What we know
What information do we have about the Eastern Board area?
What is the result of this on our health locally?
Policies
What is happening in the Eastern Board area?
References

Observational research and intervention studies show that the foundations of adult health are laid in childhood and before birth. Slow growth and poor emotional support raise the lifetime risk of poor health and reduce physical, cognitive and emotional functioning in adulthood. As cognitive, emotional and sensory inputs programme the brain’s responses, insecure emotional attachment and poor stimulation can lead to reduced readiness for school, low educational attainment, problem behaviour and the risk of social marginalisation in adulthood.

Good health-related habits, such as eating sensibly, exercising and not smoking, are associated with parental and peer group examples and with good education. Slow or retarded physical growth in childhood is associated with reduced cardiovascular, respiratory, pancreatic and kidney development and function which increases the risk of illness in childhood.
(WHO, 2003)

Please refer to the relevant section for more information on obesity, healthy eating, physical activity, smoking and education.

Children and young people are taller and heavier than previous generations, largely as a result of improved nutrition and fewer infectious diseases. However, the news is not all good. A higher percentage of children in Northern Ireland are now overweight or obese. This is thought to be due to decreased physical activity, parental concern for safety leading to children travelling to school in cars rather than on foot and an increased pre-occupation with computers and other forms of electronic entertainment. Encouraging children to take physical exercise and building increased levels of exercise into the school curriculum has important long-term benefits for our children with reduced obesity leading to reduced risk of diseases such as Type 2 diabetes.

Accidents are the main threat to life among children in our community. One hundred years ago, infectious diseases were the main cause of death in childhood, however, with the success of our immunisation campaigns and the introduction of antibiotics, death from infection has decreased dramatically. It is vital that these diseases do not return and all parents are strongly encouraged to have their children immunised against infectious diseases.

There has been a marked decline in deaths due to SIDS (Sudden Infant Death Syndrome or 'cot death') and congenital abnormalities have now replaced SIDS (cot death) as the major cause of death in infants aged 1-11 months.

There has been a marked decline in the birth prevalence of neural tube defects closely related to the recognition of the importance of folic acid supplementation in the diet of women before they become pregnant and in the early stages of pregnancy.

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In 2002 there were 132,400 people aged 0-14 years in the Eastern Board area, with a further 51,300 aged 15-19 years. Some 20% of population is aged less than 15 years and 27.7% is aged less than 20 years.

Neonatal deaths
Deaths in the Eastern Board area among infants aged less than 28 days fell steadily during the 1980's, from 8.4 per 1000 live births in 1981 to 3.5 per 1000 live births in 1990. Neonatal deaths increased during the early 1990's reaching 7.6 per 1000 live births in 1995. Some of this increase may have been due to improved recording of very premature infants as live births following the introduction of the national Confidential Enquiry into Stillbirths and Deaths in Infancy in 1993.  Since 1995 the neonatal mortality has fallen year on year, to 3.6 per 1000 live births in 2003.

Postneonatal deaths
Between 1981-83 and 1999-2001, there was a marked decline in the number of deaths in the post-neonatal period (1-11 months of age) and a marked change in the causes of death.

Between 1990-92 and 1999-2002 the number of deaths due to Sudden Infant Death Syndrome (SIDS) fell dramatically. This fall in deaths due to SIDS was confirmed by the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI). It is believed to have been due to a reduction in risk factors as a result of a public information campaign which advised parents how to reduce the risk of 'cot death' by placing the infants on their back to sleep, avoiding exposure to tobacco smoke and avoiding overheating.

Mortality among pre-school children
Deaths in children aged 1-4 years in the Eastern Board area fell by almost 80% between 1981 and 2001, from 71.5 to 14.7 per 100,000 population. This compares to a mortality rate for this age group in England and Wales in 2001 of 23.6 per 100,000 population. The number of deaths among pre-school children in the Eastern Board area fluctuates from year to year, with 5 deaths occurring in 1999.

Between 1981-83 and 1999-2001 the largest reduction in deaths in the 1-4 year age group was seen in deaths due to motor vehicle accidents. In 1999-2001 non-motor vehicle accidents were now the most common cause of death in this age group in the Eastern Board area, accounting for one in five of all deaths. At this level the number of deaths in each group is small and should be interpreted cautiously.

Mortality among school-aged children
Deaths among children aged 5-14 years in the Eastern Board area fell by almost a third between 1981 and 2001, from 27.2 to 18.8 per 100,000 population.

Down's Syndrome
There is fluctuation from year to year in the number of infants born with Down's Syndrome, with 1999 having the lowest number of births recorded with Down's Syndrome since 1981 (four in total).

The risk of Down's Syndrome increases with maternal age. An increase in the number of older mothers would be expected to increase the number of affected pregnancies. The number of infants born to mothers aged 35 and over in the Eastern Board area increased from 1046 in 1990 to 1446 in 2002, an increase of 38%.

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The child population aged 0-14 years in the Eastern Board area fell by 15% between 1981 and 2003 (from 155,790 to 132,400) and is predicted to fall to 110,000 by 2014. This will have an impact on the demand for children’s health services and also for education services. With fewer children and young people and an increasing elderly population, there are likely to be fewer carers in the future, leading to an increased reliance on health and social services to provide care in old age.

Maternal behaviour
Maternal diet during pregnancy, for example increased folic acid before and during early pregnancy, is associated with a reduced risk of neural tube defects such as spina bifida. Maternal smoking during pregnancy increases the risk of growth retardation of the fetus and its associated health effects. Maternal ingestion of prescribed and non-prescribed drugs can affect fetal development, for example thalidomide or alcohol. Diseases such as HIV, hepatitis B, chlamydia, herpes and syphilis may be transmitted from a mother to her infant during pregnancy and/or childbirth causing a range of adverse effects from miscarriage, stillbirth and life-long infection, with the associated health effects.

Environment
Children are much more vulnerable to the adverse effects of environmental hazards than adults, for a number of reasons:

	The developing brain and other organs are more susceptible to damage than mature organs.
	For their size, children consume a relatively greater volume of air and water than adults, thereby having greater exposure to any air or water-borne hazards.
	Children are less able to choose or control their environment.
	Children are physiologically more vulnerable to the effects of environmental hazards eg overheating, dehydration, burns and trauma.

Important environmental factors that influence children’s health include:

	Infection (Please refer to the Infectious Disease section of this website);
	Accidents (Please refer to the Accidents section of this website);
	Passive smoking/environmental tobacco smoke (Please refer to the Smoking section of this website).

Health services
Health services have an important role in determining the health of children and young people. As well as providing treatment services for children and young people with acute and chronic illnesses, there has historically been a particular focus on preventative services. This is important, as the benefits of prevention in childhood are likely to be lifelong.

Services and interventions are aimed at preventing a disease or condition occurring. They include:

	Immunisation against infectious diseases (Please refer to the Immunisation section of this website);
	Periconceptual care ie advice and treatment prior to and during early pregnancy eg increasing intake of folic acid to reduce the risk of neural tube defects such as spina bifida;
	Antenatal care eg identification and treatment of pregnant women with HIV, hepatitis B or syphilis infection to prevent infection in the newborn; administration of anti-D immunoglobulin to pregnant women whose blood group is Rhesus D negative to prevent haemolytic disease;
	Neonatal care, for example administration of vitamin K to prevent haemorrhagic disease (which is due to lack of vitamin K); advice on reducing the risk of 'cot death’; or SIDS (Sudden Infant Death Syndrome);
	Child health services eg dental health promotion services to prevent dental decay.

Secondary preventative services are aimed at the early detection and treatment of a disease or condition. Most involve some type of screening activity. Such services are only appropriate if there is an effective treatment for the disease/condition concerned and if early diagnosis and treatment has been shown to improve outcome (when compared to cases which are treated after symptoms or problems are identified). Services include:

	Examination of the newborn for congenital anomalies eg undescended testes;
	Newborn 'bloodspot' screening;
	Screening for congenital dislocation/developmental dysplasia of the hip;
	Hearing screening;
	Vision screening;
	Dental screening.

Please refer to the Child Health Screening Section of the website for more information.

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