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Background Early identification of children with potential development delay is essential to ensure access to care. The Ages & Stages Questionnaires (ASQ) is used as population outcome indicators in England as part of the 2.5-year review. Method The aim of this article was to systematically review the worldwide evidence for the psychometric properties of the ASQ third edition (ASQ-3TM) and the Ages & Stages Questionnaires®: Social-Emotional (ASQ:SE). Eight electronic databases and grey literature were searched for original research studies available in English language, which reported reliability, validity or responsiveness of the ASQ-3TM or ASQ:SE for children aged between 2 and 2.5 years. Twenty studies were included. Eligible studies used either the ASQ-3TM or the ASQ:SE and reported at least one measurement property of the ASQ-3TM and/or ASQ:SE. Data were extracted from all papers identified for final inclusion, drawing on Cochrane guidelines. Results Using 'positive', 'intermediate' and 'negative' criteria for evaluating psychometric properties, results showed 'positive' reliability values in 11/18 instances reported, 'positive' sensitivity values in 13/18 instances reported and 'positive' specificity values in 19/19 instances reported. Conclusions Variations in age or language versions used, quality of psychometric properties and quality of papers resulted in heterogeneous evidence. It is important to consider differences in cultural and contextual factors when measuring child development using these indicators. Further research is very likely to have an important impact on the interpretation of the ASQ-3TM and ASQ:SE psychometric evidence. [ABSTRACT FROM AUTHOR]

Background: The existing evidence is limited in terms of perspectives of preschool children with speech and language needs and their views on activities used to support their needs. This paper discusses a stream of work from the interdisciplinary research programme known as "Child Talk," based in England, UK. The overall purpose of this work stream was to gain the perspectives of preschool children aged 2 to 5 years and 11 months, with speech and language needs, to use in the development of an evidence‐based framework of activities. Methods: Twenty‐four preschool children with a variety of needs from diverse backgrounds took part. An observational methodology was used to capture children's experiences. Children were filmed during a series of sessions, with innovative head‐mounted cameras worn by the children and supported by researcher field notes. Framework analysis was used to analyse the data based on the body movement, vocalization, and visual attention of the children during these sessions. Results and Conclusions: Results included that children expressed enjoyment and engagement in the activities. The children expressed themselves and demonstrated their focus "multimodally" through combinations of body language, vocalization, and visual attention. These modalities were present across all contexts and children. It highlights the importance of encouraging participation in preschool children and consequently this innovative piece of work has national and international importance. [ABSTRACT FROM AUTHOR]

Background Children who experience difficulties in face-to-face interaction, understanding language and developing literacy can benefit from the provision of communication aids such as speech synthesizers and specialist software applications that support their social participation and learning. The Communication Aids Project (CAP) was a national initiative by the Department for Education and Skills in England, aimed at supporting and developing the provision of communication aids to children. This paper presents an analysis of the number and type of applications to CAP. In so doing, the paper begins to explore how the need for communication aids might be understood in England. Methods The analysis was carried out on a database of 3060 anonymized records, representing applications to CAP between January 2002 and January 2004. Results Applications to CAP were made on behalf of children with a broader range of disabilities than might be assumed, including a relatively high proportion of children with autistic spectrum disorder. Rates of application to CAP varied in line with Local Education Authority population size [e.g. total pupils, total pupils with special educational needs (SEN)], rather than indicators of regional variation in SEN provision (e.g. proportion of population identified as having SEN). Conclusions Within a context of changing services to children in England and increasing emphasis on the plurality and contestability of services, the relevance of these findings for service providers and service commissioners is discussed. [ABSTRACT FROM AUTHOR]

This paper describes a process evaluation that was conducted alongside a randomized controlled trial of out-of-home pre-school day care. The evaluation aimed to: (1) describe the intervention; (2) document the day care received by participating families; (3) describe the social context of the trial; and (4) provide data to assist in the interpretation of trial outcomes.The setting for the trial was an out-of-home day care Centre in Hackney, East London. Process data were collected through the use of questionnaires, interviews, and researcher field-notes. Data from questionnaires were collected from 120 mothers and included data on 143 children. Interviews were undertaken with 21 participating mothers. Staff also completed questionnaires and the Head of the Centre was interviewed. The quality of care provided was assessed using the Early Childhood Environment Rating Scale.Process data collected during the trial suggest that the day care provided was education-led, flexible in catering to families’ needs, and was of a very high quality. The social context of the trial resulted in financial pressures, which may well have influenced the intervention provided. Data collected through in-depth interviews suggested that it may be the flexibility of day care that is particularly important in allowing women to return to paid employment, but that the loss of benefits when starting work may have meant no increase in household income.The paper illustrates the value of conducting a process evaluation alongside a randomized trial, particularly where complex interventions are involved. In this case, where the intervention was not provided by the research team, the evaluation allowed an insight into the content of a multifaceted intervention, which is useful in interpreting the trial's results, and in explaining the possible effects of the social context on the intervention. [ABSTRACT FROM AUTHOR]

Background: The Healthy Child Programme is the universal public health system in England to assess and monitor child health from 0 to 19. Following a review of measures for closer monitoring at age 2 years, the Department of Health for England implemented the Ages & Stages Questionnaires®, Third Edition (ASQ‐3™; Hereon, ASQ‐3). Aim: The aim of this study was to evaluate the acceptability and understanding of the ASQ‐3 in England by health professionals and parents. Method: A mixed‐methods approach was used. This paper reports on the qualitative data drawn from interviews with 40 parents and 12 focus groups with 85 health professionals. The data were analysed using applied thematic analysis. Findings Overall, parents and health professionals found the ASQ‐3 acceptable and understandable and could use it as a measure at age 2 years. The ability to work in partnership was valued. Some limitations included potential to cause anxiety, concerns around the safety of some of the items, and use of Americanized language. Health professional's training in the use the ASQ‐3 was inconsistent. Conclusion: The ASQ‐3 is an acceptable and understandable measure to use as part of the 2‐year assessment with some adaptations to the English context and some standardized training for health professionals. [ABSTRACT FROM AUTHOR]

The article reviews the report "Variation in Recording of Child Maltreatment in Administrative Records of Hospital Admissions for Injury in England, 1997-2009," by A. González-Izquierdo, J. Woodman, and L. Copley, which appeared in a 2010 issue of the periodical "Archives of Disease in Childhood."

Background The UK Department of Health for England and Wales has issued guidance to all local Primary Care Trusts (PCTs), who have responsibility for school nursing services, for the annual weighing and measuring of all children on entry to primary school and in Year 6 (age 5 and 11 years respectively), known as the National Child Measurement Programme. The guidance places the responsibility for implementation and funding of this scheme onto the PCTs. Method This paper describes the conduct and evaluation of the 2006 monitoring exercise in a 10% sample of Leeds primary schools. Results The evaluation showed that the exercise can be carried out with little disruption in schools and minimal distress for children. Conclusions Recommendations include: adequate staff training in measuring children, along with anticipation of the issues and problems they may encounter and best practice for dealing with them. A good working relationship must be established between the team and school before the measuring day. Schools need to ensure the availability of suitable accommodation and a screen to maintain privacy. Lightweight but robust and accurate scales conforming to the European Union standard should be used and routinely checked for accuracy. Where possible, children should not be lined up, but seen individually. This is considered essential for the older Year 6 children. [ABSTRACT FROM AUTHOR]

Background Amid concern about the reach and inclusivity of parenting interventions, attempts have been made to culturally adapt programmes for specific ethnic or linguistic groups. This paper describes a novel approach of the religious adaptation of a parenting programme, namely the Family Links Islamic Values course. Methods A small-scale qualitative process evaluation was conducted on one Family Links Islamic Values course for Muslim fathers in the South of England in order to describe the intervention as implemented and its theory of change, as well as the acceptability of the programme to the participants. The data consisted of 13 semi-structured interviews (10 with parents and three with staff), 25 h of observation and reading of programme manuals. Results A logic model is presented to describe the theoretical basis of the intervention. The programme was highly acceptable to fathers who valued the integration of religious teachings and were generally very positive about their experience of attending the course. Post-course interviews with both fathers and mothers mentioned some positive changes in fathers as a result of their attendance. Conclusions It is important to be responsive to the needs of some British Muslims for religiously credible interventions. This small-scale process evaluation needs to be followed by a robust evaluation of programme outcomes for parents and children. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To explore 40 years of Child Development Centre (CDC) activity and outcomes at Northampton General Hospital 1974–2014. Methods: The study comprises 3 data sets: a published report from 1974 to 1999, an internal audit from 2001 to 2004, and more recent data collected from 2005 to 2014. The medical notes of all children who were assessed by the CDC in 2014 were reviewed, along with referral data collected by the CDC manager from this year and the preceding 10 years. Results: From January 1, 1974 to December 31, 2014, 3,786 children were assessed. The male to female ratio is 2.8:1 from 2005 to 2014. Referrals for behavioural difficulties increased from 10% (10/100 referrals) in 1999–2004 to 17.8% (18/101 referrals) in 2014. Similarly, referrals for social and communication problems, “interaction” increased two and a half fold from 10% (10/100 referrals) in 1999–2004 to 26.7% (27/101 referrals) in 2014. Between 2004 and 2014, numbers of referrals for “developmental delay” halved (22.2% to 12%). Conclusion: We are aware of no other comparable extant UK CDC database. Services should plan for a referral rate of 6.5 per 1,000 preschool children. Between 1974 and 2014, there has clearly been a change in recorded assessment outcomes. From the mid‐1980s, this reflects the change to a preschool assessment role and a shift away from purely educational outcome to include medical conditions. Covering 1974–2014, we demonstrate a clear increase in the number of referrals together with an increasing demand for assessments for social interaction and behavioural difficulties. This reflects the increased awareness of these neurodevelopmental difficulties and the changing diagnostic criteria which will now more likely result in an Autistic Spectrum Disorder diagnosis than previously. Together, these two features are most likely to have considerable implications for service development within Child Development Centres (CDCs) and Child Development Teams (CDTs). [ABSTRACT FROM AUTHOR]

The management of apparent sleep problems is often not straight-forward because of a proportion of clients attending with a 'hidden agenda', requiring more in-depth long-term treatment for psychological problems. This paper looks at a sample of 100 consecutive referrals to a community sleep clinic in the East End of London and attempts to address the question of who comes to the sleep clinic and why. A proportion of clients responded to brief intervention of a behavioural nature but 19% were referred on to other services for psycho-therapeutic help. [ABSTRACT FROM AUTHOR]

Background: Children born to migrant parents have higher rates of language difficulties, intellectual disability and autism. This study explores the relationship between migration, ethnicity and reasons for early years referrals to community paediatrics in a diverse multi‐cultural population in a city in south west England. Methods: Observational retrospective study from a community paediatric service serving a multi‐cultural urban population from June 2012 to February 2016. We tested associations of ethnicity and parental birth origin with reason for referral (developmental or non‐developmental) for children under 5 years old and estimated crude rate ratios for referrals using population census data. Results: Data were available for 514 children (52% white or mixed race, 16% Asian, 21% African diaspora, and 11.5% Somali); 53% had two UK‐born parents while 22% had two migrant (non‐UK‐born) parents. Referrals were for developmental reasons in 307 (60%) including 86 for possible autism. Parental birth origin and ethnicity were associated with reason for referral (p < 0.001). Children from African diaspora, Asian or Somali backgrounds had more than twice the rate (rate ratio [RR] 2.37, 95% CI 1.88–2.99, p < 0.001) of developmental referrals compared with white or mixed‐race children. Children of Somali or African diaspora ethnicity were, respectively, six‐times (RR 5.99, 95% CI 3.24–10.8, p < 0.001) and four times (RR 4.23, 95% CI 2.44–7.29, p < 0.001) more likely to be referred for possible autism spectrum than their white or mixed‐race peers. Developmental referral as a proportion of all referrals was twice as high among children with one migrant parent (20.4%) and three times as high among children with two migrant parents (29.5%), compared with children whose parents were both UK‐born (10.7%). Conclusions: This study supports the importance of ethnicity and parental migration as factors in young children experiencing developmental difficulties, especially concerns about social communication or autism. [ABSTRACT FROM AUTHOR]

Objective To study the relationship between disabling conditions and registration for child abuse and neglect in a 19-year whole-population birth cohort. Setting West Sussex area of the United Kingdom. Study design Retrospective whole-population cohort. Main outcomes Child-protection registration, physical abuse, sexual abuse, emotional abuse and neglect. Population and participants Infants born in West Sussex (119 729) between January 1983 and December 2001 with complete data including birthweight, gestational age, maternal age and postal code. Results Cerebral palsy, speech and language disorder, learning difficulties, conduct disorders and non-conduct psychological disorders were all significantly associated with child-protection registration before adjustment, and all but cerebral palsy retained significance after adjustment for birthweight, gestational age and socioeconomic status. Autism and sensory disabilities (vision and hearing) were not associated with an increased risk of child-protection registration. Conduct disorders and moderate/severe learning difficulty were associated with registration in each of the four categories after adjustment for socioeconomic status, birthweight and gestational age. Children with speech and language disorders and mild learning difficulties were at increased risk of physical abuse, emotional abuse and neglect. Non-conduct psychological disorders were associated with all categories except neglect, and cerebral palsy was associated with all categories except physical abuse and neglect. Conclusions Children with disabling conditions seem to be at increased risk of registration for child abuse and neglect, although the pattern of registration varies with the specific disabling condition. The strong association with registration noted for conditions such as conduct disorder and learning difficulties is likely to arise, in part, because these conditions share a common aetiological pathway with child abuse and neglect. [ABSTRACT FROM AUTHOR]

Background Sure Start Local Programmes (SSLPs) are area-based interventions to improve services for young children and their families in deprived communities, promote health and development, and reduce inequalities. We therefore investigated whether SSLPs affect the well-being of 3-year-old children and their families. Methods In a quasi-experimental observational study, we compared 5883 3-year-old children and their families from 93 disadvantaged SSLP areas with 1879 3-year-old children and their families from 72 similarly deprived areas in England who took part in the Millennium Cohort Study. We studied 14 outcomes – children's immunizations, accidents, language development, positive and negative social behaviours and independence; parenting risk; home-learning environment; father's involvement; maternal smoking, body-mass index and life satisfaction; family's service use; and mother's rating of area. Findings After we controlled for background factors, we noted beneficial effects associated with the programmes for five of 14 outcomes. Children in the SSLP areas showed better social development than those in the non-SSLP areas, with more positive social behaviour (mean difference 0.45, 95% CI 0.09 to 0.80, P = 0.01) and greater independence (0.32, 0.18 to 0.47, P < 0.0001). Families in SSLP areas showed less negative parenting (−0.90, −1.11 to −0.69, P < 0.0001) and provided a better home-learning environment (1.30, 0.75 to 1.86, P < 0.0001). These families used more services for supporting child and family development than those not living in SSLP areas (0.98, 0.86 to 1.09, P < 0.0001). Effects of SSLPs seemed to apply to all subpopulations and SSLP areas. Interpretation Children and their families benefited from living in SSLP areas. The contrast between these and previous findings on the effect of SSLPs might indicate increased exposure to programmes that have become more effective. Early interventions can improve the life chances of young children living in deprived areas. [ABSTRACT FROM AUTHOR]

Objective To examine socio-economic inequalities in rates of death from injury in children in England and Wales. Design Analysis of rates of death from injury in children by the eight-class version of the National Statistics Socio-Economic Classification (NS-SEC) and by the registrar general’s social classification. Setting England and Wales during periods of 4 years around the 1981, 1991 and 2001 censuses. Subjects Children aged 0–15 years old. Main outcome measures Death rates from injury and poisoning. Results Rates of death from injury in children fell from 11.1 deaths (95% CI 10.8–11.5 deaths) per 100 000 children per year around the 1981 census to 4.0 deaths (3.8–4.2 deaths) per 100 000 children per year around the 2001 census. Socio-economic inequalities remain: the death rate from all external causes for children of parents classified as never having worked or as long-term unemployed (NS-SEC 8) was 13.1 (10.3–16.5) times that for children in NS-SEC 1 (higher managerial/professional occupations). For deaths as pedestrians the rate in NS-SEC 8 was 20.6 (10.6–39.9) times higher than in NS-SEC 1; for deaths as cyclists it was 27.5 (6.4–118.2) times higher; for deaths because of fires it was 37.7 (11.6–121.9) times higher; and for deaths of undetermined intent it was 32.6 (15.8–67.2) times higher. Conclusions Overall, rates of death from injury and poisoning in children have fallen in England and Wales over the past 20 years, except for rates in children in families in which no adult is in paid employment. Serious inequalities in injury death rates remain, particularly for pedestrians, cyclists, house fires and deaths of undetermined intent. [ABSTRACT FROM AUTHOR]

Objective To examine the variation in serious injuries in children by the level of deprivation in an area and by types of settlement. Methods Hospital admission rates for serious injury to children aged 0–15 years in census lower super output areas in England during the 5-year period 1 April 1999 to 31 March 2004 were analysed. Results Rates of serious injury in children were higher in the most deprived areas than in the least deprived for pedestrians [rate ratio (RR) 4.1; 95% CI 2.8–6.0] and cyclists (RR 3.0; 95% CI 1.9–4.7). Rates of serious pedestrian injury were lower in towns and fringe areas (RR 0.67; 95% CI 0.53–0.86) and in village (RR 0.64; 95% CI 0.50–0.83) areas than in urban areas. The rate of serious injury to cyclists was lower in London than in other urban areas (RR 0.78; 95% CI 0.62–0.98). The rate of serious injury to car occupants was higher in village than in urban areas (RR 1.51; 95% CI 1.05–2.17). Rates of serious injury caused by falls were higher in London (RR 1.60; 95% CI 1.47–1.75) and lower in villages (RR 0.76; 95% CI 0.66–0.88) than in urban areas. Steeper socio-economic gradients in serious injury rates were identified in rural areas for cyclists and for children suffering falls. Conclusions Socio-economic inequalities in serious injury exist across the whole of England, particularly for child pedestrians. Rates of serious injury vary by settlement type, and inequalities vary by cause of injury between rural and urban settings. [ABSTRACT FROM AUTHOR]

Background: Many young people are involved in caring for parents, siblings, or other relatives who have an illness or disability. The aim of this study was to estimate the prevalence of caring by young people in England. Method: A national survey of 925 English young people was conducted using the 18‐item survey version of the Multidimensional Assessment of Caring Activities Checklist for Young Carers. Results: Around 7% of young people were identified as doing at least a high amount of caring activity and 3% a very high amount. Most frequently, caring by a young person is for a mother or a sibling, with a physical disability. Caring activity consisted mostly of domestic activities, household management, and emotional care. Conclusion: This study provides the most up to date and methodologically sophisticated survey data on the prevalence of young caring in England, with implications for policy and practice. [ABSTRACT FROM AUTHOR]

Abstract Children in the ‘care’ system are known to have poor health. Although health services can respond to and deal with health problems, it is parents, foster parents and social workers who recognize problems, seek advice and keep follow-up appointments. Many health needs remain unmet in such children. This short paper from a deprived area in north-east England shows that once a decision is made to proceed to adoption, the stable and consistent care that can then be provided meets the increased health needs that such children have. [ABSTRACT FROM AUTHOR]

Background An exploration of children and young people's views on a proposed web-based application to support personal management of chronic kidney disease at home is important for developing resources that meet their needs and preferences. Methods As part of a wider study to develop and evaluate a web-based information and support application for parents managing their child's chronic kidney disease, qualitative interviews were conducted with 26 children and young people aged 5-17 years. Interviews explored their views on content of a proposed child and young person-appropriate application to support personal management of their condition. Data were analysed by using framework technique and self-efficacy theory. Results One overarching theme of Access and three subthemes (information, accessibility and normalization) were identified. Information needed to be clear and accurate, age appropriate and secure. Access to Wi-Fi was essential to utilize information and retain contact with peers. For some, it was important to feel 'normal' and so they would choose not to access any care information when outside of the hospital as this reduced their ability to feel normal. Conclusion Developing a web-based application that meets children and young peoples' information and support needs will maximize its utility and enhance the effectiveness of home-based clinical caregiving, therefore contributing to improved outcomes for patients. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effects of Sure Start local programmes (SSLPs) on children and their families. To assess whether variations in the effectiveness of SSLPs are due to differences in implementation. Design Quasi-experimental cross sectional study using interviews with mothers and cognitive assessment of children aged 36 months who speak English. Setting Socially deprived communities in England: 150 communities with ongoing SSLPs and 50 comparison communities. Participants Mothers of 12 575 children aged 9 months and 3927 children aged 36 months in SSLP areas; mothers of 1509 children aged 9 months and 1101 children aged 36 months in comparison communities. Outcome measures Mothers’ reports of community services and local area, family functioning and parenting skills, child health and development, and verbal ability at 36 months. Results Differences between SSLP areas and comparison areas were limited, small and varied by degree of social deprivation. SSLPs had beneficial effects on non-teenage mothers (better parenting, better social functioning in children) and adverse effects on children of teenage mothers (poorer social functioning) and children of single parents or parents who did not work (lower verbal ability). SSLPs led by health services were slightly more effective than other SSLPs. Conclusion Sure Start local programmes seem to benefit relatively less socially deprived parents (who have greater personal resources) and their children but seem to have an adverse effect on the most disadvantaged children. Programmes led by health services seem to be more effective than programmes led by other agencies. [ABSTRACT FROM AUTHOR]

Background Formal IQ tests are an important part of the diagnostic and needs-based assessment process for children with neurodevelopmental disorders. However, resources for such assessments are not always available. It has been suggested that parental estimates of their child's developmental age could serve as a proxy IQ when formal measures are unavailable. Method Parental estimates of their child's developmental age were converted to a developmental quotient (DQ) in 197 children with Autism Spectrum Disorder (ASD) aged 4-9 years, and 108 children with ADHD and intellectual disability (ADHD + ID) aged 7-15 years. Formal IQ assessments were then conducted. Parents completed the Social Communication Questionnaire ((SCQ), a measure of autism symptomatology) and a demographic questionnaire. Results In the ASD sample, 58% of parent estimates were within 15 points (i.e. one standard deviation) of the child's measured IQ score. Lower measured IQ and lower SCQ total score predicted higher parental accuracy. In the ADHD + ID sample, 74% of parental estimates were within 15 points of measured IQ. In this group, higher child IQ predicted greater parental accuracy. Parents in the ADHD + ID group were more likely to overestimate children's ability level than parents in the ASD group. Conclusions In this study, the majority of parents of children with ADHD and ID were able to estimate their child's intellectual ability level with some accuracy. Parents of children with ASD were less accurate, but this may be because these parents were focussing more on children's level of adaptive functioning, which is known to be typically lower than cognitive ability in ASD. [ABSTRACT FROM AUTHOR]

Aim The aim was to examine the impact of post restraint reduction meetings upon the frequency and restrictiveness of restraint use in English children's residential services. Background Attention has been drawn to the misuse, overuse and safety of some techniques used to physically restrain children in residential services. Successful interventions to reduce restraints have been reported, mostly from the USA. Results Demonstrate a significant overall reduction in both, frequency and restrictiveness of restraints; the greatest percentage decrease in the most restrictive floor restraints. Whilst five services reduced both frequency and restrictiveness, five services showed some increases in frequency and/or restrictiveness of restraints employed. Conclusions Restraint reduction is most effectively reduced through employing multiple strategies and that post restraint reduction meetings maybe one useful component. Organisations seeking to promote restraint reduction meetings need to allocate sufficient priority and resources to support these. [ABSTRACT FROM AUTHOR]

Background Parents of disabled children are encouraged to seek peer support. Delivering one-to-one support requires resources; therefore, investigating how these services may impact on families and those providing the service is important when evaluating such services. Methods We carried out a qualitative study involving semi-structured interviews and focus groups. Participants were 12 parents and 23 befrienders who had contact with the Face2 Face one-to-one befriending service in Devon and Cornwall during a 12-month period, and 10 professionals from health, social care and education services. Findings Shared experience was perceived central to successful peer support and was a catalyst for other elements of support, enabling parents to ( i) learn from the experience of others; ( ii) speak freely in a safe and non-judgemental environment; and ( iii) receive support and encouragement from their befriender. These elements underpinned perceived outcomes for both parents providing and receiving support. Outcomes for parents receiving support centred on emotional stability, personal growth and reduced isolation. Supporting parents experienced positive outcomes through their training, mutual support and the feeling that they were helping others. Parents and befrienders appeared to benefit through expanding their social network. Nevertheless providing support was reported to create emotional burden and concerns for befrienders around their performance, and also required a substantial time commitment. Conclusions Befrienders as well as parents perceived positive outcomes from their involvement in peer support although there is also potential for less positive impact on those offering support. [ABSTRACT FROM AUTHOR]

Background Parents of disabled children often seek support from their peers. The shared experience between parents appears to be a crucial mediating factor. Understanding how a sense of shared experience is fostered can help to design and evaluate services that seek to provide peer support. Methods We carried out a qualitative study involving semi-structured interviews and focus groups. Participants were 12 parents and 23 befrienders who had contact with the Face2 Face one-to-one befriending service in Devon and Cornwall during a 12-month period, and 10 professionals from health, social care and education. Findings Formal structures and processes in place such as training and ongoing supervision and support were highly valued as was the highly personalized, confidential, flexible, one-to-one at-home nature of the service. Crucial to establishing rapport was putting the right people together and ensuring a good match between befrienders and parents. Clearly, the befriending parent has to be emotionally prepared to provide help. However, if the parent being offered support was not ready to accept help at the time it was offered or the type of support was not right for them, they are less likely to engage with the service. Conclusion Organizational and process factors as well as characteristics of the parents offering and receiving support contribute to the sense of shared experience in one-to-one peer support. These factors interact to influence whether peer support is effective and should be explicitly considered when designing and evaluating services. [ABSTRACT FROM AUTHOR]

Background Research on child development in general has highlighted the importance that the family environment plays in mediating the pathway between exposure to low socio-economic position ( SEP) and child well-being. While child developmental models in intellectual disability have highlighted the interplay between social context, family environment and child development, little empirical work has attempted to formally evaluate the evidence in support of specific mediating pathways between low SEP and child outcomes. Methods Secondary analysis of cross-sectional confidentialized needs analysis data collected in three Primary Care Trusts in England covering a total population of 1.25 million people. Case record reviews were undertaken for 46 023 households, 2236 (4.9%) of which contained a child in the target age range with developmental delay. Results Children with developmental delay, when compared with their non-disabled peers, were at significantly increased risk of poorer health outcomes and of being exposed to a wide range of social determinants of poor health. Controlling for between-group differences in exposure to social determinants of poor health reduced the risk of developmental delay being associated with poorer health outcomes by 45% for behaviour problems and 89% for risk of significant harm. For children with developmental delay, parenting difficulties appears to play a particularly significant role in partially mediating the effects of low SEP. Conclusions The findings of the present study point to the potential effectiveness of family-focused early intervention to prevent the emergence and escalation of behavioural difficulties and health problems in children with developmental delay. [ABSTRACT FROM AUTHOR]

Background Previous research has established that poor diets and eating patterns are associated with numerous adverse health outcomes. This study explored the relationships between two specific eating behaviours (daily junk food consumption and irregular eating) and self-reported physical and mental health of secondary school children, and their association with perceived parenting and child health. Methods 10 645 participants aged between 12 and 16 completed measures of junk food consumption, irregular eating, parental style, and mental and physical health through the use of an online survey implemented within 30 schools in a large British city. Results 2.9% of the sample reported never eating regularly and while 17.2% reported daily consumption of junk food. Young people who reported eating irregularly and consuming junk food daily were at a significantly greater risk of poorer mental ( OR 5.41, 95% confidence interval 4.03-7.25 and 2.75, 95% confidence interval 1.99-3.78) and physical health ( OR 4.56, 95% confidence interval 3.56-5.85 and 2.00, 95% confidence interval 1.63-2.47). Authoritative parenting was associated with healthier eating behaviours, and better mental and physical health in comparison to other parenting styles. Discussion A worrying proportion of secondary school children report unhealthy eating behaviours, particularly daily consumption of junk food, which may be associated with poorer mental and physical health. Parenting style may influence dietary habits. Interventions to improve diet may be more beneficial if also they address parenting strategies and issues related to mental and physical health. [ABSTRACT FROM AUTHOR]

Background Deprived children constitute a large population with high levels of ill health, and difficulty with access to healthcare contributes to their poor health outcomes. There is debate on how best to engage deprived families and the literature on differential access to paediatric care based on deprivation is limited. Aims To demonstrate that community paediatrics can contribute to reduction of health inequalities by providing services that are accessible to and preferentially used by children whose health is likely to be affected by deprivation., To provide a template for others to improve and monitor equity in their services., Method Long-term service reconfiguration and health equity audit. We used routinely collected activity data and the Indices of Multiple Deprivation to construct equity profiles of the children using our service, and compared these with the profile of the population aged 0-16 years in the geographical area covered by the service. Results The new patient contact rate for the most deprived children in the population was more than three times that of the least deprived [odds ratio ( OR) 3.29, 95% confidence interval ( CI) 2.76-3.93]. Deprived children were more than twice as likely to require multi-agency meetings as part of their medical care ( OR 2.28, 95% CI 1.94-2.69). Seventy per cent (3693/5312) of our total contacts were with children in the two most deprived quintiles. There was a marked socio-economic gradient in all types of contact. Conclusions The model of care used by our community paediatric service successfully engages deprived families, thereby reducing health inequalities due to poor access. Key features are multi-agency working, removing barriers to access, raising staff awareness and use of health equity audit. Our findings provide support for tackling health inequalities via health services that are available to all, but capable of responding proportionately according to level of need, a model recently described as proportionate universalism. [ABSTRACT FROM AUTHOR]

Background Low socio-economic status ( SES), post-natal mental distress and parenting impact child mental health and future well-being. There are unexplained differences in child mental health between South Asian ethnic minority groups living in the UK that may be due to variation in, and differential mediation of, these factors. Methods We used multivariate multiple regression analysis of the effect of symptoms of mental distress, socio-demographic variables and warmth of parenting on child internalizing and externalizing scores at age seven (measured in 2010) in a population cohort of English children whose mothers were of Indian ( n = 211) and Pakistani ( n = 260) origin. Results In the fully adjusted models the legacy of mental distress was visible for both internalizing (β coefficient 1.52, P = 0.04) and externalizing (1.68, P = 0.01) behaviour in the Pakistani children, and on the Indian children's internalizing (2.08, P = 0.008) but not externalizing (0.84, P = 0.204) behaviour. Lower SES was associated with worse behavioural scores for the Pakistani children, and warmth of parenting on Indian children's externalizing scores. Conclusions Symptoms of post-natal mental distress are associated with Indian and Pakistani child outcomes at age seven. The finding that warmth of parenting had a stronger association on Indian children's externalizing scores than mental distress might be explained by differences in the expression of SES on family characteristics and functioning between the two ethnic groups. [ABSTRACT FROM AUTHOR]

Introduction The concept of participation was introduced by the World Health Organisation in the International Classification of Functioning, Disability and Health, 2001. Instruments to measure participation have been developed for children and adults, but none specifically for adolescents. Adolescence is a life stage with distinct patterns of participation, and previous research has shown that young people with disabilities have poorer participation than the general population. The aim of this study was to develop a measure of participation frequency, covering all major domains, for young people with cerebral palsy ( CP). CP was chosen as an exemplar because it is a significant cause of disability in young people, with affected individuals experiencing a range of different impairments of varying severity. Methods A pool of 88 items was developed using the published literature, existing measures and qualitative data from young people. The item pool was revised following expert review by 17 experts. Cognitive interviews on the items were carried out with 12 young people and 12 carers; field-testing was then undertaken with 107 young people with CP aged 13-21 years, and 540 young people from the general population to enable item reduction and to examine reliability and construct validity. Results The content review resulted in a 92-item draft questionnaire, content validity index of 93%. Cognitive interviews led to further wording changes. Following field-testing, the questionnaire was shortened to 45 items. Known-groups validity was demonstrated by correlation with impairment severity. Test-retest reliability was satisfactory for all domains. Internal consistency varied between domains. Conclusion This is the first instrument developed specifically to measure frequency of participation across multiple domains for young people with disability. Use of the questionnaire in research and clinical work will enable its properties to be better understood and its generalizability to wider groups to be clearer. [ABSTRACT FROM AUTHOR]

Objectives To review the incidence and characteristics of preventable childhood deaths in an urban population in the UK and to determine whether the excess of preventable deaths seen previously in Asian girls still exists. Design A retrospective survey of childhood deaths from 1996 to 2002 classified in terms of preventability and compared with a previous study conducted 20 years earlier from 1976 to 1982. Setting The city of Wolverhampton in the UK. Main outcome measures Deaths from all causes in children under the age of 5 years. Results There has been a reduction in the number of deaths in all age groups and from all causes. The post-neonatal mortality rate fell from 6.5/1000 in 1976 to 3.1/1000 live births in 2002 largely because of the fall in the numbers of deaths caused by sudden infant death syndrome. Preventable deaths are still associated with low birth weight ( P < 0.001) and poverty (unemployment and overcrowding in the earlier study ( P < 0.05) and with the Townsend score in this study ( P < 0.02). There were fewer deaths among Asians and no female excess. There was a new category not seen in the previous study, deaths caused by homicide. The death rate for homicide in the first year of life was much higher in Wolverhampton (18.7/100 000) than in England and Wales (4.6/100 000). Conclusions Low birth weight and adverse socio-economic conditions remain important factors associated with preventable deaths. There is no longer an increased risk of preventable death in Asian girls. The number of non-accidental deaths is a major cause for concern. [ABSTRACT FROM AUTHOR]

Depressive symptoms in mothers of young children can have serious consequences for the health of the child. In particular, children whose mothers are experiencing depressive symptoms are at significantly greater risk of poisoning and accidental injury. A mother's risk of developing depressive symptoms has been shown to be related to socio-economic disadvantage, high levels of stress and a perceived lack of social support. Residents who perceive their neighbourhoods to be of low social capital are more likely to report poor mental health. The aim of this study was to investigate the relationship between maternal depressive symptoms, deprivation, social support, stress and neighbourhood social capital in a group of mothers living in deprived areas of Nottingham, UK. A postal questionnaire at entry to a randomized controlled trial (RCT) assessed socio-demographic characteristics and a second questionnaire, 21 months later, assessed depressive symptoms, perceived lack of social support, self-reported stress and individual-level assessment of neighbourhood social capital. A total of 846 mothers of young children living in deprived areas in Nottingham, UK, enrolled in the control group of an RCT. One-third of mothers reported high levels of depressive symptoms. Neighbourhood-level deprivation and receiving means-tested benefits were independently associated with maternal depressive symptoms. A lack of social support and high levels of self-reported stress were also strongly associated with depressive symptoms. Individual-level assessment of neighbourhood social capital was not associated with depressive symptoms amongst mothers after adjusting for self-reported stress. Neighbourhood- and individual-level variables of deprivation and psychological distress are more important than mothers’ assessment of the social capital of the neighbourhood in which she lives in determining the risk of depressive symptoms. Interventions aimed at supporting mothers of young children may be more effective at reducing the risks of depressive symptoms and consequent risks to the child's health than interventions aimed at improving a neighbourhoods’ social capital. [ABSTRACT FROM AUTHOR]

Background A multiplicity of government initiatives advocate increasing shared working between services to ensure that holistic and co-ordinated assessment of need and related shared intervention is available to children and families. Concurrently, there is an increasing demand upon services to provide a wide range of support for children with complex difficulties. Methods On the Isle of Wight, joint services have been developing shared practice. The inter-agency service was initiated in 2001 through a 3-year project funded jointly between all services on the Island and the government through the ‘Invest to Save’ initiative. The project initially focused upon developing a combined process of diagnosis of autistic spectrum disorders (ASD) and the co-ordination of intervention at schools, within families and in the child's community. Gradually, the service extended to include children with a much wider range of difficulties, including those of attention deficit hyperactivity disorder (ADHD), developmental co-ordination disorder and co-morbid diagnoses. Results There are 19 000 school-aged children on the Isle of Wight. A total of 1101 referrals have been accepted between June 2001 and May 2007. In total, 201 children have been given a diagnosis of ASD. Overall, 392 children have been given a diagnosis of ADHD or ADHD/Co-morbid. Seventy were co-morbid for ASD and ADHD. The current service is rated as 85% satisfactory by its users, in contrast to the high level of complaint which resulted in the bid for the project initially. Conclusion Following the successful conclusion of the 3-year government-funded project Education Services, Social Care and The Health Authority shared the ongoing funding of the current service. This has been operating effectively for over 6 years and has highlighted a wide variety of issues around this style of service delivery. [ABSTRACT FROM AUTHOR]

Background Poor co-ordination of services can have severe consequences for disadvantaged children with complex needs. Since 2003 national and local governments in England embarked on sweeping reforms aimed at improving and integrating local health, education and social services for children. These were to be organized locally by children's trusts and piloted by 35 children's trust pathfinders. Methods This study described and compared the experience of integrating children's services in all 35 children's trust pathfinders, covering 20% of children in England. It had a prospective mixed-methods design. Over 3 years we interviewed 147 managers and professionals working in the children's trusts, including 172 semi-structured interviews, carried out two questionnaire surveys of the 35 children's trusts and analysed official documents. Results In most areas different agencies jointly commissioned children's services, especially for mental health, disabilities and multi-purpose children's centres, and increasingly pooled finances. Provision of multi-agency and multi-professional services was increasing. Professionals generally supported these changes but found them stressful. All children's trusts appointed directors of children's services and established boards representing multiple agencies. Systems for sharing information about individual children were mostly in place but were still underused. Health services were generally less involved in joint work than were local authorities' education and social care services, with notable exceptions. Areas where local authorities and health authorities shared geographical boundaries made most progress. Some children's trusts made few changes beyond their statutory obligations. Conclusion Children's trusts enabled major changes to services in areas where local actors and organizations were motivated and empowered. In other areas the remit of children's trusts was often too broad and vague to overcome entrenched organizational and professional divisions and interests. Policymakers need to balance facilitation of change in areas with dynamic change agents with methods for ensuring that dormant areas and agencies are not left behind. [ABSTRACT FROM AUTHOR]

Background Despite the attention paid to family support services in legislation and guidance, there is still relatively little evidence on which to base the development of effective services, and even less on the costs and cost-effectiveness of different models of support. Methods The study designed and examined the practical feasibility of a methodology for collecting service use data and other information on families. Unit costs of services were calculated and data were collected in interviews with 177 young families under stress in Northern Ireland and South-East England. Service use patterns and costs were analysed. Results Comparisons showed that families made greater use than the general population of many services. There were marked variations within the sample in the patterns of service use and costs, to some extent reflecting differences in the needs of the young families. Discussion The methods developed for collecting service use data, calculating unit costs and estimating costs for families were feasible. [ABSTRACT FROM AUTHOR]

The needs and provisions for health service and housing adaptation of a cohort of school leavers with physical disabilities in two inner city London health districts are described in this cross-sectional study. Fourteen young people were assessed by two consultant community paediatricians during their last year at school, using a structured proforma that includes the British Association of Community Child Health standards of functional levels. Great difficulty was encountered in identifying the subjects, partly because of inadequate information systems. Only 16 were identified out of over 12 000 school leavers. Important discrepancies were found between the needs assessed and the services provided. For the total sample, the need for 49 potential referrals to adult specialist services was identified, but 17 were not made as such services did not exist, in contrast to what had been available within paediatric services. Adult physiotherapy and occupational therapy services were particularly under-provided for young people with physical disabilities. Only a minority were eligible for housing adaptations. Suggestions are made for improvements in information systems, the transition process, revised provision of services and closer involvement of general practitioners. [ABSTRACT FROM AUTHOR]

To illustrate the potential of injury surveillance data from an emergency department surveillance system. Bath clinical area. Data for children (0–4 years old) resident in Bath city in UK were recoded and analysed. There were a total of 3144 attendances and 2300 unintentional injuries – equivalent to an attendance rate of 131/1000. There were 91 thermal injuries and 162 poisoning/ingestions. Descriptive information is presented on the circumstances and consequences. The majority of unintentional injuries in 0–4 year olds occur in the home, which is a modifiable environment. Detailed information around the circumstances available from the Bath injury surveillance system allows better focus for prevention messages and priority setting. [ABSTRACT FROM AUTHOR]

To study the services for pre-school children with behaviour problems in a Midlands city and the level of co-ordination and co-operation between providers. A socially and ethnically diverse Midlands city in the UK. Survey methods were employed with city health visitors in order to determine their role and identify service providers. Service providers from different agencies were interviewed and data collected related to service offered, materials used, theoretical basis of interventions, referrals to and from the service, inclusion and exclusion criteria and co-ordination and co-operation with other providers. Themes were identified related to the content and process of the services using qualitative data analysis methods. Frequencies of themes were estimated for different provider groups. Health visitors and nursery nurses working in the primary care services were the primary point of contact for children with pre-school behaviour problems. Nursery nurses were one of the major sources of referral for children with pre-school behaviour problems and a significant majority of these providers had not received any specific training for this role. The majority of the providers used evidence-based programmes but few adhered strictly to a particular programme and instead used a mixture of materials drawn from different programmes. Many health service providers in particular offered interventions to parents on a one-to-one basis only. Most providers used behaviour modification approaches. While many providers claimed to have knowledge of other local providers and have good links, there was little evidence of co-ordination within and between agencies. While there appears to be high levels of activity by providers from both statutory and voluntary sectors in providing services for pre-school children with behaviour problems, there is evidence to suggest that some of the main providers of services are not being adequately prepared and supported in the role. There is a lack of co-ordination within and between services, and indication that evidence-based programmes are being modified and used in an ad hoc manner. It is concluded that surveys of this nature may be an important preliminary step in establishing co-ordinated services for the primary and secondary prevention of pre-school behaviour problems. [ABSTRACT FROM AUTHOR]

Abstract Objective To examine the outcomes of statutory health assessment of children looked after by an English City Council. Design Retrospective longitudinal documentary analysis. Setting and participants Health records of all children looked after by Southampton City Council who had attended at least two statutory health assessments within a designated paediatric service from 1996 to 1999. Main variables studied Demographic characteristics of the children; physical and mental health problems identified at assessment and extent to which health recommendations were implemented. Results Twenty-seven boys and 22 girls aged 6 months-15 years were identified who had attended at least two assessments. One-hundred and four physical and mental health needs were identified at care entry requiring further assessment or intervention. More health problems were identified for girls than boys. At care entry 15/49 of the children were not fully immunized. At review, on average 14 months later, recommendations had only been implemented in just over half of children. Conclusions In common with previous studies this work confirms that the statutory health assessment identifies health need and health neglect that may otherwise go unrecognized. Whereas children's needs and problems were diverse, many continued to suffer health neglect in the system of public care designed to help them. In order to be effective, statutory health assessments must be a health promoting rather than disease screening exercise delivered by professionals skilled to address diverse health needs. Crucially, the heath assessment can only succeed as a tool for health advocacy if complementary to and integrated with local authority care and review. [ABSTRACT FROM AUTHOR]

SummaryIn all, 1872 children were recruited as part of a larger study concerning food additives and behaviours in preschool children. This figure represented 70% of the whole population of &formmu1;3\frac{1}{4} -year-old children resident on the Isle of Wight, UK. Parents completed an assessment concerning their perceptions of their child's behaviour. The results of this assessment were compared with scores on two validated parental questionnaires, the Weiss Werry Peters (WWP) hyperactivity scale and the Emotionality, Activity and Sociability Temperament Questionnaire (EAS), which were used to assess hyperactivity. The accuracy of parents in perceiving hyperactivity in their children was found to be around 50% if the child was hyperactive, and 89% if the child was not hyperactive. The implications of these findings for services are discussed. Frequencies of potential risk groups for future Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder were also suggested. [ABSTRACT FROM AUTHOR]

SummaryAim To describe characteristics of paediatric home care teams Background Home care provision is increasing and recent government initiatives such as support for Princess Diana Memorial Fund nursing teams will provide additional impetus to universal provision. However, little is known about the characteristics of paediatric home care teams. Method A postal survey of all services in England (n = 137) listed in the 13th edition of RCN 1996 Directory of Community Children’s Nursing Services was undertaken. A response rate of 85.5% was achieved. Findings More than half (54.6%) of the teams had been founded after 1990. Most (72.2%) were managed through paediatric or child health directorates and most (77.8%) were based in hospitals. The size of teams varied enormously (range 1–22; median 3). Only a small (5.6%) minority of teams provided care at night although over a third (37%) reported making special arrangements for terminally ill children. Conclusion The survey revealed two dominant models of paediatric home care: the community model with strong links to primary health care and other local provisions and the hospital outreach model with strong links to the hospital service. A number of weaknesses in current provision are identified: variability in geographical coverage; undesirably low core staffing numbers; poor 24-h coverage; and potentially compromised staff skills and knowledge. The need for research to clarify the strengths of the different models and their effectiveness is highlighted. [ABSTRACT FROM AUTHOR]

AbstractObjective To further validate a simple instrument for the measurement of parent-reported health and morbidity in infancy and childhood when used in routine child health surveillance as part of a whole year birth cohort study. Setting The socially and ethnically diverse city of Coventry. Methods Health visitors administered the Warwick Child Health and Morbidity profile (WCHMP), incorporated into the Parent Held Record (PHR), to the parents of infants born in 1996 and enrolled in the Coventry Cohort study as part of routine child health surveillance at 8 weeks and 8 months. Criterion validity was estimated for Hospital admission status and immunization status against health records and validity against medically plausible constructs was tested by comparing responses between domains and between the two data collection points for the whole cohort. Results Criterion validity for parental reporting of immunization status (Kappa 0.824 [95% CIs, 0.708, 0.940]) and hospital admission (Weighted Kappa 0.987 [95% CIs, 0.977, 0.997]) were high. There was a high level of concordance between parental responses to related domains and the medically plausible constructs. The proportion of parents reporting chronic illness, acute significant illness, chronic illness and accidents increased as expected between 8 weeks and 8 months. As expected, adverse outcomes at 8 weeks were associated with an increased risk of the same outcomes at 8 months. Conclusions The WCHMP is a simple measure of parent-reported health and illness which was shown to be reliable and valid with low inter-observer variation on initial field-testing. Further validation of the WCHMP, incorporated into the PHR, in a routine child health surveillance programme demonstrates its suitability for use in infancy to collect cross-sectional and longitudinal health and morbidity data for research and service planning purposes. [ABSTRACT FROM AUTHOR]

Objectives To describe the performance of a school entry ‘health assessment’ based on school nurse interviews. Background Universal medical examination at school entry has largely been replaced by a ‘health assessment’ led by the school nurse, based on screening tests, a health interview, eliciting parental and professional concern and past history. As a result children with possible problems are selected for school medicals, reviewed in school or referred to a range of health professionals and other agencies. Setting Inner city south-east London. Subjects Children born between 1/3/89 and 31/8/89 who were on the class lists of 21 randomly selected primary schools. Data collection A form for each subject was distributed to the school nurse and completed as children were invited for screening, school health interviews and medical examinations. Main outcome measures Proportion of subjects attending, patterns and proportions of reviews and referrals. Results 426 children were eligible for inclusion and 419 (98%) forms were returned. 232 children were seen for a health interview and a further 50 were screened for vision, hearing and growth problems only. 124 had no contact with the school nurse or doctor. Following health interview or screening, 180 children were reviewed and/or discussed with other health professionals. 71 external referrals were made. Conclusion Adequate coverage at school entry is difficult to obtain. The objectives of school entry health assessment and the relationship between selection criteria and health needs require clarification. [ABSTRACT FROM AUTHOR]

Parents’ perceptions of how they were told that their child has special needs were examined. Thirty-nine families on the Isle of Wight completed a structured interview. Participants formed two groups. The first group comprised of 23 families who had a child aged from birth to 5 years with special needs. In the second group there were 16 families who had a child aged between 15 and 20 years with special needs. Parents were asked about their perceptions of how their child’s special needs were disclosed, their satisfaction with how they were told and what improvements they would have liked. Differences between the two cohorts were examined, and changes in how services were perceived were investigated. Overall, parents in the group with younger children were more satisfied about the way in which they were told that their child had special needs than those with older children. Implications for service delivery and future research are considered.Keywords: special needs, disclosure. [ABSTRACT FROM AUTHOR]

Informal support is a vital part of diabetes care, for adolescents in particular. However, we have a poor appreciation of how adolescents characterize informal support relationships, and how they change over time. This article is based on qualitative, in-depth interviews and focus groups with 21 adolescents (14–19 years old) in Leicestershire. We studied the content and substance of relationships between adolescents with diabetes and their families and friends, how they change and develop over time, and how they interact with formal support from health professionals. We identify a key problem — progressive independence from family life and progressive withdrawal of formal health service input leaves some older adolescents feeling isolated, with possible implications for likely maintenance of contact with routine services. [ABSTRACT FROM AUTHOR]

Inclusion of children with significant special educational needs within the ordinary classroom frequently involves additional human resources. In the UK, specialist teachers and classroom assistants (teachers' aides) are now a regular feature of many classrooms. Their purpose is to provide advice and support to the teacher and/or specifically to assist the child with special educational needs in accessing the mainstream curriculum. There has been little research into the impact of these additional adults on children not designated as having special educational needs, although their attitudes and responses are likely to prove critical to the success of any policy of inclusive education. This study examines the responses of 713 children (ages 7-14+) attending 27 schools in London to questions relating to the role of adults supporting special educational needs (SEN) children in their classrooms and to the social desirability of being singled out for support. The findings suggest that the majority of those responding saw the support being directed towards the teacher's needs. The recognition of pupils' needs was less frequently expressed. The desirability of support became challenged by some children in the upper age range of the sample. Reasons for this and the implications for inclusive education are considered. [ABSTRACT FROM AUTHOR]

The article focuses on a study that was undertaken to find out the problems which children with asthma experience at school and at home. Patient interviews with 32 asthmatic children aged between 6 and 16 years using a semi-structured questionnaire were carried out in an inner city practice in Bristol. Twenty-three children experienced exercise-induced bronchospasm which particularly upset them at school. Eleven of 14 secondary schoolchildren said that not being able to participate in sport was the worst thing about having asthma. Every child in the study admitted to some aspect of home or school life being affected by having asthma. Apart from one primary school child, they viewed these issues negatively. The most striking aspect of this small study was the degree to which exercise induced asthma adversely affected children in the practice.

This article highlights some ethical and child protection issues for nurses, in relation to the use of Covert Video Surveillance in Staffordshire, England. If the intent behind Covert Video Surveillance is to provide videotaped evidence of the commission of a criminal act, then that is the domain of the police and it is they who should be undertaking the surveillance. However, police resources are limited so this is unrealistic, and it is unlikely that the police would be concerned where the surveillance was revealing the carer tampering with samples. Equally, there is no evidence to support the idea that pursuing a criminal prosecution is in any way beneficial to the child. Custodial sentences for the perpetrator do not rehabilitate and the sentence is likely to be fairly harsh in relation to the crime. For example, the provisions of the 1988 Criminal Justice Act raised the maximum sentence for child cruelty from two years to ten years. The underlying principles of child protection are no different from the underlying ethical principles of all healthcare. All nursing interventions can be either moral or immoral, the goal for nurses is to recognize this and seek to achieve the highest degree of morality in their actions.

This article examines the emotional considerations of the children with visual disabilities in England. One of the problems facing local authorities, whose duty it is to provide education appropriate to the needs of all children, is that the population of visually impaired children is small, and widely scattered. Schools, once mainly residential and established directly to serve the needs of severely visually impaired children, and somewhat unevenly distributed across the country, therefore not within daily travelling distance for other than children from immediate areas. Sound is a primary motivation for movement in early years, and movement in relation to sound provides, perhaps unconsciously, incidental development in the use of sound echoes to indicate the presence of objects. The level of sound as a child approaches an object becomes a referent for distance in addition to guiding direction. The ability of some young children to detect obstacles is remarkable. Learning in an unknown environment where there are new people and many children, some of whom are starting school too, may well prove emotionally exhausting. Certain disturbing situations encountered by a blind child starting school will, inevitably, recur throughout life, but if handled with sensitivity and understanding, their distressing effects may, in time, be lessened or even ameliorated.

Demographic, socioeconomic, and attitudinal associations with children's cycle‐helmet use in the absence of legislation. 
 LangI.A. (2007) Injury Prevention , 13 , 355 – 358. 
 DOI: 10.1136/ip.2007.015941. [ABSTRACT FROM AUTHOR]

A review of the article "Second-generation antipsychotics for the treatment of disruptive behaviour disorders in children: a systematic review" by T. Pringsheim and D. Gorman, published in a 2012 issue of the periodical "Canadian Journal of Psychiatry," is presented

Background The aim of this study was to quantify the change in the number of conceptions and abortions among women younger than 18 years in England in relation to the government's national teenage pregnancy strategy. Methods We undertook geographical analysis of data for 148 top-tier local authority areas. The main outcomes were changes in under-18 conceptions, abortions and births between the 5-year period before implementation of the strategy (1994–1998) and the period immediately after implementation (1999–2003). Findings The number of teenage conceptions peaked in 1998, then declined after the implementation in 1999 of the teenage pregnancy strategy. Under-18 conception rates fell by an average of 2.0% (95% CI 1.8–2.2) per year between 1998 and 2003, below the rate needed to achieve the target of 50% reduction by 2010. The net change between 1994–1998 and 1999–2003 was a fall in conceptions of 3.2% (2.6–3.9) or 1.4 per 1000 women aged 15–17 years, a rise in abortions of 7.5% (6.5–8.6) or 1.4 per 1000, and a fall in births of 10·6% (9.9–11.3) or 2.8 per 1000. The change in the number of conceptions was greater in deprived and more rural areas, and in those with lower educational attainment. The change was greater in areas where services and access to them were poorer, but greater where more strategy-related resources had been targeted. Interpretation The decline in under-18 conception and birth rates since 1998 and evidence that the declines have been greatest in areas receiving higher amounts of strategy-related funding provides limited evidence of the effect of England's national teenage pregnancy strategy. The full effect of local prevention will be clear only with longer observation, and substantial further progress is needed to remedy England's historically poor international position in teenage conceptions. [ABSTRACT FROM AUTHOR]