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doi:10.1111/jpc.12526

Letters to the Editor

Dear Editor,
SWEARING IN DUTCH
I read with interest your editorial about swearing.1 I thought you
might be interested in some commonly used Dutch profanities. It
may seem unusual for an Australian paediatric rheumatologist of
Scottish heritage to have a vast knowledge of profanities in
Dutch, but the combination of making lifelong friends with a
Dutch family as an adolescent and undertaking a medical elective
in orthopaedics in Holland has exposed me to this interesting
aspect of Dutch culture. As an expert in the field of infectious
diseases, you will be most interested that many Dutch profanities
stem from infectious diseases. Tyfus (typhoid fever), tering
(tuberculosis), kolere (cholera), pleuris (pleurisy) and pokke
(smallpox) are all considered unmentionable profanities. The
addition of the word lijer or sufferer allows the word to be used
an as insult and is roughly analogous to arsehole. The most
severe and shocking of Dutch expletives is the use of the word
kanker or cancer. The short use of the word, with intonation on
the first consonant, is said in the same tone as sh%t. Unfortunately, diseases from within my own subspecialty do not seem to
have the same degree of effectiveness. Shouting out lupus when
one hits ones thumb with a hammer or insulting someone with
a passing Complex Regional Pain Syndrome Type 2 Sufferer
just does not seem to have the same degree of cathartic relief nor
level of insult. Given the inappropriateness of these words as
expletives in the first place, this is a shortcoming of my subspeciality I am more than happy to accept.

Reference
1 Isaacs D. Swearing. J. Paediatr. Child Health 2014; 50: 12.

Dr Damien McKay
Staff Specialist
Department of Rheumatology
The Childrens Hospital at Westmead
Westmead, New South Wales
Australia

benefit in adults.1,2 Paediatric treatment data are very limited,

with only one small randomised trial on steroid use which was
not placebo controlled.3 Studies often describe outcome in terms
of motor recovery, but Bells palsy has also been shown to have
important functional and psychosocial effects in adults while
nerve function is impaired.4 There are no previous data on the
psychosocial effects of Bells palsy in children. We set out to
assess the use of steroids at an Australian centre and determine
the emotional impact of Bells palsy on children and their
parents.
In a prospective observational study, we identified children
with Bells palsy presenting to the emergency department at
Royal Childrens Hospital, Melbourne. We assessed demographics and steroid use. Patients were followed up by phone at 6
months to assess recovery and whether there was a negative
emotional impact, embarrassment, or change in societal attitude
towards the child or parent.
Twenty-nine children were diagnosed with Bells palsy over
the 17-month study period. Mean age was 8.5 5.3 years
(range 5.3 months to 16.8 years). Median time from symptom
onset to ED presentation was 3 days (interquartile range of 1
to 6.5 days). All had lower motor neuron facial weakness;
21% also described headache, and 14% had subjective facial
sensory disturbance or dysarthria. Twelve (36%) were prescribed corticosteroids. Twenty-six families (90%) were
contactable by phone following presentation; 69% reported
complete and 31% partial recovery. Some recovery of motor
function was observed within a mean of 26.5 days (range 1
day to 5 months). Twenty-one of 26 parents (81%) and 19 of
21 verbal children (90%) reported being distressed, and 9 children (43%) were embarrassed by their condition. Problems
included embarrassment (2 parents, 9 children), noticing a
change in peoples attitude (2 parents, 9 children) and being
treated differently because of the childrens condition (2
parents, 4 children).
While treatment with steroids is well supported by evidence
in adults,2 only a minority of children with Bells palsy in
this series were treated in this manner. Bells palsy has unrecognised emotional impacts on children and parents. A placebocontrolled RCT is warranted to address the utility of
corticosteroids in children.

Dear Editor,
EMOTIONAL IMPACT OF BELLS PALSY IN CHILDREN
Bells palsy is an acute lower motor neuron paralysis or weakness of facial musculature. Recent evidence-based reviews have
reported acyclovir to be ineffective in terms of recovery of function in Bells palsy, whereas corticosteroids conferred significant

Conict of interest: None.

Journal of Paediatrics and Child Health 50 (2014) 245247

2014 The Authors
Journal of Paediatrics and Child Health 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians)

Dr Michelle Lee1
Dr Mark Mackay24
Miss Lisa Blackbourn1,3
Dr Franz E Babl1,3,4
1
Emergency Department
Royal Childrens Hospital
2
Department of Neurology
Royal Childrens Hospital
3
Murdoch Childrens Research Institute
4
The University of Melbourne
Melbourne, Victoria
Australia
245

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Letters to the Editor

References
1 Lockhart P, Daly F, Pitkethly M, Comerford N, Sullivan F. Antiviral
treatment for Bells palsy (idiopathic facial paralysis). Cochrane
Database Syst. Rev. 2009; (4): CD001869.
2 Salinas RA, Alvarez G, Daly F, Ferreira J. Corticosteroids for Bells palsy
(idiopathic facial paralysis). Cochrane Database Syst. Rev. 2010; (3):
CD001942, doi: 10.1002/14651858.CD001942.pub4.
3 Unvar E, Oguz F, Sidal M, Kili A. Corticosteroid treatment of
childhood Bells palsy. Pediatr. Neurol. 1999; 21: 81416.
4 Weir AM, Pentland B, Crosswaite A, Murray J, Mountain R. Bells palsy:
the effect on self-image, mood state and social activity. Clin. Rehabil.
1995; 9: 1215.

Although the limitations outlined above must be considered,

I believe that paediatric teaching can be effectively delivered by
junior house officers, who are well aware of their students
curriculum. A larger cohort study that compares the exam
results of students who receive extra teaching from junior house
officers to those who do not might provide more objective
evidence to support this type of teaching.
Dr Alexander Jan Baneke
Lister Hospital
Stevenage, Hertfordshire
United Kingdom

Acknowledgements
I would like to thank Dr Mariam Said and Dr Sharon Hall for
their help while teaching at Lister Hospital.

Dear Editor,
THE JUNIOR DOCTOR: AN UNTAPPED PAEDIATRIC TEACHING
RESOURCE?
I would like to bring your attention to the unrecognised potential of junior doctors to carry out effective paediatric teaching.
Junior house officers rarely carry out structured paediatric
teaching, and we were unable to find any reports on PubMed of
their involvement. In the UK, junior house officers often have
considerably more time available than senior paediatricians and,
having recently finished their medical school exams, are also
likely to be more aware of the demands of the paediatric students curriculum.1 Equally, non-cognitive attributes play a key
role in effective teaching. Teachers who are able to inspire,
support, actively involve and communicate with their students
are likely to be more effective, and although junior house officers may have a lesser level of clinical knowledge than consultants and registrars, they can certainly possess the above
attributes.2,3 In addition, although their level of knowledge
might not be as complete as that of senior paediatricians, teaching will replenish the knowledge of the junior house officers
themselves.
While a junior paediatric doctor at Lister Hospital, I was one
of a pair of doctors who carried out weekly teaching sessions
over a period of 3 months. After each session, all students were
asked to complete a questionnaire. The subjective feedback
received for the teaching programme was consistently positive
for both teachers, the majority of students reporting that it was
better than most other paediatric teaching received.
Both the doctors very much enjoyed the experience of teaching on a weekly basis and subjectively felt it contributed both to
their own knowledge and the knowledge of their students.
This is an anecdotal report, and it is difficult to obtain an
objective assessment of teaching effectiveness.4 Additionally,
only three groups of 56 students were assessed in total, and
only two teachers were involved. With a larger spread of students or teachers, the programme might have had different
results.
Dr Baneke is a Glaucoma Research Fellow at Guys and St Thomas Hospital,
London, UK. At the time of compiling the data for this article he was a junior
doctor in paediatrics at Lister Hospital, Stevenage, UK.
Conict of interest: No funding was received for writing this article.

246

References
1 Peadon E. I enjoy teaching but . . .: paediatricians attitudes to
teaching medical students and junior doctors. J. Paediatr. Child Health
2010; 46: 64752.
2 Sutkin G, Wagner E, Harris I, Schiffer R. What makes a good clinical
teacher in medicine? A review of the literature. Acad. Med. 2008; 83:
45266.
3 Bannister SL, Raszka WV, Maloney CG. What makes a great clinical
teacher in paediatrics? Lessons learned from the literature. Pediatrics
2010; 125: 8635.
4 Conigliaro RL. Assessing the quality of clinical teaching: a preliminary
study. Med. Educ. 2010; 44: 37986.

Dear Editor,
DRGER BABYLOG 8000 PLUS NEONATAL
RESPONSES TO CIRCUIT DISCONNECTION

VENTILATOR:

The performance of the Babylog 8000 plus neonatal ventilator

(Drger, Lbeck, Germany) following disconnection has not
been described. This study examined its performance after
reconnection following disconnection during synchronised
intermittent positive pressure ventilation with a test lung.
Volume guarantee mode and pressure-limited modes were used
at the following settings: positive end expiratory volume (PEEP)
5 cm H2O, back-up rate 50/min, and target expired tidal volume
(VTe) 5.4 mL (working peak inflating pressure (PIP) 15 cm H2O).
The circuit flow was set to 8 L/min and the inflation time to 0.3 s.
The effects of varying disconnection durations (i) less than
one ventilator cycle (1 s), (ii) longer than one cycle but before
the ventilator alarms (4 s) and (iii) just after the ventilator alarm
(8 s) and changing maximum peak inflating pressure (Pmax)
15, 20, 25, and 30 cmH2O were observed. The test lung was
disconnected and reconnected at the Wye piece. PIP, PEEP and
VTe were recorded at 200 Hz using Spectra software (Grove
Medical, London, UK). Ventilator sounds and alarms were
recorded manually.
Conict of interest: None declared.

Journal of Paediatrics and Child Health 50 (2014) 245247

2014 The Authors
Journal of Paediatrics and Child Health 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians)