Aims: To determine whether artificial food colourings and a preservative in the diet of 3 year old children in the general population influence hyperactive behaviour. Methods: A sample of 1873 children were screened in their fourth year for the presence of hyperactivity at baseline (HA), of whom 1246 had skin prick tests to identify atopy (AT). Children were selected to form the following groups: HA/AT, not-HA/AT, HA/not-AT, and not-HA/not-AT (n = 277). After baseline assessment, children were subjected to a diet eliminating artificial colourings and benzoate preservatives for one week; in the subsequent three week within subject double blind crossover study they received, in random order, periods of dietary challenge with a drink containing artificial colourings (20 mg daily) and sodium benzoate (45 mg daily) (active period), or a placebo mixture, supplementary to their diet. Behaviour was assessed by a tester blind to dietary status and by parents' ratings. Results: There were significant reductions in hyperactive behaviour during the withdrawal phase. Furthermore, there were significantly greater increases in hyperactive behaviour during the active than the placebo period based on parental reports. These effects were not influenced by the presence or absence of hyperactivity, nor by the presence or absence of atopy. There were no significant differences detected based on objective testing in the clinic. Conclusions: There is a general adverse effect of artificial food colouring and benzoate preservatives on the behaviour of 3 year old children which is detectable by parents but not by a simple clinic assessment. Subgroups are not made more vulnerable to this effect by their prior levels of hyperactivity or by atopy.

The Castang Foundation, Bath Unit for Research in Paediatrics, National Institute of Health Research, the Royal United Hospitals Bath NHS Foundation Trust, BRONNER-BENDER Stiftung/Gernsbach, University Children's Hospital Zurich.

Following the successful conclusion of the 3-year government-funded project Education Services, Social Care and The Health Authority shared the ongoing funding of the current service. This has been operating effectively for over 6 years and has highlighted a wide variety of issues around this style of service delivery.

SUMMARY A care by parent scheme was established in the children's department of a university hospital. It was seen as the natural extension of the increased involvement of parents in the care of their children in hospital. A structured observational study was carried out to monitor its effect on the lives of child patients. Children in the scheme spent far less time awake alone, cried less, and slept less than those nursed unaccompanied. They had far more social interaction with a smaller number of adults, most of their contacts being with family members rather than hospital staff. Children with a resident parent but outside the scheme were generally in an intermediate position on these factors.In Britain the daily and daylong presence of parents in children's wards is essentially a postwar phenomenon, despite Spence's earlier pioneering work in Newcastle upon Tyne.' The war itself provided ample evidence of the effects of the separation of young children from their parents. During the same period the advent of powerful anti-infective agents meant that isolation and the exclusion of 'outsiders' were no longer prerequisites for the treatment of many conditions.The publication of the Platt report2 in 1959 was the turning point in the importance of visiting children in hospital being accepted, and the report urged the provision of beds for mothers to stay with the youngest children. The Platt committee advocated this to avoid the damage caused by the separation of young children from their mothers and, also, to provide stimulation, occupation, and education appropriate to the age range. The extension of hospital education and improved play facilities, with specialised staff, followed. These aspects of Platt's recommendations were more acceptable to ward staff than the unrestricted presence of mothers. It was feared that sheer numbers would interfere with the running of the ward, that crossinfection would increase, and that. in their ignorance, mothers would frustrate the aims of nursing care for both their own and other children, while expecting hotel service for themselves. A paper written in 1965 by McCarthy and MacKeith was recently reprinted.3 It included one mother's account of severely restricted access to her child, who died after routine surgery. The emotional needs of children in hospital were discussed in relation to the requirements of their medical care.Mothers, on the other hand, had been assured for years that their presence was upsetting (if not actually dangerous) for their children, who were in 'the best place' and would settle down better without them. They were, not unnaturally, puzzled by the change of policy. When they did make extended visits or stay they thought that they were getting in the way of the nurses and the real work.4