Can singing a lullaby ease a child’s pain?


Guitar and patient
Nick Pickett playing to Sam Wallace

Amid the beeping of heart monitors, a more gentle noise can be heard on the wards of Great Ormond Street Hospital.

The soft voice of musician Nick Pickett and the strumming of his guitar are entertaining the young patients in Bear Ward.

All the children here are under three years old. Some are facing the long wait for a heart transplant and are being kept alive by the rhythmic beating of a mechanical heart.

Sam Wallace’s bed is surrounded by balloons, toys and other reminders of home. His grandmother, Viv Green, says the music has a transformative effect.

“Oh, Sammy loves music, he has always loved music.

Keira and Ian Bowers

Keira and Ian

Three-year-old Keira has been in hospital since the middle of June with heart failure.

She needs a Berlin mechanical heart, which helps her own heart pump blood around the body.

Her father Ian says the music makes a “big difference.

“It gives them a lift with the musical instruments, just to take their mind off where they are and the conditions they have.

“It perks her day up so it makes her feel wanted in a respect, so it does leave a lasting impression.”

“It just makes him happy. He will sing and dance. He loves to dance, he moves with the music as soon as he hears it and it just brightens him up completely – he’s a different boy.”

Improving moods

But is the bedside entertainment having a clinical benefit on children such as Sam? Can a rendition of Twinkle Twinkle Little Star actually help patients?

A team at the hospital and University of Roehampton tried to find out.

Thirty-seven children were played songs – including Five Little Ducks, See-Saw Marjorie Daw and Hush-a-Bye Baby – while nurses monitored their heart rates and assessed their pain levels.

The impact of the music was compared with storytelling or just leaving a child alone.

Swaddling resurgence ‘damaging hips’


Baby

Parents are risking their babies‘ health because of a surge in the popularity of swaddling, according to an orthopaedic surgeon.

The technique involves binding the arms and legs with blankets and is used to help calm a baby and prevent crying.

But Prof Nicholas Clarke, of Southampton University Hospital, said swaddling was damaging developing hips.

The Royal College of Midwives and other experts advised parents to avoid tightly swaddling a child.

Restricts movement

Swaddling has been widely used in many cultures globally. It is thought the blanket wrapping can simulate the feelings of being in the womb and calm the child.

But the technique holds the legs out straight and restricts movement, which can alter the development of the hip joint.

“Start Quote

Swaddling should not be employed in my view as there is no health benefit but a risk for adverse consequences of the growing and often immature hips”

Andreas Roposch Great Ormond Street Hospital

Writing in the journal Archives of Disease in Childhood, Prof Clarke argued: “There has been a recent resurgence of swaddling because of its perceived palliative effect on excessive crying, colic and promoting sleep.

“In order to allow for healthy hip development, legs should be able to bend up and out at the hips. This position allows for natural development of the hip joints.

“The babies’ legs should not be tightly wrapped in extension and pressed together.”

Jane Munro, of the Royal College of Midwives, said it was a “seemingly innocuous” thing to do, but it posed “significant problems” for the baby.

She said there was also the risk of the baby overheating and a raised risk of cot death.

She added: “We advise parents to avoid swaddling, but it is also crucial that we take into account each mother’s cultural background, and to provide individualised advice to ensure she knows how to keep her baby safe, able to move and not get overheated.”

Video guidance

Andreas Roposch, a consultant orthopaedic surgeon at Great Ormond Street Hospital, said: “Similar effects may be seen in all devices or manoeuvres that place the legs in a purely straight position for prolonged periods in this critical age of early infancy.

“Swaddling should not be employed in my view, as there is no health benefit but a risk for adverse consequences of the growing and often immature hips.”

Rosemary Dodds, of parenting charity the NCT, advised against tight swaddling.

“It is helpful to raise awareness of hip dysplasia in relation to swaddling. Some parents and babies seem to like swaddling, but it is important that babies do not overheat and their legs are not restricted.

“Videos are available on the NCT website showing parents who want to swaddle their baby how to do so safely.”

Child bone-marrow transplant ‘first’


First human trial of new bone-marrow transplant method.

Mohammed Ahmed
Mohammed started going to school in September

Doctors at London’s Great Ormond Street Hospital have carried out a pioneering bone-marrow transplant technique.

They say the method should help with donor shortages since it does not require a perfect cell match.

Mohammed Ahmed, who is nearly five years old, was among the first three children in the world to try out the new treatment.

He has severe combined immunodeficiency syndrome and had been waiting for a suitable donor for years.

Mohammed, who lives in Milton Keynes, was referred to Great Ormond Street Hospital when he was a year old.

“Start Quote

We waited for a full match but it did not come. By the grace of God, we took the decision to have the treatment”

Jamil Ahmed, Mohammed’s dad

His condition – a weak immune system – makes him more susceptible to infections than most, and a bone marrow transplant is the only known treatment.

While Mohammed was on the transplant waiting list, he became extremely sick with swine flu.

At that time, his doctors decided Mohammed’s only real hope was to have a mismatched bone-marrow transplant, with his father acting as the donor.

Mohammed’s dad, Jamil, agreed to give the experimental therapy a go.

Before giving his donation, Jamil was first vaccinated against swine flu so that his own bone-marrow cells would know how to fight the infection.

Mohammed’s doctors then modified these donated immune cells, called “T-cells”, in the lab to engineer a safety switch – a self-destruct message that could be activated if Mohammed’s body should start to reject them once transplanted.

Safety net

Rejection or graft-v-host disease is a serious complication of bone-marrow transplants, particularly where tissue matching between donor and recipient is not perfect, and is one of the most difficult challenges faced by patients and their doctors.

Mismatched transplants in children – where the donor is not a close match for the child – are usually depleted of T-cells to prevent graft-v-host disease, but this causes problems in terms of virus infections and leukaemia relapse.

Blood cells
White blood cells protect the body against infections

The safety switch gets round this – plenty of T-cells to be transfused and later killed off if problems do arise.

Thankfully, the transplant carried out in 2011 was a success – Mohammed’s doctors did not need to use the safety switch.

Although Mohammed still has to take a number of medicines to ward off future infections, his immune system is now in better shape.

Jamil said: “We waited for a full match but it did not come. By the grace of God, we took the decision to have the treatment.

“Now he is all right. Sometimes we forget what he has been through. We are just so grateful.”

He said Mohammed would still need close monitoring and regular health checks over the coming years, but his outlook was good.

Dr Waseem Qasim, ‎consultant in paediatric immunology at Great Ormond Street Hospital and lead author for the study, said the new approach should hopefully mean children who received a mismatched transplant could enjoy the same chance of success as those given a fully matched transplant.

“We think Mohammed is cured of his disorder. He should be able to lead a fairly normal life now.”

A full report about Mohammed’s therapy and the research by Great Ormond Street Hospital, King’s College London and the Institute of Child Health has just been published in PLoS One journal.

There are currently about 1,600 people in the UK waiting for a bone-marrow transplant and 37,000 worldwide.

Just 30% of people will find a matching donor from within their families.

Donations involve collecting blood from a vein or aspirating bone marrow from the pelvis using a needle and syringe.