word count: 297 Main text word count: 2999Page 2 of 16 ObjectivesTo report the frequency of Complementary and Alternative Medicine (CAM) use by a population of pregnant women in the UK. DesignFour postal self-completion questionnaires completed at 8, 12, 18 and 32 weeks' gestation provided the source of CAMs used. Questions asked for written descriptions about the use of any treatments, pills, medicines, ointments, homeopathic medicines, herbal medicines, supplements, drinks and herbal teas. SettingAn observational, population-based, cohort study of parents and children of 14541 pregnant women residing within the former county of Avon in south-west England. Data was available for 14115 women. ResultsOver a quarter (26.7%; n=3774) of women had used a CAM at least once in pregnancy, the use rising from 6% in the 1 st trimester to 12.4% in the 2 nd to 26.3% in the 3 rd . Herbal teas were the most commonly reported CAM at any time in pregnancy (17.7%; n=2499) followed by homeopathic medicine (14.4%; n=2038) and then herbal medicine (5.8%; n=813). The most commonly used herbal product was chamomile used by 14.6% of women, the most commonly used homeopathic product was Arnica used by 3.1% of women. Other CAMs (osteopathy, aromatherapy, acupuncture/acupressure, Chinese herbal medicine, chiropractic, cranial sacral therapy, hypnosis, non-specific massage and reflexology) accounted for less than 1% of users. ConclusionsCAM use in pregnancy, where a wide range of CAMs has been assessed, has not been widely reported. Studies that have been conducted report varying results to this study (26.7%) by between 13.3% and 87% of pregnant women. Survey results will be affected by a number of factors namely the inclusion/exclusion of vitamins and minerals, the timing of data collection, the country of source, the number of women surveyed, and the different selection criteria of either recruiting women to the study or of categorising and identifying a CAM treatment or product.

No other study, to our knowledge, has been able to map the use of HP over such a long time period in such a large cohort of children. The amount of HP use reflects a significant minority of the population who use complementary and alternative medicine treatments to manage the health of their family. Health care professionals should be aware of the confusion surrounding HP and have knowledge around some of the more commonly used HP. Parents and carers are using homeopathy wisely with appropriate remedies consistently used for acute problems. Research could focus on greater information delivery to the community and monitoring of potential health and cost benefits, or side-effects of the use of HP for acute and chronic conditions in children.

The frequency, cause and treatment of limb pain were ascertained in a cohort of children at six time points between the ages of 5 and 13 years. Data were collected using self-completion questionnaires sent to the chief carers of children in the Avon Longitudinal Study of Parents and Children. Reports of limb pain over the study period doubled from 15.1% of children aged 5 to 32.5% aged 13; 3.4% of children had limb pain at all time points, 43.4% never reported limb pain and 56.6% reported limb pain on at least one occasion. Growing pains were the most common 'cause' given for limb pains. Limb pain and growing pains were each associated with a family history of arthritis and rheumatism. Limb pain prevalence may have been under-reported in this study due to gradual attrition, particularly in the less educated mothers among whom the highest prevalence of limb pain was reported.

Background: Any intervention to reduce the inappropriate use of antibiotics for infections in children has the potential to reduce the selective pressure on antimicrobial resistance and minimise the medicalisation of self-limiting illness. Little is known about whether homeopathic products might be used by some families as an alternative to antibiotics or the characteristics of such families. We used the Avon Longitudinal Study of Parents and Children (ALSPAC) observational dataset to explore the hypothesis that the use of homeopathic products is associated with reduced antibiotic use in pre-school children and to identify characteristics of the families of pre-school children given homeopathic products.

The ability of diagnosis related groups (DRG) and refinement diagnosis related groups (RDRG) to measure differences in case-mix was investigated using discharge data for patients < 18 years of age from three specialist children's hospitals and four district hospitals. While the three children's hospitals each had a greater percentage of RDRG for more complex patients, only one children's hospital had more complex patients based on DRG and RDRG cost weights and on the percentage of diagnoses per discharge. Cost weights based on USA practices may be inappropriate in Australia, and Australian weights will be necessary for firm conclusions. Refinement diagnosis related groups with appropriate cost weights may be acceptable measures of case-mix in specialist children's hospitals, but they have inherent limitations for paediatric patients in that many complex paediatric patients are ill very seriously with one disorder, whereas complex adult patients usually have secondary diagnoses and secondary procedures. Moreover, no DRG version developed in the US will be suitable for use in Australia unless it takes account of medical costs and transfer practice.