Child Health (1)

Question 1

What outcomes can the mother’s diet and exercise influence about their baby?

Answer 1

Can influence their child’s:
Birth weight
Later adult excess weight
Associated chronic conditions e.g. T2DM

Question 2

What factors influence a child’s cognitive, physical, social, and emotional health for the first 2 years of their life?

Answer 2

Diet, exercise, relationships, sleep, stress, socio-economic factors

Foundations of behaviour begin to form at this early stage

Question 3

What else is important for a child’s first 2 years of life for a healthy start?

Answer 3

Vaccinations and breastfeeding

Question 4

What marker can be used to measure the different modifiable factors in the early years?

Answer 4

School readiness = a marker linked to education attainment, life chances and involvement in crime

Question 5

What is the biggest childhood worry currently?

Answer 5

Childhood unhealthy weight - includes overweight and obesity
1 in 5 overweight or obese entering reception
Obesity epidemic

Question 6

Why is childhood unhealthy weight so concerning?

Answer 6

Also accompanied by a rise in T2DM, fatty liver disease, arteriosclerosis etc.

Question 7

Why are good behaviours in childhood important to establish?

Answer 7

Behaviours in childhood reflect in behaviours during adolescence e.g. active in childhood = more likely to be active in adolescence

Currently, least active generation

Question 8

What is good physical literacy?

Answer 8

Having motivation and physical confidence which allows them to value physical activity

Question 9

Why is it easier to establish healthy behaviour in early life rather than change / adapt healthy behaviours later?

Answer 9

Because in later life, habit and inertia become more powerful

Question 10

So when is the optimum time to deliver interventions?

Answer 10

Early childhood

Important for parents to display good behaviours as children mirror them

Question 11

What is the biggest factor contributing to childhood obesity?

Answer 11

Parental obesity

Children mimic what they see their caregivers do

Question 12

What are Dental caries?

Answer 12

Oral bacteria metabolise sugar and produce acid that demineralises enamel and dentin from the hard coating of the tooth

Severe caries can cause pain and infection and can even lead to sepsis and death

Question 13

What are the factors affecting development of caries?

Answer 13

Obesity - associated with excessive sugar intake
Social deprivation - associated with excessive sugar intake
Poor oral hygiene

Question 14

How can dental carries be prevented?

Answer 14

Sugar reduction in the diet - reducing free sugar <10% of energy intake
Good oral hygiene
Water fluoridation

Question 15

Why is it important to take a whole family approach when considering a child’s health?

Answer 15

Family trauma can impact childhood behaviours that progress onto later life

Question 16

What are some examples of Adverse Childhood Experiences (ACEs)?

Answer 16

Experiencing abuse: physical, sexual, psychological or neglect

Witnessing domestic abuse

Having a close family member or caregiver who misused drugs or alcohol

Having a close family member or caregiver with mental health problems

Having a close family member or caregiver who served time in prison

Experiencing parental separation or divorce on account of relationship breakdown.

Question 17

What is the strength of evidence of the risk level for health outcomes relating ACEs?

Physical inactivity, overweight or obesity and diabetes

Smoking, heavy alcohol use, heart disease, respiratory disease, cancer and poor self-rated health

Mental ill health, sexual risk taking, problematic alcohol use

Problematic drug use and interpersonal and self directed violence

Answer 17

Weak / modest

Moderate

Strong

Very strong

Question 18

How does trauma experienced by a caregiver affect both: the developing baby or child?

Answer 18

Stress can affect the foetus during pregnancy

Witnessing caregiver’s trauma during childhood is an ACE

Question 19

How can LMAP interventions be presented to children and families?

Answer 19

1. Opportunistic - health coaching during appointments about other things
2. Be non-judgemental, parent may not know there is a health concern
3. Strength based approach - focus on what the’yre doing right and how to expand on that
4. Focus on barriers of particular importance to the child - concerns stopping them from carrying out healthy behaviours
5. Use other children to build relatability
6. Engage parents and family - improve parenting practices
7. Specific, short-term goals
8. Change to daily routine
9. Activities fulfilling ‘LEAP’ criteria - local, enjoyable and practical

Question 20

What is the national child measurement programme?

Answer 20

Measures height and weight of children in reception, year 6 and year 11

Looks for trends over time

Question 21

Why is it difficult to diagnose overweight and obesity in children?

Answer 21

Weight divided by height in m^2

Then compared against data from the 90s of that age group and sex

Then use BMI centiles to categorise underweight (<2), healthy weight (>2 and <85), overweight (>85 and <95), obese (>95), and severely obese (>99.6)

Question 22

What are the 4 tiers of service for the national child measurement programme?

Answer 22

Tier 1 = universal, VBA from frontline healthcare professionals and public health approaches

Tier 2 = >91 , intensive and community based, time-specific, focus on helping child grow into healthy weight rather than weightloss

Tier 3 = >99.6 or >99 +co-morbidities, specialist MDT, weight management clinics, longer term follow up

Tier 4 = not available to children, surgical interventions

Question 23

How can a conversation about weight be started with patients?

Answer 23

Choose the right opener - ask permission

Assess importance - how important is it to address the family’s health right now?

Assess feelings - how do you feel about your diet and lifestyle?

Avoid casting judgement

Question 24

How can resistance from a family be prevented?

Answer 24

Avoid giving the families an answer straight away
Ask them if they have any solutions in mind
Leave door open to discuss another day
Explore small, specific goals
Use teamwork

Question 25

How does the food environment shape our food choices?

How do our food choices impact our health?

Answer 25

Food advertising, availability and costs subconsciously impact our food choices

Contributes to complex health problems such as: childhood obesity, dental caries, vitamin and mineral deficiencies, impact negatively on development, and can even influence how we deal with stress

Question 26

What are the biggest barriers to children inactivity?

Answer 26

Accessibility depending on socio-economic background (low income = least exercise, least happy, most overweight)

Question 27

What determines how much sleep you need?

Answer 27

Genetics - orexin production

What stage of life you are at - generally less sleep as you get older

Question 28

What is orexin?

Answer 28

Neuropeptide regulating wakefulness and arousal

Question 29

What kind of biological rhythm do adults have compared to babies?

Answer 29

Adults = circadian - cycle repeats every 24hrs

Babies = ultradian - cycle repeats within 24hr period

Circadian rhythm doesn’t develop until 2 months of age

Question 30

What may be a reason teenagers are ‘night owls’?

Answer 30

Excess screen time - teenagers more sensitive to light

Caffeine - half-life = 5hrs, teens drink coffee too close to bed time