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Aim The aims of this paper are to describe the growth of urban Australian Aboriginal infants from birth to 24 months of age and to identify the proportion of these infants experiencing rapid weight gain ( RWG) and overweight/obesity. Methods The Gudaga Study is a longitudinal birth cohort of 159 Australian Aboriginal children born on the urban fringe of Sydney. Birthweight and length were extracted from hospital data. Children with a birthweight >1500 grams were included in the analysis ( n = 157). Weight, length and head circumference were measured at 2-3 weeks and then six-monthly until 24 months of age. Age- and gender-specific Z-scores were determined from the Centers for Disease Control (CDC) 2000 growth charts for weight, length, head circumference and body mass index ( BMI). The proportion of children experiencing RWG (an increase in weight-for-age Z-scores ≥0.67 between birth and 12 months) was calculated. The association between RWG and ≥85th CDC percentile for BMI at 24 months was tested using Pearson's χ2. Results The mean weight of Gudaga infants was less than the CDC mean length-for-age at birth and 2-3 weeks of age but greater than CDC mean length-for-age and weight-for-age at 18 and 24 months of age. Overall, 42 infants (34.4%) experienced RWG, and 45 infants (36.9%) were overweight/obese at 24 months of age. A greater proportion of those who experienced RWG (61.9%) were overweight/obese at 24 months than those who did not experience RWG (23.8%). Conclusion Our study suggests a concerning proportion of urban Indigenous infants experience RWG and overweight/obesity in early childhood. [ABSTRACT FROM AUTHOR]

Background: Parents' beliefs and behaviours affect children's nutrition, eating behaviours, and health outcomes; however, little is known about parents' experiences and perspectives on establishing a healthy diet with young children. Methods: A community‐recruited sample of 391 parents of young children (under age 5) completed an anonymous cross‐sectional online survey assessing the degree to which their children met recommendations outlined in Australian nutrition guidelines, perceived barriers to establishing a healthy diet with their child, and interest in receiving tips/information about establishing healthy eating habits with their children. Descriptive statistics illustrated proportions of children adhering to recommendations. Thematic analysis was used to analyse qualitative data. Results: Adherence to recommended nutrition guidelines varied across age groups. Most children across all age groups had water as their main drink, routinely consumed a variety of fruit, and consumed sweet drinks or fast foods only rarely. In contrast, less than half of 2‐ and 3‐year‐olds regularly consumed a variety of vegetables. The proportion of children consuming discretionary "treat" foods increased sharply over the first 2 years of life, and two thirds of 2‐, 3‐, and 4‐year‐olds consumed treat foods a few days per week or more. Parent‐reported barriers to establishing a healthy diet with young children included child behavioural factors (e.g., dislike of vegetables), parental influences (e.g., lack of time), family dynamics (e.g., influence of extended family) and external influences (e.g., external environment). Parents were most often interested in ways to modify child behaviour and information about child nutrition. Conclusions: Parents cite child behavioural issues as a major barrier to establishing a healthy diet with young children. Behavioural interventions that provide parents with information and support on how to establish a healthy diet with young children, as opposed to educational interventions focusing mainly on what children should be eating, may better meet families' needs. [ABSTRACT FROM AUTHOR]

Summary: ▪In this narrative review, we summarise the vast and burgeoning research on the potential and established indirect impacts on children of the COVID‐19 pandemic. We used a community child health lens to organise our findings and to consider how Australia might best respond to the needs of children (aged 0–12 years).▪We synthesised the literature on previous pandemics, epidemics and natural disasters, and the current COVID‐19 pandemic. We found clear evidence of adverse impacts of the COVID‐19 pandemic on children that either repeated or extended the findings from previous pandemics.▪We identified 11 impact areas, under three broad categories: child‐level factors (poorer mental health, poorer child health and development, poorer academic achievement); family‐level factors that affect children (poorer parent mental health, reduced family income and job losses, increased household stress, increased abuse and neglect, poorer maternal and newborn health); and service‐level factors that affect children (school closures, reduced access to health care, increased use of technology for learning, connection and health care).▪There is increasing global concern about the likely disproportionate impact of the current pandemic on children experiencing adversity, widening existing disparities in child health and developmental outcomes.▪We suggest five potential strategy areas that could begin to address these inequities: addressing financial instability through parent financial supplements; expanding the role of schools to address learning gaps and wellbeing; rethinking health care delivery to address reduced access; focusing on prevention and early intervention for mental health; and using digital solutions to address inequitable service delivery. [ABSTRACT FROM AUTHOR]

Background: Dire forecasts predict that an increasingly hostile environment globally will increase the threats to human health. Infants and young children are especially at risk because children are particularly vulnerable to climate-related stressors. The childhood diseases most affected, the breadth and magnitude of future health problems and the time frame over which these problems will manifest remain largely unknown.Objectives: To review the possibility that spacially explicit analyses can be used to determine how climate change has affected children's health to date and whether these analyses can be used for future projections.Methods: As an example of whether these objectives can be achieved, all available Australian environmental and health databases were reviewed.Results: Environmental and health data in Australia have been collected for up to 30 years for the same spatial areas at 'Statistical Area level 1' (SA1) scale. SA1s are defined as having a population of between 200 and 800 people and collectively they cover the whole of Australia without gaps or overlap. Although the SA1 environmental and health data have been collected separately, they can be merged to allow detailed statistical analyses that can determine how climate change has affected the health of children.Conclusions: The availability of environmental and health datasets that share the same precise spatial coordinates provides a pathway whereby past and emerging effects on child health can be measured and predicted into the future. Given that the future health and well-being of children is one of society's greatest concerns, this information is urgently needed. [ABSTRACT FROM AUTHOR]

Issue Addressed: In recent years, state governments throughout Australia have provided significant funding to support the expansion of school breakfast programs (SBPs), in response to concerns about children arriving at school hungry. This study investigated how schools have responded to the growing expectation that they provide breakfast for students.Methods: This qualitative study draws on case studies of five Australian primary schools that operate SBPs. Interviews or focus groups were conducted with 78 children, parents, staff, volunteers and funders and data underwent thematic analysis.Results: Three key themes were identified: Adjusting to the changing role of schools, SBPs reflecting the school's culture, Schools as an alternative or additional site for breakfast. Some staff and parents expressed unease about SBPs shifting responsibility for breakfast provision from parents to schools but were committed to supporting vulnerable students as part of the broader school culture. SBPs were found to provide an alternative or additional site for breakfast consumption for many children not experiencing food insecurity.Conclusion: The expectation that schools provide breakfast has created some challenges and tensions that have not been fully resolved. The adoption of an inclusive approach, undertaken to ensure students were not stigmatised for attendance, had resulted in concerns about the resources used by the programs as well as over-consumption of breakfast by some students. SO WHAT?: Increasingly, Australian schools are providing breakfast for students. Concerns about shifting responsibility and over-consumption could be addressed if schools were given more advice on program management by government and non-government funding bodies. [ABSTRACT FROM AUTHOR]

Aim: In children presenting to an emergency department (ED) with an acute coughing illness, the aims of this study were to: (i) describe the frequency of doctor visits and medication use; and (ii) describe management and relate it to current evidence-based guidelines.Methods: This was a cross-sectional study in ED of a major teaching hospital (Royal Children's Hospital, Brisbane, Australia). Participants included 537 children (<15 years) presenting with acute (<2 weeks) cough, with a median age of 2.2 years (interquartile range 1.0-4.0); 61.5% were boys. Hospitalised children and those with asthma, pneumonia or chronic illnesses were excluded. Main outcome measures were: (i) frequency of pre-ED doctor visits and medication use; and (ii) comparison of management to current evidence-based recommendations related to four discharge diagnoses: bronchiolitis, 'wheeze/reactive airway disease (RAD)', croup and 'non-specific acute respiratory illness'.Results: A total of 300 children (55.9%) had seen a doctor prior to their ED presentation, and use of medications pre-ED was high (53.4%). While 93.4% of children with croup were treated in accordance with guidelines, concordance was lower for children with bronchiolitis or 'wheeze/RAD'. The majority of children with a discharge diagnosis of 'wheeze/RAD' (95.6%) received bronchodilators, and 72.7% also received oral corticosteroids but were not diagnosed with asthma. More than half (55.1%) of the children with non-specific acute respiratory illness received medication(s) either prior to or during their ED presentation.Conclusions: The burden of acute cough-related illnesses in children is high, and there is a need for improved uptake of evidence-based guidelines. In addition, the large number of children diagnosed with 'wheeze/RAD' suggests asthma is likely under-diagnosed in this setting. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To describe baseline growth and prevalence of anaemia in Aboriginal and Torres Strait Islander infants and young children enrolled in a nutrition promotion and anaemia prevention program in remote northern Australia. Design: Retrospective review of most recent growth parameters and haemoglobin records during the 3 months prior to and 1 month after recruitment into a prospective study conducted between 25 May 2010 and 6 May 2012. Setting: Primary health care clinics in six remote Aboriginal communities (east Kimberley, Western Australia (n = 1); Northern Territory (n = 4); Cape York, Queensland (n = 1)). Participants: Two hundred and sixty‐two of the estimated 311 (84%) Aboriginal and Torres Strait Islander infants and young children aged 6–24 months residing in participating communities. Main outcome measures: Prevalence of anaemia, stunting, underweight and overweight at recruitment. Results: At recruitment, 42% of participants were anaemic, 18% stunted, 5% underweight and 5% overweight. Anaemia prevalence was higher than estimates (26–27%) in routine surveillance programs in remote communities and substantially higher than estimates (1.8–4.9%) in the general Australian population. One‐quarter of participants were anaemic prior to 6 months of age. Conclusions: The unexpectedly high prevalence of anaemia and stunting in these communities highlight the need for continued preventive health programs focused on ensuring adequate nutrition amongst infants, young children and their mothers. The early onset of anaemia and stunting suggests a comprehensive anaemia prevention approach is needed, including greater emphasis on maternal and pre‐pregnancy health and nutrition to increase infants’ iron stores at birth and sustain these to 6 months of age. [ABSTRACT FROM AUTHOR]

Aim: The majority of Australia's Aboriginal and/or Torres Strait Islander children live in urban areas; however, little is known about their health service use. We aimed to describe health service utilisation amongst a cohort of urban Aboriginal and/or Torres Strait Islander children aged <5 years.Methods: We analysed health service utilisation data collected in an ongoing prospective cohort study of children aged <5 years registered with an Aboriginal-owned and operated primary health-care service. Enrolled children were followed monthly for 12 months, with data on health service utilisation collected at baseline and at each monthly follow-up. Health service utilisation rates, overall and by service provider and reason for presentation, were calculated and reported as incidence rates per 100 child-months with the corresponding 95% confidence intervals (CIs).Results: Between February 2013 and November 2015, 180 children were enrolled, and 1541 child-months of observation were available for analysis. The overall incidence of health service utilisation was 52.5 per 100 child-months (95% CI 48.7-56.5); 81% of encounters were with general practitioners. Presentation rates were the highest for acute respiratory illnesses (30.7/100 child-months, 95% CI 27.8-33.9).Conclusions: In this community, acute respiratory illnesses are predominant causes of health service utilisation in young children. The health-care utilisation profile of these children presents important opportunities for health promotion and intervention. [ABSTRACT FROM AUTHOR]

Objective: To determine the proportion of the national childhood asthma burden associated with exposure to dampness and gas stoves in Australian homes.Design: Comparative risk assessment modelling study. Setting, participants: Australian children aged 14 years or less, 2011.Main Outcome Measures: The population attributable fractions (PAFs) and number of disability-adjusted life years (DALYs) for childhood asthma associated with exposure to damp housing and gas stoves.Results: 26.1% of Australian homes have dampness problems and 38.2% have natural gas as the main energy source for cooktop stoves. The PAF for childhood asthma attributable to damp housing was 7.9% (95% CI, 3.2-12.6%), causing 1760 disability-adjusted life years (DALYs; 95% CI, 416-3104 DALYs), or 42 DALYs/100 000 children. The PAF associated with gas stoves was 12.3% (95% CI, 8.9-15.8%), corresponding to 2756 DALYs (95% CI, 1271-4242), or 67 DALYs/100 000 children. If all homes with gas stoves were fitted with high efficiency range hoods to vent gas combustion products outdoors, the PAF and burden estimates were reduced to 3.4% (95% CI, 2.2-4.6%) and 761 DALYs (95% CI, 322-1199).Conclusions: Exposure to damp housing and gas stoves is common in Australia, and is associated with a considerable proportion of the childhood asthma burden. Strategies for reducing exposure to indoor dampness and gas combustion products should be communicated to parents of children with or at risk of asthma. [ABSTRACT FROM AUTHOR]

Aim: To determine (i) the proportion of different referral sources for new referrals to paediatric specialist outpatient clinics and (ii) any association of referral source with utilisation of additional health services.Methods: Survey of parents presenting with their child at five paediatric specialist outpatient clinics at two Melbourne public hospitals.Results: Just over half (52%) of the respondents were referred by a general practitioner (GP). The remainder were referred by a paediatrician (27%) at hospital discharge (16%) or from the ED (6%). Most respondents (71%) reported that their child also has a referral to see another specialist for the same health concern but had not yet had the consultation; 44% had consulted another doctor for the same health concern between receiving the referral and the appointment. Paediatrician referrals were more likely to see another specialist for the same health concern compared to other referral sources (P = 0.032).Conclusion: Only half of the referrals of new patients to paediatric specialist outpatient clinics come from GPs. Future research should investigate whether multiple referral sources have a negative impact on the co-ordination and cost of paediatric health care. [ABSTRACT FROM AUTHOR]

Aim: Telehealth is a useful method of providing specialist consultation to a geographically diverse population. Canadian studies of telehealth for paediatric surgery demonstrate good accuracy, but have low numbers of cryptorchid patients in their cohorts. Our aim was to confirm Canadian studies for our cohort and to assess accuracy regarding cryptorchidism.Methods: We conducted a cohort study of patients seen via paediatric surgical telehealth over a 12-month period, to determine accuracy of telediagnosis with respect to face-to-face diagnosis and plan.Results: A total of 183 children had 224 videoconferences, resulting in 74 surgical bookings. There was high diagnostic concordance, except for undescended testes. One discharged patient, and two patients booked for review, have subsequently required an orchidopexy (false negatives). Of 15 patients booked for surgery, three did not require an operation (false positives). Other patients had their procedures upgraded (from open to laparoscopic) or downgraded (from laparoscopic to open) due to inaccuracies in far-end assessment.Conclusion: Telehealth for paediatric surgery is accurate for most conditions seen, but for cryptorchidism there are significant concerns. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to evaluate the use of complementary and alternative medicine (CAM) among Australian children within the previous 12 months.Methods: Parents with children up to the age of 18 years were recruited from online parenting groups. Questions addressed demographic factors, socio-economic status, conventional health service use, including vaccination status and use of CAM.Results: A total of 149 parents responded to the study of which 73.8% (n = 110) had taken their child to visit a CAM practitioner or given their child a CAM product in the previous 12 months. The two most frequently visited CAM practitioners were naturopath/herbalist (30.4%) and chiropractor (18.4%). The most commonly used products were vitamins/minerals (61.7%), and herbal medicine (38.8%). Children had also consulted with a general practitioner (89.8%), community health nurse (31.29%) and paediatrician (30.3%) over the same period. A total of 52% of parents did not disclose their child's use of CAM to their medical provider. Children's vaccination status was less likely to be up-to-date if they visited a CAM practitioner (OR 0.16; CI 0.07, 0.36; P < 0.001) or used a CAM product (OR 0.25; CI 0.09, 0.64; P = 0.004).Conclusion: Despite a lack of high quality research for efficacy and safety, many children are using CAM products and practices in parallel with conventional health services, often without disclosure. This highlights the need to initiate conversations with parents about their child's use of CAM in order to ensure safe, coordinated patient care. The association between vaccine uptake and CAM use requires further investigation. [ABSTRACT FROM AUTHOR]

Unlabelled: Children with same-sex attracted parents develop well in terms of their health and wellbeing. There are many recognised factors that have an impact on child health, in general, including individual, family and wider social mediators. The aim of this study is to determine the impact of family structure and socio-demographic characteristics on child health and wellbeing in Australian same-sex parent families.Methods: A cross-sectional survey of self-identified same-sex attracted parents from across Australia was used to collect information on child health and wellbeing between May and December 2012. Mixed-effects multiple linear regression models were used to identify associations between family structure/socio-demographic characteristics and child wellbeing. Child health outcomes were measured using the Child Health Questionnaire and the Strengths and Difficulties Questionnaire.Results: In same-sex parent families, biological relationships, parental gender and parental education were not significantly associated with health and wellbeing. Parental income, rurality and stable parental relationships were associated with health and wellbeing, and living in a single-parent household was associated with poorer wellbeing.Conclusions: Stable dual parent families offer good outcomes for children with same-sex attracted parents. Family processes are most important. This study does not support the assertion that children require both male and female parents, nor that biological relationships are essential to health and wellbeing. This study provides scientific data from a cross-sectional Australian-based study to describe and understand health determinants for children in family contexts that comprise same-sex parent and all family contexts. It recommends equitable, stigma-free family support. [ABSTRACT FROM AUTHOR]

This study compares oral health outcomes and behaviours for young Australian children by residential state or territory to determine whether state differences arise from individual exposures to risk factors. Cross-sectional data for 4606 2-3 year olds and 4464 6-7 year olds were obtained from the Longitudinal Study of Australian Children. Outcome measures were parent-reports of children's caries experience, frequency of toothbrushing and dental services use. For 2-3 year olds, children from the Australian Capital Territory were less likely to have parent-reported caries than children from other states, and more likely to brush their teeth twice daily and to have used dental services. For 6-7 year olds, optimal outcomes were observed in New South Wales for lowest caries experience, Western Australia for highest toothbrushing, and South Australia for highest dental services use. Adjustments for socio-demographic predictors did not eliminate state differences in oral health. Large state differences in the oral health of young children persisted after adjustment for individual socio-demographic determinants, suggesting these arise from variations in the systems to promote and care for children's oral health. Several states would benefit from a stronger emphasis on oral health promotion in young children, and disparities from a young age suggest the need for better engagement of early childhood professionals in oral health promotion. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Objective: To provide population-based data on dental visits in preschool children, to assist in the planning of such services and preventive programs.Methodology: Dental visits in young children are described and associated factors are investigated using data from the 1995 National Health Survey.Results: Thirty-eight per cent of children aged 3-4 years had ever visited a dental professional with 31% having visited a dental professional in the previous 12 months (total n = 1596). Factors associated with having ever visited a dental professional included age in years (chi2 = 74.16, P < 0.0001), state of residence (chi2 = 25.81, P= 0.0005) and private health insurance (chi2 = 7.96, P= 0.005). Similar factors were associated with visits in last 12 months. Western Australia had the lowest proportion of preschool children aged 3-4 years having ever visited a dental professional (29%) while South Australia had the highest proportion (48%). The major reasons given for dental visits were check-up and fillings.Conclusion: Data regarding children not as likely to attend dental services can be used to target services and assist in ensuring preschool children receive appropriate dental care. [ABSTRACT FROM AUTHOR]