THE STATE OF HEALTH OF SWEDISH CHILDREN

Abstract. Sjölin, S. and Smedby, B. (Departments of Paediatrics and Social Medicine, University Hospital, Uppsala, Sweden). The state of health of Swedish children. An attempt is made briefly to describe the present health problems of Swedish children. The report is based on data available in official statistics or collected from special studies. It is concluded that the general state of health of Swedish children is good when assessed by commonly used criteria. The mortality pattern is dominated by perinatal and accidental deaths, but also neoplasms are of importance. There are indications that genetic and handicapping disorders, and psychosocial maladjustment will receive more attention in the future.     

FOUR-YEAR-OLDS IN A NEW SUBURB: THE NEED FOR MEDICAL AND SOCIAL CARE

ABSTRACT: Lagerkvist, B., Lauritzen, S., Olin, P. and Tengvald, K. (Department of Paediatrics, Karolinska Institutet, St. Goran's Hospital for Children, Stockholm, Sweden). Four-year-olds in a new suburb: The need of medical and social care. Acta Paediatr Scand, 64:413, 1975.–The standardized Swedish health examination of 4-year-olds was performed in a residential suburb of Stockholm with a high percentage of young families and immigrants. Emphasis was placed on identifying children in need of pedagogic and psychological measures. Psychological problems were identified by: a structured interview with the parents, and an examination of the child, including developmental screening tests and the parents' assessment of the child's behaviour at home. We have placed more emphasis on the findings and evaluation at the examination than on interview data when arriving at a psychological diagnosis. The somatic part of the examination revealed only minor problems, confirming previous studies on four-year-olds in Sweden. Twelve percent of the 257 children were referred for further psychological investigation, and 16% were recommended early admittance to preschool because of psychological problems. Among the 46 immigrant children who did not have any Swedish parent, more than 50% did not speak Swedish and were recommended early admittance to preschool. In the whole material, 41 % needed or were already (17 %) in preschool or day nurseries. This indicates unfulfilled demands on such services within the community. The mother's perception of her lack of social contacts in the neighbourhood correlated with the presence of psychological problems and the need for subsequent measures for her child.     

HEALTH AND BEHAVIOUR IN FOUR-YEAR-OLD CHILDREN

ABSTRACT: Köhler, E.-M. and Köhler, L. (Department of Paediatrics, University Hospital, Lund, Sweden). Health and behaviour in four-year-old children. Acta Paediatr Scand, 64:225, 1975.–A health control of an unselected population of 2447 4-year-oId-children included a thorough somatic examination as well as an analysis of child upbringing practice and problems. The relation between the children's physical health, as defined by presence or absence or "functionally important health problems" and the children's behaviour, as reported by their mothers, was elucidated. On the whole, children with health problems were not perceived as more troublesome, although children with some special kinds of disturbances, e.g. neurological and dental, constituted problems in certain areas, e.g. toilet training and hyperactivity. The use of blame as a method of upbringing was very frequent and especially frequent in children with dental defects and visual disturbances. The perception of behaviour problems and the use of methods in upbringing were the same in children with newly detected health problems as in children with previously known health problems. The implications for the Child Health Service are to identify these risk-groups, to advice and support them in order to reduce parent-child conflicts.     

Health and Nutrition in Newly Resettled Refugee Children from Chile and the Middle East

ABSTRACT. The general health and nutritional status of 105 refugee children from Chile and the Middle East were examined shortly after the arrival in Stockholm. A chronic medical condition was present in 10% and there were clinical signs of canes in 57% of the children. Iron deficiency was found in 15% of Chileans and 6% of Middle Easterners, but no other nutritional deficiencies were discovered. Stunting and wasting was rare and a significant catch-up growth was observed in both groups in a follow-up 18 months after resettlement. Obesity was common in the Chilean group on arrival in Sweden and increased further after resettlement. We conclude that chronic medical conditions, canes and obesity were the major somatic health problems in this sample of newly resettled refugee children.     

Socio-economic characteristics in children with coeliac disease

AIM: To study the relationship between socio-economic factors and coeliac disease. METHODS: This study was part of a prospective cohort study of 16 286 children born from 1 October 1997-1 October 1999 (the ABIS study; All Babies in Southeast Sweden). Eight paediatric departments recorded all children with coeliac disease in southeast Sweden. Coeliac disease was confirmed through biopsy. Socio-economic characteristics (maternal employment, civil status, whether parents were born in Sweden, parental education, place of living before pregnancy and during pregnancy, crowded living), infant sex, previous siblings, parental age and maternal alcohol consumption during pregnancy were analysed using logistic regression. All data, except for those related to diagnosis of coeliac disease, were obtained through a questionnaire distributed at birth. RESULTS: Coeliac disease in the offspring was less common among mothers who had worked < 3 mo during pregnancy (odds ratio, OR = 0.29; 95% CI: 0.09-0.94; p = 0.039). This risk decrease remained after adjustment for confounders (adjusted OR = 0.28; 95% CI: 0.09-0.92; p = 0.035). No other socio-economic factor was related to coeliac disease. CONCLUSION: This study indicates that most socio-economic factors are probably of little importance to the development of coeliac disease.     

Dental Caries in Turkish Immigrant Primary Schoolchildren

ABSTRACT. Dental caries and the utilization of the Public Dental Service in Sweden were investigated in 84 Turkish immigrant children born in Sweden, 69 Turkish children bom in Turkey and 85 Swedish age- and sex-matched controls. Dental fear was also studied. The mean age of the children was 8.3 years. Turkish immigrant children had more caries both in the primary and in the permanent teeth than Swedish children. Children born in Turkey had more caries in the primary dentition than those born in Sweden. Turkish children came more often for emergency visits than Swedish children and expressed dental fear more frequently. Turkish immigrant children therefore constitute a high risk group for caries and need supervision early after immigration.     

Health of Australian children in out-of-home care: needs and carer recognition

Aim: Following research highlighting high levels of health need in New South Wales children in out‐of‐home care, this study aimed to quantify health need in a sample of Queensland children in care based on multidisciplinary child health assessments. The study also sought to examine the concordance between foster carers' health concerns for children for whom they are providing care and health need as established through referrals made as a result of health assessment. Methods: Children entering out‐of‐home care in the north Brisbane area within the previous month were referred for baseline child health assessment. Child health was assessed by paediatricians and clinical nurses utilising a pro forma‐based methodology. Analysis of initial carer concerns, health referrals and immunisation status in the sample was undertaken. Results: Of the 63 children assessed, 70% were found to require multiple referrals to various health services. The most frequently made referrals included paediatrician follow‐up (41% of children), counselling services (30%) and audiology (26%). Only 68% of the sample was found to be fully immunised. A discrepancy was noted between foster carers' child health concerns and level of referral need established during assessment. Conclusions: Queensland children in care have high health needs similar to those evidenced by children in care in other areas of Australia. Foster carers appear to underestimate the health needs of children in their care, demonstrating the necessity of multidisciplinary health screens and foster carer training in order to detect child health problems in this population.     

Household food insecurity and child health

Food insecurity, the lack of consistent access to sufficient quality and quantity of food, affects an estimated 800 million people around the world. Although household food insecurity is generally associated with poor child nutrition and health in the USA, we know less about household food insecurity and child health in developing countries. Particularly lacking is research assessing how associations between household food insecurity and children's health outcomes may differ by child age and among children beyond age 5 years in low‐income settings. We use data from a population‐based sample of households with children ages 3–11 years (N = 431) in León, Nicaragua to consider how household food insecurity is associated with three measures of child health: illness, anaemia and low height‐for‐age. Our results provide new evidence that even mild household food insecurity is detrimental to children's health; and that child age conditions the associations between household food insecurity and child health. We find that food insecurity is especially harmful to health during early childhood, but continues to have significant associations with health into middle childhood (up to ages 7–8 years). We discuss the potential implications of these results for future child health research and policies in low‐income countries. © 2016 John Wiley & Sons Ltd     

COLLABORATION IN PRACTICE: Experiences from a Multidisciplinary Research Project on Child Abuse and Neglect

Abstract. Gustafsson, L. H., Lagerberg, D., Larsson, B. and Sundelin, C. (Department of Paediatrics, University Hospital, Uppsala, Sweden). Collaboration in practice. Experiences from a multidisciplinary research project on child abuse and neglect. This paper describes experiences from a three-year research project concerning questions of child abuse and neglect. The emphasis is placed on an attempt to define the real difficulties that have arisen during the course of this work, e.g. group pressure, breaks in continuity, goal heterogeneity, role conflicts and differences in frames of reference. Collaboration problems must be taken seriously and deserve systematic investigation. Multidisciplinary collaboration in different connections within medical, health and social care is of particular importance at this time when the care resources are limited. At the same time it is of decisive importance that the members of the team clarify their attitudes towards certain fundamental questions.     

Children in out‐of‐home care: Does routine health screening improve outcomes?

Aim:   Children in out-of-home care have high and frequently unidentified health needs. The Child Protection Unit at Sydney Children's Hospital offers comprehensive health screening to children in care. Recommendations for remediation are made, but follow-up in the clinic is not offered. Current research has failed to establish whether health screening results in health benefits for the children screened. The aim of this study was to assess the impact of the health screening clinic on children's health outcomes by tracking the first 100 children screened, determining how many of the health recommendations made for each child had been implemented and, if possible, what the health outcome had been.
Methods:   Research questionnaires were sent to the Department of Social Services caseworkers of the first 100 children screened.
Results:   Adherence to health recommendations was high; however, it was not possible to quantify the degree of health benefit to the children screened. A number of systemic problems were identified, which are likely to hinder the accessibility of health care for children in care.
Conclusions:   Comprehensive health screening of children in care is likely to benefit a child's health, although this could not be determined. Agencies responsible for placing children in care need systems in place to ensure better inter-agency collaboration between the health system and community services. This should help improve health outcomes.     

Dental neglect in children

Untreated dental diseases, particularly dental caries, can lead to a range of adverse impacts on children, including pain and infection. Yet caries is preventable if a child's basic oral health needs are met. Dental neglect occurs when there is persistent failure to meet those needs. Dentists and paediatricians can work together with other health and social care professionals to identify children with dental neglect and to intervene to safeguard their oral and general health and development.     

Socio-demographic risk factors for home-type injuries in Swedish infants and toddlers

In this paper we use data from Swedish national registers to study socio-demographic patterns of hospital admissions as a result of injuries sustained at home (poisoning, falls, scalding and ingestion/intrusion of foreign objects) in children 0-3 y. The study population comprised 546 336 children born in Sweden during the period 1987-91. The different injury mechanisms peaked at different ages: ingestion of foreign objects at 10-12 mo, scald injuries at 13-15 mo, non-drug poisoning at 16-18 mo and drug poisoning at 24-30 mo. In a multivariate analysis it was demonstrated that children of young mothers (<24 y) were more likely to have been admitted to hospital because of fall injuries and poisonings, while children with more than two siblings had a slightly increased risk for all injuries. Children of mothers born in a non-western country were more likely to have been admitted to hospital because of scald injuries; odds ratio (OR) 1.7 (95% CI: 1.4-2.1), while they were less likely to have been admitted because of fall injuries; OR 0.8 (0.7-0.8) and non-drug poisoning; OR 0.5 (0.4-0.6). Children in families who received social welfare benefits were more likely to have been admitted to hospital because of fall injuries; OR 1.3 (1.2-1.4), drug poisoning; OR 1.8 (1.7-2.0), non-drug poisoning; OR 1.4 (1.3-15) and scald injuries; OR 1.1 (1.1-1.5), while injuries with ingestion/intrusion of foreign objects tended to vary little with socio-economic indicators. CONCLUSION: Infants and toddlers in families with young mothers and in families on social welfare are at particular risk for home injuries in Sweden. The knowledge that the risk of poisoning, scalding and ingestion of foreign objects is related to specific ages can be used in timing of parent counselling.     

CHILD HEALTH IN EUROPE: A Review of WHO Activities

Abstract. Petersson, P. O. and Ichimura, K. (Administration, University Hospital, Uppsala, Sweden). Child health in Europe—A review of WHO activities. Review of the activities in maternal and child health arranged in recent years by the European Office of the World Health Organization.     

The child group used as a reference system when analysing frequency of morbidity in day–care centres

Morbidity frequency was analysed among children attending six day–care centres in a suburb of Stockholm, Sweden. Absence due to illness was calculated annually for each child and correlated with each child's own group. Thus a child was classified as "often sick" or "mainly healthy" in relation to the other children in the child's own group, constituting a reference system. In almost every group a "sick third" was found, whose absence due to illness was twice that of the rest of the group. Children from families of lower social standing, those with a relatively large number of siblings and those living in poor social conditions were found to be among those most often reported as sick. In such families, smoking was more commonplace. These parents more often lived in a rented apartment than in a single detached owner house. Multiple linear regression analysis revealed that young mothers and children with several siblings had the strongest correlation with absence due to illness of the proband child. Increasing maternal age revealed improvement vis–a–vis all socioeconomic parameters investigated, reflecting an improvement in standing correlated to less sick children.     

Developmental milestones among Aboriginal children in Canada

BACKGROUND:

Windows of achievement provide age ranges for the attainment of early developmental skills. Group-specific research is warranted given that development may be influenced by social or cultural factors.

OBJECTIVES:

To examine developmental milestones for Inuit, Métis and off-reserve First Nation children in Canada, based on developmental domains collected from the 2006 Aboriginal Children’s Survey. Sociodemographic and health predictors of risk for developmental delay were also examined.

RESULTS:

The ranges in which children achieve certain developmental milestones are presented. Gross motor and self-help skills were found to be achieved earlier (across the three Aboriginal groups), whereas language skills were achieved slightly later than in Canadian children in general. Furthermore, health factors (eg, low birth weight, chronic health conditions) were associated with late achievement of developmental outcomes even when sociodemographic characteristics were considered.

CONCLUSIONS:

Findings suggest that the timing of milestone achievement may differ for Aboriginal children, highlighting the importance of establishing culturally specific norms and standards rather than relying on those derived from general populations. This information may be useful for practitioners and parents interested in identifying the age ranges for development, as well as age ranges indicating potential for developmental risk and opportunities for early intervention among Aboriginal children.     

Health needs of Australian children living in out-of-home care

BACKGROUND: Children living in out-of-home care have high and frequently unidentified health needs. The Child Protection Unit at Sydney Children's Hospital offers comprehensive health screening to children in care. AIMS: To report the experience of the health screening clinic and the rates of identified health problems of children in care in this sample, and to compare these rates with the general child population and children in care overseas. METHODS: Comprehensive multidisciplinary health screens were offered to children in out-of-home care. RESULTS: High rates of physical, developmental and emotional health problems were identified. The rates of poor health were greater than the average child population of New South Wales, but similar to the rates of poor health reported in children in care overseas. CONCLUSIONS: Children in care are a vulnerable group of the child population who experience unacceptable levels of poor health. Comprehensive health screens can help identify previously undetected health problems.     

Infant survival in Norway and Sweden 1985–88

In recent years, considerable attention has been attached to the disquieting fact that infant survival is much lower in Norway than in Sweden. In the present study, comprising all live single births in Norway and Sweden during 1985–88, the observed infant mortality was 1.5 times higher in Norway than in Sweden. The largest difference between Norway and Sweden was found in infants of young mothers with high birth order. Thus for the second births of mothers aged less than 20 years the observed mortality ratio of Norway to Sweden was 1.8. The infant mortality ratio decreased with increasing maternal age for all birth orders, and for the second births of mothers aged 35 years or more the mortality ratio was 1.0. The higher infant mortality in Norway was evident throughout the first year of life, with the highest mortality ratio observed at 6–8 months of life. Adjustment for maternal age, birth order and geographical region did not alter the observed infant mortality ratios. In both countries, the highest risk was found among infants of young mothers, This suggests a need for a more extensive preventive health care system directed at young mothers during their pregnancy and the infancy period.     

Health information seeking by parents in the Internet age

Aim:   Studies have shown increasing Internet use for health information. We aimed to broadly examine parents' utilisation of information sources for their children's health, their trust in them and to define the role of the Internet for children's health information
Methods:   Interview of a convenience sample of parents of patients presenting to a tertiary paediatric emergency department (ED) (Royal Children's Hospital, Melbourne, Australia) in 2006/2007.
Results:   A total of 360 parents completed the interview. Parents had used on average five sources of health information for their children in the previous 6 months. In the previous 6 months and immediately prior to the ED visit, general practitioners were consulted for health information by 87% and 39%, chemists by 44% and 2%, the Internet by 43% and 6% and telephone advice health lines by 30% and 10%, respectively. Of these sources, parents 'greatly trusted' Royal Children's Hospital ED doctors and nurses 82% ( n  = 112) their regular general practitioners in 73% ( n  = 303), chemists in 45% ( n  = 160), telephone advice health lines (Nurse-On-Call) in 42% ( n  = 90) and the Internet in general in 10% ( n  = 112). Overall, 52% had sought health information for their children on the Internet. Only 20% knew and 11% had ever used the regional children's hospital web site ( http://www.rch.org.au/kidsinfo ), but 97% of the Internet users reported they would trust this information.
Conclusion:   While using numerous different sources, parents in this study mostly use and trust traditional sources of health information. Scores of respondents use the Internet to seek health information for their children and would value easier access to Internet sources that they trust.     

Parental attitudes to health of children in child-care centres and options when children are ill

OBJECTIVE: To determine parental attitudes regarding the health of children attending child-care centres, to explore concerns when children who normally attend child care are ill, and to investigate options in these circumstances. METHODOLOGY: Focus groups conducted with parents whose children attended child-care centres. Ten focus groups were conducted. RESULTS: Many parents encountered difficulty when children who normally attend child care were ill and there was a lack of options for care. Parents were concerned about the spread of infections among children but considered that there were also many health and other advantages for their children in attending child care. Child-care centres were perceived as providing a valuable support role for families. CONCLUSIONS: Many parents lack adequate options for care when their children are ill. Parents' concerns regarding health in child care are important in policy decisions regarding the health of children in child care, and the development of alternative care services for children.     

Low Caregiver Health Literacy Is Associated With Higher Pediatric Emergency Department Use and Nonurgent Visits

ObjectiveWe sought to determine the association between low caregiver health literacy and child emergency department (ED) use, both the number and urgency of ED visits.MethodsThis year long cross-sectional study utilized the Newest Vital Sign questionnaire to measure the health literacy of caregivers accompanying children to a pediatric ED. Prior ED visits were extracted from a regional database. ED visit urgency was classified by resources utilized during the index ED visit. Regression analyses were used to model 2 outcomes—prior ED visits and ED visit urgency—stratified by chronic illness. Analyses were weighted by triage level.ResultsOverall, 503 caregivers completed the study; 55% demonstrated low health literacy. Children of caregivers with low health literacy had more prior ED visits (adjusted incidence rate ratio 1.5; 95% confidence interval 1.2, 1.8) and increased odds of a nonurgent index ED visit (adjusted odds ratio 2.4; 95% confidence interval 1.3, 4.4). Among children without chronic illness, low caregiver health literacy was associated with an increased proportion of nonurgent index ED visits (48% vs 22%; adjusted odds ratio 3.2; 1.8, 5.7).ConclusionsOver half of caregivers presenting with their children to the ED have low health literacy. Low caregiver health literacy is an independent predictor of higher ED use and use of the ED for nonurgent conditions. In children without a chronic illness, low health literate caregivers had more than 3 times greater odds of presenting for a nonurgent condition than those with adequate health literacy.