We reported some time ago that a review of Cochrane reviews (yes .. we are well aware of the meta-meta here ) looking at both adult and child responses to treatments showed, on average, that an intervention was equally as likely to be effective, or ineffective, in children as it was in adults.

Like many averages, though, this one hides a wealth of difference. (Take for example, the question “Do antibiotics help children with fever?” – on average, the answer may be ‘No’, but this will hide those with sepsis who it saves, and those with viral / malignancy fevers who it only gives horrible diarrhoea, rashes and vomiting to.) Sometimes children and adults may have the same ‘name’ diagnosis (perhaps ‘heart failure’?) but have such different pathophysiologies that treatments may be differentially effective.

What about functional constipation?

This is a common condition in children and adults, and it would be great if we could get it fixed. Remember that children with chronic constipation have a far worse quality of life than children with acute leukaemia. An industry-sponsored study looked at Prucalopride

It did – in that they could take it and some got better poo~ing – but it didn’t, in that the same proportion improved on placebo. About 17% were successful in attaining ‘normal’ patterns, with an RR 1.01 (95% CI 0.88 to 1.16).

It strikes me that

• We should celebrate the honest title (“Prucalopride Is No More Effective Than Placebo for Children With Functional Constipation”) and release rather than suppression of such data
• The continued investigation of such an unpleasant condition is brilliant
• 17% success is appalling.

Now I guess that previous data have suggested that children and adults with constipation are different, so it shouldn’t be surprising, but it does keep me wondering about which are the situations where “children are not little adults” and when it’s true that “adults are just big kids”.

– Archi