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ObjectiveDue to lack of information on drug use in children, many drugs are used off-label in paediatrics. Increased knowledge of adverse drug reactions (ADRs) would enable a better risk–benefit analysis. Our aim was to characterise drugs causing psychiatric ADRs in children by conducting a descriptive study based on pharmacovigilance reports.DesignReports submitted to the Netherlands Pharmacovigilance Centre Lareb from 2003 to 2016 were used to investigate drugs causing psychiatric ADRs in the Dutch paediatric population. These data were corrected for drug utilisation in order to correct the number of reports for the number of users of a drug.Main outcome measuresORs were calculated as a measure of disproportionality for drug–ADR associations for three different age groups. Significant drug–ADR associations were checked if it was labelled in the product information.ResultsLareb received 918 reports of psychiatric ADRs, which constitute 15% of the reports of ADRs in children. Drugs used for the treatment of ADHD (methylphenidate and atomoxetine) and drugs used for the treatment of asthma (montelukast and fluticasone) were the most frequently reported. However, psychiatric ADRs were also reported for less often prescribed medications such as oxybutynin and isotretinoin.ConclusionsReal-world data on psychiatric ADRs in the Dutch paediatric population show a consistent pattern with what is known from drug labels and the literature. Reports of psychiatric ADRs should be taken seriously because of the impact on medication adherence and the well-being of the child and its family.

BackgroundChild abuse and neglect have strong negative effects on the well-being of children, not only during childhood but also later in life. Therefore, early recognition is important.Case presentationWe describe a 4-year-old Caucasian boy who had severe dental caries. This was a result of insufficient dental care: he refused to brush his teeth and drank sweetened drinks. We considered this dental neglect to be a manifestation of child neglect and social services were consequently called in to help the family.ConclusionsThere is a strong association between child abuse and neglect and dental caries. Abused children often have severe dental caries and in children who had dental caries, child abuse and neglect is often established. An important factor is insufficient parenting; therefore, we believe that severe dental caries is an important indicator for child abuse and neglect.

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ObjectivesPatients with allergic rhinitis receive their information about administering intranasal corticosteroid sprays (INCS) from healthcare workers. Since the majority of patients does not administer these sprays correctly, we investigated whether healthcare workers know how to administer INCS.SettingsWe studied participants at their working place: pharmacy, outpatient clinic or general practitioner centre for emergencies.ParticipantsPharmacist assistants, general practitioners, paediatricians and ear nose throat doctors.DesignObservational study. All the participants demonstrated the administration technique with a spray device filled with water.Primary outcomeNumber of steps of administration of INCS based on the established INCS protocol.Secondary outcomeNumber of five steps are labelled essential to obtain optimal distribution of the medication.ResultsAmong the 75 participants, none performed all the steps correctly. The median of correctly performed steps in the protocol was 14 out of 29. A significantly better result was found among the pharmacist assistants. The essential steps were performed by 27 out of the 75 participants (36%).ConclusionThe majority of healthcare workers does not know how to administer INCS correctly. Patients could, therefore, receive incorrect and non-uniform instructions. The education of healthcare workers on how to administer INCS correctly may be an option for improvement.