Tag Archives: Children

Time to help our children get a move on

 World Health Organisation and United States guidelines say adolescents should do at least an hour’s moderate-to-vigorous physical activity each day. But a new global study shows eight out of 10 fail to meet that standard – and there is a widening gender gap. Professor Yvonne Kelly and Fran Abrams outline new research revealing worrying trends which demonstrate the need for political and social choices that will help young people enjoy the social, physical and mental benefits of being active.

Physical activity has many health benefits for young people – and globally,  four in every five adolescents do not benefit from regular physical activity.

 In 2018, the WHO launched a global action plan called More Active People for a Healthier World. It aimed to reduce the proportion of people doing insufficient physical activity by 15 per cent by 2030 among both adolescents and adults. 

Now in a major new study WHO researchers have analysed information on 1.6 million school students aged 11-17 in 146 countries. They found some positive trends but argued much still needed to be done to encourage young people to exercise more.

There was a small reduction over 15 years in the proportion of boys not doing enough, though this still fell well short of the WHO’s target. But the proportion of girls meeting the target remained static and this led to a widening gender gap. 

As has been shown in the UK such gender differences start early with lower levels of physical activity in girls emerging before they become teenagers. 

The authors of a separate investigation using the Millennium Cohort Study (MCS) suggest the main reason for young people not exercising or sleeping enough is the amount of time they spend using screens. This is a hotly contested area, intuitively, ‘too much screen time’ and ‘too little exercise’ might appear to sit side by side.  However, in this kind of study, it is not possible to infer that one causes the other. 

The WHO study showed the majority of adolescents did not meet physical activity guidelines, putting their current and future health at risk. Although there were small reductions in insufficient activity among boys, the prevalence of insufficient physical activity in girls had remained unchanged since 2001.

 

Figure 1 Prevalence of insufficient physical activity among school-going adolescents aged 11–17 years, globally and by World Bank income group, 2001 and 2016

Huge dataset

The dataset used in the WHO study was huge – the young people studied had provided information for at least three years and the analysis covered four World Bank income groups, nine regions, and the globe as a whole for the years 2001–16. Saying that, although  the research data covered more than 80 per cent of the global population, it still didn’t cover every county and region. And the estimates for low-income countries need to be treated with caution as the coverage there was much lower – only 36 per cent.

The overall analysis showed that more than eight out of 10 school-going adolescents aged 11–17 did not meet the recommendations for daily physical activity. The small improvements in boys’ activity levels, combined with the static position in girls’ activity, suggested a target of more than 30 per cent of adolescents meeting the recommended level by 2030 will not be met.

Globally, across all income groups and regions and in nearly all the countries analysed, girls were less active than boys.

And perhaps surprisingly, the research did not find that the problem was worse in higher-income countries. However, this was not the case for girls, for whom there was no clear pattern in relation to country income.

Differences in activity levels

In addition to variations related to gender and affluence, there were also differences in activity levels between different parts of the world. The boys least likely to meet activity targets were in the high-income Asia Pacific region, but the second-least likely were in lower-income Sub-Saharan Africa and particularly in Sudan and Zambia. 

The boys most likely to meet the targets were found in high-income western and south Asian countries with large populations such as the USA, Bangladesh, and India.

These variations might be driven by specific characteristics of particular countries – for example, as the research looked at school children the picture might be skewed in countries where disadvantaged children often do not attend school, or in places where the tradition of school or community sport is strong.

For girls, the largest proportions failing to meet the targets were in Asia Pacific and particularly in South Korea- though in some of those countries girls’ participation in education is low and that might have affected the study’s sample.

The recent MCS study by academics from Loughborough University and University College London used data from 3899 adolescents. This study, in which young people were fitted with activity monitors, found that while nine out of 10 were getting the recommended amount of sleep, just four in ten met exercise targets and a quarter were keeping to the recommended screen time. These figures were higher than those in the WHO study, which could be explained by the different methods used to measure activity and which show just how important it is to consider HOW activity is measured.

The study looked at  some correlates of physical activity and showed that adolescent girls who had depressive symptoms were less likely to meet all three of these recommendations (8-10 hours of sleep, no more than two hours of screen time and at least an hour a day of physical activity), while those from better-off backgrounds were more likely to meet them. Among boys, those who were obese and those who had depressive symptoms were less likely to meet the recommendations. However, it is not possible to rule out the potential for cyclical associations to be at play here as low levels of physical activity could lead to depressed mood and to weight gain.

What can be done? 

  • More research is needed to understand the causes of non-participation in exercise – social, economic, cultural, environmental and technological. 
  • Policy change should be prioritised and should encourage all forms of physical education – sport, active play, and recreation as well as safe walking and cycling.
  • Social marketing campaigns such as the National Lottery funded #thisgirlcan campaign combined with community-based interventions could be starting points to increase physical activity levels in girls, particularly in countries with wide gender differences. This approach has been identified as cost-effective.
  • Schools, families, sport and recreation providers, urban planners, and city and community leaders all need to become involved.

That four in every five adolescents do not experience the enjoyment and social, physical, and mental health benefits of regular physical activity is not a chance thing – it is the consequence of political  choices. 

Young people have the right to play and should be provided with the opportunities to realise their right to physical and mental health and wellbeing. Urgent action is needed, particularly through targeted interventions to promote and retain girls’ participation in physical activity. Policymakers and stakeholders should be encouraged to act now for the health of this young generation and of future ones.

Yvonne Kelly is Professor of Lifecourse Epidemiology and Director of the ESRC International Centre for Lifecourse Studies at UCL. She is editor of the Child of our Time blog.

Fran Abrams is CEO of the Education Media Centre and freelance journalist who writes for the Child of our Time blog.

Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants, by Regina Guthold, Leanne Riley, Fiona Bull and Gretchen Stevens, is published in The Lancet Child and Adolescent Health.

Regina Guthold, Leanne Riley and Fiona Bull are based at the Department for Prevention of Noncommunicable Diseases, WHO, Geneva, Switzerland and Gretchen Stevens is at the Department for Information, Evidence and Research, WHO, Geneva, Switzerland.  Fiona Bull is also affiliated with the Department of Sport and Exercise Science, University of Western Australia, Perth.

Prevalence and Correlates of Meeting Sleep, Screen-Time, and Physical Activity Guidelines Among Adolescents in the United Kingdom, by Natalie Pearson, Lauren B Sherar and Mark Hamer, is published in JAMA Paediatrics: 

Natalie Pearson and Lauren Sherar are at the School of Sport, Exercise & Health Sciences, Loughborough University, United Kingdom, and Mark Hamer is at the Institute of Sport Exercise & Health, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, United Kingdom.

Active children

Might population-wide increases in physical activity reduce socio-economic inequalities in the proportion of children who are overweight?

Just half of children in the UK achieve the World Health Organisation’s targets for daily activity, and in England the Government has set its own strategy to tackle this. But would increased physical activity lead to fewer children being overweight or obese? And would it help to address social inequalities in the proportion of children who are overweight? Research from Anna Pearce and colleagues at the UCL Great Ormond Street Institute of Child Health in London suggests more physical activity is unlikely to reduce the prevalence or inequalities in levels of overweight.

Childhood overweight is an important public health problem, with particularly high levels in children living in disadvantaged circumstances. Physical activity is an important determinant of childhood overweight. The World Health Organization (WHO) recommends children should undertake 60 minutes of moderate-to-vigorous physical activity every day. But for many families in England, as in other high-income countries, this is an aspiration rather than the reality.

The UK Government has identified a number of strategies to increase activity among children.  But the potential for physical activity initiatives to help children achieve a healthy weight, if scaled up at the population level, hasn’t previously been assessed. In our research, we focused on the WHO target, and on the likelihood that achieving this will reduce socio-economic differences in levels of overweight or obesity.

We wanted to know how hypothetical government interventions to increase activity might reduce the prevalence and inequalities in childhood overweight at age eleven. Could population-wide interventions, aimed at all, or targeted interventions with high-risk groups, have the greatest effect?

What, specifically, might happen to the prevalence and social distribution of childhood overweight if all children achieved the WHO’s target of 60 minutes’ activity per day? What if we are only able to achieve smaller increases in activity than those required to meet the WHO target?

In our study, 27% children were overweight at age eleven. We found that hypothetical universal interventions to increase physical activity could lead to moderate reductions in this. For example, if 95 per cent of children met the target of 60 minutes of activity per day, the prevalence of overweight (including obesity) would drop to 22 per cent. But more realistic scenarios, in which interventions led to more moderate improvements in physical activity levels (of only a few minutes each day), would achieve only small reductions in overweight within the population.

Children from the most affluent backgrounds were less likely to be overweight  – around one in five children in the top fifth of household incomes were overweight or obese at 11y, compared to one in three among those in the bottom fifth of household incomes. Our analysis suggested these stark social differences in overweight are unlikely to be reduced through meeting the WHO physical activity target. This is partly because children from the highest income group had the lowestlevel of daily activity, with a median of 59 minutes’ moderate to vigorous activity compared 62 minutes for the lowest fifth of the income range.

Even more intensive intervention scenarios, given only to high-risk families (for example those who were overweight or obese at an earlier age, or those living in disadvantaged neighbourhoods), appeared unlikely to address the stark social inequalities experienced by this cohort of children.

Activity targets

The WHO’s physical activity targets are ambitious and, if achieved, are likely to benefit children’s health and wellbeing in a multitude of ways. However our findings suggest that if the Government is serious about supporting children and families – particularly those from poorer backgrounds – to maintain healthy weights, it needs to look elsewhere.

We need, therefore, to know more about how other types of initiatives to reduce childhood overweight might work. Research which aims to inform this debate should look not just at activity levels but also at environmental factors that influence diet, such as taxes on high-sugar foods and foods provided in early-years settings.

What if all children achieved WHO recommendations on physical activity? Estimating the impact on socioeconomic inequalities in childhood overweight in the UK Millennium Cohort Study, by Anna Pearce, Steven Hope, Lucy Griffiths, Mario-Cortina-Borja, Catherine Chittleborough and Catherine Law, is published in the International Journal of Epidemiology, 2019, 134–147.

Anna Pearce is based at the University of Glasgow but carried out this work out in her previous position at the UCL Institute of Child Health.

Steven Hope, Mario Cortina-Borja, and Catherine Law are based at the Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.

Lucy Griffiths is based at Swansea University but carried out this work out in her previous position at the UCL Institute of Child Health…

 Catherine Chittleborough is at the School of Public Health, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.

This blog is based on independent research funded by the National Institute for Health Research (NIHR) Policy Research Programme (Children’s Policy Research Unit). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

 

I wanna hold your hand: helping young people prepare for happy healthy relationships

The teenage years are a time for experimenting and for pushing boundaries – particularly when it comes to intimate relationships. Such experimentation is a natural part of growing up. But there are potential risks, too – particularly if these early experiences aren’t positive ones. A new study from Professor Yvonne Kelly from UCL’s Department of Epidemiology and Public  Health  and colleagues, investigates what kinds of intimate behaviour 14 year-olds engage in, and asks how this insight can help to ensure  young people are well prepared for healthy and happy adult relationships.

We know teenagers experiment with intimacy, often moving ‘up’ the scale from hand-holding or kissing to more explicitly sexual activity. But we also know teenage pregnancy numbers have been dropping in recent years. And our new study suggests that fewer young teenagers are actually having sexual intercourse than some might previously have thought. 

We’ve all seen the headlines – studies have shown us (links) that 30 per cent of those born in the 1980s and 1990s had sex before the age of 16, and that among those born in the early 1990s a little under one in five had done so by age 15. But our new evidence, based on 14 year-olds born during or just after the year 2000, paints a rather different picture of this latest generation of teenagers.

Our research used data from the Millennium Cohort Study, the most comprehensive survey of adolescent health and development in the UK. It follows children born between September 2000 and January 2002 and has collected information on them at nine months and subsequently at age  three, five, seven, 11, and  14 years. We used information from the most recently available data, when the study’s participants were 14 years old, and were able to look closely at the lives of 11,000 of them.  

Intimate activities

Participants were asked about a range of ‘light’, ‘moderate’ and ‘heavy’ intimate activities. Handholding, kissing and cuddling were classed as ‘light,’ touching and fondling under clothes as ‘moderate’ and oral sex or sexual intercourse as ‘heavy.’

As might have been expected, more than half – 58 per cent – had engaged in kissing, cuddling or hand-holding, while 7.5 per cent, or one in 13, had experienced touching or fondling. But in contrast to other studies, (though our sample was younger than those mentioned above) we found only a very small proportion – 3.2 per cent or fewer than one in 30 – had been involved in ‘heavy’ activities in the year before they were interviewed for the study.

And most parents can take comfort from the fact that if their children aren’t participating in other risky activities such as drinking or smoking, they probably aren’t having sex either – there was clear evidence of links between heavier sexual activity and these factors.

We also found those who were most likely to confide worries in a friend rather than a parent, those whose parents didn’t always know where they were and those who stayed out late were more likely than others were to be engaged in heavier forms of sexual activity. Other potential links were found to drug-taking and as well as to symptoms of depression.

Our findings suggest young people who push boundaries may push several at once – that those who drink, smoke or stay out late, for instance, are more likely to engage in early sexual activity.

So, initiatives which aim to minimise risk and promote wellbeing are crucial – and they need to look at intimate activities, health behaviours and social relationships in relation to one another. 

A key point is that if young people can learn about intimacy in a positive way at an early stage, then those good experiences can build foundations which will help them throughout their lives.

Most importantly young people need to know how to ensure their intimate experiences are mutually wanted, protected, and pleasurable. The concept of “sexual competence” – used to refer to sexual experiences characterised by autonomy, an equal willingness of partners, being ‘ready’ and (when relevant) protected by contraceptives – is important at all ages, as are close and open relationships with parents.

Better understanding of this interplay between personal relationships and behaviours are key to better support for young people. The right intervention at the right time can ensure a teenager’s intimate life is set on a positive course.

Partnered intimate activities in early adolescence – findings from the UK Millennium Cohort Study, by Yvonne Kelly. Afshin Zilanawala , Clare Tanton, Ruth Lewis and Catherine H Mercer,is published in the Journal of Adolescent Health.

*Afshin Zilanawala is based at the Research Department of Epidemiology and Public Health, University College London, and Oregon State University, United States.

Clare Tanton is based at London School of Hygiene & Tropical Medicine.

Ruth Lewis is based at the University of Glasgow.

Catherine H Merceris based at University College London.

Do children feel better outdoors?

Many of us believe it’s bad for children to spend too much time indoors or looking at screens – but what does research evidence tell us about the possible mental health benefits of interacting with nature? A major new review of the evidence by Suzanne Tillmann and colleagues at Western University and the The Lawson Foundation in Canada finds there is a positive link – but the researchers say more work needs to be done, as Fran Abrams explains.

We know that mental health issues that develop at an early age have the potential to burden people – and their families and friends – throughout life. And in recent years there have been lots of studies linking these problems to things that happen outside the family home: neighbourhood, environment, school. There have been an increasing number that have looked at positive effects – for example, the possible benefits of activities such as spending time in nature.

The researchers wanted to know more about this last factor – so they decided to look more closely at the connections between the natural environment and children’s mental health.

After searching academic databases, 35 studies published in English or French between 1990 and 2017, focused on children and teens ranging from nine months to 18 years, were included. Early adolescence was the most commonly-studied age, and three fifths of the papers came from the USA, UK or Canada. In those 35 studies there were a total of 100 individual findings.

Parks and green spaces

The papers looked at various kinds of activities which took place in natural areas such as parks, green spaces, water, gardens or forests. Fifteen focused on emotional well-being, 10 on attention deficit/hyperactivity disorder (ADHD), nine on overall mental health and nine on self-esteem, while others looked at stress, resilience, depression and health-related quality of life.

So, what did the findings show? Overall, the review showed nature could have a positive effect on many outcomes measuring mental health. But only around half of all 100 reported findings revealed statistically significant positive relationships between nature and mental health outcomes, with almost half reporting no statistical significance.

For some outcomes – ADHD, stress, resilience, overall mental health and health-related quality of life – there were more positive findings than there were non-significant ones. Studies which looked at emotional well-being, self-esteem, and depression had a greater number of non-significant findings than positive ones. Only one finding, on the impact of greenness on a subgroup of children, showed a negative effect.

So, what did we know already, and what do we know now that we didn’t know before?

We already knew nature had a significant impact on health – including physical, social and cognitive as well as mental health, especially when we look at the research on adults. However, here in this review we can see that there are quite a few studies with inconclusive results.

What has this review added? We now know a little more about the effects of nature on the mental health of those under the age of 18. It has highlighted the need for more rigorous tools to measure those effects and the growth of research on children’s mental health and nature in the past five years.

Framework

The research team have also devised a framework that might help future researchers by categorising papers into three groups based on types of nature interaction: ‘accessibility,’ meaning studies that look at mere opportunity to access outdoor space, ‘exposure,’ which means studies that look at incidental interactions with nature while taking part in another activity,  and ‘engagement,’ which means a more direct engagement such as participation in a wilderness therapy programme.

Overall, the messages are mixed. But what this review does demonstrate is the need for more in-depth and more rigorous research. Maybe we need a standard way of measuring the effects of being in nature, its authors say. Certainly we need to continue to look at this area to find out why the research shows such mixed results. But the researchers believe spending time in nature can make a difference – so it’s vital that policy makers and planners think about how we can provide opportunities for children and young people to have those experiences.

Mental health benefits of interactions with nature in children and teenagers: a systematic review is research by Suzanne Tillmann, Danielle Tobin, William Alison and Jason Gilliland and is published in the Journal of Epidemiology and Community Health.

Taking time out to scroll free

As the Royal Society for Public Health launches its #ScrollFreeSeptember campaign, encouraging people to take a break from social media, Professor Yvonne Kelly from the ESRC International Centre for Lifecourse Studies at UCL, discusses new research on the negative impacts of social media use on young people’s health. She explains how the findings point to the need to limit the time that young people, especially girls, spend on social media.

The ScrollFreeSeptember campaign accompanies the launch of a second parliamentary inquiry in less than 12 months into the impact of social media use on young people’s mental health and well-being. Our Centre will be submitting a range of important new findings to that inquiry which seeks to grow the evidence base in an area where there is a great deal of hot debate, but where little is really known and understood.

For our team of researchers, the first indication that all was not well in the world of social media and young people’s mental health came in 2015 when we found that children who were heavy users of screen-based media were less happy and had more social and emotional problems than their peers who used it moderately. Children who used social media sites for chatting were also less likely to be happy and more likely to have problems than their peers who did not.

In March this year, our widely covered work on the trends for boys’ and girls’ social media use added weight to recent calls from the Children’s Commissioner for England to, as she put it, call time on a “life of likes”. In her report, Anne Longfield argued that there was clear evidence of children finding it hard to manage the impact of online life. She said children as young as eight were becoming anxious about their identity as they craved social media likes and comments for validation.

Social media and girls

Our research, based on the experiences of 10,000 children aged 10-15 who took part in the Understanding Society study, showed that this seemed to be the case particularly for girls who used social media for more than an hour a day. 10 year-old girls in the study who spent an hour or more on a school day chatting online had considerably more social and emotional problems later on – by age 15 – than girls of the same age who spent less or no time on social media. The number of problems they faced also increased as they got older, which was not the case for boys.

It was interesting to note that more girls than boys were using social media and for greater periods of time. At age 15, 43 percent of girls and 31 per cent of boys were using it for between one and three hours per day, with 16 and 10 per cent using it for more than four hours.

We think this tells us something important about the different ways that girls and boys interact with social media. For example, girls may be more likely than boys to compare their lives with those of friends and peers – whether those are ‘filtered’ selfies or positive posts about friendships, relationships or material possessions – these could lead to feelings of inadequacy, lower levels of satisfaction and poorer wellbeing.

The pressures associated with having peers like or ‘approve’ status updates and a perceived fall in or lack of popularity could add further pressure at, what for many teenagers is a tricky time in their lives.

Boys are more likely to be gaming than interacting online in the way just described and that wasn’t covered in this research, so it’s possible that for boys, changes in well-being may be more related to gaming success or skill.

But one of the key takeaways of this research is how social media use as a very young person is linked to lower levels of happiness later on – the effects are not short term – they have longer term consequences and

Social media and depression

More recently, we have turned our attention to the social media experiences of the children in the Millennium Cohort Study (MCS), using information on 11,000 14 year-olds to look at how social media use is linked with depression. We’ve also been asking ourselves what the pathways between these two things might look like, something that’s not really been done before. So, for example, are heavier users of social media getting too little sleep or having trouble getting to sleep because they are checking accounts at bedtime; are they experiencing cyberbullying either as victims or perpetrators; do they appear to have low self-esteem or a negative view of how they look? All these questions can help us better understand what’s at play and come up with better approaches to tackling these problems.

Preliminary findings reinforce the message that girls are particularly vulnerable to the negative effects of social media. Once again we see more girls than boys in this study using social media and for longer periods of time.

Does using social media affect literacy?

A follow up piece of research looks at whether there are links between the amount of time young people spend on social media and their levels of literacy. Findings suggest a link and that this is the same for boys and girls.

In this research we look at whether the more time young people spend on social media, the less time they have for the things that might improve their literacy such as reading for enjoyment and doing homework.

There are some clear messages from our research so far:

  1. Heavy users of social media are less happy and have more problems at school and at home – interventions to help them limit and manage their social media use better are likely to be important
  2. Girls are particularly vulnerable to the negative effects of social media and may be an important group to focus on among those looking to mitigate thse effects
  3. More hours spent on social media appear to impact negatively on young people’s wellbeing and could have knock on effects for their longer term prospects at school and work

Social media companies have been accused by the former Health Secretary Jeremy Hunt among others of turning a blind eye to the problem and the chief medical officer Dame Sally Davies has been asked to recommend healthy limits for screen time.

Our research indicates that it may indeed be time for recommended healthy and safe limits of social media use, that a focus on girls, especially initiatives to boost their mental health could help mitigate some of the negative effects.

The RSPH is hoping that going scroll free this September might give us all a chance to get our social media use a little more balanced, to think about the benefits to be enjoyed and the negatives to be avoided.

As well as pausing to think about our social media use and how it affects us, it will be an opportunity to examine the facts of the matter, a time to digest new, solid evidence that these large scale studies can help us with and consider the potential longer term costs and consequences of doing nothing.

The forthcoming inquiry hopes to inform “progressive and practical solutions”, including a proposed industry Code of Practice and tools for educators, parents and young people themselves to help them enjoy the benefits and eliminate the negative effects of their social media. We wholly support those efforts and hope they result in positive changes that will make campaigns like ScrollFreeSeptember unnecessary in the future.

Wheezing: Can breastfeeding for longer make a difference?

Public health bodies put a lot of effort into encouraging mothers to breastfeed, and for good reasons. Successive studies have shown breastfeeding has a range of health benefits, including a lower risk of wheezing illnesses, which can be linked to asthma. But which of these illnesses are most likely to respond? Is a breastfed child less likely to develop wheezing after age five, or age seven, for instance? Or is the protective effect mainly measurable only in younger children? Professor Maria Quigley from the National Perinatal Epidemiology Unit at the University of Oxford, along with colleagues at Oxford and UCL, has been looking at how and when breastfeeding is associated with wheezing.

Asthma is the most common chronic condition affecting children and young people in the UK. It’s the most common reason why children are admitted to hospital, and sadly each year a few still die from the condition. According to the British Lung Foundation three children in every hundred under the age of five have been diagnosed with asthma at some point; and by age 10 that figure rises to one in 10.

There’s no cure, and so the priority for public health bodies has been to understand the disease better, to manage it better and to learn more about the factors that can protect us from it. One such protective factor is breastfeeding: two recent pieces of research have shown there is a lower risk among breastfed children, but that the effect is stronger among the very young – both for asthma and for wheezing, which has many causes and which does not necessarily develop into asthma.

Childhood wheezing can follow a variety of patterns – it can set in early but clear up before adulthood, for instance, or it can start later but continue into later life. Some wheezing will start in childhood and will continue.

Millennium Cohort Study

We wanted to look at how breastfeeding might affect these different types, so we used data from the Millennium Cohort Study, which has followed the lives of almost 19,000 children born in the UK between September 2000 and January 2002. Their parents were interviewed when they were 9 months old, and again when they were 3, 5, 7 and 11 years.

Our study focused on just over 10,000 children who were seen at all of those points and who were the product of single as opposed to multiple birth. Mothers were asked whether they had tried to breastfeed, and for how long their children had been breastfed.

Among our sample, seven out of 10 children had been breastfed: a little more than one in ten of the study sample for less than a week; a fifth for between one and three weeks, just over one in six for three to six months and around a quarter for six to nine months.

We found that at age 9 months, 6.5 per cent of children had a history of wheezing. At age 3 years, 19.5 per cent had such a history in the past year. As the children got older, though, this proportion decreased – 16 per cent at age five, 11.8 per cent at age seven and 11.4 per cent at age 11.

Overall, 37 per cent of children had suffered from wheezing at least once between 9 months and 11 years. A little under a fifth (18.8 per cent) had wheezing at younger age which cleared up when they got older, while 6.2 per cent had wheezing which started later and 11.8 per cent had persistent wheezing.

Feeding and wheezing

When we looked at the association between breastfeeding and wheezing, we found the children who had been breastfed for longest were less likely to suffer from wheezing.

But this effect lessened with time. For example, those breastfed for six to nine months were less likely to wheeze between the ages of nine months and five years, but by the age of 11 this group had no significant advantage over those who were breastfed for less time.

What does our study tell us about the relationship between breastfeeding and wheezing? The picture is a complex one. There are many causes of wheezing and of asthma, and those causes change over time. So in order to draw firm conclusions about cause and effect, we would need a much more complex dataset. It would be interesting, for instance, to look at clinical information on children’s allergies or their lung function.

But what we can say is that age matters – in order to understand how breastfeeding affects the development of wheezing during childhood, we must take a longer and more nuanced view.

Breastfeeding And Childhood Wheeze: Age-Specific Analyses and Longitudinal Wheezing Phenotypes as Complementary Approaches To The Analysis Of Cohort Data is research by Maria Quigley (University of Oxford), Claire Carson (University of Oxford) and Yvonne Kelly (UCL). It is published in the American Journal of Epidemiology.

Off the scales: time to act on childhood obesity

By 2050, it is said that obesity could cost the NHS almost £10 billion a year, with the full economic cost rising from around £27 billion today to £50 billion by then. Today, the Centre for Social Justice (CSJ) publishes its report, Off the scales: time to act on childhood obesity. It calls on the Government to put prevention, health, inequality and cross-departmental collaboration at the heart of its efforts to tackle childhood obesity, drawing particular attention to the need to address the question of why poorer children are at ever greater risk of being obese. It’s a question researchers at the ESRC International Centre for Lifecourse Studies at UCL, including our editor Yvonne Kelly, have been among the first to address.

There have been numerous major studies on childhood obesity over the past 10 years, many of which have shown the links with poverty. But our research looks specifically at why children from disadvantaged families are significantly more likely to be obese than their better off peers.

To examine this as robustly and rigorously as we could, we used data from the Millennium Cohort Study (MCS) which has tracked the lives of nearly 20,000 children from across the UK since the turn of the century. Using a range of measurements taken when the children were aged 5 and 11 together with detailed information about their backgrounds and family circumstances, we were able to demonstrate just how key poverty was in respect of their obesity.

At age 5, poor children were almost twice as likely to be obese compared with their better off peers. By the age of 11, the gap had nearly tripled.

Knowing as we do that obese children are less likely than their peers to grow into economically successful adults and that obesity is clearly linked with a range of chronic diseases, it’s reasonable to say that for these children, the future is far from bright. From a policy perspective it is also clear that unless the gap between rich and poor children can be closed the chances of reducing the overall obesity trend, as the Government states it is committed to doing, are pretty slim.

How is poverty linked to obesity?

The MCS collects a broad range of data, allowing us to dig beneath these headline numbers to tease out some of the specific ways in which relative poverty in childhood leads to an increased risk of obesity.

To examine this question of whether a parent’s own lifestyle might have a role, we looked at factors previously shown to be linked to the increased risk of obesity, such as whether the mother smoked during pregnancy, how long she breastfed for and whether the child was introduced to solid food before the age of four months.

We could also factor in the degree to which a mother was herself overweight or obese and assess children’s physical behaviour, such as how often they exercised, played and how many hours they spent watching TV or playing on a computer, and the time that they went to bed. We looked at whether the child skipped breakfast, how much fruit they ate and how often they had sweet drinks.

A lot of these factors were relevant. A mother’s behaviour when her child was very young was certainly important. Markers of an ‘unhealthy’ lifestyle here could mean as much as a 20 per cent additional risk of obesity for a child.

Obese and overweight children living in poor families were more likely to have mothers who did not breastfeed or breastfed for a shorter duration, who introduced solid foods early in infancy, who smoked during pregnancy, and who were overweight or obese. The poorest children were also more likely to spend more time watching TV and using a PC (and so have greater exposure to food and drink advertising), experience later and more irregular bedtimes, do less sports and be more physically inactive, engage less in active play with their parent, live in an area without a playground, and not have breakfast every day.

5-year-olds from poorer families were also much more likely to gain excess weight up to age 11 than richer children, leading us to conclude that the earlier certain risk factors can be challenged and the appropriate support provided for the least well off families, the greater the chance of positive impact on the risk of obesity and in a reduction in inequality.

Pathways to obesity

More recently we have identified four BMI trajectories for children. The good news is that 80 per cent of them are on a stable path where, on average, from when they’re born through to age 11, they are not overweight.

There is a small group of children who are obese at age 3 but then join the stable group by age 7. We call them the ‘decreasing’ group. There is a ‘moderate increasing group’ (13.1 per cent) where children are not overweight at age 3 but whose BMIs increase throughout childhood into the overweight (but not obese) range. Finally we have a ‘high increasing’ group of children (2.5 per cent) who are obese at age 3 and whose BMI continues to increase.

From an inequality perspective, what’s most striking here is that the wealthiest children are least likely to be in the ‘moderate increasing’ BMI group whilst the poorest children are more than twice as likely to be on the high increasing path.

Today’s CSJ report agrees with our analysis that early intervention is key and, in line with it, proposes three key early years intervention opportunities to ensure children get the healthiest start possible before they reach primary school age.

The report acknowledges that the Government is already trying to persuade families to eat more healthily and take more exercise. But it has joined a body of voices critical of the Childhood Obesity Plan, which, it believes, “fails to put reducing inequality as a goal … despite acknowledging that the childhood obesity burden falls hardest on the poorest children.”

Certainly our body of evidence indicates that policy makers need to acknowledge and address inequality as a root cause of obesity. Doing something about the structural factors in people’s lives is what is needed rather than ‘tinkering around the edges’ of the problem.

Today the CSJ asks why there are disproportionately high levels of obesity, particularly childhood obesity, in our most deprived communities. Our research has gone some way to answering that question, and makes it clear that there is no simple one-stop shop solution.

Obesity is caused by a combination of environmental, biological, cultural and psychological factors, where one factor does not dominate and yet our obsessional search for the ‘one thing’ that can tackle obesity continues. If the Government is going to reduce obesity rates, it will indeed, need to introduce multiple bold measures in tandem across the entire ecosystem and recognise that success may only be measurable after a few years.

Why are poorer children at higher risk of obesity and overweight? A UK cohort study is research by Alice Goisis, Amanda Sacker and Yvonne Kelly and is published in the European Journal of Public Health

BMI Development and Early Adolescent Psychosocial Well-Being: UK Millennium Cohort Study is research by Yvonne Kelly, Praveetha Patalay, Scott Montgomery and Amanda Sacker and is published in Pediatrics

Don’t let the kids get jet-lag: why regular bedtimes are key to a happy healthy childhood

The very best of sleep medicine and research is being presented at the World Sleep Congress in Prague this week. Among that research are findings from work by Child of our Time Editor, Professor Yvonne Kelly and colleagues at the ESRC International Centre for Lifecourse Studies. They have been trying to find out what it is about sleep that matters most when it comes to giving children the best possible start in life. Here Yvonne explains what they have found to date and why regular bedtimes are key to a healthy happy childhood.

What happens in the early years has profound implications for what happens later on in life. Thousands of research papers, many of them using the wonderful rich data in the British Birth Cohort studies, have documented the enduring impacts of the way we live our lives as children on how we fare later on. Children who get a poor start in life are much more likely to experience poor outcomes as adults, whether that’s to do with poor health or their ability to enjoy work and family life later on.

So what has all that got to do with getting enough sleep as a toddler you might ask? Well our research shows it is one of a number of important factors related to getting children off to the best possible start in life and here’s why.

Recommended sleep

The National Sleep Foundation recommends that toddlers should get around 11 to 14 hours sleep every day. For 3-5 year-olds, the recommendation is 10-13 hours and it suggests 9-11 hours for children once they’re at primary school. But is it all about the number of hours sleep children get, or is there more to it than that? Those are the questions we have been addressing in our research into children’s sleep and how it ties in with how they get on at home and at school across the first decade of their life.

Digging into one of those studies mentioned earlier, the Millennium Cohort Study, which has followed the lives of some 20,000 children since the turn of the century, we found that it’s not just the number of hours a child sleeps that matters, but also having consistent or regular bedtimes.

First we looked at the relationship between regular and irregular bedtimes and how the children got on in a range of cognitive tests. The results were striking. Children with irregular bedtimes had lower scores on maths, reading and spatial awareness tests.

Parents who took part in the MCS were asked whether their children went to bed at a regular time on weekdays. Those who answered “always” or “usually” were put in the regular bedtime group, while those who answered “sometimes” or “never” were put in the irregular bedtime group.

Interestingly, the time that children went to bed had little or no effect on their basic number skills, and ability to work with shapes. But having no set bedtime often led to lower scores, with effects particularly pronounced at age three and the greatest dip in test results seen in girls who had no set bedtime throughout their early life.

The key to understanding all this is circadian rhythms. If I travel from London to New York, when I get to there I’m likely to be slightly ragged because jet lag is not only going to harm my cognitive abilities, but also my appetite and emotions. That’s for me, an adult. If I bring one of my children with me and I want them to do well at a maths test having just jumped across time zones, they will struggle even more than I will. The body is an instrument, and a child’s is especially prone to getting out of tune.

The same thing happens when children go to bed at 8 p.m. one night, 10 p.m. the next and 7 p.m. another — we sometimes call this a “social jet lag effect.” Without ever getting on a plane, a child’s bodily systems get shuffled through time zones and their circadian rhythms and hormonal systems take a hit as a result.

Bedtimes and behaviour

Having established the importance of sleep to a child’s intellectual development, we turned our attention to the relationship between regular bedtimes and their behaviour.

At age 7, according to parents and teachers, children in the MCS who had irregular bedtimes were considerably more likely to have behaviour problems than their peers who had a regular bedtime. In addition, the longer a child had been able to go to bed at different times each night, the worse his or her behaviour problems were. In other words the problems accumulated through childhood.

One really important piece of good news was that we found that those negative effects appeared to be reversible, so children who changed from not having to having regular bedtimes showed improvements in their behaviour. There seems to be a clear message here that it’s never too late to help children back onto a positive path and a small change could make a big difference to how well they get on. Of course, the reverse was also true so the behaviour of children with a regular bedtime who switched to an irregular one, worsened.

Bedtimes and obesity

In a follow up study, which looked at the impact of routines including bedtimes on obesity, we reported that children with irregular bedtimes were more likely to be overweight and have lower self-esteem and satisfaction with their bodies.

In fact, of all the routines we studied, an inconsistent bedtime was most strongly associated with the risk of obesity, supporting other recent findings which showed that young children who skipped breakfast and went to bed at irregular times were more likely to be obese at age 11.

Even children who ‘usually’ had a regular bedtime were 20 per cent more likely to be obese than those who ‘always’ went to bed at around the same time.

So we have a body of robust evidence now that shows very clearly that regular bedtimes really matter when it comes to a child’s health and development over that important first decade of their life.

Providing that evidence in the form of advice to parents and all those caring for young children alongside recommended hours of sleep could make a real difference, helping protect our children from ‘social jet-lag’ and getting them off to a flying start instead.

Equally protected children: one step closer

In 2015 UCL researchers Anja Heilmann, Yvonne Kelly and Richard Watt produced a report, which showed that there was ample evidence that physical punishment can damage children and escalate into physical abuse. Together with the children’s charities that commissioned the report, they called for urgent action to provide children with the same legal protection against violence that British adults enjoy. The report was at the heart of Scottish MSP John Finnie’s proposed Children (Equal Protection from Assault) Bill which the Scottish Government have just announced that they will support in their programme for the coming year. The Bill would make Scotland the first UK country to outlaw all physical punishment by removing the defence of “justifiable assault” of children, and giving them the same protection as adults. Lead researcher, Anja Heilmann, reflects on the news and what she hopes it might mean for the human rights of children in Scotland and elsewhere.

On 11 May 2017, John Finnie MSP proposed a Bill to the Scottish Parliament to “give children equal protection from assault by prohibiting the physical punishment of children by parents and others caring for or in charge of children”.

After a three month consultation, which received more than 650 responses, the majority positive (75 per cent), that Bill became part of the Scottish Government’s plans for the next year, as Nicola Sturgeon announced she would not oppose it.

If passed, the Bill will prohibit the physical punishment of children by ending the existing common-law position that physical punishment by parents can be defended as reasonable chastisement and therefore be lawful. The Bill will not create a new criminal offence, as the common law offence of assault will apply (with a modification removing the reasonable chastisement defence).

It’s a far cry from similar efforts made in Scotland in 2002 to prohibit the physical punishment of children under the age of three. Back then, not only did a majority of MSPs reject the idea, but it was branded as “ridiculous” and an unwelcome intrusion into family life by many parents and the media.

15 years on it seems attitudes may have changed significantly. In the foreword to the Bill, John Finnie himself said:

“We would no longer consider it acceptable…. to allow our children to roam freely in the back of the car when going on a journey. Neither would we dream of taking them to a cinema if they had to watch a film through a fug of cigarette smoke … Attitudes towards these and many other fundamental societal issues have dramatically changed.”

Those attitudes changed as the result of a clear presentation of the evidence – the hard facts about the damage that those behaviours could cause.

We believe that, in this case, our evidence has made it clear for all to see that hitting children can not only damage them, but it carries the risk of escalation into physical abuse. It is a clear violation of international human rights law and children should and must be afforded the same rights as adults in this respect.

Overwhelming evidence

The evidence for the detrimental effects of physical punishment is vast and consistent. In short, our summary of the available evidence showed that physical punishment was related to increased aggression, delinquency and other anti-social behaviour over time. It also showed the more physical punishment suffered by a child, the worse the subsequent problem behaviour.

There was also a clear link between physical punishment and more serious child maltreatment and negative effects continued into adulthood, including problems of drug and alcohol dependency.

Half-hearted responses to recent human rights rulings condemning the physical punishment of children need to become wholehearted changes to the law, not tinkering that does just enough to meet the minimum requirements of those judgments rather than properly respect the rights of children.

The UN Committee on the Rights of the Child is unequivocal – all forms of corporal punishment of children are unacceptable. Let’s hope the Scottish Parliament can find the courage to make that statement a reality and show the rest of the UK the way.

As Martin Crewe of Barnardo’s Scotland stated:

“This is a huge step forward and sends a very clear message about the kind of Scotland we want to see for our children.”

Personally, I am hoping it’s a kind of Scotland and indeed UK, we WILL see in the not too distant future and I appeal to all MSPs to listen to the evidence and support the Bill.

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.

Do mental health problems have their roots in the primary school years?

Recent reports have shown worrying rises in young people suffering from mental health problems. A study for the Department of Education showed more than a third of teenage girls reporting depression, anxiety and low self-esteem. To try to understand this growing problem, Dr Afshin Zilanawala and fellow researchers from the ESRC International Centre for Lifecourse Studies at UCL have investigated how certain aspects of learning in the primary school years and success affect the behaviour and wellbeing of early adolescents.

Young people who drink, smoke and have behavioural problems are known to be at risk of suffering poor health as adults.

Understanding what causes this risky behaviour, and the anxiety and low self-esteem associated with it, can help professionals to target those most likely to drop out of school, become pregnant as a teenager, become obese or to suffer other long-term health issues.

By planning support and prevention programmes during childhood, they can improve the likelihood of a successful and healthy adulthood for our most vulnerable young people, and reduce the pressure on health and social services.

Mental health

A recent YouGov survey of Britain’s university students revealed that more than a quarter of them report depression and poor mental health.

But could the roots of these problems be found by looking more closely at how children develop and learn throughout the primary school years?

Information on more than 11,000 children collected by the UK Millennium Cohort Study (MCS) was used in our research, which explores the links between children’s verbal abilities and their behaviour and well-being as they make the move to secondary school.

Using information collected at ages three, five, seven and 11, we were able to see how well they could read, the range of their vocabulary and their verbal reasoning skills.

Then, at age 11, the children were asked about their school work and life, their family and friends and their appearance. There were questions about how happy they were, whether they felt good about themselves. They were also asked if they had tried cigarettes or alcohol, and if they had stolen anything or damaged property.

Verbal performance

In terms of how well they were getting on, the children were divided into three groups (low, average and high verbal achievers).

This in itself produced a startling and worrying view of the diverging paths these different children follow over time, particularly between the ages of seven and 11. One in five of the children (the high achievers) did better and better at the verbal tests, stretching away from their peers as they prepared to head to secondary school. The majority (around three quarters) of children were on the middle path, making steady progress but then plateauing off. But, most striking of all was what happened to the low achieving group (around one in 17 of the children), whose verbal abilities declined steeply.

Verbal ability

Millennium Cohort Study

Having established these pathways, we went on to look at which children at age 11 were involved in risky behaviours and then to dig deeper to see how these behaviours related to their progress to date. We also looked at what other factors, especially those related to their family circumstances, might be at play.

Boys were more likely than girls to be smoking and drinking or getting involved in anti-social behaviour. Girls were more likely to suffer from low self-esteem. First-born children were happier and had higher self-esteem, and were less likely to smoke, drink and have problem behaviours than second or later birth-order children. Children with younger mums were also more likely to engage in risky behaviour.

Those from disadvantaged backgrounds and those with more unsupervised time were more likely to suffer from poor mental health. We also found those whose mothers suffered from depression were more at risk of mental health problems.

Looking at the raw data, the low achieving children were three times more likely to smoke than their high achieving peers and twice as likely as the average group. Low achieving and average achieving children were also more likely to drink.

One in three of the low achieving children compared with one in five of the high achievers had been involved in anti-social behaviour and were more than four times more likely to have behaviour problems as reported by their parent. They also had much lower levels of self esteem.

Family factors

When we took a range of family factors into account including the child’s age and gender, mother’s age and mental health and socioeconomic circumstances, many or all of the differences between the groups disappeared or became smaller, confirming the overriding importance of the family and social environment.

However, we can say, for the first time, and with considerable confidence, that how well children are reading, talking and reasoning, can and does influence their health and well-being as they become adolescents. Indeed, we found clear evidence that children who were performing below average in this area across childhood were more at risk of poor mental health and risky behaviour than their consistently above-average performing peers.

If we want those children to stand a better chance of a healthy and happy life, we need to focus a great deal of attention on what is happening at home and at school in those early years, particularly, our research would seem to show, between the ages of 7 and 11.

Our results are consistent with other research, which demonstrates the huge challenge for young people with poor verbal skills, who arrive at the doorstep of adolescence with mental health, self-esteem and behavioural issues, which are likely to continue into adult life.

Recent reports that child poverty figures in the UK are continuing to rise, despite successive Governments’ promises to reduce them, does not bode well in this context. Indeed, it would seem to indicate that it will be some time before the yawning gaps in inequality that we see at primary school and their knock-on effects on children’s wellbeing in adolescence can be closed.

Longitudinal Latent Cognitive Profiles and Psychosocial Well-being in Early Adolescence is research by Afshin Zilanawala, Amanda Sacker and Yvonne Kelly and is published in the Journal of Adolescent Health

Photo credit: Creative curriculum  US.Army