Our new venture into Eco-Paediatrics

It is early January in Edmonton, the time of year when ‘a nice day’ means it is brilliantly sunny and cold rather than cloudy and cold. One bonus is that we no longer have to even consider arthropod-borne disease in the differential diagnosis for non-travellers! I would wager that the only Latin phrase that almost all English-speaking physicians would be able to accurately translate would be ‘Primum Non Nocere’ (First, do no harm). Harm in paediatrics consists of not only suggesting remedies that result in adverse events but also advising parents or the health-care system to spend their limited, hard-earned cash on remedies that have no efficacy. It is vital to educate healthcare workers about therapies that have been proven to not be worthwhile. Thus, we are introducing a new column in this issue entitled ‘Eco-Paediatrics . . . . Reducing waste in child health one intervention at a time’. The premiere column outlines therapies that are of no value for otitis media with effusion (1). A common concern amongst clinicians is that parents will seek help elsewhere if they are sent home with reassurance rather than a prescription. However, two studies have shown that when properly informed, parents are satisfied with delayed or no antibiotic prescriptions for acute otitis media (2). A study from the US published a decade ago showed that even if provided with an ‘emergency prescription’, most parents managed their child with acute otitis media without filling the prescription (3). We need to recognize that the relationship between going home with a bottle of medicine and parental satisfaction may be markedly over-estimated by clinicians. Moving from the level of the patient to the level of the public payer, there is increasing interest in the notion that the correlation between cost and improvement in quality of health deserves to be a key factor in deciding which interventions should be promoted (4). Cardiff Child Protection Systematic Reviews (CORE INFO) is a product of collaboration between the National Society for the Prevention of Cruelty to Children and the Early Years research section of the Cochrane Institute of Primary Care and Public Health, Department of Child Health, School