The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

A male child suffering from generalized tonic clonic epilepsy, on treatment with valproate, developed fulminant hepatic failure, hyperammonemia and encephalopathy due to drug toxicity. The most extraordinary feature was his MRI (FLAIR image) of brain which showed unilateral hyperintensities in right putamen and caudate nucleus. The patient recovered on withdrawal of valproate with mild residual left sided athetotic movements during remission. Repeat investigation confirmed an improved MRI imaging and normalised blood ammonia levels. The case report is unique because of unilateral involvement of basal ganglia due to valproate-induced encephalopathy.

OBJECTIVES:To assess the role of different factors that are associated with initiation and continuation of adolescent smoking.MATERIALS AND METHODS:A total of 2535 students (1465 males and 1070 females) between the age groups of 14 and 19 years were selected from four schools and two colleges of the city by two-stage cluster sampling design for this cross-sectional study.RESULTS:The prevalence of cigarette smoking was 21.58%. Smoking was found to be considerably influenced with having seen best friend, father, sibling and favorite movie star smoke and also with receiving pocket money.CONCLUSION:Experimentation of substance use, motivated by family members, peer groups and the surrounding environment is common among adolescents and starts early in life. Therefore, it is necessary to come up with health promotion programs directed toward students which encourage attitude shaping among them toward self-confidence and healthy life style.

Background: In developing countries, 80% of the births take place in the community. Methods: Birthweight, mid-arm and chest circumferences were measured in 294 newborns admitted in a tertiary-level hospital in Kolkata between April and August 2010. Colour-coded measuring tapes were devised using receiver operating characteristic curves to calculate the most sensitive and specific cut-off values to identify birthweight < 2.5 and 1.8 kg. Result: There is no significant difference in accuracy of Mid-arm circumference (MAC) and Chest circumference (CC) for prediction of low birth weight and birthweight < 1.8 kg. The tape has three zones, green [weight (wt) > 2.5 kg, MAC > 8.4 cm, CC > 30 cm], yellow (wt 2.5-1.8 kg, MAC 8.4-6.7 cm, CC 30-25.5 cm) indicating some risk, and red (wt < 1.8 kg, MAC < 6.7 cm, CC < 25.5 cm) indicating babies needing referral and admission in Level II neonatal care unit.

BACKGROUND:Despite the huge proportion of the babies in the developing world being born low birthweight, only about half of the newborns are weighed at birth as weighing scales often tend to be either non-available or defective.OBJECTIVE:Designing a nomogram for estimation of birthweight from head circumference (HC) and mid-upper arm circumference (MUAC).METHOD:Birthweight, HC and MUAC of 500 newborns who were admitted in the baby nursery of Medical College and Hospital, Kolkata between July 2010 to December 2010 were measured.RESULTS:Multiple linear regression equation for prediction of birth weight from MUAC and HC was derived and a nomogram was constructed from the same.CONCLUSION:The birthweight estimation nomogram is an inexpensive and convenient tool for use in the community setting where weighing machines may not be always available and may thus allow prompt and early referral.

Congenital malaria is an established though infrequent disease entity. So far, 300 cases are reported in literature which are mostly caused by transplacental transfer of parasitized erythrocyte during pregnancy or at the time of delivery from an undiagnosed or untreated mother. We report a case where mother inspite of being adequately treated for Plasmodium vivax during her antenatal period, couldn’t prevent transplacental transmission to the neonate. The probable mechanism was relapse from hypnozoites which were not eliminated due to restrictions on use of Primaquine during pregnancy. The case brings in forth the importance of early neonatal screening in such situations of Plasmodium vivax malaria in mother irrespective of treatment or recovery. The case also emphasizes the need to evaluate the role of chemoprophylaxis in pregnant mothers of endemic regions. Presence of parasite in the microscopical section of the placenta, parasite illustrated within 7 day of life in newborn’s peripheral blood smear and that of maternal blood smear after delivery and IgG anti malarial antibodies in infant’s blood are indicators of congenital malaria. The onset, spectrum of clinical presentation , and prognosis are however diverse.

A 3-year-old boy receiving valproate for 1.5 months presented with sudden-onset unprovoked seizures and unconsciousness. Hypoketotic hypoglycemia, hyperammonemia, and deranged liver function were detected. Elevated medium-chain urinary acylglycines and plasma acylcarnitine were detected. His serum valproate level was elevated. Valproate toxicity had been precipitated in presence of medium-chain acyl-CoA dehydrogenase deficiency. Cranial magnetic resonance imaging brain indicated unilateral basal ganglia ischemia instead of the bilateral changes expected in metabolic disease.

We report a 2 year 6 months old girl suffering from HIV infection and presenting with two giant condyloma acuminata of perianal and perivulvar region along with oral candidiasis.

Cutis marmorata telangiectatica congenita (CMTC) is a rare congenital disorder with persistent cutis marmorata, telengiectasia, and phlebectesia, which may be associated with cutaneaus atrophy and ulceration of the involved skin. We herewith report a full-term newborn female baby with CMTC at birth with ulceration over the extensor aspects of both the knee joints and right elbow joint. CMTC is a benign vascular anomaly representing dilatation of capillaries and veins of dermis and is apparent at birth. The baby had a reticulated bluish purple skin changes all over the body including the face and limb. Although it resembled physiological cutis marmorata, it was strikingly pronounced and definitely was unvarying and permanent. A variety of vascular malformation has been described along with this disorder. Etiology is not very clear and may be multifactorial, teratogens and genes are also been suggested. Prognoses in uncomplicated cases are good.

Head and neck masses in children are common but the spectrum of pathology differs from that in adults. In children the lesions are related to congenital anomalies, inflammation etc are commoner than the primary malignancies unlike that in adults. Primary malignant tumors of head and neck account for about 5% of all neoplasms occurring in children. Suspicious or long standing masses are referred to the otolaryngologist who faces the dilemma of deciding which one requires surgical intervention. It is also very important to exclude the inflammatory masses from the neoplastic ones, as they are often cured by conservative treatment only. Role of FNAC is very important because early diagnosis can be given segregating the masses allowing more rational planning of treatment.