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Questions have been raised as to whether propranolol, which crosses the blood-brain barrier, when used early in life may have an adverse effect on gross motor development. A retrospective survey asking questions about gross motor development was sent to the families of children who had been prescribed oral propranolol for infantile haemangioma at Sydney Children's Hospital between 2008 and 2013. It was found that of the 84 patients surveyed, four were delayed in walking unassisted. There was a statistically significant influence if the child was taking other medications which included prednisolone, vincristine, omeprazole, ranitidine, salbutamol, Flixotide, Timoptol and antibiotics. This was not further analysed in this study because of the low numbers involved. There was no statistically significant influence of gestational age, birth weight or length of time on propranolol. This study adds to the retrospective data available; however large-scale prospective studies are needed to identify unexpected long-term side-effects.

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Introduction The Maintenance of Wakefulness Test (MWT) has been used as an objective measure of the ability to stay awake and can be used to assess effectiveness of treatment. There are no universally accepted guidelines for assessing effective treatment or driving readiness in adolescents with narcolepsy and there is only limited data published on the use of MWT in children. The purpose of this study is to present a single-centre experience recording the use of MWT in a paediatric series. Methods This study reviewed the charts of children with narcolepsy who had an MWT performed between April 2014-January 2022. Demographics, clinical characteristics, MWT findings, change in management and driving status were obtained. Results MWT-40 minute protocol was used on 12 children with narcolepsy (median age 16.38 years, range 15.92 – 18.97years), of which 9 (75%) had cataplexy and four (33%) were males. The MWT was used to assess response to treatment and driving suitability. Two (17%) fell asleep during the 4 wake-trials. The median mean sleep latency for all studies was 16.88 minutes (range 5.75-28 minutes). In these two patients, findings from the MWT resulted in changes in management. Eight obtained their learners-driver’s licence after the MWT Five signed “driving contracts” with their physician. Discussion Our result suggests that the MWT has clinical usefulness in evaluating responses to treatment in adolescents with narcolepsy. Changes in management occurred in all patients who failed MWT. This test was used in half patients to help determine readiness for driving in this group.