tag:theconversation.com,2011:/global/topics/child-health-5935/articlesChild health – The Conversation2024-03-18T12:24:52Ztag:theconversation.com,2011:article/2232702024-03-18T12:24:52Z2024-03-18T12:24:52ZFree school meals for all may reduce childhood obesity, while easing financial and logistical burdens for families and schools<figure><img src="https://images.theconversation.com/files/580529/original/file-20240307-16-nylyj3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1024%2C683&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">School meal waivers that started with the COVID-19 pandemic stopped with the end of the public health emergency.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/plymouth-ma-a-student-at-plymouth-county-intermediate-news-photo/1242013592">Jonathan Wiggs/The Boston Globe via Getty Images</a></span></figcaption></figure><p>School meals are critical to child health. Research has shown that <a href="https://doi.org/10.3390/nu9090924">school meals can be more nutritious</a> than meals from other sources, such as meals brought from home. </p>
<p>A recent study that one of us conducted found the quality of school meals has steadily improved, especially since the 2010 <a href="https://doi.org/10.1001/jama.2020.9517">Healthy, Hunger-Free Kids Act</a> strengthened nutrition standards for school meals. In fact, by 2017, another study found that school meals provided the <a href="https://doi.org/10.1001/jamanetworkopen.2021.5262">best diet quality</a> of any major U.S. food source.</p>
<p>Many American families became familiar with universal free school meals during the COVID-19 pandemic. To ease the financial and logistical burdens of the pandemic on families and schools, the <a href="https://www.fns.usda.gov/coronavirus">U.S. Department of Agriculture issued waivers</a> that allowed schools nationwide to provide free breakfast and lunch to all students. However, these <a href="https://www.fns.usda.gov/cn/offsite-monitoring-after-phe#">waivers expired</a> by the 2022-23 school year. </p>
<p>Since that time, there has been a substantial increase in schools participating in the <a href="https://www.fns.usda.gov/cn/community-eligibility-provision">Community Eligibility Provision</a>, a federal policy that allows schools in high poverty areas to provide free breakfast and lunch to all attending students. The policy became available as an option for low-income schools nationwide in 2014 and was part of the <a href="https://obamawhitehouse.archives.gov/sites/default/files/Child_Nutrition_Fact_Sheet_12_10_10.pdf">Healthy, Hunger-Free Kids Act</a>. By the 2022-23 school year, <a href="https://frac.org/cep-report-2023">over 40,000 schools</a> had adopted the Community Eligibility Provision, an increase of more than 20% over the prior year.</p>
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<figcaption><span class="caption">Many families felt stressed when a federal program providing free school meals during the pandemic came to an end.</span></figcaption>
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<p>We are <a href="https://scholar.google.com/citations?user=ihU7JuoAAAAJ&hl=en">public health</a> <a href="https://scholar.google.com/citations?user=VkqyJPcAAAAJ&hl=en">researchers who</a> study the health effects of nutrition-related policies, particularly those that alleviate poverty. Our newly published research found that the Community Eligibility Provision was associated with a net <a href="https://doi.org/10.1542/peds.2023-063749">reduction in the prevalence of childhood obesity</a>.</p>
<h2>Improving the health of American children</h2>
<p>President Harry Truman <a href="https://www.fns.usda.gov/nslp/nslp-fact-sheet">established the National School Lunch Program</a> in 1946, with the stated goal of protecting the health and well-being of American children. The program established permanent federal funding for school lunches, and participating schools were required to provide free or reduced-price lunches to children from qualifying households. Eligibility is <a href="https://www.fns.usda.gov/cn/fr-020923">determined by income</a> based on federal poverty levels, both of which are <a href="https://www.federalregister.gov/documents/2024/01/17/2024-00796/annual-update-of-the-hhs-poverty-guidelines#">revised annually</a>.</p>
<p>In 1966, the <a href="https://www.fns.usda.gov/cna-amended-pl-111-296">Child Nutrition Act</a> piloted the <a href="https://www.fns.usda.gov/sbp/program-history">School Breakfast Program</a>, which provides free, reduced-price and full-price breakfasts to students. This program was later made permanent through an amendment in 1975.</p>
<p>The <a href="https://www.fns.usda.gov/cn/community-eligibility-provision">Community Eligibility Provision</a> was piloted in several states beginning in 2011 and became an option for eligible schools nationwide beginning in 2014. It operates through the national school lunch and school breakfast programs and expands on these programs.</p>
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<a href="https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Gloved hand placing cheese slices on bun slices" src="https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Various federal and state programs have sought to make food more accessible to children.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/cafeteria-worker-puts-together-sandwiches-for-free-meals-as-news-photo/1213018954">John Moore/Getty Images</a></span>
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<p>The policy allows all students in a school to receive free breakfast and lunch, rather than determine eligibility by individual households. Entire schools or school districts are eligible for free lunches if at least 40% of their students are directly certified to receive free meals, meaning their household participated in a means-based safety net program, such as the <a href="https://fns-prod.azureedge.us/sites/default/files/resource-files/NSLPDirectCertification2016.pdf">Supplemental Nutrition Assistance Program</a>, or the child is identified as runaway, homeless, in foster care or enrolled in Head Start. Some states also <a href="https://www.fns.usda.gov/cn/direct-certification-medicaid-demonstration-project">use Medicaid for direct certification</a>.</p>
<p>The Community Eligibility Provision increases school meal participation by <a href="https://doi.org/10.2105/AJPH.2011.300134">reducing the stigma</a> associated with receiving free meals, eliminating the need to complete and process applications and extending access to students in households with incomes above the eligibility threshold for free meals. As of 2023, the eligibility threshold for free meals is 130% of the federal poverty level, which amounts to US$39,000 for a family of four.</p>
<h2>Universal free meals and obesity</h2>
<p>We analyzed whether providing universal free meals at school through the Community Eligibility Provision was associated with lower childhood obesity before the COVID-19 pandemic.</p>
<p>To do this, we measured <a href="https://doi.org/10.1542/peds.2023-063749">changes in obesity prevalence</a> from 2013 to 2019 among 3,531 low-income California schools. We used over 3.5 million body mass index measurements of students in fifth, seventh and ninth grade that were taken annually and aggregated at the school level. To ensure rigorous results, we <a href="https://doi.org/10.1016/j.jeconom.2020.12.001">accounted for differences</a> between schools that adopted the policy and eligible schools that did not. We also followed the same schools over time, comparing obesity prevalence before and after the policy.</p>
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<a href="https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Child scooping food from salad bar onto a tray; other children lean against the wall" src="https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=381&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=381&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=381&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=479&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=479&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=479&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Free school meals may help reduce health disparities among marginalized and low-income children.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/westbrook-middle-school-fifth-grade-student-salem-bukasa-news-photo/469592304">Whitney Hayward/Portland Portland Press Herald via Getty Images</a></span>
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<p>We found that schools participating in the Community Eligibility Provision had a <a href="https://doi.org/10.1542/peds.2023-063749">2.4% relative reduction</a> in obesity prevalence compared with eligible schools that did not participate in the provision. Although our findings are modest, even small improvements in obesity levels are notable because effective strategies to reduce obesity at a population level <a href="https://doi.org/10.1038/s41574-019-0176-8">remain elusive</a>. Additionally, because obesity <a href="http://dx.doi.org/10.15620/cdc:106273">disproportionately affects</a> racially and ethnically marginalized and low-income children, this policy could contribute to reducing health disparities.</p>
<p>The Community Eligibility Provision likely reduces obesity prevalence by substituting up to half of a child’s weekly diet with healthier options and simultaneously <a href="https://doi.org/10.1016/j.jhealeco.2022.102646">freeing up more disposable income</a> for low-to-middle-income families. Families receiving free breakfast and lunch save approximately $4.70 per day per child, or $850 per year. For low-income families, particularly those with multiple school-age children, this could result in meaningful savings that families can use for other health-promoting goods or services.</p>
<h2>Expanding access to school meals</h2>
<p>Childhood obesity <a href="https://doi.org/10.1542/peds.2021-053708">has been</a> <a href="https://doi.org/10.1001/jama.2020.14590">increasing over</a> the past several decades. Obesity often <a href="https://doi.org/10.1111/obr.12334">continues into adulthood</a> <a href="https://theconversation.com/obesity-in-children-is-rising-dramatically-and-it-comes-with-major-and-sometimes-lifelong-health-consequences-202595">and is linked</a> to a range of <a href="https://doi.org/10.2105/ajph.2016.303326">chronic health conditions and premature death</a>. </p>
<p>Growing research is showing the benefits of universal free school meals for the health and well-being of children. Along with our study of California schools, other researchers have found an association between universal free school meals and reduced obesity in <a href="https://doi.org/10.1086/723824">Chile</a>, <a href="https://doi.org/10.1016/j.ssmph.2022.101072">South Korea</a> and <a href="https://doi.org/10.1016/j.pubecp.2022.100016">England</a>, as well as among <a href="https://doi.org/10.1002/pam.22175">New York City schools</a> and school districts in <a href="https://doi.org/10.1162/edfp_a_00380">New York state</a>.</p>
<p>Studies have also linked the Community Eligibility Provision to <a href="https://doi.org/10.3368/jhr.57.3.0518-9509R3">improvements in academic performance</a> and <a href="https://doi.org/10.3102/00028312231222266">reductions in suspensions</a>.</p>
<p>While our research observed a reduction in the prevalence of obesity among schools participating in the Community Eligibility Provision relative to schools that did not, obesity increased over time in both groups, with a greater increase among nonparticipating schools.</p>
<p>Universal free meals policies may slow the rise in childhood obesity rates, but they alone will not be sufficient to reverse these trends. Alongside universal free meals, identifying <a href="https://theconversation.com/fixing-the-global-childhood-obesity-epidemic-begins-with-making-healthy-choices-the-easier-choices-and-that-requires-new-laws-and-policies-207975">other population-level strategies</a> to reduce obesity among children is necessary to address this public health issue.</p>
<p>As of 2023, <a href="https://www.americanprogress.org/article/5-states-addressing-child-hunger-and-food-insecurity-with-free-school-meals-for-all/">several states have implemented their own</a> universal free school meals policies. States such as California, Maine, Colorado, Minnesota and New Mexico have pledged to cover the difference between school meal expenditures and federal reimbursements. As more states adopt their own universal free meals policies, understanding their effects on child health and well-being, as well as barriers and supports to successfully implementing these programs, will be critical.</p><img src="https://counter.theconversation.com/content/223270/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessica Jones-Smith receives funding from the National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Anna Localio does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Since nutrition standards were strengthened in 2010, eating at school provides many students with healthier food than is available cheaply elsewhere. Plus, reducing stigma increases the number of kids getting fed.Anna Localio, Ph.D. Candidate in Health Services, University of WashingtonJessica Jones-Smith, Associate Professor of Health Systems and Population Health, Epidemiology, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2236062024-03-15T13:32:02Z2024-03-15T13:32:02ZChild health is in crisis in the UK – here’s what needs to change<figure><img src="https://images.theconversation.com/files/581689/original/file-20240313-18-eed233.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C3489%2C2331&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hungry-child-big-clear-eyes-eating-210938179">Slava Samusevich/Shutterstock</a></span></figcaption></figure><p>A <a href="https://acmedsci.ac.uk/more/news/urgent-action-needed-on-failing-child-health">new report</a> from the Academy of Medical Sciences highlights the “appalling decline” in child health and a need for “urgent action”. In recent years, child vaccination rates have fallen well below World Health Organization target levels, creating a resurgence of outbreaks of <a href="https://www.nature.com/articles/d41586-024-00265-8">serious disease</a> such as measles. </p>
<p>In England, more than one in five children are <a href="https://www.rcpch.ac.uk/news-events/news/rcpch-responds-latest-childhood-obesity-figures-england-202223">overweight or obese</a> by age five and <a href="https://www.gov.uk/government/statistics/oral-health-survey-of-5-year-old-children-2019">one in four</a> children have tooth decay. Demand for child mental health services <a href="https://www.theguardian.com/society/2024/feb/07/childrens-emergency-mental-health-referrals-in-england-soar-by-53">has surged</a>. Perhaps most worryingly, the rise in infant mortality means that UK is now <a href="https://data.oecd.org/healthstat/infant-mortality-rates.htm">ranked 30 out of 49</a> OECD countries – well behind other European countries except Bulgaria, Romania and Slovakia.</p>
<p>One of the most important drivers of this crisis is the number of children in the UK living in extreme poverty, which <a href="https://www.independent.co.uk/news/uk/home-news/poverty-children-dwp-energy-bills-food-b2434506.html">tripled</a> between 2019-2022. </p>
<p>The early years, the period from pregnancy to the first five years of life, have historically been overlooked in research and policy. More recently, the <a href="https://assets.publishing.service.gov.uk/media/605c5e61d3bf7f2f0d94183a/The_best_start_for_life_a_vision_for_the_1_001_critical_days.pdf">first 1,001 days</a> from conception to age two has been recognised as a critical period in which the building blocks for lifelong emotional and physical health are laid down.</p>
<p>Investing in the early years is one of the most important things we can do as a society to build a better future and promote the nation’s health, wellbeing and prosperity. There is clear evidence that such investment will be cost-effective in enabling future adults to live long and productive lives. </p>
<p>For example, data from the Royal Foundation and the London School of Economics has shown that the <a href="https://assets.ctfassets.net/qwnplnakca8g/2iLCWZESD2RLu24m443HUf/1c802df74c44ac6bc94d4338ff7ac53d/RFCEC_BCCS_Report_and_Appendices.pdf">cost to society</a> of addressing issues that might have been avoided through action in early childhood is more than £16 billion each year – <a href="https://centreforearlychildhood.org/report/#:%7E:text=This%20sum%20of%20%C2%A316.13,specialist%20perinatal%20mental%20health%20support.">nearly five times</a> the total annual spend in England on early education and childcare entitlements. </p>
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<h2>How to reverse the decline</h2>
<p>So what can be done to reverse these worrying trends? </p>
<p>The Academy of Medical Sciences’ report outlines several recommendations to improve the health and wellbeing of children in the UK and the adults they will become. </p>
<p>The first recommendation is to implement effective early years interventions. One example of such an intervention is the Family Nurse Partnership (FNP), an intensive early home visiting programme for first time teenage mothers. The FNP aims to improve birth outcomes, child health and development, and promote economic self-sufficiency among young mothers. </p>
<p>My colleagues and I recently <a href="https://bmjpublichealth.bmj.com/content/2/1/e000514">evaluated outcomes of 26,000 mothers</a> in England participating in the FNP from 2010-2019. We found some evidence to suggest that children born to mothers enrolled in FNP were more likely to achieve a good level of development at school entry (age five), supporting findings from a <a href="https://bmjopen.bmj.com/content/12/2/e049960">previous trial</a>. Mothers were engaged in the programme, with the majority meeting fidelity targets (Figure 1). </p>
<p>However, in local areas where the FNP was offered, <a href="https://jech.bmj.com/content/76/12/991">only one in four mothers</a> are enrolled due to insufficient places on the programme. In areas with high numbers of teenage mothers, enrolment rates are even lower. More needs to be done to ensure that when interventions are implemented, they are offered to all those who could benefit from support. </p>
<p>A further recommendation is to address the decline in the child and family health workforce. Health visitors are trained nurses who are <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/960708/Commissioning_guide_2.pdf">uniquely placed</a> to influence and work with the whole family in the interests of children on social, psychological and health choices. Years of austerity, cuts and a depleted workforce have meant that since 2015, the health visiting workforce has <a href="https://ihv.org.uk/news-and-views/news/health-visitor-workforce-numbers-in-england-reach-an-all-time-low/">decreased by 37%</a> (from 11,193 to 7,030 in 2022). </p>
<p>The real term value of the public health grant from which health visiting is commissioned <a href="https://www.health.org.uk/news-and-comment/charts-and-infographics/public-health-grant-what-it-is-and-why-greater-investment-is-needed">has fallen by 27%</a>. In the context of this disinvestment, there is huge variation in how local areas are delivering their services. For example, <a href="https://pubmed.ncbi.nlm.nih.gov/35193912/">our research</a> has shown that the number of children receiving their (mandated) 2 to 2½-year review ranges between 33%-97% depending on in which area they live (Figure 2).</p>
<p>Investment in targeted interventions and universal services in the early years is key to supporting the health and development of children and the wellbeing of their families in the critical period before school. </p>
<h2>Children need joined-up thinking</h2>
<p>However, such interventions and policies should be underpinned by high-quality research and evaluation. We need to consider the wider determinants of health and wellbeing across the lifecourse, such as education, social care income, criminal justice and the environment, to support a more joined up and cross-government approach to improving outcomes. </p>
<p>Historically, linking cross-sectoral data in this way has been challenging. However, there is promising progress in this area. One example of this is <a href="https://www.ucl.ac.uk/child-health/echild">Echild</a>, a national resource linking together data from hospitals, schools and social care for 20 million children in England and their mothers (Figure 3). </p>
<p>This unique data set represents a significant step towards a more holistic approach to understanding the <a href="https://www.adruk.org/news-publications/news-blogs/how-administrative-data-can-uncover-the-relationship-between-childrens-health-and-education/">many factors influencing child wellbeing</a>, including maternal mental health, childhood chronic conditions and school absences.</p><img src="https://counter.theconversation.com/content/223606/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Harron does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Children are bearing the brunt of austerity. From obesity to infant mortality, child health is affected by sustained under-investment. What can be done to reverse the decline?Katie Harron, Professor of Statistics and Health Data Science, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2232132024-02-28T13:11:58Z2024-02-28T13:11:58ZAre slushies really bad for young children’s health?<p>Recently there have been concerning reports <a href="https://www.thescottishsun.co.uk/health/11883723/parents-risks-expert-slushie-kid-collapse/">in the news</a> of a three-year-old boy who collapsed and was admitted to hospital after drinking a slushy drink. Fortunately, after a few days, the child recovered completely. </p>
<p>This has led to calls for improved labelling where slushies are sold so that parents are better educated about the potential risks to young children consuming these drinks. It has also led to calls for the drinks to be removed from sale at certain venues, such as soft-play centres. </p>
<p>This follows from reports of <a href="https://www.food.gov.uk/news-alerts/news/not-suitable-for-under-4s-new-industry-guidance-issued-on-glycerol-in-slush-ice-drinks">three other young children</a> being admitted to hospital following consuming slushy drinks containing glycerol, which in 2023 led to the Food Standards Agency in the UK reviewing the safety of glycerol in slushies. These children had low blood glucose and high levels of glycerol before recovering. </p>
<p>This led to the recommendation that slushy drinks containing glycerol should not be offered to children aged <a href="https://www.food.gov.uk/news-alerts/news/not-suitable-for-under-4s-new-industry-guidance-issued-on-glycerol-in-slush-ice-drinks">four years and younger</a>.</p>
<p>Using these figures it was also recommended that children under ten should not be offered free refills. This advice also includes the recommendation that these customers should be informed of these <a href="https://www.foodstandards.gov.scot/publications-and-research/publications/industry-guidelines-for-the-food-additive-glycerol-e-422-in-slush-ice-drinks">risks and restrictions</a> for young children, but no recommendations were made about restricting where they could be sold.</p>
<h2>What is glycerol?</h2>
<p>Glycerol also known as glycerine <a href="https://www.food.gov.uk/business-guidance/approved-additives-and-e-numbers#:%7E:text=Glycerol%20E%20422">or E422</a> is recognised as being <a href="https://www.fda.gov/files/food/published/GRAS-Notice-000583---Esterified-propoxylated-glycerol.pdf">generally safe as a food additive</a> by the EU and the US Food and Drug Administration. Chemically, it is described as a <a href="https://foodinsight.org/what-is-glycerin/#:%7E:text=Highlights,vinegar%2C%20wine%20and%20wine%20vinegar.">sugar alcohol</a>. </p>
<p>Aside from slushies, glycerol is also found in flavourings such as vanilla essence and is often used to keep icing soft.</p>
<p>Normally, in our bodies, glycerol is connected to fatty acids, so levels in the blood are low. Also, our bodies do not have a way of regulating or controlling glycerol in the same way we produce insulin to control glucose (blood sugar). So there is no way for our body to simply start using more glycerol in cells in the way we can with glucose after a meal. </p>
<p>This does not mean glycerol is toxic, it just means it can stay in blood for longer than glucose. As this adds to the amount of things dissolved in our blood, it means the plasma in blood becomes more concentrated and can draw water from other parts of the body, including the brain, which can lead to symptoms such as headache, nausea and dizziness.</p>
<figure class="align-center ">
<img alt="Two girls share a slushy" src="https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576018/original/file-20240215-30-fxsqil.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There is no way for our body to use more glycerol.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-cute-little-sisters-drinking-colorful-530498500">MNStudio/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Why use glycerol in slushies?</h2>
<p>How slushies are made has changed, at least partly in response to a UK government policy on sugar reduction and the <a href="https://www.gov.uk/money/soft-drinks-industry-levy">Soft Drinks Industry Levy</a> (the “sugar tax”). Where most sweetened soft drinks, were able to use a mix of low- and no-calorie sweeteners – such as aspartame – this doesn’t work when it comes to slushies.</p>
<p>The challenge when making slushies, compared to normal soft drinks, is the sugar does more than provide sweetness. Sugar has the physical function in slushies of decreasing the freezing point of water. Water freezes at 0°C, but adding sugar reduces the ability of the water molecules to connect by hydrogen bonds and form ice. </p>
<p>Adding sugar to water and churning as the temperature drops below zero produces slush rather than ice. To do this, you need at least 12g of sugar per 100ml, which would mean sugar-containing slushies would be liable for the highest rate of <a href="https://www.gov.uk/government/statistics/soft-drinks-industry-levy-statistics/soft-drinks-industry-levy-statistics-commentary-2021#:%7E:text=Soft%20Drinks%20Industry%20Levy%20net%20liabilities,-SDIL%20rates&text=In%20April%202023%2C%20SDIL%20was,rate%20(24p%20per%20litre).">tax at 24p per litre</a> in the UK. </p>
<p>In line with <a href="https://www.gov.uk/government/collections/sugar-reduction">sugar reduction strategies</a>, aimed at helping people consume the target set by the government’s <a href="https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report">Scientific Advisory Committee on Nutrition</a> of less than 5% of energy from added sugar, manufacturers have looked for another solution.</p>
<p>In a slushy, intense sweeteners, such as aspartame, won’t work as it is a very intense sweetener <a href="https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report">being 200 times sweeter</a> than sugar. So you can’t just swap out sugars for aspartame. A different solution is needed, one where a similar quantity of sweetener is used compared with sugar. These so-called bulk sweeteners, such as sorbitol and mannitol, can have a laxative effect, so they aren’t great options. </p>
<p>Glycerol was the chosen solution, which can make a slushy with around 5g per 100ml. But is that amount safe to consume?</p>
<p>European Food Safety Agency reassessed the <a href="https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2017.4720">safety of glycerol</a> in 2017. It reported that consuming 125mg per kilogram of body weight per hour was enough to increase the concentration of blood and potentially cause symptoms in patients. This was based on how glycerol was used in the past to treat swelling in the brain (cerebral oedema). However, there is little data on the effect of glycerol outside of hospitals, and it was assumed that this level of intake could be linked to potential risks. </p>
<p>For an adult, there are no risks of drinking an average-sized slushy, simply because they are bigger and unlikely to achieve a blood level high enough to bring on symptoms. But for a young child, because of their size, it was considered that the risk was deemed high enough for warnings to be issued.</p>
<p>However, the Food Standards Agency’s response and recommendations to restrict the supply of slushies to young children could benefit from being more clearly communicated and more effectively applied.</p><img src="https://counter.theconversation.com/content/223213/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Duane Mellor consulted with Frozen Brothers as part of the Food Standards Agency work on the safety of glycerol as a sweetener in slush drinks</span></em></p>The Food Standards Agency advises that children under four should not be given these drinks.Duane Mellor, Lead for Evidence-Based Medicine and Nutrition, Aston Medical School, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2230372024-02-27T16:31:23Z2024-02-27T16:31:23ZChildren get arthitis too, with life-changing effects – but exercise can help<figure><img src="https://images.theconversation.com/files/576156/original/file-20240216-22-hvocoq.jpg?ixlib=rb-1.1.0&rect=46%2C23%2C5184%2C3422&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rheumatoid-arthritis-xray-both-child-hands-228508336">Puwadol Jaturawutthichai/Shutterstock</a></span></figcaption></figure><p>Arthritis is usually associated with older people but kids can suffer too. Juvenile idiopathic arthritis (JIA) is the most common type of arthritis in children. It affects about about 1 in 1,000 kids under 16 in the UK <a href="https://www.jarproject.org/about-jia">(roughly 15,000 children)</a>, and causes joint pain and inflammation in the hands, knees, ankles, elbows and wrists – although it can affect other body parts, too.</p>
<p>There’s no cure for JIA. Pain can be managed through treatments to ease symptoms, reduce pain and swelling, and prevent joint damage. Medications such as <a href="https://versusarthritis.org/about-arthritis/treatments/drugs/methotrexate/">immunosuppressant methotrexate</a> and <a href="https://bnf.nice.org.uk/drugs/etanercept/">biological medicine etanercept</a> are widely used. But these treatments can have side effects, such as decreasing ability to fight infection.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9015041/">Physical activity is essential</a> for kids with juvenile idiopathic arthritis, but sometimes there’s worry it might make their symptoms worse. This condition can cause joint pain, stiffness, and weak muscles, which might stop children from being active. Yet even with these challenges, exercise is beneficial for children with JIA. </p>
<p>JIA isn’t just a physical issue. It affects <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406228/">social connections</a> and future independence, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830373/">requiring more than medical care</a>. <a href="https://advancesinrheumatology.biomedcentral.com/articles/10.1186/s42358-020-00138-4">Teens with JIA struggle</a> more than their peers, bringing extra difficulties with <a href="https://ped-rheum.biomedcentral.com/articles/10.1186/s12969-017-0172-2">school, career choices</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9015041/">staying active</a>, and social development. </p>
<h2>How arthritis leaves kids isolated</h2>
<p>In particular, JIA students struggle with <a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-13-2">attendance and participation</a>. They may need to <a href="https://journals.sagepub.com/doi/10.1177/13674935221083167?icid=int.sj-challenge-page.citing-articles.1045">avoid some physical activities</a>, which can leave them <a href="https://jia.org.uk/resource/emotions-and-mental-health/">feeling isolated</a> and impact their studies.</p>
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<p>Schools can support them with <a href="https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(18)30311-0/fulltext">tailored programs</a> that address their needs, helping them manage their illness and stay engaged in school. This <a href="https://www.versusarthritis.org/media/25560/supporting-a-young-person-information-booklet-may2023.pdf">support is vital</a> for their educational success and future career prospects, but missing school and activities can still hinder their achievements.</p>
<p>If the teenage years are not handled well, it can <a href="https://pubmed.ncbi.nlm.nih.gov/28503954/">affect their work life later on</a>. They might find themselves missing work often, struggling to focus while at work, or facing disabilities that make working difficult. </p>
<p>JIA changes over time, which can also make work more difficult. Some people might see their symptoms improve and go into remission, while others might deal with ongoing disability. This uncertainty makes planning for the future and finding the right job even more challenging.</p>
<p>It’s essential, then, to help these young people manage their illness and support their mental and social needs at an early stage.</p>
<h2>Physical Activity</h2>
<p>One thing that can make a difference is enabling them to take part in physical activity. Lack of activity can lead to weak bones and a lower quality of life whereas appropriate exercise can help make children’s bones stronger, build muscle, improve their ability to exercise, and make them feel better overall. Experts suggest children with JIA should try to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9015041/#:%7E:text=Physical%20activity%20(PA)%20and%20exercise,children%20including%20children%20with%20JIA.&text=Current%20PA%20recommendations%20for%20children,least%203%20days%20per%20week.">active for 60 minutes a day</a> in a way that suits their health and symptoms. </p>
<p>JIA doesn’t have to <a href="https://www.arthritis.org/health-wellness/healthy-living/physical-activity/getting-started/sports-safety-for-kids-with-arthritis">preclude taking part in sports</a>, as demonstrated by professional golfer <a href="https://curearthritis.org/scientists/kristy-mcpherson/">Kristy McPherson</a> and American football star <a href="https://youtu.be/_3F5KaI5EfU?feature=shared">Charcandrick West</a> who forged careers as elite athletes despite the challenges of their condition.</p>
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<p>Yet, kids with this condition <a href="https://www.contemporarypediatrics.com/view/patients-with-juvenile-idiopathic-arthritis-less-physically-active-than-controls">often do less exercise</a> than their peers, illustrating the need for clear, tailored advice on how children with JIA can exercise safely. This advice should be part of a bigger plan that includes their medical treatment and regular, suitable exercise to help improve their health and avoid future problems.</p>
<p>The problem is <a href="https://pubmed.ncbi.nlm.nih.gov/38328475/#:%7E:text=Only%2019%25%20of%20respondents%20were,incorrect%20assumptions%20to%20be%20true.">low awareness about arthritis</a> in young people can prevent them from getting the support they need to thrive. So it’s crucial for adults in influential roles, like teachers and policymakers – such as politicians and healthcare commissioners – to understand these challenges to improve support for young people with JIA.</p>
<p>Research is underway at the University of Manchester to <a href="https://www.nuffieldfoundation.org/project/juvenile-onset-rheumatic-diseases-education-vocational-readiness-employment">better understand the impact</a> of various juvenile rheumatic diseases, including JIA, on adolescents and young adults. Our research aims to address some of the unique challenges faced by young people with JIA by informing the development of evidence-based policies that can be implemented by schools, in the work place and government policy to help support the needs of young people with arthritis.</p>
<p>JIA may not always be visible, yet its profound impact on young lives extends far beyond childhood, influencing education, social connections, and future employment. Recognising the full scope of JIA’s effects, alongside ensuring comprehensive support that encompasses both medical and social care, is essential for empowering affected children to navigate their challenges more effectively and lead fulfilling lives.</p><img src="https://counter.theconversation.com/content/223037/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ash Cox receives funding from Nuffield Foundation. </span></em></p>Low awareness of how arthritis affects young people leaves thousands of children without appropriate support.Ash Cox, Postdoctoral research associate, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2158922024-01-14T19:05:46Z2024-01-14T19:05:46ZHelp, I’ve just discovered my teen has watched porn! What should I do?<figure><img src="https://images.theconversation.com/files/562600/original/file-20231130-15-eyet8z.jpg?ixlib=rb-1.1.0&rect=122%2C0%2C8057%2C5297&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/worried-teenage-girl-sitting-desk-bedroom-2261420967">Shutterstock</a></span></figcaption></figure><p>Unlike in previous generations, you’re unlikely to discover your adolescent’s first exposure to adult sexual content from finding a scrunched-up Playboy magazine under their mattress. </p>
<p>With easy access to the internet and the use of tablets and mobile phones, it’s more likely to be from free, mainstream online porn. And it can be a very shocking introduction to sex.</p>
<p>But it’s <a href="https://doi.org/10.1111/1753-6405.12678">common</a> and has become normalised among young people. The <a href="https://doi.org/10.1111/1753-6405.12678">median age</a> for boys to first view pornography is 13, while for girls it’s 16. </p>
<p>OK, so your child or adolescent has watched a porn video. First, stay calm. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tiktok-has-a-startling-amount-of-sexual-content-and-its-way-too-easy-for-children-to-access-216114">TikTok has a startling amount of sexual content – and it's way too easy for children to access</a>
</strong>
</em>
</p>
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<h2>Start a discussion about what porn is – and isn’t</h2>
<p>How much detail you go into and what’s appropriate for them to know will depend on their age and level of maturity. </p>
<p>Many parents let their adolescents know porn is not real – it’s a fantasy. But it’s not enough to just say, “that’s not real”. They also need to know what reality is. </p>
<p>Explain that porn is not what sex is like – and what’s wrong with depictions of sex in porn: everyone who’s involved should be enjoying it, not just the man. </p>
<p>In porn, you don’t see all the normal things that happen around sex, like discussions on how to ask about consent, or even the bloopers of sex, such as when people change positions, negotiate, and move around. </p>
<p>Porn is not designed to show sex the way it would be experienced as pleasurable, or show what positive relationships are meant to look like. People don’t tend to ask, “do you want to do that?” And if they do, you won’t see what happens if someone says “no”. The performers aren’t doing it in a way that feels good, but instead focus on what is deemed to “look good”. </p>
<p>Porn doesn’t present sex in a real way, and it can change young people’s ideas and expectations about <a href="https://www.thegist.org.au/topics/how-porn-is-different-from-sex-in-the-real-world/">what sex is</a>. </p>
<h2>How are adolescents accessing porn?</h2>
<p>Adolescents are used to discovering things on their own using the internet and are naturally curious about sex. Their exposure to porn can come from something as simple as googling a term they’ve never heard of before, or their friends <a href="https://doi.org/10.1111/1753-6405.12678">sending them a link</a>. </p>
<p>They’re most likely to come across mainstream porn. With lots of flesh, quick movements and closeups, it can be very graphic and can come across as violent to someone seeing it for the first time. </p>
<p>This becomes how adolescents, who don’t have personal experiences of sex, or have the information they need, learn about sex. Just as they go to YouTube to learn how to cook a meal or fix the tap, they are used to watching and following. </p>
<p>And for something private and stigmatised like sex, there are limited good alternatives for them to learn how it really works.</p>
<figure class="align-center ">
<img alt="Girl looks at her phone while sitting at her desk" src="https://images.theconversation.com/files/562596/original/file-20231130-21-lxi54r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562596/original/file-20231130-21-lxi54r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562596/original/file-20231130-21-lxi54r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562596/original/file-20231130-21-lxi54r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562596/original/file-20231130-21-lxi54r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562596/original/file-20231130-21-lxi54r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562596/original/file-20231130-21-lxi54r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are limited alternatives to learn how sex really works.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/worried-teenage-girl-sitting-desk-bedroom-2261420967">Shutterstock</a></span>
</figcaption>
</figure>
<h2>When should we have ‘the talk’?</h2>
<p>An open conversation about safety, sex, consent and relationships and gender roles is important throughout their whole life. Introduce the topic of sex gradually, depending on your child’s age. It doesn’t have to be a big sit down, to have a big talk.</p>
<p>It’s best to bring it up in relevant situations, particularly on seeking ongoing consent, because that applies to all aspects of life. Everyone has the right to make decisions about their own body, and it’s up to them if they <a href="https://www.thegist.org.au/topics/enthusiastic-consent-and-communication">want to be</a> touched, hugged, kissed or have sex. It’s also important to reinforce that women and girls have feelings and needs, and they’re not just there to look pretty. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-you-teach-a-primary-school-child-about-consent-you-can-start-with-these-books-190063">How do you teach a primary school child about consent? You can start with these books</a>
</strong>
</em>
</p>
<hr>
<p>If they’re asking questions, then they’re old enough to talk about it. Ideally, you won’t wait for them to ask. You should be having conversations about consent, positive relationships, and sex from an early age. But it’s important to talk about it earlier rather than later, even if you don’t think they’ve watched porn. </p>
<p>Instead of saying “have you heard about porn?”, let them know from a young age they can trust you if they see something online that they don’t like or confuses them. Assure them you can’t believe everything you see online and you’re a safe person to go to with any questions.</p>
<p>Let them know it’s not their fault if they see something they don’t like, make sure they are OK and ask how it made them feel. Remind them to simply close the browser or turn off the screen if they see something that <a href="https://www.esafety.gov.au/kids/i-want-help-with/i-saw-something-online-i-didn%E2%80%99t-like">upsets them</a> or makes them feel yuck. </p>
<h2>Can I prevent my child accessing porn?</h2>
<p>Your children will <a href="https://www.sciencedirect.com/science/article/pii/S1326020023010269?via%3Dihub">probably see porn</a> at some point, but the older they are when they first see it, <a href="https://www.sciencedirect.com/science/article/pii/S1326020023010269?via%3Dihub">the better</a>.</p>
<p>Data shows watching porn is <a href="https://doi.org/10.2196/16702">associated with</a> poor mental health, riskier sexual behaviours, and attitudes <a href="https://doi.org/10.1080/00224499.2017.1417350">supporting violence against women</a>.</p>
<p>Unlike with adolescents where conversations are paramount, restrictions can prevent and protect young children from seeing porn. These include <a href="https://www.esafety.gov.au/parents/issues-and-advice/parental-controls?gclid=CjwKCAjws9ipBhB1EiwAccEi1HAKM-aKbxzwQ2oY8BM7Jpi4yjP4QPSK1vOk7GIy9d7xLyfEtM9CuBoCI1EQAvD_BwE">parental controls</a> on devices, apps or browsers, or establishing rules about when, where and with whom they can access their phones, computers or tablets. Yes, older teenagers can probably get past them, but younger kids can’t.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-we-need-to-talk-about-porn-when-we-talk-about-andrew-tate-201059">Why we need to talk about porn when we talk about Andrew Tate</a>
</strong>
</em>
</p>
<hr>
<p>Be open and honest with your kids about using internet restrictions – don’t spy on them. Let them know why you’re doing it, explaining there are bad things online you need to protect them from – it’s about building trust.</p>
<p>If you find your child showing unusual behaviour or acting out towards other children, or your teen shows signs of addiction (where their viewing activities interfere with their day-to-day lives), <a href="https://www.thegist.org.au/support-services/">seek</a> professional <a href="https://www.esafety.gov.au/">help</a>. </p>
<p><em><a href="https://www.thegist.org.au/">The GIST</a> is a great resource for parents and older teens about how to approach difficult topics like this. If you’re a child or adolescent and need support, you can call the <a href="https://kidshelpline.com.au/">Kids Help Line</a> on 1800 55 1800.</em></p><img src="https://counter.theconversation.com/content/215892/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Megan Lim receives funding from the National Health and Medical Research Council, VicHealth, Westpac Foundation, and the Office of the eSafety Commissioner. </span></em></p>Chances are, your teenager has already seen online porn. How should you respond if you find out they are watching it? What conversations should you be having with young children to prepare them?Megan Lim, Head of Young People's Health Research, Burnet InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2166862024-01-03T17:41:27Z2024-01-03T17:41:27ZDyspraxia affects children’s wellbeing – here’s how parents and caregivers can help<figure><img src="https://images.theconversation.com/files/567121/original/file-20231221-22-obf0w5.jpg?ixlib=rb-1.1.0&rect=23%2C59%2C7106%2C5237&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lonely-asian-school-boy-watches-his-1479198308">Vietnam Stock Images/Shutterstock</a></span></figcaption></figure><p>It’s likely <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2066137/">at least one child</a> in every classroom has movement difficulties in the form of developmental coordination disorder (DCD), also known as developmental dyspraxia.</p>
<p>DCD is a disorder that affects a child’s ability to perform and learn everyday tasks that require <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.14132">motor coordination</a>. Children with DCD typically struggle with academic tasks such as handwriting, as well as dressing themselves and using cutlery and tools. They may <a href="https://dcdaustralia.org.au/what-is-dcd-2/">find it difficult</a> to play ball games or to learn to ride a bike or swim. Parents also report that their children with DCD are <a href="https://dcdaustralia.org.au/wp-content/uploads/2022/09/Impact-for-DCD-Report-Summary.pdf">more tired</a> than other children at the end of the day. </p>
<p>When these skills are hard and frustrating to learn – and tiring too – a child’s motivation to take part in them can wane, along with their self-belief. </p>
<h2>Hidden struggles</h2>
<p>DCD is a <a href="https://dyspraxiafoundation.org.uk/what_is_dyspraxia/dyspraxia-at-a-glance/">common childhood disorder</a>. Children with DCD often also have one or more <a href="https://dyspraxiafoundation.org.uk/what_is_dyspraxia/dyspraxia-foundation-faqs/">other developmental disorders</a>, such as ADHD, autism and developmental language and learning disorders. But because children with DCD often avoid the tasks they struggle with, their issues may become invisible. </p>
<p>Children with DCD often have lower <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770330/">academic attainment</a> than their peers. Parents in Australia reported that they believed the <a href="https://dcdaustralia.org.au/wp-content/uploads/2022/09/Impact-for-DCD-Report-Summary.pdf">main challenges</a> at school for their children with DCD were “teacher awareness of the condition, fatigue and keeping up in class, making friends and socialising, inclusion in the playground, and bullying”.</p>
<p>Children with DCD are likely to take part in less <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/oti.1393">physical activity</a> than peers. This can be exacerbated by adult leaders not knowing how to successfully integrate children with DCD into a <a href="https://journals.lww.com/pedpt/fulltext/2018/04000/role_of_pediatric_physical_therapists_in_promoting.9.aspx">team sport environment</a>. Children with DCD are more likely to choose <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/oti.1393">sedentary activities</a>, such as reading and playing computer or board games. </p>
<p>This can result in less physically active lifestyles and lower physical fitness and <a href="https://www.sciencedirect.com/science/article/pii/S0891422218301264?via%3Dihub">cardiovascular health</a>. </p>
<p>What’s more, avoiding group and social activities can lead to a child with DCD becoming left out – and this has an impact on their happiness. Children with DCD often <a href="https://www.sciencedirect.com/science/article/pii/S0891422221002365#:%7E:text=Children%20with%20developmental%20coordination%20disorder,dimensions%20than%20typically%20developing%20peers.">score lower</a> on quality of life measures than their peers in areas including physical wellbeing and friendships. DCD <a href="https://link.springer.com/article/10.1007/s11136-018-2075-1">also affects</a> parents’ and siblings’ wellbeing, family life and the parents’ work. </p>
<p>Adults with suspected DCD <a href="https://www.sciencedirect.com/science/article/pii/S089142221300005X">report issues</a> with anxiety and depression and rate their life satisfaction fairly poorly. </p>
<h2>Taking action</h2>
<p>Seeking a referral to a health professional who is versed in paediatric treatment can be a positive first step to help a child deal with DCD. Telehealth programmes – remote healthcare that takes place, for instance, over video call – to help improve motor skills are just starting to emerge, with <a href="https://journals.sagepub.com/doi/pdf/10.1177/03080226231181018">preliminary evidence</a> suggesting they are effective. </p>
<p>School- and other group-based activity programs are <a href="https://www.sciencedirect.com/science/article/pii/S0891422218300027">also beneficial</a> for skill development, social interaction and fitness, but are not widely available. Active video games <a href="https://www.sciencedirect.com/science/article/pii/S0891422218300027">may also be useful</a> to hone skill and fitness. <a href="http://elearningcanchild.ca/dcd_workshop/index.html">Online resources</a> can help point parents towards ways to assist their child with activities they find difficult. </p>
<figure class="align-center ">
<img alt="Boy writing in notebook with pencil" src="https://images.theconversation.com/files/567141/original/file-20231221-23-wxxywl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567141/original/file-20231221-23-wxxywl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567141/original/file-20231221-23-wxxywl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567141/original/file-20231221-23-wxxywl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567141/original/file-20231221-23-wxxywl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567141/original/file-20231221-23-wxxywl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567141/original/file-20231221-23-wxxywl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">DCD can make handwriting difficult.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/student-drawing-pencil-on-notebook-boy-1582631920">Fabio Principe/Shutterstock</a></span>
</figcaption>
</figure>
<p>Raising awareness of DCD matters. It has consequences for the child and their families, but also for society. <a href="https://journals.sagepub.com/doi/10.1177/0308022619866642">Research has found</a> that in the UK, the average direct healthcare cost to parents of a child with DCD. over a six-month period was £700. But this does not take into account any changes to employment – affecting the workforce – that might be needed to accommodate care needs. </p>
<p>Awareness of DCD remains low, which means children are not receiving the support they desperately need. Parents also report difficulties <a href="https://journals.sagepub.com/doi/10.1177/0308022619866642">accessing services</a> for their children. </p>
<p>For parents or caregivers, it is recommended that their child with DCD receive intervention delivered by healthcare professionals with the relevant <a href="https://onlinelibrary.wiley.com/doi/10.1111/dmcn.14132">training and expertise</a>. Informed intervention that considers the individual aspirations and preferences of the child, and that integrates sound motor learning strategies will enable them to improve their motor skills, build confidence, and meet their life goals.</p><img src="https://counter.theconversation.com/content/216686/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carolyn Dunford receives funding from Elizabeth Casson Foundation.
Authors: Carolyn Dunford, Peter Wilson, Mellissa Prunty as part of the “DCD Big Ideas Group” 25 key researchers in the field of DCD (from early-career to established) working to develop a clear vision for the future of research on DCD.</span></em></p><p class="fine-print"><em><span>Mellissa Prunty receives funding from The Royal College of Occupational Therapists. She is also Chair of the National Handwriting Association.</span></em></p><p class="fine-print"><em><span>Peter Wilson receives funding from the Australian Automobile Association (AAA), and previously from the Australian Research Council (ARC). </span></em></p>Children with DCD often avoid the tasks they struggle with, meaning their issues may become invisible.Carolyn Dunford, Reader in Occupational Therapy, Brunel University LondonMellissa Prunty, Reader in Occupational Therapy, Brunel University LondonPeter Wilson, Professor of Developmental Psychology, Australian Catholic UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2193902023-12-24T20:54:28Z2023-12-24T20:54:28ZRelax – having different sleeping arrangements over the holidays probably won’t wreck your child’s sleep routine<figure><img src="https://images.theconversation.com/files/564133/original/file-20231207-25-tzvzwq.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C4743%2C3145&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-boy-jumping-on-bed-bedroom-1024614475">Shutterstock</a></span></figcaption></figure><p>Sleep, along with diet and physical activity, is one of the three pillars of good health. Good sleep makes it easier to grow, learn, perform, be happy, stay in our best weight range and generally be in the best mental and physical health. This is true for all humans but is particularly important with children.</p>
<p>Regular sleep patterns are important for good sleep. But children and their families often stay with relatives or in holiday accommodation around this time of year. Parents may anxiously wonder: will changing sleeping arrangements during school holidays sabotage good habits formed and maintained during the school term? </p>
<p>For over 20 years, I have researched and treated children sleep problems. The research suggests changing sleep patterns over the summer break does not have to be a problem. And there’s a lot you can do to manage sleep issues during and after the holidays.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5184%2C3453&q=45&auto=format&w=1000&fit=clip"><img alt="A dad kisses his daughter on the head at bedtime as she lies in the bottom bunk." src="https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5184%2C3453&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Changing sleep patterns over the summer break does not have to be a problem.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/father-kissing-goodnight-daughter-bedtime-627688967">Shutterstock</a></span>
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</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-loosen-up-on-the-kids-bedtime-these-holidays-or-stick-to-the-schedule-tips-from-a-child-sleep-expert-192727">Should I loosen up on the kids' bedtime these holidays – or stick to the schedule? Tips from a child sleep expert</a>
</strong>
</em>
</p>
<hr>
<h2>Sleeping as a skill</h2>
<p>In Australia, as in many western industrialised countries, parents often (but not always) expect their children to <a href="https://jcsm.aasm.org/doi/full/10.5664/jcsm.6284">sleep alone</a> in their own room and in their own bed. </p>
<p>Up to <a href="https://pubmed.ncbi.nlm.nih.gov/20582760/">40% of families</a> use behavioural sleep strategies to teach their child sleep alone. While such strategies are generally successful in achieving this, it can be hard work for all the family.</p>
<p>Many parents worry that having children share a room or even a bed with their parents over the holidays will become the habit during term time, too.</p>
<p>However, the science says once children have learned a skill, such as sleeping alone, they have a “<a href="https://eclass.uowm.gr/modules/document/file.php/NURED263/Pound%20How%20Children%20Learn_%20Educational%20Theories%20and%20Approaches%202014%20book.pdf">neural understanding</a>” of that skill. That means their brain has registered, recorded and filed the “memory” of sleeping alone and this is stored for quite a long time.</p>
<p>Short relapses or interruptions to using that skill will not eradicate it in the brief time of a holiday. The child will still know how to sleep alone. </p>
<p>However, <a href="https://theconversation.com/is-there-such-a-thing-as-too-old-to-co-sleep-with-your-child-the-research-might-surprise-you-188145">they may not want to</a>.</p>
<p>Children may may realise sleeping with parents or siblings is actually pretty great (for them). It may be less fun, however, for the parents (who may not necessarily want to share a bed with a wriggly child, or feel frustrated by seeing siblings who don’t normally share a room, muck around when they should be asleep).</p>
<p>Like many aspects of parenting, it helps for parents to remind their children of the rules at home and guide them back to their regular sleep pattern.</p>
<p>Helping children to understand the co-sleeping or room sharing arrangement may be temporary is helpful. Children can and do learn sleeping arrangements can be different in different places, but the rules stay the same at home.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two children peek out from a bunk bed." src="https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sometimes, being on holidays means sharing a room with your sibling or cousins for the first time.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-happy-young-boy-brother-lying-140064361">Shutterstock</a></span>
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</figure>
<h2>What if my child won’t sleep at the holiday accommodation?</h2>
<p>This is a problem not just because it keeps parents and others from a good night’s sleep. It also deprives the child of sleep.</p>
<p>For some children, particularly sensitive or anxious children, changing sleep routines and particularly sleep environments can really throw them off. These children <a href="https://pubmed.ncbi.nlm.nih.gov/29302831/">may find any change very difficult</a>. </p>
<p>When these children are faced with an unknown sleeping environment, they may keenly feel the separation from their parents (who make them feel safe). It can be very difficult and sometimes impossible for them to adjust quickly. </p>
<p>The result may be a child taking a longer time to get to sleep, or long and unsettled overnight wakings. Parents may need to mentally prepare and adjust their expectations.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A young girl touches the light switch of a lamp on her bedside table." src="https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Like many adults, some children struggle to sleep in an unfamiliar environment.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-child-girl-resting-on-bedturning-1847058961">Shutterstock</a></span>
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<p>It may help to prepare the child for the changes. Find out information about sleeping arrangements, <em>before</em> you go to your holiday accommodation. Talk to the child about the sleep set up, who will be there, look at pictures and share the excitement of a new place with the child. </p>
<p>Discuss being scared and anxious with the child and learn some strategies together to help them be brave and calm such as “You will have your favourite bunny with you. And we will just be in the next room”? Or, “We can take our night light from home?” Practise these before leaving on the holiday.</p>
<p>Encouraging and helping your child to be brave rather than expecting them to be brave alone is more likely to result in a <a href="https://psycnet.apa.org/record/2015-24314-010">smoother transition</a> from home to holiday and back again. Don’t shame them for feeling scared, but try to gently and empathetically help them learn some strategies to cope. Facing a difficult challenge such as changing sleep environments will also teach them resilience.</p>
<p>So parents don’t need to fear any negative repercussions from changing sleeping environments during the summer holidays. Bring on summer and enjoy.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/many-parents-use-melatonin-gummies-to-help-children-sleep-so-how-do-they-work-and-what-are-the-risks-190129">Many parents use melatonin gummies to help children sleep. So how do they work and what are the risks?</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/219390/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Blunden does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For over 20 years, I have researched and treated children sleep problems. The research suggests changing sleep patterns over the summer break does not have to be a problem.Sarah Blunden, Professor and Head of Paediatric Sleep Research, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2169062023-12-06T22:04:49Z2023-12-06T22:04:49Z5 expert tips on how to look after your baby in a heatwave<figure><img src="https://images.theconversation.com/files/562908/original/file-20231201-21-qxkftk.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-being-washed-face-down-during-2217329091">b-finity/Shutterstock</a></span></figcaption></figure><p>Extreme heat events are becoming more <a href="https://www.acs.gov.au/pages/heatwaves">frequent and intense</a> in Australia. This can cause illness or worsen existing conditions. During hot weather, hospital admissions and deaths <a href="https://www.climatechange.environment.nsw.gov.au/impacts-climate-change/weather-and-oceans/heatwaves">increase</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1732139339596083256"}"></div></p>
<p>Babies are among those particularly vulnerable.</p>
<p>Looking after a baby during extreme heat takes a little planning and a lot of patience. Here are five practical tips.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/extreme-weather-is-landing-more-australians-in-hospital-and-heat-is-the-biggest-culprit-216440">Extreme weather is landing more Australians in hospital – and heat is the biggest culprit</a>
</strong>
</em>
</p>
<hr>
<h2>Why are babies particularly at risk?</h2>
<p>Babies are more vulnerable to extreme heat for several reasons.</p>
<p>They have a <a href="https://www.science.org/doi/10.1126/science.abe5017">higher metabolic rate</a> than older children and adults, so their body generates more internal heat. </p>
<p>They also have a larger surface area compared with the volume of their body. So they <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770410">adsorb heat</a> more easily from the environment. </p>
<p>Their sweat glands are <a href="https://www.livescience.com/newborns-no-tears-or-sweat.html">not fully developed</a>. So they cannot lose heat by sweating as easily as older children and adults.</p>
<p>Babies also have to rely on adults to keep them safe when the weather is hot. They cannot move to a cooler place or drink more fluids without help from their parents or caregivers.</p>
<h2>1. Plan ahead</h2>
<p>Knowing if hot weather is coming allows you to prepare and avoid, or reduce, your baby’s exposure to heat. </p>
<p>So keep an eye on forecasts from the <a href="http://www.bom.gov.au/">Bureau of Meteorology</a> (including its <a href="http://www.bom.gov.au/australia/heatwave/">heatwave warning service</a>). Your local <a href="https://www.abc.net.au/local">ABC radio station</a> broadcasts emergency information, and you can search for emergency conditions on the <a href="https://www.abc.net.au/emergency">ABC website</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/worried-about-heat-and-fire-this-summer-heres-how-to-prepare-212443">Worried about heat and fire this summer? Here's how to prepare</a>
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</em>
</p>
<hr>
<h2>2. Keep your home cool</h2>
<p>On hot days, close windows, blinds and curtains early in the day and keep outside doors shut. If you live in a multi-storey building, stay downstairs where the air will be cooler. </p>
<p>Air conditioning will keep you cool if you have it. Staying in one part of the house and closing doors to the rest, can make air conditioning more effective and reduce your energy use. Take care to ensure rooms do not become too cold and ensure air flow from air conditioners or fans is not directed at your baby. That’s because babies also have difficulty <a href="https://www.chop.edu/conditions-diseases/warmth-and-temperature-regulation">regulating their temperature</a> in the cold and their temperature can quickly drop. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Fan on chest of drawers, cot in background" src="https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Make sure your fan isn’t blowing directly at your baby.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/modern-fan-on-commode-baby-room-1897747780">New Africa/Shutterstock</a></span>
</figcaption>
</figure>
<p>Power blackouts are <a href="https://www.energynetworks.com.au/resources/fact-sheets/heatwaves-and-energy-supply-explained/#:%7E:text=Heatwaves%20are%20three%20or%20more,faults%2C%20bushfires%20or%20generator%20faults.">common</a> during extreme heat events. So, think about what you’ll do if you can’t use air conditioning because of a blackout.</p>
<p>If you cannot keep cool at home, try to find somewhere you can go that is air conditioned. This could be a public building, such as a library or shopping centre, or the home of a friend or relative. </p>
<p>Some communities have “<a href="https://www.smh.com.au/national/nsw/no-way-to-escape-the-heat-push-for-havens-to-stop-australia-s-silent-killer-20230816-p5dwzl.html">heat havens</a>” or “<a href="https://www.smh.com.au/national/nsw/homes-aren-t-safe-western-sydney-prepares-evacuation-shelters-for-hot-summers-20220505-p5aioj.html">heat shelters</a>” where vulnerable people, including pregnant women and families with babies, can go during extreme heat.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/evacuating-with-a-baby-heres-what-to-put-in-your-emergency-kit-127026">Evacuating with a baby? Here's what to put in your emergency kit</a>
</strong>
</em>
</p>
<hr>
<h2>3. Take care if you need to go out</h2>
<p>If you do have to go out, ensure your baby is sheltered from the sun and heat as much as possible. </p>
<p>Use a sunshade on car windows to protect you baby from direct sunlight. Never leave a baby or young child <a href="https://raisingchildren.net.au/toddlers/safety/car-pedestrian-safety/never-leave-children-in-cars">in a parked car</a>.</p>
<p>You can help keep your baby cool in their pram by covering it with a light, damp cloth and spraying it with water every 15-20 minutes. Don’t let the cloth dry out completely because this can <a href="https://theconversation.com/covering-your-babys-pram-with-a-dry-cloth-can-increase-the-temperature-by-almost-4-degrees-heres-what-to-do-instead-199099">increase the temperature</a> in the pram.</p>
<p>Once the day starts to cool down, playing with water in a shady spot outside is a great way to cool down. Always supervise babies in or near water.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1629708787866038272"}"></div></p>
<h2>4. Offer babies extra fluids</h2>
<p>Babies need extra fluids during hot weather, but their pattern of feeding can change when it’s hot.</p>
<p>For breastfed babies this often means they start fussing or crying at the breast after just a few minutes, then want to breastfeed again as soon as 30-40 minutes later. </p>
<p>Mothers may worry their breasts have run out of milk, but they haven’t. These short feeds provide milk that is <a href="http://www.foodandnutritionjournal.org/volume2number2/importance-of-exclusive-breastfeeding-and-complementary-feeding-among-infants/">higher in water</a> than a longer breastfeed. </p>
<p>Just like adults, babies don’t want to eat a full meal when they’re hot. Once the day starts to cool down, most babies will have several <a href="https://www.breastfeeding.asn.au/resources/breastfeeding-hot-weather">longer, more satisfying feeds</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1730246909317579131"}"></div></p>
<p>Similarly, formula-fed babies will often take less milk at a feed during the heat of the day but look for another feed sooner than usual.</p>
<p>Instead of trying to make a baby finish a whole bottle, try splitting their usual feed into two. If the baby finishes the first bottle, you can top it up from the second bottle or keep it in the fridge and warm it up again when they start <a href="https://www.breastfeeding.asn.au/resources/feeding-cues">looking hungry</a> again. Just like breastfed babies, they will usually be looking for slightly bigger feeds as the day starts to cool. </p>
<p>Do NOT give babies under six months old water as this can make them very ill. Their kidneys are not mature and <a href="https://www.reuters.com/article/us-water-babies-idUSCOL16728820080521">cannot handle the extra water</a>.</p>
<p>You can tell your baby is getting enough fluids if they have <a href="https://www.breastfeeding.asn.au/resources/baby-getting-enough-breastmilk">five heavy, wet disposable nappies</a> in 24 hours, their urine is pale yellow and doesn’t have a strong smell. </p>
<p>If this isn’t happening, your baby <a href="https://www.health.nsw.gov.au/environment/beattheheat/Pages/babies-children-hot-weather.aspx">needs more fluids</a> and you need to offer more frequent feeds. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Baby chewing on water melon outside in grassy garden or park" src="https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">For older babies, try offering watermelon or strawberries.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-boy-eating-watermelon-red-garden-459152617">Dudaeva/Shutterstock</a></span>
</figcaption>
</figure>
<p>From six months, babies can be given small amounts of <a href="https://www.health.tas.gov.au/publications/drinking-water-babies-fact-sheet">cooled boiled water</a> in addition to breastmilk or formula. You can also offer foods containing lots of water, such as watermelon or strawberries, or iceblocks made with breastmilk, formula or diluted fruit juice. Chewing on a cold, wet face washer is another way older babies can get extra fluids.</p>
<p>Remember to look after yourself when the weather gets hot. Have a glass of water at least every time your baby feeds. If you are breastfeeding and the heat makes skin contact uncomfortable for you and your baby, you can put a light cloth or damp hand-towel between you, or you can lie down to feed so your baby is next to your body instead of on it.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-do-i-tell-if-im-dehydrated-107437">Health Check: how do I tell if I'm dehydrated?</a>
</strong>
</em>
</p>
<hr>
<h2>5. Prepare for sleep</h2>
<p>Everyone struggles to sleep in hot weather. A lukewarm bath may help your baby cool off enough to fall asleep. However, avoid cold baths as your baby’s temperature may drop too much. </p>
<p>Nobody sleeps well on hot nights and we all need to catch up on sleep when the weather cools.</p>
<hr>
<p><em>In extreme heat, if your baby won’t feed well, is limp or floppy, has dull sunken eyes and a sunken soft spot in the skull (fontanelle), seek medical treatment straight away. In an emergency, call 000.</em></p><img src="https://counter.theconversation.com/content/216906/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karleen Gribble is project lead on the Australian Breastfeeding Association's Community Protection for Infants and Young Children in Bushfire Emergencies Project and is an Australian Breastfeeding Association Educator and Counsellor. Karleen is also on the steering committee of the international interagency collaboration the Infant and Young Child Feeding in Emergencies Core Group and has been involved in the development of international guidance and training on infant and young child feeding in emergencies for over a decade.
</span></em></p><p class="fine-print"><em><span>Michelle Hamrosi is the community engagement officer on the Australian Breastfeeding Association's Community Protection for Infants and Young Children in Bushfire Emergencies Project. Michelle is also a general practitioner and an international board certified lactation consultant. Michelle volunteers as a breastfeeding counsellor and group leader for the Australian Breastfeeding Association Eurobodalla group. She is also a member of Doctors for the Environment, Climate and Health Alliance and Australian Parents for Climate Action.</span></em></p><p class="fine-print"><em><span>Nina Chad is an infant and young child feeding consultant for the World Health Organization. She is a member of the Public Health Association of Australia, the World Public Health Nutrition Association, and the Australian Breastfeeding Association.</span></em></p>Looking after a baby during extreme heat events takes a little planning and a lot of patience. Here are some practical steps you can take.Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney UniversityMichelle Hamrosi, Clinical lecturer, Rural Clinical School, Australian National UniversityNina Jane Chad, Research Fellow, University of Sydney School of Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2150642023-12-06T00:00:07Z2023-12-06T00:00:07ZCurious Kids: why do some farts smell and some don’t? And why do some farts feel hot?<figure><img src="https://images.theconversation.com/files/563527/original/file-20231205-25-zu7j1t.jpg?ixlib=rb-1.1.0&rect=27%2C315%2C5979%2C3692&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://theconversation.com/drafts/219203/edit#">Shutterstock</a></span></figcaption></figure><blockquote>
<p><strong>Why do some farts smell and some don’t, and some feel hot? – Kian, age 6, from Maleny in Queensland</strong></p>
</blockquote>
<p><a href="https://theconversation.com/au/topics/curious-kids-36782"><img src="https://images.theconversation.com/files/291898/original/file-20190911-190031-enlxbk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=90&fit=crop&dpr=1" width="100%"></a></p>
<p>Hi Kian, thanks for your interesting questions!</p>
<p>Let’s start with the smell. Whether or not farts smell depends on what you’ve been eating and whether or not you have an upset tummy. </p>
<p>Having a tummy bug can also <a href="https://pubmed.ncbi.nlm.nih.gov/30191735/">change the smell of your poo</a>, especially if you have diarrhoea (runny poo). This is because of the smell of undigested food and the bugs, too.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-do-whales-fart-and-sneeze-159636">Curious kids: do whales fart and sneeze?</a>
</strong>
</em>
</p>
<hr>
<h2>Really smelly farts</h2>
<p>When you digest food your intestines produce gas as part of the normal process of breaking food down. </p>
<p>Most <a href="https://pubmed.ncbi.nlm.nih.gov/19830557/">gasses produced</a> – like carbon dioxide, nitrogen, hydrogen and methane – don’t smell at all. That is why you can fart sometimes and nobody really notices. </p>
<p>But there is one gas found in some farts that is <em>really</em> <em>really</em> smelly. It’s called <a href="https://www.health.wa.gov.au/articles/f_i/hydrogen-sulfide-and-public-health">hydrogen sulphide</a> and has the nickname “rotten egg gas” because that is exactly what it smells like. </p>
<p>This is why sometimes you can do a small fart but everyone has to hold their nose. These smelly farts contain <em>more</em> hydrogen sulphide.</p>
<h2>Food and farts</h2>
<p>If you eat foods that have a lot of sulphur, your gut will produce more hydrogen sulphide. </p>
<p>Some <a href="https://en.wikipedia.org/wiki/Brassica">vegetables</a> have a lot of <a href="https://www.healthline.com/nutrition/foods-with-sulfur#food-beverage-sources">sulphur</a>, such as broccoli, Brussels sprouts, cauliflower, cabbage, kale, turnips and Asian greens. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/10198924/">Meat</a> does too. If you eat a really huge piece of meat, your body can have trouble digesting it all at once. </p>
<figure class="align-center ">
<img alt="Digestive system" src="https://images.theconversation.com/files/563550/original/file-20231205-23-8elmtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563550/original/file-20231205-23-8elmtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563550/original/file-20231205-23-8elmtu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563550/original/file-20231205-23-8elmtu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563550/original/file-20231205-23-8elmtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563550/original/file-20231205-23-8elmtu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563550/original/file-20231205-23-8elmtu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Food moves from our stomach, through our intestines, and out through the anus.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/medical-education-chart-biology-digestive-system-638539159">Shutterstock</a></span>
</figcaption>
</figure>
<p>As you digest food, it moves from your stomach into the <a href="https://www.healthdirect.gov.au/digestive-system#what-is">large intestine or colon</a>. Once the foods with sulphur get there, bugs in your gut break them down and produce the hydrogen sulphide gas. </p>
<p>If a lot of it builds up and gets released in a fart, it will be very, very smelly. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-much-food-should-my-child-be-eating-and-how-can-i-get-them-to-eat-more-healthily-130470">How much food should my child be eating? And how can I get them to eat more healthily?</a>
</strong>
</em>
</p>
<hr>
<h2>So why do farts sometimes feel hot?</h2>
<p>Farts sometimes feel hot because of the temperature difference between inside your body, which is a very warm 37 degrees, and the air temperature outside, which is usually cooler. </p>
<p>This means that fart gas feels hot as it moves from your large intestine, leaves through the opening in your bottom called the <a href="https://www.healthdirect.gov.au/digestive-system#what-is">anus</a>, and touches the cooler skin. </p>
<p>You’re not as likely to notice the temperature if farts comes out really fast because speedy ones don’t have as much contact with your bottom.</p>
<p>There is another reason why farts can feel hot. Sometimes people get a hot or burning feeling in their bottom after they eat really spicy food. This is due to a spicy food chemical called <a href="https://en.wikipedia.org/wiki/Capsaicin">capsaicin</a>. </p>
<figure class="align-center ">
<img alt="Older child eating spicy soup." src="https://images.theconversation.com/files/563551/original/file-20231205-15-82bjts.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563551/original/file-20231205-15-82bjts.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563551/original/file-20231205-15-82bjts.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563551/original/file-20231205-15-82bjts.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563551/original/file-20231205-15-82bjts.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563551/original/file-20231205-15-82bjts.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563551/original/file-20231205-15-82bjts.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sometimes farts feel hot after eating spicy foods.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-boy-eating-noodles-long-hands-2370482909">Shutterstock</a></span>
</figcaption>
</figure>
<p>If you eat food that has chilli or hot spices in it, the capsaicin makes your mouth feel hot. When you eat lots and lots of spicy food, some of the capsaicin <a href="https://pubmed.ncbi.nlm.nih.gov/35644413/">travels all the way to your large intestine</a> and gets passed out in your poo. </p>
<p>The capsaicin then gives you a <a href="https://pubmed.ncbi.nlm.nih.gov/36601592/">hot feeling in your bottom</a> when you go to the toilet. The reaction is the same as that burning feeling in your mouth after eating spicy food, except it happens at the other end.</p>
<h2>Did you know there are fart-proof undies?</h2>
<p>Researchers did some experiments to test whether they could catch fart smells by getting people to wear <a href="https://pubmed.ncbi.nlm.nih.gov/15667499/">special undies</a> that can absorb hydrogen sulphide gas. </p>
<p>And the experiments worked! </p>
<p>Now a <a href="https://shreddies.com.au/about/">company in Australia sells</a> these undies to help people who have gut problems. Their company says it wants to help people “fart with confidence”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-happens-when-you-hold-in-a-fart-98310">Health Check: what happens when you hold in a fart?</a>
</strong>
</em>
</p>
<hr>
<p><em>Hello, Curious Kids! Do you have a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p><img src="https://counter.theconversation.com/content/215064/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Collins AO is a Laureate Professor in Nutrition and Dietetics at the University of Newcastle, NSW and a Hunter Medical Research Institute (HMRI) affiliated researcher. She is a National Health and Medical Research Council (NHMRC) Leadership Fellow and has received research grants from NHMRC, ARC, MRFF, HMRI, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia, WA Dept. Health, Meat and Livestock Australia, and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers, the Sax Institute, Dietitians Australia and the ABC. She was a team member conducting systematic reviews to inform the 2013 Australian Dietary Guidelines update and the Heart Foundation evidence reviews on meat and dietary patterns.</span></em></p>Kian, age 6, has some interesting questions about farts that we’re probably all wondering about.Clare Collins, Laureate Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2164502023-11-15T14:30:06Z2023-11-15T14:30:06ZHealth risks at home: a study in six African countries shows how healthy housing saves children’s lives<p>Housing is a critical social determinant of health. The World Health Organization (WHO) <a href="https://iris.who.int/bitstream/handle/10665/276001/9789241550376-eng.pdf?sequence=22">defines healthy housing</a> as a shelter that supports physical, mental and social wellbeing. </p>
<p>The WHO has developed <a href="https://iris.who.int/bitstream/handle/10665/276001/9789241550376-eng.pdf?sequence=1">guidelines</a> outlining the attributes of healthy housing. These include structural soundness, as well as access to a local community that enables social interactions. Healthy housing protects inhabitants from the effects of disasters, pollution, waste and extreme heat or cold. It provides a feeling of home, including a sense of belonging, security and privacy. </p>
<p>Health risks in the home environment are important to think about because of the amount of time people spend there. In countries where unemployment levels are high or where most work is home based, people spend <a href="https://iris.who.int/bitstream/handle/10665/276001/9789241550376-eng.pdf?sequence=23">more than 70% of their time indoors</a>. Children especially spend a large amount of time at home, which exposes them to any health risks in the home environment.</p>
<p>We are researchers from the African Population and Health Research Center with an interest in urbanisation and population dynamics. We recently set out to <a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03992-5">study the link between housing and children’s health</a>. We found that healthy housing generally lowered the chances of children falling ill with three diseases that we tracked: diarrhoea, acute respiratory illnesses and fever. </p>
<p>The impacts of housing quality extend beyond health and can have significant implications for education and subsequent economic outcomes, particularly for children. </p>
<h2>The research</h2>
<p><a href="https://www.brookings.edu/articles/can-rapid-urbanization-in-africa-reduce-poverty-causes-opportunities-and-policy-recommendations/">Rapid urbanisation and population growth</a> in Africa have pushed many people into informal settlements. Sub-Saharan Africa has <a href="https://blogs.afdb.org/fr/inclusive-growth/urbanization-africa-191">65%</a> of the world’s slum dwellers. This population generally lives in poor housing that lacks access to clean water, sanitation and hygiene services. The structures are overcrowded. They tend to have leaking roofs and damp walls, floors and foundations. They may also have indoor pollution, compromising the health of millions of people.</p>
<p>We set out to <a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03992-5">evaluate</a> the relationship between healthy housing and the likelihood of children falling sick across six African countries: Burkina Faso, Cameroon, Ghana, Kenya, Nigeria and South Africa.</p>
<p>We studied the incidence of diarrhoea, acute respiratory illness and fever among children under the age of five. These three conditions can have severe consequences for child health and wellbeing. </p>
<p>Diarrhoea and acute respiratory infections are <a href="https://academic.oup.com/inthealth/advance-article/doi/10.1093/inthealth/ihad046/7210800">leading causes</a> of disease and deaths in children aged below five worldwide. Diarrhoea accounted for <a href="https://data.unicef.org/topic/child-health/diarrhoeal-disease/">9%</a> of all deaths among children under five in 2019. Acute respiratory illnesses caused about <a href="https://www.who.int/data/gho/indicator-metadata-registry/imr-details/3147">20%</a> of deaths among children in this age group. The burden of under-five deaths linked to diarrhoea and respiratory illnesses like pneumonia is <a href="https://childmortality.org/wp-content/uploads/2023/01/UN-IGME-Child-Mortality-Report-2022.pdf#page=4">higher</a> for children in developing countries than those in developed regions. </p>
<p>We selected the six countries in our study because they provided data on the three diseases we tracked. They also allow for a comparative analysis across African countries. Our study used the latest available demographic and health survey data at the time of our research: Burkina Faso (2010), Cameroon (2011), Ghana (2014), Kenya (2014), Nigeria (2018) and South Africa (2016). We sampled data on 91,096 children aged under five.</p>
<h2>The findings</h2>
<p>Our study found that healthy housing was <a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03992-5/tables/2">generally associated with reduced odds</a> of contracting the three illnesses we considered: diarrhoea, acute respiratory illness and fever. Our definition of healthy housing considered several attributes, including sanitation, drinking water sources and housing characteristics. </p>
<p>Homes that protect occupants from the elements, ensure access to adequate space and reduce overcrowding help keep children healthy. Homes that use cleaner cooking and lighting fuels reduce household air pollution, which leads to lower chances of respiratory infections.</p>
<p>Children living in healthy housing had fewer incidences of fever in all countries apart from South Africa. Here, children living in the healthiest homes are twice as likely to have fever than those living in unhealthy homes.</p>
<p>Fever is an indication of an underlying infection that could be viral or bacterial. Such infections are common in South Africa. In addition, the main causes of fevers among children under five are <a href="https://www.hindawi.com/journals/grp/2023/1906782/">diarrhoea and acute respiratory illnesses</a>. Among the countries included in the analysis, South Africa had the highest proportion of young mothers (aged below 25) and never-married mothers. This increases the chances that these mothers are engaged in work outside the home, leading to the early introduction of complementary feeding. This has been shown to increase the incidence of diarrhoea. These results call for addressing the causes of diarrhoea and respiratory illnesses by, for instance, ensuring South African homes have access to clean drinking water, adequate sanitation and clean energy for cooking.</p>
<p>While healthy housing is crucial, it’s not the sole determinant of a child’s health. Other factors, such as a sense of community, environmental exposure, parental education, income levels, healthcare access, and maternal and child-level factors <a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03992-5/tables/3">also contribute to the overall health status of children</a>. For instance, we found that children in Burkina Faso who were not breastfed had higher chances of getting diarrhoea than those who were breastfed despite the condition of their housing. This tracks with studies that have documented that breastfeeding has a <a href="https://doi.org/10.3389/fped.2023.1086999">protective role</a> over gastrointestinal and respiratory tract infections among children. </p>
<h2>What next</h2>
<p>From our findings, parents can improve the wellbeing of their children by implementing simple strategies. This includes ensuring they use clean energy for cooking to reduce indoor air pollution and consequently reduce the incidence of acute respiratory illnesses. Similarly, using clean drinking water, hand washing and improving sanitation can help reduce cases of diarrhoea. </p>
<p>Bold but nuanced policy and programme government-level interventions can also help address the incidence of diseases affecting children under five in Africa. This requires efforts that go beyond just addressing the issue of housing to working with complementary sectors, like health, urban planning, environment and education.</p><img src="https://counter.theconversation.com/content/216450/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hellen Gitau received funding from Wellcome Trust for this Complex Urban System for Sustainability and Health study. </span></em></p><p class="fine-print"><em><span>Blessing Mberu received funding from Wellcome Trust for this Complex Urban System for Sustainability and Health study. </span></em></p><p class="fine-print"><em><span>Kanyiva Muindi received funding from Wellcome Trust for this Complex Urban System for Sustainability and Health study. </span></em></p><p class="fine-print"><em><span>Samuel Iddi received funding from Wellcome Trust for this Complex Urban System for Sustainability and Health study.</span></em></p>The impact of housing quality extends beyond health to education and subsequent economic outcomes, particularly for children.Hellen Gitau, Research officer, African Population and Health Research CenterBlessing Mberu, Head of Urbanisation and Wellbeing, African Population and Health Research Center, African Population and Health Research CenterKanyiva Muindi, Associate Research Scientist, African Population and Health Research CenterSamuel Iddi, Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2128702023-10-17T04:25:40Z2023-10-17T04:25:40ZWorried about your child’s teeth? Focus on these 3 things<figure><img src="https://images.theconversation.com/files/554152/original/file-20231017-23-mrst9.jpg?ixlib=rb-1.1.0&rect=98%2C0%2C5876%2C3834&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-little-asian-girl-child-showing-1329690827">Shutterstock</a></span></figcaption></figure><p><a href="https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/healthy-teeth">One in three Australian children</a> have tooth decay by the time they start school. This rises to more than 40% by the time they’re <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0268899">eight or nine</a>.</p>
<p>Teeth <a href="https://www.nature.com/articles/nrdp201730">decay</a> occurs when frequent and excessive amounts of sugar disturb bacteria in the mouth. This can lead to holes or “cavities”, which may need fillings. </p>
<p>If untreated, the holes can get bigger, causing pain and infection. Tooth decay is the most common cause of toothache among children and tooth decay is a leading cause of preventable <a href="https://onlinelibrary.wiley.com/doi/10.1111/jpc.15338">hospital admission</a>.</p>
<p>Parents and carers sometimes think baby teeth are less important than adult teeth. But tooth decay can <a href="https://doi.org/10.14219/jada.archive.2009.0250">impair</a> a child’s ability to eat, sleep, learn and socialise. It can affect the <a href="https://doi.org/10.1038/sj.bdj.4814259">quality of life</a> of children, and their parents and carers.</p>
<p>The good news is tooth decay is preventable with three <a href="https://onlinelibrary.wiley.com/doi/10.1111/adj.12973">good dental habits</a>: early dental check-ups, twice daily brushing and limiting sugar.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/yes-baby-teeth-fall-out-but-theyre-still-important-heres-how-to-help-your-kids-look-after-them-148190">Yes, baby teeth fall out. But they're still important — here's how to help your kids look after them</a>
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<h2>1. Early dental check-ups</h2>
<p><a href="https://onlinelibrary.wiley.com/doi/10.1111/adj.12973">Australian</a> and <a href="https://www.aapd.org/globalassets/media/policy-center/year1visit.pdf">international</a> guidelines recommend children have their first dental check-up when the first tooth emerges from the gums (usually at age six months), or by at least 12 months of age. </p>
<p>Yet few families <a href="http://doi.org/10.1111/1753-6405.13224">follow this advice</a>, presuming their child is too young, or that they have healthy teeth.</p>
<p>Early dental check-ups can pick up early signs of tooth decay. This allows simple treatments, such as topical <a href="http://doi.org/10.1002/14651858.CD002279.pub2">fluoride varnish</a>, which stop tooth decay getting worse.</p>
<figure class="align-center ">
<img alt="Dentist shows instrument to child patient" src="https://images.theconversation.com/files/554150/original/file-20231017-17-boe4ni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/554150/original/file-20231017-17-boe4ni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/554150/original/file-20231017-17-boe4ni.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/554150/original/file-20231017-17-boe4ni.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/554150/original/file-20231017-17-boe4ni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/554150/original/file-20231017-17-boe4ni.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/554150/original/file-20231017-17-boe4ni.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Early treatments can stop decay getting worse.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/dentist-showing-a-dental-tool-to-patient-7800560/">Nadezhda Moryak/Pexels</a></span>
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<p>Australian children from families experiencing the greatest adversity are the <a href="https://doi.org/10.3390/ijerph16111970">least likely</a> to access dental services. However, all preschool-aged children are eligible for free dental check-ups through <a href="https://www.teeth.org.au/government-dental-care">public dental services</a>. </p>
<p>Medicare’s <a href="https://www.servicesaustralia.gov.au/child-dental-benefits-schedule">Child Dental Benefits Scheme</a> also provides a capped benefit for eligible children to use at their local dentist. Around 95% of dentists <a href="https://www.health.gov.au/sites/default/files/2023-08/report-on-the-fifth-review-of-the-dental-benefits-act-2008_0.pdf">bulk bill</a> services under the Medicare scheme. </p>
<p>However, with uptake <a href="https://www.health.gov.au/sites/default/files/2023-08/report-on-the-fifth-review-of-the-dental-benefits-act-2008_0.pdf">below 40%</a>, most eligible families are not using the scheme, indicating cost is <a href="https://doi.org/10.1111/hsc.13803">only one barrier</a>. Families living in rural and remote areas, for instance, may find it difficult accessing dental services.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-some-kids-are-more-prone-to-dental-decay-100961">Why some kids are more prone to dental decay</a>
</strong>
</em>
</p>
<hr>
<h2>2. Brush their teeth</h2>
<p><a href="https://doi.org/10.1111/adj.12973">Twice daily brushing</a> using age-appropriate fluoridated toothpaste is recommended. The <a href="http://doi.org/10.1111/adj.12742">Australian fluoride guidelines</a> recommend a low-strength fluoridated toothpaste is used from 18 months of age. </p>
<p>Many young children have teeth spaced apart, so flossing between teeth may not be necessary. However, your dentist may recommend flossing if teeth are in tight contact.</p>
<p>While most Australian adults brush their teeth twice daily, tooth brushing is <a href="https://rchpoll.org.au/wp-content/uploads/2018/03/NCHP10_Poll-report_Child-oral-health.pdf">less consistent</a> in the early years. </p>
<figure class="align-center ">
<img alt="Mum puts toothpaste on daughter's toothbrush" src="https://images.theconversation.com/files/554139/original/file-20231017-25-dfk584.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/554139/original/file-20231017-25-dfk584.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/554139/original/file-20231017-25-dfk584.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/554139/original/file-20231017-25-dfk584.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/554139/original/file-20231017-25-dfk584.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/554139/original/file-20231017-25-dfk584.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/554139/original/file-20231017-25-dfk584.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Use a low-strength fluoride toothpaste from 18 months of age.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/mother-guiding-daughter-on-dental-care-10565654/">Rdne Stock Project/Pexels</a></span>
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<p>For some parents and carers, tooth brushing can be a low priority, as it becomes difficult when young children are uncooperative. Dental check-ups can help parents and carers get individualised support with these important dental habits.</p>
<p>Manual dexterity varies between children, so it’s important to assist children with tooth brushing well into primary school. Some children may need help for longer than others. Ask at your next dental check-up whether your child is brushing well.</p>
<h2>3. Limit sugar</h2>
<p>Consuming sugar early in life can <a href="https://publications.aap.org/pediatrics/article-abstract/134/Supplement_1/S56/33059/The-Association-of-Sugar-Sweetened-Beverage-Intake?redirectedFrom=fulltext">increase the preference</a> for sugar as children get older.</p>
<p>Parents and carers should <a href="http://doi.org/10.1542/peds.2014-0646J">avoid giving free sugars</a> to children. <a href="https://iris.who.int/bitstream/handle/10665/149782/9789241549028_eng.pdf?sequence=1">Free sugars</a> are those added to food and drinks (such as confectionery and soft drinks) and those naturally present in honey and fruit juices.</p>
<p>The World Health Organisation <a href="https://iris.who.int/bitstream/handle/10665/149782/9789241549028_eng.pdf?sequence=1">recommends</a> limiting free sugars to less than 5% of total energy intake. However, many Australian children <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.011%7E2011-12%7EMain%20Features%7EDietary%20Energy%20from%20Free%20Sugars%7E9">consume</a> well above this amount.</p>
<p>Parents and carers <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/nutrition-and-packaging-characteristics-of-toddler-foods-and-milks-in-australia/1C6BA80843B773FC058BD3087D1A22BA">should be wary</a> of aggressive marketing and deceptive labelling of sweet drinks and snacks as healthy alternatives. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/misleading-food-labels-contribute-to-babies-and-toddlers-eating-too-much-sugar-3-things-parents-can-do-194168">Misleading food labels contribute to babies and toddlers eating too much sugar. 3 things parents can do</a>
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<p>Children should also avoid eating and drinking around bedtime to <a href="http://doi.org/10.1177/2380084417749215">reduce</a> the risk of tooth decay. This includes consumption of milk and other sugar-sweetened drinks from bottles to sleep.</p>
<figure class="align-right ">
<img alt="Boy swings" src="https://images.theconversation.com/files/554154/original/file-20231017-23-d0umzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/554154/original/file-20231017-23-d0umzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/554154/original/file-20231017-23-d0umzy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/554154/original/file-20231017-23-d0umzy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/554154/original/file-20231017-23-d0umzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/554154/original/file-20231017-23-d0umzy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/554154/original/file-20231017-23-d0umzy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fluoridated water protects kids’ teeth from decay.</span>
<span class="attribution"><a class="source" href="https://pixabay.com/photos/kid-boy-swinging-young-swing-386642/">Cherylholt/Pixabay</a></span>
</figcaption>
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<p>The best alternative to sugar-sweetened drinks is water. Drinking water from a fluoridated water supply will help <a href="https://doi.org/10.3390/ijerph16111970">protect</a> your child’s teeth from decay.</p>
<p>Community water fluoridation was one of the <a href="https://blogs.cdc.gov/pcd/2015/04/23/community-water-fluoridation-one-of-the-10-greatest-public-health-achievements-of-the-20th-century/">greatest public health achievements</a> of the 20th century. But some Australians, particularly in rural and remote areas, miss out. People living in these areas might benefit from other fluoride therapies (such as fluoride mouth rinses) but should discuss this with their dentist.</p>
<p>Families have an important role to play in children’s dental health. Early dental check-ups, brushing teeth twice a day with age-appropriate fluoridated toothpaste, and limiting sugar will allow children to reach adulthood with healthy mouths.</p><img src="https://counter.theconversation.com/content/212870/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mihiri Silva receives funding from the Medical Research Futures Fund. She is affiliated with the Australian Dental Association as the chair of the Oral Health Committee. </span></em></p><p class="fine-print"><em><span>Sharon Goldfeld receives funding from the Candian Institutes of Health Research. </span></em></p><p class="fine-print"><em><span>Elodie O'Connor and Rachelle Welti do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tooth decay in children is preventable. Here’s what to focus on.Mihiri Silva, Paediatric dentist, Senior Lecturer and Clinician-Scientist Fellow, MCRI and University of Melbourne, Murdoch Children's Research InstituteElodie O'Connor, Research Officer, Murdoch Children's Research InstituteRachelle Welti, Lecturer, The University of MelbourneSharon Goldfeld, Director, Center for Community Child Health Royal Children's Hospital; Professor, Department of Paediatrics, University of Melbourne; Theme Director Population Health, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2151332023-10-16T12:31:43Z2023-10-16T12:31:43ZGun deaths among children and teens have soared – but there are ways to reverse the trend<p>Firearm injuries are now <a href="https://doi.org//10.1056/NEJMc2201761">the leading cause of death</a> among U.S. children and teens following a huge decadelong rise.</p>
<p>Analyses published on Oct. 5, 2023, by a research team in Boston found an <a href="https://doi.org/10.1542/peds.2023-063411">87% increase in firearm-involved fatalities</a> among Americans under the age of 18 from 2011 to 2021.</p>
<p>Such an increase is obviously very concerning. But <a href="https://ssw.umich.edu/faculty/profiles/tenure-track/rlsokol">as scholars</a> <a href="https://sph.umich.edu/faculty-profiles/zimmerman-marc.html">of adolescent health</a> <a href="https://medicine.umich.edu/dept/emergency-medicine/patrick-carter-md">and firearm violence</a>, we know there are many evidence-based steps that elected officials, health care professionals, community leaders, school administrators and parents can implement to help reverse this trend.</p>
<h2>Trends in firearm deaths</h2>
<p>The latest study is based on data from the Centers for Disease Control and Prevention. This data also provides information on whether firearm deaths were the result of homicide, suicide or unintentional shootings.</p>
<p>We have seen <a href="https://www.pewresearch.org/short-reads/2023/04/06/gun-deaths-among-us-kids-rose-50-percent-in-two-years/">increases over time</a> in all three areas. The steepest increase has been in the rate of firearm homicides, which <a href="https://wisqars.cdc.gov/reports/">doubled over the decade</a> to 2021, reaching 2.1 deaths per 100,000 children and teens, or about 1,500 fatalities annually. Firearm-involved suicides have also increased steadily to 1.1 deaths per 100,000 children and teens in 2021.</p>
<p>Whereas the proportion of youth firearm-involved deaths due to unintentional shootings is typically highest during childhood, the <a href="https://wisqars.cdc.gov/reports/">share of gun deaths</a> due to suicide peaks in adolescence.</p>
<p>In 2021, homicide was the most common form of firearm-involved deaths in almost every age group under the age of 18, with an exception of 12- and 13-year-olds, in which suicide was the leading cause of firearm fatalities.</p>
<p>Racial disparities in firearm deaths, which have been present for multiple generations, are <a href="https://www.cdc.gov/vitalsigns/firearm-deaths/index.html">also expanding</a>, research shows.</p>
<p>Black children and teens are now dying from firearms at around <a href="https://wisqars.cdc.gov/reports/">4.5 times the rate</a> of their white peers. </p>
<p>This disparity is the consequence of structural factors, including the effects of systemic racism and economic disinvestment within many communities. Addressing racial disparities in firearm-involved deaths will require supporting communities and <a href="https://doi.org//10.1001/jamanetworkopen.2023.12425">disrupting inequity by</a> addressing long-term underfunding in Black communities and punitive policymaking.</p>
<p>More research is needed to fully understand why firearm-involved deaths are universally increasing across homicide, suicide and unintentional deaths. The COVID-19 pandemic and its <a href="https://doi.org/10.1016/j.amepre.2021.08.026">exacerbation of social inequities and vulnerabilities</a> likely explain some of these increases. </p>
<h2>How to reduce gun fatalities</h2>
<p>Reducing young people’s <a href="https://theconversation.com/how-easy-access-to-guns-at-home-contributes-to-americas-youth-suicide-problem-187744">access to unsecured and loaded firearms</a> can prevent firearm-involved deaths across all intents — including suicide, homicide and unintentional shootings.</p>
<p>Gun-owning parents <a href="https://doi.org//10.1001/jamapediatrics.2019.1078">can help</a> by storing all firearms in a secure manner – such as in a locked gun safe or with a trigger or cable lock – and unloaded so they are not accessible to children or teens within the household.</p>
<p>Data shows that only one-third of firearm-owning households with teens in the U.S. currently <a href="https://link.springer.com/article/10.1007/s10865-021-00242-w">store all their firearms unloaded and locked</a>.</p>
<p>In addition to locking household firearms, parents should consider storing a firearm away from the home, such as in a gun shop or shooting range, or temporarily transferring ownership to a family member if they have a teen experiencing a mental health crisis.</p>
<p>Families, including those that don’t own firearms, should also consider how firearms are stored in homes where their children or teens may spend time, such as a grandparent’s or neighbor’s house.</p>
<p>Community-based and clinical programs that provide counseling on the importance of locked storage and provide free devices are effective in improving the ways people store their firearms. In addition, researchers have found that states with <a href="https://everytownresearch.org/rankings/law/secure-storage-or-child-access-prevention-required/">child access prevention laws</a>, which impose criminal liability on adults for negligently stored firearms, are associated with <a href="https://doi.org//10.1001/jamapediatrics.2019.6227">lower rates of child and teen firearm deaths</a>.</p>
<p>Reducing the number of young people who carry and use firearms in risky ways is another key step to prevent firearm deaths among children and teens. Existing hospital- and community-based prevention services support this work by identifying and enrolling youth at risk in programs that reduce violence involvement, the carrying of firearms and risky firearm behaviors. </p>
<p>While researchers are currently testing such programs to understand how well they work, early findings suggest that the most promising programs include a combination of reducing risky behaviors – through, for example, nonviolent conflict resolution; enhancing youth engagement in pro-social activities and with positive mentors; and supporting youth mental health.</p>
<h2>Support structures</h2>
<p>In addition to ongoing focused prevention efforts, hospital-, school- and community-based interventions that support youth in advancing social, emotional, mental, physical and financial health can reduce the risk of firearm deaths. Such measures include both <a href="http://doi.org//10.2105/AJPH.2021.306311">creating opportunities for children and teens</a> – building playgrounds, establishing youth programs and providing access to the arts and green spaces – and <a href="https://doi.org//10.2105/AJPH.2016.303434">community-level improvements</a>, such as improved public transportation, economic opportunities, environmental safety conditions and affordable and quality housing. Allocating resources toward these initiatives is an investment in every community member’s safety.</p>
<p>Over the past decade, we have seen an 87% increase in firearm-involved fatalities among children and teens in the United States. But we also have the strategies and tools to stop and reverse this troubling trend.</p><img src="https://counter.theconversation.com/content/215133/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebeccah Sokol receives funding from the National Institutes of Health and Centers for Disease Control and Prevention to conduct research to prevent violence.</span></em></p><p class="fine-print"><em><span>Marc A. Zimmerman receives funding from NIH, CDC, BJA, & foundations. </span></em></p><p class="fine-print"><em><span>Patrick Carter receives funding from NIH and CDC for conducting firearm-related prevention research. </span></em></p>Fatalities from gun homicides, suicides and accidents are all up for Americans ages 18 and under.Rebeccah Sokol, Assistant Professor of Social Work, University of MichiganMarc A. Zimmerman, Professor of Public Health, University of MichiganPatrick Carter, Co-Director, Institute for Firearm Injury Prevention; Associate Professor of Emergency Medicine, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2153142023-10-12T13:39:33Z2023-10-12T13:39:33ZJerry Coovadia remembered - a champion of science, children and compassionate public health<p>Deeply saddened as we in the South African health community were by the loss of Professor Jerry Hoosen Coovadia on 4 October 2023, I reflected on what he had come to mean in my medical career and in my life. </p>
<p>“Prof Jerry”, as we called him, was an internationally renowned South African paediatrician, public health and justice activist and clinician scientist. He made a lasting impact on child health, the response to HIV in South Africa and the region. He died, aged 83, at his home in KwaZulu-Natal, leaving his wife, Dr Zubeida “Zubie” Hamed. </p>
<p>What stands out for me is his principled, pragmatic and compassionate approach to paediatrics and child health. And then how these principles were brought to bear in response to the HIV epidemic. </p>
<h2>Earlier years</h2>
<p>In 1988 I found myself working to repay a government bursary at the quaint but very busy Eshowe Provincial Hospital in northern KwaZulu-Natal. There were three of us fresh new medical officers who, guided by a few key and wonderfully committed specialists, worked day and night in the emergency unit, outpatients and wards of this bustling public sector hospital serving rural communities. </p>
<p>Those “bush doctoring” days were some of my most fulfilling and exciting. It was satisfying to be carrying out emergency medicine or administering anaesthetics on two out of three nights. At the same time it was terrifying to put the mostly theoretical information we had gained in the last seven years to urgent and critical, practical use.</p>
<p>Paediatrics was no less terrifying than surgery or obstetrics. But we had the wonderful duo of Jenny Chapman guiding us in paediatrics and John Larson in obstetrics and gynaecology, and a library of important manuals and textbooks in the hospital boardroom. </p>
<p>Jenny, who was one of the most dedicated and caring paediatricians I have ever met, simply swore by Prof Jerry, his books and his teaching. I had not yet met Professor Coovadia in person, but I certainly came to intimately know his textbook (as I recall mine was a green version, much dog-eared and underlined) and his teachings not only at medical school but then under Jenny’s tutelage. </p>
<p>What set this book, <a href="https://global.oup.com/academic/product/coovadias-paediatrics-and-child-health-a-manual-for-health-professionals-in-developing-countries-9780199053940?cc=za&lang=en&">Paediatrics and Child Health</a>, apart was how it so practically but compassionately spoke to our setting and the African child. It dealt with the dilemmas and quandaries we faced daily in getting the best care to every child with our constrained resources. Jenny also taught me that it was wise to call and consult when the dilemma needed more than one opinion. And no opinion was more important than Prof Jerry’s.</p>
<p>When I later had the great good fortune to meet Prof Jerry in the 1990s as the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754430/">HIV epidemic was taking off in KwaZulu-Natal</a>, I was thrilled to discover the author was just as I had imagined him from his book: principled, passionate and pragmatic. </p>
<p>Throughout the next decade, our paths crossed frequently as we all took up the business of getting lifesaving HIV treatment to Africa. This meant building clinical evidence, writing guidelines and taking to the <a href="https://assets.publishing.service.gov.uk/media/57a08cc840f0b6497400143c/long_live_zackie.pdf">streets and courtrooms</a> as activists. His resolute and strong stance against <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61581-6/fulltext">AIDS denialism</a> was critical and inspiring. </p>
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Read more:
<a href="https://theconversation.com/jerry-coovadia-the-south-african-doctor-who-led-the-fight-against-hiv-in-children-215080">Jerry Coovadia: the South African doctor who led the fight against HIV in children</a>
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<p>With the <a href="https://www.unaids.org/en/resources/presscentre/featurestories/2009/november/20091101southafrica">end of the denialist era</a>, from 2008 onwards, Prof Jerry’s wisdom continued to be greatly valued. I always enjoyed hearing his opinion or proposed solution to a challenge. True to his nature, the proposal first and foremost had the child, the patient, their family and their community at the heart. </p>
<p>Thereafter, it was carefully considered with the known current evidence available and finally it was pragmatic and feasible in our setting and considerate of the primary health system. </p>
<p>That opinion was always delivered with a quiet but firm voice and his active eyebrows and ready smile providing the right amount of emphasis and exclamation. A recent interview that captured Prof Jerry so wonderfully quoted him as saying <a href="https://www.dailymaverick.co.za/article/2021-05-30-be-true-to-science-and-kind-to-patients-says-healthcare-giant-jerry-coovadia/">“be true to science and kind to patients”</a>, an instruction that should be given to every healthcare professional as they embark on their careers. </p>
<p>Prof Jerry was, and remains, an inspiring model.</p><img src="https://counter.theconversation.com/content/215314/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Linda-Gail Bekker does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>His teaching spoke practically but compassionately to the needs of the African child.Linda-Gail Bekker, Professor of medicine and deputy director of the Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050312023-10-03T19:04:57Z2023-10-03T19:04:57ZNo, stress won’t dry up your milk. How to keep breastfeeding your baby in an emergency<figure><img src="https://images.theconversation.com/files/551576/original/file-20231002-29-1b6ak7.jpg?ixlib=rb-1.1.0&rect=53%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-boy-sucking-milk-mothers-1981392881">Nastyaofly/Shutterstock</a></span></figcaption></figure><p>Bushfires <a href="https://www.theguardian.com/australia-news/2023/oct/02/australia-records-driest-september-since-observations-began-as-fires-rage-in-victoria-and-nsw">currently burning</a> in Victoria, New South Wales and Tasmania bring into sharp focus the fire risks Australian families face over the coming summer months.</p>
<p>Although babies don’t understand <a href="https://theconversation.com/babies-and-toddlers-might-not-know-theres-a-fire-but-disasters-still-take-their-toll-129699">the nature of emergencies</a> such as bushfires, floods and cyclones, they and their mothers are impacted. </p>
<p>During natural disasters, electricity, clean water and food supplies may be interrupted, and <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7528-0">gastroenteritis is common</a>. At these times, breastfeeding provides babies with safe food, water, and <a href="https://waba.org.my/pdf/ilca-iycf-emergencies.pdf">protection from infection</a>, as well as a feeling of comfort and safety.</p>
<p>But mothers can find it difficult to breastfeed during emergencies, and may believe stress affects their milk supply. Some end up stopping even though they didn’t plan to and even though during a disaster is a particularly bad time to wean.</p>
<p>The good news is stress doesn’t reduce milk supply, and while breastfeeding during an emergency carries added challenges, mothers can and do breastfeed through even the worst of disasters.</p>
<h2>Demand and supply</h2>
<p>During pregnancy, hormones develop the milk-making structures inside women’s breasts. After birth, the breasts automatically make milk to feed the baby, but over time they change to a <a href="https://www.breastfeeding.asn.au/resources/how-breasts-make-milk">demand and supply</a> way of working. </p>
<p>This means that when the baby feeds and milk is removed from the breasts, the breasts make more milk. The more frequently milk is removed from the breasts, the more milk will be made.</p>
<p>Babies drink the milk made in the breasts with the help of a hormone called oxytocin. When babies suckle, oxytocin tells the muscle-like cells that surround the small structures <a href="https://link.springer.com/article/10.1007/s12015-023-10534-0">where milk is made and stored</a> to contract. This squeezes the milk towards the nipple where the baby can drink it. </p>
<p>Oxytocin is sometimes called the “<a href="https://www.health.harvard.edu/mind-and-mood/oxytocin-the-love-hormone">love hormone</a>” because it’s also produced when you feel lovingly towards someone. </p>
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Read more:
<a href="https://theconversation.com/i-regret-stopping-breastfeeding-how-do-i-start-again-143183">I regret stopping breastfeeding. How do I start again?</a>
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<h2>Stress doesn’t impact milk production</h2>
<p>There isn’t any way for stress to interfere with the demand and supply process of milk making.</p>
<p>However, <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/suboptimal-infant-and-young-child-feeding-practices-among-internally-displaced-persons-during-conflict-in-eastern-ukraine/9F4B0EA5F13A05B7724BC69AF98B593A">mothers often worry</a> that the stress of an emergency has <a href="https://www.breastfeeding.asn.au/sites/default/files/2023-06/BiBS%20Study%20Report%20Final.pdf">reduced their milk supply</a>. Usually, this is because they are noticing their baby’s behaviour has changed.</p>
<p>During emergencies, babies are often more unsettled, want to be held more, <a href="https://www.breastfeeding.asn.au/sites/default/files/2023-06/BiBS%20Study%20Report%20Final.pdf">feed more frequently</a>, may be fussy at the breast, and wake more overnight. All of this is a normal response to the disruption of an emergency. </p>
<p>Although stress won’t hamper a mother’s milk supply, it can <a href="https://journals.lww.com/greenjournal/abstract/1994/08000/influence_of_psychological_stress_on.21.aspx">temporarily reduce oxytocin release</a>, slowing the flow of milk. This is another reason a baby may be unsettled during feeding.</p>
<h2>Some challenges</h2>
<p>Emergencies like bushfires and floods are difficult for everyone, but can be <a href="https://theconversation.com/the-black-summer-bushfires-put-an-enormous-strain-on-families-with-young-children-we-cant-make-the-same-mistakes-again-205026">especially challenging</a> for parents of babies and toddlers.</p>
<p>For breastfeeding mothers, the busyness of an emergency and a lack of privacy may mean they miss their baby’s cues or delay breastfeeding. Less frequent breastfeeds <a href="https://www.ncbi.nlm.nih.gov/books/NBK153484/">can reduce milk supply</a>. </p>
<p>Another factor that can affect milk supply is dehydration. Mothers may not drink enough water during an emergency because they’re <a href="https://www.breastfeeding.asn.au/sites/default/files/2023-06/BiBS%20Study%20Report%20Final.pdf">focused on looking after their children</a>, water is limited, or they are restricting water intake because there are no toilets. </p>
<h2>How can I keep breastfeeding through an emergency?</h2>
<p>Expect your baby to breastfeed more often than usual during an emergency. They may breastfeed for comfort as well as food. Keeping your baby close, breastfeeding frequently, and drinking enough water will protect your milk supply. </p>
<p>Know the signs that your baby is getting enough milk. If they have at least five heavily wet nappies in 24 hours, their wee is pale (not dark) in colour, and their poo is runny if they are only breastfed or soft if they are also eating solid foods, you can be confident <a href="https://www.breastfeeding.asn.au/resources/baby-getting-enough-breastmilk">your baby is getting enough breastmilk</a>.</p>
<figure class="align-center ">
<img alt="A woman sits on a couch comforting two small children." src="https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Emergencies can be stressful for parents of young children.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mom-children-hug-together-on-couch-1658307964">Natalia Lebedinskaia/Shutterstock</a></span>
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<p>You can encourage the release of oxytocin and the flow of milk when you breastfeed by looking at your baby and thinking about how much you love them. This can also help you feel less stressed.</p>
<p>You can be reassured that if your milk supply has decreased because of less frequent breastfeeding or dehydration this can be easily reversed by <a href="https://www.breastfeeding.asn.au/resources/increasing-supply">feeding more often</a> and drinking water. If you stopped breastfeeding because of an emergency, <a href="https://theconversation.com/i-regret-stopping-breastfeeding-how-do-i-start-again-143183">it’s possible to start again</a> if you want to.</p>
<p>If you are concerned about your milk supply, seek help from a health worker. The free <a href="https://www.breastfeeding.asn.au/breastfeeding-helpline">national breastfeeding helpline</a> is available 24/7 and is a good place to find support.</p>
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<img alt="" src="https://images.theconversation.com/files/551623/original/file-20231003-19-eqmv5e.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/551623/original/file-20231003-19-eqmv5e.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=916&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551623/original/file-20231003-19-eqmv5e.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=916&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551623/original/file-20231003-19-eqmv5e.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=916&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551623/original/file-20231003-19-eqmv5e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1151&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551623/original/file-20231003-19-eqmv5e.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1151&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551623/original/file-20231003-19-eqmv5e.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1151&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">Author provided</span></span>
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<h2>Preparing for an emergency</h2>
<p>Make an emergency plan that includes packing an <a href="https://www.breastfeeding.asn.au/emergency-resources-babies-and-toddlers">evacuation kit</a>, leaving early and evacuating to a relative or friend’s home rather than an evacuation centre if possible. Ensure your evacuation kit includes a baby sling to keep your baby safe and close, and some water and snacks for you. </p>
<p>If you are exclusively expressing milk, learn how to hand express and cup feed (even very young babies can be fed <a href="https://www.cdc.gov/nutrition/emergencies-infant-feeding/cup-feeding.html">using a cup</a>). Store some paper cups so you have all you need if you are without power and water for washing.</p>
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Read more:
<a href="https://theconversation.com/evacuating-with-a-baby-heres-what-to-put-in-your-emergency-kit-127026">Evacuating with a baby? Here's what to put in your emergency kit</a>
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<p>Anything emergency responders can do to reduce the burden of the emergency on mothers, such as prioritising them for services and offering them private spaces in evacuation centres, will help them to care for and breastfeed their babies. A free e-learning module for emergency responders on disaster support for babies, toddlers and their caregivers is <a href="https://www.aba.asn.au/emodule-prepare">available here</a>.</p><img src="https://counter.theconversation.com/content/205031/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karleen Gribble is Project Lead on the Australian Breastfeeding Association's Community Protection for Infants and Young Children in Bushfire Emergencies Project and is an Australian Breastfeeding Association Scientific Advisor, Educator and Counsellor. Karleen is also on the steering committee of the international interagency collaboration the Infant and Young Child Feeding in Emergencies Core Group and has been involved in the development of international guidance and training on infant and young child feeding in emergencies for over a decade. She is a member of the Public Health Association of Australia. </span></em></p><p class="fine-print"><em><span>Michelle Hamrosi is the Community Engagement Officer on the Australian Breastfeeding Association's Community Protection for Infants and Young Children in Bushfire Emergencies Project. Michelle is also a General Practitioner and an International Board Certified Lactation Consultant, as well as a Clinical Lecturer for the Australian National University’s Rural Medical School. Michelle volunteers as an ABA Breastfeeding Counsellor and Group Leader for the Australian Breastfeeding Association Eurobodalla Group. She is also a member of Doctors for the Environment, Climate and Health Alliance and Australian Parents for Climate Action.</span></em></p><p class="fine-print"><em><span>Nina Chad is the Infant and Young Child Feeding Consultant for the Department of Nutrition and Food Safety at the World Health Organization. She has been a volunteer breastfeeding counsellor for the Australian Breastfeeding Association for more than 20 years. </span></em></p>Being caught up in an emergency like a bushfire can make breastfeeding more challenging – but there are ways to continue.Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney UniversityMichelle Hamrosi, Clinical lecturer, Rural Clinical School, Australian National UniversityNina Jane Chad, Research Fellow, University of Sydney School of Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2108992023-09-13T02:03:34Z2023-09-13T02:03:34ZCould my child have low iron? And what are my options if they do?<p>Around <a href="https://www.mdpi.com/2072-6643/14/7/1381">75%</a> of infants aged six to 12 months and 25% of toddlers aged one to two years in Australia don’t get the recommended dietary intake of iron.</p>
<p>Despite their small size, weaning infants and children require <a href="https://www.eatforhealth.gov.au/nutrient-reference-values/nutrients/iron">similar amounts of iron</a> to adults. The iron is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631790/">crucial</a> for supporting their rapid growth in blood and muscles, immunity, brain development and learning. </p>
<p>Untreated iron deficiency can progress to anaemia – severe iron deficiency where there are insufficient healthy <a href="https://www.rch.org.au/immigranthealth/clinical/Iron_deficiency_and_anaemia/">red blood cells</a> to carry oxygen around the body. Alarmingly, anaemia affects around <a href="https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/iron-deficiency-and-associated-factors-in-australian-children-aged-46-years/3BA7853FF00196359E6F07EF4C50E282">8%</a> of Australian children under five, and if untreated, can be associated with developmental setbacks and later <a href="https://publications.aap.org/pediatrics/article/126/5/1040/65343/Diagnosis-and-Prevention-of-Iron-Deficiency-and">cognitive deficits</a>.</p>
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Read more:
<a href="https://theconversation.com/why-iron-is-such-an-important-part-of-your-diet-69974">Why iron is such an important part of your diet</a>
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<h2>How do I know if my kids have iron deficiency?</h2>
<p>Iron deficiency in children is often <a href="https://www.aafp.org/pubs/afp/issues/2016/0215/p270.html">associated with vague or no symptoms</a>, especially if it has not progressed to anaemia. </p>
<p>Symptoms can include <a href="https://australianprescriber.tg.org.au/articles/non-anaemic-iron-deficiency.html">fatigue, difficulty concentrating</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121846/">poor behaviour, frequent infections, and pica</a> (eating non-food substances such as paper, clay or soil).</p>
<p>Diagnosis typically involves a blood test that screens for iron markers such as ferritin, a protein that stores iron. Doctors often recommend these tests for people who are at high risk, detailed in the figure below.</p>
<iframe src="https://flo.uri.sh/visualisation/14722840/embed" title="Interactive or visual content" class="flourish-embed-iframe" frameborder="0" scrolling="no" style="width:100%;height:600px;" sandbox="allow-same-origin allow-forms allow-scripts allow-downloads allow-popups allow-popups-to-escape-sandbox allow-top-navigation-by-user-activation" width="100%" height="400"></iframe>
<div style="width:100%!;margin-top:4px!important;text-align:right!important;"><a class="flourish-credit" href="https://public.flourish.studio/visualisation/14722840/?utm_source=embed&utm_campaign=visualisation/14722840" target="_top"><img alt="Made with Flourish" src="https://public.flourish.studio/resources/made_with_flourish.svg"> </a></div>
<h2>What are the first options for treatment?</h2>
<p>When iron deficiency and anaemia are caused by a lack of dietary iron, both can often be effectively addressed through <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155616/">changes to the diet</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/36849195/">oral iron supplements</a>. </p>
<p>The <a href="https://www.rch.org.au/clinicalguide/guideline_index/iron_deficiency/">Royal Children’s Hospital</a> in Melbourne recommends boosting intake of <a href="https://www.rch.org.au/uploadedFiles/Main/Content/nutrition/Iron.pdf">iron-rich foods</a> such as meat, fish, eggs, leafy greens and legumes, and drinking less than 500mL (about two cups) of cow’s milk per day. This is because cow’s milk has been associated with <a href="https://academic.oup.com/nutritionreviews/article/69/suppl_1/S37/1815349">reduced iron stores</a> in young children.</p>
<p>Doctors might also prescribe oral iron supplements. A course of liquid or tablets would usually be recommended for a minimum of <a href="https://www.rch.org.au/clinicalguide/guideline_index/iron_deficiency/">three months</a> , during which follow-up blood tests can show how well the child is responding to the supplementation.</p>
<p>Existing evidence suggests <a href="https://www.sciencedirect.com/science/article/abs/pii/S0025712516373552?via=ihub">supplements</a> are a more effective way to replenish iron stores than dietary changes alone, and ferrous sulfate is the most <a href="https://gh.bmj.com/content/8/2/e010745">effective iron supplement</a> for young children.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Plain background with pieces of meat, bowl of cheese cubes etc" src="https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=416&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=416&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=416&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=523&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=523&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=523&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Meat, legumes and nuts are high in iron.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Navigating the side effects</h2>
<p>Iron supplements are known to have some nasty <a href="https://www.ncbi.nlm.nih.gov/books/NBK557376/">side effects</a> including constipation, nausea, diarrhoea, dark stools, and stained teeth. This may make compliance challenging, especially for young children. The approaches to alleviate side effects vary depending on the child. </p>
<p>The doctor may recommend alternative supplements as some may be <a href="https://australianprescriber.tg.org.au/articles/non-anaemic-iron-deficiency.html">better tolerated</a> than others. Another option is to adjust the dosage, with lower dose supplements or taking it <a href="https://ashpublications.org/hematology/article/2019/1/315/422602/Management-of-iron-deficiency">every other day</a>. </p>
<p>Consuming iron supplements with food or immediately after eating can also <a href="https://www.ncbi.nlm.nih.gov/books/NBK557376/">lessen side effects</a>. However this may result in reduced absorption, and should be discussed with your doctor. </p>
<p>For cases where iron supplements don’t appear to be working or where compliance is an issue, <a href="https://www.blood.gov.au/system/files/documents/appendix-2-from-iron-product-choice-and-dose-calculation04082015.pdf">iron infusions</a> may be prescribed by your doctor. These involve injecting iron over multiple visits at a hospital and/or specialist clinic, with each session potentially lasting an hour or more.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ive-been-diagnosed-with-iron-deficiency-now-what-87670">I've been diagnosed with iron deficiency, now what?</a>
</strong>
</em>
</p>
<hr>
<h2>How can I prevent iron deficiency in my kids?</h2>
<p>To prevent iron deficiency, it’s important to keep an eye on your child’s iron intake, and the factors that may influence their absorption. </p>
<p>For example, drinks which contain tannins (tea, coffee, chocolate drinks) may inhibit iron absorption. But vitamin C and organic acids from fruits and vegetables, as well as high-quality proteins such as those found in meat and fish, can <a href="https://pubs.acs.org/doi/full/10.1021/acsomega.2c01833">promote absorption</a>. </p>
<p>From infancy, following the <a href="https://www.nhmrc.gov.au/about-us/publications/infant-feeding-guidelines-information-health-workers">national feeding guidelines</a> will help to support your child’s iron status. This includes introducing iron-rich solid foods from around six months of age for healthy breastfed infants to replenish their iron stores from birth. </p>
<p>Around six months is also the prime time for introducing foods to minimise <a href="https://www.frontiersin.org/articles/10.3389/fped.2020.00448/full">risk of food allergies</a>, including to iron-rich foods such as seafood and nut butters.</p>
<hr>
<iframe src="https://flo.uri.sh/visualisation/14810991/embed" title="Interactive or visual content" class="flourish-embed-iframe" frameborder="0" scrolling="no" style="width:100%;height:600px;" sandbox="allow-same-origin allow-forms allow-scripts allow-downloads allow-popups allow-popups-to-escape-sandbox allow-top-navigation-by-user-activation" width="100%" height="400"></iframe>
<div style="width:100%!;margin-top:4px!important;text-align:right!important;"><a class="flourish-credit" href="https://public.flourish.studio/visualisation/14810991/?utm_source=embed&utm_campaign=visualisation/14810991" target="_top"><img alt="Made with Flourish" src="https://public.flourish.studio/resources/made_with_flourish.svg"> </a></div>
<hr>
<p>From 12 months onwards, children’s diets should align with the <a href="https://www.eatforhealth.gov.au/">Australian Dietary Guidelines</a>, emphasising a balanced, nutritious diet encompassing a range of foods. Diets following this pattern should deliver ample iron from meats, breads and cereals, as well as iron absorption promotors such as oranges, capsicum and other fresh fruits and vegetables?.</p>
<p>In cases where the child is a picky eater, or where access to a diversity of foods is limited, look for fortified iron options such as in bread, drinks (for example juice for <a href="https://www.nhmrc.gov.au/about-us/publications/infant-feeding-guidelines-information-health-workers">kids over 12 months</a>, and Milo for older kids), and breakfast cereals.</p>
<p>If your child is diagnosed with iron deficiency, remember each path to recovery is unique. Consultation with a GP or dietitian can help tailor solutions catering to their specific needs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-to-drink-with-dinner-to-get-the-most-iron-from-your-food-and-what-to-avoid-156579">What to drink with dinner to get the most iron from your food (and what to avoid)</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/210899/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yianna Zhang has previously received a postgraduate scholarship from CSIRO, which investigated food-based chemical interactions potentially affecting iron absorption.</span></em></p><p class="fine-print"><em><span>Amanda Patterson has previously received funding from the Hunter Medical Research Institute and Meat and Livestock Australia for research on Iron Deficiency.</span></em></p><p class="fine-print"><em><span>Ken Ng does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Despite their small size, infants and children actually require about the same amount of iron as adults, to help them grow. Many aren’t getting enough.Yianna Zhang, Sessional tutor, The University of MelbourneAmanda Patterson, Senior Lecturer in the School of Health Sciences, University of NewcastleKen Ng, Senior Lecturer & Course Coordinator (Master of Food Science), The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2110462023-08-30T04:19:59Z2023-08-30T04:19:59ZToo many young people who’ve been in detention die prematurely. They deserve better<figure><img src="https://images.theconversation.com/files/544694/original/file-20230825-25-a34sg8.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-jail-147711227">Shutterstock</a></span></figcaption></figure><p>Young people in contact with the criminal justice system – be it under community-based orders or in youth detention – are among the <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(19)30217-8/fulltext">most marginalised</a> in our society. And the health and health-care disadvantage faced by these young people may be evident for years.</p>
<p><a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00144-5/fulltext">Our research</a> found high levels of largely-preventable diseases and avoidable premature deaths for these young people in Australia. This indicates inadequate health care both in youth detention and in the community.</p>
<p>It’s time we provided health care for people in youth detention that’s culturally safe and equivalent to what’s available in the community. That includes access to Australia’s so-called universal health-care scheme, Medicare. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/locking-up-kids-damages-their-mental-health-and-sets-them-up-for-more-disadvantage-is-this-what-we-want-117674">Locking up kids damages their mental health and sets them up for more disadvantage. Is this what we want?</a>
</strong>
</em>
</p>
<hr>
<h2>Children as young as 10</h2>
<p>Australian courts can sentence children as young as ten who are convicted of a criminal offence to a community-based order, or to youth detention. </p>
<p>During the 2021-22 financial year, <a href="https://www.aihw.gov.au/getmedia/3fe01ba6-3917-41fc-a908-39290f9f4b55/aihw-juv-140.pdf.aspx?inline=true">4,350 young people</a> aged ten to 18 were detained at some point, typically for eight days or less.</p>
<p>Almost 50% of young people under youth justice supervision <a href="https://www.aihw.gov.au/getmedia/3fe01ba6-3917-41fc-a908-39290f9f4b55/aihw-juv-140.pdf.aspx?inline=true">are Indigenous</a>, and they are 24 times more likely than non-Indigenous young people to go into youth detention.</p>
<p>Young people in detention commonly have <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(19)30217-8/fulltext">very poor health</a>. This includes high rates of one or more physical and mental health problems, cognitive and neurodevelopmental disabilities, and substance dependence. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1689828524939788288"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-social-determinants-of-justice-8-factors-that-increase-your-risk-of-imprisonment-203661">The social determinants of justice: 8 factors that increase your risk of imprisonment</a>
</strong>
</em>
</p>
<hr>
<h2>What we found</h2>
<p>In the nearly 25 years of data covered in our study, <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00144-5/fulltext">we found</a> young people with a history of contact with the youth justice system died at a rate more than four times higher than those of the same age and sex in the general Australian population.</p>
<p>We found those most at risk of dying prematurely were Indigenous children, males, and those whose first contact with the youth justice system was before they were 14 years old.</p>
<p>Until now, there’s been a remarkable lack of evidence on the burden of noncommunicable diseases, such as cancers and cardiovascular diseases, among young people during and after contact with the youth justice system. However, we found that compared with their peers, these young people have nearly double the rate of dying from such diseases.</p>
<p>For young Indigenous males, cardiovascular and digestive diseases, including chronic liver diseases, were particularly prominent (and largely preventable) causes of death.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-nations-people-in-the-nt-receive-just-16-of-the-medicare-funding-of-an-average-australian-183210">First Nations people in the NT receive just 16% of the Medicare funding of an average Australian</a>
</strong>
</em>
</p>
<hr>
<h2>What we need</h2>
<p>Our findings highlight the need for young people involved with the justice system to access high-quality and holistic health care that’s age- and culturally appropriate. This is essential to identify and manage their complex health conditions, both during periods of supervision and – critically – after return to the community. </p>
<p>Aboriginal Community Controlled Health Organisations are <a href="https://link.springer.com/article/10.1186/s12889-020-09943-4">well placed</a> to provide this and to support continuity of care as these children transition in and out of detention.</p>
<p>But the Northern Territory is the only jurisdiction where they are funded to provide health care in youth detention.</p>
<p>Aboriginal Community Controlled Health Organisations are unable to access Commonwealth funding to support health care in detention elsewhere.</p>
<p>Discriminatory exclusion from access to Medicare, which typically prevents access to Aboriginal Community Controlled Health Organisations in detention, is an example of the “<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00243-9/fulltext">inverse care law</a>”. This is when those most in need of high-quality health care are least likely to receive it.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1320998841097711616"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/victorias-prison-health-care-system-should-match-community-health-care-180558">Victoria’s prison health care system should match community health care</a>
</strong>
</em>
</p>
<hr>
<h2>Progress has been slow so far</h2>
<p>Health-care reform in youth justice is clearly and urgently required, but progress has been slow. One reason is the lack of independent oversight of these systems. </p>
<p>Despite <a href="https://www.ombudsman.gov.au/industry-and-agency-oversight/monitoring-places-of-detention-opcat">ratifying</a> the UN Optional Protocol to the Convention against Torture in 2017, Australia has <a href="https://theconversation.com/australias-twice-extended-deadline-for-torture-prevention-is-today-but-weve-missed-it-again-197793">yet to establish</a> the mechanisms required under this protocol to permit independent scrutiny of places of detention. </p>
<p>As a priority, we need to meet our international obligations – through both permitting unfettered access to all youth detention centres and investing appropriately in <a href="https://www.ombudsman.gov.au/industry-and-agency-oversight/monitoring-places-of-detention-opcat">independent scrutiny</a> – in every state and territory.</p>
<p>Australia is also lagging behind in routine monitoring of health and health care in youth detention. More than five years ago, the Australian Institute of Health and Welfare <a href="https://www.aihw.gov.au/reports/youth-justice/health-justice-involved-young-people-2016-17/summary">recommended</a> producing regular reports on health care in youth justice settings. But there is still no Commonwealth or state/territory funding or mechanism for this critical monitoring.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-twice-extended-deadline-for-torture-prevention-is-today-but-weve-missed-it-again-197793">Australia's twice extended deadline for torture prevention is today, but we've missed it again</a>
</strong>
</em>
</p>
<hr>
<h2>Why we need to lift our game</h2>
<p>Improving the health of this marginalised group is important to improving health equity, closing the gap, and preventing the tragic loss of young lives. </p>
<p>Australia can no longer ignore that some of our most disadvantaged children are dying at a much faster rate than expected, and from causes that are largely preventable. Doing so would amplify cycles of racism and social exclusion. </p>
<p>Under the <a href="https://www.unicef.org.au/united-nations-convention-on-the-rights-of-the-child">UN Convention on the Rights of the Child</a> all children, including those in contact with the youth justice system, have the right to the highest attainable standard of health. We owe it to them to make this a reality.</p><img src="https://counter.theconversation.com/content/211046/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lucas Calais Ferreira receives funding from Suicide Prevention Australia.</span></em></p><p class="fine-print"><em><span>Stuart Kinner receives funding from the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Professor Susan Sawyer is a member of the Youth Justice Act Independent Expert Group for the Victorian Government, Department of Justice and Community Safety.</span></em></p><p class="fine-print"><em><span>Alex Brown does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Children as young as ten don’t have access to Medicare if detained. And they’re dying of largely preventable diseases.Lucas Calais Ferreira, Postdoctoral Research Fellow, The University of MelbourneAlex Brown, Professor of Indigenous Genomics, Australian National UniversityStuart Kinner, Professor of Health Equity, Curtin UniversitySusan M Sawyer, Professor of Adolescent Health The University of Melbourne; Director, Royal Children's Hospital Centre for Adolescent Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2054772023-08-18T02:08:23Z2023-08-18T02:08:23ZCurious Kids: why do babies cry when they come out of their mum?<figure><img src="https://images.theconversation.com/files/543119/original/file-20230816-21-5r1861.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C995%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-78559918">Shutterstock</a></span></figcaption></figure><blockquote>
<p>Why do babies always cry when they come out of their mum? – Nam, 12, Hanoi, Vietnam</p>
</blockquote>
<p><a href="https://theconversation.com/au/topics/curious-kids-36782"><img src="https://images.theconversation.com/files/291898/original/file-20190911-190031-enlxbk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=90&fit=crop&dpr=1" width="100%"></a></p>
<p>When babies are born, they all seem to cry. We see this a lot <a href="https://www.goldderby.com/gallery/best-tv-births-ranked-worst-to-best/tvs-most-memorable-births-little-house-ont-the-prarie/">on TV</a>.</p>
<p>But not all newborn babies cry straight away. Here’s what’s going on.</p>
<h2>What happens at birth?</h2>
<p>When a baby is born, they move from their mum’s warm body, and out of their dark, watery world into a much cooler, drier and brighter one.</p>
<p>It’s a bit of a squeeze. As the baby comes out from their mum, the cooler air hits their wet skin. </p>
<p>The cooler air makes them gasp. They also gasp when the midwife or doctor touches their body to help them come into the world.</p>
<p>That gasp is their first breath, which usually comes with a cry. And when this happens the gasp or cry triggers an amazing <a href="https://www.youtube.com/watch?v=zTXmaVgobNw">change</a> in how the baby gets oxygen and moves it around their body.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-we-cry-119814">Curious Kids: why do we cry?</a>
</strong>
</em>
</p>
<hr>
<h2>What changes?</h2>
<p>In the womb, babies depend on their mum for oxygen – via the <a href="https://theconversation.com/explainer-what-is-placenta-28851">placenta</a> and <a href="https://theconversation.com/ive-always-wondered-whats-behind-the-belly-button-84598">umbilical cord</a>.</p>
<p>The placenta looks a bit like a pancake and filters oxygen-rich blood from the mum. The umbilical cord then pumps that to the unborn baby.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Unborn baby with umbilical cord and placenta" src="https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The placenta, on the left, and the umbilical cord work together to send oxygen from the mum’s blood to the unborn baby.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendered-medically-accurate-illustration-fetus-727111807">Shutterstock</a></span>
</figcaption>
</figure>
<p>But once babies are born, their first breath or cry triggers a whole range of changes to the way their heart moves blood around their body. So, rather than breathing fluid from the womb, they can now breathe air and get oxygen into their lungs just like we do. </p>
<p>The process of being born also squeezes water out of the baby’s lungs, allowing them to work properly.</p>
<p>A newborn baby crying is a sound parents and health workers are very <a href="https://www.romper.com/p/why-do-babies-cry-at-birth-the-answer-will-probably-surprise-you-18746386">happy</a> to hear. That’s because it usually means the baby is well and won’t need any extra help to breathe.</p>
<p>But not all newborn babies cry. And it’s not always something to be worried about.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-is-it-true-that-male-seahorses-give-birth-92843">Curious Kids: Is it true that male seahorses give birth?</a>
</strong>
</em>
</p>
<hr>
<h2>Why don’t all babies cry?</h2>
<p>Sometimes this switch to moving oxygen around the body just like us <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/persistent-pulmonary-hypertension#:%7E:text=In%20persistent%20pulmonary%20hypertension%2C%20also,difficult%20birth%2C%20or%20birth%20asphyxia.">does not happen smoothly</a>.</p>
<p>There might be problems with the baby’s heart, or there may have been a difficult birth. For instance, the baby might have been very short of oxygen in the womb and need some help to start breathing when they are born. </p>
<p>Sometimes there’s a delay in babies crying. </p>
<p>Babies born by caesarean section – when doctors operate on the mum to lift the baby out of her womb – might be <a href="https://link.springer.com/article/10.1007/s00404-019-05208-7">slower</a> to breathe and cry. That’s because they don’t have the fluid squeezed from the lungs like they do when born through the vagina. </p>
<p>Sometimes newborn babies don’t cry at all.</p>
<p>Babies born in water (known as a <a href="https://www.bellybelly.com.au/birth/doulas/preparing-for-a-water-birth/">waterbirth</a>) may have lots of warm water around them and not even realise they are born. That’s because they don’t feel cold air as they come into the world; they are often in their mother’s arms in the water. So they tend to just <a href="https://www.sarawickham.com/questions-and-answers/whats-an-aqua-apgar/">breathe quietly</a>, and turn pink (showing they are getting enough oxygen), without crying.</p>
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<p><em>Hello, Curious Kids! Do you have a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p><img src="https://counter.theconversation.com/content/205477/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Dahlen receives funding from NHMRC and ARC. She is affiliated with The Australian College of Midwives</span></em></p>Crying triggers changes in how a newborn baby gets their oxygen. But not all new babies cry, and it’s not always a problem.Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2088552023-07-26T00:32:56Z2023-07-26T00:32:56ZRSV is everywhere right now. What parents need to know about respiratory syncytial virus<figure><img src="https://images.theconversation.com/files/538668/original/file-20230721-21-8jb0lp.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C997%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-weakened-bronchitis-getting-oxygen-1022883532">Shutterstock</a></span></figcaption></figure><p>This winter, we’re having to get our heads around another respiratory virus – RSV.</p>
<p>It’s less well known than COVID or flu, but it’s also responsible for unplanned visits to the GP or emergency department, and days off school, childcare and work.</p>
<p>It’s the <a href="https://pubmed.ncbi.nlm.nih.gov/31383776/">most common</a> cause of hospitalisation in infants. Most children have at least one RSV infection by the age of three years and yet, many Australians have not heard of RSV or know little about this potentially serious winter virus.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mondays-medical-myth-you-can-catch-a-cold-by-getting-cold-2488">Monday's medical myth: you can catch a cold by getting cold</a>
</strong>
</em>
</p>
<hr>
<h2>What is RSV?</h2>
<p>RSV stands for respiratory syncytial (pronounced sin-CITY-al) virus. This common respiratory virus usually causes a mild cold with symptoms such as a fever, runny nose, coughing, decreased appetite and a wheeze. </p>
<p>Adults can be infected with RSV but usually recover in a few days.</p>
<p>But in young babies RSV can cause more severe respiratory illnesses such as <a href="https://www.rch.org.au/kidsinfo/fact_sheets/pneumonia/">pneumonia</a> or <a href="https://www.rch.org.au/kidsinfo/fact_sheets/bronchiolitis/">bronchiolitis</a>. These cause babies to breathe rapidly, stop breathing for a few seconds (apnoeas) and/or feed poorly. RSV in infancy can also potentially affect a child’s long-term health, increasing their risk of asthma, wheezing and allergies. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1676938514951462912"}"></div></p>
<p>In Australia, a wave of RSV infections typically begins in late autumn (April-May) and peaks in June-July. Cases are <a href="https://nindss.health.gov.au/pbi-dashboard/">starting to decline</a> in Australia now.</p>
<p>Because health staff have to report cases of RSV, we can keep track of <a href="https://nindss.health.gov.au/pbi-dashboard/">known cases</a>. But we suspect most go unreported as they are mild and/or doctors don’t always test for the virus.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heard-of-kindy-flu-theres-no-such-thing-but-kids-are-at-risk-this-flu-season-for-one-simple-reason-207825">Heard of 'kindy flu'? There's no such thing. But kids are at risk this flu season for one simple reason</a>
</strong>
</em>
</p>
<hr>
<h2>Who’s most at risk?</h2>
<p>Both young and old people are most at risk of severe disease. </p>
<p>For children, those <a href="https://adc.bmj.com/content/107/4/359.long">most at risk</a> of severe disease include babies under two months old, premature infants, those with other medical conditions, or ones infected with another virus at the same time. First Nations children are <a href="https://pubmed.ncbi.nlm.nih.gov/31066061/">three to six times</a> more likely to be hospitalised with bronchiolitis caused by RSV than non-First Nations children.</p>
<p>Otherwise healthy children under 12 months old (usually under six months old) are the ones most often admitted to hospital. Of children admitted to hospital, <a href="https://pubmed.ncbi.nlm.nih.gov/35168504/">about a quarter</a> (26%) will be admitted to intensive care.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C994%2C667&q=45&auto=format&w=1000&fit=clip"><img alt="Male toddler with oxygen mask over face in hospital bed" src="https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C994%2C667&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Young children and the elderly are most at risk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/2-years-old-asian-toddler-boy-1163046754">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Why are we seeing so many cases now?</h2>
<p>RSV is spread via coughing and sneezing so it’s easy to see how the virus can spread among children inside during winter months.</p>
<p>But measures earlier in the COVID pandemic limited the spread of RSV.</p>
<p>There was very little RSV circulating in 2020 during the harshest lockdowns. However, in New South Wales and Western Australia (in late 2020) and in Victoria (early 2021) there was an <a href="https://www.nature.com/articles/s41467-022-30485-3">out-of-season re-emergence</a> of RSV, overwhelming hospitals and health-care facilities.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1531461682307821570"}"></div></p>
<p>In 2022, RSV settled back into the usual winter peak. However, many states are experiencing a winter surge in cases and hospitalisations attributed to it this year – bigger than before the pandemic.</p>
<p>This may relate to <a href="https://www.health.gov.au/diseases/respiratory-syncytial-virus-rsv-infection">new reporting requirements</a> for RSV and more testing for it.</p>
<p>However, reduced immunity in young infants due to lower maternal and infant exposure may have contributed to the record number of cases.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ive-had-covid-and-am-constantly-getting-colds-did-covid-harm-my-immune-system-am-i-now-at-risk-of-other-infectious-diseases-188899">I've had COVID and am constantly getting colds. Did COVID harm my immune system? Am I now at risk of other infectious diseases?</a>
</strong>
</em>
</p>
<hr>
<h2>Is there a vaccine?</h2>
<p>There are no vaccines to protect against RSV in Australia.</p>
<p>Australia’s only currently available preventative medicine is <a href="https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Palivizumab_for_at-risk_patients/">palivizumab</a>, which is a long-acting monoclonal antibody given monthly during the RSV season. Due to its cost, it is reserved for infants at highest risk for severe RSV infection and is usually given in hospital. </p>
<p>However, several new preventative agents are in the pipeline. </p>
<p><a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-respiratory-syncytial-virus-rsv-vaccine">In May this year</a>, the US Food and Drug Administration approved the RSV vaccine Arexvy for people aged 60 and over. It is being <a href="https://www.tga.gov.au/resources/prescription-medicines-under-evaluation/arexvy-glaxosmithkline-australia-pty-ltd">considered for use</a> in Australia.</p>
<p>Results from clinical trials for RSV vaccines given to pregnant women to protect their baby for the first six months are promising. The maternal Pfizer vaccine <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2216480">has demonstrated</a> greater than 80% effectiveness against severe lower respiratory tract illness in their infants for the 90 days after birth.</p>
<p>However, safety data is being closely examined, including a <a href="https://www.bmj.com/content/381/bmj.p1021">potential risk</a> of premature birth. </p>
<p>The long-acting monoclonal antibody nirsevimab, (given as a single injection at the beginning of the RSV season) has regulatory approval in Europe and the US. It is currently <a href="https://www.tga.gov.au/resources/prescription-medicines-under-evaluation/beyfortus-astrazeneca-pty-ltd">being considered</a> for Australian children.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fdas-approval-of-the-worlds-first-vaccine-against-rsv-will-offer-a-new-tool-in-an-old-fight-4-questions-answered-205111">FDA's approval of the world's first vaccine against RSV will offer a new tool in an old fight – 4 questions answered</a>
</strong>
</em>
</p>
<hr>
<h2>How can I protect my children in the meantime?</h2>
<p>Parents can minimise the risk of RSV by using many of the measures we’ve been using during the COVID pandemic. Encourage children to cover their mouths and noses when coughing or sneezing, and regularly wash their hands.</p>
<p>Ensuring kids stay away from school, childcare or other children when sick helps prevent the spread of many viruses, including RSV.</p>
<p><a href="https://www.rch.org.au/kidsinfo/fact_sheets/Respiratory_syncytial_virus_RSV/">Viral symptoms</a> to watch out for include difficulty feeding, cough, irritability and/or rapid breathing. If parents notice these signs or are worried about their child they should seek urgent medical assessment and not delay.</p><img src="https://counter.theconversation.com/content/208855/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Tuckerman is an investigator on a project grant sponsored by Industry. Her institution has received funding from Industry (GSK) for investigator led research. She does not receive any personal payments from Industry. </span></em></p><p class="fine-print"><em><span>Ashleigh Rak receives funding from NHMRC and the Victorian Government.</span></em></p><p class="fine-print"><em><span>Danielle Wurzel receives funding from NHMRC, MRFF and has received honoraria and/or consultancy fees from MSD, Sanofi, GSK which have been paid into her research fund.</span></em></p><p class="fine-print"><em><span>Margie Danchin receives funding from NHMRC, MRFF, WHO, DFAT and the Victorian Government. She is chair, Australian Regional Immunisation Alliance. </span></em></p>Even otherwise healthy children can end up in hospital with this winter respiratory virus.Jane Tuckerman, Senior Research Officer, Murdoch Children's Research InstituteAshleigh Rak, Research Nurse Coordinator, Murdoch Children's Research InstituteDanielle Wurzel, Paediatric Respiratory Physician, and Honorary Fellow Manager, Murdoch Children's Research InstituteMargie Danchin, Paediatrician at the Royal Childrens Hospital and Associate Professor and Clinician Scientist, University of Melbourne and MCRI, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2078252023-06-25T20:04:25Z2023-06-25T20:04:25ZHeard of ‘kindy flu’? There’s no such thing. But kids are at risk this flu season for one simple reason<figure><img src="https://images.theconversation.com/files/533372/original/file-20230622-25-qj4y5m.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/small-sick-toddler-girl-indoors-home-1688033386">Shutterstock</a></span></figcaption></figure><p>The 2023 flu season may be one of Australia’s largest flu seasons on record, and doctors <a href="https://www.abc.net.au/news/2023-06-06/influenza-flu-season-affecting-kids-children-hospital-cases-up/102387982">are concerned</a> about the impact on children.</p>
<p>You may have seen <a href="https://www.9news.com.au/national/kindy-flu-warning-for-parents-highly-contagious-influenza-a-vaccination/bd4af754-2763-4b08-8b98-a2134ef29be5">headlines</a> warning parents about “<a href="https://www.kidspot.com.au/lifestyle/family-health/what-is-kindy-flu-and-do-parents-need-to-worry-about-it/news-story/1a229dd2d6dd55fa6b76b8b40ed7ea06">kindy flu</a>”. These can be misleading. This year’s flu virus does not “target” children. But during the 2023 flu season, children are particularly vulnerable for one important reason – low vaccination rates.</p>
<p>We are concerned that <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/national-influenza-vaccination-coverage-all-people">fewer children</a> have received their annual flu vaccine in 2023, compared to previous years. And it leaves them, and the wider community, at risk of flu and its complications.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-the-flu-13985">Explainer: what is the flu?</a>
</strong>
</em>
</p>
<hr>
<h2>How bad is it?</h2>
<p>In <a href="https://nindss.health.gov.au/pbi-dashboard/">2023</a>, we are on track for a similar influenza season <a href="https://www.health.gov.au/sites/default/files/documents/2022/10/aisr-2019-national-influenza-season-summary.pdf">to 2019</a> – the largest influenza season on record in Australia. That’s when there were more than 300,000 recorded influenza cases.</p>
<p>At the time of writing, we’ve had <a href="https://nindss.health.gov.au/pbi-dashboard/">107,941 recorded flu cases</a> so far in 2023, and the flu season still has months to go. Of these, 48,873 cases have been in children under 15 years and 22,365 in those aged five to nine years. </p>
<p>Since the flu season started in late April, children have made up almost <a href="https://www.health.gov.au/sites/default/files/2023-06/aisr-fortnightly-report-no-5-29-may-to-11-june-2023_0.pdf">80% of those admitted to hospital</a> across the country at sentinel surveillance sites. Many children’s hospitals are reporting high numbers of children <a href="https://www.schn.health.nsw.gov.au/news/articles/2023/06/protecting-children-through-flu-vaccine">hospitalised</a> with flu.</p>
<p>Sadly, one child has died of influenza, a <a href="https://7news.com.au/news/public-health/perth-familys-message-after-toddler-dies-from-flu-c-10895076">three year old</a> in Perth.</p>
<p>These large case numbers come after <a href="https://pubmed.ncbi.nlm.nih.gov/32986804/">low influenza case numbers</a> seen <a href="https://www.health.gov.au/resources/publications/aisr-2021-national-influenza-season-summary?language=en">earlier</a> in the <a href="https://www.health.gov.au/sites/default/files/documents/2022/10/aisr-2020-national-influenza-season-summary.pdf">pandemic</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kids-are-more-vulnerable-to-the-flu-heres-what-to-look-out-for-this-winter-117748">Kids are more vulnerable to the flu – here's what to look out for this winter</a>
</strong>
</em>
</p>
<hr>
<h2>Why is this happening?</h2>
<p>The 2023 flu strains do not seem to be any more severe than in other years, according to a number of measures.</p>
<p>In hospitals, the number of those admitted directly to intensive care (currently <a href="https://www.health.gov.au/sites/default/files/2023-06/aisr-fortnightly-report-no-5-29-may-to-11-june-2023_0.pdf">7%</a>) is similar to previous seasons. </p>
<p>In the community, the number of those with flu-like illnesses needing to take time off regular duties is <a href="https://info.flutracking.net/about/">also similar.</a></p>
<p>There is also no evidence the <a href="https://www.health.gov.au/sites/default/files/2023-06/aisr-fortnightly-report-no-5-29-may-to-11-june-2023_0.pdf">current strains</a> circulating are more likely to infect children, or for them to infect others, compared with strains circulating in previous years.</p>
<p>So something else must be going on.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man at home, sick with cold or flu, wiping nose" src="https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533377/original/file-20230622-27-j3hxmm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Home sick from work? You’re not alone.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sick-man-sits-home-on-gray-2223553363">Shutterstock</a></span>
</figcaption>
</figure>
<h2>So what’s different in 2023?</h2>
<p>The single thing different to pre-pandemic years is the number of younger Australians not getting an influenza vaccine. </p>
<p>In 2020, at this stage of the season, nearly <a href="https://ncirs.org.au/influenza-vaccination-coverage-data/national-influenza-vaccination-coverage-all-people">40% of children</a> aged from six months to under five years were vaccinated, compared with just 20% currently. In those aged five to under 15 years, 25% were vaccinated in 2020 compared with just 12% now.</p>
<p>This makes us worried. </p>
<p>Young children, particularly those <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi4004f.htm">under five years</a>, are the group most likely to be hospitalised with flu.</p>
<p>Although children with underlying medical conditions – including chronic disorders of the heart, lungs, nervous and immune system – are most susceptible, <a href="https://academic.oup.com/cid/article/68/6/940/5077025">more than half of children</a> admitted to hospital each year with flu are otherwise healthy. While rare, <a href="https://publications.aap.org/pediatrics/article/132/5/796/31654/Influenza-Associated-Pediatric-Deaths-in-the">flu deaths</a> also occur in previously healthy children.</p>
<p>We are also worried about influenza making children more vulnerable to <a href="https://www.cdc.gov/flu/about/keyfacts.htm">secondary bacterial infections</a>. These include
<a href="https://www.9news.com.au/national/strep-a-australia-victorian-health-authorities-warning-strep-a-cases-are-rising-among-children/87989de5-94ca-4544-8cc1-d470f013c947">invasive group A streptococcus</a> and pneumococccal disease.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Strep A" src="https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=237&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=237&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=237&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=298&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=298&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533382/original/file-20230622-17-wv9z60.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=298&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Complications from flu can include invasive group A streptococcus infection.</span>
<span class="attribution"><a class="source" href="https://www.who.int/europe/news/item/12-12-2022-increase-in-invasive-group-a-streptococcal-infections-among-children-in-europe--including-fatalities">Meredith Newlove/CDC/WHO</a></span>
</figcaption>
</figure>
<h2>Another reason to get vaccinated</h2>
<p>Children have large volumes of virus in their nasal secretions and, after infection, shed this for days. They also have poorer hygiene practices, often coughing and spluttering over those closest to them.</p>
<p>So children will quickly infect their parents, grandparents and younger siblings. Some will be at higher risk of getting unwell and being hospitalised, such as the elderly, the very young, First Nations people, and those with underlying medical issues <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu#people-at-risk-of-severe-disease-from-influenza">including</a> heart, lung, kidney and immune problems.</p>
<p>Primary school-age children are the group that <a href="https://pubmed.ncbi.nlm.nih.gov/24115913/">most frequently transmits flu</a> in the community. In
2023, we expect the largest number of cases in the community to be in five to nine-year-olds.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-a-flu-vaccine-this-year-heres-what-you-need-to-know-203406">Should I get a flu vaccine this year? Here's what you need to know</a>
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</em>
</p>
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<h2>When to seek medical attention</h2>
<p>Flu in children commonly <a href="https://www.rch.org.au/kidsinfo/fact_sheets/influenza_the_flu/">causes</a> high temperatures, sore throats, miserable kids and a non-stop runny nose and cough. Most cases can be safely managed at home. </p>
<p>But if you’re worried about your child during the flu season, seek medical advice, particularly if your child:</p>
<ul>
<li><p>has difficulty breathing (breathing rapidly or drawing in chest or neck muscles)</p></li>
<li><p>is vomiting and refusing to drink</p></li>
<li><p>is more sleepy than normal</p></li>
<li><p>has pain that doesn’t get better with simple pain relief medication.</p></li>
</ul>
<p>And right now, before they get sick, book in your children for their annual flu vaccine. It prevents more than <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/irv.12939">half</a> of flu infections. And even if infected, vaccinated children are <a href="https://theconversation.com/thinking-about-getting-your-child-the-flu-vaccine-heres-what-you-need-to-know-94393">less likely</a> to be hospitalised with it.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-about-getting-your-child-the-flu-vaccine-heres-what-you-need-to-know-94393">Thinking about getting your child the flu vaccine? Here's what you need to know</a>
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</em>
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<img src="https://counter.theconversation.com/content/207825/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Asha Bowen receives funding from National Health and Medical Research Council of Australia, and Medical Research Futures Fund of Australia. </span></em></p><p class="fine-print"><em><span>Christopher Blyth receives funding from the National Health and Medical Research Council of Australia, and Medical Research Futures Fund of Australia. He is a member of the COVID-19 Vaccines and Treatments for Australia – Science and Industry Technical Advisory Group and past member of the Australian Technical Advisory Group on Immunisation.</span></em></p>Rates of flu vaccination are down for children. That leaves them and us vulnerable to the flu and its complications.Asha Bowen, Program Head, Telethon Kids InstituteChristopher Blyth, Paediatrician, Infectious Diseases Physician and Clinical Microbiologist, Telethon Kids Institute, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2071502023-06-25T11:11:29Z2023-06-25T11:11:29ZChildren’s movement affects health and development but research is lacking in Africa: here’s why<figure><img src="https://images.theconversation.com/files/531373/original/file-20230612-220077-jzsxfb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Children’s health and development depend on how much time they spend doing physical activity, being sedentary and sleeping.</p>
<p>Research on movement behaviours in children is essential. It helps us to understand what influences these behaviours, and their contribution to health and development. </p>
<p>Most <a href="https://bmjopen.bmj.com/content/11/10/e049267">evidence</a> on movement behaviours comes from high-income countries. Here children have different lifestyles, environments and cultures from those in low- and middle-income countries. For example, children in African countries face different challenges in achieving healthy levels of physical activity and sleep. Safety, transport, infrastructure, culture, climate, nutrition, and different levels and types of screen time exposure may all present challenges. </p>
<p>Africa, as a continent, contributes less than <a href="https://www.elsevier.com/connect/africa-generates-less-than-1-of-the-worlds-research-data-analytics-can-change-that">1% of research</a> worldwide. This means over <a href="https://www.worldometers.info/world-population/africa-population/">16%</a> of the world’s population has been excluded from the research. </p>
<p>The international <a href="https://sunrise-study.com/#about">SUNRISE study</a>, which we are part of, aims to bridge this gap. It conducts studies on movement behaviour in collaboration with researchers in several African countries, including Ethiopia, Nigeria and South Africa, where we are based. We bring a collective expertise across disciplines such as public health, physiotherapy and child development. </p>
<p>SUNRISE findings so far show that the proportion of children in low- and middle-income countries meeting recommendations for movement behaviours is low, compared to high-income countries. This highlights the need for research and intervention in Africa. </p>
<p>But since the beginning of this study we have faced a wide range of challenges. In each country, the target number of children for the study is around 1,000. Researching their movement behaviour requires technology.</p>
<p>The challenges include access to devices to track movement, the lack of awareness of such tools and what they do, difficulty in securing funds, and institutional challenges. </p>
<p>Solutions include local collaboration, reducing financial barriers, developing new low-cost devices, and using contextually relevant methods. The following sections describe the challenges and possible solutions in detail.</p>
<h2>Challenges</h2>
<p><strong>Access to devices</strong></p>
<p>Accelerometers are a type of digital wearable device, similar to Fitbits and smart watches. But they measure movement more accurately than commercially available devices. This is why they are more commonly used in research. These devices are generally more expensive because they are “research-grade”, and upwards of US$250 each (before software and delivery). This is a major challenge for those of us working in African countries, as at least 50 devices would be needed to conduct large scale studies like SUNRISE. There is no local manufacturer or distributor of accelerometer devices. Researchers need a legal licence to import or export them. </p>
<p>The SUNRISE study is able to loan devices. But exorbitant customs and shipping charges for moving this equipment to and between African countries makes sharing difficult – even when it’s only for research. This leads to unnecessary costs and delays, which means Africa gets left behind in this scientific field. </p>
<p><strong>Lack of awareness about the benefits of accelerometers</strong></p>
<p>These devices are often novel in African settings. Some parents and caregivers in our study areas have been sceptical about using them. For example, caregivers have asked whether the devices attract lightning, or whether they have some physical effect on the body. This may lead to another challenge in recruiting sufficient participants for the study. And data collection can take a long time when the shortage of devices is added to the time to get local buy-in. </p>
<p><strong>Difficulty in securing funds</strong></p>
<p>SUNRISE study researchers in Africa battle to get funding. They rely on highly competitive international funding, which seldom prioritises movement behaviour research in young children. It costs a lot to attend conferences internationally and to publish research in reputable academic journals. Open access journal fees can even exceed the monthly salary of a research assistant in an African country. </p>
<p><strong>Institutional challenges</strong></p>
<p>Within African research institutions, another challenge is how to build capacity. Few research institutes focus on movement behaviours in Africa. Accelerometer data is often complex to manage, and needs trained staff. High-income countries typically have access to support staff and students who can assist with this. This is not the case in many African countries. So it is difficult to conduct high-quality research and translate it into policy and practice. </p>
<h2>Possible solutions</h2>
<p>A possible solution is to collaborate with local partners and stakeholders to identify the most appropriate devices for each context and population. </p>
<p>All stakeholders, including local government and non-government organisations, ought to remove barriers so that the researchers can focus on the quality of evidence to inform policy and practice that is anchored to the local context. </p>
<p>Establishing some type of research equipment hub in Africa would go some way to help. But even moving equipment within Africa is not easy. Governments should consider waiving import and export charges for research equipment. The development of low-cost devices that can be produced and used efficiently in Africa is the best way forward. </p>
<p>Researchers in Africa could also examine other new data collection methods that are customised to the local context. Qualitative research (interviews and focus groups) can provide valuable insights into the factors that influence movement behaviours in different contexts. These insights are vital for the development of measurement tools and interventions that are culturally appropriate and effective. </p>
<h2>Conclusion</h2>
<p>There are many other pressing needs in Africa. But the contribution of movement behaviours to population health and development is significant, particularly as there is growing evidence of the global economic costs of physical <a href="https://www.thelancet.com/action/showPdf?pii=S2214-109X%2822%2900482-X">inactivity</a>. We need local research on these behaviours, starting in the early years, when patterns of behaviour are established. </p>
<p>Without addressing barriers to robust research, researchers in this region will continue to lag behind in this field. </p>
<p>This means that we lose opportunities to learn how to promote movement behaviours that support health and development, thus setting children on the best path for life.</p><img src="https://counter.theconversation.com/content/207150/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Draper receives or has received funding from the British Academy for the Humanities and Social Sciences, the South African Medical Research Council, the Jacobs Foundation, and the European Commission.</span></em></p><p class="fine-print"><em><span>Anthony Okely receives funding from NHMRC, Research Council of Norway, World Health Organization, and UNICEF.</span></em></p><p class="fine-print"><em><span>Aoko Oluwayomi receives funding from ISBNPA-PIONEER PROGRAM SCHOLARSHIP 2022</span></em></p><p class="fine-print"><em><span>Chalchisa Abdeta receives funding through HDR Scholarship from the University of Wollongong, Australia.</span></em></p>Africa contributes less than 1% of research worldwide on movement behaviours in children. This means that research on movement behaviours has largely excluded over 16% of the world’s population.Catherine Draper, Associate Professor at MRC/Wits Developmental Pathways for Health Research Unit, University of the WitwatersrandAnthony Okely, Distinguished Professor of Public Health, University of WollongongAoko Oluwayomi, PhD Candidate (Exercise Physiology), University of LagosChalchisa Abdeta, PhD candidate, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2081462023-06-23T12:28:57Z2023-06-23T12:28:57ZMore than 1.5 million Americans lost Medicaid coverage in the spring of 2023 due to the end of pandemic policies – and paperwork problems<figure><img src="https://images.theconversation.com/files/533251/original/file-20230621-15460-7pdgnh.jpg?ixlib=rb-1.1.0&rect=1802%2C134%2C6377%2C4574&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Medicaid helps millions of low-income Americans get health care.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sad-girl-having-a-medical-appointment-with-her-royalty-free-image/1448475165?adppopup=true">skynesher/E+ via Getty Images</a></span></figcaption></figure><figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=255&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=255&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=255&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=321&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=321&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533564/original/file-20230622-15-uhh2l7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=321&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<p>At least 1.5 million Americans lost Medicaid coverage in <a href="https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-and-unwinding-tracker/">April, May and the first three weeks of June 2023</a>, according to the Kaiser Family Foundation, a nonprofit that tracks health data. </p>
<p>Because only 25 states had publicly reported this data as of June 22, the actual number of people who lost coverage through Medicaid, the government’s main health insurance program for low-income people and people with certain disabilities, is surely much higher.</p>
<p>This swift <a href="https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/">decline in Medicaid enrollment follows a huge increase</a> that started in early 2020 and was brought about by <a href="https://ysph.yale.edu/news-article/3-essential-questions-the-end-of-medicaid-continuous-enrollment/">temporary policy changes</a> in effect for the first three years of the COVID-19 pandemic. During that time, the <a href="https://theconversation.com/medicaid-enrollment-soared-by-25-during-the-covid-19-pandemic-but-a-big-decline-could-happen-soon-190494">federal government didn’t let states</a>, which administer Medicaid, drop anyone from the program – even if their income grew too high to qualify.</p>
<p>As of January 2023, the most recent month for which full data is available, a <a href="https://data.medicaid.gov/dataset/6165f45b-ca93-5bb5-9d06-db29c692a360/data">total of 93 million Americans were insured</a> through either Medicaid or the <a href="https://www.verywellhealth.com/understanding-the-difference-between-medicaid-and-chip-4137934">Children’s Health Insurance Program</a>, known as CHIP, a related program. That marked a 30.7% increase from February 2020.</p>
<p>The federal government has estimated that <a href="https://aspe.hhs.gov/sites/default/files/documents/a892859839a80f8c3b9a1df1fcb79844/aspe-end-mcaid-continuous-coverage.pdf">15 million people will lose their coverage</a>, including 5.3 million children, by mid-2024 due to the end of the continuous enrollment policy.</p>
<p><iframe id="ELIcj" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/ELIcj/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Public health emergency over</h2>
<p>The sharp spike in Medicaid enrollment stopped abruptly because the U.S. <a href="https://theconversation.com/what-does-ending-the-emergency-status-of-the-covid-19-pandemic-in-the-us-mean-in-practice-4-questions-answered-205165">COVID-19 pandemic public health emergency status has expired</a>.</p>
<p>States now must phase out <a href="https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/">their continuous enrollment policies</a>, but they are doing it on different schedules. Some began in April 2023; others started to send out termination letters in May or June. There are also states that will not begin this process until later in the year or <a href="https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/unwinding-and-returning-regular-operations-after-covid-19/covid-19-phe-unwinding-section-1902e14a-waiver-approvals/index.html">are taking steps to minimize</a> the number of people losing their coverage.</p>
<p>For about 3 in 4 of the people who lost their Medicaid coverage, it was <a href="https://www.nytimes.com/2023/05/26/us/politics/medicaid-coverage-pandemic-loss.html">for procedural reasons</a>, such as not filing required paperwork. The remaining 1 in 4 probably became ineligible due to an <a href="https://www.policygenius.com/health-insurance/a-state-by-state-guide-to-medicaid/">increase in their income</a>.</p>
<h2>Gains from Medicaid</h2>
<p>There is <a href="https://doi.org/10.1177/0002716219874772">mounting evidence</a> that Medicaid has many benefits for society – especially children.</p>
<p>For example, when low-income families <a href="https://doi.org/10.3368/jhr.54.3.0816.8173R1">remain in the program for long periods of time</a>, they tend to have <a href="https://www.jstor.org/stable/2138939">lower child mortality rates</a>. Medicaid coverage is also associated with <a href="https://doi.org/10.1002/soej.12614">kids faring better in school</a>.</p>
<p>Researchers have also determined that the federal government and state governments can get <a href="https://doi.org/10.1377/hlthaff.2020.00633">boosts in tax revenue</a> when families obtain this health insurance coverage through Medicaid and CHIP that exceed government spending on these programs. That’s because having better access to health care in the long term is <a href="https://doi.org/10.1093/qje/qjaa006">associated with being healthier</a>, staying in school longer and eventually earning a higher income.</p>
<p>The toll that the steep decline in health insurance coverage now underway will take on Americans remains to be seen.</p><img src="https://counter.theconversation.com/content/208146/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maithreyi Gopalan has received funding from the Spencer Foundation, American Educational Research Association, Russell Sage Foundation, and the Student Experience Research Network. She is an Impact Fellow (2023-24) at the Federation of American Scientists. </span></em></p>The health coverage program’s enrollment soared during the three years after March 2020 due to temporary policies adopted at the start of the COVID-19 pandemic.Maithreyi Gopalan, Assistant Professor of Education and Public Policy, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2055152023-06-15T06:09:04Z2023-06-15T06:09:04ZMeasles and whooping cough outbreaks in South Africa: a sign of low vaccination coverage, experts warn<figure><img src="https://images.theconversation.com/files/530906/original/file-20230608-12385-a4sqhf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Caregivers are conflicted about vaccinating their children. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>The concentrated global effort to use vaccination as a public health intervention began in <a href="https://www.who.int/news-room/fact-sheets/detail/immunization-coverage">1974</a>. Since then, vaccination has changed our lives. Worldwide, in the decades 2000-2020, childhood vaccination led to the reduction of deaths in children under 5 by 50% to <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31891-9/fulltext">5.4 million deaths</a> per year. Vaccination currently averts more than <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32657-X/fulltext">5 million deaths</a> each year <a href="https://www.youtube.com/watch?app=desktop&v=vfAcG_ur27g">worldwide</a>. These are deaths that would have been caused by measles, whooping cough, tetanus, polio, diphtheria, pneumonia, rotavirus diarrhoea, and other <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32657-X/fulltext">vaccine-preventable diseases</a>. But in recent months there have been numerous outbreaks of these diseases. Scientists from the South African Medical Research Council explain why these diseases continue to threaten children’s health in the country.</em></p>
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<h2>The country currently has outbreaks of several diseases. What are they?</h2>
<p>There is an increased spread of <a href="https://www.nicd.ac.za/south-african-measles-outbreak-update-2023-9-june-2023/">measles</a> in South Africa now.</p>
<p>Measles is a highly infectious disease that spreads through droplets. It is the second most frequently reported disease outbreak in Africa after cholera. It accounts for 11.5% of all reported disease <a href="https://www.cambridge.org/core/journals/epidemiology-and-infection/article/infectious-disease-outbreaks-in-the-african-region-overview-of-events-reported-to-the-world-health-organization-in-2018/A504999B25CBA5E179B951FABB8CFE53">epidemics on the continent</a>.</p>
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<strong>
Read more:
<a href="https://theconversation.com/explainer-a-history-of-the-measles-virus-and-why-its-so-tenacious-130262">Explainer: a history of the measles virus and why it's so tenacious</a>
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<p>Children who have not been vaccinated against measles are at high risk of the disease and its complications. These include pneumonia, brain damage, and death. Measles is one of the most dangerous but preventable childhood diseases. Up to <a href="http://www.samj.org.za/index.php/samj/article/view/6196/4933">10% of children</a> under five years of age who develop measles die from complications of the disease. </p>
<p>An effective vaccine against measles has been available for decades. A child requires two doses of the measles vaccine to develop protective immunity against the disease. The two doses of the measles vaccine are given at 6 and 12 months of age in South Africa. At least 95% coverage of 2 doses of the measles vaccine is required for herd immunity against <a href="https://www.who.int/news-room/fact-sheets/detail/measles">measles</a> and protect those who aren’t able to get vaccinated.</p>
<p>Another highly infectious disease that has recently seen an increase in cases in South Africa is pertussis, also referred to as <a href="https://www.nicd.ac.za/an-increase-in-pertussis-cases-13-dec-2022/">whooping cough</a>. Pertussis spreads easily from person to person through droplets produced by coughing or sneezing. Complications of whooping cough include pneumonia, seizures, brain damage, and death. The best way to prevent pertussis is through <a href="https://www.who.int/health-topics/pertussis#tab=tab_2">vaccination</a>. </p>
<h2>These diseases are preventable. What’s behind the spread?</h2>
<p>The resurgence of vaccine-preventable diseases in South Africa is due to immunity gaps caused by low vaccination coverage. A <a href="https://www.health.gov.za/wp-content/uploads/2022/03/National-EPI-Coverage-Survey_Final-full-report-Dec-2020.pdf">national survey</a> conducted from July to December 2019 found that only 81% of children had received all their vaccine doses scheduled up to 12 months of age in South Africa. This percentage has increased only slightly to <a href="https://www.who.int/data/gho/data/themes/topics/immunization-coverage">82%</a> since then, according to estimates from the World Health Organization (WHO) and the United Nations Children Fund (UNICEF).</p>
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<strong>
Read more:
<a href="https://theconversation.com/south-africas-immunisation-record-risks-being-dented-by-anti-vaccination-views-153549">South Africa's immunisation record risks being dented by anti-vaccination views</a>
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<h2>What’s the cause of the gaps in immunisation?</h2>
<p>Over the last two years, routine immunisation services and coverage of essential childhood vaccines have been disrupted. And many <a href="https://www.who.int/news/item/24-04-2023-global-partners-announce-a-new-effort-the-big-catch-up-to-vaccinate-millions-of-children-and-restore-immunization-progress-lost-during-the-pandemic">catch-up vaccination efforts</a> have been postponed due to the COVID-19 pandemic. This has led to an increase in the number of children who are unvaccinated or under-vaccinated. </p>
<p>The country’s low vaccination coverage is due to both <a href="https://doi.org/10.1002/14651858.CD013265.pub2">supply and demand issues</a>. These relate to the provision of vaccines and the population’s decision to vaccinate. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378923/pdf/CD013265.pdf">Structural barriers</a> such as vaccine availability and access to health facilities are well known to reduce vaccination coverage. </p>
<p>Research also <a href="https://www.tandfonline.com/doi/pdf/10.1080/21645515.2018.1460987?needAccess=true&role=button">suggests</a> that social and psychological factors, such as concerns about the safety and efficacy of vaccines, influence decisions around vaccination. Some caregivers are conflicted about vaccinating their children. </p>
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Read more:
<a href="https://theconversation.com/unpacking-parents-reasons-for-not-vaccinating-their-children-why-it-matters-171527">Unpacking parents' reasons for not vaccinating their children: why it matters</a>
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<p><a href="https://journalofethics.ama-assn.org/sites/journalofethics.ama-assn.org/files/2018-05/mhst1-1201.pdf">Vaccine hesitancy</a> represents a motivational state of being conflicted about or opposed to vaccination. Evidence from several studies conducted in South Africa has shown a significant <a href="https://www.tandfonline.com/doi/pdf/10.1080/14760584.2021.1949291">increase in vaccine hesitancy</a>. This has had a dramatic impact on routine immunisation services and ultimately reduced vaccine coverage over the years.</p>
<h2>What steps can be taken to close these gaps?</h2>
<p>Globally, many initiatives exist to improve childhood immunization, especially in low- and middle-income countries. Within the context of the Immunization Agenda 2030 (IA2030) programme, WHO, UNICEF and Gavi, are launching the <a href="https://www.who.int/news/item/24-04-2023-global-partners-announce-a-new-effort-the-big-catch-up-to-vaccinate-millions-of-children-and-restore-immunization-progress-lost-during-the-pandemic">“Big Catch-Up”</a> initiative. This initiative aims to support countries like South Africa to plan and implement intensified efforts to bolster immunisation. It has three main objectives: </p>
<ul>
<li><p>to reach children who missed vaccination during 2020-2022 for catch-up vaccination</p></li>
<li><p>to restore vaccination coverage to the last best coverage in 2019 </p></li>
<li><p>to strengthen immunisation programmes to reach the under-vaccinated and unvaccinated children. </p></li>
</ul>
<p><a href="https://bmjopen.bmj.com/content/bmjopen/12/11/e058258.full.pdf">Interventions</a> that are focused on improving the healthcare system include cold-chain infrastructure improvements to ensure availability and access to vaccines. Some other <a href="https://www.tandfonline.com/doi/epdf/10.1080/21645515.2016.1221553?needAccess=true&role=button">interventions</a> that can improve uptake of vaccines include using motivational posters or flyers, sending reminders (messages or letters), and material or monetary incentives to caregivers or pay-for-performance schemes for healthcare workers providing vaccinations to children. </p>
<p>Informing and providing education to caregivers and healthcare workers has also been <a href="https://bmjopen.bmj.com/content/bmjopen/12/11/e058258.full.pdf">effective</a> increasing vaccination in children in cases where parents were hesitant. However, not enough research is done on interventions to dispel misinformation and misconception regarding immunisation, which is one of the leading causes of vaccine hesitancy.</p><img src="https://counter.theconversation.com/content/205515/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Duduzile Ndwandwe receives funding from the South African Medical Research Council. She is affiliated with Eh! Woza, a non-profit Organization for public engagement. </span></em></p><p class="fine-print"><em><span>Charles Shey Wiysonge and Lindi Mathebula do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Over the last two years, routine immunisation services and coverage of essential childhood vaccines have been disrupted.Charles Shey Wiysonge, Director, Cochrane South Africa, South African Medical Research CouncilDuduzile Ndwandwe, Deputy Director and Specialist Scientist , South African Medical Research CouncilLindi Mathebula, Project Manager, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2070242023-06-13T20:06:12Z2023-06-13T20:06:12Z‘Help, my kids keep getting head lice!’ Here’s how to break the cycle of nits<figure><img src="https://images.theconversation.com/files/530776/original/file-20230608-29-jdt55.jpg?ixlib=rb-1.1.0&rect=0%2C1800%2C5352%2C4335&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/P5MXtYfgmmw">Nathan Dumlao/Unsplash</a></span></figcaption></figure><p>Wrangling head lice, and the children they infest, must be up there with the most challenging duties a parent or carer has to face.</p>
<p>Primary school-aged children, who seem to always be in close proximity to one another, are the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-4362.1999.00680.x">most susceptible</a> to lice. </p>
<p>But by exploiting the <a href="https://www.dailymail.co.uk/health/article-4667628/Smartphones-young-children-head-lice.html">screen-sharing</a> and <a href="https://www.abc.net.au/news/2017-07-12/head-lice-expert-busts-myths-about-nits/8697362">selfie-taking</a> habits of tweens and teens, these little parasites are finding more ways to spread.</p>
<p>And they’re no easier to kill off.</p>
<h2>What are head lice and nits?</h2>
<p>Head lice, known by their scientific name <em>Pediculus humanus capitis</em>, are tiny insects that are only found among the hair on a human’s head. They’re not found anywhere else on the planet.</p>
<p>They scuttle up and down shafts of hair. They have perfectly designed claws, that look a little like carabiners, allowing them to move about how a rock climber uses guide ropes. They’re agile on our hair, but clumsy once they’re off.</p>
<p>They don’t jump or fly. They move from head to head through direct physical contact.</p>
<figure class="align-center ">
<img alt="Teenagers take a selfie" src="https://images.theconversation.com/files/530806/original/file-20230608-29-3hd1zy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530806/original/file-20230608-29-3hd1zy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530806/original/file-20230608-29-3hd1zy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530806/original/file-20230608-29-3hd1zy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530806/original/file-20230608-29-3hd1zy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530806/original/file-20230608-29-3hd1zy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530806/original/file-20230608-29-3hd1zy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Lice spread through head-to-head contact.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/dyTxwGriLoY">Unsplash/Priscilla du Preez</a></span>
</figcaption>
</figure>
<p>Our hair is their home but our blood is their food. Head lice feed on the scalp and have specially designed mouth-parts to suck out blood up to a half dozen times a day. It means child with an average sized infestation of head lice may give up <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-4632.2005.02520.x">less than 0.01 ml of blood per day</a>.</p>
<p>When it comes time to lay eggs, that we affectionately refer to as “nits”, the lice don’t want the more than 100 or so eggs they can produce in a lifespan just rolling off our heads. They “<a href="https://academic.oup.com/mbe/article/39/2/msab351/6481551?login=false">cement</a>” their eggs to the shafts of hair. It’s some of the best “superglue” you can find!</p>
<p>Once laid, the eggs will hatch within a few days. Within a week, the lice are ready to lay more eggs. The adult lice can live for up to a month if conditions are right.</p>
<h2>My child has head lice, should I be worried?</h2>
<p>While closely related lice have been implicated in the spread of some of the <a href="https://www.cdc.gov/typhus/epidemic/index.html">most dangerous and deadly pathogens</a> to human health, head lice are much more benign. They’re annoying but <a href="https://www.cdc.gov/parasites/lice/head/disease.html">won’t make us sick</a>.</p>
<p>Their bites may cause an <a href="https://www.sciencedirect.com/science/article/abs/pii/019096229170190D">itchy irritation to our skin</a>. Our bodies react to the saliva they inject when they bite. In the same way we all vary in our reaction to <a href="https://theconversation.com/feel-like-youre-a-mozzie-magnet-its-true-mosquitoes-prefer-to-bite-some-people-over-others-128788">mosquito bites</a>, the same differences result from lice bites. Some people will hardly notice them, others will be driven wild with itchiness.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/530796/original/file-20230608-17-dnukfp.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530796/original/file-20230608-17-dnukfp.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530796/original/file-20230608-17-dnukfp.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530796/original/file-20230608-17-dnukfp.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530796/original/file-20230608-17-dnukfp.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530796/original/file-20230608-17-dnukfp.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530796/original/file-20230608-17-dnukfp.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Feeling itchy?</span>
<span class="attribution"><span class="source">A/Prof Webb/NSW Health Pathology</span></span>
</figcaption>
</figure>
<p><a href="https://www.health.nsw.gov.au/environment/headlice/Pages/default.aspx">Health authorities in Australia</a> do not consider head lice a risk of transmitting pathogens that are <a href="https://entomologytoday.org/2014/01/11/why-do-body-lice-spread-disease-while-head-lice-do-not/">harmful to humans</a>. </p>
<p>There is no doubt they’re annoying but perhaps the greatest health threat of head lice is to the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/nuf.12423">health and well-being of parents</a> responsible for their eradication. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-how-you-beat-indestructible-head-lice-63594">Here's how you beat 'indestructible' head lice</a>
</strong>
</em>
</p>
<hr>
<h2>Do we really need chemicals?</h2>
<p>“Just kill them all, whatever it takes” is a common refrain among those trying to rid their children of the latest round of infestation.</p>
<p>There is a wide range of products available at your local pharmacy to treat head lice. These products should be registered with the <a href="https://www.tga.gov.au/">Therapeutic Goods Administration</a> and be assessed as both safe and effective to use. Most of these products are insecticides that kill the lice on contact.</p>
<p>However, evidence seems to be mounting that some of these insecticides <a href="https://academic.oup.com/jme/article/53/3/653/2222496">aren’t working as well as they once did</a>. Resistance in head lice to commonly used products may be the result of their excessive or incorrect use. The more lice that escape a treatment, the greater the chances of them developing resistance in much the same way bacteria are <a href="https://theconversation.com/looming-behind-antibiotic-resistance-is-another-bacterial-threat-antibiotic-tolerance-200226">developing tolerance and resistance to commonly used antibiotics</a>.</p>
<p>Head lice are still susceptible to alternative approaches. Products derived from Australian plants, such as <a href="https://bmcdermatol.biomedcentral.com/articles/10.1186/1471-5945-10-6">tea tree</a> or <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ajd.12626">eucalyptus</a>, may be better than insecticides. But these are still chemicals.</p>
<p>All these products should be used in accordance with the directions for safe use.</p>
<p>A range of products are marketed as “repelling” head lice. But there is little evidence these are a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-4632.2007.03132.x">reliable way to avoid picking up head lice</a> from your friends or family.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/530797/original/file-20230608-21-cnp98t.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530797/original/file-20230608-21-cnp98t.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530797/original/file-20230608-21-cnp98t.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530797/original/file-20230608-21-cnp98t.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530797/original/file-20230608-21-cnp98t.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530797/original/file-20230608-21-cnp98t.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530797/original/file-20230608-21-cnp98t.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Head lice have perfectly designed claws to scuttle up shafts of hair.</span>
<span class="attribution"><span class="source">A/Prof Webb/NSW Health Pathology</span></span>
</figcaption>
</figure>
<h2>Is there a chemical-free approach?</h2>
<p>A strong recommendation by health authorities in Australia is to skip the sprays, creams, and lotions and embrace the “<a href="https://www.health.vic.gov.au/infectious-diseases/pediculosis-head-lice">conditioner and comb</a>” or “<a href="https://www.choice.com.au/babies-and-kids/health/conditions/articles/how-to-get-rid-of-head-lice">wet comb</a>” method and physically remove the lice.</p>
<p>This is not just good advice for those not wanting to avoid chemicals, it overcomes having to deal with insecticide-resistant lice.</p>
<p>The <a href="https://www.racgp.org.au/afp/2013/march/wet-combing">steps in this process</a> are relatively straight forward.</p>
<p>To immobilise the lice, apply hair conditioner to the child’s damp hair. Then use a fine toothed “lice comb” to systematically work through the hair and remove adult lice. Regularly wiping the comb on tissues or paper towel will reveal the dispatched lice.</p>
<p>This approach works but must be repeated twice, about a week apart, to break the life cycle of the head lice.</p>
<p>Head lice eggs are less susceptible to treatment, no matter what treatment you choose. As all the eggs will hatch within a week or so, repeating treatments again and targeting the adult lice before a new batch of eggs is laid will provide the best results.</p>
<p>The secret to effective eradication of the infestations is patience and persistence. Perhaps a new practice in <a href="https://www.smh.com.au/lifestyle/health-and-wellness/why-nitpicking-is-not-such-a-lousy-idea-for-me-20230306-p5cpon.html">mindfulness?</a></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-whats-the-point-of-nits-116158">Curious Kids: what's the point of nits?!</a>
</strong>
</em>
</p>
<hr>
<h2>Will our household ever be free of them?</h2>
<p>Head lice are a normal part of life for young children. It doesn’t matter how clean and tidy your house is, you’ll inevitably have to deal with an infestation.</p>
<p>Frequent washing of bed sheets, towels, and vacuuming floors won’t keep them away. Head lice don’t survive long out of our hair so you’re unlikely to pick them up from carpet, furniture, or even sharing hats. They don’t <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-4632.2007.03011.x">float around in swimming pools</a> either.</p>
<p>If a child has persistent infestations and has an adverse reaction to the head lice, consult your local health professional. There are some alternative options, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1525-1470.2010.01317.x">including some medications</a>, that may also assist in reducing the bite reactions as well as the infestation itself.</p><img src="https://counter.theconversation.com/content/207024/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cameron Webb and the Department of Medical Entomology, NSW Health Pathology, have been engaged by a wide range of insect repellent and insecticide manufacturers to provide testing of products and provide expert advice on mosquito biology. Cameron has also received funding from local, state and federal agencies to undertake research into mosquito-borne disease surveillance and management.</span></em></p>Head lice are hard to get rid of and seem to come back again and again. Here’s what works.Cameron Webb, Clinical Associate Professor and Principal Hospital Scientist, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2072502023-06-08T16:29:24Z2023-06-08T16:29:24ZBreastfeeding linked to higher GCSE results: how to understand the nuance behind the numbers – and the lack of support for parents<figure><img src="https://images.theconversation.com/files/530854/original/file-20230608-25-6n674r.jpg?ixlib=rb-1.1.0&rect=17%2C5%2C3817%2C2149&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tired-mother-rocking-feeding-her-newborn-1900453813">kryzhov/Shutterstock</a></span></figcaption></figure><p><a href="https://adc.bmj.com/content/early/2023/05/04/archdischild-2022-325148">Recently published research</a> has found a link between breastfeeding for longer and higher GCSE grades.</p>
<p>We know from <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext?preview=true&preview=true">previous research</a> that across a whole population, breastfeeding can help support health and development. Babies who are breastfed are statistically less likely to develop certain health issues, or – as in this study – slightly more likely to gain higher grades. But the key phrase is “likely”. </p>
<p>No research has ever shown that a baby who is not breastfed will develop an illness, or that a baby who is breastfed will not. But nuance like this can go missing from headlines, like <a href="https://www.thetimes.co.uk/article/breast-fed-children-pass-gcse-exams-uk-study-2023-jgqcnn67c">those seen</a> when this <a href="https://www.independent.co.uk/news/uk/home-news/breastfeeding-babies-gcses-higher-marks-b2352149.html">study was published</a>. And so can recognition that child development is always more complex than whether a baby is breastfed or not, as multiple factors affect our health. </p>
<p>This is clear from the research study itself. It found that around one in six students in the study achieved a high pass in maths and English. Within that, once factors such as maternal education and social class taken into account, babies who were breastfed for 12 months or more were around a third more likely to achieve a top grade in maths and English than those never breastfed. </p>
<p>Given that only a minority achieved top grades, this translates to a small increased chance of top grades among babies breastfed for a year or more. Data for shorter durations, or other outcomes such as passing five GCSEs or more was less conclusive.</p>
<p>So, most children did not get a top grade, however they were fed. Some babies who were never breastfed achieved top grades. </p>
<h2>Complex factors</h2>
<p>On an individual level, once you also consider other factors that <a href="https://www.frontiersin.org/articles/10.3389/feduc.2022.849765/full">could affect grades</a> but can’t be measured in a study like this – things out of our control such as genetics, luck, and how hard a teen chooses to revise – the difference will likely be even smaller. Certainly not at a level that should cause concern if you are reading this as a parent whose baby could not be breastfed. </p>
<p>Although it would be wrong to imply that breastfeeding never plays a role, it’s more likely that it plays a role alongside many other important factors too.</p>
<p>Saying that, studies that show a small increase such as this are important, because they might persuade governments and other organisations that breastfeeding support is <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01044-2/fulltext">worth investing in</a>. There has been a <a href="https://www.theguardian.com/lifeandstyle/2018/jul/27/breastfeeding-support-services-failing-mothers-due-to-cuts">sustained failure</a> in understanding and supporting all aspects of infant feeding. </p>
<p>The <a href="https://adc.bmj.com/content/early/2023/05/04/archdischild-2022-325148">study itself</a> is well conducted and highlights its own limitations. But it has led to a multitude of news headlines stating that breastfed children <a href="https://www.thetimes.co.uk/article/breast-fed-children-pass-gcse-exams-uk-study-2023-jgqcnn67c">do better at school</a> – and <a href="https://www.independent.co.uk/news/uk/home-news/breastfeeding-babies-gcses-higher-marks-b2352149.html">calling on mothers to breastfeed</a> to improve their children’s grades.</p>
<p>The media interpretation has reignited feelings of grief and anger among those who feel let down by the dire <a href="https://twitter.com/LittleDoctorVic/status/1666350722999373824">lack of investment</a> in infant feeding. The response <a href="https://www.huffingtonpost.co.uk/entry/breastfed-kids-doing-better-on-exams-is-the-absolute-last-thing-women-need-to-hear_uk_647f1eabe4b0a7554f46c296">has been fierce</a>. </p>
<p>For women who want to breastfeed, news articles like the ones that reported the new study do little to actually support parents to do so. The 2010 <a href="https://doc.ukdataservice.ac.uk/doc/7281/mrdoc/pdf/7281_ifs-uk-2010_report.pdf">infant feeding survey</a> found that around a third of women who had started breastfeeding stopped altogether in the first six weeks. Four out of five would have liked to <a href="https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010">carry on for longer</a>. </p>
<p>What use is knowing that breastfeeding could potentially improve your child’s educational outcomes if the support that you need to do that is missing?</p>
<figure class="align-center ">
<img alt="Woman bottle feeding baby" src="https://images.theconversation.com/files/530857/original/file-20230608-2966-g3nm04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530857/original/file-20230608-2966-g3nm04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=334&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530857/original/file-20230608-2966-g3nm04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=334&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530857/original/file-20230608-2966-g3nm04.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=334&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530857/original/file-20230608-2966-g3nm04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=420&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530857/original/file-20230608-2966-g3nm04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=420&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530857/original/file-20230608-2966-g3nm04.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=420&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">All mothers should be supported.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-enjoy-happy-love-family-african-1682289811">Art_Photo/Shutterstock</a></span>
</figcaption>
</figure>
<p>Many women stop for reasons outside their control, such as difficulty accessing support to position their baby without pain, complications such as tongue tie, conflicting advice, exhaustion, health reasons, or milk supply issues. </p>
<p>Others feel <a href="https://orca.cardiff.ac.uk/id/eprint/118475/">pressured into stopping</a> by family, have challenges <a href="https://www.mdpi.com/1229866">returning to work</a>, or feel <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/mcn.13407">criticised feeding in public</a>. Some cannot breastfeed due to <a href="https://www.frontiersin.org/articles/10.3389/fped.2018.00278/full">health complications</a> meaning continuing to breastfeed would not have led to optimal outcomes for them. </p>
<p>I could cite a hundred reasons why women stop or do not breastfeed – but not knowing that breastfeeding could possibly, at a population level, slightly increase their child’s GCSE results would not be one of them. </p>
<p>It is also important to consider <a href="https://connect.springerpub.com/content/sgrcl/9/4/200?implicit-login=true&sigma-login=has-d&sigma-token=pEgVISe7k6RoRyZjib5Qo7ubnTzxwV8ETwj2nhYmg4c">why breastfeeding might be important</a> to women.
In my research, <a href="https://pinterandmartin.com/why-breastfeeding-grief-and-trauma-matter">women have talked about</a> the importance of breastfeeding to them because their baby was premature or unwell, because of cultural or religious reasons, or a preference to care for their baby in a certain way. A simple desire for their body to work as they hoped. </p>
<p>Many can’t put it in words. When breastfeeding doesn’t work women can feel like they <a href="https://welldoing.org/article/why-breastfeeding-grief-trauma-matter">lose much more</a> than hypothetical future good grades. It’s not about GCSE grades, but rather expectations being shattered, tied up in a lack of promised support, <a href="https://graziadaily.co.uk/life/parenting/us-formula-milk-shortages-breastfeeding-guilt-tongue-tie/">casual judgements</a> of your decisions, or a dismissal of how breastfeeding <a href="https://www.glamourmagazine.co.uk/article/breastfeeding-grief">mattered to you</a>. Our main focus should be on ensuring that all new parents get the support they need now in navigating caring for their baby.</p><img src="https://counter.theconversation.com/content/207250/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has received funding from the ESRC, MRC, NIHR, HEFCW, UKRI, Infant feeding charities and Public Health Wales. She is a trustee for First Steps Nutrition Trust. </span></em></p>Child development is always more complex than whether a baby is breastfed or not, as multiple factors affect our health.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2056842023-05-23T13:56:37Z2023-05-23T13:56:37ZBuilding a nutrition programme? Understanding how people behave is key<figure><img src="https://images.theconversation.com/files/526560/original/file-20230516-21-r6gzv4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Riccardo Mayer/Shutterstock</span></span></figcaption></figure><p>Undernutrition contributes to up to <a href="https://www.afro.who.int/health-topics/nutrition">45%</a> of child deaths in African countries. At the same time, <a href="https://www.afro.who.int/health-topics/nutrition">child obesity rates have doubled</a> between 2006 and 2016. More than <a href="https://globalnutritionreport.org/resources/nutrition-profiles/africa/">40%</a> of women of reproductive age are anaemic. And <a href="https://globalnutritionreport.org/resources/nutrition-profiles/africa/">13.7%</a> of infants have low weight at birth. Stunting in the African region is <a href="https://globalnutritionreport.org/resources/nutrition-profiles/africa/">30.7%</a> – above the world average of 22%. </p>
<p>In <a href="https://www.fao.org/documents/card/en/c/cb7496en">2020</a>, over a fifth of Africa’s population faced hunger; 346.4 million people experience severe food insecurity; and 452 million experienced moderate food insecurity. </p>
<p>Nutrition programmes have been supporting families in Africa for decades. But many of these programmes have inconclusive results. </p>
<p>As health psychologists and behavioural scientists, we believe this is because the programmes don’t focus on fitting into families’ lives. Doing so would also make nutrition interventions sustainable. Understanding the behaviours of the people being targeted by nutrition programmes could improve their nutrition status. </p>
<p>Our <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000401">recent research</a> looked at the outcomes of studies that had behaviour change embedded within programmes to improve nutrition for mothers and children in sub-Saharan Africa. Our findings show that nutrition programmes that focus on family and community behaviour change have better health outcomes for mothers and children. </p>
<p>The World Health Organization has outlined the importance of <a href="https://apps.who.int/iris/handle/10665/259399">behaviour change</a> to support mother and child health and help address barriers in current nutrition programmes. Our study goes a step further to show how to use behaviour change models to design better nutrition programmes. </p>
<h2>Behavioural science</h2>
<p>Health psychologists and behavioural scientists developed the COM-B model. It suggests that a person’s Capability, Opportunity and Motivation can change their <a href="https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-6-42?report=reader">Behaviour</a>. Our study showed that this model can be used to consider what is happening in the lives of people when designing <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000401">nutrition interventions</a> including what barriers there might be to eating healthy food. </p>
<p>“Capability” from the COM-B model refers to a person’s physical capability, such as their skill sets, and psychological capability, such as knowledge about a behaviour. If a person doesn’t know what foods to be eating to be healthy or doesn’t feel they have the skills to cook healthy foods, they can’t change the behaviour. Programmes need to support people to know what the healthy local foods are and how to cook these foods, potentially through community-led cooking demonstrations. Our findings show that simply educating people isn’t enough. Making lessons interactive and practical in people’s daily lives increases the likelihood of behaviour change.</p>
<p>“Opportunity” from the COM-B model refers to a person’s physical opportunities in their environment, and their social opportunities such as their family and wider community. For example, if communities don’t have apples and bananas growing in their environment, or for sale, then they simply won’t be able access these foods. Programmes therefore need to support the foods that are already available to buy in people’s environment. If possible, they should also support the wider community to grow food. The people around us influence what we do and what we eat. Programmes should try to encourage key community and family figures to support nutrition practices. </p>
<p>“Motivation” from the COM-B model refers to a person’s habits and things they do without realising it (automatic motivation). One of the habits or norms in many communities is to prioritise men, then children, to eat first. Women often get the leftovers, even when they are pregnant. This means that pregnant women don’t get the nutrients they need. Programmes need to work with women, men and wider communities to motivate them to prioritise women’s nutrition, while respecting culture and tradition. This would encourage reflective motivation where people can consciously make decisions about food within social structures.</p>
<h2>Building nutrition programmes</h2>
<p>When designing nutrition programmes, the best way to learn about people’s motivations is to ask them directly about the issues they are facing and the solutions they want. Once you know their issues and potential solutions, you can use behavioural science models such as the COM-B model to categorise the issues and solutions, and start designing programmes to address these gaps. </p>
<p>To go a step further, the same behavioural scientists also developed the Behaviour Change Wheel, which helps us to think of different <a href="https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-6-42?report=reader">methods</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/526522/original/file-20230516-17-ml1e3n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/526522/original/file-20230516-17-ml1e3n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/526522/original/file-20230516-17-ml1e3n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526522/original/file-20230516-17-ml1e3n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526522/original/file-20230516-17-ml1e3n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526522/original/file-20230516-17-ml1e3n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=496&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526522/original/file-20230516-17-ml1e3n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=496&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526522/original/file-20230516-17-ml1e3n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=496&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Behaviour Change Wheel, with the COM-B at the centre and the intervention functions in the outer circle.</span>
<span class="attribution"><a class="source" href="https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-6-42">Michie et al</a></span>
</figcaption>
</figure>
<p>Our study shows that applying the Behaviour Change Wheel to nutrition programmes may also increase their impact. The wheel suggests:</p>
<ul>
<li><p>giving participants incentives</p></li>
<li><p>using persuasive communication</p></li>
<li><p>modelling healthy diets</p></li>
<li><p>restructuring the environment</p></li>
<li><p>educating on nutrition, in an interactive way</p></li>
<li><p>supplying resources such as tools and seedlings (enablement)</p></li>
<li><p>training communities in cooking or agricultural methods. </p></li>
</ul>
<p>Using simple behavioural science models can help programmes to understand people’s lives and how to design nutrition interventions that directly benefit them, even when the funding ends.</p><img src="https://counter.theconversation.com/content/205684/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniella Watson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Using simple behavioural science models can help programmes to understand people’s lives and how to design nutrition interventions that directly benefit them.Daniella Watson, Postdoctoral Researcher and Health Psychologist, King's College LondonLicensed as Creative Commons – attribution, no derivatives.