Abstract Surveillance of clinical research involving child subjects, or tissues taken from them, continues to become more formalized and sophisticated. Many doctors and most paediatricians can be expected to be offered the opportunity to serve on paediatric Institutional Ethics Committees (IEC) at some stage of their professional lives. Fearless and independent Ethics Committees have considerable influence on both the design and implementation of clinical research, and on the topics of allowable research in which infants and children will be involved. The composition of lECs generally is designed to give a balance of sexes, professional backgrounds, and institutional and non‐institutional affiliations. In addition to these now well established compositional guidelines, lECs adjudicating on paediatric research have a pragmatic requirement for three extra specific roles: those of in loco parentis, in loco infanti , and the special role of nursing staff. These roles and the ethical basis for them are defined. Further, the in loco parentis role is ethically complex, and an IEC considering this role should be clear about its implications. Paediatric research projects involve not only specific risks inherent to the project in question, but also more general risks inherent in any clinical research intervention endeavour itself. Paediatric lECs should act in a mode of encouragement, rather than purely as ‘doctor watchers’, and should insist ab initio on the publication of results as a condition of permission to undertake the research in question. One particularly effective form of ethical audit is the national and international peer review that follows such publication of paediatric research. This report discusses these special themes in the evolving context of greater surveillance of paediatric research.
A review of 19 consecutive serious bathtub immersion accidents (11 survivals, 8 fatalities) is presented. In all instances, consciousness was lost in the water. Unlike other childhood accidents which usually show a male predominance, the sexes are equally affected. The modal age is 11 months. Six separate causes of bath drownings and near-drownings have been identified, and in 14 of the 19 accidents, two or more causes were operating concurrently. Median estimated immersion time for survivals was four minutes, and five minutes for fatalities. The median depth of water was eight inches. An "at risk" profile for home bathtub drownings is presented; this includes the youngest or second youngest child of a large family, a family of grade 4 to 7 sociooccupational status (Congalton) and a family in which routine is temporarily broken.
Follow-up of victims who have been subjected to a variety of marine and terrestrial envenomations, has shown that many victims require attention over a prolonged period of convalescence. Months rather than weeks is the usual time for recovery after significant envenomations; and for some types of clinical poisoning, such as ciguatera, the convalescent period may stretch to years rather than months. The clinical management of the envenomed patient is a commitment not only for the dramatic situation of the acutely ill victim, and for his or her often therapeutic rescue, but for the prolonged clinical contract of a protracted convalescence.
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