Child rearing and child outcomes in Japan and the UK

Abstract Japan and the UK are compared in relation to various child health outcomes. It is noted that in the rates of child abuse and criminal activity. Japan is in a more favorable position. Rates of behavior problems and suicide rates are very similar in the two countries. Consideration is given to the reasons for the differences. The rates of single parents and divorce are much lower in Japan. The rates of working mothers are about the same, but Japanese women work longer hours. However, it is suggested that more important differences may lie in the greater respect for authority and emphasis on discipline and conformity in Japan. The effects of industrialization on family life and on child development are summarized. It is suggested that the separation of the adolescent age group from the rest of the population has had especially negative results in Western industrialized countries. Various suggestions are made concerning the positive role that pediatricians can play in promoting child development. In particular, pediatricians are encouraged to support and not undermine parents, to involve fathers in management of illness and disability, to press for full implementation of the United Nations Convention on the Rights of the Child, and for ready availability of good substitute child care facilities.     

The role of nutrition in integrated early child development in the 21st century: contribution from the Maternal and Child Nutrition journal

Even though it is widely recognized that early childhood development (ECD) is one of the most important predictors of future social capital and national productivity, the recently published ECD Lancet Series reports that about 250 million children under 5 years are at risk of not reaching their developmental potential, mainly as a result of poverty and social injustice. So why is this and what will it take to reverse this situation? The purpose of this special issue is to highlight important contributions from previously published articles in Maternal & Child Nutrition to the field of nutrition and ECD. The collection of papers presented in this special issue collectively indicates that although nutrition‐specific interventions are essential for child development, they are not sufficient by themselves for children to reach their full developmental potential. This is because ECD is influenced by many other factors besides nutrition, including hand washing/sanitation, parenting skills, psychosocial stimulation, and social protection. Future research should focus on mixed‐methods implementation science seeking to understand how best to translate evidence‐based integrated ECD packages into effective intersectoral policies and programs on a large scale. In addition to health and nutrition, these programs need to consider and include responsive parenting (including responsive feeding), learning stimulation, education, and social protection. Future studies should also address if and how childhood obesity affects human physical, socioemotional, and cognitive development.     

Role of the tertiary child protection paediatrician: expert and advocate

AIM: The role of the child protection paediatrician is varied. This study examines perceptions of how tertiary child protection (tCP) paediatricians view their multifaceted roles, perceived adequacy of length of pre-FRACP training and how this relates to confidence and satisfaction in their roles. METHODS: An anonymous self-report survey was distributed to child protection paediatricians working in tertiary hospitals across New Zealand and Australia. The survey addressed the adequacy of training and confidence within the diverse roles encountered within child protection work. It also identified perceptions of stress and satisfaction. RESULTS: Responses were received from 32 out of 45 of eligible tCP paediatricians (72%). The majority (71.8%) had entered directly into a tCP unit in their first consultant position. Two-thirds (65.7%) of tCP paediatricians received less than 4 months of pre-FRACP child protection training while a third received no training at all. Generally tCP paediatricians perceived their training in all domains of child protection to be inadequate although their current confidence levels in all roles are high. They expressed most concerns within their role as forensic expert. CONCLUSION: Despite receiving little or no training pre-FRACP in child protection, this group of tCP paediatricians function in their specialised roles in tCP and feel confident in fulfilling the dimensions of forensic expert and child advocate. As the field of medical child protection continues to evolve, it is important for training to keep pace with expectations of the varied roles of the paediatric specialist in child protection.     

Changes in growth,anaemia, and iron deficiency among children aged 6–23 months in two districts in Nepal that were part of the post‐pilot scale‐up of an integrated infant and young child feeding and micronutrient powder intervention

There is limited research on integrated infant and young child feeding (IYCF) and micronutrient powders (MNPs) programmes operating at scale, despite widespread implementation. This study uses cross‐sectional baseline (n = 2,542) and endline (n = 2,578) surveys representative of children 6–23 months in two districts in Nepal that were part of a post‐pilot scale‐up of a IYCF–MNP programme. Multivariable log‐binomial regression models were used to estimate prevalence ratios (PRs) for stunting (length‐for‐age z‐score <?2), wasting (weight‐for‐length z‐score <?2), underweight (weight‐for‐age z‐score <?2), anaemia (altitude‐adjusted haemoglobin <110 μg/L), moderate or severe anaemia (altitude‐adjusted haemoglobin <100 g/L), iron deficiency (inflammation‐adjusted ferritin <12 μg/L), and iron deficiency anaemia (iron deficiency + anaemia [IDA]) at endline versus baseline and also to compare children in the endline survey based on frequency of mothers' interactions with female community health volunteers (FCHVs; >1× per month or monthly vs. <1× per month) and MNP coverage (1 or ≥2 distributions vs. none among children 12–23 months). Endline children were significantly less likely to be stunted than baseline children in both districts (multivariable‐adjusted PR [95% CI]: 0.77 [0.69, 0.85], P < 0.001 and 0.82 [0.75, 0.91], P < 0.001 in Kapilvastu and Achham, respectively); however, only Achham had significantly lower prevalences of underweight, moderate/severe anaemia, iron deficiency, and IDA at endline. At endline, 53.5% and 71.4% of children had tried MNP in Kapilvastu and Achham districts, respectively, consuming an average of 24 sachets from the last distribution. Frequent maternal–FCHV interactions were associated with a reduced risk of stunting and underweight at endline, whereas repeat MNP coverage was associated with reduced risk of anaemia and IDA. Future research using experimental designs should verify the potential of integrated IYCF–MNP programmes to improve children's nutritional status.     

Stage-related behavioural problems in the 1-4 year old child: Parental expectations in a child development unit referral group compared with a control group

Abstract Behavioural problems in preschool (1-4 years) children are a common cause of referral to health services. Parents of children presenting to the child development unit with behavioural problems ( n = 18) were compared with a control group ( n = 45). A questionnaire was utilized to examine the parents'expectations of the children's behaviours.
As might be expected, the parents of children presenting to the Unit rated their children as having more difficult behaviours. These parents had unrealistic expectations, particularly for the 'negative'behaviours (disobedience, temper tantrums, defiance and whinging). However, they were able to anticipate normal age-related difficulties in some problem areas (dawdling during mealtimes, masturbating, not sharing toys and being jealous of one's siblings).
Counselling should address the issue of matching the expectations of parents with the individual rates of development of their children.     

Electronic Health Record Tools to Identify Child Maltreatment: Scoping Literature Review and Key Informant Interviews

ObjectiveTo prevent missed cases and standardize care, health systems are beginning to implement EHR-based screens (EHR-CA-S) and clinical decision supports systems (EHR-CA-CDSS) for the identification and management of child maltreatment. This study aimed to 1) document the existing research evidence on the performance of EHR-CA-S and EHR-CA-CDSS and 2) examine clinical perspectives regarding the use of such tools and factors that affect uptake.MethodsWe searched MEDLINE, Embase, EBSCO, Scopus, and CINAHL databases for English language articles published prior to November 2021 that describe and/or evaluated an EHR-CA-S and/or EHR-CA-CDSS involving 0 to 18-year olds. We performed semistructured interviews with 20 individuals who have experience in identifying, evaluating, and/or treating child maltreatment and/or conducting research on these topics.ResultsOur search identified 574 articles; 16 met inclusion criteria. Studies examined screening, alerts and triggers, and quality improvement. None evaluated long-term clinical outcomes. Sensitivity ranged from 0.14 to 1.00, specificity from 0.865 to 1.00, positive predictive value from 0.03 to 1.00 and negative predictive value from 0.55 to 1.00. A variety of EHR-CA-S and/or EHR-CA-CDSS have been implemented at institutions in our sample. Interviewees cited missed cases, policy requirements, and the lack of standardization of care as impetuses for adopting these tools, yet expressed concerns regarding insufficient evidence, bias, and time-intensiveness of implementation.ConclusionsInterviewees and the literature agree that current evidence does not support adoption of a particular CA-S or CA-CDSS. Further refinement and research on EHR-CA-S and EHR-CA-CDSS is necessary for these tools to be feasibly implemented and sustained, reliable for clinical practice, and not cause any unintentional harms.     

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.     

CHILD HEALTH IN SWEDEN

ABSTRACT. Sjölin, S. and Vahlquist, B. (Department of Paediatrics, University Hospital, Uppsala, Sweden). Child health in Sweden. Acta Paediatr Scand, 63: 485, 1974.—On the basis of relevant vital statistics, some characteristic features of the health of Swedish children during the last two centuries are presented and analysed with regard to probable causative factors. An attempt is also made to define in brief the child health problems of the future.     

Childhood neglect: a clinical perspective and introducing the Graded Care Profile 2

Neglect has serious consequences for children in terms of their health, growth, and development. Neglect may even directly cause or contribute to child deaths. In common with other forms of abuse and exposure to adverse childhood experiences, neglect is linked with health risks in adulthood that lead to diseases that cause premature death. Healthcare professionals working with children and young people must be skilled in identifying and dealing with it. Early recognition is vital but whilst neglect is the most prevalent form of abuse it remains difficult to identify and assess. This review examines how neglect can impact on the developmental process and how this can be identified. Clinically discernible features are described, along with advice about how best to address them. It also introduces a tool which can help overcome some of the difficulties associated with the assessment of neglect: The Graded Care Profile 2 (GCP2).     

Exploring why junk foods are ‘essential’ foods and how culturally tailored recommendations improved feeding in Egyptian children

In Egypt, the double burden of malnutrition and rising overweight and obesity in adults mirrors the transition to westernized diets and a growing reliance on energy‐dense, low‐nutrient foods. This study utilized the trials of improved practices (TIPs) methodology to gain an understanding of the cultural beliefs and perceptions related to feeding practices of infants and young children 0–23 months of age and used this information to work in tandem with 150 mothers to implement feasible solutions to feeding problems in Lower and Upper Egypt. The study triangulated in‐depth interviews (IDIs) with mothers participating in TIPs, with IDIs with 40 health providers, 40 fathers and 40 grandmothers to gain an understanding of the influence and importance of the role of other caretakers and health providers in supporting these feeding practices. Study findings reveal high consumption of junk foods among toddlers, increasing in age and peaking at 12–23 months of age. Sponge cakes and sugary biscuits are not perceived as harmful and considered ‘ideal’ common complementary foods. Junk foods and beverages often compensate for trivial amounts of food given. Mothers are cautious about introducing nutritious foods to young children because of fears of illness and inability to digest food. Although challenges in feeding nutritious foods exist, mothers were able to substitute junk foods with locally available and affordable foods. Future programming should build upon cultural considerations learned in TIPs to address sustainable, meaningful changes in infant and young child feeding to reduce junk foods and increase dietary quality, quantity and frequency.     

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.     

Allogeneic bone marrow transplantation in children: single institution experience from 1974 to 1992

At the Children's Hospital, University of Helsinki, Finland, bone marrow transplantations have been performed since 1974. Between 1974 and 1992, 62 children received allogeneic bone marrow grafts. Median patient age was 9.3 years. Thirty-two patients had ALL, 13 AML and 11 had severe aplastic anemia (SAA). Graft failure occurred in 4 of the 62 patients. The overall long-term survival rate was 47%. Relapse of leukemia was the most common cause of death, especially in patients with ALL transplanted in second or later remission. Deaths during the first 2 months after transplant have decreased with time. In a small country such as Finland, it is important to centralize the experience of allogeneic BMTs, particularly for pediatric patients.     

Patterns of disease among children: A simple and versatile measure of child health in communities

Objective : To derive an indicator of community child health that is simple, stable, cost-effective and suitable for small communities.
Methodology : Discharge diagnoses of children have been tabulated for hospitals in Australia and other countries and from an Aboriginal community, for up to 40 years. The differences in ratios between main diagnostic groups relate to the child health status in the community.
Results : As we pass from 'developing' to 'developed' conditions, the proportion of different diagnoses changes with a relative decrease in gastroenteritis and a relative increase in respiratory and other diseases. These changes parallel changes in infant mortality rates and child growth that are independent indicators of community child health.
Conclusions : The ratios of diagnoses of hospital discharges, the 'disease pyramid' is a reliable, valid and cost-effective way of measuring child health in a community while avoiding many of the uncertainties of conventional disease-specific and age-specific discharge rate statistics.     

儿童颅咽管瘤术后迟发性低钠血症及治疗探讨

为探讨儿童颅咽管瘤术后迟发性低钠血症的发生、发展及治疗，以提供合理的处理方法，对12例颅咽管瘤术后患儿血电解质、尿和血常规变化和治疗方法进行分析。结果为12例中发生迟发性低钠血症6例，出现低钠血症的时间为术后3天－8天，均伴有低血钾、低血氯等。通过限制补液量、补充高渗氯化钠和使用速尿等治疗后，血钠水平在术后4－14天恢复正常。提示儿童颅咽管瘤术后迟发性低钠血症较为多见，术后2周内应严密监测血电解质和血、尿渗透压，不宜过早使用抗利尿激素制剂。     

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.