Unsettled infant behaviour and health service use: a cross-sectional community survey in Melbourne, Australia

Aims: To investigate factors associated with health service use by women and their infants in Victoria, Australia. Methods: Cross‐sectional screening survey of 875 women with 4‐month‐old infants attending immunisation clinics in five local government areas in Melbourne between May 2007 and August 2008. The self‐report instrument assessed socio‐demographic characteristics, unsettled infant behaviour, maternal mood (Edinburgh Postnatal Depression Scale) and, the outcome, health service use during the first 4 months post‐partum. Results: Mothers and their infants used on average 2.8 different health services in the first 4 months post‐partum (range 0–8). After adjustment for other factors, high health service use (defined as >3 different services) was more common in mothers whose infants were unsettled with persistent crying, resistance to soothing and poor sleep. A one‐point increase on the unsettled infant behaviour measure was associated with an 8% (2–14%) increase in the use of >3 services, 9% (3–16%) in use of emergency departments, 7% (2–13%) in use of telephone helplines and 9% (3–14%) of parenting services. Poorer maternal mental health was also implicated with a one‐point increase on the Edinburgh Postnatal Depression Scale associated with a 4% (0.4–8%) increase in the likelihood of using more than three services. Conclusions: Unsettled infant behaviour is associated with increased use of multiple health services. The high use of emergency departments by families with unsettled infants found in this study suggests that enhancement of primary health‐care capacity might be required.     

Infant feeding and cost of health care: a cohort study

Aim: To compare the use and cost of health care in infants with different feeding patterns. Methods: Observational study on a cohort of 842 infants born in ten hospitals in northern Italy and followed up to age 12 months. Data on feeding gathered through telephone interviews with 24-hour recall. Data on use of health services reported by mothers and checked against records. Data on hospital cost derived from Disease Related Groups codes. Data on cost of other services obtained from maternal reports and available price lists. Results: At three months, 56% of infants were fully breastfed, 17% complementary fed and 27% not breastfed. Infants fully breastfed at three months had 4.90 episodes of illness requiring ambulatory care and 0.10 hospital admissions per infant/year compared with 6.02 and 0.17, respectively, in infants not or not fully breastfed. They had also a lower cost of health care: €34.69 versus 54.59 per infant/year for ambulatory care, and €133.53 versus 254.03 per infant/year for hospital care. Higher cost of health care was significantly associated with having a hospital admission and being a twin; cost of health care decreased with each additional gram of birth weight, each month of delayed return of the mother to work after the third month, and each extra month of breastfeeding. Conclusion: Lack of breastfeeding and higher use and cost of health care are significantly associated.     

Do adolescents know where to find help for mental health problems? A brief report

Objective: Few previous studies have investigated adolescents' knowledge of the services available to provide help with mental health problems. This is an important omission as knowledge about the availability of mental health services may significantly influence the extent to which adolescents with mental health problems receive appropriate help for their difficulties. The purpose of this study was to investigate knowledge of mental health services among socio-economically disadvantaged adolescents.
Methodology: Students attending the participating high school completed a questionnaire describing mental health services in South Australia.
Results: The results suggest that the adolescents had little knowledge of mental health services and they primarily discussed their problems with other family members or friends. The results also suggest that the adolescents prefer to obtain information about mental health problems from education programmes in schools or on television.
Conclusions: There is a need to make adolescents and their families more aware of the services available to provide help for mental health problems.     

Professional and non‐professional sources of formula feeding advice for parents in the first six months

Breastfeeding is beneficial to both the mother and infant, yet many infants are either partially or fully fed with formula milk. Those parents feeding with formula receive less support from professional sources than those breastfeeding and may rely on more non‐professional sources for advice, and this contributes to negative emotional experiences such as guilt. This paper explores the sources of advice for formula feeding, factors associated with using professional or non‐professional sources and compares these sources with those used for breastfeeding advice. A secondary analysis of Australian survey data from 270 mothers was performed. Mothers of six‐month‐old infants participated in an online survey, providing information on advice they received or read about formula feeding and/or breastfeeding from professional and non‐professional sources. A fifth of mothers who were formula feeding did not receive any formula feeding advice from professional sources, and only a small fraction (4.5%) of mothers breastfeeding did not received any breastfeeding advice from professional sources. Compared with those mothers breastfeeding receiving breastfeeding advice, fewer mothers formula feeding receive formula feeding advice from both professional and non‐professional sources. The tin of formula was the most used source of formula advice. Mothers feeding with formula at six months were more likely to have received formula feeding advice from professional sources if they had been fully formula feeding before their infant was under the age of three months. Further research is needed to understand the specific barriers to accessing formula feeding advice and what other factors influence access to formula feeding advice.     

UK health visitors' role in identifying and intervening with infants at risk of developing obesity

Childhood obesity is associated with a number of modifiable risk factors that can be identified during infancy or earlier. In the UK, health visitors advise parents about infant feeding, but little is known about their role in obesity prevention. The aim of this study was to investigate the beliefs and current practices of UK health visitors in relation to recognising and intervening with infants at risk of developing obesity. Thirty members of the health visiting team were interviewed. The interviews were audio‐recorded and transcribed verbatim. Thematic analysis was applied using an interpretative, inductive approach. Health visitors were aware of some of the modifiable risk factors for childhood obesity such as infant feeding practices. They felt they had a role in advising parents about diet but did not formally identify and/or intervene with larger infants. Infant overweight was considered a sensitive issue that was difficult to raise with parents. They believed some parents preferred larger infants and were unaware that their feeding practices might be contributing to obesity risk. A need for training and guidance was identified together with strategies to overcome system barriers. Health visitors do not currently target parents of infants at risk of obesity largely because they do not perceive they have appropriate guidance and skills to enable them to do so. There is an urgent need for tools and training to enable all health care professionals to recognise and manage infants at risk of developing obesity without creating a sense of blame.     

Strengthening health services to deliver nutrition education to promote complementary feeding and healthy growth of infants and young children: formative research for a successful intervention in peri‐urban Trujillo,Peru

Formative research is critical for developing effective nutrition‐specific interventions to improve infant and young child (IYC) feeding practices and promote healthy growth. Health workers interact with caregivers during health facility visits, yet there is limited research about how to optimize delivery of such interventions during these visits. The extensive reach of IYC health services globally calls for research to address this gap. In Trujillo, Peru, formative research was conducted to explore complementary feeding practices with caregivers as well as health worker routines and interactions with caregivers related to feeding and healthy growth; results informed the development and delivery of an educational intervention. Multiple qualitative methods were used to collect data on a purposive sample of health workers and caregivers from three health facilities and communities: household trials followed. Complementary feeding messages with doable behaviours were developed, and three were selected as key to promote based on their nutritional impact and cultural acceptability. In the health facilities, medical consultation, well‐child visits and nutrition consultation all dealt with aspects of IYC nutrition/growth during their interactions with caregivers but were independent and inconsistent in approach. A nutrition education strategy was developed based on consistency, quality and coverage in the IYC health services. We conclude that formative research undertaken in the community and IYC health services was critical to developing a successful and culturally relevant intervention to promote optimal complementary feeding practices and healthy growth during interactions between health workers and caregivers at routine health facility visits. © 2016 John Wiley & Sons Ltd     

Child health services in transition: I. Theories, methods and launching

AIM: To describe an evidence-based model for preventive child health care and present some findings from baseline measurements. METHODS: The model includes: parent education; methods for interaction and language training; follow-up of low birthweight children; identification and treatment of postnatal depression, interaction difficulties, motor problems, parenthood stress, and psychosocial problems. After baseline measurements at 18 mo (cohort I), the intervention was tested on children from 0 to 18 mo at 18 child health centres in Uppsala County (cohort II). Eighteen centres in other counties served as controls. Two centres from a privileged area were included in the baseline measurements as a "contrasting" sample. Data are derived from health records and questionnaires to nurses and mothers. RESULTS: Baseline experiment (n = 457) and control mothers (n = 510) were largely comparable in a number of respects. Experiment parents were of higher educational and occupational status, and were more frequently of non-Nordic ethnicity. Mothers in the privileged area (n = 72) differed from other mothers in several respects. Experiment nurses devoted considerably fewer hours per week to child health services and to child patients than did control nurses. CONCLUSIONS: Despite certain differences, experiment and control samples appeared comparable enough to permit, in a second step, conclusions about the effectiveness of the intervention.     

Use of health care by young Asian New Zealanders: findings from a national youth health survey

Aim: To examine the use of health services and perceived barriers to accessing health care among young Asian New Zealanders. Methods: Secondary analysis of data from Youth2000, a cross‐sectional survey of secondary school students in New Zealand (NZ) conducted in 2001. Of the 9567 survey participants (aged 12–18 years), this study was restricted to students who identified with an ‘Asian’ ethnic category (n = 922). Results: Chinese and Indian students (the largest Asian ethnic groups in NZ) reported levels of overall health comparable to NZ European (NZE) students. However, relative to NZE students, Chinese students were more likely to report (i) not having a usual location for health care (adjusted OR 3.28; 95% CI: 2.51–4.43); and (ii) having problems getting health care when they needed it (adjusted OR 1.61; 95% CI: 1.32–1.96). Asian students who had been in NZ for 5 years or less (compared with NZ‐born students), as well as those who did not speak English at home (compared with those who did) were less likely to report having a usual source of health care, even after adjusting for their overall health (adjusted OR 2.13, 95% CI: 1.27–3.56; and adjusted OR 1.69, 95% CI: 1.11–2.56, respectively). Conclusion: Young Asian New Zealanders are less likely to access health care than their NZE counterparts. The perceived barriers require explicit attention within the broader platforms of health‐care quality, and professional and cultural competence of health‐care services.     

Community Outreach: An expanding role for hospitals

Abstract Pressures for paediatric institutions to expand their traditional roles have come from changes in morbidity patterns, training requirements and community needs. Planning for new models of health care delivery has led to the development of the Community Outreach Program (COP), a hospital-based model which utilizes existing community resources to provide early intervention services, training in community paediatrics and integtration of hospital and community based health care.
A process evaluation of the COP was performed after 18 months operation. Eighty-eight children were seen in a 7 week period, 20% with complex problems requiring further assessment and community consultation. Staff at the community agencies serviced considered the COP to be a major contributor to health care in their areas. Medical trainees developed new assessment techniques and management strategies for children with problems not previously encountered. It appears that the COP is a useful model for the delivery of health care, in particular to disadvantaged communities.     

Reproductive health problems and help seeking behavior among adolescents in urban India

Objective To assess their reproductive health problems and help seeking behaviour among urban school going adolescents. Method A sample of 300 urban school going adolescents between 11–14 years were chosen at random and assessed using four tools namely, self administered questionnaire: provision of adolescent friendly services; medical screening and focus group discussions. Results Seventy two percent girls and 56% boys reported health problems during survey with an average of 1.93 complaints per girl and 0.5 complaints per boy. However, only 43% girls and 35% boys reported to the clinic voluntarily to seek help and only one fifth the amount of problems were reported at the clinic in comparison to the quantum of problems reported in survey, which probably reflects a poor health seeking behaviour. A medical checkup with emphasis on assessment of reproductive health and nutritional status helped in detecting almost the same number of reproductive health problems as reported by them in survey. This intervention helped to increase the client attendance in subsequent period of next one year from 43% to 60% among girls and from 35% to 42% among boys. Conclusion Our study shows that to increase help seeking behaviour of adolescents, apart from health and life skill education, their medical screening with a focus on reproductive health by trained physicians, parental involvement, supported by adolescent friendly centers (AFC) for counseling, referral and follow up are essential.     

Telephone reminders improve adolescent clinic attendance: a randomized controlled trial

OBJECTIVES: To measure the effect of telephone reminders on adolescent clinic attendance. METHODS: Clinic bookings of adolescents were randomly assigned to either a telephone reminder one day prior to their appointment, or a routine booking (no reminder). The setting was four general adolescent health clinics within a tertiary public adolescent health care service at the Centre for Adolescent Health. The main outcome measures were clinic non-attendance, reason for non-attendance, and satisfaction with the booking system. RESULTS: One hundred and seventy one adolescent appointments were studied. Of these, 51.5% were female, and 25% of bookings were for new, rather than review appointments. One hundred and one adolescents were randomly allocated to the reminder group, of whom 87% were contacted. The use of reminders (intention to treat analysis) significantly reduced the non-attendance rate from 20% to 8% (odds ratio 0.35; P = 0.03). Non-attendance was three times more likely for a new appointment than for review appointments. 'Forgetting' was the most common explanation given by patients (35%) who did not attend. Seventy-nine per cent of parents reported telephone reminders were helpful at prompting attendance. CONCLUSION: Telephone reminders greatly improved attendance at these adolescent clinics. The background non-attendance rate and the proportion of high-risk patients for non-attendance (new appointments in this setting) will determine whether reminders are more efficiently targeted at specific bookings than used routinely.     

Children's unmet need for mental health care within and outside metropolitan areas

BackgroundRural communities experience a lack of pediatric mental health providers. It is unclear if this leads to greater unmet needs for specialty mental health services among rural children.MethodsData from the 2016–2019 National Survey of Children's Health were used to identify children aged 6–17 years with a mental health condition. Caregiver-reported need and receipt of specialty mental health care for their child (met need, unmet need, or no need) was compared according to residence in a Metropolitan Statistical Area (MSA).ResultsThe analysis included 13,021 children (14% living outside MSAs). Unmet need for mental health services was reported for 9% of children, with no difference by rural-urban residence (p = 0.940). Multivariable analysis confirmed this finding and identified urban children as less likely to have no need for mental health services, compared to rural children (relative risk ratio of no need vs. met need: 0.79; 95% confidence interval: 0.65, 0.95; p = 0.015).ConclusionChildren with mental health conditions living in rural areas (outside MSAs) did not have higher rates of unmet needs for specialty mental health services, but they had lower rates of any caregiver-reported needs for such services. Further work is needed to examine caregivers’ demand for pediatric specialty mental health services.     

Severe sleep problems among infants in a normal population in Sweden: prevalence, severity and correlates

The aim of this study was to explore the prevalence of parentally experienced infant sleep problems, with special interest in severe problems, in a total community sample of 2518 infants aged 6-18 mo. Correlates to severe sleep problems were sought. The families were approached using a questionnaire and 83% responded. Data from the collection procedure point to a non-selective dropout. Sixteen percent of the parents reported their children as having moderate or severe difficulties in falling asleep at night (sleep refusal, bedtime struggles) and 30% reported frequent night waking. Almost all (93%) of the parents had sought help at the Child Health Centre (CHC), but only 48% were satisfied with the support and advice they got. Severe sleep problems as defined by the ICSD (International Classification of Sleep Disorders, 1990) were found in 129 of the children (6.2%), who were studied in detail, with the rest of the population as controls. Severe sleep problems were found to be correlated with parental worries and anxiety concerning infant health (although the children were reported as being as healthy as the controls), infant feeding problems and intensive parental interventional behaviour (especially feeding) during the evening and night. A common factor of insecurity in the parental role is suggested.     

Prevention of mental health problems: rationale for a universal approach.

BACKGROUND AND OBJECTIVE: Mental health problems are a public health issue affecting as many as 20% of children in modern communities. Risk factors for externalising and internalising problems can occur in infancy. Infants at high risk live in stressed families with parent mental health problems, substance misuse, relationship conflict, social isolation, financial problems or infant temperamental difficulty. Although current prevention programmes target services to high-risk groups, targeting can stigmatise families and miss many children in need. The addition of universal prevention programmes for all families could address these concerns. This survey assessed the prevalence of infants at risk attending a primary care service as a delivery point for universal prevention. DESIGN: Survey of mothers of 6-month-old infants attending well-child clinics across six government areas of Melbourne, Victoria, Australia, between August and September 2004. A brief survey measured sociodemographic characteristics and the following family risks: maternal depression, anxiety, stress, substance misuse, violence at home, social isolation and infant temperamental difficulty. RESULTS: The survey was completed by 733 mothers, representing 69% of infant births presented to the primary care service. Of these, 39% of infants were classified as at risk for developing mental health problems. The percentage of infants classified as at risk was not markedly dissimilar across socioeconomic levels (low, 42%; middle, 40%; high, 35%). CONCLUSIONS: A substantial number of infants attending routine universal primary care are at risk of developing mental health problems. This primary care setting could provide an ideal platform for preventing early externalising and internalising problems via a universally offered, evidence-based parenting programme.     

Survey of parents, nurses, and school principals on their perceptions of the controversial role of schools in health promotion

BACKGROUND: The aim of this paper was to study the perceptions of parents, nurses, and school principals of the role of the health services in elementary schools. METHODS: A questionnaire was distributed to the heads of parents' committees, school nurses, and school principals of 35 randomly selected elementary public schools in Israel. Respondents were asked to qualify the degree of importance of the traditional and contemporary roles of the school health-care team. RESULTS: Response rates were 80.0% for parents, 100% for nurses, and 97.1% for principals. All respondents agreed that both the traditional and new roles are very important. Nurses rated three interconnected roles significantly lower than parents and school principals: 'Evaluation of students with behavioral problems', 'Evaluation of students with low academic performance', and 'Follow up and care of students with behavioral problems and low performance'. CONCLUSIONS: Nurses, parents and school principals in Israel agree that the traditional roles of health teams in elementary schools, that is, providing first aid and ensuring school hygiene, are very important. Most are ready to accept a move from an illness-based to a social-based model, with less time spent on screening and surveillance and more on identifying and managing special needs of children and staff.     

Mothers' experiences of child health clinic services in Sweden

AIM: To investigate women's experiences of child health clinic (CHC) care and risk factors for being dissatisfied. Experiences of specific aspects of care were further explored in subgroups of women who were not generally satisfied. METHODS: All Swedish-speaking women admitted to any of the approximately 600 antenatal clinics in Sweden during 3 wk evenly spread over 1 y in 1999 and 2000 were invited to participate in the study. Altogether, 3113 women agreed to participate. Data were collected by questionnaires: in early pregnancy, 2 mo and 1 y postpartum, and from the Swedish Medical Birth Register. For the purpose of this study, data from the 2415 women who answered the question used as the principal outcome in this study, i.e. overall satisfaction with CHC care, were analysed. RESULTS: Psychological factors, such as maternal depressive symptoms and worry about caring for the newborn, and serious infant feeding problems were predictors of less satisfied or mixed feelings about CHC care. About one in three women were dissatisfied with the attention paid to their own needs, and a similar proportion said information about vaccinations was insufficient. Of the four subgroups-mothers whose babies had feeding problems and mothers with depressive symptoms at 2 mo, 1 y, and on both occasions-the latter group was the least satisfied with the nurse and the time allocated to various issues. CONCLUSIONS: Swedish mothers appear to be satisfied with the attention given to their infants at CHCs, but many feel that their own needs as new mothers are neglected. This study supports current development towards screening for maternal depression at CHCs.     

Perceptions of vulnerability 3 1/2 years after problems of feeding and crying behavior in early infancy

The long-term consequences for infants with problems of feeding and crying behavior remain unknown. The purpose of this research was to determine whether such children are later perceived by their parents as vulnerable and more often have behavior problems and have different personalities than children without problems in infancy. The implications of managing such problems by changing milk formulas is explored. Mothers of 379 infants were enrolled in the postpartum period. Information about problems of feeding and crying behavior was obtained at 4 months. Thirty-six percent of the infants had problems and the formula had been changed for 17%. At 3 1/2 years, 320 (84%) mothers completed a questionnaire. Children who had had problems were more often perceived as vulnerable (relative risk [RR] 1.86; 95% confidence interval [CI] 1.09, 3.19) and more often had behavior problems (RR 1.78; 95% CI 1.03, 3.07). There were no differences in personality. Children whose problems had been managed by changing milk formulas were more often perceived as vulnerable (RR 2.18; 95% CI 1.05, 4.53). Although allergies were reported significantly more often for those children who had had problems, there were no differences in the prevalence of asthma or eczema. Problems of feeding and crying behavior in early infancy and the way they are managed may have long-term implications for the child.     

We need psychologists!

Paediatricians are more likely than ever to encounter patients with mental health problems on a daily basis. There is a need for investment in proven treatments, such as psychology-based interventions, for children identified with mental health disorders. There are four main arguments supporting the engagement of psychologists for children with mental health problems: there is clear evidence that psychological interventions can effectively treat a wide range of mental health disorders; many parents and children are more open to exploring psychological therapies rather than medication for mental health problems; psychologists are trained and licensed to perform psychoeducational assessments, which can provide invaluable information about a child’s learning profile, attention problems and overall intelligence; and behaviour problems in children can be prevented or improved through parent-based interventions. The authors’ strongly advocate for the public funding of psychology services – both in collaborative primary care models and in the school setting.     

We need psychologists! Paediatr Child Health

Paediatricians are more likely than ever to encounter patients with mental health problems on a daily basis. There is a need for investment in proven treatments, such as psychology-based interventions, for children identified with mental health disorders. There are four main arguments supporting the engagement of psychologists for children with mental health problems: there is clear evidence that psychological interventions can effectively treat a wide range of mental health disorders; many parents and children are more open to exploring psychological therapies rather than medication for mental health problems; psychologists are trained and licensed to perform psychoeducational assessments, which can provide invaluable information about a child’s learning profile, attention problems and overall intelligence; and behaviour problems in children can be prevented or improved through parent-based interventions. The authors’ strongly advocate for the public funding of psychology services – both in collaborative primary care models and in the school setting.