Pediatric Grand Rounds: Vol 1 Issue 25

"Daddy, you should do a Tom and Jerry blog."

How can I resist those eyes.

A 7-year old (who looks like Cindy-Loo Who) has special powers over the dominant male in her household. Any of you men out there with daughters know what I mean. It is like they hold your remote-control. Yes, it is a somewhat violent cartoon, but what is done is done. Now I have no choice. I must obey.

So, I give you:

Pediatric Grand Rounds, a la Tom and Jerry!

(Click below to start with the opening theme song)


Now, I have to confess, this is a daunting task. How in the world can I tie Tom and Jerry into Grand Rounds? So I looked in Wikipedia:

The plots of each short usually center on Tom\’s frustrated attempts to catch Jerry, and the mayhem and destruction that ensues. Because they seem to get along in some cartoon shorts (at least in the first minute or so), it is unclear why Tom chases Jerry so much, but some reasons given may include normal feline/mouse enmity, duty according to his owner, revenge, or competition with another cat, among other reasons.

Tom rarely succeeds in catching Jerry, mainly because of Jerry\’s craftiness and cunning abilities, but sometimes because of Tom\’s own stupidity. Tom usually beats Jerry when Jerry becomes the instigator or when he crosses some sort of line.

Then it hit me: they are the ultimate symbol of the battle between protagonist and antagonist. It is good versus evil, strong versus weak, monkey versus llama, accordions versus…well, basically anything besides accordions, all wrapped into one!!! What a brilliant child I have!

Section I: Mankind vs. Disease

We are in a battle with disease. The job of the medical profession is to help mankind fight against disease and suffering. The focus of pediatrics is even more serious in that the victims are the smallest and most vulnerable.

Walter at Highlight Health uses a recent report on the over-use of antibiotics and under-use of nasal steroids in sinusitis to give a very good overview of the proper treatment of this condition.

From Medgadget comes the review of the EarCheck Middle Ear Monitor. Is this good or bad? Imagine a parent arguing that you are not as reliable as the ear monitor. Note to self: when the hair stands up on the back of your neck, pay attention.

Bryan from Parenting Solved discusses Nestle\’s new formula containing probiotics. So I ask you: are you pro or anti biotic?

Ex Utero of Tales from the Womb reviews an article regarding Extremely Low Birthweight Infants and their long-term outcomes. Is the glass half-empty or half-full?

In one of two posts for PGR, Girl MD brings up the distressingly common use of antibiotics for asthma (or Vitamin Z, as I like to call it).

Thanks to Sidharth Sethi for pointing me to the Most Popular Pediatrics Websites of 2006.

The "Sultan of Pediatrics" (as he likes to be called), Clark Bartram posts a terrific article about pain in the Neonate on his blog Unintelligent Design.

We have come a long way in how we prevent, interpret, and treat pain in the neonate, particularly during acutely painful events such as the ubiquitous heel sticks I mentioned above. Sadly it wasn\’t that long ago that we questioned whether neonates even felt pain.

From the world-renown Breath Spa for Kids, Shinga (who is by far the smartest Shinga I have ever met) writes about the dangers of Misdiagnosis or Inappropriate Allergy and Intolerance Tests:

In addition to clinical harm, children who are mis-diagnosed with allergies or intolerances may follow a very restricted diet that might not provide all of the nutrients that they need and may lead to malnutrition.

Section II: Knowledge vs. Ignorance

Ignorance may be the most deadly disease of all. How much of our time and energy is needlessly spent over dispelling misconceptions put there by folks with an agenda? The battle starts here for many bloggers.

Steve Novella from NeuroLogica Blog discusses genetic aspects of Autism, dismissing the myth of immunizations being the cause:

However, it is distressing that so many ideologues have targeted autism for campaigns of misinformation, conspiracy mongering, and pseudoscience. They have largely placed themselves at odds with the scientific and medical community, and if anything, despite their intentions, are hampering progress.

Prometheus from A Photon in the Darkness discusses whether Listening to Autism is about listening to parents\’ biased perspective or to the science:

If people are going to “listen to autism” and ignore the science, what’s the point?

Flea (who always loves a good llama) reviews the book Unstrange Minds by Richard Grinker – a book by an Anthropologist who is also the father of an autistic child:

Grinker\’s major contribution in this book is to demystify the concept of "epidemic" as it applies to the category "autism". In clear and robust language, accessible to the non-academic reader, Grinker explains that autistic people have always been with us. It is only now that we are able to see them because we know how to name the phenomenon.

Following this, Flea even got a thank-you from the author.


Dr Crippen talks about an encounter with a patient who clearly has asthma, but both patient and mother (or "Mum" as he puts it) are reluctant to accept this diagnosis.

We have to find a way to convince her that antibiotics are not the answer to Robbie’s cough, and we are not helped by the fact that some helpful “health care professionals” have an amoxicillin-rich relationship with Robbie at the local walk-in centre.

Do patients accept the evidence, or do they look to what they want to hear. It sounds like things are the same across the pond as they are here.


The ever thought-provoking Sandy from Junkfood Science posted two articles which challenge popular thoughts on obesity in childhood. The first discusses the failure of public health interventions on childhood obesity:

There has not been a peep in our news about this story, nor about the results of a number of recent clinical trials in Britain that have tested childhood obesity prevention programs based on increasing activity levels in children. The results are not surprising to those who understand the physiology of the development of body sizes, but probably sound unbelievable to anyone who’s relied on mainstream media for their information.

She Continues:

The body of evidence has consistently shown that no physical activity-based childhood obesity intervention effort — no matter how intensive, comprehensive or long-lasting — has ever been able to show a reduction in childhood obesity rates. Not here, not anywhere.

The second article challenges the popularly-accepted correlation between obesity and early menarche in girls. Not only is this unproven, it could drive us back to a Victorian mindset.

Kevin, M.D. points to a study which shows inflated infant mortality numbers that are potentially used for political agendas. Manipulate information for political gain? I am utterly shocked at the thought!

Section III: Good vs. Bad Parenting

I wear both hats. I am a pediatrician and a parent. I tell people how to parent, then go home and am mystified as to how I should parent. Some things come easily, others much harder. The bottom line is that being a good parent takes more work than being a bad one.

Anxiety, Addiction and Depression Treatments discusses the fact that many parents are reluctant to have their children associate with children with a psychiatric diagnosis. They raise the point that this kind of interaction is exactly what is best for the children. I raise the point that these same parents let their children associate with Sponge Bob, Brittany Spears, and watch violent TV. "Like Tom and Jerry?" you ask. Hey, that\’s not fair!

From Revolution Health is Stacy Stryer, who confesses to sneaking sweets. We need to watch what we teach our children. They may just do what we do!

Imagine that, not telling the truth to your pediatrician! Judy from Tiggers Don\’t Jump confesses that she was not always truthful with her child\’s doctor. I am still reeling.

Section IV: Choice A vs. Choice B

Sometimes decisions are not black and white. Sometimes we have to decide between two things that have some good and some bad on their sides. These are choices where the help of other colleagues and friends comes in most welcome.

Neonatal Doc looks at two articles regarding Caesarian Sections. Are there too many? Is the risk worth the benefit?

Immunizations are on #1 Dinosaur\’s mind as he muses (which I must say, is a very good habit) about various vaccines. Should we mandate Varivax, Gardisil, Hep B, and Meningiococcal vaccines? Smart people can have opposite views on things like this. It is a discussion well-worth having.

Dr. Charles thinks about the whole concept of having a fast-food restaurant in a Children\’s hospital, raising the point that most parents are going out to get fast-food for the children, even if they are not in the hospital. What is the solution, to single out a villain (like McDonalds) or change society? I agree with the first comment in response to this post: When was the last time you found healthy food in a hospital?

Stacy (of The Preemie Experiment) has a post regarding Resuscitation Limitations based on gestation that got 78 comments (as of my reading)! I am not sure if I got that many comments since the start of the year! Do you think she touched a nerve? Who has the right to choose when children are resuscitated? Comment away!

Section V: Frustration vs. Joy

Yes, this is a hard job we have chosen – either as a pediatric healthcare worker, or as a parent. But there are moments where the frustration gives way to the pleasure that drew us to the task in the first place.

Dr. Val from Revolution Health tells a sweet tale of an encounter with a Girl Scout selling cookies. I\’ll take an order of Samoas.

Scalpel or Sword rejoices in getting a thank-you note from a child. Yes, that is truly a spoonful of sugar.

A very fun read can be had at Trauma Queen, where Kal discusses the advantage of taking time to see the point of view of other healthcare workers, after he spends some time on the pediatric (or paediatric) ward. He seems like a nice bloke!

Putting the joy of childbirth in a new perspective, N=1 of Universal Health shares of a nurse\’s experience helping ewes give birth to lambs:

Later that afternoon, with the ewe and lamb rested, and Mary and her sister recovered, they took chairs out to the pasture to watch the lambs frolic. Mary delighted in recounting the scene.

“You’d be sitting and watching the peaceful, cud-chewing mothers when all of a sudden, UP would pop a lamb, and then another one, and another. And they would cavort and twirl and have just the most fun at being lambs, at saying ‘Hello World’ and at playing joyfully. It was fantastic. I was mesmerized.”

And that’s how I welcome Spring – with warm memories of Dr. Adams and visions of lambs frolicking, sisters pioneering, nurses nursing and mothers lambing – all in a field of green.

Section VI: The old way vs. The new way

A definition of insanity: doing the same thing every day with the hopes that tomorrow will change. Despite the fact that things are wrong, many sit by and complain, not making an effort to change. There are others, however, who are always looking for new and better ways of doing things.

Anil Minocha MD of Digestion, health and nutrition tells of something new to me: a Milk Bank. Just as blood can be donated, human milk can be donated, pasteurized, and given to infants in need. Interesting idea.

A nice story from the Times tells of a mother who had to deal with her child getting blood drawn. The child has lupus and will need regular blood testing. In response to the trauma of blood tests, the mother wrote the children\’s book Sandy the Starfish, a book that helps kids work through this unfortunate circumstance.

Manu Varma of Transplant Headquarters shares information regarding summer camps for children who have undergone transplants. Some of my fondest childhood memories are from summer camp, so I can see how this resource is incredibly valuable.

Hsien-Hsien Lei from A Hearty Life gives some tips on Safe Games and Activities for Children After Heart Surgery. Where else but the blog community could you find that?

Section VII: Civilization vs. Madness

I am going to leave Tom and Jerry out of this section. This is the serious stuff. As much fun as I like to have, we must not ever forget that this is a life and death battle we face.

Girl MD comments on a physician from Kazakhstan who performs a potentially harmful medical procedure for the sake of increasing income. First, do no harm?

Finally, what I consider the best submission this week comes from Uganda. Travelingdoc of the blog Borneo Breezes gives us all perspective in her post Sad News. This tells of the death of a child she cared for in Uganda. While we are all doing our best in our own situation, we need to stay aware that there are those whose needs we could not fathom. The work is great, but the workers are few.


This is the first time I have done pediatric grand rounds, and I have to say it was a very enjoyable experience. There are an awful lot of very good writers out there fighting the same foes as I fight. Several people were key in making this PGR happen:

  • Clark Bartram, keeper of PGR, who threatens gets people to host.

  • Shinga of Breath Spa for Kids, who scours the pediatric blogs and submits 75% of what you see here.

  • My daughter C, who chose such a wonderful theme. Thanks sweetie!


Flea will host grand rounds in 2 weeks. Control yourselves, ladies. That\’s not really him.

Thanks for stopping by!