1-Introduction to the Unit
How is health defined?
- Medical Model: abscence of disease.
- Holistic Model: state of well-being.
- WHO 1946: 'State of complete physical, mental and social well-being...'
- WHO 1984: '...satisfy needs and to change or cope with the environment...'
Health needs of:
- In Utero Risks: maternal health/nutrition, maternal stress, infections, environmental toxins, drugs/alcohol, smoking
- Infants: health/nutrition, sensory stimulation, attachment, stable environment, sleeping-position/room temp./air quality, hygeine, immunisations
- Toddlers: accident prevention, immunisations, developmental screening, motor development, social skills, language
- Pre-school: safety, nutrition, self-care skills, toilet-training
- School Age Children: self-care skills, nutrition, sleep, exercise
2 - Newborn Infants and Early Infant Feeding
- Immediate needs of the baby: keep warm and dry, skin to skin contact, breast-feeding, assessment, monitoring
- Advantages for baby: contains growth factors / high quality balanced food / confers immunity / protects against allergies / less likely to be overweight / protects against GI and respiratory infections / increased intelligence / reduced risk of middle-ear and urinary tract infections / reduced risk of neonatal necrotising enterocolitis.
- Advantages for mother: reduced risk of breast and ovarian cancer / regain figure more quickly / reduced risk of osteoperosis and hip fracture / contraception
3 - Infant Feeding, Weaning and Childhood Diet
- WHO - exclusive breast-feeding to 6 months
- BUT window at 4-6 months where baby more likely to try new foods - against WHO advice.
- 9 months - introduce different tastes and textures
- ALSPAC - most mothers introduce solids by 4 months.
- Earlier introduction to solids makes obesity more likely.
- If solids introduced after 10 months, greater feeding difficulties at 15 months.
- ALSPAC - most mothers introduce solids by 4 months.
- Healthy Start Vouchers - for milk, fresh fruit and veg., forumula (free vitamin drops)
- Birth to Five
- Important for baby to eat with family - interaction/inclusion.
- Babies generally know when they have eaten enough.
- Avoid giving babies salt, sugar and honey.
- Under ones should have full-fat milk only - reduced fat ok in cooking for under 5s.
- By 1-year should use free-flow cup to learn to sip not ****.
4 - Developmental Pathways and Impacts on Dvlpt
- Latency - factors in early life that have lifelong impact.
- Pathway - early life factors directing child on to different courses.
- Cummulative - accumulation of advantage / disadvantage.
- Bronfenbrenner's Ecological Model - External factors interact with a child features to produce health outcome.
Flaherty et al. (2006)
- Exposure to abuse and household dysfunction leads to poor health in adulthood:
- cancer / liver disease / skeletal fractures / chronic lung disease / ischemic heart disease
- smoking / suicide / depression / obesity / drug abuse / alcoholism / teen pregnancy / sexual risk behaviours / STDs
- One adverse exposure doubles chance of poor health, 4 triples chance.
5 - Child Health Promotion
- Things That Impact on a Child's Health - poverty / diet and weight / pecking order in larger families / exercise / birth injury / environmental factors / pre-natal factors / access to healthcare / genetic disease / lifestyle / relationships / education.
- Universal vs. Targeted Screening.
- Absolute risk - what is my % chance of getting it?
- Relative Risk - how many times more likely are those at risk to get it?
Healthy Child Programme
- Promote breast-feeding and nutrition
- Play and development
- Awareness of environmental factors
- Delivery: Personal Child Health Record / Children's Centres / GP Surgeries / Multi-disciplinary teams - health visitors, midwives, children's centre staff.
6 - Childhood Injury Prevention
- 2 million children a year in A+E from unintentional injury.
- Cost of treating severe scald - £250,000.
- Economic factors: space to play / affording safeguards / appropriate supervision / access to services / education and awareness.
- Number of unintentional injuries has fallen: better car design / technological advances / fewer children play on roads / people more aware / change in government / legislation and enforcement.
- Boys experience more burns and scalds than girls:
- males more exporatory / taller at most ages than girls so can reach surfaces.
- Age plays a factor: mobility / height / younger children more likely to play in kitchen - need supervision.
- Prevention - use back burners on hob / turn pan handles inwards / regulate bath water temperature / remove table cloths / hot drinks in centre of table.
7 - Over and Under Nutrition in Children
- WHO Growth Standars 2006:
- Description of optimal growth.
- Data from breast-fed infanct of non-smoking mothers.
- Affluent countries.
- Faltering growth - weight falls below height by 2 centiles for over 2 measurements or weight centile falls across more than 2 centiles over time.
- Across all socio-economic groups - normally medical cause.
- Wasting - low weight for height.
- Stunting - low height for age.
- Adiposity - dip and rise in BMI - if it happens early, obesity more likely.
- 22 million children overweight worldwide.
- In the UK 22% boys and 28% girls.
- Overweight: BMI 91st centile.
- Obese: BMI 98th centile.
8 - Immunisation and Prevention of Infection
- Clean water and immunisation are 2 public health interventions with greatest impact.
- Aims of immunisation: give protections /long-lasting immunity / interrupt spread.
- Passive immunisation - anti-toxins and immunoglobin, immediate antibodies eg. tetanus.
- Active immunisation - antigens simulate antibody production, live/inactivated.
- Advantages - strong immune response / local and systemic immunity / long-lasting single dose.
- Disadvantages - bad for immunosuppressed patients / poor stability - organism could die and be ineffective / interference by viruses or vaccines and passive antibody.
- Advantages - constituents clearly defined / stable / unable to cause the infection.
- Disadvantages - need several doses / local reactions common / adjuvant needed
8 - Immunisation Schedule 2012
- 2 months - Diptheria Tetanus Pertussis (DTaP) / Inactivated Polio (IPV) / Haemophilus Influenzae B (Hib) / Pneumococcal 13 valent (PCV).
- 3 months - DTaP / IPV / Hib / Meningococcus C (MenC)
- 4 months - DTap / IPV / Hib / PCV / MenC
- 12 months - MenC / Hib
- 13 months - PCV / MMR
- 3 1/4 - 4 years - DTap / IPV / MMR
- 11/12 years - HPV Vaccine for girls.
- 14 - 16 years - Diptheria Tetanus Polio (dt) / IPV
Local: normally with non-live, pain, redness, swelling at injection site. up to 60%
Systemic: normally with live, fever, headache, loss of appetite. 2/3%
Allergic: anaphylaxis / severe systemic. 1 in a million
9 - Developmental Problems/Disability
- Impairment: abnormality of a structure or function.
- Disability: functional consequence.
- Handicap: social consequence.
Medical Model - Minority group issue / Impariment groups / Categorical.
Social Model - Continuum / Everyone may have a disability / Applies to nearly all.
Disability Groups - Physical, motor, mobility / Sensory / Cognitive / Psychiatric / Systemic disease, chronic illness.
- Diagnosis can be disabling.
- Parents can have an agenda for diagnosis - put mind at ease / labeling / get support
Shakespeare and Watson (2002)
- 'Disability as social oppression not the form of impairment.'
- Social model denies difference, denies plural identities.
10 - Common Illnesses & Acutely Unwell Children
- In general practice per 1000 per year:
- Upper respiratory infections: 0-4yrs = 900, 5-14yrs = 398
- Lower respiratory infections: 0-4yrs = 198, 5-14yrs = 82
- Asthma: 0-4yrs = 9, 5-14yrs = 12
- Reasons for rise of some illnesses: drug resistance / immigration? / AIDs
- Reasons for fall of some illnesses: rising standards of living / higher incidence = higher natural immunity?
- Why has asthma increased? Air pollution / cigarette smoking / indoor air quality / genetics / diet and obesity.
- Symptoms of meningitis: headache / high-pitched cry / dislike of bright lights / stiff neck / temperature / rash.
11 - Child Dvlpmt, Atchmt & Maternal Depression
- Leave baby or pick it up? - Learn to regulate emotions or facilitate attachment?
- 4-7 months - preference for mum.
- 9 months - secure base / object permanence ie. understanding mum will come back.
- Insecure - anxious
- Insecure - avoidant
- Maternal depression can affect attachment even before birth: reduced attentional bias to distressed infants / reduced feelings of 'wanting to comfort' / reduced maternal responses after birth.
- Interventions: infant massage / parental guidance / video feedback.
12 - Psych. Aspects of Life Lmtng/Thrtng Cndtns
- Chronic Condtion: last more than 3 mths / cannot be cured / treatment aimed at reducing negative effects eg. asthma / sickle cell anaemia / migraines.
- Life-limiting Condition: no reasonable hope of cure / child or young person will die / sometimes progressive deterioration.
- Life - threatening Condition: curative treatment feasible but can fail eg. cancer.
- STATS: 31% under 18s have a chronic condition / 5852 deaths per year (2002-05)
- Impact on Child: disrupted attachment - caregiver associated with pain? / increased risk of mental illness / striving for a normal lfie - teen risk-taking behaviour / reduced opportunities.
- Impact on Parents: increased stress / financial pressures / reduced career opportunities / impact on physical health / increased risk of mental health issues / 'emotional roller coaster'.
- Impact on Siblings: disrupted attachment . increased risk of mental illness / ambivalent feelings towards ill sibling and parents / isolation / reduced opportunities / protective of parents at cost to self?
- Factors affecting ability to cope: feelings of distress / resources / support / resilience.
13 - Vulnerable Children
- All children in UK: 11 million
- Vulnerable Children: 4 million
- Children in Need: 3-400,000
- Looked After Children: 53,000
- On Child Protection Register: 32,000
- High risk groups: children with disabilities or chronic illnesses / abused and neglected / 'looked after' by LA / living with DV / refugees and asylum seekers / travelling families / parents with mental health problems - learning difficulties, chronic health problems, drug & alcohol use.
- Poverty means more likely to: be born early / be born too small / die in the 1st year of life / die from accidents in childhood / die earlier as adults.
- Travelling families: poor life expectancy / infant mortality 1.5-2 x settled community / many chronic illnesses / smoking very common / poor nutrition.
- Outcomes for Looked After Children: 40% no quals. at 16 / 1/3 experience homelessness / 50% have a mental health problem / 50% care leavers unemployed.
14 - Child Protection is Everybody's Business
- 4 types of abuse: physical / emotional / sexual / neglect.
- Parental issues that my increase risk: substance misuse / DV / MH issues / learning difficulties / young parents / own experiences of parenting.
- No legal age for when you can leave a child home alone.
15 - Global Child Health
- Millenium Development Goals:
- Eradicate extreme poverty and hunger.
- Achieve universal primary education.
- Promote gender equality.
- Reduce child mortality by 2/3, 1990-2015.
- Improve maternal health - reduce maternal mortality by 3/4.
- Combat big 3 - HIV/AIDs, malaria and TB.
- Ensure environmental sustainability.
- Global partnership for development.
- Top 5 killers: diarrhoeal disease/ Acute Respiratory Infection/ Malaria/ Measles/ Malnutrition.
- Integrated management of Childhood Illness (IMCI) - under 5s / reduce - death, illness, disability / promote growth & development / preventative & curative elements.
- Risk Factors: access to healthcare - significant drop in attendance if more than 3 hours away / percieve health needs / conflict & instability eg. Iraq, Afghanistan, Ethiopia.