Tag Archives: Babies

Giving children the best possible start – what matters most?

Child of our Time Editor Yvonne Kelly spoke to a 500-strong audience of politicians and professionals in Gothenburg recently on what matters when it comes to giving children the best possible start in life.

Yvonne was the keynote speaker at the conference hoping to identify the best strategies for making Gothenburg a more equal and socially sustainable city.

Yvonne, Professor of Lifecourse Epidemiology at the ESRC International Centre for Lifecourse Studies at UCL  explained which factors are most closely linked with a child’s health and well-being and presented her research findings on children’s verbal skills, behaviour, bedtimes, reading and obesity.

Putting a SPRING in the step of mums-to-be

Making sure that mums-to-be are in the best possible health is key to ensuring their baby gets the best possible start in life. But what sorts of things can help them achieve that? In this episode of the Child of our Time Podcast, Professor Hazel Inskip from the MRC Lifecourse Epidemiology Unit at the University of Southampton, talks about an ongoing trial making use of healthy conversations and Vitamin D supplements to try to improve the diet of just pregnant women.

Photo credit: Pregnant, Frank de Kleine

Better start for children

Giving children the best possible start in life is the topic of a keynote talk today by our editor Yvonne Kelly.

Yvonne will be presenting a range of new evidence from the ESRC International Centre for Lifecourse Studies  to politicians, business leaders, and other professionals and key decision makers at an event discussing how Gothenburg can be made an equal and socially sustainable city.

Yvonne will talk about the factors which are most closely linked with a child’s health and well-being and present findings on children’s verbal skills, behaviour, bedtimes, reading and obesity. She will make the case that signs of social inequalities are evident early in a child’s life and that it is important to intervene early to tackle those inequalities.

Sugar-coating the childhood obesity problem

Child obesity figures appear to be on the rise again, causing much concern after earlier signs they had levelled off.  The proportion of  10- and 11-year-olds who were obese in 2015-16 was 19.8 percent, up 0.7 percent on the year before. There was a rise of 0.2 percent among four- and five-year-olds. The announcement comes as researchers at the ESRC International Centre for Lifecourse Studies at UCL have been looking in detail at how and when children become overweight. The team has also been asking whether children who are overweight are more likely to go on to smoke and drink alcohol and if their mental health suffers as they become adolescents. Yvonne Kelly explains the research findings, and considers their implications for the Government’s recent strategy for tackling the childhood obesity epidemic.

The Government’s much-awaited and much-debated childhood obesity strategy was published in August. In the end, it was less comprehensive than had been anticipated, less draconian too. It focuses on two things – reducing sugar consumption and increasing physical activity. But will it be effective in reversing this worrying obesity trend among our children?

It’s fair to say we don’t fully understand what things influence whether, when and why a child might become overweight. Research to date has shown three distinct weight pathways for children: a healthy BMI throughout childhood; becoming overweight during childhood and being overweight/obese throughout childhood.

Previous research has also shown that the child’s mother’s weight, smoking in pregnancy, mental health and other social and economic factors have some link to childhood obesity. But the evidence is far from complete and, where a child’s own mental health is concerned, it’s not at all clear which way the association works.

To try to get a clearer picture of all these things, our research looked at the BMI paths of the participants in the Millennium Cohort Study, which has tracked the lives of nearly 20,000 children born between 2000-2002. We used data collected at birth, 9 months, age 3, 5, 7 and 11.

Once we had established who was on which BMI path, we were able to look at what factors were at play in their lives and to see whether a tendency to overweight and obesity was an indication that a child would go on to face mental health difficulties in early adolescence or start smoking and drinking.

Four pathways to obesity

The BMI data for the 17,000 children we were able to look at for our study showed four distinct groups of children. More than 80 per cent of them stayed on an average non-overweight path throughout their childhood – we call it the ‘stable’ path. There was a small group (0.6 percent) of children who were obese at age 3 but were then in the stable group by age 7. We call them the the ‘decreasing’ group. There was a ‘moderate increasing group’ (13.1 percent) where children were not overweight at age 3 but whose BMIs increased throughout childhood into the overweight (but not obese) range. Finally we had a ‘high increasing’ group of children (2.5 percent) who were obese at age 3 and whose BMIs continued to increase.

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Girls were 30 percent more likely to be in the ‘moderate increasing’ group than boys and were half as likely to be on the ‘decreasing’ path. Indian, Pakistani and Black African children were up to two times more likely to be on the ‘moderate increasing’ path whilst Pakistani, Black Caribbean and Black African children were up to three times more likely to belong to the ‘high increasing’ group.

The wealthiest children were least likely to be in the ‘moderate increasing’ BMI group and children of mums who smoked during pregnancy were up to two times as likely to belong to increasing BMI groups. Children with overweight mums were most likely to be on the moderate and high increasing paths.

Children on the moderate and high increasing paths were less likely to have regular family routines – they were more likely to skip breakfast or have non-regular bedtime schedules. Interestingly, however, no strong links emerged with some of the things more readily linked with childhood obesity such as sugary drinks and snacks, watching TV and lack of physical activity such as sports, the main focus of the newly published childhood obesity strategy.

Overweight factors

So it seems quite a large range of factors influence the likelihood of a child becoming overweight or obese over the first decade of their life. On top of this, being overweight or obese would also seem to point to a less happy and fulfilling early adolescence and a tendency to explore risky behaviours like smoking and drinking.

Although our research did not show a clear link with sugary drinks and snacks, there are nevertheless some compelling arguments for reducing the sugar intake of our children. These are not only related to problems of obesity, but to wider issues including the major issue of tooth decay and associated emergency hospital admissions. There is also increasing evidence of the ‘addictive’ nature of sugar with research suggesting that it stimulates a sort of ‘reward path’ in certain centres of the brain meaning that the more we have the more we want. It has been shown that people who reduce their sugar intake tend to crave it less.

Where sugar taxes have been introduced in other countries (Mexico, France, Denmark, South Africa amongst others), the intervention has been shown to help reduce the consumption of sugary drinks. As yet, there is no evidence that it helps reduce BMI and tackle obesity, but it’s argued it will take time for us to see an effect on whole populations.

Disadvantaged families

It is hard to predict how much impact the voluntary rather than mandatory reduction in sugar content of drinks and snacks agreed in the strategy will have. As for the sugar tax that will be introduced in two years’ time, there remain concerns that disadvantaged families more likely to purchase and consume sugary goods than their better off counterparts will be hardest hit. Policy makers will need to think hard about how any negative consequences of this might be counteracted.

Our research shows clearly that when it comes to the likelihood of a child becoming overweight or obese in the first decade of their life, there are many more influences than just sugar. Those influences are at play in families even before our children are born.

Helping pregnant women to stop smoking and maintain a healthy weight, making sure all young children have healthy eating and sleeping routines would seem to be key, together with targeted support for the ethnic and social groups identified as being most at risk.

Further information and resources

BMI development and early adolescent psychosocial well-being: UK Millennium Cohort Study is research by Yvonne Kelly, Praveetha Patalay, Scott Montgomery, and Amanda Sacker. The work, published in Pediatrics, is funded by the Economic and Social Research Council.

Media coverage

Photo credit: Kim Stromstad

BMI development and early adolescent psychosocial well-being

Research looking at how and when children become overweight is helping to shed new light on ongoing efforts by the Government and others to tackle the childhood obesity epidemic.

A team of researchers at the ESRC International Centre for Lifecourse Studies at UCL has also been asking whether children who are overweight are more likely to go on to smoke and drink alcohol and if their mental health suffers as they become adolescents.

The research, published in Pediatrics, shows clearly that when it comes to the likelihood of a child becoming overweight or obese in the first decade of their life, there are many more influences than just sugar (a main plank in the Government’s Childhood Obesity Strategy).

The research also shows that  influences are at play in families even before children are born and indicates that helping pregnant women to stop smoking and maintain a healthy weight, making sure all young children have healthy eating and sleeping routines may be key, together with targeted support for ethnic and social groups identified as being most at risk.

Lead researcher, Yvonne Kelly presented the findings at the Society for Longitudinal and Life Course Studies 2016 conference in Bamberg.

A bedtime story

Reading is key to giving children the best possible start in life. That’s what Child of our Time Editor Professor Yvonne Kelly will be telling representatives of the Swedish Government and European Commission today when she delivers the key note presentation at a seminar highlighting the importance and benefits of early interventions in children’s lives.

The seminar in Brussels has been organised by the City of Gothenburg in Sweden as part of its efforts to achieve the political goal of becoming an equal city and of its commitment to reduce inequalities.

Yvonne will be sharing research by herself and colleagues at the ESRC International Centre for Lifecourse Studies looking at factors associated with children’s poor verbal skills and behaviour problems. The research shows the links between regular bedtimes and reading with children and better outcomes for them in terms of behaviour and how well they get on at school.

Organisers of the event hope their efforts will encourage other cities in Europe to join them in their ambition to create health equality and a good start in life for all.

Photo credit: Lars Plougmann

Are our children’s human rights equally protected?

It’s time to stop hitting our children and give them the same human rights protection afforded to adults says an important new report published by the NSPCC today. The report, which reviews all the available evidence on the impacts of physical punishment on children has been compiled by a team of academics at UCL: Dr Anja Heilmann, Professor Richard Watt and Child of our Time co-editor Professor Yvonne Kelly. Consultant paediatrician Dr Lucy Reynolds told us what she makes of the report and the impact she hopes it will have on policy makers, her colleagues in the medical profession, parents and children themselves.

Equally Protected? A review of the evidence on the physical punishment of children was commissioned by NSPCC Scotland, CHILDREN 1st, Barnardo’s Scotland and the Children and Young People’s Commissioner Scotland.

Photo credit: Paediatrician, UW Health

We know enough now to stop hitting our children

Despite a steady decline in recent decades, the physical punishment of children remains common in British homes. The UK is one of only five countries in the European Union which has not committed to outlawing all physical punishment. British children have less protection from physical violence than adults – a clear violation of international human rights law. And, as a new study commissioned by a group of children’s charities shows, there’s ample evidence physical punishment can damage children and escalate into physical abuse. Author of the report, Dr Anja Heilmann from University College London makes the case for urgent action:

Sadly, it’s only the most extreme forms of child maltreatment that have dominated the headlines in recent years. As far as the media is concerned, there is a dearth of in-depth coverage of the issue of physical punishment, whilst UK governments have not implemented the kind of legal reform that has been happening in countries across the world.

Though there are variations between the nations of the UK, broadly all allow a defence of ‘reasonable punishment’ to a parent accused of lesser physical assault of a child in their care. In Scotland, the defence is one of ‘justifiable assault’.

In 2008, the Scottish Government said :

‘the current position ensures that the law gives children sufficient protection without unnecessarily criminalising parents who lightly smack their child.’

This position, however, is at odds with the substantial evidence base.

Much new research

Internationally, the past decade has seen a surge in the number of studies on the prevalence and outcomes of the physical punishment of children. The most recent substantial review in the UK was a 2008 study in Northern Ireland.

Our aim was to summarise the evidence that has become available since then. To do this we reviewed relevant studies published in English between January 2005 and June 2015. For a definition of physical punishment we used that provided by the United Nations Convention on the Rights of the Child:

‘Corporal’ or ‘physical’ punishment is any punishment in which physical force is used and intended to cause some degree of pain or discomfort, however light.’     

We defined a ‘child’ as anyone under 18. Our initial search yielded more than 1500 returns. We narrowed these down to 98 for in-depth review.

Clear evidence of negative effects

The good news is that the physical punishment of children is in decline. One study found that in 1998 in the UK, 61% of young adults reported having been smacked as a child, while in 2009 this was true for 43%.

Public attitudes have also shifted with the use of physical punishment becoming less and less acceptable and a higher proportion of parents doubting its usefulness.

On a less positive note, we found clear evidence of physical punishment continuing to lead to serious negative outcomes for the child. Four-fifths of the relevant studies found physical punishment was related to increased aggression, delinquency and other anti-social behaviour.

One study in Scotland found that children who had been smacked during their first two years of life were more than twice as likely to have emotional and behavioural problems at age 4 than children who had not been smacked. There was evidence that the more physical punishment suffered by a child, the worse the subsequent problem behaviour.

The evidence suggests that physical punishment is still harmful even when administered in a generally loving and positive family environment – the “loving smack” might be a myth. In addition, all studies that tested it found a link between physical punishment and more serious child maltreatment.

The negative effects continue into adulthood. Again, four out of five relevant studies suggest a link between childhood physical punishment and adult aggression and antisocial behaviour. One large study in the US found that participants who had been physically punished as children were 60% more likely to suffer alcohol or drug dependence.

Legislate and communicate

Though the UK is in a minority in allowing physical punishment, it is not alone. We also looked at five European countries with varying legislative regimes. In all we found a large and growing majority of parents striving to rear their children without physical punishment.

Those countries which had both legislated to give children equal protection against assault and promoted intensive, long-term campaigns of public education had been more effective in changing attitudes and behaviours than those which had pursued either strategy alone.

The international approach to children’s rights is clear: they should be equal to those of adults. The United Nations Convention on the Rights of the Child, which states that all steps to protect children from physical violence should be taken, has been ratified by the UK. And the UK’s continuing failure to explicitly prohibit all corporal punishment in the home has been criticised by the committee that monitors implementation of the Convention.

Act now

“Further research needed” is often one recommendation coming out of a study like this. And there is still a need to know more, for instance, about the efficacy of measures to reduce the incidence of childhood physical punishment.

But no more research is needed to tell us that physical punishment has the potential to damage children and carries the risk of escalation into physical abuse. Our conclusions only reinforce the findings of the 2008 Northern Ireland study.

We need legislation now. And legislation backed up by a large-scale information and awareness campaign.

Equally Protected? A review of the evidence on the physical punishment of children by Dr Anja Heilmann, Professor Yvonne Kelly and Professor Richard G Watt was commissioned by NSPCC Scotland, CHILDREN 1st, Barnardo’s Scotland and the Children and Young People’s Commissioner Scotland.

Photo credit: ellyn.

 

Parenting before and after separation

Do more involved dads have more contact with their child in the event of a separation? And does a mother’s confidence in her ability as a parent take a knock on separation? Researchers Professor Lucinda Platt from the London School of Economics and Political Science and Dr Tina Haux from the University of Kent  have been investigating these questions, using the Millennium Cohort Study, in a Nuffield Foundation funded research project looking at parenting before and after separation.

 

Photo credit: Dani Vazquez

Ethnicity, birthweight and growth in early childhood

Birthweight varies according to ethnic group but height at the age of five does not. Why might that be? Does it tell us anything about the lives of second and third generation immigrants? And does it offer any useful guidance to health professionals hoping to target disadvantaged groups? Professor Yvonne Kelly outlines recent research with colleagues at the ESRC International Centre for Lifecourse Studies looking at differences in birthweight and early growth between ethnic groups.

Birthweight is important. There is a large body of work that suggests links between low birthweight and the development of chronic disease. Height at the age of five is a less straightforward indicator but still an important measure. The relationship between the two is important as well. Rapid post-natal growth may also have a role in later disease risk, and any correlation may tell us something about the lives of people born in the UK to parents born elsewhere.

Earlier research shows that babies born to South Asian and Black mothers weigh up to 300g less than those with White mothers. They are also up to two and a half times more likely than their White counterparts to have low birthweight.

Our study made use of the rich information available in the Millennium Cohort Study and enabled us to drill down further into ethnic differences. We were able to look at White, Indian, Pakistani, Bangladeshi, Black Caribbean and Black African groups.

These, of course, are groups that have very different migration histories. The Black Caribbeans and Indians mainly migrated to the UK in the 1950s and 1960s. The Pakistanis arrived in the 1960s and 1970s, the Bangladeshis in the 1980s and the Black Africans in the 1990s.

Social v biological

If you accept that ethnicity is a social not a biological construct, these variations must be the result of factors that are not intrinsic to the group but tend to go with membership. Relevant factors are likely to be either socioeconomic or maternal.

So, if one group tends to have higher incomes and higher levels of educational attainment, it is likely to have fewer babies with low birthweight. Similarly, if mothers within one group are less likely to smoke they too are likely to have heavier babies.

Because our research compared data on birthweight to those on ethnicity, socioeconomic status and maternal characteristics, it was possible to identify which were most closely associated.

The results suggest that socioeconomic factors are important in explaining birthweight differences in Black Caribbean, Black African, Bangladeshi and Pakistani infants. Maternal characteristics are important in explaining birthweight differences in Indian and Bangladeshi groups. Clearly, both must operate to some extent in all cases.

Our study identifies the dominant factor for each ethnic group and recommends policy-makers pay attention to the different socioeconomic and culturally related profiles of ethnic minority groups when devising policies aimed at reducing inequalities in birthweight.

A question of height

One key maternal characteristic identified was height. Mothers from the Indian, Pakistani and Bangladeshi groups were on average 8cm shorter than White mothers. We speculate that it might take several generations for individuals within ethnic groups to reach their height potential.

And it could be that increases in maternal height do not happen so much for the first couple of migrant generations due to the ‘accumulated effects of disadvantage, including racism, discrimination and poverty that are disproportionately experienced by migrants’. That idea was put to the test in a second study also using MCS data.

The primary aim of this research was to investigate ethnic differences in height at 5 years of age. The same ethnic groups were used. Again, the sample was large and broadly representative of the whole UK.

Playing catch up

In contrast to the findings on birthweight, Indian, Pakistani, Black Caribbean and Black African children were taller than White children at age 5. Bangladeshi children were the same as White children. Birthweight was not entirely irrelevant. It was a weak to moderate predictor of height in White, Pakistani, Bangladeshi and African children.

All the measured variables favoured the White group over all ethnic minorities. This is consistent with the suggestion floated towards the end of the first study that what is happening is that a generation is ‘catching up’, earlier generations having been previously thwarted by such factors as poor nutrition in underdeveloped home countries.

Saying that, catch-up growth is likely to explain only a part of the ethnic height differences identified and further research is important here. It is also important to note that taller children are more inclined to obesity and so the height advantage of ethnic minority children might not translate into a health advantage in adulthood.

The links between ethnicity, birthweight and height in childhood are not, then, straightforward or by any means fully understood. It is clear that outcomes associated with different groups are the result of social and not biological characteristics.

The length of time a group has been established in the UK also appears to play a part with at least some suggestion of a generational ‘catch-up’ effect. Though there may be plenty of inequality left to address, that does at least suggest things are moving in the right direction.

Further information

Why does birthweight vary among ethnic groups in the UK? Findings from the Millennium Cohort Study is research by Yvonne Kelly, Lidia Panico, Mel Bartley, Michael Marmot, James Nazroo and Amanda Sacker and is published in the Journal of Public Health.

Ethnic differences in growth in early childhood: an investigation of two potential mechanisms is research by Amanda Sacker and Yvonne Kelly and is published in the European Journal of Public Health.

Photo credit: moinuddin forhad

[1] Ethnic differences in growth in early childhood: an investigation of two potential mechanisms. A. Sacker, Y. Kelly