Downloaded from http://adc.bmj.com/ on November 16, 2015 - Published by group.bmj.com
Editorial bruises to the ear in collections from early mobile infants—both rare sites for accidental injuries in any age group in my experience.” In addition to these changes, the final paragraph has been revised.
3 4
Competing interests 1 December 2011–31 October 2014 Board of Trustees, NSPCC.
▸ http://dx.doi.org/10.1136/archdischild-2014-307120
Provenance and peer review Commissioned; internally peer reviewed.
Arch Dis Child 2015;100:419–420. doi:10.1136/archdischild-2014-307869
To cite Stephenson T. Arch Dis Child 2015;100:419– 420.
REFERENCES
Received 7 January 2015 Accepted 14 January 2015 Published Online First 4 February 2015
2
1
Stephenson TJ, Bialis Y. Estimation of the age of bruising. Arch Dis Child 1996;74:53–5. Mortimer PE, Freeman M. Are facial bruises in babies ever accidental? Arch Dis Child 1983;58:75–6.
5
6
Labbé J, Caouette G. Recent skin injuries in normal children. Pediatrics 2001;108:271–6. Pierce M, Kaczor K, Aldridge S, et al. Bruising characteristics discriminating physical child abuse from accidental trauma. Pediatrics 2010;125: 67–74. Kemp AM, Dunstan F, Nuttall D, et al. Patterns of bruising in preschool children—a longitudinal study. Arch Dis Child 2015;100:426–31. Kemp AM, Maguire SA, Nuttall D, et al. Bruising in children who are assessed for suspected physical abuse. Arch Dis Child 2014;99:108–13.
ARCHIVIST
Medicines for tummy-aches: what works? It is a frequent paradox that the more common a condition, the less impressive the evidencebase for its management. A good example is functional abdominal pain (FAP), one of the most common problems we see in our clinics. A team from The Netherlands undertook a systematic review to examine the evidence for drug treatments in children aged 4 to 18 years (Korterink J, et al. J Pediatr 2015;166:424–31). They found much written on the subject, but little hard evidence. From over 300 papers, they found only six studies worth considering, and all of these were considered to be of ‘very poor’ methodological quality. For many commonly used drugs (eg, Mebeverine) published data exists only for adults. They found evidence from double-blind placebo-controlled randomised controlled trials in FAP, for only five drugs or combinations. All of it was weak: ▸ Peppermint oil: one trial in children with irritable bowel syndrome (IBS) associated FAP showed significant improvement in pain scores ▸ Amitryptiline (a tricyclic antidepressant): two trials, which showed improvements in ‘quality of life’ scores but not in pain or IBS symptoms. ▸ Famotidine (an H-2 receptor antagonist, similar to Ranitidine): one trial in children with pain and dyspeptic symptoms showed no improvement in pain but a significant ‘global improvement’. ▸ Cyproheptadine (an antihistamine and serotonin antagonist, similar to Pizotifen): one trial showing significant improvement in pain frequency and severity, and in ‘global assessment’. ▸ Polyethylene glycol (PEG) (‘Movicol’, an osmotic laxative) in combination with Tergaserod (a stimulant laxative, now banned in the US due to safety concerns in adults): one trial in children with constipation-predominant IBS showing the combination was significantly superior to PEG alone in improving pain symptoms. Follow-up periods were short, mostly 2–4 weeks. There were suspiciously no good studies reporting negative findings, suggesting a publication bias towards positive outcomes. It was notable that all the studies had a high placebo-response rate, between 20% and 50%. There are problems in conducting this kind of research: parents may be reluctant to consent to a trial where their child has a 50% chance of getting a placebo; numbers need to be large to see a significant benefit because of the expected high placebo response rate; there may be reluctance to fund research into something seen by some as trivial and non-life threatening. There is better evidence for the effectiveness of psychological therapies in functional abdominal pain (see Arch Dis Child 2015;100:37): but of course, this requires more resources than just prescribing a medicine. Competing interests None. Provenance and peer review Commissioned; internally peer reviewed. Received 05 March 2015 Accepted 11 March 2015 Arch Dis Child 2015;100:420. doi:10.1136/archdischild-2015-308538
420
Stephenson T. Arch Dis Child May 2015 Vol 100 No 5
Downloaded from http://adc.bmj.com/ on November 16, 2015 - Published by group.bmj.com
Medicines for tummy-aches: what works?
Arch Dis Child 2015 100: 420
doi: 10.1136/archdischild-2015-308538 Updated information and services can be found at: http://adc.bmj.com/content/100/5/420
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Editorial bruises to the ear in collections from early mobile infants—both rare sites for accidental injuries in any age group in my experience.” In addition to these changes, the final paragraph has been revised.
3 4
Competing interests 1 December 2011–31 October 2014 Board of Trustees, NSPCC.
▸ http://dx.doi.org/10.1136/archdischild-2014-307120
Provenance and peer review Commissioned; internally peer reviewed.
Arch Dis Child 2015;100:419–420. doi:10.1136/archdischild-2014-307869
To cite Stephenson T. Arch Dis Child 2015;100:419– 420.
REFERENCES
Received 7 January 2015 Accepted 14 January 2015 Published Online First 4 February 2015
2
1
Stephenson TJ, Bialis Y. Estimation of the age of bruising. Arch Dis Child 1996;74:53–5. Mortimer PE, Freeman M. Are facial bruises in babies ever accidental? Arch Dis Child 1983;58:75–6.
5
6
Labbé J, Caouette G. Recent skin injuries in normal children. Pediatrics 2001;108:271–6. Pierce M, Kaczor K, Aldridge S, et al. Bruising characteristics discriminating physical child abuse from accidental trauma. Pediatrics 2010;125: 67–74. Kemp AM, Dunstan F, Nuttall D, et al. Patterns of bruising in preschool children—a longitudinal study. Arch Dis Child 2015;100:426–31. Kemp AM, Maguire SA, Nuttall D, et al. Bruising in children who are assessed for suspected physical abuse. Arch Dis Child 2014;99:108–13.
ARCHIVIST
Medicines for tummy-aches: what works? It is a frequent paradox that the more common a condition, the less impressive the evidencebase for its management. A good example is functional abdominal pain (FAP), one of the most common problems we see in our clinics. A team from The Netherlands undertook a systematic review to examine the evidence for drug treatments in children aged 4 to 18 years (Korterink J, et al. J Pediatr 2015;166:424–31). They found much written on the subject, but little hard evidence. From over 300 papers, they found only six studies worth considering, and all of these were considered to be of ‘very poor’ methodological quality. For many commonly used drugs (eg, Mebeverine) published data exists only for adults. They found evidence from double-blind placebo-controlled randomised controlled trials in FAP, for only five drugs or combinations. All of it was weak: ▸ Peppermint oil: one trial in children with irritable bowel syndrome (IBS) associated FAP showed significant improvement in pain scores ▸ Amitryptiline (a tricyclic antidepressant): two trials, which showed improvements in ‘quality of life’ scores but not in pain or IBS symptoms. ▸ Famotidine (an H-2 receptor antagonist, similar to Ranitidine): one trial in children with pain and dyspeptic symptoms showed no improvement in pain but a significant ‘global improvement’. ▸ Cyproheptadine (an antihistamine and serotonin antagonist, similar to Pizotifen): one trial showing significant improvement in pain frequency and severity, and in ‘global assessment’. ▸ Polyethylene glycol (PEG) (‘Movicol’, an osmotic laxative) in combination with Tergaserod (a stimulant laxative, now banned in the US due to safety concerns in adults): one trial in children with constipation-predominant IBS showing the combination was significantly superior to PEG alone in improving pain symptoms. Follow-up periods were short, mostly 2–4 weeks. There were suspiciously no good studies reporting negative findings, suggesting a publication bias towards positive outcomes. It was notable that all the studies had a high placebo-response rate, between 20% and 50%. There are problems in conducting this kind of research: parents may be reluctant to consent to a trial where their child has a 50% chance of getting a placebo; numbers need to be large to see a significant benefit because of the expected high placebo response rate; there may be reluctance to fund research into something seen by some as trivial and non-life threatening. There is better evidence for the effectiveness of psychological therapies in functional abdominal pain (see Arch Dis Child 2015;100:37): but of course, this requires more resources than just prescribing a medicine. Competing interests None. Provenance and peer review Commissioned; internally peer reviewed. Received 05 March 2015 Accepted 11 March 2015 Arch Dis Child 2015;100:420. doi:10.1136/archdischild-2015-308538
420
Stephenson T. Arch Dis Child May 2015 Vol 100 No 5
Downloaded from http://adc.bmj.com/ on November 16, 2015 - Published by group.bmj.com
Medicines for tummy-aches: what works?
Arch Dis Child 2015 100: 420
doi: 10.1136/archdischild-2015-308538 Updated information and services can be found at: http://adc.bmj.com/content/100/5/420
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
