Child Health And Illnesses

Question 1

Childhood deaths in England and Wales

Answer 1

More than 5000 infants , children and adolescents die every year in England and Wales

Mortality is highest in infancy , dropping to very low rates in middle childhood rates before rising again in adolescence

Patterns of mortality vary with age and sex

Question 2

Patterns of mortality

Answer 2

Perinatal and congenital causes predominate in infancy

Acquired natural causes become prominent in later childhood and adolescence

> 50% of deaths in adolescents occur from external causes

Males in all age groups have higher mortality rates with 15-19 age range being the most different and highest - adolescent death rates exceed those of younger children with much higher rate in boys

Question 3

Illness in children

Answer 3

Congenital abnormality

• chromosomal anomalies
• cardiac lesions

Infection 
Respiratory disorders 
Trauma 
Malignancy 
Neurological disease 

External causes of child death is highest in 15-19 yrs age group and males being higher than females

Question 4

Patterns of illness

Answer 4

Acute illness - in a previously well child

Acute child with underlying chronicity - e.g SKA with IDDM , asthma excerbation

Chronic long term illness e.g cystic fibrosis , chronic renal failure and cerebral palsy

Question 5

Timing of illness

Answer 5

Prenatal 
Perinatal 
Neonatal 
Infant 
Toddler 
School age 
Adolescent 

Boys >70% more likely to die or be injured

Traffic accidents account for > 50% of all external deaths in adolescents with 10-14 age group being highest

Question 6

Causes of deaths in infants

Answer 6

Congenital 
Prematurity 
Asphyxia 
Unexplained 
Other 

With prematurity being highest in pre term babies and congenital highest in term infants

Question 7

Other non intentional causes of child death

Answer 7

Two peaks in occurrence : infancy and early childhood and adolescence

• drowning
• falls
• fire related injuries

Suffocation and strangulation (young infants with SUDI and toddlers )

Question 8

Fatal maltreatment and deaths from assault

Answer 8

• infanticide and covert homicide
• severe physical assaults ( shaking )
• abuse , neglect or deprivation
• deliberate or overt homicides
• deaths related to but not directly caused by maltreatment

Question 9

Suicide and deliberate self harm

Answer 9

Rare in children younger than 10 yrs

Higher in older adolescents boys (>60 deaths per year )

Ligature , jumping , poisoning

Question 10

Types of injuries

Answer 10

Falls

Head injuries

Road traffic collisions

Drowning - mostly in bath or outdoor pools - 4x as likely if epileptic - 50% reduction with pool fencing

Swallowed foreign body

Majority child pedestrians hit by vehicles , reminder unrestrained children

Question 11

Poisoning

Answer 11

50% occur in under 5s
Almost all occur in child’s home
Over half are non medicinal - cosmetics , cleaning substances
Declining due to child resistant containers and safer medicines

Medicines - analgesics , cough products , antibiotics and vitamins

Question 12

Childhood cancers 2001-2005

Answer 12

Three most common types of cancer diagnosed in children are leukaemias , brain and CNS tumours and lymphomas collectively accounting for around 2/3rds of all cancers diagnosed in 0-14 yrs old

Question 13

CNS diseases

Answer 13

Many as a result of perinatal problems

• birth asphyxia /hypoxic- ischeamic encephalopathy
• low birth weight / prematurity

Epilepsy
Cerebral palsy
Neuro developmental disorders

Question 14

Chronic illness in UK

Answer 14

Cystic fibrosis 
Diabetes mellitus 
Epilepsy 
IBD
Neuro disability /CP
Psychiatric illness 
Obesity 
Asthma

Question 15

Implications of chronic illness

Answer 15

Child - physical , mental , social 
School - repeated absences 
Family - parents and siblings 
Financial family and community 
National health provision / planning 
Lifelong - ex- premature baby

Question 16

Cost implications

Answer 16

5 million asthmatic children in US 
Annually 170 000 admissions 
$38 dollars acute admissions
10 million school days missed 
<20 children special needs / disability but spend > 80% of allocated budget

Question 17

Why children die

Answer 17

In 2012 in the UK

> 3,000 babies died before 1 year
2,000 children and young people died between 1-19 yrs

50% deaths in childhood occur during the first year of a child’s life

Pre term birth and low birth weight are the major causes with risk factors including -
Maternal age , smoking and socioeconomic disadvantage

After infancy , injury is the most frequent cause of death , > 75% of deaths due to injury in the age bracket of 10-18 year olds are related to traffic accidents

Suicide remains a leading cause of death in young people in the UK and the number of deaths due to intentional Injuries and self harm have not declined in 30 years

Question 18

Next steps

Answer 18

• reduce risk of preterm babies and LBW and promote maternal health
• improve recognition and management of serious illness across the health service
• implement policies for common causes of deaths from accidents and injuries
• improve management of chronic diseases ( asthma , epilepsy , diabetes ) and long term conditions inclu mental health

Question 19

Role of society and government

Answer 19

Resource availability and equity impact on mortality and on life chances

• poverty kills children
• equity saves lives
• social protection is life saving