Review of meningococcal infection in children at a United Kingdom hospital.

Sixty-nine children were identified and evaluable. Forty-one (60%) presented with hypotension and/or abnormal neurological signs. In 34 (49%) a petechial rash was present on admission. Of note, 13 (19%) had a non-petechial rash, and rash was absent in 19 (28%). Twenty-one (30%) presented with meningism or meningitis. In one child the illness was so mild that the child was discharged prior to making a diagnosis. Five children died (7%). Sixty-three cases (91%) were diagnosed by blood or cerebrospinal fluid culture; these investigations remain the mainstay of diagnosis.

The prognosis of cyclical vomiting syndrome.

AIMS: The medium term prognosis of cyclical vomiting syndrome (CVS) was studied to determine the proportion of affected individuals who had gone on to develop headaches fulfilling the International Headache Society criteria for migraine. METHODS: Twenty six (76%) of 34 CVS sufferers identified from the authors' clinical records were traced, and all agreed to participate. Each child was matched to a control, and telephone interviews were conducted using a standardised questionnaire. RESULTS: Thirteen (50%) of the subjects had continuing CVS and/or migraine headaches while the remainder were currently asymptomatic. The prevalence of past or present migraine headaches in subjects (46%) was significantly higher than in the control population (12%). CONCLUSION: Results support the concept that CVS is closely related to migraine.

Is cyclical vomiting an abdominal form of migraine in children?

Cyclical vomiting is an intermittent episodic disorder found most commonly in children. It bears considerable similarities to abdominal migraine and to migraine headaches. It has been proposed that cyclical vomiting is a form of or juvenile equivalent of migraine and that there is a spectrum of disease encompassing cyclical vomiting, abdominal migraine, and migraine headaches. There are considerable overlaps among the syndromes that support this concept. It seems, however, unlikely that all cases of cyclical vomiting are migranous in origin.

Twelve cases of analgesic headache.

Analgesic headache occurs when drugs given for the treatment of headache aggravate symptoms. The condition is well recognised in adults but has not been described before in children in whom it may be induced by mild analgesics such as paracetamol used alone. Twelve children (nine girls and three boys, aged 6 to 16.5 years) with analgesic headache (from three months to 10 years) are reported. Five children were taking paracetamol alone, six were taking paracetamol with codeine, and one child was taking ibuprofen. The abrupt withdrawal of analgesic drugs was successful in eight of the children; two had episodic migraine headaches; one had headaches but with reduced frequency; and one returned to analgesic abuse.

The relationship between cyclic vomiting syndrome and abdominal migraine.

Abdominal migraine and cyclic vomiting are both self-limiting episodic conditions of children, with periods of complete normality between episodes. The clinical features of both syndromes show considerable similarity, and resemble those found in association with migraine headaches. It is proposed that cyclic vomiting is a condition related to migraine.

Double blind placebo controlled trial of pizotifen syrup in the treatment of abdominal migraine.

Fourteen children with abdominal migraine were treated with pizotifen and placebo in a double blind crossover trial. The results showed pizotifen to be clearly superior to placebo in the prophylaxis of abdominal migraine. The importance of clearly distinguishing abdominal migraine from other forms of recurrent abdominal pain is emphasised.

Abdominal migraine: a childhood syndrome defined.

It has long been recognized that some cases of recurrent abdominal pain in children are related to migraine, but the diagnostic criteria for abdominal migraine have not been defined. We have identified a group of children with recurrent abdominal pain who had a family history of migraine--in over half the cases in a first-degree relative--and who obtained marked relief from their symptoms from specific anti-migraine therapy. These children had a well-defined syndrome comprising episodes of midline abdominal pain of sufficient severity to interfere with normal activities and lasting for prolonged periods, frequently accompanied by pallor, headache, anorexia, nausea, and vomiting. It is proposed that these children have "abdominal migraine".

Abnormally high sweat osmolality in children with Down's syndrome.

There are few data on sweat analysis in Down's syndrome. We studied 25 children with Down's syndrome and obtained sweat samples by pilocarpine iontophoresis. Sweat osmolality was elevated in Down's syndrome compared to normal. The results of sweat testing must be regarded with caution when cystic fibrosis is suspected in children with Down's syndrome.

Buccal administration of fenoterol aerosol in childhood asthma.

We have studied 23 asthmatic children who were wheezy when attending a hospital clinic or following tests for exercise-induced asthma. Fenoterol was administered by metered dose aerosol against the buccal mucosa on the inside of the cheek. This produced marked improvement in peak-expiratory-flow-rate and relieved clinical symptoms. Buccal administration of fenoterol may be a useful treatment for children with mild asthma who have difficulty in using inhaled drugs.