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Objective To describe the extent to which parent- and teacher-reported child mental health problems vary by different indicators of socioeconomic status. Methods Participants were 4–5-year-old children in the Longitudinal Study of Australian Children (LSAC). Parents (N = 4968) and teacher (N = 3245) completed the 3–4-year-old version of Strengths and Difficulties Questionnaire (SDQ). Parents also reported the socioeconomic indicators of income, education, employment, and family composition (1- vs 2-parent families). Logistic regression models were used to predict SDQ total difficulties and each of the 4 SDQ subscales problems, as reported by parents and by teacher, and considered all putative socioeconomic status (SES) predictor variables simultaneously. Results The proportions of children scoring in the abnormal range varied according to SES indicator and mental health subscale. All of the SES indicators independently predicted parent-reported child mental health problems, although odds ratios were generally small to moderate (1.2 to 2.4), and not all reached statistical significance. Low income and parent education showed larger associations than sole parenthood or unemployment. The pattern for teachers was similar, though less consistent. Behavioral problems showed stronger associations with social disadvantage than emotional problems. Conclusions Research examining pathways to young children's mental health should include diverse measures of SES, particularly of family income and education. The fact that mental health problems were most strongly associated with parent education and income should be of interest to policy makers because education and income reflect investments in the lives of our participants' parents during their own childhood and adolescence.

PURPOSE OF REVIEW: Despite intense policy, media and research interest, childhood obesity rates continue to rise in most countries. Screening may seem a logical response to a situation in which obesity does not usually resolve spontaneously, yet most obese children do not present for treatment. This article explores recent evidence for and against monitoring and screening of children's BMI. RECENT FINDINGS: Whether conducted in primary care or school settings, population screening of children's BMI can be feasible, acceptable and not intrinsically harmful. However, it incurs a substantial cost, and randomized controlled trials do not suggest that it improves BMI outcomes. Population trends in BMI are more complex than a simple rise in obesity; birth cohorts with higher rates of childhood overweight are not inevitably more overweight as young adults. The consequences of a concomitant increase in thinness are uncertain. SUMMARY: Systematic monitoring of BMI is essential, but need not be continuous, and could involve representative samples rather than all individuals in a population. In contrast, BMI screening cannot be recommended until more effective management becomes available for overweight and mildly obese children. Research into prevention and intervention should, therefore, be prioritized over population screening at this point in time.

This study examines potential predictors of ‘precocious talking’ (expressive language ⩾90th percentile) at one and two years of age, and of ‘stability’ in precocious talking across both time periods, drawing on data from a prospective community cohort comprising over 1,800 children. Logistic regression was used to examine the relationship between precocious talking and the following potential predictors: gender, birth order, birth weight, non-English speaking background, socioeconomic status, maternal age, maternal mental health scores, and vocabulary and educational attainment of parents. The strongest predictors of precocity (being female and having a younger mother) warrant further exploration. Overall, however, it appears that precocity in early vocabulary development is not strongly influenced by the variables examined, which together explained just 2·6% and 1% of the variation at 1 ; 0 and 2 ; 0 respectively.

Objective: To describe time adolescents spend using electronic media (television, computer, video games, and telephone); and to examine associations between self-reported health/well-being and daily time spent using electronic media overall and each type of electronic media. Methods: Design–Cross-sectional data from the third (2005) wave of the Health of Young Victorians Study, an Australian school-based population study. Outcome Measures–Global health, health-related quality of life (HRQoL; KIDSCREEN), health status (Pediatric Quality of Life Inventory 4.0; PedsQL), depression/anxiety (Kessler-10), and behavior problems (Strengths and Difficulties Questionnaire). Exposure Measures–Duration of electronic media use averaged over 1 to 4 days recalled with the Multimedia Activity Recall for Children and Adolescents (MARCA) computerized time-use diary. Analysis–Linear and logistic regression; adjusted for demographic variables and body mass index z score. Results: A total of 925 adolescents (mean ± standard deviation age, 16.1 ± 1.2 years) spent, on average, 3 hours 16 minutes per day using electronic media (television, 128 minutes per day; video games, 35; computers, 19; telephone, 13). High overall electronic media use was associated with poorer behavior, health status, and HRQoL. Associations with duration of specific media exposures were mixed; there was a favorable association between computer use (typing/Internet) and psychological distress, whereas high video game use was associated with poorer health status, HRQoL, global health, and depression/anxiety. Television and telephone durations were not associated with any outcome measure. Conclusions: Despite television's associations with obesity, time spent in other forms of media use appear more strongly related to adolescent health and well-being. This study supports efforts to reduce high video game use and further exploration of the role of computers in health enhancement. Refereed/Peer-reviewed

BACKGROUND. Adequate sleep optimizes children's learning and behavior. However, the natural history and impact of sleep problems during school transition is unknown.OBJECTIVES. To determine (1) the natural history of sleep problems over the 2-year period spanning school entry and (2) associations of children's health-related quality of life, language, behavior, learning, and cognition at ages 6.5 to 7.5 years with (a) timing and (b) severity of sleep problems.METHODS. Data were drawn from the Longitudinal Study of Australian Children. Children were aged 4 to 5 years at wave 1 and 6 to 7 years at wave 2. Parent-reported predictors included (1) timing (none, persistent, resolved, incident) of moderate/severe sleep problems over the 2 waves and (2) severity (none, mild, moderate/severe) of sleep problems at wave 2. Outcomes included parent-reported health-related quality of life and language, parent- and teacher-reported behavior, teacher-reported learning, and directly assessed nonverbal (matrix reasoning) and verbal (receptive vocabulary) cognition. Linear regression, adjusted for child age, gender, and social demographic variables, was used to quantify associations of outcomes with sleep-problem timing and severity.RESULTS. Sleep data were available at both waves for 4460 (89.5%) children, of whom 22.6% (17.0% mild, 5.7% moderate/severe) had sleep problems at wave 2. From wave 1, 2.9% persisted and 2.8% developed a moderate/severe problem, whereas 10.1% resolved. Compared with no sleep problems, persistent and incident sleep problems predicted poorest health-related quality of life, behavior, language, and learning scores, whereas resolving problems showed intermediate outcomes. These outcomes also showed a dose-response relationship with severity at wave 2, with effect sizes for moderate/severe sleep problems ranging from −0.25 to −1.04 SDs. Cognitive outcomes were unaffected.CONCLUSIONS. Sleep problems during school transition are common and associated with poorer child outcomes. Randomized, controlled trials could determine if population-based sleep interventions can reduce the prevalence and impact of sleep problems.

OBJECTIVES. Our goals were to document (1) the onset of stuttering and (2) whether specific child, family, or environmental factors predict stuttering onset in children aged up to 3 years. METHODS. Participants included a community-ascertained cohort of 1619 2-year-old Australian children recruited at 8 months of age to study the longitudinal development of early language. The main outcome measure was parental telephone report of stuttering onset, verified by face-to-face expert diagnosis. Preonset continuous measures of the child's temperament (approach/withdrawal) and language development were available. Information on a range of predictor measures hypothesized to be associated with stuttering onset was obtained (maternal mental health and education levels, gender, premature birth status, birth weight, birth order, twinning, socioeconomic status, family history of stuttering). RESULTS. By 3 years of age, the cumulative incidence of stuttering onset was 8.5%. Onset often occurred suddenly over 1 to 3 days (49.6%) and involved the use of word combinations (97.1%). Children who stuttered were not more shy or withdrawn. Male gender, twin birth status, higher vocabulary scores at 2 years of age, and high maternal education were associated with stuttering onset. The multivariable model, however, had low predictive strength; just 3.7% of the total variation in stuttering onset was accounted for. CONCLUSIONS. The cumulative incidence of stuttering onset was much higher than reported previously. The hypothesized risk factors for stuttering onset together explained little of the variation in stuttering onset up to 3 years of age. Early onset was not associated with language delay, social and environmental factors, or preonset shyness/withdrawal. Health professionals can reassure parents that onset is not unusual up to 3 years of age and seems to be associated with rapid growth in language development.

In childhood, mental health problems primarily consist of behaviour and emotional problems. These affect one in every seven children (i.e. 200 000 in Australia). Left untreated, up to 50% of preschool problems continue through the childhood years. Because of their high prevalence, population-based approaches will be needed to reduce their associated burden. The aim of the present study was therefore to identify evidence-based preventive interventions for behavioural and emotional problems of children aged 0–8 years. Randomized controlled trials of preventive interventions for behavioural and emotional problems were located by searching standard clinical databases and systematic reviews. The authors determined which programmes were effective and ineffective, dividing the effective programmes into those with high or low risk of trial bias. Among effective programmes, the most promising for delivery in Australian contexts were identified, selected for their strength of evidence, sample comparability to Australia's population, and programme compatibility with Australia's service system. Around 50 preventive interventions have been evaluated in randomized controlled trials. Most targeted children's behavioural problems, and a few targeted emotional problems. Three US programmes have the best balance of evidence: in infancy, the individual Nurse Home Visitation Programme; at preschool age, the individual Family Check Up; at school age, the Good Behaviour Game class programme. Three parenting programmes in England and Australia are also worthy of highlight: the Incredible Years group format, Triple P individual format, and Parent Education Programme group format. Effective preventive interventions exist primarily for behaviour and, to a lesser extent, emotional problems, and could be disseminated from research to mainstream in Australia, ensuring fidelity to original programmes. Future research should develop programmes targeting emotional problems, and replicate effective programmes for behaviour problems in quality population translation trials. Randomized trial methods in staged roll-outs can determine population cost–benefits for children's mental health without delaying dissemination.

The aim of this paper is to provide an overview of the methods and preliminary findings from the Early Language In Victoria Study (ELVS) a prospective, longitudinal study of child language impairment. Specifically, we provide a summary of early communication and vocabulary development and examine the contributions a range of risk factors and predictors make to these outcomes. The sample was a community-ascertained cohort of 1911 infants, recruited at 8 months and followed at ages 12 and 24 months. The main outcomes of interest were parent reported infant and toddler communication (Communication and Symbolic Behavior Scales, CSBS) and expressive vocabulary (MacArthur-Bates Communicative Development Inventories, CDI). Predictors included gender, preterm birth, birth weight, multiple birth, birth order, socioeconomic status, maternal mental health, maternal vocabulary and education, maternal age at birth of child, non–English-speaking background, and a family history of speech and/or language difficulties. R...

Background Understanding the impact of illnesses and morbidities experienced by children and adolescents is essential to clinical and population health programme decision making and intervention research. This study sought to: (1) examine the population prevalence of physical and mental health conditions for children and quantify their impact on multiple dimensions of children's health and well-being; and (2) examine the cumulative effect of concurrent conditions. Methods We conducted a cross-sectional school-based epidemiological study of 5414 children and adolescents aged 5–18 years, and examined parental reports of child health and well-being using the parent-report Child Health Questionnaire (CHQ) PF50 13 scales are scored on a 0–100 pt scale with clinically meaningful differences of five points and the presence of childhood conditions (illnesses and health problems). Results Asthma, dental, vision and allergies are the most commonly identified health problems for children and adolescents, followed by attention- and behaviour-related problems (asthma 17.9–23.2%, dental 11.9–22.7%, vision 7.2–14.7%, chronic allergies 8.8–13.9%, attention problems 5.1–13.8% and behaviour problems 5.7–12.0%). As the number of concurrent health problems increase, overall health and well-being decreases substantively with mean differences in CHQ scale scores of 14 points (−7.69 to −21.51) for physical health conditions, and 28 points (−5.15 to −33.81) for mental health conditions. Conclusions Children's health and well-being decreases linearly with increasing presence and frequency of health problems. Having three or more conditions concurrently significantly burdens children's health and well-being, particularly for family-related CHQ domains, with a greater burden experienced for mental health conditions than physical health conditions.

Aims: The first aim of this study was to determine the health-related quality of life (HRQoL) of children with chronic hepatitis C virus (HCV) infection and compare HRQoL as reported by parents. The second aim was to ascertain parents' perceptions and concerns about current and future life for their child with HCV, and compare these findings with those reported by adolescents. Methods: The study group comprised children attending a tertiary pediatric HCV-clinic in Melbourne, Australia, who acquired HCV prior to 12 months of age by vertical transmission or blood transfusion. Two validated (parent- and self-reported) questionnaires of HRQoL were completed (CHQ-PF 50 and CHQ-CF 50). Scores for children with HCV were compared with normative data (representative sample of 3119 age-matched Victorian children). A study-designed questionnaire relating to the impact of the diagnosis of HCV on parent and child perceptions of current and future health was administered. Results: In total, 83% (19/23) questionnaires were returned. Physical and psychosocial summary scores were significantly lower in HCV than non-HCV children (45.3 vs 49.6 and 44.0 vs 50.1, respectively). Nine out of 11 scale scores were significantly lower in children with HCV, most notably the General health (49.9 vs 77.1; P

Growing Up in Australia is a national longitudinal study of the development and wellbeing of 10,000 Australian children. The study has been committed since inception to support data linkage to other datasets, to value‐add to the primary modes of data collection from parents and others. It can increase the efficiency of data collection by reducing respondent and interviewer burden as well as adding new dimensions to addressing key research questions. The viability of data linkage needs to take into account the relevance of the data for research and policy, as well as data quality and cost, privacy and consent issues and the ease of access. This article documents the various sources for data linkage considered for Growing Up in Australia, including government health and education records, child care accreditation data, and community‐level data, and examines the strengths and challenges associated with each. †Views expressed in this article are those of the authors and may not reflect the policy or opinions ...

OBJECTIVE. This article responds to evidence gaps regarding language impairment identified by the US Preventive Services Task Force in 2006. We examine the contributions of putative child, family, and environmental risk factors to language outcomes at 24 months of age. METHODS. A community-ascertained sample of 1720 infants who were recruited at 8 months of age were followed at ages 12 and 24 months in a prospective, longitudinal study in metropolitan Melbourne, Australia. Outcomes at 24 months were parent-reported infant communication (Communication and Symbolic Behavior Scales and MacArthur-Bates Communicative Development Inventories vocabulary production score). Putative risk factors were gender, preterm birth, birth weight, multiple birth, birth order, socioeconomic status, maternal mental health, maternal vocabulary and education, maternal age at birth of child, non–English-speaking background, and family history of speech-language difficulties. Linear regression models were fitted to total standardized Communication and Symbolic Behavior Scales and Communicative Development Inventories vocabulary production scores; a logistic regression model was fitted to late-talking status at 24 months. RESULTS. The regression models accounted for 4.3% and 7.0% of the variation in the 24-month Communication and Symbolic Behavior Scales and Communicative Development Inventories scores, respectively. Male gender and family history were strongly associated with poorer outcomes on both instruments. Lower Communication and Symbolic Behavior Scales scores were also associated with lower maternal vocabulary and older maternal age. Lower vocabulary production scores were associated with birth order and non–English-speaking background. When the 12-month Communication and Symbolic Behavior Scales Total score was added as a covariate in the linear regression of 24-month Communication and Symbolic Behavior Scales Total score, it was by far the strongest predictor. CONCLUSIONS. These early risk factors explained no more than 7% of the variation in language at 24 months. They seem unlikely to be helpful in screening for early language delay.

OBJECTIVE. The purpose of this work was to determine relationships between BMI status at ages 4 to 5 years and mothers' and fathers' parenting dimensions and parenting styles. PARTICIPANTS AND METHODS. Participants were composed of all 4983 of the 4- to 5-year-old children in wave 1 of the nationally representative Longitudinal Study of Australian Children with complete BMI and maternal parenting data. Mothers and fathers self-reported their parenting behaviors on 3 multi-item continuous scales (warmth, control, and irritability) and were each categorized as having 1 of 4 parenting styles (authoritative, authoritarian, permissive, and disengaged) using internal warmth and control tertile cut points. Using a proportional odds model, odds ratios for children being in a higher BMI category were computed for mothers and fathers separately and together, after adjustment for factors associated with child BMI, including mothers' and fathers' BMI status. RESULTS. The sample was composed of 2537 boys and 2446 girls with a mean age 56.9 months; 15% were overweight and 5% were obese (International Obesity Task Force criteria). Mothers' parenting behaviors and styles were not associated in any model with higher odds of children being in a heavier BMI category, with or without multiple imputation to account for missing maternal BMI data. Higher father control scores were associated with lower odds of the child being in a higher BMI category. Compared with the reference authoritative style, children of fathers with permissive and disengaged parenting styles had higher odds of being in a higher BMI category. CONCLUSIONS. This article is the first, to our knowledge, to examine the parenting of both parents in relation to preschoolers' BMI status while also adjusting for parental BMI status. Fathers' but not mothers' parenting behaviors and styles were associated with increased risks of preschooler overweight and obesity. Longitudinal impacts of parenting on BMI gain remain to be determined.

Purpose of review To illustrate potential risks and benefits of disease screening for newborns using the example of Duchenne muscular dystrophy. Recent findings There is a wide range in the reported positive predictive value for screening male newborns for Duchenne muscular dystrophy by the creatine kinase level on dried blood spots. Some parental anxiety is associated with both early detection and false-positive screening results. No data are available about the impact of the diagnosis on the child, including the impact of early initiation of therapy. Studies suggest that few parents change their future reproductive planning based on identification of Duchenne muscular dystrophy through screening. Few data are available regarding the cost of newborn screening for Duchenne muscular dystrophy, and there are insufficient data to evaluate the cost-effectiveness of Duchenne muscular dystrophy screening. Summary Available data are insufficient to recommend routine newborn screening for Duchenne muscular dystrophy. Understanding the gaps in knowledge provides insight into the evidence needed to recommend newborn screening for Duchenne muscular dystrophy. Studies are needed to evaluate the potential risks and benefits of screening, including the associated incremental costs.

OBJECTIVE. Infant sleep problems are strongly associated with poorer maternal mental health. It is not known whether they are also associated with poorer paternal mental health, nor whether sleep problems in older children are associated with maternal or paternal mental health. We aimed to examine relationships between child sleep problems and maternal and paternal mental health and general well-being in each of the infant and preschool-aged groups. METHODS. Participants of this cross-sectional survey included families of infants (n = 5107) and preschool-aged children (n = 4983) participating in the first wave of the nationally representative Longitudinal Study of Australian Children, surveyed March through November 2004. The primary outcomes were mother and father serious psychological distress (measured by the Kessler-6) and general health (parent report of general health taken from the 12-item Short Form Health Survey and dichotomized into poor versus good health). A primary caregiver's report of the child's sleep problem was dichotomized into moderate/severe versus none/mild. RESULTS. The prevalence of severe psychological distress ranged from 3% to 5%, and prevalence of poor general health ranged from 8% to 11%. Moderate to severe sleep problems affected 17% of infants and 14% of preschool-aged children. Infant sleep problems were associated with poor general health in mothers and with poor general health in fathers. Preschool sleep problems were associated with poor maternal general health. In mothers with no past history of depression, infant sleep problems had a greater effect on severe psychological distress compared with mothers with a past history of depression. CONCLUSIONS. Sleep problems are common in infants and preschool-aged children. Infant sleep problems, in particular, are associated with poorer health in both parents, especially the mental health of mothers with no past history of depression.

Objectives: To determine whether a community-delivered intervention targeting infant sleep problems improves infant sleep and maternal well-being and to report the costs of this approach to the healthcare system. Design: Cluster randomised trial. Setting: 49 Maternal and Child Health (MCH) centres (clusters) in Melbourne, Australia. Participants: 328 mothers reporting an infant sleep problem at 7 months recruited during October–November 2003. Intervention: Behavioural strategies delivered over individual structured MCH consultations versus usual care. Main outcome measures: Maternal report of infant sleep problem, depression symptoms (Edinburgh Postnatal Depression Scale (EPDS)), and SF-12 mental and physical health scores when infants were 10 and 12 months old. Costs included MCH sleep consultations, other healthcare services and intervention costs. Results: Prevalence of infant sleep problems was lower in the intervention than control group at 10 months (56% vs 68%; adjusted OR 0.58 (95% CI: 0.36 to 0.94)) and 12 months (39% vs 55%; adjusted OR 0.50 (0.31 to 0.80)). EPDS scores indicated less depression at 10 months (adjusted mean difference −1.4 (−2.3 to −0.4) and 12 months (−1.7 (−2.6 to −0.7)). SF-12 mental health scores indicated better health at 10 months (adjusted mean difference 3.7 (1.5 to 5.8)) and 12 months (3.9 (1.8 to 6.1)). Total mean costs including intervention design, delivery and use of non-MCH nurse services were £96.93 and £116.79 per intervention and control family, respectively. Conclusions: Implementing this sleep intervention may lead to health gains for infants and mothers and resource savings for the healthcare system. Trial registration: Current Controlled Trial Registry, number ISRCTN48752250 (registered November 2004).

Objectives: To determine whether the introduction of a 14-day post-tonsillectomy analgesic regime would be associated with a statistically significant decrease in readmission rate.Method: A comparative study of tonsillectomy patients over two study periods. A retrospective review was undertaken of 342 patients (group one, five-day analgesic regime) who had undergone tonsillectomy. A prospective study was undertaken of 228 patients (group two, 14-day analgesic regime). The readmission rates for the two study periods were compared.Results: The median age of group one patients was 8.1 years (range, zero to 43 years). In this group, ‘cold steel’ dissection was performed in 177 patients (52 per cent) and bipolar dissection in 165 patients (48 per cent); seven patients suffered reactionary haemorrhage, all from the cold steel dissection group. The median age of group two patients was 8.0 years (range, one to 47 years). In this group, cold steel dissection was performed in 103 patients (45 per cent) and bipolar dissection in 125 patients (55 per cent); there were no cases of reactionary haemorrhage. The readmission rate for group one was 9.9 per cent (34 patients), with 2.1 per cent (seven patients) returning to the operating theatre for control of haemorrhage. In group two, 8.8 per cent (20 patients) were readmitted and 1.3 per cent (three patients) returned to the operating theatre. The main reason for readmission was secondary haemorrhage: 9.1 per cent from group one and 8.3 per cent from group two. No significant difference in readmission was found between the 5-day analgesia and the 14-day analgesia groups (p=0.443). However, there was a significant difference between the diathermy and cold steel dissection groups (pConclusion: The post-tonsillectomy readmission rate was not affected by the duration of post-operative analgesia; however, operating technique did have an effect.

To conduct an exploratory study of time-use patterns in Australian 5-year-old children, and to pilot the novel Children's Light Time-Use Diary as a potential tool for investigating relationships between children's time-use and weight status.Subjects for the present cross-sectional study were drawn from an established longitudinal cohort and included eighty-four 5-year-old Australian children (36 males) originally recruited as infants in three local government areas of Melbourne. Children were weighed and measured, and body mass index (BMI; kg/m(2)) calculated. Over three to four complete 24-hour periods, parents completed the Children's Light Time-Use Diary to record their child's activities in 15-minute blocks and details about the context in which the activities took place, selecting from a list of predetermined options.The children studied were largely sedentary, with television viewing the most time-consuming activity outside sleep. Only 49% of children spent any time walking for transport or pleasure. Children spent a median of 71% of their time in activities that were likely to be physically active when outdoors, compared with 3% when indoors, but averaged only 110 minutes/day outdoors (excluding passive transport). The 11 overweight/obese children watched significantly more television than non-overweight children.The Children's Light Time-Use Diary appears to be a practical and informative tool, which may complement accelerometry as a tool relevant to future studies of the determinants of child overweight/obesity. Further validation studies and larger research trials seem warranted.

Background and objective: Mental health problems are a public health issue affecting as many as 20% of children in modern communities. Risk factors for externalising and internalising problems can occur in infancy. Infants at high risk live in stressed families with parent mental health problems, substance misuse, relationship conflict, social isolation, financial problems or infant temperamental difficulty. Although current prevention programmes target services to high-risk groups, targeting can stigmatise families and miss many children in need. The addition of universal prevention programmes for all families could address these concerns. This survey assessed the prevalence of infants at risk attending a primary care service as a delivery point for universal prevention. Design: Survey of mothers of 6-month-old infants attending well-child clinics across six government areas of Melbourne, Victoria, Australia, between August and September 2004. A brief survey measured sociodemographic characteristics and the following family risks: maternal depression, anxiety, stress, substance misuse, violence at home, social isolation and infant temperamental difficulty. Results: The survey was completed by 733 mothers, representing 69% of infant births presented to the primary care service. Of these, 39% of infants were classified as at risk for developing mental health problems. The percentage of infants classified as at risk was not markedly dissimilar across socioeconomic levels (low, 42%; middle, 40%; high, 35%). Conclusions: A substantial number of infants attending routine universal primary care are at risk of developing mental health problems. This primary care setting could provide an ideal platform for preventing early externalising and internalising problems via a universally offered, evidence-based parenting programme.

Aim: Sleep problems in the second 6 months of life are common and associated with maternal depression. This paper extends previous research to (i) establish the prevalence of sleep problems in younger infants from a broader socio-economic spectrum, (ii) examine the relationship between infant sleep problems and maternal physical, as well as mental, health, and (iii) explore mothers’ sleep quality as a potential mediator of this relationship. Methods: Design: Cross-sectional, community survey in Melbourne, Australia. Sample: Mothers of 3- to 6-month-old infants (mean 4.6 months) recruited from well-child clinics in six sociodemographically diverse metropolitan local government areas. Outcome measures: Maternal mental and physical health; standardised questionnaire on infant sleep patterns; maternal report of an infant sleep problem (yes/no). Results: The survey was completed by 692 mothers; 237 (34%) reported an infant sleep problem, of whom 73 (31%) rated the problem as severe. Sleep patterns characterising a problem included the infant waking seven nights per week, nursing the infant to sleep at the beginning of the night, the infant sleeping in the parent’s room, and parental disagreement regarding managing infant sleep. There was no relationship between sleep problems and socio-economic levels. Mothers reporting infant sleep problems had poorer mental and physical health compared with those not reporting sleep problems. Conclusion: Sleep problems are common in early infancy across metropolitan socio-economic levels and are associated with poorer maternal health and well-being. Preventive strategies for infant sleep problems need to begin early in primary care to improve mothers’ health.

BACKGROUND: The level of body fat mass (BFM) in childhood that is associated with weight related morbidity is unclear. Bioelectrical impedance analysis (BIA) offers an inexpensive, acceptable and portable method for measuring body composition in children. However, different equations have been derived to estimate BFM, and relationships between equations have not been explored. OBJECTIVE: To compare body mass index (BMI) and BIA as tools for estimating adiposity-related health risks in children. METHODS: Height, weight and BIA were measured in a population based cross-sectional survey of 341 healthy 5-year-old Australian children. Percent BFM was estimated using four published BIA-based predictive equations for pre-school children. Ranking of children according to total BFM was compared for all equations. RESULTS: Each equation produced different estimates of percent BFM. In general, increasing BMI was associated with increasing BFM, but wide ranges of BFM estimates were produced for children of similar BMI. For all of the equations, females had a higher percent BFM compared with males of the same BMI (p

Adhesive capsulitis of the shoulder (frozen shoulder) is a common disease characterised by spontaneous onset of pain and restriction of movement, followed by ‘thawing’, with complete or near-complete resolution. Adhesive capsulitis of the hip has been reported in around a dozen patients. This report describes an otherwise-healthy middle-aged woman with apparent sequential resolving adhesive capsulitis of all four ball-and-socket joints over a 9-year period, initially affecting each hip and then each shoulder sequentially. The likely hip diagnosis became clear only retrospectively with development of the second frozen shoulder, 5 years after the first pain. All joints subsequently resolved within the expected timeframe and the patient remains healthy, other than having mild hypertension. This case illustrates that, when hip precedes shoulder involvement, there is the potential for the frozen hip to receive alternate diagnoses for which invasive open hip surgery could unnecessarily be recommended.

To examine the relationship between mothers' health-related quality of life (HRQoL) and child behaviour problems at age 2 years. To investigate whether the relationship between maternal HRQoL and child behaviour problems is independent of maternal mental health.Cross-sectional survey nested within a population-level, cluster randomised trial, which aims to prevent early child behaviour problems. One hundred and sixty mothers of 2-year-old children, in nine local government areas in Victoria, Australia. HRQoL was measured using the Assessment of Quality of Life 6D and child behaviour was measured using the child behaviour checklist (CBCL/1.5-5 years). Maternal mental health was measured using the Depression Anxiety Stress Scale. Data were collected at child age 2 years; demographic data were collected at child age 8 months.HRQoL was lower for mothers with children that had borderline/clinical behaviour problems compared to those with children without problems (mean difference -0.14, 95% confidence interval (CI): -0.16 to -0.12, P0.001). The finding did not markedly change when adjusting for household income, financial security, child gender, child temperament and intervention group status at child age 8 months (mean difference -0.12, 95% CI: -0.15 to -0.09, P0.001), but did attenuate when additionally adjusting for concurrent maternal mental health (mean difference -0.03, 95% CI: -0.05 to -0.02, P0.001).Child behaviour problems were associated with lower maternal HRQoL. Child behaviour problems prevention programmes could consider this association with maternal HRQoL and be designed to improve and report both mothers' and their child's health and wellbeing.

OBJECTIVE: We have previously shown short-term benefits to phonology, letter knowledge, and possibly expressive language from systematically ascertaining language delay at age 4 years followed by the Language for Learning intervention. Here, we report the trial’s definitive 6-year outcomes. METHODS: Randomized trial nested in a population-based ascertainment. Children with language scores >1.25 SD below the mean at age 4 were randomized, with intervention children receiving 18 1-hour home-based therapy sessions. Primary outcome was receptive/expressive language. Secondary outcomes were phonological, receptive vocabulary, literacy, and narrative skills; parent-reported pragmatic language, behavior, and health-related quality of life; costs of intervention; and health service use. For intention-to-treat analyses, trial arms were compared using linear regression models. RESULTS: Of 1464 children assessed at age 4, 266 were eligible and 200 randomized; 90% and 82% of intervention and control children were retained respectively. By age 6, mean language scores had normalized, but there was little evidence of a treatment effect for receptive (adjusted mean difference 2.3; 95% confidence interval [CI] –1.2 to 5.7; P = .20) or expressive (0.8; 95% CI –1.6 to 3.2; P = .49) language. Of the secondary outcomes, only phonological awareness skills (effect size 0.36; 95% CI 0.08–0.65; P = .01) showed benefit. Costs were higher for intervention families (mean difference AU$4276; 95% CI: $3424 to $5128). CONCLUSIONS: Population-based intervention targeting 4-year-old language delay was feasible but did not have lasting impacts on language, possibly reflecting resolution in both groups. Long-term literacy benefits remain possible but must be weighed against its cost.

The bottom line Learning to speak is one of life’s most important accomplishments. Language, usually acquired so effortlessly, underpins every child’s learning and ability to interact with others and to establish relationships. Poor communication has profound implications for employment, health, literacy, parenting the next generation, and social inequalities. It is therefore of great societal concern that language, speech, and fluency disorders are among the most common developmental disorders. The aim of this clinical review is to summarise the current information on language and speech impairments to help general practitioners, universal well child services, and paediatricians to identify the most common problems, understand their clinical course, decide when to refer and for what services, and understand what improvements can be expected. #### Sources and selection criteria We carried out a search of Medline using the terms “children”, “language”, “speech”, “stuttering” or “stammering” AND “delay”, “disorder”, “impairment”, “treatment”, and “intervention.” We also searched the Cochrane database of systematic reviews using the terms “children”, “language”, “speech”, and “stuttering/stammering”. Incidence and prevalence data were derived from prospective longitudinal cohorts and cross-sectional population studies with direct assessment of …

Child health varies with body mass index (BMI), but it is unknown by what age or how much this attracts additional population health-care costs. We aimed to determine the (1) cross-sectional relationships between BMI and costs across the first decade of life and (2) in longitudinal analyses, whether costs increase with duration of underweight or obesity.Baby (n = 4230) and Kindergarten (n = 4543) cohorts in the nationally representative Longitudinal Study of Australian Children.Medicare Benefits Scheme (including all general practitioner plus a large proportion of paediatrician visits) plus prescription medication costs to federal government from birth to sixth (Baby cohort) and fourth to tenth (Kindergarten cohort) birthdays.biennial BMI measurements over the same period.Among Australian children under 10 years of age, 5-6% were underweight, 11-18% overweight and 5-6% obese. Excess costs with low and high BMI became evident from age 4-5 years, with normal weight accruing the least, obesity the most, and underweight and overweight intermediate costs. Relative to overall between-child variation, these excess costs per child were very modest, with a maximum of $94 per year at age 4-5 years. Nonetheless, this projects to a substantial cost to government of approximately $13 million per annum for all Australian children aged less than 10 years.Substantial excess population costs provide further economic justification for promoting healthy body weight. However, obese children's low individual excess health-care costs mean that effective treatments are likely to increase short-term costs to the public health purse during childhood.

Objective: (1) To determine the prevalence of overweight and obesity in Australian 4-5-year-old children. (2) To investigate associations between socio-economic characteristics and (a) overweight/obesity and (b) waist circumference. Design: Cross-sectional population survey. Setting: Wave 1 (2004) of the Longitudinal Study of Australian Children. Participants: Nationally representative sample of 4983 4-5-year-old children (2537 boys and 2446 girls; mean age 56.9 months (s.d. 2.64 months; range 51-67 months)). Main outcome measures: Prevalence of overweight and obesity (International Obesity TaskForce definitions) and waist circumference (cm). Analysis: Prevalence estimates were obtained as weighted percentages. Uni- and multivariable ordinal logistic regression (using the proportional odds model) were used to assess associations between potential predictors and the risk of higher child body mass index status and a multivariable linear regression model to assess relationships between the same potential predictors and waist circumference. Results: 15.2% of Australian preschoolers are estimated to be overweight and 5.5% obese. In univariate analyses, seven of the 12 variables were associated with higher odds of being in a heavier body mass index category. In a multivariable regression model, speaking a language other than English (particularly for boys), indigenous status and lower disadvantage quintile were the clearest independent predictors of higher body mass index status, with children in the lowest quintile of social disadvantage having 47% higher odds (95% CI 14, 92%) of being in a heavier body mass index category compared to those in the highest quintile. Waist circumference was not related to any socio-economic variable. Conclusions: This nationally representative survey confirms high rates of overweight and obesity in preschoolers throughout Australia. The recent emergence of a substantial socio-economic gradient should bring new urgency to public health measures to combat the obesity epidemic.

= 37.0). Conclusions: There is a dramatic increase in communication skills between 8 and 12 months, particularly the development of gesture, which (as in previous studies) predates and predicts future language development. Risk factors explained little variation in early communication trajectories and therefore, based on our findings, this developmental course is more likely to be biologically predetermined. Rather than focusing on risk factors, we suggest that language promotion activities in otherwise healthy young infants should either be universal or, if targeted, be based on the level of communication skills displayed.

OBJECTIVE. The goal was to determine the prevalence and effects of slight/mild bilateral sensorineural hearing loss among children in elementary school. METHODS. A cross-sectional, cluster-sample survey of 6581 children (response: 85%; grade 1: n = 3367; grade 5: n = 3214) in 89 schools in Melbourne, Australia, was performed. Slight/mild bilateral sensorineural hearing loss was defined as a low-frequency pure-tone average across 0.5, 1, and 2 kHz and/or a high-frequency pure-tone average across 3, 4, and 6 kHz of 16 to 40 dB hearing level in the better ear, with air/bone-conduction gaps of RESULTS. Fifty-five children (0.88%) had slight/mild bilateral sensorineural hearing loss. Children with and without sensorineural hearing loss scored similarly in language (mean: 97.2 vs 99.7), reading (101.1 vs 102.8), behavior (8.4 vs 7.0), and parent- and child-reported child health-related quality of life (77.6 vs 80.0 and 76.1 vs 77.0, respectively), but phonologic short-term memory was poorer (91.0 vs 102.8) in the sensorineural hearing loss group. CONCLUSIONS. The prevalence of slight/mild bilateral sensorineural hearing loss was lower than reported in previous studies. There was no strong evidence that slight/mild bilateral sensorineural hearing loss affects adversely language, reading, behavior, or health-related quality of life in children who are otherwise healthy and of normal intelligence.

Clinical genetic research is often regarded as more ethically problematic than other forms of research, and in some countries is subject to specific regulation, requiring researchers to follow specialised guidelines. In this paper, an approach to enhancing the ethical conduct of genetic research is proposed, which is believed to be more effective than simply attempting to follow general guidelines. The potential concerns, likely areas of misunderstanding and negative reactions of the participant group are systematically investigated before starting a study on genetics. This would constitute, in effect, an ethical pilot study, similar to a feasibility pilot study to test equipment, procedures and logistics. The findings of the ethical pilot study would be used to help in designing ethically important aspects of research protocol, such as recruitment procedures, written and other information for potential participants, informed consent processes and reporting of results including ambiguous or uncertain results.

Aim: To ascertain the extent to which general practitioners (GPs) routinely weigh, measure and calculate body mass index (BMI) in children, and to assess the accuracy and accessibility of their anthropometric equipment. Methods: A convenience sample of 34 GPs from 29 primary care family medical practices in Melbourne, Australia, completed a questionnaire regarding their routine anthropometric practice for 5–10-year-old children and perceived role in managing childhood overweight and obesity. Practice audits (April–June 2002) assessed the accuracy and accessibility of anthropometric equipment. Results: Forty-four per cent of GPs reported regularly weighing children; 38% regularly measured children's height. Only one regularly calculated children's BMI. Formal training in child anthropometry and servicing of anthropometric equipment was rare. The majority of equipment was accessible. Stadiometers on average measured the height of a ‘short’ pole (true height 92.68 cm) as 92.52 cm (SD = 0.8), and measured the height of a ‘tall’ pole (true height 157.64 cm) as 157.55 cm (SD = 0.9). On average, calibration weights of 20 kg and 80 kg were recorded as 19.7 kg (SD = 0.6) and 79.2 kg (SD = 1.5) respectively. Despite these shortcomings, these GPs generally felt they played a key role in managing overweight in children. Conclusions: Self-reported practice by these GPs falls well short of 2003 National Health and Medical Research Council guidelines recommending bi-annual measuring of all children in the primary care setting. The variability of anthropometric equipment audited could result in widely discrepant BMI values, leading to serious misclassification of many children's weight status.

To assess maternal concern about overweight in Australian preschool-aged children and factors predicting maternal concern about children's current and future weight status.Cross-sectional survey of child's body mass index and parent questionnaire.Metropolitan Melbourne, Victoria, 2002.A community-based cohort of 324 4-year-old children and their parents.Mothers' reports of concern about the child's current and future weight status, and perceptions of the child's weight, diet and activity relative to their peers were compared with the child's measured weight status, and parent and child characteristics.The prevalence of overweight or obesity was 19%, but only 5% of mothers indicated concern about their child being currently overweight, while 16% worried their child would become overweight. Over 70% of mothers of overweight children saw them as being of similar weight to their peers. Most mothers saw their children as being equally or more active than other children and having a diet at least as healthy as their peers. Overweight daughters were more likely to elicit maternal concern about current weight than overweight sons (relative risk, 4.6; 95% CI, 1.1-19.8). Mothers were more likely to worry about their child's potential for future overweight if they or the child's father were overweight.Despite mounting public concern about childhood obesity in Australia, most mothers surveyed were not concerned about their child's weight, and many mothers did not perceive their overweight children as different from their peers. This may have implications for interventions that rely on acknowledgement of child overweight as a first step to change.

Aim To examine the feasibility and determine the maximum tolerated dose of outpatient carboplatin given with synchronous hypofractionated accelerated radiotherapy for squamous cell carcinoma of the head and neck (SCCHN). Materials and methods Patients with stages II–IV SCCHN and unresected primary tumour were treated with synchronous carboplatin given in an outpatient setting on day 1 and day 21 in cohorts of three to six patients with incremental area under curve (AUC) factors commencing at 3.5. Grade 3 mucositis persisting for 4 weeks in two patients in a cohort was considered dose limiting. Results A total of 19 patients were enrolled and assessable for toxicity. All 19 patients completed 55 Gy of radiotherapy and were assessable for response. Grade 3 mucositis lasting 4 weeks or more was seen in three patients, two of them received AUC 5 carboplatin. A complete response was seen in 16 patients, with a further patient having a partial response, giving a response rate of 89%. With a median follow-up of 24 months (range 11–30 months), 13 patients were alive with no evidence of recurrent disease. Local recurrence had occurred in four patients with distant spread in three patients. Conclusion Carboplatin with concurrent hypofractionated accelerated radiotherapy is feasible for patients with advanced SCCHN and good performance status. The recommended phase II dose of carboplatin given in week 1 and week 4 with 55 Gy in 20 fractions is AUC 4.5.

INTRODUCTION: Birmingham Children's Hospital (BCH) is the centre for a regional comprehensive cleft service attempting to implement the national guidelines for minimum standards of care. A national audit of cleft management (CSAG) found that 58% of alveolar bone grafts were successful; published series suggest that success rates can be of the order of 95%. We present the results of an audit of alveolar bone grafting over a 33-month period, after implementation. PATIENTS AND METHODS: A retrospective clinical process audit was taken from the hospital notes and an analysis of radiological outcome by Bergland score was obtained by two independent assessors. RESULTS: The audit highlighted the difficulties of integrating the increased clinical workload. Other difficulties included poorly standardised pre- and postoperative occlusal radiography, inconsistent orthodontic management and a lack of prospective data collection. An 81% success rate for alveolar bone grafting compares favourably to the CSAG study. Of 82 patients, 68 had sufficient data for a retrospective review; 21 were our own patients and 47 were referred into the centralised service. The success of bone grafting as defined by CSAG (including Bergland scores) is based on only two-thirds of the patients as many have their orthodontic treatment managed in more distant units and radiographs are much harder to obtain. Bone grafting later than age 11 years, was true for 28% (6/21) of our BCH patients and 46% (22/47) for those referred to our service. CONCLUSIONS: This audit demonstrates what has been achieved in a re-organised service in the context of Real Politik in the NHS and suggests the areas that require improvement.

Universal parenting programs could offer effective prevention for externalising behaviour problems in children. Demonstration of effectiveness requires formal trials, but feasibility data are essen...

Objective: Universal Newborn Hearing Screening (UNHS) programmes have been widely implemented, but their costs, benefits and long-term logistics remain to be clearly defined. There are few rigorous evaluations of alternative strategies. In this paper, we evaluate the performance of the distraction test component of the two-tiered Victorian Infant Hearing Screening Program (VIHSP). Methods: All babies born in the State of Victoria, Australia in 1993 who survived the neonatal period were screened for the presence of risk factors for hearing loss. Those at-risk were referred for Auditory Brainstem Evoked Response (ABR) screening by a professional audiologist. All others were screened by modified distraction test at age 7–9 months. This birth cohort was followed through age 6 for diagnoses of congenital hearing loss resulting in fitting of hearing aids. Estimates of false-positives, false-negatives, sensitivity, specificity and positive predictive values were determined for the distraction test as a population screen. Ages at diagnosis and aid fitting for screen failures with hearing loss were compared with current goals. Results: For targeted (moderate or greater-aided) losses, the distraction test yielded eight (0.02%) documented false-negatives (one severe and seven moderate) and an estimated 4265 (99%) false-positives. Distraction test sensitivity was 65%, specificity 91% and PPV 0.3%. Mean age at diagnosis for distraction test failures across all severities, including mild losses, was 23 (SD 18) months with a mean age at aid fitting of 26 (SD 20) months. Conclusions: The distraction test screen generated large numbers of false-positives and a significant number of false-negatives, performing particularly poorly with moderate losses. Ages at diagnosis and aid fitting for screen failures were far older than currently accepted goals. There is little evidence that the distraction test can be made to work acceptably as a population-based screen.

Background: Better language outcomes are reported for preschool children with hearing impairment (HI) diagnosed very early, irrespective of severity. However, population studies of older children are required to substantiate longer term benefits of early detection. Aims: To study impact of age of diagnosis and severity of HI in a population cohort of 7–8 year old children. Methods: Eighty eight 7–8 year old children born in Victoria, who were (a) fitted with hearing aids for congenital HI by 4.5 years and (b) did not have intellectual or major physical disability were studied. Main outcome measures were Clinical Evaluation of Language Fundamentals (CELF) and Peabody Picture Vocabulary Test (PPVT). Predictors were pure tone average (0.5, 1, 2 kHz) in better ear at diagnosis and age at diagnosis. Marginal (adjusted) means were estimated with general linear models. Results: Response rate was 67% (n = 89; 53 boys). Mean age at diagnosis was 21.6 months (SD 14.4); 21% had mild, 34% moderate, 21% severe, and 24% profound HI; mean non-verbal IQ was 104.6 (SD 16.7). Mean total CELF score was 76.7 (SD 21.4) and mean PPVT score 78.1 (SD 18.1). Age of diagnosis, adjusted for severity and IQ, did not contribute to language scores. In contrast, adjusted mean CELF and PPVT language scores fell sequentially with increasing severity of HI. Conclusions: More severe HI, but not later diagnosis, was strongly related to poorer language outcomes at 7–8 years. Further systematic study is needed to understand why children with hearing impairment have good or poor outcomes.

Objective.—To report 1) health-related quality of life (HRQoL) in 7- to 8-year-old children with congenital hearing loss and 2) effects of severity and age of diagnosis on parent-reported child HRQoL. Methods.—Setting: State of Victoria, Australia. Design: Two population-based cohorts of 7- to 8-year-old children. Participants: Cohort 1 consisted of 83 children (51 boys) fitted with hearing aids or cochlear implants for congenital hearing loss by 4.5 years, born before universal newborn hearing screening, and without intellectual disability (the Children with Hearing Impairment in Victoria Outcome Study). Cohort 2 consisted of 895 children representative of the Victorian 7- to 8-year-old school population (the 1997 Health of Young Victorians Study). Outcome: The 28-item parent-proxy Child Health Questionnaire measure of HRQoL. Results.—Response rate for cohort 1 was 67%; 22% had mild, 33% had moderate, 17% had severe, and 29% had profound hearing loss; and the mean nonverbal IQ was 105.4 (SD = 16.5). Children with hearing loss scored significantly more poorly than the normative sample on 6 Child Health Questionnaire scales (Role/Social-Physical, Behavior, Mental Health, Parent Impact–Emotional, Parent Impact–Time, and Family Activities) and on the Psychosocial Summary Score. HRQoL was poorer with milder losses, accounting for 10% and 11% of variance in the Physical and Psychosocial Summary scores, respectively. Age at diagnosis did not contribute significantly to the Summary scores, but only 11 children were diagnosed Conclusions.—Parent-reported psychosocial well-being of 7- to 8-year-old children with hearing loss is poorer than that of their hearing peers. Future studies should determine whether HRQoL has improved after introduction of universal newborn hearing screening.

Improved long-term outcomes of hearing loss at a population level is the underlying reason for interventions such as newborn hearing screening programs. Therefore, high-quality population surveys are needed for older children across the spectrum of hearing losses that might be detected by such programs, against which to assess future secular improvements. Measured outcomes should cover a broad range of parameters, including health-related quality of life.Population-based cohort study (CHIVOS, the Children with Hearing Impairment in Victoria Outcome Study).State of Victoria, Australia.Eighty-six 7- to 8-yr-old children born in Victoria, who were (a) fitted with hearing aids for congenital hearing loss by 4.5 yr and (b) had no intellectual or major physical disability.Standardized measures of language (CELF and PPVT), articulation (Goldman-Fristoe Test of Articulation), cognition (WISC), reading, adaptive functioning, health-related quality of life, parent developmental concerns, parent- and teacher-reported intelligibility and behavior, and teacher-reported school functioning.Response rate was 67% (N = 89). Of the 86 able to be included in analyses, 53 were boys; 22% had mild, 31% moderate, 17% severe, and 29% profound hearing loss; the mean nonverbal IQ was 104.6 (SD 16.7). The sample scored far below (1.3 to 1.7 SDs) the normative populations on the PPVT and on the Receptive, Expressive and Total CELF scores. On average, children's reading age was delayed nearly 10 mo. For every outcome measure except physical health, these children scored significantly worse than the relevant normative population. Language and vocabulary scores worsened with increasing severity of hearing loss, but adaptive functioning, health-related quality of life, academic skills and behavior did not.Comprehensive data such as these highlight the continuing plight experienced by hearing-impaired children, and will help evaluate over time whether outcomes for children with hearing loss are improving at a population level.

OBJECTIVE—To assess change in health-related quality of life (HRQOL) in children with diabetes over 2 years and determine its relationship to change in metabolic control. RESEARCH DESIGN AND METHODS—In 1998, parents of children aged 5–18 years attending a tertiary diabetes clinic reported their child’s HRQOL using the Child Health Questionnaire PF-50. Those aged 12–18 years also self-reported their HRQOL using the analogous Child Health Questionnaire CF-80. HbA1c levels were recorded. In 2000, identical measures were collected for those who were aged ≤18 years and still attending the clinic. RESULTS—Of 117 eligible subjects, 83 (71%) participated. Parents reported no significant difference in children’s HRQOL at baseline and follow-up. However, adolescents reported significant improvements on the Family Activities (P < 0.001), Bodily Pain (P = 0.04), and General Health Perceptions (P = 0.001) scales and worsening on the Behavior (P = 0.04) scale. HbA1c at baseline and follow-up were strongly correlated (r = 0.57). HbA1c increased significantly (mean 7.8% in 1998 vs. 8.5% in 2000; P < 0.001), with lower baseline HbA1c strongly predicting an increase in HbA1c over the 2 years (r2 = 0.25, P < 0.001). Lower parent-reported Physical Summary and adolescent-reported Physical Functioning scores at baseline also predicted increasing HbA1c. Poorer parent-reported Psychosocial Summary scores were related to higher HbA1c at both times but did not predict change in HbA1c. CONCLUSIONS—Changes in parent and adolescent reports of HRQOL differ. Better physical functioning may protect against deteriorating HbA1c, at least in the medium term. While the HRQOL of children with diabetes does not appear to deteriorate over time, we should not be complacent, as it is consistently poorer than that of their healthy peers.

This study addressed the question of whether a hearing loss caused by mutations in the connexin 26 gene had a significant effect on language and speech perception outcomes in children using cochlear implants or hearing aids. The families of children who had participated in two previous studies of language development were invited to participate in this genetic study. From the 52 children whose families agreed to participate, 15 children with connexin 26 mutations in both chromosomes were identified. After taking into account other factors which are known to affect language development and speech perception in children with impaired hearing, no significant differences were found between the 15 children where connexin 26 was known to be the cause of deafness and the other 37 children in the study.

The aim of this study was to report the incidence, prevalence and clinical characteristics of congenital hearing loss sufficient to require hearing aid fitting in the first 6 years of life for the 1993 birth cohort of the state of Victoria (population 4.4 million), Australia. In 1993, 64,116 infants born in the state of Victoria survived the neonatal period. Subjects included all children with congenital hearing loss for which hearing aids were fitted, at any time up to and including 31 December 1999, when the youngest member of the cohort reached 6 years of age. Data on the degree, type and etiology of hearing loss were available from the Australian Hearing database for all subjects. Sociodemographic and health data were available from the Victorian Infant Hearing Screening Program (VIHSP) and parent questionnaires. The known prevalence of identified congenital hearing loss increased as the cohort aged. By the time the youngest member had reached the age of 6 years, 134 children (78 boys, 56 girls) had been fitted with hearing aids for permanent congenital hearing loss of any degree (2.09/1000). Fifty-four (40%) of these had known mild losses (20-40 dB HL). The prevalence of known moderate or greater loss (> 40 dB HL) was 1.12/1000; the data suggest that over 90% could have been detectable by neonatal hearing screening. A further seven children from the birth cohort were fitted with hearing aids due to acquired forms of hearing loss (0.11/1000). The etiology was known in only 57 (43%) congenital cases, with known non-syndromal genetic causes accounting for 21 (37%) of these. This study reports on the prevalence of congenital hearing loss requiring hearing aid fitting for an entire birth cohort. These data indicate the possible yield from neonatal screening, and hence the likely benefit of such screening. For a large proportion of cases, the etiology remains unknown. These data have implications for health service delivery and illustrate the usefulness of a population database in monitoring the prevalence of congenital hearing loss.

Objective: To trial the Parents’ Evaluation of Developmental Status (PEDS) as an instrument for reporting developmental concerns for Australian preschool children. Method: A cross-sectional survey of parents and carers of 262 children attending five day-care centres and two kindergartens in Melbourne was conducted between October and November 1999. Parents and carers completed the written PEDS questionnaire, comprising 10 questions eliciting concerns about learning, development and behaviour, and answered questions about the acceptability and use of the PEDS. Results: Of 445 children, 389 were eligible for inclusion. Complete parent and carer PEDS data were available for 262 children (67% response: 47% boys; 53% girls) aged from 18 months to 5 years, 9 months. Most parents found the PEDS questionnaire easy to complete (98%) and likely to be useful to health professionals (89%). Twenty-four children (9%) were classified as being at high-risk of disabilities and 49 (19%) were classified as being at medium-risk of disabilities. Parents of 125 children (48%) reported no concerns. The prevalence of parental concerns was similar to the USA norming sample. Carers reported similar prevalences of concerns. Although overall agreement was high, parent/carer κ-values were modest, being highest for the gross motor (κ = 0.40) and social−emotional (κ = 0.37) domains. Conclusions: The PEDS is acceptable to parents of Australian preschool children, with a prevalence of significant concerns (i.e. children at high- and medium-risk of developmental problems) that is similar to those in the USA. Further research is needed to assess what factors differentially influence whether a concern is felt in a particular domain for a particular child.

Aims : To assess the validity of the Child Health Questionnaire (CHQ) as a screening tool for detecting 'at risk' emotional and behavioural maladjustment in children with diabetes, using the Behaviour Assessment System for Children (BASC) as a gold standard measure. Methods : CHQ and BASC were administered to 103 parents of children with Type 1 diabetes, aged 7–12 years. Sub-scales of the two measures were compared using Pearson's bivariate correlations. CHQ sensitivity and specificity cut-points were optimized against the BASC borderline category using receiver operating characteristic curves. Results : The BASC Externalizing Problems scale correlated strongly with CHQ Behaviour, Global Behaviour, Mental Health, Family Activities and Family Cohesion scales (r-values −0.68, −0.54, −0.51, −0.59, and −0.42, respectively). BASC Internalizing Problems scale correlated strongly with CHQ Behaviour, Mental Health and Family Cohesion scales (r-values −0.40, −0.43 and −0.45, respectively). Using receiver operating characteristic curve analysis, the CHQ Mental Health scale most effectively identified children classified as borderline on the BASC Internalizing Problems scale (sensitivity 87%, specificity 78%), while the CHQ Global Behaviour scale most effectively identified children classified as borderline on the BASC Externalizing Problems scale (sensitivity 73%, specificity 82%). Conclusions : Significant correlations were seen between the CHQ Global Behaviour and Mental Health scales and the BASC Externalizing and Internalizing scales, respectively. Sequential use of the CHQ, as a screening tool, followed by an established mental health measure such as the BASC, may help identify children with diabetes 'at risk' for chronic maladjustment and poor health outcomes.

The improving prognosis for children with cancer refocuses attention to long-term outcomes with an emphasis on quality of life. Few studies have examined relationships and differences in reported results between the parent, child and clinician. We examined parent-proxy and clinician-reported functional status and health-related quality of life for children and adolescents with acute lymphoblastic leukemia (ALL). Children and adolescents, 5-18 years, in the maintenance phase of treatment for ALL attending the Haematology/Oncology outpatient clinic at the Royal Children's Hospital, Melbourne, were eligible. Measures included: 1) parent-reported functional health and well-being (Child Health Questionnaire [CHQ]); 2) parent-reported condition specific quality of life (Pediatric Cancer Quality of Life inventory [PCQL]); 3) clinician ratings of physical and psychosocial health; and 4) clinical indicators. Insufficient numbers of older patients prohibited collection of adolescent self-reports. We had a 94% response and 31 participants. Mean time since diagnosis: 1.5 (SD 0.4) years. Parents reported significantly lower functioning and well-being than population norms for all CHQ scales, whereas cancer-specific quality of life was comparable to PCQL norms. Clinician reports of the child's global physical and psychosocial health were moderately associated with each other (r(s) = 0.56, p < 0.001), and with the parent-reported physical (r(s) = 0.47, p < 0.01) and psychosocial (r(s) = 0.56, p < 0.001) CHQ summary scores. Clinician reports of the child's psychosocial health were not associated with any clinical indicators reported regularly. The results demonstrate that the social, physical and emotional health and well-being of children with ALL is significantly poorer than the health of their community-based peers. Routinely collected indicators of clinical progress conceal the psychosocial burden of ALL. Data on health, well-being and quality of life can easily be incorporated into clinical care.

Background Social patterning of dietary-related diseases may partly be explained by population disparities in children’s diets. This study aimed to determine which early life socioeconomic factors best predict dietary trajectories across childhood. Methods For waves 2–6 of the Baby (B) Cohort (ages 2–3 to 10–11 years) and waves 1–6 of the Kindergarten (K) Cohort (ages 4–5 to 14–15 years) of the Longitudinal Study of Australian Children, we constructed trajectories of dietary scores and of empirically derived dietary patterns. Dietary scores, based on the Australian Dietary Guidelines, summed children’s consumption frequencies of seven groups of foods or drinks over the last 24 hours. Dietary patterns at each wave were derived using factor analyses of 12–16 food or drink items. Using multinomial logistic regression analyses, we examined associations of baseline single (parental education, remoteness area, parental employment, income, food security and home ownership) and composite (socioeconomic position and neighbourhood disadvantage) factors with adherence to dietary trajectories. Results All dietary trajectory outcomes across both cohorts showed profound gradients by composite socioeconomic position but not by neighbourhood disadvantage. For example, odds for children in the lowest relative to highest socioeconomic position quintile being in the ‘never healthy’ relative to the ‘always healthy’ score trajectory were OR=16.40, 95% CI 9.40 to 28.61 (B Cohort). Among the single variables, only parental education consistently predicted dietary trajectories. Conclusion Child dietary trajectories vary profoundly by family socioeconomic position. If causal, reducing dietary inequities may require researching underlying pathways, tackling socioeconomic inequities and targeting health promoting interventions to less educated families.

Introduction The aetiology of congenital hearing loss is heterogeneous, and in many infants a genetic cause is suspected. Parents face a diagnostic odyssey when searching for a cause of their infant’s hearing loss. Through the Melbourne Genomics Health Alliance, a prospective cohort of infants will be offered whole-exome sequencing (WES) with targeted analysis in conjunction with chromosome microarray to determine the genetic causes of congenital hearing loss. Parents will also be offered the opportunity to receive additional results from their infant’s WES. Methods Eligible infants will be identified through the Victorian Infant Hearing Screening Program and offered an appointment in a paediatrician-run clinic, a genetics assessment and enrolment in the Victorian Childhood Hearing Impairment Longitudinal Databank. If parents consent to WES, genes causing deafness will be analysed and they can choose to obtain additional findings. For the additional results component, a modified laboratory protocol has been designed for reporting of results in the absence of a relevant phenotype. Parents’ experience of being offered WES will be evaluated using surveys. Discussion This project will provide descriptive analysis of the genetic aetiology of congenital hearing loss in this cohort and may provide data on genotype–phenotype correlations. Additionally, choices regarding additional findings will be analysed. Participants will represent a diverse cross section of the population, increasing the ability to generalise results beyond the study group. Evaluation surveys will allow analysis of preferences around counselling, usefulness of a decision aid and adequacy of information provision.

Background The HealthNuts study previously reported interim prevalence data showing the highest prevalence of challenge-confirmed food allergy in infants internationally. However, population-derived prevalence data on challenge-confirmed food allergy and other allergic diseases in preschool-aged children remain sparse. Objective This study aimed to report the updated prevalence of food allergy at age 1 year from the whole cohort, and to report the prevalence of food allergy, asthma, eczema, and allergic rhinitis at age 4 years. Methods HealthNuts is a population-based cohort study with baseline recruitment of 5276 one-year-old children who underwent skin prick test (SPT) to 4 food allergens and those with detectable SPT results had formal food challenges. At age 4 years, parents completed a questionnaire (81.3% completed) and those who previously attended the HealthNuts clinic at age 1 year or reported symptoms of a new food allergy were invited for an assessment that included SPT and oral food challenges. Data on asthma, eczema, and allergic rhinitis were captured by validated International Study of Asthma and Allergies in Childhood questionnaires. Results The prevalence of challenge-confirmed food allergy at age 1 and 4 years was 11.0% and 3.8%, respectively. At age 4 years, peanut allergy prevalence was 1.9% (95% CI, 1.6% to 2.3%), egg allergy was 1.2% (95% CI, 0.9% to 1.6%), and sesame allergy was 0.4% (95% CI, 0.3% to 0.6%). Late-onset peanut allergy at age 4 years was rare (0.2%). The prevalence of current asthma was 10.8% (95% CI, 9.7% to 12.1%), current eczema was 16.0% (95% CI, 14.7% to 17.4%), and current allergic rhinitis was 8.3% (95% CI, 7.2% to 9.4%). Forty percent to 50% of this population-based cohort experienced symptoms of an allergic disease in the first 4 years of their life. Conclusions Although the prevalence of food allergy decreased between age 1 year and age 4 years in this population-based cohort, the prevalence of any allergic disease among 4-year-old children in Melbourne, Australia, is remarkably high.