12 FEBRUARY 2002

MMR, Measles in the Gut, Cough Medicines, Antibiotics, Food Poisoning, Ritalin

MMR – DO RECENT REPORTS HELP US DECIDE?

The Government is planning to run a series of TV adverts to persuade parents that MMR is a safe option for our children. What do the recent reports and news items add to the information we already have?

With MMR still dominating the newspapers this week and signs that there may be several measles outbreaks, it has been a difficult week for parents of pre-school children. A lot of what is being written and discussed is clouded by emotion and powerful emotive language. We provide a summary of the controversy looking at the details of what is known about the vaccines and a discussion of the science behind the controversy. Read our article on MMR. The National Electronic Library for Health, an NHS pilot site, analyses scientific reports and how they are reported. They discuss and criticise the reports on MMR’s safety and the links with autism and bowel disease (read them at NeLH: 'Hitting the Headlines') and the way the papers have interpreted the findings – the Daily Mail gets lambasted for its poor interpretation of the evidence. They also detail the report of 498 autistic children in North London where no apparent link was found between MMR and the incidence or onset of autism – it is the only recent report to look at vaccinated and unvaccinated children.

MEASLES IN THE GUT

Most of the papers have reported the study from the Royal Free published online this week looking at the bowels of children with developmental disorders and bowel inflammation. Measles virus was found in the guts of 75 out of 91 children in the affected group and only 5 out of 70 controls. However it is impossible to extrapolate this to the MMR/autism controversy as the children were not autistic and it is not known if any of the children in either group had had MMR or what the source of the virus in the bowel was. Read the paper online at Molecular Pathology - Potential viral pathogenic mechanism for new variant inflammatory bowel disease and read a discussion of it at the National Electronic Library for Health site (see above), ‘Misreporting Measles Research’.

ARE COUGH MEDICINES A WASTE OF MONEY?

A report in this week’s British Medical Journal pooled the results of several studies that compared cough medicines to placebos (something that looks and tastes the same but has no clinical effect) in adults. They found that cough medicines don’t seem to work! In 9 of the 15 trials there was no difference between the drugs and the placebos and in the other 6 trials the ‘studies were of questionable clinical significance’. Of course it is very difficult to tell if a cough mixture is working and they admitted that the trials did not assess things like the quality of sleep at night, but parents should know that children’s cough mixtures usually contain even safer (i.e. lower) doses of the drugs to prevent coughing and so may be even more useless. Both antihistamines and codeine were assessed in the trials which can be read at BMJ - cough medicines. Don’t forget that coughs can be a sign of other diseases - in particular, a persistent or recurring night time cough may be a sign of asthma – so read our analysis of children’s coughs. Considering that the cough medicine industry is worth £94 million in the UK each year parents may want to save their money. Sugary syrups can relieve pain in babies and make you feel sleepy so even without drugs a ‘simple linctus’ (cough syrup with no drugs in) can calm a coughing child and make them feel sleepy – the very act of a parent giving personal care and affection will make an ill child feel better.

THE GREAT ANTIBIOTIC CONUNDRUM

It’s the season of coughs and colds - should you ask your doctor for antibiotics for your child or will you be adding to the new ‘superbugs’ resistant to commonly prescribed antibiotics? A recent report published by the British Lung foundation found that if patients asked for antibiotics they were far more likely to be given them by their GP.

Most coughs and colds are caused by viruses which get better without treatment in a few days. It is impossible to tell by looking at the throat whether an infection is viral or bacterial. When you or your child are one or two days into a viral infection and feeling terrible then a course of antibiotics will coincide with the recovery period from the virus – often leading parents to think that the antibiotics have cured them or the child when, in fact they would have recovered anyway. While there is little risk to a child from antibiotics they can have an environmental effect and also upset the normal bowel flora leading children more susceptible to other infections such as thrush. There are no treatments for the common cold; paracetamol and ibuprofen can help fever and warm steamy air and drinking plenty of fluids may also help. So why go to the doctor at all? Occasionally coughs and colds do develop into other problems - ear infections, bronchitis etc – and if you have any worries or concerns particularly about young children it is worth getting your doctor to check them out. And what to do about the antibiotics? Try saying to the doctor as you go in to the surgery ‘I don’t want antibiotics unless absolutely necessary’ – your child will probably get better anyway and it will help the environment. You can access the British Lung Foundation through their website.

FOOD POISONING

The Government has released figures that show that 4 million people a year in the UK get food poisoning often because of poor food handling and hygienic practices. What should you do if your child gets diarrhoea and vomiting? These are usually simple to treat at home – read diarrhoea and vomiting in babies and small children and gastroenteritis for advice. If you think that your child may have food poisoning you should contact your GP who will test the stool and notify the local infectious disease team; they may be able to trace the source – shop, canteen or restaurant - and hopefully prevent other children getting sick. One of the commonest sources of food poisoning is lack of hygiene when handling food, such as not washing hands, and as it is estimated that most people don’t report food poisoning to their doctors, these poor hygienic practices are allowed to continue putting your family’s health at risk.

RITALIN

There was a first hand account of an adult’s addiction to Ritalin in the Guardian this week. While it is only personal experience parents whose children are on Ritalin or who have ADHD may be interested to read about its effects from an adult (who admittedly has depression and all sorts of other problems!). Read it at ‘Fast Times’ in the Guardian. For more detailed analysis of Ritalin and the diagnosis and treatment of ADHD read our article on attention deficit hyperactivity disorder.