Lessening the impact of poverty on children

The present paper is divided into three sections. The first section deals with two issues: the impact of poverty on children and the hypothesized mechanisms by which poverty affects children. The second section discusses four guiding principles for programs that aim to reduce deficits in the quality of life and life chances of poor children. The third section describes promising intervention programs.     

The impact of poverty on the current and future health status of children

Child poverty in Canada is a significant public health concern. Because child development during the early years lays the foundation for later health and development, children must be given the best possible start in life. Family income is a key determinant of healthy child development. Children in families with greater material resources enjoy more secure living conditions and greater access to a range of opportunities that are often unavailable to children from low-income families. On average, children living in low-income families or neighbourhoods have poorer health outcomes. Furthermore, poverty affects children’s health not only when they are young, but also later in their lives as adults. The health sector should provide services to mitigate the health effects of poverty, and articulate the health-related significance of child poverty, in collaboration with other sectors to advance healthy public policy.     

Oh Canada! Too many children in poverty for too long

Despite continued economic growth, Canada’s record on child poverty is worse than it was in 1989, when the House of Commons unanimously resolved to end child poverty by the year 2000. Most recent data indicate that nearly 1.2 million children – almost one of every six children – live in low-income households. Campaign 2000 contends that poverty and income inequality are major barriers to the healthy development of children, the cohesion of our communities and, ultimately, to the social and economic well-being of Canada. Canada needs to adopt a poverty-reduction strategy that responds to the UNICEF challenge to establish credible targets and timetables to bring the child poverty rate well below 10%, as other Organisation for Economic Co-operation and Development nations have done. Campaign 2000 calls on the federal government to develop a cross-Canada poverty-reduction strategy in conjunction with the provinces, territories and First Nations, and in consultation with low-income people. This strategy needs to include good jobs at living wages that ensure that full-time work is a pathway out of poverty; an effective child benefit of $5,100 that is indexed; a system of affordable, universally accessible early learning and child care services available to all families irrespective of employment status; an affordable housing program that creates more affordable housing and helps to sustain existing stock; and affordable and accessible postsecondary education and training programs that prepare youth and adults for employment leading to economic independence.     

Child poverty. Ways forward for the paediatrician: A comprehensive overview of poverty reduction strategies requiring paediatric support

The harmful effects of child poverty are well documented. Despite this, progress in poverty reduction in Canada has been slow. A significant gap exists between what is known about eradicating poverty and its implementation. Paediatricians can play an important role in bridging this gap by understanding and advancing child poverty reduction. Establishment of a comprehensive national poverty reduction plan is essential to improving progress. The present review identifies the key components of an effective poverty reduction strategy. These elements include effective poverty screening, promoting healthy child development and readiness to learn, ensuring food and housing security, providing extended health care coverage for the uninsured and using place-based solutions and team-level interventions. Specific economic interventions are also reviewed. Addressing the social determinants of health in these ways is crucial to narrowing disparities in wealth and health so that all children in Canada reach their full potential.     

Why are children living in poverty getting fatter?

In recent decades, there has been a dramatic increase in unhealthy weight for both children and adults. The Canadian standard of living has changed in favour of more easily prepared, calorie-dense foods and sedentary practices. Many family characteristics have also changed over the past 50 years. More Canadian families are living in disadvantaged situations, forecasting a host of unhealthy behaviours and attitudes in adults. The poor are not only getting poorer, they are also becoming heavier. Children from disadvantaged families seem to be leading the trend in increasing prevalence of unhealthy weight. Because they live in neighbourhoods that are perceived as unsafe, these children are likely spending more time indoors. This is associated with watching more television, which not only displaces other forms of educational and active entertainment but also places them at risk of learning inaccurate information about proper eating. Social science research helps identify factors contributing most to the rise in excess weight within this population, thus providing essential clues for effective approaches to its eradication.     

The impact of childhood maltreatment on biological systems: Implications for clinical interventions

Childhood maltreatment represents a significant risk factor for the development of a number of mental and physical health outcomes. Converging evidence suggests that early adversity induces significant and persistent biological changes in individuals (‘biological embedding’). The present review focuses on the impact of childhood maltreatment on the hypothalamic-pituitary-adrenal axis and immune system function in both children and adults. Research suggests that childhood maltreatment is associated with hypothalamic-pituitary-adrenal axis dysregulation and diurnal cortisol profiles, as well as stress reactivity. Furthermore, childhood maltreatment is associated with disruptions in various immune system markers including pro- and anti-inflammatory substances, and markers of cell-mediated immunity. The potential of interventions to reduce these negative biological effects in maltreated children is also discussed.     

Effects of interventions for promoting physical activity during recess in elementary schools: a systematic review

ObjectiveSummarize the effects of interventions designed to promote physical activity during elementary school recess in children between 5 and 10 years old. Effective school interventions for children can promote physical activity and healthy behaviors.MethodsPubMed, Scopus, Bireme, SciELO, Web of Science, PsychINFO, Proquest, Physical Education Index, Sports Discus, and Eric databases were included in the data search. Original intervention articles on physical activity that used regression methods, published between 2000 and 2019 in English, Portuguese and Spanish were analyzed. Analyses were performed in 2019. Outcomes were organized according to the direction of the association by independent variables. Ten articles were considered eligible for data extraction and evaluation.ResultsSeveral strategies were used including playground markings, demarcation of physical activities zones, group activities, availability of sports equipment and facilities. Most of the studies were conducted in the United States. Recess periods ranged from 20–94 min per day and intervention time ranged from 6 weeks to 2 years. Recess duration and intervention effects were positively associated with physical activity. Gender (girls) and age (oldest) were negatively associated with physical activity during recess.ConclusionsInterventions based on modifications of school environment such as playground markings demarcation of physical activities zones, group activities, availability of sports equipment and facilities are cheap and cost-effective for increasing physical activity in school recess.     

对慢性病患儿及其父母教育干预的效果研究

目的：评价针对慢性病患儿及其父母的教育干预措施的效果,为临床建立系统的针对慢性病患儿及其父母的教育干预项目提供依据。方法：50名慢性病患儿和75名慢性病患儿父母为研究对象。干预组为2007年8月至2008年1月住院的患儿及其父母,对照组为2007年2月~7月住院的患儿及其父母。患儿入院2 d后开始教育干预,内容包括疾病知识、自我管理、用药知识和应对技巧等。在患儿出院前1天、出院后3个月时评价两组患儿及患儿父母的知识水平、应激源、应对方式、心理状态及服药依从性。结果：教育干预后,干预组患儿父母及患儿的知识问卷得分均高于对照组(P0.05)。结论：教育干预可以提高慢性病患儿及父母疾病知识水平,减少患儿及父母的应激源数,使父母更多地采用积极的应对方式,但对改善患儿及父母的焦虑、抑郁状态无明显作用。［中国当代儿科杂志,2010,12（6）：462-467］     

The impact of surgical strategies on outcomes for pediatric chronic pancreatitis

Purpose

To review our institutional experience in the surgical treatment of pediatric chronic pancreatitis (CP) and evaluate predictors of long-term pain relief.

Methods

Outcomes of patients ≤21 years surgically treated for CP in a single institution from 1995 to 2014 were evaluated.

Results

Twenty patients underwent surgery for CP at a median of 16.6 years (IQR 10.7–20.6 years). The most common etiology was pancreas divisum (n = 7; 35%). Therapeutic endoscopy was the first-line treatment in 17 cases (85%). Surgical procedures included: longitudinal pancreaticojejunostomy (n = 4, 20%), pancreatectomy (n = 9, 45%), total pancreatectomy with islet autotransplantation (n = 2; 10%), sphincteroplasty (n = 2, 10%) and pseudocyst drainage (n = 3, 15%). At a median follow-up of 5.3 years (IQR 4.2–5.3), twelve patients (63.2%) were pain free and five (26.3%) were insulin dependent. In univariate analysis, previous surgical procedure or >5 endoscopic treatments were associated with a lower likelihood of pain relief (OR 0.06; 95% CI 0.006–0.57; OR 0.07; 95%, CI 0.01–0.89). However, these associations were not present in multivariate analysis.

Conclusion

In children with CP, the step-up practice including a limited trial of endoscopic interventions followed by surgery tailored to anatomical abnormalities and gene mutation status is effective in ensuring long-term pain relief and preserving pancreatic function.

     

贫困县双亲生育取向和对子女性别赋值的研究

目的 探讨贫困地区双亲的生育愿望和对子女性别的期望值。方法 从三个国家级贫困县每县随机选取0～6岁女童,1岁1个年龄组,共6个年龄组,每年龄组50名,共300名。3县共900名女童为实验组。按同样条件随机选取900男童作为对照组。结果 (1)独生子女的比例对照组为58．0％,实验组为65．0％。(2)男女童的性别比为1：0．87～1：0．95～1：0．97。(3)双亲的生育愿望取向趋向于少子女和小家庭。独生子女家庭占58．0％～65．0％,2个子女以下家庭占95．3％～96．6％。隔代亲属共居的家庭只占约40％,无隔代亲属家庭亦占约40％。对是否希望生男童的问题。持肯定态度者,占62．2％以上。但是对必需生男童的问题。持肯定态度者,占39．8％以下,(4)在“谁能养老”的选择中,大多数选择女童。结论 (1)被调查贫困地区基本生活条件,卫生服务和信息交流等大环境较过去已有较大进步,基本上达到国家的要求。这些变化对双亲性别认识(男女一样)产生很大的作用。(2)双亲的生育愿望取向趋向于少子女和小家庭。(3)双亲对子女性别赋值和预期值有重大变化。在“谁能养老”的选择中,绝大多数选择女孩。此种性别预期值的改变,是今日中国农村重大变化的标志(4)脱贫是实际上保障男女平等的一个重要物质基础。     

The impact of violence on children

Existing research on the effects of children's exposure to violence covers a broad range of community, family, and media violence. This research is relevant and useful to an examination of domestic violence in two key ways. First, understanding how exposure to various types of violence affects children and what best enables them to cope can point to important considerations when trying to help children cope with exposure to domestic violence in particular. And second, many families experiencing domestic violence are exposed to other types of violence as well. Exposure to violence on multiple levels can affect the parents' behavior and can compound the effects on children. This article begins with an overview of the extent of children's exposure to various types of violence, and then examines what is known about the effects of this exposure across the developmental continuum. Key protective factors for children exposed to violence are examined. Research indicates that the most important resource protecting children from the negative effects of exposure to violence is a strong relationship with a competent, caring, positive adult, most often a parent. Yet, when parents are themselves witnesses to or victims of violence, they may have difficulty fulfilling this role. In the final section, directions for future research are discussed.     

Poverty during pregnancy: Its effects on child health outcomes

It is estimated that nearly 100,000 children are born into poverty each year in Canada. During pregnancy, their mothers are likely to face multiple stressful life events, including lone-mother and teenage pregnancies, unemployment, more crowded or polluted physical environments, and far fewer resources to deal with these exposures. The early child health consequences of poverty and pregnancy are multiple, and often set a newborn child on a life-long course of disparities in health outcomes. Included are greatly increased risks for preterm birth, intrauterine growth restriction, and neonatal or infant death. Poverty has consistently been found to be a powerful determinant of delayed cognitive development and poor school performance. Behaviour problems among young children and adolescents are strongly associated with maternal poverty. Sound evidence in support of policies and programs to reduce these disparities among the poor, including the role of health practitioners, is difficult to find. This is partly because many interventions and programs targeting the poor are not properly evaluated or critically appraised.     

Early school-based learning difficulties in children born very preterm

Background

Educational underachievement is a major morbidity associated with very preterm (VPT) birth. However, few studies have examined early school outcomes with most employing global, clinic based measures.

Objective

To examine the early school achievement in a cohort of children born VPT and studied to age 6 years.

Methods

A regional cohort of 102 VPT children (≤ 33 weeks GA) were followed prospectively alongside a comparison group of 108 full term (FT) children born during the same period (1998-2000). At 6 years corrected age, all children underwent a comprehensive neurodevelopmental evaluation that included the Woodcock-Johnson Tests of Achievement (WJ-III), teacher report and national numeracy and literacy test results. Rates of specific learning disabilities (LD) were also examined.

Results

VPT children performed less well than FT children on WJ-III subtests (ps < .05), national tests (ps < .01), and in all curricular areas rated by teachers (ps < .01) except expressive language. Even VPT children without severe neurodevelopmental impairment scored lower on the WJ-III math, national tests (ps < .05) and were 2-3 times more likely to show delays (ps < .02) in math (43% vs. 19%), written language (36% vs. 22%), language comprehension (26% vs. 14%), handwriting (36% vs. 17%), spelling (38% vs. 30%) and physical education (33% vs. 11%). They were also twice as likely as FT children to have math LD (47% vs. 21%).

Conclusions

By age 6, a substantial proportion of VPT children are lagging behind their FT peers across multiple curriculum areas, with difficulties being most prominent in math. Findings highlight the need for early identification and educational supports to help maximise VPT children's learning opportunities during the transition to school.     

The impact of cognitive delay on pediatric heart transplant outcomes

The presence of CD may be viewed as a relative contraindication to transplantation; however, its impact on pediatric HTx outcomes is poorly characterized. The aim of this study was to assess the impact of CD on pediatric HTx outcomes using academic progress as a surrogate measure of cognitive performance. The OPTN database was queried for all pediatric HTx recipients (2004‐2014) with reported academic progress. Multivariable analysis assessed the impact of DGL and the need for SE on post‐HTx graft survival. A total of 2245 children were included: 1707 (76%) within grade level, 269 (12%) with DGL, and 269 (12%) who required SE. The need for SE was not a risk factor for post‐HTx mortality; however, DGL was an independent risk factor for worse post‐HTx outcomes (AHR 1.4, 95% CI 1.02, 1.79, P=.03). Patients who require SE have similar outcomes compared to those without CD, likely secondary to significant parental involvement. Children with DGL demonstrate inferior post‐HTx survival, which could result from less parental oversight in children perceived to maintain compliance. Ensuring adequate social support for patients with evidence of CD may help to improve outcomes.