Clinical risk in paediatrics: Medicines

The risk to children's health from medicines both prescribed and unprescribed is not insignificant and is probably greater than for adults. It arises from a long standing, and only recently rectified, lack of investment of research into the area of medicines for children, combined with the greater susceptibility of this age group to the effects of human error. This article explores some of the issues that contribute to this risk.

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The Health of Children, A Crisis of Ethics

PEDIATRICS ◽

10.1542/peds.73.4.550 ◽

1984 ◽

Vol 73 (4) ◽

pp. 550-558

Author(s):

C. Arden Miller

Keyword(s):

Health Services ◽

Cost Effective ◽

Health Problems ◽

Health Needs ◽

Children's Health ◽

Children’S Health ◽

Age Group ◽

Poverty Level ◽

Out Of Pocket Payments ◽

The World

A number of reviews emphasize the considerable extent to which infants and children of this country continue to be burdened with afflictions and risks of poor health.1-4 Persistent problems invite speculation that either the nation's wisdom or its resources are insufficient to serve fully the health needs of children. Neither of these explanations is well supported. A thoughtful policy paper5 published by the World Bank, dealing with the health of all children in the world, marshalls evidence that the most pressing health problems of children can be controlled or treated with presently known technologies. For this country, the Select Panel for the Promotion of Child Health found that the most pressing children's health problems were related to deficiencies of access to essential basic health services, and that the cost of providing those services as a public expense would be both small and cost effective.6 Services for children account for an exceedingly small portion of the federal health expenditures; out-of-pocket payments for children's health services are proportionally higher than for any other age group, even though a higher propontion of children than any other age group live in poverty-level households.7,8 Explanations other than lack of information or lack of national resources must be sought for the failure of this nation to address adequately the health needs of children. This paper attempts to serve two purposes. It first marshalls new testimony on the health status of children and then attempts to analyze barriers that thwart effort to address unmet needs. In the first instance, the circumstances quoted are intended to confirm that in spite of substantial progress over the past decade there are some persistent problems and some new warning signals about children's health.

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Role of vitamin D in pre-school children’s health

Medical Council ◽

10.21518/2079-701x-2021-1-37-48. ◽

2021 ◽

pp. 37-49

Author(s):

Irina N. Zakharova ◽

Svetlana V. Dolbnya ◽

Victoriya A. Kuryaninova ◽

Leonid Ya. Klimov ◽

Shamil O. Kipkeev ◽

...

Keyword(s):

Vitamin D ◽

Preschool Children ◽

Randomized Clinical Trials ◽

Biological Effects ◽

Daily Intake ◽

Ethnic Composition ◽

Children's Health ◽

Children’S Health ◽

Age Group ◽

Tract Infections

Vitamin D has pleiotropic effects, including maintaining calcium and phosphate homeostasis, and affecting the immune and endocrine systems. The article summarizes data on the expected biological effects of vitamin D on children’s health. The results of randomized clinical trials evaluating the effect of vitamin D supplementation on the incidence of acute respiratory tract infections are reviewed in detail. It has been shown that daily intake of vitamin D at a dose of 10 to 25 mcg/day (400–1000 IU/day) compared with placebo leads to a significant decrease in the proportion of children and adolescents who have had at least one episode of acute respiratory infection. The criteria for the provision of calciferol and the gradation of the status of vitamin D deficiency and deficiency in different countries are discussed. It has been shown that in the interpretation of the 25 (OH) D results there is a consensus on two points: calcidiol levels below 12 ng/ml (30 nmol/L) are considered clearly insufficient, and levels above 30 ng/ml (75 nmol/L) are considered sufficient in all regions. The incidence of hypovitaminosis D has been reported in children aged 3 to 7 years, where the overall combined assessment, regardless of age group, ethnic composition and breadth of the studied populations, showed that 13% of European children had a serum calcidiol concentration of less than 12 ng/ml (<30 nmol/L), and about 40% had a level of less than 30 ng/ml (<75 nmol/L). The data on the physiological need and the recommended daily dose of vitamin D for preschool children have been analyzed. In each country, the recommended intake of vitamin D is set (from 400 to 4000 IU), depending on the target concentration of serum calcidiol, the level of insolation, and nutritional characteristics. The necessity of conducting clinical studies in the age group from 3 to 7 years to determine an adequate, effective and safe preventive dose of vitamin D for preschool children in the Russian Federation is emphasized.

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