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Professor Graham Vimpani is head of the Discipline of Paediatrics & Child Health, University of Newcastle.One hundred years ago maternal and child health services emerged as a community response in Australia, and most other industrialised countries, to concerns about the high rates of infant and early childhood mortality from infectious disease and poor nutrition. Major family and social changes over the past 30 years have impacted in new ways on children's health and wellbeing leading to a profound rethink about the kinds of services that are needed. At the same time, second thoughts have emerged about the role of government in service provision, driven by neoliberal and rational economic philosophies as outlined in the paper in this issue by Keleher and Reiger (2004). Together, these issues have challenged the very foundations on which the services were traditionally based.

This study was funded by the Hunter Area Health Service and the NSW Department of Education.This paper examines the perceived service needs of families of Hunter region preschool aged children with disruptive behaviour problems, attending centre-based child care services. Families were recruited via clinics and child care services, using defined eligibility criteria. Respondents ranked their service needs in clinical, early education, and community-based categories, as well as strategies for cost reduction. Respondents also provided service utilisation, family stress, and socio-demographic details. The highest clinical service priorities entailed expansion of mainstream community treatment services. In the early education sector, highest priority was given to extending the behaviour management skills of existing child care staff, ahead of the need to recruit specialist staff. Priority was given to support groups and an information and referral service, ahead of respite services. Exceptional levels of family stress and burden of care were detected for this group. The findings provide a consumer's perspective on the provision of services for preschool-aged children with disruptive behaviour.

Early childhood exposure to environmental lead may result in subtle deficits in neuropsychological development. Most studies, however, have reported global measures of development, and the findings have not been consistent. In this report, we examine the association between blood lead concentration and a specific aspect of neuropsychological development, visual-motor integration. Each child in a cohort of 494 children living in and around the lead smelting town of Port Pirie, South Australia, was followed for its first 7 years of life. Serial blood samples were collected at various ages to estimate the lifetime burden of each individual. At the time of each blood sampling, systematic information was obtained on a wide range of other variables relevant to child development. We evaluated visual-motor integration at age 7 with the Beery Developmental Test of Visual-Motor Integration (mean score: 13.4). There was an inverse relation between blood lead concentration and visual-motor performance. After adjustment for potential confounding factors, both prenatal and postnatal blood lead concentrations exhibited a dose-related inverse association with children's visual-motor performance. For an increase in lifetime average blood lead concentration from 10 μag per dl (0.48 μmol per liter) to 30 μg per dl (1.45 μmol per liter), the estimated deficit in children's visual-motor performance was 1.6 points (95 confidence interval 0.3–2.9). The results indicate that visual-motor integration may be a more sensitive index than global measures of development, such as intelligence quotient, for the assessment of lead effects on child development.

ABSTRACT The mortality in children who were aged 0–14 years in the Northern Territory in 1983–1985 was 2.5‐times higher than it was for Australia generally over the same period. Total accidental‐death rates over the period 1979–1983 in Aboriginal children were 2.2‐times higher than in non‐Aboriginal children. A trend towards an excess in Aboriginal child mortality was present in most categories except drowning and was particularly noteworthy for deaths due to natural and environmental causes (predominantly caused by box‐jellyfish stings). Non‐Aboriginal children experienced higher rates of death due to drowning than they did elsewhere in Australia; most of these occurred in domestic swimming‐pools. A higher mortality was encountered in rural areas. The pattern of motor‐vehicle‐related deaths differed between Aboriginal children and non‐Aboriginal children, with the former experiencing a greater number of deaths due to non‐collision accidents that involved “loss of control”. The implications of these findings for the development of appropriate preventive strategies is discussed.

Abstract: We report a simple protocol which has potential to estimate community paediatric blood lead levels using opportunistic testing. Permission to use leftover blood for a lead assay was sought from parents or guardians of 397 children one month to 13 years of age who were admitted to general paediatric wards of John Hunter Hospital, Newcastle, between May and August 1993 and who had blood for a full blood count taken for any reason. Results were reviewed by a medical officer and returned to parents. Where a child's blood lead level was of concern according to National Health and Medical Research Council guidelines, the child was referred to a specialist paediatrician for clinical assessment. Written consent was received from the parents or guardians of 95.5 per cent of eligible children (n= 379); 93.4 per cent of responders (354 of 379) had blood suitable for testing, giving an overall result rate of 89.2 per cent (354 of 397). The mean blood lead level for the whole group was 5.3 μg/dL. The highest blood lead level for any age group was 6.4 μg/dL in the 36 to <60 month age group. Stratification by geographical area showed a trend in increasing blood lead with increasing population density and areas where lead polluting industries exist. The approximate cost per result achieved was $40. This opportunistic survey method provides a promising technique for obtaining data on community blood lead levels. It may be a practical and resource–efficient alternative to large–scale community surveys. Further studies are under way to validate the method as a community surveillance tool.

In the context of a wider prospective investigation into the effects of cumulative exposure to lead, in uteroand postnatally, on the outcome of pregnancy and growth and development in early childhood, 831 pregnant women who were living in Port Pirie, South Australia, the site of Australia's largest lead smelter, were recruited between May 1979 and May 1982, and the various factors that were likely to influence their blood lead concentration were examined. No significant difference in blood lead level was found among different stages of pregnancy. Higher concentrations of blood lead were measured in women who resided in areas of high soil lead content and in women who had resided in Port Pirie for three or more years. A low socioeconomic status, the use of water from the reticulated water supply rather than rainwater, an age of 21 years or less, a high body mass index, a low dietary intake of calcium, and cigarette smoking were all factors that were associated with a higher blood lead concentration. Lower blood lead concentrations were observed in women who took iron and folic acid to supplement their diet. Multiple regression analysis of average antenatal blood lead levels confirmed most of the univariate associations.

A survey of 3660 Year 10 students, with an average age of 15 years, was carried out in a random sample of Adelaide secondary schools to determine the prevalence of structural scoliosis and the need for implementing a programme of scoliosis screening. By means of the Forward Bending Test and a specially devised scoring system 144 (3.9%) children were found to have signs that were suggestive of scoliosis; all but 12 were assessed subsequently by standardized clinical and radiological examinations. One hundred and three children were found to have structural scoliosis of 5° or more; this represented a prevalence of 3.1%. The prevalence in girls (4.3%) was significantly higher than in boys (1.9%), and girls tended to have more severe curves and require treatment more frequently. Only one third (34) of the cases of structural scoliosis had been detected before this survey; most (28) of these had been detected through an earlier, subsequently discontinued, school screening programme. This study concludes that screening for scoliosis by means of a scored Forward Bending Test should be carried out in South Australian schools for all students in Year 8 and for girls in Year 10. The policy of screening boys in Year 8 should be the subject of further research. An educational programme for health professionals, parents, students and physical education teachers should support the programme.

A cohort of over 600 children who were born between 1979 and 1982 and accounted for the great majority of all births in Port Pirie, South Australia, and its immediate environs, underwent capillary blood sampling at the ages of 6 months, 15 months, 2 years, and annually thereafter. The mean blood lead concentration (Pb‐B) initially rose markedly, peaked at 2 years of age, and subsequently declined gradually at 3 and 4 years of age. No differences in Pb‐B were observed between girls and boys. Secular trends in Pb‐B at the age of 2 years that were observed in blood samples taken over the 1981‐1984 period suggest that both the drought of 1982 and changes in community behaviour may have accounted for some of the age‐related variation. The Pb‐B was associated positively with surface soil lead concentrations, with a two‐fold variation in mean Pb‐B between residential zones within Port Pirie. Pb‐B was higher in summer than in winter months at the ages of 6 and 15 months, but not at older ages. These findings suggest that lead in dust influences strongly blood lead concentrations in early childhood.

To determine the potential for using urine instead of blood as an indicator of lead exposure, especially in infants, lead concentrations and high-precision lead isotopic measurements have been compared in venous blood and “spot” urine (n>260 from 182 different subjects) collected within the same 24-h period. Physiological conditions for the children and most of the adults were considered to be in a steady-state between body stores and lead in the environment. In the case of some adults, conditions were initially not steady-state because exposure conditions changed (for example, subjects moved to a country with lead of different isotopic composition.) There was a high correlation (r2=0.98) between the blood and urine measurements of the isotope ratios but about 10% of measurements were outliers—the blood and urine measurements were further apart than was consistent with the measurement error that was generally obtained. The discrepancy was usually found to be associated with the urine measurement and was attributed to contamination during sampling. Weekly urine and monthly blood monitoring of an adult male over a 24-month period showed excellent correlations, although the standard deviations were about an order of magnitude higher than the precision measured for replicate analyses of a single blood or urine sample. “Spot” urine analyses for two male subjects gave excellent agreement with 24-h urine samples. Standard deviations of the spot analyses were of similar order to those in the 24-month monitored subject. In cases where female adults from Eastern Europe migrated to Australia, there was generally a more rapid exchange of skeletal lead with Australian environmental lead in urine compared with blood. These data do not support a differential partitioning of endogenous lead into the plasma. At this stage, isotopic measurements of urine can be used as a proxy for isotopic measurements in blood. However, lead concentrations in blood and in urine are only weakly related. Concentrations of lead in urine cannot serve to predict concentrations of lead in blood, particularly at the lower range of exposures, for example, at blood lead concentrations less than 10 μg/dl.

We report a simple protocol which has potential to estimate community paediatric blood lead levels using opportunistic testing. Permission to use leftover blood for a lead assay was sought from parents or guardians of 397 children one month to 13 years of age who were admitted to general paediatric wards of John Hunter Hospital, Newcastle, between May and August 1993 and who had blood for a full blood count taken for any reason. Results were reviewed by a medical officer and returned to parents. Where a child’s blood lead level was of concern according to National Health and Medical Research Council guidelines, the child was referred to a specialist paediatrician for clinical assessment. Written consent was received from the parents or guardians of 95.5 per cent of eligible children (n= 379); 93.4 per cent of responders (354 of 379) had blood suitable for testing, giving an overall result rate of 89.2 per cent (354 of 397). The mean blood lead level for the whole group was 5.3 μg/dL. The highest blood lead level for any age group was 6.4 μg/dL in the 36 to <60 month age group. Stratification by geographical area showed a trend in increasing blood lead with increasing population density and areas where lead polluting industries exist. The approximate cost per result achieved was $40. This opportunistic survey method provides a promising technique for obtaining data on community blood lead levels. It may be a practical and resource-efficient alternative to large-scale community surveys. Further studies are under way to validate the method as a community surveillance tool.

There is controversy over whether the method of feeding in infancy affects intellectual development. We investigated the relationship between breastfeeding status at 6 months of age and long-term cognitive development in a cohort of 375 children born in Port Pirie, South Australia, between 1979 and 1982. Cognitive assessments were conducted at ages 2, 4, 7 and 11 to 13 years. After adjustment for sociodemographic, environmental and biomedical factors, a small, statistically non-significant, beneficial effect of breastfeeding on cognitive functioning was observed. Compared with the bottle-fed children, the breast-fed children had a 3.4 (95% C1 -0.1 to 6.9), 1.3 (-2.3 to 4.9), 1.2 (-2.0 to 4.4) and 0.8 (-1.9 to 3.5) point advantage on the Bayley Mental Developmental Index at age 2 years, the McCarthy General Cognitive Index at age 4 years and the Wechsler Full-Scale IQ at ages 7 and 11 to 13 years, respectively. Our data suggest that any beneficial effect of breastfeeding on cognitive development is quite small in magnitude.

There is controversy over whether the method of feeding in infancy affects intellectual development. We investigated the relationship between breastfeeding status at 6 months of age and long‐term cognitive development in a cohort of 375 children born in Port Pirie, South Australia, between 1979 and 1982. Cognitive assessments were conducted at ages 2, 4, 7 and 11 to 13 years. After adjustment for sociodemographic, environmental and biomedical factors, a small, statistically non‐significant, beneficial effect of breastfeeding on cognitive functioning was observed. Compared with the bottle‐fed children, the breast‐fed children had a 3.4 (95% C1 ‐0.1 to 6.9), 1.3 (‐2.3 to 4.9), 1.2 (‐2.0 to 4.4) and 0.8 (‐1.9 to 3.5) point advantage on the Bayley Mental Developmental Index at age 2 years, the McCarthy General Cognitive Index at age 4 years and the Wechsler Full‐Scale IQ at ages 7 and 11 to 13 years, respectively. Our data suggest that any beneficial effect of breastfeeding on cognitive development is quite small in magnitude.

The blood pressures of 6346 children who were between the ages of seven and 17 years were measured under standardized conditions. Blood pressures were similar in prepubertal boys and girls. After puberty, the systolic blood pressures of the girls remained unchanged whereas those of the boys continued to rise. The difference between the fourth and fifth Korotkoff sounds was 2 mm at both the 50th and 95th percentiles. The systolic blood pressure was observed to fall over a 10‐min period by 4‐9 mmHg at the 50th percentile and 9‐15 mmHg at the 95th percentile. Over the same period of time, the diastolic blood pressure was seen to fall by 2‐3 mmHg and 3‐6 mmHg at the 50th and 95th percentiles, respectively. There was no further fall in blood pressure after 10 min. The conditions and timing of measurement are important in blood‐pressure evaluation and may explain the differences in blood pressure that have been reported for different populations.

Discusses the emphasis given by Australian Labor Party leader Mark Latham to the importance of early childhood development. Role of parents in the child's success in the formal education system; Evidence that learning begins well before the first day of extrauterine life; Publications on early childhood development.

The pattern of contemporary morbidity in young Australians (15-20 per cent mental health problems) is indicative of widespread community, social and family dysfunction.

This article outlines the advantages of extended home visiting for families and children at risk. This form of visiting by a nurse, welfare worker or trained volunteer which may begin in pregnancy or in the first few weeks of life, usually continues regularly and frequently over a period of many months, and in the case of participants in the Olds study, for two years after birth.