Professor Tom Irons October 9th 2007 “Paediatric Pearls”
The USA schedule is far more complex than the British counterpart. Many immunisations are “routine” or recommended in the USA, but not so in UK.
Pertussis: big increase in >11 year olds, due to waning immunity. Logical to give booster acellular vaccine in >11 year olds to boost herd immunity. Best way to diagnose pertussis is clinically with cough >2 weeks, sometimes with whoop. apnoea or cyanosis. Note that cough is a late manifestation of the infection.
Rotavirus: big cause of mortality and morbidity world-wide and even in the USA causes up to 70,000 hospitalisations at a cost of 1 BN $! Immunisation give 98% protection and gives a drop of 96% in hospitalisations.
Immunisation gives no increase in intussusceptions rates now the immunisation is given outside the intussusceptions age- range.
HPV Vaccine: cervical cancer is a massive killer in the 3rd world. You need 3 immunisations, each at a cost of c. $120. Not justified if you can rely on the patient having her cervical smear regularly. The vaccine against the 4 strains gives virtually 100% against the 4 strains
Autism – best thought of as Autism Spectrum Disorder. Increasing though we don’t know why. Increase is definitely not related to immunisations – totally disproven.
It is a neurological disorder affecting sensory integration, social relations and communication. Diagnose it as early as possible as early diagnosis does make a difference. A reliable early sign is poor eye contact.
“They all need B6 and Magnesium”. Make sure they don’t have celiac – especially if they have any stigmata of celiac.
Tom recommends especially the writings of Stanley Greenspan.
Also highly recommends the book:
More Than Words: Helping Parents
Promote Communication and Social Skills in Children with Autism Spectrum
by Fern Sussman (Author), Robin Baird Lewis (Illustrator)
This book was developed to support More Than Words
– The Hanen. Program. ®. for Parents of Children with Autism Spectrum
Disorder, and is also widely used ...
He also recommends the book “The curious incident of the dog in the night-time” to further understanding of autistic spectrum disorders.
Also the Sunrise movement which has apparently come to the UK - www.sunriseschool.net/
Basically, “You never want to miss these conditions: early treatment makes a huge difference!”
Enuresis: Tom recommends the ERIC web-site and the modern alarm, which really does the job. www.eric.org.uk/main.html Use DDAVP for social emergencies
Obesity: a lot of these children should be on metformin as many of them are insulin resistant and many have acanthosis nigricans. “Every clinic I see a patient on metformin”. They also need dietary counselling of course.
Depression: “I never stopped treating my patients with SSRIs” (in spite of the scare!). Recent spectacular rise in suicides age 12 – 19, paralleling the drop in anti-depressant prescribing during that time! You need to watch these children very carefully for the first 3 weeks which is the danger time.
OCD: “I use sertraline in most of them, most often needing to go beyond 50 mgm per day.
ADHD: clonidine useful for aggressive behaviour – use it as a patch. The combination with Ritalin is very effective. I have a patient of 60 I treat for ADHD! (It persists into adulthood commonly!)
Summarised with apologies by BS as it scarcely does justice to the stories and the wider picture of the lecture!