid.-Based Child Health 8: 253–254 (2013)Published online in Wiley Online Library (http://www.evidence-basedchildhealth.com). DOI: 10.1002/ebch.1908

Editorial

Our new venture into Eco-Paediatrics

Joan L. Robinson1*1Department of Pediatrics, University of Alberta and Stollery Children’s Hospital, Edmonton, Alberta, Canada

It is early January in Edmonton, the time of year when‘a nice day’ means it is brilliantly sunny and coldrather than cloudy and cold. One bonus is that we nolonger have to even consider arthropod-borne diseasein the differential diagnosis for non-travellers!

I would wager that the only Latin phrase thatalmost all English-speaking physicians would be ableto accurately translate would be ‘Primum Non Nocere’(First, do no harm). Harm in paediatrics consists of notonly suggesting remedies that result in adverse eventsbut also advising parents or the health-care systemto spend their limited, hard-earned cash on remediesthat have no efficacy. It is vital to educate health-care workers about therapies that have been provento not be worthwhile. Thus, we are introducing anew column in this issue entitled ‘Eco-Paediatrics . . . .Reducing waste in child health one intervention ata time’. The premiere column outlines therapies thatare of no value for otitis media with effusion (1). Acommon concern amongst clinicians is that parentswill seek help elsewhere if they are sent home withreassurance rather than a prescription. However, twostudies have shown that when properly informed,parents are satisfied with delayed or no antibioticprescriptions for acute otitis media (2). A studyfrom the US published a decade ago showed thateven if provided with an ‘emergency prescription’,most parents managed their child with acute otitismedia without filling the prescription (3). We needto recognize that the relationship between going homewith a bottle of medicine and parental satisfaction maybe markedly over-estimated by clinicians. Movingfrom the level of the patient to the level of the publicpayer, there is increasing interest in the notion that thecorrelation between cost and improvement in qualityof health deserves to be a key factor in deciding whichinterventions should be promoted (4).

Cardiff Child Protection Systematic Reviews(CORE INFO) is a product of collaboration betweenthe National Society for the Prevention of Crueltyto Children and the Early Years research sectionof the Cochrane Institute of Primary Care andPublic Health, Department of Child Health, School

*Correspondence to: Joan L. Robinson, Stollery Children’s Hos-pital, University of Alberta, Edmonton, Alberta, Canada. E-mail:jr3@ualberta.ca

of Medicine, Cardiff University (http://www.core-info.cardiff.ac.uk/). They currently have 11 reviews ontopics related to child abuse and neglect. We have thepleasure of publishing the most recent update of theirbruising review in this issue (5) which is worth a readby anyone who could potentially see abused children.

Life can be complicated for children with autismspectrum disorder and their families even if they havenormal intelligence as these children have limitedinsight into how their behaviour affects others. Gainsin social skills are vital for maintaining good rela-tionships with friends and family and for ultimatelystaying employed. The commentary by Gillies pointsout the limitations of current studies on the efficacyof social skills groups for school-aged children withautism spectrum disorder and normal intelligence (6).

Another group of children who create difficultiesfor parents, teachers and themselves are those withconduct disorders. Prisons are full of adults who hadconduct disorder as children, often combined withfoetal alcohol syndrome. For the review ‘Behaviouraland cognitive-behavioural group-based parenting pro-grammes for early-onset conduct problems in childrenaged 3 to 12 years’ (7), Haroon points out in thecommentary that although long-term studies are lack-ing, there is sufficient evidence that short-term gainsare achieved by parenting groups to argue for theirwidespread availability (8).

The vast majority of patients receiving chemother-apy for malignancies or in intensive care units forany reason in developing countries have a tunnelled ornon-tunnelled central venous catheter for infusions andfor obtaining blood samples. Such catheters are espe-cially beneficial in paediatrics where venous accesscan be ‘a nightmare’ for clinicians and needle phobiacan be ‘a nightmare’ for the child. However, it is verydisappointing when a vital central catheter becomesoccluded and is no longer functional. Many institutionshave protocols for use of anti-coagulants in this settingas most occlusions are assumed to be due to thrombi.The commentary by Massicotte et al . (9) reviews thestate of the art in the field after publication of thereview ‘Interventions for restoring patency of occludedcentral venous catheter lumens’ (10).

Comments are forever welcome at jr3@ualberta.ca

Copyright 2013 John Wiley & Sons, Ltd.

254 Editorial

Declaration of interest

No conflicts of interest related to this article.

References1. EBCH Editorial Office, Cohen E. Antihistamines or decongestants

for otitis media with effusion—do they work? Evid-Based ChildHealth 2013; 8: 264–265.

2. Andrews T, Thompson M, Buckley DI, Heneghan C, Deyo R,Redmond N, et al . Interventions to influence consulting andantibiotic use for acute respiratory tract infections in children: Asystematic review and meta-analysis. PLoS One 2012; 7: e30334.DOI: 10.1371/journal.pone.0030334. Epub Jan 27, 2012.

3. Siegel RM, Kiely M, Bien JP, Joseph EC, Davis JB, Mendel SG,et al . Treatment of otitis media with observation and a safety-netantibiotic prescription. Pediatrics 2003; 112(3 Pt 1): 527–531.

4. Hussey PS, Wertheimer S, Mehrotra A. The association betweenhealth care quality and cost: A systematic review. Ann Intern Med .2013; 158: 27–34.

5. Maguire S, Mann M. Systematic reviews of bruising in relation tochild abuse - what have we learnt: an overview of review updates.Evid-Based Child Health 2013; 8: 255–263.

6. Gillies D, Carroll L, Loos M. Commentary on ‘Social skills groupsfor people aged 6 to 21 with autism spectrum disorders (ASD)’.Evid-Based Child Health 2013; 8: 316–317.

7. Furlong M, McGilloway S, Bywater T, Hutchings J, SmithSM, Donnelly M. Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems inchildren aged 3 to 12 years. Cochrane Database Syst Rev 2012;Issue 2. Art. No.: CD008225.

8. Haroon M. Commentary on ‘Behavioural and cognitive-behavioural group-based parenting programmes for early-onsetconduct problems in children aged 3 to 12 years’. Evid-BasedChild Health 2013; 8: 693–694.

9. Bauman ME, Massicotte MP. Commentary on ‘Interventions forrestoring patency of central venous catheter lumens’. Evid-BasedChild Health 2013; 8: 750–751.

10. Van Miert C, Hill R, Jones L. Interventions for restoring patencyof occluded central venous catheter lumens. Cochrane DatabaseSyst Rev 2012; Issue 4. Art. No.: CD007119.

Copyright 2013 John Wiley & Sons, Ltd. Evid.-Based Child Health 8: 253–254 (2013)DOI: 10.1002/ebch.1908