Child Public Health Resources
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Hot Reads for Child Public Health April 2010
Thanks to Russell Willis and David Grayson for alerting us to the March issue of Health Affairs which is devoted to the issue of childhood obesity. The papers cover a wide range of issues including epidemiology, policy, built environment, school meals, economics and effective policy interventions. One paper references the youtube video produced to reduce sugary drink consumption in New York City (which is horribly graphic). For an encouraging anecdote about one household changing their habits with dramatic effect read the article: ‘How Much Does Zozo Weigh Today?’ And some advice to overweight doctors is contained in ‘The elephant in the exam room’ (both these latter articles available in full text).
Can preschool improve child health outcomes? A systematic review. Soc Sci Med 2010 Feb 12. From the University of South Australia comes a systematic review that highlights the importance of a sound evidence base for policy interventions. The study examined evidence for child health effects of centre-based preschool intervention programs for healthy 4 year olds, beyond the preschool years, and reviewed 37 eligible studies which investigated a heterogeneous group of interventions. The review found generally null effects of preschool interventions across a range of health outcomes, however there was some evidence for obesity reduction, greater social competence, improved mental health and crime prevention.
The VicGeneration study - a birth cohort to examine the environmental, behavioural and biological predictors of early childhood caries: background, aims and methods. BMC Public Health. 2010 10:97. From Victoria a detailed methods paper for a proposed longitudinal study to gather data on the risk factors for dental caries in pre-school aged children. The study will begin with recruitment of a birth cohort of children in disadvantaged communities and follow them for 18 months. The focus of the study seems to be on basic science (e.g. individual microbial patterns) and lifestyle (feeding choices). The authors expect to “generate knowledge about pathways, prevalence and preventive opportunities for early childhood caries, the most prevalent child health inequality.”Antecedents of teenage pregnancy from a 14-year follow-up study using data linkage. BMC Public Health. 2010;10:63. Analysis of the WA Child Health Survey (WACHS), in conjunction with administrative data relating to subsequent births and hospital admissions of the 1374 female children in the survey, identified 155 girls who were aged under 20 years when their first pregnancy was recorded. Teenage pregnancy was significantly associated with a number of family and parental factors, and with aggressive and delinquent behaviours in the individual girl. The authors suggest the introduction of interventions to reduce teenage pregnancy rates in primary schools, including the prevention and management of aggressive and delinquent behaviour.
An exploration of knowledge, attitudes and advice given by health professionals to parents in Ireland about the introduction of solid foods. A pilot study. BMC Public Health. 10:201 An interesting paper from Ireland detailing the conflicting guidelines on weaning advice in Europe. The resulting confusion for parents would seem to be compounded by “varying levels of knowledge of official weaning recommendations and a variety of advice practices” among the General Practitioners, Practice Nurses, Public Health Nurses and Community Dieticians surveyed in a pilot study. Conversations with practitioners in Australia suggest results of a similar survey here could also provide interesting results.
Elevations in mortality associated with weaning persist into the second year of life among uninfected children born to HIV-infected mothers. Clin Infect Dis. 2010 Feb 1;50(3):437-44. From Lusaka, Zambia, a reminder of the ethical obligation to “first do no harm” with advice about weaning. The authors critically evaluate the outcomes of early weaning of children of human immunodeficiency virus (HIV) infected mothers, which has been recommended to reduce postnatal HIV transmission. In a randomized trial, 958 HIV-infected mothers and their infants were recruited and followed up from birth to age 24 months. One-half of the cohort was randomized to wean abruptly at 4 months, and the other half of the cohort was randomized to continue breast-feeding. Early weaning was associated with significantly increased risk of mortality at all ages, and these risks were stronger among infants born to mothers with higher CD4(+) cell counts. In a resource-poor setting, the risks associated with shortening the normal duration of breast-feeding for uninfected children born to HIV-infected mothers outweighed any potential benefits from reduced vetrtical transmission of infection even with nutritional and counseling interventions.
Child home injury prevention: understanding the context of unintentional injuries to preschool children. DOI: 10.1080/17457300903135636 Int J Inj Contr Saf Promot. 2009 16:159-67. Semi-structured interviews with a convenience sample of 100 caregivers attending a NZ emergency with a child aged under 5 years who were presenting with an injury that occurred at home found that the factors associated with reported home injury are complex and multifaceted. “Factors related to the environment, the child, the parent, their behaviours and activity interacted, with common patterns preceding injury being evident such as times of day and disrupted routines … Complex parental factors were identified, such as not anticipating risk, having unrealistic expectations of children, lacking knowledge of child development and accepting injury as a norm. A useful paper to prompt further research.
Children's roles in parents' diabetes self-management. Am J Prev Med. 2009 Dec;37(6 Suppl 1):S251-61. A community-based participatory research project engaged 24 Latino and African-American adults with diabetes and a child (aged 10-17 years) in their home to explore the extent of children’s caregiving roles. Both adults and children identified multiple roles played by children in adults’ diabetes management. “Parents described children as monitoring parents' dietary intake and reminding them what they should not be eating. Some children helped with shopping and meal preparation. Families described children reminding parents to exercise and exercising with their parents. Children reminded parents about medications and assisted with tasks such as checking blood sugar.” The key sentence in the abstract is in the conclusion (italics added): “Healthcare providers should encourage family lifestyle changes, strengthen social support for families, and direct children toward roles that are beneficial for both parent and child without placing an unreasonable level of responsibility on the child.
Climate change, water resources and child health. oi:10.1136/adc.2009.175307 Arch Dis Child. Thanks to Graham Vimpani for notice of this article that views the issue of climate change from the perspective of the likely effects on child health. The authors argue the importance of paediatricians and healthcare professionals taking a critical leadership role in both policy development and programme implementation to prevent or at least minimize serious deterioration of global child health.