By Dr Ray O’connor
Copyright imt
This week I would like to describe a few different papers on the topic which should be of interest. Cough is a common reason for preschool children to be seen in primary or ambulatory care. Estimated prevalence ranges from five per cent to 23 per cent of all primary care encounters. Although causes of cough are usually self-limiting, healthcare professionals need to consider and exclude potentially serious underlying conditions. This ’10 minute consultation’ article1 outlines how to assess young children with chronic or recurrent episodes of cough and how to make evidence-informed management plans with parents. The ‘practice points’ are helpful and succinct.
They are as follows. Chronic cough in preschool aged children is a common cause of concern for parents and caregivers. Assess whether the cough is dry or wet, and what triggers are present, to help determine the cause and whether further intervention is required. For a well child with normal examination findings and no red flag features, no further investigations are required.
The commonest ‘Red flags’ and causes of chronic cough are listed and can be easily accessed. Overall, this is a very practical article to have at your fingertips as we head into the autumn.
Childhood vaccination has come under increased scrutiny in recent times especially since Robert Kennedy Junior took office in the USA. This next paper from the Morbidity and Mortality Weekly Report (MMWR)2 summarises the benefits of routine childhood vaccination in the US over the last 30 years. Just to remind our readers that MMWR is the primary scientific publication vehicle for the Centers for Disease Control and Prevention (CDC) in the US.
The report’s findings were as follows. Since 1994, the US Vaccines for Children (VFC) program has covered the cost of vaccines for children whose families might not otherwise be able to afford vaccines.
The report assessed and quantified the health benefits and economic impact of routine U.S. childhood immunizations among both VFC-eligible and non–VFC-eligible children born during 1994–2023. Diphtheria and tetanus toxoids and acellular pertussis vaccine; Haemophilus influenzae type b conjugate vaccine; oral and inactivated poliovirus vaccines; measles, mumps, and rubella vaccine; hepatitis B vaccine; varicella vaccine; pneumococcal conjugate vaccine; hepatitis A vaccine; and rotavirus vaccine were included.
Averted illnesses and deaths and associated costs over the lifetimes of 30 annual cohorts of children born during 1994–2023 were estimated using established economic models. Net savings were calculated from the payer and societal perspectives.
It was estimated that among approximately 117 million children born during 1994–2023, routine childhood vaccinations will have prevented approximately 508 million lifetime cases of illness, 32 million hospitalizations, and 1,129,000 deaths, at a net savings of $540 billion in direct costs and $2.7 trillion in societal costs. It found that from both payer and societal perspectives, routine childhood vaccinations among children born during 1994–2023 resulted in substantial cost savings. The article concludes that childhood immunizations continue to provide substantial health and economic benefits, while promoting health equity.
How best to treat childhood fever? This network meta-analysis3 looked at randomized trials comparing acetaminophen (Paracetamol), ibuprofen, both alternating, and both combined, for treating children with fever.
An important limitation was that the authors only evaluated the efficacy and safety during the first six hours. Their conclusion was that dual may be superior to single therapies for treating fever in children. Acetaminophen may be inferior to combined or alternating therapies to get children afebrile at four and six hours. Compared with ibuprofen, acetaminophen was also inferior to ibuprofen alone at four hours, but similar at six hours.
The Barnardos advert that ‘Childhood lasts a lifetime’ is well borne out by the next report,4 which describes an investigation by UNICEF UK.5 The report found that people born and living their early years in the most deprived areas of England have worse health and outcomes throughout their life in terms of obesity, tooth decay, attendances at hospital emergency departments, and educational success.
An analysis found that every local authority in the top 20 per cent of deprivation in England was in the bottom 20 per cent for multiple measures of child health and development.
It also found that during the first five years of life the effects of deprivation and poverty are evident, well established, and are likely to impact that child for the rest of their life. Another finding was that 1.2 million babies and children under the age of five (35 per cent of the age group’s total population) are now living in poverty in England. A stark reminder, if one were needed, of the importance in investing in our children and eliminating poverty.
One uncomfortable truth that is becoming increasingly apparent is that sexual activity is happening at a younger age. The American Academy of Paediatrics have addressed this in a recent updated policy statement.6 While their advice applies only to their own members (Paediatricians in the USA), it may also be of relevance to GPs. It recommends that paediatricians provide contraceptive care for adolescents.
It states that contraceptive prescribing and counselling skills ensure the safety and well-being of adolescents, enabling paediatricians to help adolescents achieve optimal reproductive health. This policy statement updates the 2014 policy statement on contraception for adolescents and is designed to be used in tandem with the accompanying clinical report, “Contraceptive Counselling and Methods for Adolescents” and the series of method-specific policy statements and clinical reports from the Academy. The report holds that the policy statement provides the paediatrician with evidence-informed and equity informed practices in contraceptive care for adolescents.
Finally, a little lighter reading but about a very serious topic. It is an essay by Dr Giles Dawnay in the BJGP.7 The author describes himself as a GP, writer and poet. He describes seeing a cluster of 10 young teenagers in school uniforms waiting at a bus stop.
“All neatly spaced apart and seemingly calm, in that hunched position that is Homo sapiens looking at their smartphone. Not a single one was speaking to each other!” He then describes the Channel 4 documentary, Swiped, which is about an experiment where a school encouraged a group of 12-year-old pupils to part with their phones for three weeks.
This age group can spend up to nine hours a day on their phones. Another insight is where he discusses a book by Jonathan Haidt called The Anxious Generation. The challenging observation is made that ‘we are growing a generation of children who are overprotected in the physical world and under protected virtually. Children are given less space to roam unsupervised and yet seemingly can go where they want to online.’
Food for thought indeed.
References:
Peek R et al. 10-MINUTE CONSULTATION: Chronic cough in preschool aged children. BMJ 2024;386:e079747. http://dx.doi.org/10.1136/bmj-2024-079747.
Zhou F et al. Health and Economic Benefits of Routine Childhood Immunizations in the Era of the Vaccines for Children Program — United States, 1994–2023. MMWR Morb Mortal Wkly Rep 2024;73:682–685. DOI: http://dx.doi.org/10.15585/mmwr.mm7331a2.
De La Cruz-Mena J et al. Short-term Dual Therapy or Mono Therapy With Acetaminophen and Ibuprofen for Fever: A Network Meta-Analysis. Pediatrics 2024 Oct 1;154(4):e2023065390. DOI: 10.1542/peds.2023-065390.
O’Dowd A. Childhood deprivation has life long impact on health. BMJ 2025;389:r1193 http://doi.org/10.1136/bmj.r1193.
Unicef UK. Held back from the start: the impact of deprivation on early childhood. 9 June 2025. unicef.org.uk/wp-content/uploads/2025/06/Embargoed-09.06.25-Held-Back-From-the-Start-UNICEFUK-FINAL.pdf.
Ott M et al. Committee on Adolescence; Contraception for Adolescents: Policy Statement. Pediatrics July 2025; 156 (1): e2025072217. 10.1542/peds.2025-072217. https://doi.org/10.1542/peds.2025-072217
Dawnay G. Adolescent screening for digital diabetes. British Journal of General Practice 2025; 75 (753): 170. DOI: https://doi.org/10.3399/bjgp25X741189
