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Objective Maternal depression is common among mothers of very low birthweight (VLBW) infants. In a cohort of mother–VLBW infant dyads followed to preschool age, the authors assessed the impact of maternal depression on mothers9 perceptions of their children9s social aptitude and reported participation in age-appropriate preschool activities. Methods Longitudinal multivariable analysis of a nationally representative sample of VLBW infants in the USA. Models were adjusted for children9s developmental abilities according to the Bayley Scales of Infant Development, Mental Development Index. Results 800 VLBW singletons (mean gestational age 28.9 weeks) were analysed. During the preschool years, depressed mothers perceived their children9s social abilities more negatively than non-depressed mothers. Specifically, they saw their children as less likely to be able to share with others (aOR 0.37, 95% CI 0.14 to 0.96), make friends (aOR 0.58, 95% CI 0.35 to 0.96) or play independently (aOR 0.30, 95% CI 0.16 to 0.58). These negative perceptions were not shared by the children9s preschool teachers. Children of depressed mothers were also less likely to participate in age-appropriate preschool activities (aOR 0.30, 95% CI 0.16 to 0.58). Each of these associations either lost significance or were substantially attenuated in a separate population of former healthy term infants. Conclusion Among former VLBW infants, maternal depression is associated with negative perceptions of children9s social abilities and decreased participation in preschool activities. Maternal mental health should be considered in ongoing efforts to maximise the social-emotional development of preterm infants.

Background: The combined impact of maternal depression and in-home violence, and how their relationship with physical punishment varies with child behaviour are unknown. Objectives: To determine the combined impact of maternal depression and violence exposure on smacking and explore the role of child behaviours in this relationship. Methods: Multivariable regression analysis of a sample of kindergarten children. Maternal depressive symptoms, violence exposure and smacking were measured by parent interview. Child behaviours were reported by teachers. Results: 12 764 mother–child dyads were examined. The adjusted odds ratio (aOR) for smacking among depressed mothers was 1.59 (95% CI 1.40 to 1.80), mothers exposed to in-home violence 1.48 (95% CI 1.18 to 1.85) and dually exposed mothers 2.51 (95% CI 1.87 to 3.37). Adjusting for child self-control or externalising behaviour did not change these associations, and no effect modification by child behaviour was detected. Among mothers smacking children, depression was associated with increased smacking frequency (adjusted incident rate ratio (aIRR) 1.12; 95% CI 1.01 to 1.24), but became borderline significant after adjusting for child self-control or externalising behaviour (aIRRs 1.10; 95% CI 1.00 to 1.21). Depressed mothers exposed to violence demonstrated higher rates of smacking (aIRR 1.29; 95% CI 1.09 to 1.53); this remained stable when adjusting for child behaviours. Conclusion: Maternal depression and violence exposure are associated with smacking, particularly when depression and violence co-exist, when they are also associated with smacking frequency. Child self-control and externalising behaviour do not substantially impact the association between maternal depressive symptoms, violence exposure and smacking.

In the past 15 years, North America made significant advances towards the Millennium Development Goal (MDG) targets despite a crippling and global financial crisis beginning in 2008. The three countries making up North America—Canada, the USA and Mexico—aspired to reach MDGs under strikingly different political and cultural contexts; yet within their own countries, they all face the common challenge of reducing the disparities that exist in education, employment and health across socioeconomic, racial and gender spectrums. Progress towards reduction of disparities in poverty and hunger is evident in North America. Mexico met its goal to cut in half the percentage of people living off

Approximately 47 million Americans – 16% of the total US population – lack health insurance.1 An additional 25 million have insurance plans that limit their access to services, or cover only a small percentage of expenses.2 The USA spends $7026 per capita on healthcare, which amounts to 16% of the nation's gross domestic product (GDP).1 2 By contrast, the UK, which covers all of its citizens, spends 8.3% of its GDP on healthcare, and Japan, 8.0%. Despite these high expenditures, US health outcomes, reflected in measures of infant mortality and life expectancy, lag behind those of most other developed nations.1 Many in the USA, therefore, consider healthcare reform long overdue, and such reform is one of President Obama's principal domestic initiatives. The Obama administration's vision for reform is based on three pillars: (1) expansion of coverage, (2) containment of costs and (3) improvement of quality. Although we discuss these tenets of healthcare reform specifically as they relate to children's health, we acknowledge that Obama's vision for healthcare reform is less focused on children's health than on other issues. Additionally, we recognise that his proposals have been victim to ideological pressures (specifically regarding reproductive rights and abortion), misinformation (many people believed Obama's reforms would establish death panels to force the elderly to proactively decline resuscitative efforts) and over-dramatisation of the government's control over the healthcare system. With regard to children, the goal of expanding coverage must be viewed in historical context. In 1997, under President Clinton, the Children's Health Insurance Program (CHIP) was established to provide coverage for children who did not qualify for Medicaid (the US government insurance programme for the poor) but whose families could not afford private insurance. This legislation reduced the rate of uninsured low-income children by almost one third, from 23% (7.6 …