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Purpose. This study aimed to quantify the non-hospital healthcare costs associated with language difficulties within two nationally representative samples of children. Method. Data were from three biennial waves (2004-2008) of the Longitudinal Study of Australian Children (B cohort: 0-5 years; K cohort: 4-9 years). Language difficulties were defined as scores ≤ 1.25 SD below the mean on measures of parent-reported communication (0-3 years) and directly assessed vocabulary (4-9 years). Participant data were linked to administrative data on non-hospital healthcare attendances and prescription medications from the universal Australian Medicare subsidized healthcare scheme. Result. It was found that healthcare costs over each 2-year age band were higher for children with than without language difficulties at 0-1, 2-3, and 4-5 years, notably 36% higher (mean difference = $ AU206, 95% CI = $ 90, $ 321) at 4-5 years (B cohort). The slightly higher 2-year healthcare costs for children with language difficulties at 6-7 and 8-9 years were not statistically different from those without language difficulties. Modelled to the corresponding Australian child population, 2-year government costs ranged from $ AU1.2-$ AU12.1 million (depending on age examined). Six-year healthcare costs increased with the persistence of language difficulties in the K cohort, with total Medicare costs increasing by $ 192 (95% CI = $74, $311; p = .002) for each additional wave of language difficulties. Conclusion. Language difficulties (whether transient or persistent) were associated with substantial excess population healthcare costs in childhood, which are in addition to the known broader costs incurred through the education system. It is unclear whether healthcare costs were specifically due to the assessment and/or treatment of language difficulties, as opposed to conditions that may be co-morbid with or may cause language difficulties.

Children from single-parent families fare more poorly on multiple outcomes than those in two-parent families. Most explanations for these differences assume that compromised parenting and parent mental health play a central role. This chapter explores the contribution of a range of factors to the parenting and mental health of single mothers using data from approximately 1000 Australian single mothers with a child aged 4–5 or 8–9 years. The findings show that single mothers are more likely than couple mothers to experience parenting and mental health difficulties; however, they also face heightened adversity in their home and extra-familial environments. Importantly, this comparison of single and couple mothers facing similar levels of adversity shows no difference in poor parenting practices, although single mothers remain more vulnerable to psychological distress. These findings have policy implications since they challenge the prevailing view that single-parent families inherently provide sub-optimal environments for raising children.

We thank Professor Parkinson for his response (Parkinson, 2013) to our paper published in the Journal of Family Studies (Lucas, Nicholson, & Erbas, 2013) and the opportunity to expand upon the position presented in our discussion. Parkinson argues that it was inappropriate for us to cite his report For Kids' Sake: Repairing the social environment for Australian children and young people (FKS) (Parkinson, 2011) as supporting claims that two biological parent households are superior environments for children to grow up in, and takes exception to our view that such a position is a 'simplistic view of the relationship between family structure and child outcomes' (Lucas et al., 2013). We acknowledge that the FKS report reviewed a considerable amount of contemporary family research that covered an array of viewpoints regarding the effects of living in a non-two-biological parent family on children. We also support the majority of recommendations made in the report.

Aim: Children born low birthweight, preterm and/or small for gestational age (SGA) sustain substantially increased costs for hospital-based health care and additional educational support in the first few years of life. This is the first study internationally to investigate costs beyond hospital care, to community-based health care and prescription medicines across early and middle childhood with actual cost data, and to examine these costs according to the severity of perinatal risk. Method: In the prospective Longitudinal Study of Australian Children, we followed two cohorts of children from age of 0 to 5 years (no increased perinatal risk, n = 3973; mild risk, n = 442; and moderate-to-high risk, n = 297), and from age of 4 to 9 years (no increased perinatal risk, n = 3629; mild risk, n = 465; and moderate-to-high risk, n = 361). Children were defined as mild risk if born 32-36 weeks, with birthweight 1500-2499g, and/or SGA (<5-9th percentile), and moderate-to-high risk if born <32 weeks, birthweight <1500g and/or extremely SGA (<5th percentile). Federal government expenditure (2011 $AUD) on healthcare attendances and prescription medication from birth to 9 years were calculated via data linkage to the Australian Medicare records. Results: Mean costs per child were A$362 higher (95% CI $156; 568) from 0 to 5 years and A$306 higher (95% CI $137; 475) from 4 to 9 years, for children with any compared with no increased perinatal risk (P < 0.001). At the population level, an additional A$32m was spent per year for children 0-9 years with any relative to no increased perinatal risk. Conclusions: Perinatal risk is a major public health issue conferring considerable additional expense to community-based health care, most marked in the first year of life but persisting up to at least 10 years. Even without additionally considering burden, these findings add to the urgency of identifying effective mechanisms to reduce perinatal risk across its full spectrum.

In this article, we use longitudinal data on Australian two-parent families to assess the impact of mothers' leave duration after childbirth on their subsequent mental health, quality of parenting, and couple relationships. We found that 2 to 3 years after the birth, psychological distress was significantly less likely among mothers who took >13 weeks paid leave or >26 to 52 weeks leave in total. However, those who took >26 weeks in total were more likely to register as "distant" in their parenting relationship. The analysis also highlighted the importance of leave supports at the workplace: Mothers who experienced workplace problems during their pregnancy were more likely to report feeling rushed and to rate their couple relationship as unhappy or argumentative 2 to 3 years later. Overall, our study underlined the complexity of leave impact but affirmed the importance of leave duration for maternal mental health and leave takers' workplace supports for maternal and family outcomes.

Background: Early and persistent exposure to socioeconomic disadvantage impairs children’s health and wellbeing. However, it is unclear at what age health inequalities emerge or whether these relationships vary across ages and outcomes. We address these issues using cross-sectional Australian population data on the physical and developmental health of children at ages 0-1, 2-3, 4-5 and 6-7 years. Methods: 10 physical and developmental health outcomes were assessed in 2004 and 2006 for two cohorts each comprising around 5000 children. Socioeconomic position was measured as a composite of parental education, occupation and household income. Results: Lower socioeconomic position was associated with increased odds for poor outcomes. For physical health outcomes and socio-emotional competence, associations were similar across age groups and were consistent with either threshold effects (for poor general health, special healthcare needs and socio-emotional competence) or gradient effects (for illness with wheeze, sleep problems and injury). For socio-emotional difficulties, communication, vocabulary and emergent literacy, stronger socioeconomic associations were observed. The patterns were linear or accelerated and varied across ages. Conclusions: From very early childhood, social disadvantage was associated with poorer outcomes across most measures of physical and developmental health and showed no evidence of either strengthening or attenuating at older compared to younger ages. Findings confirm the importance of early childhood as a key focus for health promotion and prevention efforts.

Background: While inequalities in oral health are generally well documented, it is less clear whether such patterns are evident from early childhood. Using four measures of potential inequality, this study examined patterns in oral health for Australian children at ages 2-3 and 6-7 years. Methods: Cross-sectional data from two cohorts of children in the Longitudinal Study of Australian Children (LSAC) were used to explore associations between reported oral health and four indicators of social disadvantage: socio-economic position (SEP), residential remoteness, Indigenous status and non-English speaking background. Results: For both cohorts, lower SEP and Indigenous status were associated with higher odds of poor oral health on all three indicators, and less accessible location was associated with increased odds for caries. Non-English speaking background was associated with increased odds for caries experience in 2-3 year olds and non-use of dental services in the older cohort. Inequalities were larger in the older cohort for socio-economic position and toothbrushing. Conclusions: Marked social disparities in oral health appear as early as 2 years of age and remain evident in school-age children. Interventions to reduce such disparities should start as early as possible.

OBJECTIVE: To determine predictors of child externalizing (behavioral) and internalizing (emotional) symptoms in a national population sample. METHODS: Data were collected in 3 biennial waves (2004, 2006, and 2008) from 2 cohorts in the Longitudinal Study of Australian Children, initially including 5107 children 0 to 1 year of age and 4983 children 4 to 5 years of age. The primary outcomes were child externalizing and internalizing symptoms. Relationships between potential risk factors and child mental health outcomes were described by using linear regression. RESULTS: In unadjusted analyses, children's mental health symptoms were predicted by a large number of risk factors. In multivariate models, early childhood factors (birth through 5 years) explained 30% and 18% of variations in externalizing and internalizing symptoms, respectively, at 4 to 5 years of age. Middle childhood (5-9 years of age) factors explained 20% and 23% of variations in externalizing and internalizing symptoms, respectively, at 8 to 9 years of age. Harsh discipline was a strong consistent predictor of externalizing symptoms in both age groups, whereas poorer child physical health, maternal emotional distress, harsh discipline, and overinvolved/protective parenting (younger cohort only) predicted internalizing symptoms consistently. CONCLUSIONS: National data on predictors of child mental health symptoms highlighted a small number of significant risk factors, situated in the family context and present from a very young age. This knowledge is informing population-level, randomized, prevention trials of family support programs.

Background: This study compares oral health outcomes and behaviours for young Australian children by residential state or territory to determine whether state differences arise from individual exposures to risk factors. Methods: Cross-sectional data for 4606 2-3 year olds and 4464 6-7 year olds were obtained from the Longitudinal Study of Australian Children. Outcome measures were parent-reports of children's caries experience, frequency of toothbrushing and dental services use. Results: For 2-3 year olds, children from the Australian Capital Territory were less likely to have parent-reported caries than children from other states, and more likely to brush their teeth twice daily and to have used dental services. For 6-7 year olds, optimal outcomes were observed in New South Wales for lowest caries experience, Western Australia for highest toothbrushing, and South Australia for highest dental services use. Adjustments for socio-demographic predictors did not eliminate state differences in oral health. Conclusions: Large state differences in the oral health of young children persisted after adjustment for individual sociodemographic determinants, suggesting these arise from variations in the systems to promote and care for children's oral health. Several states would benefit from a stronger emphasis on oral health promotion in young children, and disparities from a young age suggest the need for better engagement of early childhood professionals in oral health promotion.