Preventive activities in children and young people

Preventive activities in children and young people

Early intervention
Prevention and promotion in the early years, from conception to age 5 years, is important for an individual’s lifelong health and wellbeing.77 It may also be an opportunity to redress health inequalities.78, 79 In adolescence, neurodevelopmental studies support the value of early intervention to prevent ongoing harm.80 Many infants and children visit their GP frequently and adolescents visit at least once a year.81 This frequent contact provides opportunities for disease prevention and health promotion. Evidence provides moderate support for the hypothesis that ‘accessible, family-centred, continuous, comprehensive, coordinated, compassionate and culturally effective care improves health outcomes for children with special healthcare needs’.82 There is also evidence that supports the beneficial impact of similar care for children without special healthcare needs.83 There is little Australian research investigating interventions based in general practice. Recommendations in this section are largely drawn from expert consensus and parental values.
Health inequity Compared with non-Indigenous Australians, Aboriginal and Torres Strait Islander children are three times more likely to die before their first birthday, five times more likely to succumb to sudden infant death syndrome (SIDS), twice as likely to be born premature or with low birthweight, and nearly four times as likely to be hospitalised with respiratory infection. Indigenous Australian mothers are eight times more likely than non-Indigenous mothers to receive inadequate antenatal care and rates of breastfeeding are lower in Indigenous than non-Indigenous communities.84 There is a socioeconomic gradient in the health of Australian children and young people, both Indigenous and nonIndigenous, which has an impact that is both immediate and lifelong. There are large numbers of vulnerable children in the mid-socioeconomic range of the population and it is the size of this group that justifies universal intervention. On the other hand, the magnitude of the ill-health experienced by the smaller number at the bottom of the spectrum justifies targeted intervention. Michael Marmot has attempted to resolve this tension by arguing for ‘proportionate universalism’.78 Maternal smoking during pregnancy is more prevalent among women of lower socioeconomic status (SES) and single mothers, and is strongly associated with low birthweight. Mothers from lower socioeconomic backgrounds have fewer and less regular antenatal visits. Lower rates of breastfeeding and shorter duration of breastfeeding have been reported for mothers in a variety of disadvantaged backgrounds including single, low income, migrant, unemployed families, poorly educated parents and disadvantaged communities. Higher mortality rates in infancy and childhood including deaths from neonatal hypoxia, SIDS, prematurity-related disorders, and accidental and non-accidental injury are reported for lower socioeconomic children and children living in disadvantaged neighbourhoods.84 Health inequity present at school entry gets worse thereafter. The Australian data was summarised in Alan Hayes in 2011.79 Early intervention
Prevention and promotion in the early years, from conception to age 5 years, is important for an individual’s lifelong health and wellbeing.77 It may also be an opportunity to redress health inequalities.78, 79 In adolescence, neurodevelopmental studies support the value of early intervention to prevent ongoing harm.80 Many infants and children visit their GP frequently and adolescents visit at least once a year.81 This frequent contact provides opportunities for disease prevention and health promotion. Evidence provides moderate support for the hypothesis that ‘accessible, family-centred, continuous, comprehensive, coordinated, compassionate and culturally effective care improves health outcomes for children with special healthcare needs’.82 There is also evidence that supports the beneficial impact of similar care for children without special healthcare needs.83 There is little Australian research investigating interventions based in general practice. Recommendations in this section are largely drawn from expert consensus and parental values.
Health inequity Compared with non-Indigenous Australians, Aboriginal and Torres Strait Islander children are three times more likely to die before their first birthday, five times more likely to succumb to sudden infant death syndrome (SIDS), twice as likely to be born premature or with low birthweight, and nearly four times as likely to be hospitalised with respiratory infection. Indigenous Australian mothers are eight times more likely than non-Indigenous mothers to receive inadequate antenatal care and rates of breastfeeding are lower in Indigenous than non-Indigenous communities.84 There is a socioeconomic gradient in the health of Australian children and young people, both Indigenous and nonIndigenous, which has an impact that is both immediate and lifelong. There are large numbers of vulnerable children in the mid-socioeconomic range of the population and it is the size of this group that justifies universal intervention. On the other hand, the magnitude of the ill-health experienced by the smaller number at the bottom of the spectrum justifies targeted intervention. Michael Marmot has attempted to resolve this tension by arguing for ‘proportionate universalism’.78 Maternal smoking during pregnancy is more prevalent among women of lower socioeconomic status (SES) and single mothers, and is strongly associated with low birthweight. Mothers from lower socioeconomic backgrounds have fewer and less regular antenatal visits. Lower rates of breastfeeding and shorter duration of breastfeeding have been reported for mothers in a variety of disadvantaged backgrounds including single, low income, migrant, unemployed families, poorly educated parents and disadvantaged communities. Higher mortality rates in infancy and childhood including deaths from neonatal hypoxia, SIDS, prematurity-related disorders, and accidental and non-accidental injury are reported for lower socioeconomic children and children living in disadvantaged neighbourhoods.84 Health inequity present at school entry gets worse thereafter. The Australian data was summarised in Alan Hayes in 2011.