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Arch Dis Child 2004;89:353-358. doi: 10.1136/adc.2002.024125 Aims: To determine key themes from parents' comments on paths to diagnosis and intervention for their children with hearing loss, following introduction of at-risk [...]

Aims: To assess short and longer term parent reported impacts of false positive referrals in the Victorian Infant Hearing Screening Program (VIHSP). Methods: Mailed retrospective case-control survey of infants consecutively [...]

Arch Dis Child 2002;86:245-250 Aims: To determine whether a two tier universal infant hearing screening programme (population based risk factor ascertainment and universal distraction testing) lowered median age of diagnosis […]

BACKGROUND: Higher adult blood pressure, even without hypertension, predicts cardiovascular outcomes, and is predicted by childhood blood pressure. Regular dark chocolate intake lowers blood pressure in adults, but effects in children are unknown. AIM: To examine the feasibility of school-based provision of dark chocolate and its short-term efficacy in reducing mean group blood pressure. METHODS: 194 children (aged 10-12 years) were randomised by class to intervention (7 g dark chocolate daily for 7 weeks, n=124) or control (n=70) groups; 98% and 93% provided baseline and follow-up measurements, respectively. RESULTS: Intervention and control students had similar systolic (mean difference 1.7 mm Hg, 95% CI -0.6 to 4.1) and diastolic (-1.2 mm Hg, 95% CI -3.6 to 1.3) blood pressure, anthropometry and well-being at outcome. CONCLUSION: Results show that providing dark chocolate is feasible and acceptable in the school setting. For a definitive trial, the authors recommend a larger sample, endovascular function measures, and consideration of higher antioxidant 'dose' by virtue of duration and/or content. [ABSTRACT FROM AUTHOR]

Background and Objective: As caesarean delivery and childhood allergy continue to rise, their inter-relationships may change. We examined whether caesarean delivery predicts allergic disease and impaired lung function in two contemporary harmonised population-based cohorts., Methods: Parent-reported asthma and eczema data were drawn from two prospective Australian infant cohorts, HealthNuts (n=5276, born 2006-2010) and the Longitudinal Study of Australian Children (LSAC, n=5107, born 2003-2004) at age 6-7 years, and spirometric lung function from LSAC's Child Health CheckPoint (n=1756) at age 11-12 years. Logistic regression estimated associations between delivery mode and current asthma and eczema at 6-7 years, and linear regression examined lung function at 11-12 years. Models were adjusted for potential confounding factors., Results: Complete case analysis included 3135 HealthNuts and 3654 LSAC children (32.2% and 30.9% born by caesarean, respectively). An association was evident between caesarean delivery and asthma at age 6-7 years in HealthNuts (adjusted OR (aOR) 1.25, 95% CI 1.00 to 1.57) but not in LSAC (aOR 1.05, 95% CI 0.86 to 1.28), while neither study showed clear associations with eczema (HealthNuts: aOR 1.09, 95% CI 0.88 to 1.35; LSAC: aOR 0.89, 95% CI 0.69 to 1.15). Spirometric lung function parameters at age 11-12 years were similar by delivery mode. Associations were not modified by duration of breast feeding, maternal history of asthma/eczema, childcare attendance, number of older siblings or pet exposure., Conclusions: In two unselected populations using harmonised protocols, the likely association of caesarean delivery with developing childhood allergy was small., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To investigate the associations of hearing thresholds and slight to mild hearing loss with academic, behavioural and quality of life outcomes in children at a population level., Methods: Design and participants: children aged 11-12 years in the population-based cross-sectional Child Health CheckPoint study within the Longitudinal Study of Australian Children. Audiometry: mean hearing threshold across 1, 2 and 4 kHz (better and worse ear); slight/mild hearing loss (threshold of 16-40 decibels hearing loss (dB HL)). Outcomes: National Assessment Program - Literacy and Numeracy, language, teacher-reported learning, parent and teacher reported behaviour and self-reported quality of life. Analysis: linear regression quantified associations of hearing threshold/loss with outcomes., Results: Of 1483 children (mean age 11.5 years), 9.2% and 13.1% had slight/mild bilateral and unilateral hearing loss, respectively. Per SD increment in better ear threshold (5.7 dB HL), scores were worse on several academic outcomes (eg, reading 0.11 SD, 95% CI 0.05 to 0.16), parent-reported behaviour (0.06 SD, 95% CI 0.01 to 0.11) and physical (0.09 SD, 95% CI 0.04 to 0.14) and psychosocial (0.06 SD, 95% CI 0.01 to 0.11) Pediatric Quality of Life Inventory (PedsQL). Compared with normally hearing children, children with bilateral slight/mild losses scored 0.2-0.3 SDs lower in sentence repetition, teacher-reported learning and physical PedsQL but not other outcomes. Similar but attenuated patterns were seen in unilateral slight/mild losses., Conclusions: Hearing thresholds and slight/mild hearing loss showed small but important associations with some child outcomes at 11-12 years. Justifying hearing screening or intervention at this age would require better understanding of its longitudinal and indirect effects, alongside effective management and appropriate early identification programmes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Chronic conditions are the leading cause of mortality, morbidity and disability in children. However, children and caregivers are rarely involved in identifying research priorities, which may limit the value of research in supporting patient-centred practice and policy., Objective: To identify priorities of patients, caregivers and health professionals for research in childhood chronic conditions and describe the reason for their choices., Setting: An Australian paediatric hospital and health consumer organisations., Methods: Recruited participants (n=73) included patients aged 8 to 14 years with a chronic condition (n=3), parents/caregivers of children aged 0 to 18 years with a chronic condition (n=19), representatives from consumer organisations (n=13) and health professionals including clinicians, researches (n=38) identified and discussed research priorities. Transcripts were thematically analysed., Results: Seventy-eight research questions were identified. Five themes underpinned participants' priorities: maintaining a sense of normality (enabling participation in school, supporting social functioning, promoting understanding and acceptance), empowering self-management and partnership in care (overcoming communication barriers, gaining knowledge and skills, motivation for treatment adherence, making informed decisions, access and understanding of complementary and alternative therapies),strengthening ability to cope (learning to have a positive outlook, preparing for home care management, transitioning to adult services), broadening focus to family (supporting sibling well-being, parental resilience and financial loss, alleviating caregiver burden), and improving quality and scope of health and social care (readdressing variability and inequities, preventing disease complications and treatment side effects, identifying risk factors, improving long-term outcomes, harnessing technology, integrating multidisciplinary services)., Conclusion: Research priorities identified by children, caregivers and health professionals emphasise a focus on life participation, psychosocial well-being, impact on family and quality of care. These priorities may be used by funding and policy organisations in establishing a paediatric research agenda., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To evaluate research priority setting approaches in childhood chronic diseases and to describe the priorities of stakeholders including patients, caregivers/families and health professionals., Design: We conducted a systematic review of MEDLINE, Embase, PsycINFO and CINAHL from inception to 16 October 2016. Studies that elicited stakeholder priorities for paediatric chronic disease research were eligible for inclusion. Data on the prioritisation process were extracted using an appraisal checklist. Generated priorities were collated into common topic areas., Results: We identified 83 studies (n=15 722). Twenty (24%) studies involved parents/caregivers and four (5%) children. The top three health areas were cancer (11%), neurology (8%) and endocrine/metabolism (8%). Priority topic areas were treatment (78%), disease trajectory (48%), quality of life/psychosocial impact (48%), disease onset/prevention (43%), knowledge/self-management (33%), prevalence (30%), diagnostic methods (28%), access to healthcare (25%) and transition to adulthood (12%). The methods included workshops, Delphi techniques, surveys and focus groups/interviews. Specific methods for collecting and prioritising research topics were described in only 60% of studies. Most reviewed studies were conducted in high-income nations., Conclusions: Research priority setting activities in paediatric chronic disease cover many discipline areas and have elicited a broad range of topics. However, child/caregiver involvement is uncommon, and the methods often lack clarity. A systematic and explicit process that involves patients and families in partnership may help to inform a more patient and family-relevant research agenda in paediatric chronic disease., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: To estimate prevalence and persistence of 19 common paediatric conditions from infancy to 14-15 years., Design: Population-based prospective cohort study., Setting: Australia., Participants: Parallel cohorts assessed biennially from 2004 to 2014 from ages 0-1 and 4-5 years to 10-11 and 14-15 years, respectively, in the Longitudinal Study of Australian Children., Main Outcome Measures: 19 health conditions: 17 parent-reported, 2 (overweight/obesity, obesity) directly assessed. Two general measures: health status, special health care needs., Analysis: (1) prevalence estimated in 2-year age-bands and (2) persistence rates calculated at each subsequent time point for each condition among affected children., Results: 10 090 children participated in Wave 1 and 6717 in all waves. From age 2, more than 60% of children were experiencing at least one health condition at any age. Distinct prevalence patterns by age-bands comprised eight conditions that steadily rose (overweight/obesity, obesity, injury, anxiety/depression, frequent headaches, abdominal pain, autism spectrum disorder, attention-deficit hyperactivity disorder). Six conditions fell with age (eczema, sleep problems, day-wetting, soiling, constipation, recurrent tonsillitis), three remained stable (asthma, diabetes, epilepsy) and two peaked in mid-childhood (dental decay, recurrent ear infections). Conditions were more likely to persist if present for 2 years; persistence was especially high for obesity beyond 6-7 (91.3%-95.1% persisting at 14-15)., Conclusions: Beyond infancy, most Australian children are experiencing at least one ongoing health condition at any given time. This study's age-specific estimates of prevalence and persistence should assist families and clinicians to plan care. Conditions showing little resolution (obesity, asthma, attention-deficit hyperactivity disorder) require long-term planning and management., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: In a national study of Australian children aged 11-12 years old, we examined the (1) prevalence and characteristics of hearing loss, (2) its demographic risk factors and (3) evidence for secular increases since 1990., Methods: This is a cross-sectional CheckPoint wave within the Longitudinal Study of Australian Children. 1485 children (49.8% retention; 49.7% boys) underwent air-conduction audiometry. Aim 1: hearing loss (≥16 decibels hearing level (dB HL)) was defined in four ways to enable prior/future comparisons: high Fletcher Index (mean of 1, 2 and 4 kHz; primary outcome relevant to speech perception), four-frequency (1, 2, 4 and 8 kHz), lower frequency (1 and 2 kHz) and higher frequency (4 and 8 kHz); aim 2: logistic regression of hearing loss by age, gender and disadvantage index; and aim 3: P for trend examining CheckPoint and reported prevalence in studies arranged by date since 1990., Results: For high Fletcher Index, the prevalence of bilateral and unilateral hearing loss ≥16 dB HL was 9.3% and 13.3%, respectively. Slight losses (16-25 dB HL) were more prevalent than mild or greater (≥26 dB HL) losses (bilateral 8.5% vs 0.8%; unilateral 12.5% vs 0.9%), and lower frequency more prevalent than higher frequency losses (bilateral 11.0% vs 6.9%; unilateral 15.4% vs 11.5%). Demographic characteristics did not convincingly predict hearing loss. Prevalence of bilateral/unilateral lower and higher frequency losses ≥16 dB HL has risen since 1990 (all P for trend <0.001)., Conclusions and Relevance: Childhood hearing loss is prevalent and has risen since 1990. Future research should investigate the causes, course and impact of these changes., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objectives: To determine which of multiple early-life exposures predict onset or resolution of overweight/obesity during a 9-year period., Methods: Design : longitudinal cohort from three harmonised community-based cohorts enriched for overweight and obesity. Early-life exposures : child-gestational age; delivery; birth weight; breast feeding; solids introduction; baseline body mass index (BMI); waist circumference; diet; activity; global, physical and psychosocial health. Mother-baseline BMI; education; age; neighbourhood disadvantage; concern for child's weight. Outcome : change in BMI category. Analyses : adjusted logistic regression., Results: On average, the 363 children (57% retention) were 6 and 15 years old at baseline and follow-up. Children were classified as 'never' overweight/obese (38%), 'resolving' overweight/obese (15%), 'becoming' overweight/obese (8%) or 'always' overweight/obese (39%). Compared with 'never overweight/obese' children, odds of 'becoming overweight/obese' were greater with higher child (OR 2.33, 95% CI 1.02 to 5.29) and maternal BMI (OR 1.18, CI 1.07 to 1.31), and lower with higher maternal education (OR 0.09, CI 0.02 to 0.34). Compared with 'always overweight/obese' children, odds of 'resolving overweight/obese' were lower with higher maternal BMI (OR 0.87, CI 0.78 to 0.97), and higher with better child physical health (OR 1.06, CI 1.02 to 1.10) and higher maternal age (OR 1.11, CI 1.01 to 1.22) and education (OR 4.07, CI 1.02 to 16.19)., Conclusions: Readily available baseline information (child/maternal BMI, maternal age, education and child health) were the strongest predictors of both onset and resolution of overweight/obesity between the primary school and adolescent years. Perinatal, breastfeeding and lifestyle exposures were not strongly predictive. Results could stimulate development of algorithms identifying children most in need of targeted prevention or treatment., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objective: To provide accurate population normative data documenting cross-sectional, age-specific sleep patterns in Australian children aged 0-9 years., Design and Setting: The first three waves of the nationally representative Longitudinal Study of Australian Children, comprising two cohorts recruited in 2004 at ages 0-1 years (n=5107) and 4-5 years (n=4983), and assessed biennially., Participants: Children with analysable sleep data for at least one wave., Measures: At every wave, parents prospectively completed 24-h time-use diaries for a randomly selected week or weekend day. 'Sleeping, napping' was one of the 26 precoded activities recorded in 15-min time intervals., Results: From 0 to 9 years of age, 24-h sleep duration fell from a mean peak of 14 (SD 2.2) h at 4-6 months to 10 (SD 1.9) h at 9 years, mainly due to progressively later mean sleep onset time from 20:00 (SD 75 min) to 21:00 (SD 60 min) and declining length of day sleep from 3.0 (SD 1.7) h to 0.03 (SD 0.2) h. Number and duration of night wakings also fell. By primary school, wake and sleep onset times were markedly later on weekend days. The most striking feature of the centile charts is the huge variation at all ages in sleep duration, sleep onset time and, especially, wake time in this normal population., Conclusions: Parents and professionals can use these new centile charts to judge normalcy of children's sleep. In future research, these population parameters will now be used to empirically determine optimal child sleep patterns for child and parent outcomes like mental and physical health.

Objective: Secondary care could be the optimal sector for managing child and adolescent obesity, given low primary care uptake and limited tertiary services. We aimed to determine Australian paediatricians' self-reported competence and training in managing obesity and, in a linked patient-level audit, whether these predict rates of measurement and obesity diagnosis., Design, Setting and Patients: Australian Paediatric Research Network members completed an online survey, plus a prospective patient-level audit of up to 100 consecutive consultations over 2 weeks., Survey: self-reported competencies, training in and use of clinical skills in obesity and its comorbidities. Audit: paediatricians reported each child's height, weight, age, sex and diagnoses including overweight/obesity., Results: Of 166 (44.7% response) paediatricians, most felt very/quite competent in assessing (89%) and managing (68%) obesity, but few in making a difference to obesity (20%) or managing hypertension (45%), insulin resistance (32%), fatty liver disease (22%) or dyslipidaemia (21%). The audit of 200 (66.2% response) paediatricians included 8345 patients. On average paediatricians recorded height and weight for 66.5% of patients (SD 30.0%, range 0-100%). Of the 296 (12.3%) patients obese by CDC cutpoints, 118 (39.9%) were diagnosed as obese; perceived competence increased the odds of recording this diagnosis but not measurement. Training levels were low, showed little association with measurement or obesity diagnosis, and skills learnt were not routinely used., Conclusions: There is a clear need for better paediatrician training in obesity management. However, care and outcomes for obese children are unlikely to improve unless effective management models can be operationalised systematically.

Objective: Short sleep duration may contribute to childhood obesity. Amenable to intervention, sleep thus provides a potential path for prevention. The authors aimed to determine the impact of a behavioural intervention that successfully reduced parent-reported infant sleep problems on adiposity at age 6., Design: 5-year follow-up of a previously reported population-based cluster randomised trial. Participant allocation was concealed to researchers and data collection blinded., Setting: Recruitment from well-child centres in Melbourne, Australia., Participants: 328 children (174 intervention) with parent-reported sleep problems at age 7-8 months drawn from 49 centres (clusters)., Intervention: Behavioural sleep strategies delivered over one to three structured individual nurse consultations from 8 to 10 months, versus usual care. MAIN OUTCOMES AT AGE 6 YEARS: Body mass index (BMI) z-score, percentage overweight/obese and waist circumference., Analyses: Intention-to-treat regression analyses adjusted for potential confounders., Results: Anthropometric data were available for 193 children (59% retention) at age 6. There was no evidence of a difference between intervention (N=101) and control (N=92) children for BMI z-score (adjusted mean difference 0.2, 95% CI -0.1 to 0.4), overweight/obese status (20% vs 17%; adjusted OR 1.4, 95% CI 0.7 to 2.8) and waist circumference (adjusted mean difference -0.3, 95% CI -1.6 to 1.1). In posthoc analyses, neither infant nor childhood sleep duration were associated with anthropometric outcomes., Conclusions: A brief infant sleep intervention did not reduce overweight/obesity at 6 years. Population-based primary care sleep services seem unlikely to reduce the early childhood obesity epidemic.

Objective: To determine whether a structured programme of parent anticipatory guidance 'Toddlers Without Tears,' delivered in universal primary care, can prevent preschool child behaviour problems., Design: Cluster randomised controlled trial., Setting/participants: 40 primary care nursing centres (clusters) in metropolitan Melbourne, Australia. 733 English-speaking mothers of 6- to 7-month-old infants consecutively recruited from well-child appointments; 589 (80%) retained at age 3 years., Intervention: Parenting programme from age 8 to 15 months, with two group sessions co-led by well-child providers and a parenting expert. The programme addressed normal behaviour development and offered strategies to increase desired and reduce unwanted behaviour. While 93% of intervention parents received at least some of the programme, only 49% completed all components. Control Usual primary care., Main Outcome Measures: Maternal report of child externalising behaviour (Child Behaviour Checklist), parenting (Parent Behaviour Checklist) and maternal mental health (Depression Anxiety Stress Scales) when children were aged 3 years., Results: Behaviour scores in the intervention and control groups were similar (mean (SD)) 11.4 (7.1) versus 12.4 (7.6); adjusted mean difference -0.8, 95% CI -2.2 to 0.6, p=0.26). On the parenting subscale scores, intervention parents reported fewer unreasonable expectations of child development (37.3 (10.9) vs 39.9 (10.2), adjusted mean difference -3.1, 95% CI -4.9 to -1.4, p=0.001). The mean scores for harsh/abusive and nurturing parenting, and maternal mental health, were similar between the two groups., Conclusions: A brief universal parenting programme in primary care is insufficient to prevent development of preschool externalising problems. A new population trial targeting more intensive prevention to distressed parents with toddler behaviour problems is now under way, aiming to prevent externalising and internalising problems before school entry., Trial Registration Number: ISRCTN77531789.

Objectives: Adolescent obesity is linked to metabolic and cardiovascular risk, but its associations with adolescents' experienced health and morbidity are less clear. Morbidities experienced by overweight/obese adolescents and associations between morbidities and timing of overweight/obesity were examined., Methods: Data were from the Health of Young Victorians Study (HOYVS; 1997, 2000, 2005), a school-based longitudinal study. Outcomes were blood pressure, health status (Pediatric Quality of Life Inventory 4.0 (PedsQL), global health), mental health (Strengths and Difficulties Questionnaire), psychological distress (Kessler-10), physical symptoms, sleep, asthma, dieting, and healthcare needs and visits. Regression methods assessed associations with body mass index status and timing of overweight/obesity., Results: Of the 923 adolescents (20.2% overweight, 6.1% obese), 63.5% were classified as "never" overweight/obese, 8.5% as "childhood only", 7.3% as "adolescence only" and 20.8% as "persistent". Compared to non-overweight, current obesity was associated with lower PedsQL physical summary scores (mean -6.58, 95% CI -9.52 to -3.63) and good/fair/poor global health (OR 3.52, 95% CI 1.95 to 6.36), hypertension (systolic 8.86, 95% CI 4.70 to 16.71; diastolic 5.29, 95% CI 2.74 to 10.20) and dieting (OR 5.79, 95% CI 3.28 to 10.23), with intermediate associations for overweight. Associations with psychosocial morbidity were weaker and inconsistent and there were few associations with health symptoms and problems. Only dieting (OR 2.30, 95% CI 1.36 to 3.89) was associated with resolved childhood overweight/obesity., Conclusions: Despite poorer overall health, overweight/obese adolescents were not more likely to report specific problems that might prompt health intervention. Morbidity was mainly associated with concurrent, rather than earlier, overweight/obesity.