Children and screens: Groupe de Pédiatrie Générale (Société française de pédiatrie) guidelines for pediatricians and families

The Groupe de Pédiatrie Générale (General Pediatrics Group), a member of the Société française de pédiatrie (French Pediatrics Society), has proposed guidelines for families and doctors regarding children's use of digital screens. A number of guidelines have already been published, in particular by the French Academy of Sciences in 2013 and the American Academy of Pediatrics in 2016. These new guidelines were preceded by an investigation into the location of digital screen use by young children in France, a survey of medical concerns on the misuse of digital devices, and a review of their documented benefits. The Conseil Supérieur de l'Audiovisuel (Higher Council on Audiovisual Technology) and the Union Nationale de Associations Familiales (National Union of Family Associations) have taken part in the preparation of this document. Five simple messages are proposed: understanding without demonizing; screen use in common living areas, but not in bedrooms; preserve time with no digital devices (morning, meals, sleep, etc.); provide parental guidance for screen use; and prevent social isolation.

[Catch-up vaccination of worldwide newcoming (adopted, refugee or migrant) children in France]

In France, international adoption includes around to 90,000 children since 1980 and near 300,000 immigrant children were counted in 2008. This population is heterogeneous, according to age and country of origin, and its large number. It is not easy to completely and surely assess the vaccine status of the child. Due to a great variability of individual situations, it is not possible to have systematic and unchangeable rules. This article aims to give an update of catch-up vaccination of internationally adopted or refugee or migrant children in France. The vaccination status of a child who recently arrived in France is complex and has to be adapted to his country of origin. Some of them were never vaccinated whereas the vaccine status of others is uncertain or unknown. Three parameters have to be considered: the age of the child, the country of origin, and sometimes serology in the case of doubts of his vaccine status. Catch-up vaccination of foreign children has to be adapted to French vaccine recommendations, as a reference, and to vaccines already administered to the child.

[Current events in vaccination]

The annual meeting of the Infectious Disease Society of America (IDSA) ; which brought together nearly 5000 participants from over 80 countries in Vancouver, Canada, October 21 to 24, 2010 ; provided a review of the influenza (H1N1) 2009 pandemic, evaluated vaccination programmes and presented new vaccines under development. With 12,500 deaths in the United States in 2009-2010, the influenza (H1N1) 2009 pandemic was actually less deadly than the seasonal flu. But it essentially hit the young, and the toll calculated in years of life lost is high. The monovalent vaccines, whether live attenuated or inactivated with or without adjuvants, were well tolerated in toddlers, children, adults and pregnant women. In order to protect infants against pertussis, family members are urged to get their booster shots. The introduction of the 13-valent Pneumococcal conjugated vaccine in the beginning of 2010 may solve - but for how long ? - the problem of serotype replacement, responsible for the re-increasing incidence of invasive Pneumococcal infections observed in countries that had introduced the 7-valent vaccine. The efficacy of a rotavirus vaccine has been confirmed, with a reduction in hospitalization in the United States and a reduction in gastroenteritis-related deaths in Mexico. In the United States, vaccination of pre-adolescents against human papillomavirus (HPV) has not resulted in any specific undesirable effects. Routine vaccination against chicken pox, recommended since 1995, has not had an impact on the evolution of the incidence of shingles. Vaccination against shingles, recommended in the United States for subjects 60 years and over, shows an effectiveness of 55 %, according to a cohort study (Kaiser Permanente, Southern California). Although some propose the development of personalized vaccines according to individual genetic characteristics, the priority remains with increasing vaccine coverage, not only in infants but also in adults and the elderly. Vaccine calendars that cover a whole lifetime should be promoted, since the vaccination of adults and seniors is a determining factor of good health at all ages.

[Lead exposure in pregnant women and newborns: a screening update]

Human lead exposure has many sources. Relative importance of these sources varies widely according to geographic regions and human lifestyle. The impact of lead exposure on health has been well studied and public health interventions have been conducted.

OBJECTIVE

The aim of this study was to evaluate current prevalence of lead burden in neonates, and seek for sources of maternal and fetal intoxication.

POPULATION AND METHODS

A prospective multicentre study was conducted by the "Réseau périnatal 92" on a population of pregnant women attending 3 maternal wards in the north of 'Hauts-de-Seine' department in France. Between December 2003 and May 2004, a total of 1021 pregnant women were included. All patients signed an informed consent before participating in the study. Cord blood samples were collected at delivery for lead measurements.

RESULTS

The mean cord blood lead concentration was 23.2 microg/l. Eighteen neonates over 1021 (1.8%) had lead levels above 100 microg/l. An environmental query was conducted by the social and public health office of the department (DDASS), and data were collected regarding the state of the housing and the lifestyle of the concerned family. Main sources of lead intoxication were 'tagine' food plates in 83.3% of cases, 'khôl' powder (used as eyeliner) in 88.9% of cases and substandard housings in 22.2% of cases. A specialized paediatric follow-up for the 18 neonates was performed.

CONCLUSION

With the exception of substandard housing (old lead painting), other sources of lead intoxication were discovered: 'tagine' plates and 'khôl' powder. Almost all of these products came from Morocco. A public health intervention would be able to inform the population about these yet unknown sources of lead intoxication.

[Evaluating the effectiveness of child lead poisoning prevention programs]

PROBLEM

A multi annual screening and prevention program against lead poisoning was implemented in a suburb of the Paris area. We attempted to assess the effectiveness of this program based on data available from children screening and follow-up.

METHODS

Indicators of effectiveness included the evolution of blood lead levels at screening and the frequency of secondary increases in blood lead levels. Buildings inclusion dates were used to control for the increasing selection of less exposed children.

RESULTS

A total of 3,660 children were screened between 1992 and 2000. We observed a regular decrease in blood lead levels at screening, in the highest blood lead levels obtained for each child and in the proportion of children whose blood lead levels increased after screening: the proportion of children with initial blood lead levels >=15 micro g/dl fell from 17.4% in the 1992-1996 period to 4.1% in the 1997-2000 period. A multivariate analysis taking into account the first year that children were screened in a given building showed that less exposed children were included over time, but found also an additional independent decrease in blood lead levels that can be related to the effectiveness of prevention efforts. A "building by building" analysis of 30 buildings where more than 20 children were located over the whole study period confirmed that the incidence of lead poisoning decreased within most of these buildings.

CONCLUSIONS

Taking into account buildings'inclusion dates makes it possible to distinguish program effectiveness from the consequences of including less exposed children The effectiveness of preventive actions is associated with several interacting factors, including the participation of families and the active involvement of local technical staff and policy makers. The finding that the decrease in blood lead levels leveled off after 1997 calls for further actions.

[Compliance with the vaccination recommendations for 0- to 24-month-old infants in general or paediatric practice]

PURPOSE

To describe the vaccine practice of general practitioners and paediatricians for the 0-24-month-old infants and their deviations to the official recommendations.

RESULTS

One thousand three hundred and fifty-five practitioners, 46 +/- 8-year-old took part in the survey. Among them 42.7% were general practitioners and 57.3% were paediatrician. Only one third of them, strictly complied with the official vaccination recommendation (33.1%). This percentage was higher for the general practitioners (43.4%) than for the paediatricians (25.5% P < 0.001). When practitioners adapted the vaccination program, their modifications essentially concerned the first administration of the DTCP Hib vaccine, which was delayed of 1 or 2 months. Some vaccines were specifically concerned by the modifications. The ROR was delayed and the vaccination coverage reached only 75% at 18 months. General practitioners adapted the vaccination calendar more often than paediatricians (16.9 vs. 9.0%: P < 0.05). The B Hepatitis vaccination schedule was the most frequently adapted one by general practitioners as well as paediatricians to deal with multiple injections (53.5%), and the age of the infants (39.1%).

CONCLUSION

The availability of hexavalent vaccination containing B Hepatitis should contribute to increase the vaccination coverage of the population against B Hepatitis and could allow an antipneumococcal vaccination through an heptavalent vaccine without increasing the number of injections. On the other hand, general practitioners and paediatricians must actively contribute to increase the ROR vaccination coverage.

[New molluscocid organophosphorous compounds]

The authors show that, among the studied phosphoryl compounds, some dissymetric derivatives of the 2,4,5 trichlorophenol have an exceptional activity against the limneas, chosen as representatives of aquatic molluscs, and have, at the same time, a slight toxicity for mice and fish.