During April and May this year the Nottinghamshire Safeguarding Children Board (NSCB) is undertaking an online survey with those who work with children and families. We would like to seek your views about safeguarding children; the support that you receive to carry out your role and how well equipped you feel to deal with the sometimes complex and challenging area of work.
As we develop new safeguarding arrangements over the next year (in response to Working Together to Safeguard Children 2018) the results from the survey will provide a particularly important perspective which will help guide how safeguarding children work is coordinated and supported in the future.
The survey should take no more than 15 minutes to complete and your contribution will help us to better respond to the needs of those who work with children and families and therefore help to improve the outcomes for children and young people in Nottinghamshire.
In children with epilepsy, fever and infection can trigger seizures. Immunization can also induce inflammation and fever, which could theoretically trigger a seizure. The risk of seizure after immunization in children with pre-existing epilepsy is not known. The study objective was to determine the risk of medically attended seizure after immunization in children with epilepsy < 7 years of age.
We conducted a retrospective study of children < 7 years of age with epilepsy in Nova Scotia, Canada from 2010 to 2014. Hospitalizations, emergency visits, unscheduled clinic visits, and telephone calls for seizures were extracted from medical records. Immunization records were obtained from family physicians and Public Health with informed consent. We conducted a risk interval analysis to estimate the relative risk (RR) of seizure during risk periods 0–14, 0–2, and 5–14 days post-immunization versus a control period 21–83 days post-immunization.
There were 302 children with epilepsy who were eligible for the study. Immunization records were retrieved on 147 patients (49%), of whom 80 (54%) had one or more immunizations between the epilepsy diagnosis date and age 7 years. These 80 children had 161 immunization visits and 197 medically attended seizures. Children with immunizations had more seizures than either those with no immunizations or those with no records (mean 2.5 versus 0.7 versus 0.9, p < 0.001). The risk of medically attended seizure was not increased 0–14 days after any vaccine (RR = 1.1, 95% confidence interval (CI): 0.5–2.8) or 0–2 days after inactivated vaccines (RR = 0.9, 95% CI: 0.1–7.1) versus 21–83 days post-immunization. No seizure events occurred 5–14 days after live vaccines.
Children with epilepsy do not appear to be at increased risk of medically attended seizure following immunization. These findings suggest that immunization is safe in children with epilepsy, with benefits outweighing risks.
We, as parent caregivers, write to you on behalf of 247 parents of children with chronic, complex, medical conditions from various locations across the United States. We are parent caregivers of a unique population of fun, bright, and talented children with incredibly complicated medical issues. Our children are unique; they do not follow a standard, 1-dimensional, format of care. They need constant, specialized, and coordinated care, and they rely on you to support their quality of life.
Objective To determine the trajectory of cognitive test scores from infancy to adulthood in individuals born extremely preterm compared with term-born individuals.
Design A prospective, population-based cohort study.
Setting 276 maternity units in the UK and Ireland.
Patients 315 surviving infants born less than 26 completed weeks of gestation recruited at birth in 1995 and 160 term-born classroom controls recruited at age 6.
Main outcome measures Bayley Scales of Infant Development-Second Edition (age 2.5); Kaufman Assessment Battery for Children (ages 6/11); Wechsler Abbreviated Scale of Intelligence-Second Edition (age 19).
Results The mean cognitive scores of extremely preterm individuals over the period were on average 25.2 points below their term-born peers (95% CI −27.8 to −22.6) and remained significantly lower at every assessment. Cognitive trajectories in term-born boys and girls did not differ significantly, but the scores of extremely preterm boys were on average 8.8 points below those of extremely preterm girls (95% CI −13.6 to −4.0). Higher maternal education elevated scores in both groups by 3.2 points (95% CI 0.8 to 5.7). Within the extremely preterm group, moderate/severe neonatal brain injury (mean difference: −10.9, 95% CI −15.5 to −6.3) and gestational age less than 25 weeks (mean difference: −4.4, 95% CI −8.4 to −0.4) also had an adverse impact on cognitive function.
Conclusions There is no evidence that impaired cognitive function in extremely preterm individuals materially recovers or deteriorates from infancy through to 19 years. Cognitive test scores in infancy and early childhood reflect early adult outcomes
There is unlikely to be anyone in the world who would not be supportive of good health for children. Yet, child health is struggling. A year ago, the UK Royal College of Paediatrics and Child Health (RCPCH) published ‘State of Child Health’. We found nearly one in five children in the UK to be living in poverty and troubling disparity between the health of children in the UK and many similar nations in Europe. A year on and the RCPCH has issued a series of scorecards, showing what change there has been in the nations of the UK. Individual nations, chiefly Scotland and Wales, have made commendable progress. However, what emerges is a picture of piecemeal policy, not the astute, visionary, integrated strategy so sorely needed. Current UK metrics remain stark; child mortality is higher than in many comparable countries; about a third of 10-year-old children are overweight or obese; a quarter of 5-year-olds have tooth decay; self-harm among girls aged 13–16 has risen by two-thirds in the last 3 years; compared with 2015–2016, there has been a decrease in 2016–2017 in coverage of four of the six routine vaccinations at age 1 and 2 years, and coverage for Measles, Mumps and Rubella decreased for the third year in a row, following previous annual increases over 9 years. Child poverty is at its highest since 2010 and compared with the overall population, children are more likely to be living in a low-income household.
Poor child health has very serious wider implications. Over 80% of obese children will remain obese as they grow older, and this will lead to them losing about 15–20 healthy-life years as adults. Teenagers, even if only at the upper end of normal body weight, have a substantially increased risk of premature death in adulthood. Air pollution experienced in fetal life, infancy and early childhood scars lungs for life, increasing the likelihood of chronic respiratory conditions in old age. Adverse childhood experiences increase the risk of health-harming behaviours and non-communicable diseases in later life. These are classic examples of societies fouling their own nests, by failing to see the destructive consequences for everyone of not safeguarding child health. The moral case for better child health is self-evident, as is that vested in self-interest, but these aside, there is a powerful economic case too. Governments need populations that are healthy, economically active and not crippled by chronic illness in old age. This means placing health foremost, especially during early development when life-long trajectories of well-being are set.
I was born with several heart conditions. By the age of 10, I’d had around 18 cardiac procedures: three with my chest opened, others by keyhole, others simply diagnostic. All came with general anaesthetics. Throughout my childhood I was called brave and told there was nothing to be scared of. Doctors, nurses, family members—they all said these words to try and comfort me, especially when I told them I was sad or frightened. But the words didn’t stop me from feeling scared. They just made me feel it was wrong to cry, to have these feelings, or even to talk about them.
I just needed a break
The most terrifying experience was going under anaesthetic. It was such an alien feeling—so different from sleeping—that I linked it to death. Every time I was put to sleep, I thought I’d never wake up again. My distrust of anaesthetists started around age 6. I was crying so much from the fear of what was about to happen that they allowed me to sit on my mum’s lap in the anaesthetic room. I just needed a break; I needed her to carry me out for a few minutes, make me feel safe, and tell me it was all going to be okay, that I’d wake up again. However, the anaesthetists wafted the gas mask over my mum’s shoulder instead, increasing my anxiety during future procedures.
After years of progress the UK is stalling in areas such as infant mortality and immunisation levels and is lagging behind similar countries on mortality, breastfeeding, and the prevalence of obesity.
Several new reports detail the worrying state of the nation’s child health. Health professionals say that the latest figures are cause for alarm and are calling on the government to act urgently to develop a comprehensive child health strategy.