Assessing changes of hospital admission in preschool children. Critical evaluation

Measuring the frequency of "severe" accidental injury in childhood

STUDY OBJECTIVE

The aim was to improve the epidemiological information concerning child accidental injuries which can be extracted from routine inpatient and coroners' inquest data.

DESIGN

This was a retrospective study of coroners' inquest reports and inpatient case notes to undertake objective severity scaling and to extract basic data. This material was related to denominators from OPCS mid-year population estimates, to 1981 census ward populations, and to sociodemographic data collected in a local census in 1986.

SETTING

The study population was derived from three north east health districts and their corresponding census enumeration districts.

PARTICIPANTS

A stratified sample of 500 children aged 0-16 years from among residents admitted to hospital with accidental injuries in 1986 was studied, together with all accidental injury child deaths between 1980 and 1986; 94% of the relevant case notes were localised and extracted.

MAIN RESULTS

When differentiated by injury severity there are major systematic differences in the basic epidemiology of child accidental injury by age and place of residence of victims as well as in the nature and causes of injuries sustained.

CONCLUSIONS

Injury severity scores can be used to define a "severity" threshold, within the spectrum of injuries, leading to hospital admission or death. By ensuring complete ascertainment this technique can provide a more accurate case definition than crude admission rates for estimating the frequency of injury in a population of children.

Mother's age, birth order and health status in a British national sample

Using data from a longitudinal study of a national sample of British children, it is shown that mother's age and experience with child rearing are related to the attention paid to the child's health. Younger mothers, whose children are usually the first born, tend to be more concerned with health care facility use than are older mothers of children born subsequently. Younger mothers more often take their child to infant and toddler clinics, and are more likely to have their child immunized against the most threatening of childhood diseases. It is also the younger mothers who more often seek medical care for their children in addition to that provided in the infant and toddler clinics, more often have their child in hospital overnight, and more often report the child to be sickly (less healthy) than do older mothers with several children.

Follow-up of the first national birth cohort: findings from the Medical Research Council National Survey of Health and Development

The medical work of a 40 year birth cohort study is described in order to show the continuing associations of childhood factors with later life health, behaviour, illness and survival. Comparisons with the health of children born at later times show the importance of a sensitive monitoring of changes in child health. A summary of work on social and psychological topics is also given, together with a complete list of publications from the study.

Amphetamine addiction and pregnancy. III. One year follow-up of the children. Psychosocial and pediatric aspects

Sixty-six infants born to amphetamine-addicted mothers were followed during their first year of life. The children were divided into three groups, according to whether or not the mother stopped her abuse in early pregnancy (Group I) or continued (Group II) and whether or not the latter children were placed in foster homes immediately after birth (Group III). All but 2 of 16 mothers in Group I stayed off drugs and mostly met non-addicted friends. In Group II, on the contrary, all but 2 of 36 mothers continued their abuse one year after delivery. At the age of one year, all but one child in Group I were in their mothers' custody and all children in Group III had remained in foster care. In Group II one-third of the children lived in foster homes after revocation of the maternal custody. Several infants in Group II had experienced multiple transfers between the biological home and different foster homes. There were indicators that maternal amphetamine abuse causes temporary drowsiness in the infants during the first months after birth. However, all children at the age of 12 months, regardless of group, had a somatic and psychomotor development in accordance with the normal Swedish standard. In all groups there was an increased rate of medical care mainly because of infections. Some infants in Group II compared to none in Groups I and III were hospitalized because of failure to thrive or suspected physical abuse. Symptoms indicating emotional disturbance were more common in infants of Group II than in infants of Groups I and III.