Professionals working in child and adolescent mental health services are increasingly encouraged to examine the evidence underlying their clinical practice. Embracing evidence-based practice can present difficulties, as barriers to changing practice exist. These difficulties are examined, along with the meaning of evidence-based practice in a multidisciplinary speciality, and the potential benefits that develop from it.

The accurate assessment of body composition is of importance in the Prader-Willi syndrome. Many techniques are not applicable due to ethical or practical reasons. However, the bioelectrical impedance technique is a rapid, painless, noninvasive method of estimating total body water and hence, fat-free mass in obese children and adolescents. We have compared estimates of total body water derived from bioelectrical impedance with actual measurements taken, using H2 18O dilution, in 14 children with Prader-Willi syndrome. Existing equations for predicting total body water from impedance showed a bias to underestimate actual measures of body water. There were positive correlations between the degree of underestimation with age and body fatness. It is possible that changes in body shapes influence bioelectrical impedance measurements in obese individuals, and that a prediction equation based upon a normal population will not be applicable to obese individuals.

In infants, sleeping metabolic rate (SMR) is used as a proxy for basal metabolic rate (BMR). BMR can be predicted from anthropometry using published equations. Our study was intended to evaluate the ability of these equations to predict measured SMR in infants aged 6 weeks to 12 months. SMR was measured in a mixed longitudinal study using the Douglas bag technique (n = 105). Measured SMR values were compared with BMR predicted from weight (BMR-1) or weight and length (BMR-2). These equations were not successful in predicting SMR in this age group. Percentage error of predicted BMR was related to infant weight (BMR-1: r = 0.26; p < 0.005; BMR-2: r = 0.18; p < 0.06). Alternative logarithmic equations were derived from this study (R = 0.84-0.87; SEE = 0.159-0.168). We conclude that the new equations, relating to contemporary infants, are more suitable but actual measurements remain preferred.

Professionals working in child and adolescent mental health services are increasingly encouraged to examine the evidence underlying their clinical practice. Embracing evidence-based practice can present difficulties, as barriers to changing practice exist. These difficulties are examined, along with the meaning of evidence-based practice in a multidisciplinary speciality, and the potential benefits that develop from it.

Financial benefits for child health and well-being in low income or socially disadvantaged families in developed world countries.