Child and Adolescent Health

Chapter 16 Child and Adolescent Health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. The Health of a Child Has Long-Term Implications    Health habits adopted by children and youth profoundly influence their potential to lead healthy, productive lives. The physical and emotional health of a child plays a pivotal role in the overall development and well-being of the entire family. Children who are healthy, well-nourished, well cared for at home, and safe and secure in their world achieve a higher potential. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 U.S. Children by Race/Ethnicity Figure 16-1 From Federal Interagency Forum on Child and Family Statistics: America’s children in brief: key national indicators of well-being, 2012. www.childstats.gov/americaschildren/demo.asp. Accessed March 8, 2013. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Impact of Pregnancy on a Child’s Health   The health of the mother before, during, and after pregnancy has a direct impact on the health and well-being of her children. Child and Adolescent Health

A comprehensive approach is needed to… ➢ ➢ ➢ ➢ Identify and treat potential risks Overcome barriers to good health before, between, and beyond pregnancy Protect and promote the health of women and children Ensure the health of future generations Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Risk Factors Risks to mother → Risks to baby  Not in optimal health → Poor pregnancy outcome  Uncontrolled medical conditions → Low birth weight with serious medical conditions  Exposure to drug, alcohol, tobacco, poor nutrition → Chronic conditions that affect health and well-being  Unsafe environment (secondhand smoke, lead-based paint) → Chronic conditions throughout childhood and maybe adolescence/adulthood Risks to Children  No preventive health care and immunizations → preventable diseases or chronic conditions in life Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Infant Mortality   Infant mortality reflects the health and welfare of an entire community and is used as a broad indicator of health care and health status. Infant mortality is related to several factors:

➢ ➢ ➢ ➢ Maternal health Medical care quality and access Socioeconomic conditions Public health practices Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Infant Mortality (Cont.)  Leading causes of infant death in the United States (almost 60% of all infant deaths) ➢ ➢ ➢ ➢ ➢  Congenital defects Disorders relating to short gestation and low birth weight Sudden infant death syndrome (SIDS) Maternal complications of pregnancy Accidents such as suffocation United States ranks 27th in infant mortality among industrialized nations Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 U.S. Infant Mortality   Has dropped every year since 1940 (not 2002) Attributable to public health measures and improved standard of living ➢ ➢ ➢ ➢ ➢  Improved sanitation Clean milk supply Immunizations Nutritious food Enhances access to maternal health care Technological advances also contributed ➢ e.g., synthetic lung surfactant Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 International Comparisons of Infant Mortality Rates* (2011) World Rank Country 1960 2011 1 Iceland 13.0 0.9 2 Sweden 16.6 2.1 3 Japan 30.7 2.3 4 Finland 21.0 2.4 4 Norway 16.0 2.4 6 Czech Republic 20.0 2.7 7 Republic of Korea — 3.0 8 Portugal 77.5 3.1 9 Spain 43.7 3.2 10 Belgium 31.4 3.3 *Infant mortality rate represents infant deaths per 1000 live births. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9

International Comparisons of Infant Mortality Rates* (2011) (Cont.)

World Rank Country 1960 2011 11 Italy 43.9 3.4 11 Greece 40.1 3.4 13 France 27.7 3.5 13 Israel — 3.5 13 Ireland 29.3 3.5 16 Germany 35.0 3.6 16 Austria 37.5 3.6 16 Denmark 21.5 3.6 16 Netherlands 16.5 3.6 20 Switzerland 21.1 3.8 *Infant mortality rate represents infant deaths per 1000 live births. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 International Comparisons of Infant Mortality Rates* (2011) (Cont.) World Rank Country 1960 2011 20 Australia 20.2 3.8 22 United Kingdom 22.5 4.3 23 Poland 54.8 4.7 24 Slovakia 28.6 4.9 24 Hungary 47.6 4.9 26 New Zealand 22.6 5.5 27 United States 26.0 6.1 28 Chile 120.3 7.4 29 Turkey 189.5 7.7 30 Mexico 92.3 13.6 *Infant mortality rate represents infant deaths per 1000 live births. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Infant Mortality Rates Figure 16-2 From Murphy SL, Xu J, Kochanek KD: Deaths: Final Data for 2010, National Vital Statistics Report, Vol 61, No.4, May 8, 2013. Child and Adolescent Health http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf. Accessed September 3, 2013. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Preterm Birth and Low Birth Weight      Preterm: Birth before 37 weeks of gestation LBW: Infant born less than 5.5 pounds Important predictors of infant health Greater risk of death than full term Greater risk of mental and physical disabilities ➢ ➢ ➢ ➢ ➢ Cerebral palsy Visual problems (e.g., retinopathy of prematurity) Feeding problems Hearing loss Developmental delays Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Preterm Birth and Low Birth Weight (Cont.)  Factors associated with preterm and LBW ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ Minority status Chronic stress Maternal age of <17 years and >35 years Chronic health problems of mother Lack of prenatal care Multiple births Certain problems with the uterus or cervix Low socioeconomic status Unhealthy maternal habits Induced labor and elective C-section births Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Preconception Health   Half of all pregnancies are unintended. Impact on developing fetal organ systems by:

➢ ➢ ➢ ➢ ➢ ➢ Healthy maternal weight and good nutrition Tending to chronic maternal diseases Being up-to-date on vaccinations Avoiding environmental toxins Decreasing stress and eliminating abusive relationships Avoiding illicit drugs, tobacco, and alcohol Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Preconception Health (Cont.)  Preconception counseling as a prevention strategy: ➢ Effective contraception to avoid unintended pregnancies and pregnancy spacing ➢ Recommend intake of folic acid daily ➢ Encourage healthy lifestyle modifications   Prenatal care Prenatal substance use Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Prenatal Care  Early and regular prenatal care enhances chance of a healthy, full-term baby. ➢ Health education and counseling ➢ Risk identification

➢ Monitoring and treatment of symptoms ➢ Referral to health, nutrition, social services • Medicaid, WIC, food stamps, smoking cessation services, housing, child care, job training, substance abuse treatment, domestic violence screening and counseling Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Prenatal Substance Use  The use of tobacco, alcohol, or illicit drugs in any combination is dangerous to a woman’s health and worsens infant health and development outcomes. ➢ ➢ ➢ Smoking is one of the most preventable causes of infant morbidity and mortality Alcohol can lead to FAS Drugs can cause permanent harm to an unborn baby Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Breastfeeding “Breastfeeding is a natural and beneficial source of nutrition and provides the healthiest start for an infant. In addition to the nutritional benefits, breastfeeding promotes a unique and emotional connection between mother and baby.” – American Academy of Pediatrics, 2012 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Breastfeeding (Cont.)  AAP recommends

➢ Exclusive breastfeeding for first 6 months ➢ Breastfeeding in combination with introduction of complementary foods until at least 12 months ➢ Continuation of breastfeeding for as long as mutually desired by mother and baby  2011Surgeon General’s Call to Action to Support Breastfeeding ➢ ➢ Actions aimed at increasing society support Nurses, other professionals, and support groups Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Breastfeeding Advantages Mother     Baby Lower risk of breast and ovarian cancer Lower risk of postpartum depression Lower risk of type 2 diabetes Saves money on formula       Cells, hormones, and antibodies in breast milk Lower risk of asthma Lower risk of obesity Lower risk of diabetes Lower risk of SIDS Fewer illnesses Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Sudden Unexplained Infant Death  Definition of SUID ➢ ➢ ➢ ➢  Less than 1 year of age Occurs suddenly and unexpectedly Cause of death not immediately obvious before investigation Half of SUID are SIDS Definition of SIDS ➢ Death cannot be explained after a thorough investigation, including autopsy, examining death scene, and review of clinical history Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Sudden Unexplained Infant Death (Cont.)  Back to Sleep campaign (1994)

➢ ➢  Heighten awareness of the safety of positioning infants on their backs for sleep SIDS death declined by >50% Safe to Sleep campaign (2010) ➢ Included other actions to reduce risks of other sleep-related causes of death (e.g., suffocation) http://www.nichd.nih.gov/sts Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Safe to Sleep Campaign Recommendations           Always place baby on back to sleep for naps and night Place baby on firm surface with fitted sheet Not in adult bed, couch, or chair alone or with adults Keep soft objects, toys, and loose bedding out of sleep area Do not smoke during pregnancy

Do not allow smoking around baby Do not let baby get too hot during sleep Follow vaccine and health check-up recommendations Avoid advertised SIDS products Get regular health care during pregnancy – National Institute of Child Health & Human Development: Safe sleep for your Baby, 2013 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Childhood Health Issues       Accidental injury is the leading cause of death in children ages 1 to 14. Childhood obesity is a health crisis; it can lead to numerous health problems. Childhood immunization is a benchmark of child health. Environmental concerns can be found in air, water, and from toxic exposure to chemicals. Child maltreatment is an indicator of children’s physical and emotional health status. Children with special health care needs frequently need multiple health care services. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25

Adolescent Health Issues     Adolescent sexual activity is often unprotected and can result in pregnancy and STIs. Teen childbearing and parenting often have long-term negative consequences for both child and mother. Violence among youth is a multifaceted problem. The use of tobacco, alcohol, and drugs has serious and long-lasting consequences for adolescents and society. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Factors Affecting Child and Adolescent Health  Significant factors in overall well-being: Parents’ or caregivers’ income, education, and stability ➢ Security and safety of the home ➢ Nutritional and environmental issues ➢ Health care access and use ➢  Specific issues: ➢ ➢ ➢ Poverty Racial and ethnic disparities Health care use Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 27 Children Lacking Health Insurance Figure 16-5 Data from DeNavas-Walt C, Proctor D, and Smith J: Income, poverty, and health insurance coverage in the United States: 2011. U.S. Census Bureau Current Population Reports, September 2012. http://www.census.gov/prod/2012pubs/p60-243.pdf. Accessed March 8, 2013. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 28 Strategies to Improve Child and Adolescent Health    Collect/analyze data tracking well-being of children and adolescents. Establish goals and set measurable objectives using Healthy People 2020. Implement health promotion and disease prevention strategies. ➢  More significant and cost-effective for children than other age groups. Utilize public health programs targeted to children and adolescents. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 29 Public Health Programs Targeted to Children and Adolescents  Health Care Coverage Programs ➢ ➢ ➢  Affordable Care Act Medicaid and CHIP EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) Direct Health Care delivery programs ➢ ➢ ➢ ➢ Maternal and Child Health Block Grant (Title V) Community & Migrant Health Centers program School-Based Health Centers WIC Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 30 Sharing Responsibility for Improving Child and Adolescent Health     

Parents’ role Community’s role Employer’s role Government’s role Community health nurse’s role Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 31 Community Health Nurse’s Role       An advocate for improved individual and community responses to children’s needs. A researcher for effective strategies to serve women and children. A participant in publicly funded programs. A promoter of social interventions that enhance the living situations of high-risk families. A partner with other professionals to improve service collaboration and coordination. Understand the legal and ethical implications of decision making. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32 Monitoring the Health and Well-Being of Children Resource Website address Centers for Disease Control and Prevention (CDC) http://www.cdc.gov Federal Interagency Forum on Child and Family Statistics http://www.childstats.gov National Center for Education Statistics (NCES) http://nces.ed.gov National Center for Health Statistics (NCHS) http://www.cdc.gov/nchs US Bureau of Justice http://www.ojp.usdoj.gov/bjs US Bureau of Labor Statistics http://www.bls.gov US Census Bureau http://www.census.gov USDHHS Healthy People 2020 http://www.healthypeople.gov Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 33 … Child and Adolescent Health