Current Child Health Research Articles

The Optimal Cut-Off Point of Physical Activity for the Prevention of Childhood Overweight and Obesity.

Childhood obesity might threaten children's current and adulthood health outcomes. Previous studies have illustrated the positive effects of physical activity on weight control; however, there is a lack of evidence on the optimal dose of physical activity. Therefore, we aimed to explore the relationship between physical activity and overweight and obesity, as well as the optimal threshold for physical activity. The median (interquartile range) and number (proportion) were used to describe the statistics. The Mann-Whitney U test and chi-square test were used for an univariable analysis. The generalized additive model with a smooth function was used to depict the preliminary relationship between physical activity and overweight and obesity. The cut-off level of physical activity was identified using AddFor algorithms, and a logistic regression model was applied to explore the multivariable relationship between physical activity and overweight and obesity after adjusting for control variables. According to the statistical analyses, 24.3% of 842 children and adolescents had overweight and obesity. The average number of days that the participants engaged in more than one hour of physical activity was three days a week. The optimal cut-off level of physical activity for the prevention of childhood overweight and obesity was 4 times a week. The participants who exercised more than four times a week (AOR(95% CI) = 0.56(0.38, 0.83), p = 0.004) were less likely to be overweight and obese. In the context of the general lack of physical activity among children and adolescents, we recommend that children and adolescents engage in 60 min of physical activity more than four times a week for a healthy weight.

The Support Needs and Current Practices of Public Health Nurses in the Republic of Ireland Who Provide Support to Breastfeeding Mothers: A Cross-Sectional Survey.

Breastfeeding continuation rates are low in Ireland. The Breastfeeding Observation and Assessment Tool (BOAT) was developed to assist public health nurses in assessing breastfeeding challenges; however, little is known of its actual usage, the level of training experienced or desired by public health nurses, or their level of confidence in the support they provide to breastfeeding mothers. To identify the current practices and support needs of public health nurses who provide breastfeeding support in Ireland. An online questionnaire was devised to collect respondents' confidence with breastfeeding issues, caseload, and practices. It was distributed to public health nurses with a current child health caseload in one Community Healthcare Organization. Mann Whitney U tests were used to ascertain the relationship between public health nurses' confidence level and those with qualifications in midwifery or as an International Board Certified Lactation Consultant (IBCLC). The survey was completed by 66 public health nurses. Only 14 respondents (21.2%) indicated that they always used the BOAT. The most common reason for not doing so was a lack of education on its use (n = 17, 25.8%). Postholders also certified as IBCLCs were considered by participants to be the most appropriate professionals to resolve certain breastfeeding issues. Confidence levels to manage breastfeeding issues were highest among public health nurses with IBCLC credentialing (U = 12.5, p = .001) while no difference was seen when comparing those with a midwifery degree to those without (U = 184.0, p = .92). Face-to-face workshops and blended-learning approaches were ranked as the preferred formats for breastfeeding education (Median rank = 2). Breastfeeding education incorporating a face-to-face component is needed to support public health nurses who work with breastfeeding mothers, as is prioritization of recruitment in the community of public health nurses with IBCLC credentials.

Prevalence of Zero-Food among infants and young children in India: patterns of change across the States and Union Territories of India, 1993–2021

The extent of food deprivation and insecurity among infants and young children-a critical phase for children's current and future health and well-being-in India is unknown. We estimate the prevalence of food deprivation among infants and young children in India and describe its evolution over time at sub-national levels. Data from five National Family Health Surveys (NFHS) conducted in 1993, 1999, 2006, 2016 and 2021 for the 36 states/Union Territories (UTs) of India were used. The study population consisted of the most recent children (6-23 months) born to mothers (aged 15-49 years), who were alive and living with the mother at the time of survey (n=175,614 after excluding observations that had no responses to the food question). Food deprivation was defined based on the mother's reporting of the child having not eaten any food of substantial calorific content (i.e., any solid/semi-solid/soft/mushy food types, infant formula and powdered/tinned/fresh milk) in the past 24hours (h), which we labelled as "Zero-Food". In this study, we analyzed Zero-Food in terms of percent prevalence as well as population headcount burden. We calculated the Absolute Change (AC) to quantify the change in the percentage points of Zero-Food across time periods for all-India and by states/UTs. The prevalence of Zero-Food in India marginally declined from 20.0% (95% CI: 19.3%-20.7%) in 1993 to 17.8% (95% CI: 17.5%-18.1%) in 2021. There were considerable differences in the trajectories of change in the prevalence of Zero-Food across states. Chhattisgarh, Mizoram, and Jammu and Kashmir experienced high increase in the prevalence of Zero-Food over this time period, while Nagaland, Odisha, Rajasthan and Madhya Pradesh witnessed a significant decline. In 2021, Uttar Pradesh (27.4%), Chhattisgarh (24.6%), Jharkhand (21%), Rajasthan (19.8%) and Assam (19.4%) were states with the highest prevalence of Zero-Food. As of 2021, the estimated number of Zero-Food children in India was 5,998,138, with the states of Uttar Pradesh (28.4%), Bihar (14.2%), Maharashtra (7.1%), Rajasthan (6.5%), and Madhya Pradesh (6%) accounting for nearly two-thirds of the total Zero-Food children in India. Zero-Food in 2021 was concerningly high among children aged 6-11 months (30.6%) and substantial even among children aged 18-23 months (8.5%). Overall, socioeconomically advantaged groups had lower prevalence of Zero-Food than disadvantaged groups. Concerted efforts at the national and state levels are required to further strengthen existing policies, and design and develop new ones to provide affordable food to children in a timely and equitable manner to ensure food security among infants and young children. This study was supported by a grant from the Bill & Melinda Gates Foundation INV-002992.

Autistic characteristics and mental health symptoms in autistic youth during the first COVID-19 wave in Canada.

Autistic youth are at heightened risk for mental health issues, and pandemic-related stressors may exacerbate this risk. This study (1) described caregiver-reported youth mental health prior to and during the pandemic; and (2) explored individual, caregiver, and environmental factors associated with changes in autistic characteristics, social-emotional symptoms, and overall mental health. 582 caregivers of autistic children (2-18 years old) completed an online survey between June and July 2020 in which they provided demographic information, their child's pre-COVID and current mental health, autistic characteristics, and social-emotional symptoms. Caregivers also rated their own perceived stress, and COVID-related household and service disruption. According to caregivers, youth experienced more autistic characteristics and social-emotional concerns during the pandemic. Autistic youth were also reported to experience poorer overall mental health during the pandemic than before the pandemic. Older youth whose caregiver's indicatedhigher perceived stress and greater household disruption were reported to experience more autistic traits during pandemic. Caregiver-reported increases in youth social-emotional symptoms (i.e., behavior problems, anxiety, and low mood) was associated with being older, the presence of a pre-existing mental health condition, higher caregiver stress, and greater household and service disruption. Finally, experiencing less household financial hardship prior to COVID-19, absence of a pre-existing psychiatric condition, less caregiver stress, and less service disruption were associated with better youth pandemic mental health. Strategies to support the autistic community during and following the pandemic need to be developed. The developmental-ecological factors identified in this study could help target support strategies to those autistic youth who are most vulnerable to mental health problems.

The Fusion of Public Health and Speech-Language Therapy in Schools: Has the Time Come?

BACKGROUND: The burden of communication disorders in school age children is substantial. These disorders are among the most prevalent in schools. Communication disorders are also linked to numerous sequalae, such as poor socio-emotional health, poor academic and professional outcomes, high levels of unemployment, and increased healthcare utilization and costs. Nevertheless, children with these disorders are among the least likely to receive services from a rehabilitation professional. In fact, more than half of school-aged children with a communication disorder do not receive any speech-language therapy support. Clearly, new approaches to communication disorders in schools are needed.
 
 METHODS: We conducted a narrative review of scholarly and applied literature in three parts. The first justifies the fusion of public health and speech-language therapy in schools. The second explores public health frameworks for speech-language therapy and compares the same to tiered service delivery models recently implemented within schools. The third addresses the implications of this fusion for research in communication disorders and for clinical practice.
 
 RESULTS: Traditional models of speech-language therapy clinical practice in schools are no longer sustainable given the current challenges posed by childhood communication disorders. A communication disability public health approach is needed to overcome these challenges. Tiered service delivery models provide an excellent opportunity to pivot speech-language therapy practice and research in schools towards a public health approach.
 
 CONCLUSION: Through this narrative review, we argue that the future of speech-language therapy in schools must take advantage of advances in public health to respond to current child health needs in our communities. We strongly recommend the fusion of public health and school-based speech-language therapy to address the communication health needs of future generations.

Assessment of dietary intakes and feeding practices in children aged 6-23 months in a town in the Northeast region of Argentina.

An adequate quantity and quality of complementary feeding is essential during the first 2 years of life. The objective of this study was to assess dietary intakes and feeding practices in children aged 6-23 months in a town in the Northeast region of Argentina. Descriptive, crosssectional study (second semester of 2019). Intakes from 24-hour dietary recall interviews conducted among caregivers of children aged 6-23 months were assessed. Data were compared to dietary reference intakes. Feeding practices were assessed as per the World Health Organization's indicators. A total of 138 children aged 6-23 months were assessed. The mean adequacy ratio of energy and vitamins A, D, and E was below 100% for all ages, whereas the protein adequacy for children aged 7-12 and 13-23 months was 142.8% and 168.1%, respectively. A remarkable number of cases had energy and vitamin A intakes below the estimated average requirement. In relation to feeding practice indicators, 50.8% of infants received a minimum acceptable diet. There is a high prevalence of an inadequate level of energy and critical nutrient intake during complementary feeding of the children aged 6-23 months included in the study. Nutritional interventions that promote feeding practices to improve micronutrient intake would be highly important for children's current and future health.

School dental screening programmes for oral health.

In school dental screening, a dental health professional visually inspects children's oral cavities in a school setting and provides information for parents on their child's current oral health status and treatment needs. Screening at school aims to identify potential problems before symptomatic disease presentation, hence prompting preventive and therapeutic oral health care for the children. This review evaluates the effectiveness of school dental screening for improving oral health status. It is the second update of a review originally published in December 2017 and first updated in August 2019. To assess the effectiveness of school dental screening programmes on overall oral health status and use of dental services. An information specialist searched four bibliographic databases up to 15 October 2021 and used additional search methods to identify published, unpublished and ongoing studies. We included randomised controlled trials (RCTs; cluster- or individually randomised) that evaluated school dental screening compared with no intervention, or that compared two different types of screening. We used standard methodological procedures expected by Cochrane. The previous version of this review included seven RCTs, and our updated search identified one additional trial. Therefore, this update included eight trials (six cluster-RCTs) with 21,290 children aged 4 to 15 years. Four trials were conducted in the UK, two in India, one in the USA and one in Saudi Arabia. We rated two trials at low risk of bias, three at high risk of bias and three at unclear risk of bias. No trials had long-term follow-up to ascertain the lasting effects of school dental screening. The trials assessed outcomes at 3 to 11 months of follow-up. No trials reported the proportion of children with treated or untreated oral diseases other than caries. Neither did they report on cost-effectiveness or adverse events. Four trials evaluated traditional screening versus no screening. We performed a meta-analysis for the outcome 'dental attendance' and found an inconclusive result with high heterogeneity. The heterogeneity was partly due to study design (three cluster-RCTs and one individually randomised trial). Due to this inconsistency, and unclear risk of bias, we downgraded the evidence to very low certainty, and we are unable to draw conclusions about this comparison. Two cluster-RCTs (both four-arm trials) evaluated criteria-based screening versus no screening, suggesting a possible small benefit (pooled risk ratio (RR) 1.07, 95% confidence interval (CI) 0.99 to 1.16; low-certainty evidence). There was no evidence of a difference when comparing criteria-based screening to traditional screening (RR 1.01, 95% CI 0.94 to 1.08; very low-certainty evidence). One trial compared a specific (personalised) referral letter to a non-specific letter. Results favoured the specific referral letter for increasing attendance at general dentist services (RR 1.39, 95% CI 1.09 to 1.77; very low-certainty evidence) and attendance at specialist orthodontist services (RR 1.90, 95% CI 1.18 to 3.06; very low-certainty evidence). One trial compared screening supplemented with motivation to screening alone. Dental attendance was more likely after screening supplemented with motivation (RR 3.08, 95% CI 2.57 to 3.71; very low-certainty evidence). One trial compared referral to a specific dental treatment facility with advice to attend a dentist. There was no evidence of a difference in dental attendance between these two referrals (RR 0.91, 95% CI 0.34 to 2.47; very low-certainty evidence). Only one trial reported the proportion of children with treated dental caries. This trial evaluated a post-screening referral letter based on the common-sense model of self-regulation (a theoretical framework that explains how people understand and respond to threats to their health), with or without a dental information guide, compared to a standard referral letter. The findings were inconclusive. Due to high risk of bias, indirectness and imprecision, we assessed the evidence as very low certainty. The evidence is insufficient to draw conclusions about whether there is a role for school dental screening in improving dental attendance. We are uncertain whether traditional screening is better than no screening (very low-certainty evidence). Criteria-based screening may improve dental attendance when compared to no screening (low-certainty evidence). However, when compared to traditional screening, there is no evidence of a difference in dental attendance (very low-certainty evidence). For children requiring treatment, personalised or specific referral letters may improve dental attendance when compared to non-specific referral letters (very low-certainty evidence). Screening supplemented with motivation (oral health education and offer of free treatment) may improve dental attendance in comparison to screening alone (very low-certainty evidence). We are uncertain whether a referral letter based on the 'common-sense model of self-regulation' is better than a standard referral letter (very low-certainty evidence) or whether specific referral to a dental treatment facility is better than a generic advice letter to visit the dentist (very low-certainty evidence). The trials included in this review evaluated effects of school dental screening in the short term. None of them evaluated its effectiveness for improving oral health or addressed possible adverse effects or costs.

Changes in parental smoking behavior and children's health status in Chile

Studies on parental smoking behavior have mostly been conducted for developed countries and show that current parental smoking is negatively associated with children's current health. Using four waves of a Chilean longitudinal survey (Encuesta de Protección Social), we estimate probit and ordinary least squares models relating parents' self-report of their children's current health status to several covariates, including current parental smoking status and change (transitions) in parental smoking status across the waves of the survey. The data were collected in the years 2004, 2006, 2009, and 2015. The working sample includes 25,052 observations. The study revealed that parents' self-report of their children's current health status is strongly associated with current and past parental smoking status. Parents who smoke have an increased 11.17% probability of reporting that their children are in fair, poor, or very poor health status, when compared to non-smoking parents. The effect is stronger if the smoker is the mother, and it is exacerbated if she is less educated or unemployed/inactive. In addition, quitting smoking has a significant positive effect on children's reported health status, which is greater if the mother quits smoking. Cessation among mothers who are unemployed or inactive is also associated with a more positive assessment of their children's health status. The findings suggest that cessation programs may have health benefits not only for smoking parents, but also for their children. Improving coverage or establishing a national cessation program may have important present and future effects on population health and well-being.

Psychometrics of the Pragmatic Rating Scale for School-Age Children With a Range of Linguistic and Social Communication Skills.

Purpose Social communication or pragmatic skills are continuously distributed in the general population. Impairment in these skills is associated with two clinical disorders, autism spectrum disorder (ASD) and social (pragmatic) communication disorder. Such impairment can impact a child's peer acceptance, school performance, and current and later mental health. Valid, reliable, examiner-rated observational measures of social communication from a semistructured language sample are needed to detect social communication impairment. We evaluated the psychometrics of an examiner-rated measure of social (pragmatic) communication, the Pragmatic Rating Scale-School Age (PRS-SA). Method The analytic sample consisted of 130 children, ages 7-12 years, from five mutually exclusive groups: ASD (n = 25), language concern (LC; n = 5), ASD + LC (n = 10), social communication impairment only (n = 22), and typically developing (TD; n = 68). All children received language and autism assessments. The PRS-SA was rated separately using video-recorded communication samples from the Autism Diagnostic Observation Schedule. Assessment data were employed to evaluate the psychometrics of the PRS-SA. Analysis of covariance models were used to assess whether the PRS-SA would detect differences in social communication functioning across the five groups. Results The PRS-SA demonstrated strong internal reliability, concurrent validity, and interrater reliability. PRS-SA scores were significantly higher in all groups compared to the TD group and differed significantly in most pairwise comparisons; the ASD + LC group had the highest (more atypical) scores. Conclusions The PRS-SA shows promise as a measure of social communication skills in school-age verbally fluent children with a range of social and language abilities. More research is needed with a larger sample, including a wider age range and geographical diversity, to replicate findings. Supplemental Material https://doi.org/10.23641/asha.15138240.

A new era: improving use of sociodemographic constructs in the analysis of pediatric cohort study data.

Given the diversity of sex, gender identity, race, ethnicity, and socioeconomic position (SEP) in children across the US, it is incumbent upon pediatric and epidemiologic researchers to conduct their work in ways that promote inclusivity, understanding and reduction in inequities. Current child health research often utilizes an approach of “convenience” in how data related to these constructs are collected, categorized and included in models; the field needs to be more systematic and thoughtful in its approach to understand how sociodemographics affect child health. We offer suggestions for improving the discourse around sex, gender identity, race, ethnicity and SEP in child health research. We explain how analytic models should be driven by a conceptual framework grounding the choices of variables that are included in analyses, without the automatic “adjusting for” all sociodemographic constructs. We propose to leverage newly available data from large multi-cohort consortia as unique opportunities to improve the current standards for analyzing and reporting core sociodemographic constructs. Improving the characterization and interpretation of child health studies with regards to core sociodemographic constructs is critical for optimizing child health and reducing inequities in the health and well-being of all children across the US.

The Need for Investment in Rigorous Interventions to Improve Child Food Security

The Need for Investment in Rigorous Interventions to Improve Child Food Security

The interaction between parental concern and socioeconomic status in pediatric hydrocephalus management.

Parent or guardian involvement is implicit in the care of pediatric patients with hydrocephalus. Some parents and guardians are more engaged than others. The relationship between socioeconomic status (SES), the level of parental concern about their child's hydrocephalus management and future, and overall health status has not been clearly delineated. In this study, the authors sought to clarify this connection using hydrocephalus patient-reported health outcomes. This cross-sectional study included children with surgically managed hydrocephalus whose parent or guardian completed the validated Hydrocephalus Outcome Questionnaire (HOQ) and Hydrocephalus Concern Questionnaire for parents (HCQ-P) on a return visit to the pediatric neurosurgery clinic at Vanderbilt University Medical Center between 2016 and 2018. Patients were excluded if the questionnaires were not completed in full. The calculated Overall Health Score (OHS) was used to represent the child's global physical, emotional, cognitive, and social health. The HCQ-P was used to assess parental concern about their child. Type of insurance was a proxy for SES. The HOQ and HCQ-P were administered and completed in full by 170 patient families. In the cohort, 91% of patients (n = 155) had shunt-treated hydrocephalus, and the remaining patients had undergone endoscopic third ventriculostomy. The mean (± SD) patient age was 12 ± 4 years. Half of the patients were male (n = 90, 53%), and most were Caucasian (n = 134, 79%). One in four patients lived in single-parent homes or with a designated guardian (n = 45, 26%). Public insurance and self-pay accounted for 38% of patients (n = 64), while the remaining 62% had private or military insurance. In general, parents with higher concern about their child's medical condition indicated that their son or daughter had a higher OHS (χ2 = 17.07, p < 0.001). Patients in families with a lower SES did not have different OHSs from those with a higher SES (χ2 = 3.53, p = 0.06). However, parents with a lower SES were more worried about management of their child's hydrocephalus and their child's future success (χ2 = 11.49, p < 0.001). In general, parents were not preoccupied with one particular aspect of their child's hydrocephalus management. More engaged parents, regardless of their family's SES, reported a better OHS for their child. Parents with public or self-paid insurance were more likely to report higher concern about their child's hydrocephalus and future, but this was not associated with a difference in their child's current health status.

Unmet Health Needs in Early Childhood in South Korea

ABSTRACTThis study aimed to evaluate child health needs in South Korea and the country’s healthcare system capacities to meet them. A comprehensive needs assessment was performed by reviewing child health programs in Korea, followed by focus group discussions and individual interviews with multiple health experts and practitioners. Analysis of the meeting and interview transcripts were identified seven major domains of child health needs and healthcare system capacities. Comparison of child health needs and healthcare system capacities revealed that a much-needed linkage system between child health resources and preventive healthcare services is lacking. A new government policy to integrate current child health programs with high-quality preventive care is required.

Ethical Issues in Newborn Sequencing Research: The Case Study of BabySeq.

The BabySeq Project is a study funded by the National Institutes of Health and aimed at exploring the medical, behavioral, and economic impacts of integrating genomic sequencing into the care of both healthy newborns and newborns who are sick. Infants were randomly assigned to receive standard of care or standard of care plus sequencing. The protocol and consent specified that only childhood-onset conditions would be returned. When 1 child was found to carry a BRCA2 mutation despite a negative family history, the research team experienced moral distress about nondisclosure and sought institutional review board permission to disclose. The protocol was then modified to require participants to agree to receive results for adult-onset-only conditions as a precondition to study enrollment. The BabySeq team asserted that their new protocol was in the child's best interest because having one's parents alive and well provides both an individual child benefit and a "family benefit." We begin with a short description of BabySeq and the controversy regarding predictive genetic testing of children for adult-onset conditions. We then examine the ethical problems with (1) the revised BabySeq protocol and (2) the concept of family benefit as a justification for the return of adult-onset-only conditions. We reject family benefit as a moral reason to expand genomic sequencing of children beyond conditions that present in childhood. We also argue that researchers should design their pediatric studies to avoid, when possible, identifying adult-onset-only genetic variants and that parents should not be offered the return of this information if discovered unless relevant for the child's current or imminent health.

School dental screening programmes for oral health.

School dental screening programmes for oral health.

School dental screening programmes for oral health.

School dental screening refers to visual inspection of children's oral cavity in a school setting followed by making parents aware of their child's current oral health status and treatment needs. Screening at school intends to identify children at an earlier stage than symptomatic disease presentation, hence prompting preventive and therapeutic oral health care for the children. This review evaluates the effectiveness of school dental screening in improving oral health status. To assess the effectiveness of school dental screening programmes on overall oral health status and use of dental services. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 March 2017), the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Register of Studies, to 15 March 2017), MEDLINE Ovid (1946 to 15 March 2017), and Embase Ovid (15 September 2016 to 15 March 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status when searching the electronic databases; however, the search of Embase was restricted to the last six months due to the Cochrane Centralised Search Project to identify all clinical trials and add them to CENTRAL. We included randomised controlled trials (RCTs) (cluster or parallel) that evaluated school dental screening compared with no intervention or with one type of screening compared with another. We used standard methodological procedures expected by Cochrane. We included six trials (four were cluster-RCTs) with 19,498 children who were 4 to 15 years of age. Four trials were conducted in the UK and two were based in India. We assessed two trials to be at low risk of bias, one trial to be at high risk of bias and three trials to be at unclear risk of bias.None of the six trials reported the proportion of children with untreated caries or other oral diseases.Four trials evaluated traditional screening versus no screening. We performed a meta-analysis for the outcome 'dental attendance' and found an inconclusive result with high heterogeneity. The heterogeneity was found it to be, in part, due to study design (three cluster-RCTs and one individual-level RCT). Due to the inconsistency, we downgraded the evidence to 'very low certainty' and are unable to draw conclusions about this comparison.Two cluster-RCTs (both four-arm trials) evaluated criteria-based screening versus no screening and showed a pooled effect estimate of RR 1.07 (95% CI 0.99 to 1.16), suggesting a possible benefit for screening (low-certainty evidence). There was no evidence of a difference when criteria-based screening was compared to traditional screening (RR 1.01, 95% CI 0.94 to 1.08) (very low-certainty evidence).In one trial, a specific (personalised) referral letter was compared to a non-specific one. Results favoured the specific referral letter with an effect estimate of RR 1.39 (95% CI 1.09 to 1.77) for attendance at general dentist services and effect estimate of RR 1.90 (95% CI 1.18 to 3.06) for attendance at specialist orthodontist services (low-certainty evidence).One trial compared screening supplemented with motivation to screening alone. Dental attendance was more likely after screening supplemented with motivation, with an effect estimate of RR 3.08 (95% CI 2.57 to 3.71) (low-certainty evidence).None of the trials had long-term follow-up to ascertain the lasting effects of school dental screening.None of the trials reported cost-effectiveness and adverse events. The trials included in this review evaluated short-term effects of screening, assessing follow-up periods of three to eight months. We found very low certainty evidence that was insufficient to allow us to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance. For criteria-based screening, we found low-certainty evidence that it may improve dental attendance when compared to no screening. However, when compared to traditional screening there was no evidence of a difference in dental attendance (very low-certainty evidence).We found low-certainty evidence to conclude that personalised or specific referral letters improve dental attendance when compared to non-specific counterparts. We also found low-certainty evidence that screening supplemented with motivation (oral health education and offer of free treatment) improves dental attendance in comparison to screening alone.We did not find any trials addressing cost-effectiveness and adverse effects of school dental screening.

Perspectives on current child health issues

EBN perspectives brings together key issues from the commentaries in one of our nursing topic themes.

Child Poverty and the Promise of Human Capacity: Childhood as a Foundation for Healthy Aging

The effect of child poverty and related early life experiences on adult health outcomes and patterns of aging has become a central focus of child health research and advocacy. In this article a critical review of this proliferating literature and its relevance to child health programs and policy are presented. This literature review focused on evidence of the influence of child poverty on the major contributors to adult morbidity and mortality in the United States, the mechanisms by which these associations operate, and the implications for reforming child health programs and policies. Strong and varied evidence base documents the effect of child poverty and related early life experiences and exposures on the major threats to adult health and healthy aging. Studies using a variety of methodologies, including longitudinal and cross-sectional strategies, have reported significant findings regarding cardiovascular disorders, obesity and diabetes, certain cancers, mental health conditions, osteoporosis and fractures, and possibly dementia. These relationships can operate through alterations in fetal and infant development, stress reactivity and inflammation, the development of adverse health behaviors, the conveyance of child chronic illness into adulthood, and inadequate access to effective interventions in childhood. Although the reviewed studies document meaningful relationships between child poverty and adult outcomes, they also reveal that poverty, experiences, and behaviors in adulthood make important contributions to adult health and aging. There is strong evidence that poverty in childhood contributes significantly to adult health. Changes in the content, financing, and advocacy of current child health programs will be required to address the childhood influences on adult health and disease. Policy reforms that reduce child poverty and mitigate its developmental effects must be integrated into broader initiatives and advocacy that also attend to the health and well-being of adults.

Moving Focus from Weight to Health. What Are the Components Used in Interventions to Improve Cardiovascular Health in Children?

IntroductionObesity in childhood impacts on many areas of the child’s current and future health, including their cardiovascular health. To date many attempts have been made to design interventions to tackle excess childhood weight but with limited success. We aimed to establish the components common to interventions in children that improve cardiovascular health parameters.MethodsWe searched the following databases: EMBASE 1974-week 3 November 2014, Ovid Medline 1946 Present, and PsychINFO 1967-Present for studies reporting interventions in healthy young people under the age of 18. Included interventions had to contain an education component and have been carried out in a community, school, or clinical setting. Papers had to report on at least one of the pre-specified CVD risk parameters and at least one non-biological outcome from knowledge, attitudes or behaviours.ResultsWe retrieved 2451 papers, from which 12 studies (18 papers) of 3046 participants were included. From the selected papers we identified four component themes; Health Behaviours, Self-Concept, Practical and Cognitive Tools, and Intervention Characteristics. The subcomponents that made up these themes were fairly consistent across the studies analysed although the studies varied in their duration, settings and children with which they were carried out. Nine of the studies were able to bring about positive change in at least one biological and one non-biological aspect of child cardiovascular health.ConclusionThe component themes identified here were common to intervention studies that had success in improving parameters of cardiovascular health. We suggest that the focus of childhood health interventions be moved from weight onto cardiovascular health parameters and that future interventions use the lessons learned by their predecessors to incorporate those components that are associated with successful interventions.

Social class, anxieties and mothers' foodwork.

In the context of concerns about childhood obesity, mothers are placed at the forefront of responsibility for shaping the eating behaviour and consequently the health of their young children. This is evident in a multitude of diverse sites such as government reports, health promotion materials, reality TV shows and the advice of childcare nurses and preschools. These sites produce a range of resources available to mothers to draw on to constitute themselves as mothers in terms of caring for their children's health. Drawing on a qualitative study of mothers recruited through three Australian preschool centres, this article examines how the working-class and middle-class mothers of preschool-aged children engage with knowledge about motherhood, children and health and how those engagements impact on their mothering, their foodwork and their children. We argue that, unlike the working-class mothers pathologised in some literature on obesity, these working-class mothers demonstrated a no-nonsense (but still responsibilised) approach to feeding their children. The middle-class mothers, on the other hand, were more likely to engage in practices of self-surveillance and to demonstrate considerable anxieties about the appropriateness of their practices for their children's current and future health.