Normal DPT (wP) versus "Painless DPT (aP)" - what does the science say?

SAGE-WHO recommendations vindicated IAP ACVIP stand on Pertussis vaccination:

wP Versus aP vaccines:

Acellular vaccines
o Lower initial efficacy
o Faster waning of immunity
o Possible reduced impact on transmission
o Likely to result in resurgence
o Magnitude and timing of resurgence difficult to predict
o Potential increased risk of death in those too young to be vaccinated

Must consider overall goal of national immunization program
1. Protection of infants ? No benefit of aP over wP vaccines
o disease-related mortality significantly reduced with either wP or aP vaccination
2. Protection of older children or adults ? Multiple doses of aP required
o Only possible with aP vaccines (less reactogenic)
o Requires repeat boosting (limited duration of efficacy) to limit/prevent resurgence and increased risks to infants
o Increased program cost
wP vaccines preferred when:
o Program target is prevention of infant disease
o Limited number of pertussis doses delivered / affordable

 aP vaccines should only be considered when:
o Program objectives include older children and adults
o Large numbers of doses may be included in a national immunization schedule
o Cost implications (higher unit cost & number of required doses)

CONCLUSIONS:
SAGE concluded that the licensed acellular pertussis vaccines (aP) lower initial efficacy, have faster waning of immunity, and possibly a reduced impact on disease transmission relative to currently internationally available whole-cell vaccines (wP). The risk of resurgence of pertussis associated with the use of aP vaccines including increased infant disease, indicates that countries currently using wP should continue using wP vaccines for early infant vaccination.

As communicated by Dr Naveen Thacker 

Soda consumption is associated with negative behavior in young children

J Pediatr. 2013;163:1323-8.

Question: Among young children, what is the association of soda consumption with negative behavior?

Design Prospective birth cohort from the Fragile Families and Child Wellbeing Study.

Setting 20 large US cities.

Participants Children age 60 months.

Intervention Daily soda consumption vs. none.

Conclusions Soda consumption is associated with negative behavior among very young children.

Commentary During the past two decades, there have been substantial studies on the adverse effects of soft drinks on human health, especially chronic disease among adults. Find-
ings from these studies have led to changes in policies (eg, taxing soft drinks) in some countries. The study by Suglia et al focuses on soft drinks and behavior among children.
Consistent with findings among adolescents in Norway and US, high soft drink consumption is positively related to behavior problems in children age 5 years. The study is important because of its large sample size and ability to adjust for a range of confounding factors. The study’s findings are supported by existing evidence. In addition to the chemicals in soft drinks mentioned by the authors, phthalates from plastic packaging may also explain the link. A high maternal prenatal urinary phthalates level is associated with child behavior problems at age 3 years. Data from the National Health and Nutrition Examination Survey suggest that there is an association between phthalates and attention deficit disorder in children. High consumption of soft drinks among young children is of great concern and supports focusing attention towards reducing consumption. 
Zumin Shi, PhD
University of Adelaide
Adelaide, South Australia

Fake medical certificates demanded by school teachers for students attending family function. what is the solution?

Many pediatricians have faced this problem.This question has been asked in a forum of pediatricians and has given me food for thought as well.
What is happening is that Teachers are not only forcing the parents for a medical certificate after a short illness but even if the family is going out of town for a family function they ask the parents to get a medical certificate !!
Now this becomes very embarrassing for a doctor who does not like to issue fake certificates and the family is a regular? from decades! ! How to say No!! 

I have issued medical certificates once in a while on demand of 'strict' schools where every leave has to be condoned with a medical certificate, even if it is for a family function. How do we proceed since otherwise the child/ parents may be harassed?
I remember what my father did when I was 10 years, and we wanted to see the 1982 Asian Games in Delhi. He was a pediatrician in the Army, and he could obviously have generated a medical certificate from one of his colleagues. However, he chose to go to Principal of the school and told her the truth. The principal appreciated this fact, and was quite impressed to day the least.
I am not saying that this will work for everyone, but stating the truth may be an alternative to consider, rather than asking your pediatrician for a false certificate.