Child Health

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
  

• Immediate needs of the baby: keep warm and dry, skin to skin contact, breast-feeding, assessment, monitoring

Breast-feeding

• 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

• 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.

• 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 ****.

Effects:

• 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.

• 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

• Immunisation
• 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.

• 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.

Drago (2005)

• 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.

• 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.

• 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.

Live Vaccines

• 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.

Inactivated Vaccines

• Advantages - constituents clearly defined / stable / unable to cause the infection.
  
• Disadvantages - need several doses / local reactions common / adjuvant needed

• 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

REACTIONS

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

• 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.

Hodge (2005)

• 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.

• 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.

• 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.

Attachment Styles:

• Secure
• 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.

• 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.

• Stats:
  • 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.

• 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.

• 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.