Australian Children Research Articles

Protocol for the Australian Type 1 Diabetes National Screening Pilot: Assessing the feasibility and acceptability of three general population screening models in children.

One third of Australian children diagnosed with type 1 diabetes present with life-threatening diabetic ketoacidosis (DKA) at diagnosis. Screening for early-stage, presymptomatic type 1 diabetes, with ongoing follow-up, can substantially reduce this risk (<5% risk). Several screening models are being trialled internationally, without consensus on the optimal approach. This pilot study aims to assess three models for a routine, population-wide screening programme in Australia. An implementation science-guided pilot study to evaluate the feasibility, acceptability and costs of three screening models in children will be conducted between July 2022 and June 2024. These models are as follows: (1) Genetic risk-stratified screening using newborn heel prick dried bloodspots, followed by autoantibody testing from 11 months of age; (2) genetic risk-stratified screening of infant (6-12 months) saliva followed by autoantibody testing from 10 months of age; and (3) autoantibody screening using capillary dried bloodspots collected from children aged 2, 6 or 10 years. Cohorts for each model will be recruited from targeted geographic areas across Australia involving ≥2 states per cohort, with a recruitment target of up to 3000 children per cohort (total up to 9000 children). The primary outcome is screening uptake for each cohort. Secondary outcomes include programme feasibility, costs, parental anxiety, risk perception, satisfaction, well-being and quality of life, and health professional attitudes and satisfaction. This pilot is the first direct comparison of three screening implementation models for general population screening. Findings will provide evidence to inform a potential national screening programme for Australian children. ACTRN12622000381785.

Socio-demographic factors and mental health trajectories in Australian children and primary carers: Implications for policy and intervention using latent class analysis.

Children's mental health status (MHS) is frequently influenced by their primary carers (PCs), underscoring the significance of monitoring disparities longitudinally. This research investigated the association between socio-demographic clusters and mental health trajectories among children and their PCs over time. Data from waves 6-9c2 of the Longitudinal Study of Australian Children (LSAC) were analyzed using Latent Class Analysis (LCA) to identify four socio-demographic classes among children aged 10-11 years at wave 6. Multinomial logistic regression and predictive marginal analysis explored associations between classes and mental health outcomes. PCs in Class 4 (disadvantaged and separated families with indigenous children) exhibited higher odds of borderline and abnormal MHS compared to Class 1 (prosperous and stable working families) across all waves. However, while MHS of PCs' impacted children consistently, the association with socio-demographic classes was significant only in wave 6. Class 4 children had elevated risks of mental illness compared to Class 1, while Class 3, characterized by educated working mothers, had lower risks. Reducing mental health risks entails addressing socio-economic disparities, supporting stable family structures, and offering tailored interventions like counseling and co-parenting support. Longitudinal monitoring and culturally sensitive approaches are crucial for promoting mental well-being across diverse groups.

What is ‘children’s television’ in the streaming era?: Assessing content discoverability through Australian children’s streaming platform fluencies

In line with international trends, increasing numbers of children in Australia use streaming video platforms to watch television on-demand from extensive catalogues. Child viewers thus tend to negotiate platform interfaces organised by algorithmic curation to select content, rather than accessing content via scheduled linear TV. The deeper implications of this substantial shift in child audience habits around television have yet to be robustly reckoned with across scholarly and national policy approaches. Indeed, policy settings in Australia have not kept pace with these transformations, one result of which has been that 84% less Australian content was aired on free-to-air commercial broadcasters in 2022 compared to 2019. Key producer bodies fear the sector is in serious peril and may not withstand the current instability. Given that local children’s television meets Australian children’s best interests by situating them within their own socio-cultural context, the issue has become a site of significant policy, industry, and cultural concern. At this precarious time for the Australian children’s television sector, this article outlines key findings of a mixed method study with Australian children aged 7–9 ( n = 37) and their adult guardians to illustrate how children understand, identify, and discover ‘local’ and ‘children’s’ content on streaming platforms. This child audience research contributes to current policy and scholarly debates around the ‘routes to content’ audiences develop in the streaming era. A focus of our analysis is how and if children find Australian content. Our aim is to shed light on how ‘discoverability’ issues compound the current state of turmoil for the sector. We elucidate children’s digital fluencies with platform interfaces but highlight their limited cultural literacies with the content itself, which poses significant implications for industry and policy strategy around local content discoverability for child audiences on streaming platforms.

Caring for kids: Australian general practice registrar confidence in delivering paediatric primary care.

The burden of disease for Australian children from non-acute conditions is growing; however, little is known about how well prevocational training experiences prepare trainee doctors. This study examines the confidence of general practice registrars in managing paediatric consultations in primary care and whether confidence varies by prevocational training type. This was a cross-sectional national survey of Australian general practice registrars that measured confidence in managing paediatric primary care presentations. Respondents reported feeling confident (65%) or very confident (8%) in managing paediatrics in primary care, with higher confidence for those more advanced in their training or with greater exposure to paediatrics during prevocational training. Regression models showed registrars were more likely to report higher confidence when managing acute versus non-acute presentations. Although most registrars reported confidence in managing paediatric presentations, confidence levels were notably lower for non-acute conditions and when prevocational training experiences included limited exposure to paediatric patients.

A non-randomized feasibility study of a voice assistant for parents to support their children's mental health.

Mental disorders affect one in seven Australian children and although effective, evidenced based treatments exist, there is a critical shortage of mental health clinicians which has created a "treatment gap." Artificial intelligence has the potential to address the high prevalence rates of mental disorders within overburdened mental health systems. This was a non-randomized feasibility study to evaluate the novel application of voice technology to an evidence-based parenting intervention designed to support children's mental health. We deployed an Amazon Alexa app to parents recruited from the community (N = 55) and to parents with children receiving psychological treatment (N = 4). Parents from the community used the app independently whereas parents from the clinical group used the app in conjunction with attending a six-week parenting program. The primary outcome measure, feasibility was assessed in terms of acceptability, via recruitment and retention rates, quantitative surveys and qualitative interviews. In the community group, the recruitment rate was 23.8% and the retention rate 49.1%. In the clinical group, all 6 families approached for recruitment agreed to participate and 4 out of 6 completed the trial. Parents attending the parenting program spent on average, three times longer using the app than parents from the community. Overall, parents reported that the app contained easy-to-understand information on parenting, and that they could see the potential of voice technology to learn and practice parenting skills. Parents also faced several challenges, including difficulties with installation and interactions with the app and expressed privacy concerns related to voice technology. Further, parents reported that the voices used within the app sounded monotone and robotic. We offer specific recommendations that could foster a better voice assistant user experience for parents to support their children's mental health. The app is highly scalable and has the potential to addresses many of the barriers faced by parents who attempt to access traditional parenting interventions.

Children’s time allocation and the socioeconomic gap in human capital

Children’s time investments in various activities may be important for reducing socioeconomic status (SES) gaps in educational and mental health outcomes. Using detailed time use diaries of Australian children aged 4–14, we observe that children from low SES backgrounds spend more time on digital media and less time on out-of-school enrichment activities, organised or for leisure. We explain the SES gap by employing a human capital development panel model and find that this difference contributes about 3% to the observed SES gap in numeracy skills. The results are supported by exogeneity tests and numerous robustness checks. The contribution is larger for males, older age groups, and if the cumulative effect on learning is considered. No clear results are found for literacy skills and mental health outcomes. The findings imply that interventions promoting a shift away from digital media towards out-of-school enrichment activities could help reduce the SES gap in human capital.

Cross-sectional associations of movement behaviour compositions with health-related quality of life in Australian children

ObjectivesTo examine associations of movement behaviour compositions with health-related quality of life in children. MethodsBaseline data (2018) from the TransformUs study were used. Overall, 891 children aged 7–12 years [69% of consented sample] recorded valid accelerometry data (ActiGraph GT3X+; 4 days, including ≥1 weekend day). Time spent sedentary, and in light-, moderate-, and vigorous-intensity physical activity were extracted. Health-related quality of life was assessed using five EQ-5D-Y health-related quality of life dimensions (mobility, looking after myself, doing usual activities, having pain/discomfort, and feeling worried/sad/unhappy [all dichotomized as no versus any problems]) and one continuous scale assessing overall perceived health. Regression models examined associations between waking movement behaviour compositions, including longer and shorter sedentary (<5 and ≥ 5 min) and physical activity (<1 and ≥ 1 min) bouts, and health-related quality of life. ResultsThe waking movement behaviour composition was associated with overall perceived health (whole sample, and boys and girls separately, but high socio-economic status only) and having pain/discomfort. More relative time in shorter versus longer sedentary bouts was associated with lower overall perceived health and higher odds of pain/discomfort. More relative time in shorter versus longer light-intensity and moderate-intensity bouts, were associated with decreased and increased odds of pain/discomfort, respectively. Finally, more time in shorter versus longer vigorous-intensity physical activity bouts was associated with better perceived health. ConclusionsChildren's movement behaviours seem to be related to health-related quality of life. Longitudinal evidence from more diverse samples with 24-h wear protocols and context-specific measures are needed to better understand this association.

Adverse childhood experiences and externalizing, internalizing, and prosocial behaviors in children and adolescents: A longitudinal study

BackgroundAdverse childhood experiences (ACEs) have a profound impact on individuals, shaping their long-term health and life opportunities. This study delves into the complex ties between ACEs and the socioemotional development of Australian children and youth by examining the relationships between adverse childhood experiences and externalizing, internalizing, and prosocial behaviors. MethodsThis study utilized data from the Longitudinal Study of Australian Children and employed the generalized estimating equation method to investigate the relationships between adverse childhood experiences and externalizing, internalizing, and prosocial behaviors in Australian children and adolescents. ResultsAdverse childhood experiences such as physical punishment, hostile parenting, parental conflicts, separation, financial strain, and parental mental health issues increased the risk of externalizing and internalizing behaviors while reducing prosocial behaviors. The risk increases with the number of ACEs, as evidenced by the incidence ratio (IR); for example, for externalizing behaviors, an ACEs score of one leads to IR = 1.69, while an ACEs score of 4 results in IR = 3.34. Similar trends were observed for internalizing and prosocial behaviors. LimitationsThe presence of imbalanced longitudinal data, arising from variations in the number of observations across different time points, challenges robust inferences. Furthermore, this study investigates the relationship between ACEs and behavioral problems, without establishing causality. Consequently, the results should be interpreted with caution. ConclusionsThe findings of this study highlight that adverse childhood experiences significantly influence behavioral outcomes in children and adolescents. These findings underscore the critical need for early detection and intervention to mitigate the consequences of traumatic childhood experiences.

Trajectories of Sugar-Sweetened Beverage Intake in Early Life: Evidence from a Birth Cohort Study.

Infancy and early childhood are periods of dietary transition. Early exposure to specific foods and the establishment of dietary habits during this period can shape long-term food preferences and have lasting effects on health. This study aimed to examine the longitudinal trajectories of sugar-sweetened beverage (SSB) intake in Australian children from birth to age 3 years and identify early-life and socioeconomic factors influencing those trajectories. Mother-infant dyads (n = 934) from the Healthy Smiles Healthy Kids birth cohort study were interviewed on their weekly frequency of SSB intake at 4-month, 8-month, 1-year, 2-year, and 3-year age points. Group-based trajectory modelling analysis was performed to identify trajectories for SSB intake among Australian children. A multivariable logistic regression was performed to identify the maternal and child-related predictors of resulting trajectories. The intake of SSBs showed two distinct quadratic trajectories (high and low) with age. While the two trajectories remained distinctive throughout, the SSB consumption for both groups consistently increased between 4 months and 2 years of age and subsequently stabilised. Compared to low SSB consumers (75%), the high SSB consumers (25%) were significantly more likely to be living in households with three or more children (relative risk (RR): 1.59, 95%CI: 1.02-2.48), had low maternal education (left school < year 12-RR: 1.75, 95%CI: 1.09-2.81; completed year 12-RR: 1.57, 95%CI: 1.02-2.81), and resided in highly/the most socioeconomically disadvantaged areas (highly disadvantaged-RR: 1.89, 95%CI: 1.13-3.18; most disadvantaged-RR: 2.06, 95%CI: 1.25-3.38). Children's SSB intake patterns are established early in life as they transition from infancy to preschool age, and the trajectories of intake established during early childhood are strongly influenced by socioeconomic factors. Hence, interventions targeted to limit SSB intake and improve nutrition amongst children should occur in early life.

Influence of changing dentition on food texture preferences and perception of eating difficulty in Australian children.

The transition from primary to permanent dentition is an important phase in children's oral development, yet its impact on texture perception and food acceptance are less explored. This study aimed to investigate how changing dentition and tooth loss influence texture preferences and perception of eating difficulty among children aged 5 to 12 years. Children (n = 475) completed a forced-choice questionnaire featuring drawings of six food pairs, each available in hard or soft texture, and reported whether they had started losing primary teeth and the number of tooth gaps present. They also tasted four samples: chocolate snacks (cake and biscuits) and cheddar cheese (grated and cubes), evaluating their perceived eating difficulty and liking for each sample. Analysis of questionnaire responses showed a general preference for softer food textures among children, with a 36% probability of choosing hard foods. Preferences were not related to child's dental state, including primary teeth loss (p = .13) or number of tooth gaps (p = .45). In the taste test, chocolate biscuits and cheese cubes were perceived as significantly more difficult to eat than chocolate cake and grated cheese, respectively (both p < .0001). Children with more than two tooth gaps reported greater eating difficulty for chocolate biscuits and cheese cubes compared to children with fewer or no tooth gaps. This study demonstrated that children's texture preferences for hardness of foods remained consistent during dentition change, while their perception of eating difficulty could vary based on their dental state at specific points in time.

EPIC-CP pilot trial study protocol: a multicentre, randomised controlled trial investigating the feasibility and acceptability of social prescribing for Australian children with cerebral palsy

IntroductionThe social determinants of health contribute to poorer health outcomes for children with cerebral palsy (CP) and are barriers to families accessing health services. At an individual level, social determinants...

Ivermectin therapy for young children with scabies infection: a multicentre phase 2 non-randomized trial

Ivermectin, an effective treatment for scabies, is not licensed for children weighing <15kg. Pharmacokinetic modelling has shown a 3mg dose in young children (2-4 years, weighing 10-14kg) achieves comparable drug exposure to a 200μg/kg dose in children aged ≥5 years. This trial evaluated a 3mg dose in young children. Multicentre, phase 2 trial in five health centres in Lao PDR. Children aged 2-4 years, weighing 10-14kg with scabies received 3mg ivermectin and had two plasma concentrations determined (Clinicaltrials.gov ID NCT05500326). On day 14, clinical outcomes and adverse effects were assessed, and a second dose given to complete treatment. The primary outcome was the mean plasma ivermectin exposure (AUC0-∞) after the first dose (compared to a historical control of Indigenous Australian children aged ≥5 years weighing ≥15kg receiving 200μg/kg). Secondary outcomes were clinical improvement and adverse effects. Overall, 100 children with a median age of 3.0 years (IQR 2.6-3.9) and weight of 11.9kg (IQR 11.0-13.1) were enrolled. The mean observed ivermectin AUC0-∞ was comparable to the historical control group aged 5-11 years (815μgh/L vs 953μgh/L, p=0.256). Complete resolution of scabies occurred in 90/99 children by day 14. Adverse effects were mild, occurring in 7/99. A 3mg ivermectin dose in children aged 2-4 years and weighing 10-14kg achieved a mean plasma AUC0-∞ comparable to older children, was highly effective in treating scabies and well tolerated. This study supports extending ivermectin treatment to younger children improving global efforts to control this neglected disease. Project funding provided by a Thrasher Foundation Early Career Research Award.

The Production and Performance of Workplace Hierarchies in Australian Outside School Hours Care

Outside School Hours Care (OSHC) provides play, leisure, care and education for significant numbers of Australian children. As government has become increasingly involved in the regulation of OSHC, the sector has become increasingly professionalised. OSHC practitioners are active participants in quality improvement processes and increasingly likely to have qualifications. Despite its growing social importance, there is little research about the OSHC workforce. This article draws on a research project conducted with OSHC practitioners who participated in a professional development program that introduced a set of professional standards for practitioners. The research investigated how participants engaged with the standards after completion of the program and demonstrated that uptake of the professional standards was complicated by workplace and sector hierarchies. Participants were less likely to use the standards for service leaders and short-term, casualised workers. These hierarchies formed in complex ways around dominant discourses that underestimate care and leisure work and position OSHC as a secondary consideration for school management. The findings in this research have important implications for the sustainability of the OSHC workforce, how it is perceived and how it engages with professional development programs.

Environmental Determinants of Islet Autoimmunity (ENDIA) longitudinal prospective pregnancy to childhood cohort study of Australian children at risk of type 1 diabetes: parental demographics and birth information

IntroductionThe Environmental Determinants of Islet Autoimmunity (ENDIA) Study is an ongoing Australian prospective cohort study investigating how modifiable prenatal and early-life exposures drive the development of islet autoimmunity and type...

Kidney transplantation access and outcomes for Aboriginal and Torres Strait Islander children and young adults, 1963-2020: an ANZDATA registry study.

To assess differences between Aboriginal and Torres Strait Islander and non-Indigenous Australian children and young adults in access to and outcomes of kidney transplantation. A cohort study based on prospectively collected data; analysis of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. Children and young adults aged 0-24 years who commenced kidney replacement therapy in Australia during 1963-2020. Proportions of children and young adults who received kidney transplants within five years of commencing dialysis; 5- and 10-year death-censored graft survival; and 5- and 10-year survival of children and young adults who received kidney transplants or who remained on dialysis. During 1963-2020, 3736 children and young adults received kidney replacement therapy in Australia: 213 (5.8%) Aboriginal and Torres Strait Islander and 3523 (94.2%) non-Indigenous children and young adults. During follow-up (median, eight years; interquartile range [IQR], 2.6-15 years), 2762 children and young adults received kidney transplants: 93 Aboriginal and Torres Strait Islander (43.7% of those receiving kidney replacement therapy) and 2669 non-Indigenous children and young adults (75.8%). Smaller proportions of Aboriginal and Torres Strait Islander than of non-Indigenous children and young adults received transplants within five years of commencing dialysis (99, 46% v 2924, 83.0%), received living donor transplants (19, 20% v 1170, 43.9%), or underwent pre-emptive transplantation (one, 1.1% v 363, 13.6%). Five-year graft survival for Aboriginal and Torres Strait Islander recipients was similar to non-Indigenous recipients (61% v 75%; adjusted hazard ratio [aHR], 1.43; 95% confidence interval [CI], 0.02-2.05), but 10-year graft survival was lower (35% v 61%; aHR, 1.69; 95% CI, 1.25-2.28). Five- and 10-year survival after kidney transplantation was similar for Aboriginal and Torres Strait Islander and non-Indigenous people. Among those who remained on dialysis, 10-year survival was poorer for Aboriginal and Torres Strait Islander than non-Indigenous children and young adults (aHR, 1.50; 95% CI, 1.08-2.10). Five-year graft and recipient survival were excellent for Aboriginal and Torres Strait Islander children and young adults who received kidney transplants; however, a lower proportion received transplants within five years of dialysis initiation, than non-Indigenous children and young adults. Improving transplant access within five years of dialysis commencement should be a priority.

‘Sons go wrong without fathers’: Australian children and absent serviceman fathers in the Second World War

This article analyses the perceived problems and proposed solutions concerning absent Australian servicemen fathers during the Second World War, and places them within the broader context of contemporary ideas about masculinity. The absence of servicemen fathers led to concerns from all areas of society about the impact on their children, in particular sons. There were fears that being raised solely by women would lead to boys becoming lonely, effeminate, spoilt, or juvenile delinquents. It was suggested that existing male family members, such as uncles and grandfathers, as well as male teachers, act as surrogate fathers and become role models. Boys’ clubs, such as Scouts and the YMCA, also provided boys with access to male role models, and their weekly meetings, Father Son events, and camping provided opportunities for imparting the ‘code of boyhood’ and the development of masculine qualities.

Mental health in children conceived by Assisted Reproductive Technologies (ARTs): Insights from a longitudinal study of Australian children

Mental health in children conceived by Assisted Reproductive Technologies (ARTs): Insights from a longitudinal study of Australian children

Insecure maternal employment and children's behaviour difficulties: Evidence from the longitudinal study of Australian children

Although a large body of research has documented the negative effects of insecure employment for adult workers, less is known about the consequences for their children's well-being. Our understanding of the mechanisms through which insecure maternal employment may affect children is particularly limited. This study examines the relationship between insecure maternal employment and child behaviour difficulties from the age of 4–16 using seven waves of data for nearly 5000 families from Growing Up in Australia: The Longitudinal Study of Australian Children. Employing fixed effects models to account for unobserved time-invariant heterogeneity, we found that children whose mothers were casual contract employees or economically inactive had greater behaviour difficulties, on average, than their peers whose mothers were permanent employees. Maternal mental health and parenting, rather than household financial strain, contributed to explaining the association between insecure maternal employment and child behaviour difficulties. These results were more pronounced for younger children (up to the age of 12). This study contributes to the literature on the consequences of maternal employment insecurity for child mental health in high-income countries by clarifying the mechanisms behind this association.

Characterization of Gram-negative Bloodstream Infections in Hospitalized Australian Children and Their Clinical Outcomes.

Gram-negative bloodstream infections (GNBSIs) more commonly occur in children with comorbidities and are increasingly associated with antimicrobial resistance. There are few large studies of GNBSIs in children that relate the clinical presentation, pathogen characteristics, and outcomes. A 3-year prospective study of GNBSIs in children aged <18 years was conducted in 5 Australian children's hospitals between 2019 and 2021. The clinical characteristics, disease severity, and outcomes were recorded. Causative pathogens underwent antibiotic susceptibility testing and whole genome sequencing. There were 931 GNBSI episodes involving 818 children. Median age was 3 years (interquartile range, 0.6-8.5). A total of 576/931 episodes (62%) were community onset, though 661/931 (71%) occurred in children with comorbidities and a central venous catheter was present in 558/931 (60%). Central venous catheter (145/931) and urinary tract (149/931) were the most common sources (16% each). One hundred of 931 (11%) children required intensive care unit admission and a further 11% (105/931) developed GNBSIs in intensive care unit. A total of 659/927 (71%) isolates were Enterobacterales, of which 22% (138/630) were third-generation cephalosporin resistant (3GCR). Extended spectrum beta-lactamase genes were confirmed in 65/138 (47%) 3GCR Enterobacterales. Most common extended spectrum beta-lactamase genes were blaCTX-M-15 (34/94, 36%) and blaSHV-12 (10/94, 11%). There were 48 deaths overall and 30-day in-hospital mortality was 3% (32/931). Infections with 3GCR Enterobacterales were independently associated with higher mortality (adjusted odds ratio, 3.2; 95% confidence interval, 1.6-6.4). GNBSIs in children are frequently healthcare associated and affect children younger than age 5 years. Infections with 3GCR Enterobacterales were associated with worse outcomes. These findings will inform optimal management guidelines and help prioritize future antimicrobial clinical trials.

Scurvy and vitamin C deficiency in an Australian tertiary children's hospital.

We aimed to investigate the frequency of vitamin C deficiency scurvy in the Australian paediatric context, describe cohorts at risk, and identify factors associated with development of symptoms in children with vitamin C deficiency. We also aimed to propose a management guideline for children with features of scurvy. A retrospective study was done at a tertiary paediatric hospital in Australia over a three-year period, from August 2019 to July 2022. Children from birth to 18 years old, whose vitamin C levels were low (<23 μmol/L), were included. Data extracted from hospital medical records included demographics, weight, co-morbidities, eating disorder diagnoses, clinical features, investigations and treatment. Descriptive statistics and risk statistics were performed. In a cohort of 887 patients who had their vitamin C levels checked, we identified 272 (31%) who had a vitamin C level <23 μmol/L. Of these, 13 (5%) were symptomatic of vitamin C deficiency and 19 (7%) may have been symptomatic. In patients with vitamin C deficiency, 248 (91%) had comorbidities, neurodevelopmental disorders being most common, and 176 (65%) had restricted eating. When the asymptomatic and symptomatic groups were compared, in the symptomatic group, there was a significantly lower vitamin C level and disordered eating related to autism spectrum disorders was more common. In order to avoid delayed diagnoses and unnecessary investigations, clinicians should be familiar with symptoms of scurvy and perform a dietary assessment, vitamin C assay, and commence empiric vitamin C supplementation where appropriate.