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BACKGROUND Prevention is key to reducing socioeconomic inequities in children’s mental health problems, especially given limited availability and accessibility of services. We investigated the potential to reduce inequities for disadvantaged children by improving parental mental health and preschool attendance in early childhood. METHODS Data from the nationally representative birth cohort, Longitudinal Study of Australian Children (N = 5107, commenced in 2004), were used to examine the impact of socioeconomic disadvantage (0–1 year) on children’s mental health problems (10–11 years). Using an interventional effects approach, we estimated the extent to which inequities could be reduced by improving disadvantaged children’s parental mental health (4–5 years) and their preschool attendance (4–5 years). RESULTS Disadvantaged children had a higher prevalence of elevated mental health symptoms (32.8%) compared with their nondisadvantaged peers (18.7%): confounder-adjusted difference in prevalence is 11.6% (95% confidence interval: 7.7% to 15.4%). Improving disadvantaged children’s parental mental health and their preschool attendance to the level of their nondisadvantaged peers could reduce 6.5% and 0.3% of socioeconomic differences in children’s mental health problems, respectively (equivalent to 0.8% and 0.04% absolute reductions). If these interventions were delivered in combination, a 10.8% (95% confidence interval: 6.9% to 14.7%) higher prevalence of elevated symptoms would remain for disadvantaged children. CONCLUSIONS Targeted policy interventions that improve parental mental health and preschool attendance for disadvantaged children are potential opportunities to reduce socioeconomic inequities in children’s mental health problems. Such interventions should be considered within a broader, sustained, and multipronged approach that includes addressing socioeconomic disadvantage itself.

▪In this narrative review, we summarise the vast and burgeoning research on the potential and established indirect impacts on children of the COVID-19 pandemic. We used a community child health lens to organise our findings and to consider how Australia might best respond to the needs of children (aged 0-12 years). ▪We synthesised the literature on previous pandemics, epidemics and natural disasters, and the current COVID-19 pandemic. We found clear evidence of adverse impacts of the COVID-19 pandemic on children that either repeated or extended the findings from previous pandemics. ▪We identified 11 impact areas, under three broad categories: child-level factors (poorer mental health, poorer child health and development, poorer academic achievement); family-level factors that affect children (poorer parent mental health, reduced family income and job losses, increased household stress, increased abuse and neglect, poorer maternal and newborn health); and service-level factors that affect children (school closures, reduced access to health care, increased use of technology for learning, connection and health care). ▪There is increasing global concern about the likely disproportionate impact of the current pandemic on children experiencing adversity, widening existing disparities in child health and developmental outcomes. ▪We suggest five potential strategy areas that could begin to address these inequities: addressing financial instability through parent financial supplements; expanding the role of schools to address learning gaps and wellbeing; rethinking health care delivery to address reduced access; focusing on prevention and early intervention for mental health; and using digital solutions to address inequitable service delivery.

Major policy reforms were instigated in 2008 in Australia to ensure that all children have access to a preschool program in the year before starting school. The Australian Early Development Census (AEDC) provides a means of monitoring the impact of these reforms at the population level, as teachers of all children in their first year of school retrospectively report on children’s preschool experiences every three years. Early indications from AEDC data spanning the preschool years of 2008–2011 indicated that the proportion of children attending preschool remained relatively stable over this period. In this short communication, we update this with analysis of preschool trends from 2008 to 2014. We find evidence of increasing preschool attendance over this longer time frame (80.43% in 2008, compared to 91.30% in 2014; OR 2.53, 99% CI 2.44–2.62). Consistent with earlier data, children from disadvantaged communities had higher odds of non-attendance, compared to those living in the most advantaged communities (OR 2.94, 99% CI 2.74–3.15). In 2014, children who did not attend preschool were also disproportionately Indigenous and from non-English speaking backgrounds. Findings suggest that participation in preschool appears to have increased, concurrent to government efforts to promote participation through universal access. Engaging the most vulnerable families in preschool programs remains a major challenge that requires continued policy focus.

Aim Many Australian children have dental decay in their deciduous teeth. Poor oral health can negatively impact a child's ability to eat, speak, sleep and socialise, with adverse impacts later in life. Paediatricians are well placed to examine children's teeth and to provide advice and education about oral health. Using a sample of Australian paediatricians, we aimed to determine: (i) self-reported oral health knowledge and skills, (ii) frequency of office-based oral health-related discussions, (iii) perceived role of paediatricians and (iv) barriers to oral health-related discussions. Methods Members of a national network of paediatricians - the Australian Paediatric Research Network - completed a multi-topic survey, which included questions designed to assess oral health knowledge, current practice and barriers to oral health-related discussions. Results Of 430 active members, 178 (41%) completed the survey. Few paediatricians reported very good/excellent ability to assess plaque build-up (8%) and dental caries (17%). Only 10% reported broaching the issue of oral health with all patients. Significant barriers included lack of professional training (52%) and other more pressing issues needing to be addressed (67%). Conclusions The increasing (and inequitable) rates of dental decay in Australian children mean that paediatricians should play a key role in the management of children's oral health. Many paediatricians reported a lack of specific training in oral health and limited ability to assess children and educate families. Despite the traditional divide between medicine and oral health, this study highlights the opportunity for Australian paediatricians to improve oral health through early intervention in the consultation room and beyond.

Objective Children from socioeconomically disadvantaged backgrounds have poorer learning outcomes. These inequities are a significant public health issue, tracking forward to adverse health outcomes in adulthood. We examined the potential to reduce socioeconomic gaps in children's reading skills through increasing home reading and preschool attendance among disadvantaged children. Methods We drew on data from the nationally representative birth cohort of the Longitudinal Study of Australian Children (N = 5107) to examine the impact of socioeconomic disadvantage (0–1 year) on children's reading skills (8–9 years). An interventional effects approach was applied to estimate the extent to which improving the levels of home reading (2–5 years) and preschool attendance (4–5 years) of socioeconomically disadvantaged children to be commensurate with their advantaged peers, could potentially reduce socioeconomic gaps in children's reading skills. Results Socioeconomically disadvantaged children had a higher risk of poor reading outcomes compared to more advantaged peers: absolute risk difference = 20.1% (95% confidence interval [CI]: 16.0%–24.2%). Results suggest that improving disadvantaged children's home reading and preschool attendance to the level of their advantaged peers could eliminate 6.5% and 2.1% of socioeconomic gaps in reading skills, respectively. However, large socioeconomic gaps would remain, with disadvantaged children maintaining an 18.3% (95% CI: 14.0%–22.7%) higher risk of poor reading outcomes in absolute terms. Conclusion There are clear socioeconomic disparities in children's reading skills by late childhood. Findings suggest that interventions that improve home reading and preschool attendance may contribute to reducing these inequities, but alone are unlikely to be sufficient to close the equity gap.

There is increasing acknowledgement of the importance of the early years of school in laying the foundations for children’s learning pathways, and interest in the role of mental health in promoting positive early learning experiences. Understanding child mental health requires consideration of both mental health competence and mental health difficulties. The aim of this paper was to determine how profiles of competence and difficulties relate to children’s early learning skills in their first year of school. Cross-sectional data from a population census was used to explore whether children’s mental health profile (the combination of competence and difficulties) predicted key domains of early learning. In 2015, the Australian Early Development Census (a teacher-rated measure of child development) was completed for 96.5% of Australian children in their first year of schooling (N = 302,003; M = 5 years, 7 months of age). Logistic regression analyses revealed that mental health profiles were strongly related to two key domains of early learning: language and cognitive skills, and communication skills and general knowledge. Anything less than the optimal high competence with low difficulties profile was associated with substantially poorer early learning skills (OR 2.17, p

Monitoring oral language skills at the population level would provide valuable data to inform policy decisions to better support children's oral language skills in schools. The Australian Early Development Census (AEDC) is a teacher-rated population measure of early child development that includes a rating of children's oral communication in the classroom (OCC).This study evaluates the validity of the OCC indicator for population monitoring of children's oral language skills, capitalising on data from two datasets: the 2012 AEDC cohort (n = 289 973) and a subsample of children from the Longitudinal Study of Australian Children for whom AEDC data were also collected (n = 720).Construct validity was demonstrated by showing significant differences in OCC ratings between subpopulations of children who would be expected to differ in terms of oral language skills at school entry (e.g. children with a diagnosed speech-language impairment compared to those with no impairment). OCC ratings were associated with externally validated measures of language, suggesting convergent validity. No relationship was found between OCC ratings and physical health scores, indicating divergent validity.The findings support the use and interpretation of the OCC indicator as a tool for population-level monitoring of oral language in Australian school entrants.

Compared with most other Organization for Economic Co-operation and Development (OECD) countries, information about the patterns of health service use for children from immigrant families in Australia is currently limited, and internationally, data on unmet healthcare needs are scarce. This study aims to examine the distribution of health service utilisation and unmet healthcare needs for immigrant children aged 10-11 years in Australia. We drew on data from the Longitudinal Study of Australian Children Birth (B; n = 5,107) and Kindergarten (K; n = 4,983) cohorts. The exposure was family immigration background collected at 0-1 (B-cohort) and 4-5 (K-cohort) years. Outcomes were parent-reported child health service use and unmet healthcare needs (defined as the difference between services needed and services received) at 10-11 years. Logistic regression analyses were used to examine associations between family immigration background and health service use/unmet healthcare needs, adjusting for potential confounders. Results showed that one-third of Australian children (B-cohort: 29.0%; K-cohort: 33.4%) came from immigrant families. There were similar patterns of health service use and unmet healthcare needs between children from English-speaking immigrant and Australian-born families. However, children from non-English-speaking immigrant families used fewer health services, including paediatric, dental, mental health and emergency ward services. There was a disparity between the services used when considering children's health needs, particularly for paediatric specialist services (B-cohort: OR = 2.43, 95% CI 1.11-5.31; K-cohort: OR = 2.72, 95% CI 1.32-5.58). Findings indicate that Australian children from non-English-speaking immigrant families experience more unmet healthcare needs and face more barriers in accessing health services. Further effort is needed to ensure that the healthcare system meets the needs of all families.

Background Disadvantage rarely manifests as a single event, but rather is the enduring context in which a child’s development unfolds. We aimed to characterize patterns of stability and change in multiple aspects of disadvantage over the childhood period, in order to inform more precise and nuanced policy development. Methods Participants were from the Longitudinal Study of Australian Children birth cohort (n = 5107). Four lenses of disadvantage (sociodemographic, geographic environment, health conditions and risk factors), and a composite of these representing average exposure across all lenses, were assessed longitudinally from 0 to 9 years of age. Trajectory models identified groups of children with similar patterns of disadvantage over time for each of these lenses and for composite disadvantage. Concurrent validity of these trajectory groups was examined through associations with academic performance at 10–11 years. Results We found four distinct trajectories of children’s exposure to composite disadvantage, which showed high levels of stability over time. In regard to the individual lenses of disadvantage, three exhibited notable change over time (the sociodemographic lens was the exception). Over a third of children (36.3%) were exposed to the ‘most disadvantaged’ trajectory in at least one lens. Trajectories of disadvantage were associated with academic performance, providing evidence of concurrent validity. Conclusions Children’s overall level of composite disadvantage was stable over time, whereas geographic environments, health conditions and risk factors changed over time for some children. Measuring disadvantage as uni-dimensional, at a single time point, is likely to understate the true extent and persistence of disadvantage.

Background: Understanding the relationship between different aspects of disadvantage over time and domains of child development will facilitate the formulation of more precise policy responses. We examined the association between exposure to aspects of disadvantage over the childhood period (from 0-9 years) and child development at 10-11 years. Methods: We used data from the nationally representative birth cohort of the Longitudinal Study of Australian Children (n = 4979). Generalized linear models with log-Poisson link were used to estimate the association between previously derived disadvantage trajectories (in each of four lenses of sociodemographic, geographic environments, health conditions and risk factors, and a composite of these) and risk of poor child developmental outcomes. Population-attributable fractions were calculated to quantify the potential benefit of providing all children with optimal conditions for each developmental outcome. Results: Trajectories of disadvantage were associated with developmental outcomes: children in the most disadvantaged composite trajectory had seven times higher risk of poor outcomes on two or more developmental domains, compared with those most advantaged. Trajectories of disadvantage in different lenses were varyingly associated with the child development domains of socio-emotional adjustment, physical functioning and learning competencies. Exposure to the most advantaged trajectory across all lenses could reduce poor developmental outcomes by as much as 70%. Conclusions: Exposure to disadvantage over time is associated with adverse child development outcomes. Developmental outcomes varied with the aspects of disadvantage experienced, highlighting potential targets for more precise policy responses. The findings provide evidence to stimulate advocacy and action to reduce child inequities.

Participation in a preschool program in the year before starting school can promote children’s healthy development, and has the potential to reduce inequities in developmental outcomes for at-risk subpopulations. In Australia, boosting preschool attendance has emerged as a national policy priority. In this paper, we draw on data from the Australian Early Development Census (AEDC) to describe preschool attendance in two sequential population cohorts, with preschool experiences in 2008 and 2011 reported retrospectively by teachers of children in their first year of school. Overall, findings show that the proportion of children attending preschool remained relatively stable between the two AEDC cohorts (in 2008, preschool attendance ranged from 57.0% to 85.8% across the states and territories, while in 2011, attendance ranged from 49.2% to 93.7%). At a subpopulation level, children from non-English speaking and Indigenous backgrounds and children living in disadvantaged communities all had substantially higher odds of not attending preschool in both 2008 and 2011. These findings highlight the need to maintain policy attention on efforts to further reduce barriers to preschool access for at-risk subpopulations, and the value of monitoring population trends in preschool attendance to better inform policy and service provision.

Aim Some children's special health-care needs (SHCN) are formalised at the start of schooling (established SHCN), but a larger proportion start with difficulties that are milder or not yet diagnosed (emerging SHCN). This study explores whether: (i) the prevalence of teacher-identified SHCN (both overall and according to type of needs) and (ii) distribution across disadvantaged communities have changed over three successive population cohorts of Australian children. Methods We draw on repeated cross-sectional data from the Australian Early Development Census, a teacher-reported checklist completed on full populations of Australian school entrants in 2009, 2012 and 2015. It includes a measure of SHCN, as well as demographic information. Results The proportion of children with emerging and established needs was mostly stable from 2009 to 2015 (emerging needs: 17.1-18.9%; established needs: 4.4-4.9%). Change over time was observed in the prevalence of some specific types of impairment. Speech impairment rose by 14.7% for children with emerging needs, and emotional problems rose by 13.7% for children with established needs. Children living in the most disadvantaged neighbourhoods had higher odds of SHCN in all years (e.g. emerging needs relative risk ratio 1.65 (99% confidence interval 1.55-1.75) in 2015; established needs relative risk ratio 1.88 (99% confidence interval 1.71-2.06) in 2015). Conclusions A large proportion of children starting school each year have SHCN. The types of SHCN that children present with increasingly reflect complex difficulties that require input from both the health and education sectors. Effective responses also need to consider the added impact of disadvantage.

The Australian educational system is increasingly challenged to meet the needs of multilingual students, who comprise a fifth of the student population. Within the context of a monolingual English curriculum, multilingual children who enter school not yet English proficient may be at risk of experiencing inequitable educational outcomes.We examined the relationship between the timing of multilingual children's acquisition of receptive English vocabulary skills and subsequent reading and numeracy outcomes, as well as factors associated with earlier versus later timing of acquisition. Data were drawn from the Kindergarten-cohort (n = 4983) of the Longitudinal Study of Australian Children - a nationally representative, community sample of Australian children.Linear regression analyses revealed that multilingual children who begin school with proficient receptive English vocabulary skills, or who acquire proficiency early in schooling, are indistinguishable from their monolingual peers in literacy and numeracy outcomes by 10-11 years. However, later acquisition of receptive English vocabulary skills (i.e. after 6-7 years) was associated with poorer literacy outcomes. In turn, socioeconomic disadvantage and broader language or learning problems predicted this later acquisition of receptive English vocabulary skills.All children need to be supported during the early years of school to reach their full educational potential.

Socio-environmental factors, including the neighbourhoods in which children live and grow, are key determinants of children’s developmental outcomes. Thus, it is important to examine and consider the relationships between these factors and the multiple contexts that influence children. Drawing on a broad disciplinary range of existing research, we aimed to develop a conceptual model of neighbourhood effects influencing early childhood development. The neighbourhood effects literature was reviewed with a specific focus on existing models and frameworks. This review was then further expanded through consultation with our cross-disciplinary research collaboration (Kids in Communities Study Collaboration). From this a theoretical model specific to early childhood development was developed. The hypothesised model comprised five interconnected domains: physical, social, service, socio-economic, and governance. A small trial of indicator measurement was conducted and findings were used to make a series of recommendations regarding measures or indicators which might provide useful and effective for neighbourhood effects research. The proposed model provides a useful and novel conceptual framework for classifying neighbourhood effects research. By synthesising disparate but related areas of research, the resultant five domains provide a useful approach to understanding and measuring child development in the context of community and environment, therefore advancing knowledge in this area. Expanding the current neighbourhood effects paradigm to accommodate broader constructs appears critical in considering the multiple environments that may act as key determinants of children’s wellbeing and psychosocial outcomes.

Background: Poor oral health in childhood can lead to adverse impacts later in life. We aimed to estimate the prevalence and population distribution of childhood dental caries in Australia and investigate factors that might ameliorate inequalities. Methods: Data from the nationally representative birth cohort Longitudinal Study of Australian Children (N = 5107), using questions assessing: The experience of dental caries during each biennial follow-up period (2&ndash, 3 years to 10&ndash, 11 years), socioeconomic position (SEP), and policy modifiable oral health factors. Results: The odds of dental caries were higher for children with lowest vs. highest SEP (adjusted OR (adjOR) 1.92, 95% CI 1.49&ndash, 2.46), and lower where water was fluoridated to recommended levels (adjOR 0.53, 95% CI 0.43&ndash, 0.64). There was no evidence of an association between caries experience and either reported sugary diet or tooth brushing. When SEP and fluoridation were considered in conjunction, compared to the highest SEP group with water fluoridation children in the lowest SEP with fluoridation had adjOR 1.54 for caries, (95% CI 1.14&ndash, 2.07), and children in the lowest SEP without fluoridation had adjOR 4.06 (95% CI 2.88&ndash, 5.42). For patterns of service use: The highest SEP group reported a greater percentage of service use in the absence of caries. Conclusions: Dental caries appears prevalent and is socially distributed in Australia. Policy efforts should consider how to ensure that children with dental caries receive adequate prevention and early care with equitable uptake.

A growing body of evidence suggests that engagement with quality early childhood education and care (ECEC) programs such as preschool can enhance children's early development. The Australian Early Development Census (AEDC) provides a unique opportunity to explore the relationship between ECEC and children's developmental outcomes in a full population cohort of Australian school entrants. The AEDC is a teacher-rated checklist that provides data on ECEC experiences in the year before starting school, as well as five important domains of child development at school entry: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge. In 2009, the AEDC was completed for 97.5% of Australian children in their first year of formal schooling (N=261,147; M=5 years, 7 months of age). Logistic regression analyses revealed that attendance at preschool was associated with reduced odds (OR=0.69, p

El presente estudio ex post facto fue diseñado para examinar el estado de ánimo y la calidad de vida (QQL) entre 423 personas con enfermedad neurológica progresiva. En particular, se ha investigado la relación entre las variables de la enfermedad y el estado de ánimo y calidad de vida de 120 personas con enfermedad de la neuronales motoras (MND), 48 con enfermedad de Huntington (HD), 143 con Parkinson y 112 con esclerosis múltiple (MS). Los resultados demostraron que las personas con HD comparadas con los grupos con otras enfermedades experimentaban los síntomas más severos de enfermedad, el estado de ánimo más pobre y la más baja calidad de vida. Los síntomas psicológicos fueron predictores más fuertes del estado de ánimo y calidad de vida para todos los grupos, aunque hubo algunas diferencias entre los grupos de enfermedades. Los resultados de este estudio subrayan la importancia de desarrollar programas de información y tratamientos específicos en cuanto a la enfermedad junto con la incorporación de estrategias generalas para que las personas con enfermedades neurológicas progresivas puedan hacer frente a los síntomas de estos trastornos.