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The 25th Bubble Wrap [Holiday Edition]


With millions upon millions of journal articles published every year, it is impossible to keep up. Every month, we ask some of our friends from PERUKI (Paediatric Emergency Research in the UK and Ireland) to point out something that has caught their eye.

Article 1: What’s on the kids’ Christmas list this year?

What’s it all about?

At the beginning of December, I made my children write a letter to Santa to explain just what they wanted him to bring down the chimney. The two-year-old had a simple request—Smarties—but the eldest asked for something that I had never heard of: unicorns and slime. Where on earth did she get that idea from? Perhaps this paper has the answer.

Pine et al. classified television viewing as high, moderate or light depending on a self-reported survey of viewing habits.  They then drilled down a little further to determine if the kids watched mainly commercial television channels or those free from advertising. The study was done in the UK, so think BBC vs ITV. A couple of weeks later they took these 98 children and had them participate in a little exercise where their teachers had them write a letter to Santa. Those children who had watched more television were more likely to ask for named products (Unicorn Poopsie Slime Surprise) than generic ones (a doll, a toy car)

Why does it matter?

Children watch, on average, 2 1/2 hours of television a day. If they only whispered to Santa what they really, really wanted, they might be disappointed. If you examine their viewing habits, you might gain valuable insight into their deepest desires. Alternatively, if you don’t let them watch any television, they might be happy with that generic dolls house.

The Bottom Line?

My 7-year-old believes that Unicorn Poopsie Slime Surprises are real. I must keep her away from the television in the future.

Reviewed by: Andy Tagg

Article 2: Infant behavioural responses to infant-directed singing and other maternal interactions

de l’Etoile, S. (2006). Infant behavioral responses to infant-directed singing and other maternal interactions. Infant Behavior and Development, 29(3), 456-470.

What’s it about?

One of the distraction methods employed by one of our play therapists is not blowing bubbles or playing episodes of Peppa Pig on the iPad, but her voice. There is nothing more expensive than simply singing to children to soothe their anxieties, and I have honestly seen children fall asleep during a painful procedure to her dulcet tones.

Given the amount of singing at Christmas, I wondered if there was any evidence behind this. And there is!

A professor of Music Therapy (Shannon de l’Etoil) has investigated a mother’s song’s impact on their infants. Her pivotal work examined six different approaches to engaging a 6-9 month-old: their mother singing an assigned song, their mother singing a song of the mother’s choice, both mother and infant listening to recorded music, the mother reading a book, the mother playing with a toy and a stranger singing an assigned song. All approaches were videotaped, and a bespoke cognitive score demonstrated that engagement through singing was as powerful as by book or toy and much higher than if recorded music was used. There was evidence that if initial infant responses were negative, the mothers would adjust the tone and pitch of their voices to re-engage them.

Clinical Relevant Bottom Line

Singing frees the soul and is a popular Christmas pastime. If you’ve run out of bubbles or your iPad is out of juice, perhaps consider asking the mother to sing to the infant* you are cannulating. You never know; it may help!

*whether a festive tune adds additional benefit has yet to be studied.

Reviewed by: Damian Roland

Article 3: How do you get kids to eat their greens??

Lee SXJ, Burrows T, Yoong S and Wyse R. Association of parental investment of time and cost in food provisioning with adherence to dietary guidelines for the consumption of fruits, vegetables and non-core foods in pre-schoolers. Public Health Nutr. Volume 21, Issue 13 September 2018 , pp. 2434-2442 Published online: 01 June 2018

What’s it about?

Does spending more time and money on food for pre-schoolers lead to better adherence to dietary guidelines? This NSW group, led by Dr Rebecca Wyse, surveyed 396 parents of preschoolers to identify whether their child’s fruits and vegetables were in keeping with guidelines whilst identifying several factors regarding compliance, using a standardised instrument, the Childhood Dietary Questionnaire. It’s worth noting that Dr Wyse’s group, based out of the Newcastle region, are prolific publishers and have published many similar articles.

Clinically Relevant Bottom Line:

For this survey, the population was generally educated to a higher level, with a slightly higher than average household income compared to the Australian mean at the time (2010). With this in mind, 63% of children had their diet adhering to guidelines. That said, kids also ate a lot of ‘junk’; preschoolers frequently exceeded the dietary guidelines for occasions of the non-core foods subscale. As for doing the prep, the mean time was 120 minutes(!).

For me, the really interesting part of this paper is the discussion, which is beautifully scientific and pragmatic in its approach to weighing up some of the challenges of increasing fruit and veg from an ecological perspective.

Reviewed by: Henry Goldstein

Article 4: Which medical specialties are on the “Nice” list?

Millar, S., Johnson, T. (2017) The Specialty and Naughty/Nice Tendency Audit (SANTA): which medical specialists can be trusted to follow recipes? Medical Journal of Australia, Vol 207 (11) pp 487 – 489. doi: 10.5694/mja17.00811 

What’s it about?

The age-old stereotypes of medicine persist into the 21st century. Paediatrics? Big kids with bubbles and stickers who mostly watch cartoons at work. This team asked which of the specialities is more likely to be on Santa’s “Nice” List, with the theory being that this depends on the quality of food left for him on Christmas Eve.

A survey was distributed to a medical group on Facebook, asking which speciality they were currently training in (or had completed training in) and whether they followed recipes while cooking. Those who followed recipes were deemed to be “Nice,” while those who went a bit rogue in the kitchen were deemed to be “Naughty.”

The three specialities that were 100% nice based on responders included Dermatology, Clinical Genetics, and Nuclear Medicine. The remaining specialities in the nice list, Renal, Public Health, ICU, Retrieval Teams and Paediatric Surgery, made the cut based on the majority stating they follow recipes when cooking.

Unfortunately, this leaves a lot of specialities on the naughty list, including paediatrics!

The bottom line

Speaking from personal experience, just because you don’t follow a recipe does not mean your Christmas baking will end up a disaster (it occasionally does – ask my husband). I would advocate for a different study to try and assess which specialities belong on the “Naughty or Nice” list. Perhaps “number of coffees seniors bought for juniors over the year” or “discharge summary completion rate” or “average response time to pages”…so many options to choose from! Who is up for the challenge next year?

Reviewed by: Tina Abi Abdallah

Article 5: Can you crack the codes this Christmas?

Williams R. A Christmas Guide to Clinical Coding. BMJ 2018;363:k5209 

What’s it about?

This article celebrates the importance of medical coding but, in particular, takes a humorous look at the many variances in Read coding currently used in UK primary care. For example, Read coding has a list of 532 codes for falls to include specific events such as a “fall from a cable car (T613.00) or from a moving vehicle (T183.00) into a dock, pit, or storm drain (TC3y100, TC3y300, TC32100)” or perhaps even “from a turret (TC25.00), a haystack (TC4y100), or a flagpole (TC23.00)”.

Why does it matter?

In hospitals, we code various diagnoses, symptoms, tests, and procedures in electronic health records. Coding can help collate accurate and reliable patient information for their own care and, on a broader scale, help with research, billing, and improving patient safety.

Currently, we use multiple coding systems in Australia for different purposes, including the ACS, ICD 10-AM and ACHI. In the UK, Read coding is used for clinical documentation of health data, but plans are to replace this with SNOMED (Systematized Nomenclature of Medicine) terminology. SNOMED has benefits, including being a numeric-only coding system with a wide range of clinical and non-clinical codes, which will help improve accuracy and specificity in coding.

The Bottom Line

When you’re on your next shift at work, you may enjoy exploring the many avenues that clinical coding covers. This article is well worth a full read, and to the author’s credit, I particularly enjoyed the demonstration of Read coding in Figure 3: “a tale from a general practice somewhere in the Middle East…”

Reviewed by: Grace Leo

If we have missed out on something useful or you think other articles are absolutely worth sharing, please add them in the comments! That’s it for this month. Many thanks to all of our reviewers who have taken the time to scour the literature so you don’t have to.


  • Grace is a Registrar at Sydney Children's Hospital. She loves innovative medical education and paediatrics. She is on the organising committee for the DFTB18 and SMACC conference. Grace is a former internal director of the AMSJ. She enjoys board games, cooking and graphic design.

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