It is with our great pleasure to present you this issue of the Children’s Research Digest, focusing on “Improving Child Health Through Research”. Children make up one-third of our global population and represent the future. According to the World Health Organization’s definition (WHO, 2006) “Child health is a state of physical, mental, intellectual, social and emotional wellbeing and not merely the absence of disease or infirmity. Healthy children live in families, environments, and communities that provide them with the opportunity to reach their fullest developmental potential”. Global child health has improved significantly in the past decade due to evidence based policy and practice that has quantified health problems and identified strategies such as diarrhoea management, breastfeeding promotion, mother-to-child transmitted diseases (e.g. HIV), amongst others. There has been remarkable progress in reducing infant mortality and maternal death through expanding the research and policy based reach of programs (WHO, 2015). Deaths among children under-5 dropped from nearly 12 million in 1990, to about 5.9 million in 2015.
New figures from Eurostat, the EU’s statistical agency, shows that Ireland has the highest birth rate for 2016, 13.5%, which means 63.9 births per 1,000 residents. The infant mortality rate (IMR) for Ireland (2012) is at 3.5 per 1000 live births, 33% lower than the 2002 IMR rate and lower than the European average of 3.9 per 1000 live births (McGarvey, C. et al. 2013). Ireland registered the lowest death rate at 6.4 deaths per 1,000 residents. In the context of births relative to deaths, Ireland shows the greatest natural increase of population (Eurostat, 2017).
Less impressive are other health statistics from Ireland. Recently reported exclusive breastfeeding rates in Ireland on discharge from maternity hospital is 46.3% (HSE, 2016), yet only 15% children are exclusively breastfed for their first six months of life, a very low rate compared to the global average of 38%. The promotion, support, and protection of breastfeeding are a top priority set by the Department of Health (2016) in Ireland to ensure optimum growth and development for children. In 2016, the HSE published a Breastfeeding Action Plan 2016 - 2021 which sets out the priority areas to be addressed over the next five years to improve breastfeeding support, to enable more mothers in Ireland to breastfeed and to improve health outcomes for mothers and children in Ireland. It is interesting to note then that the budget set aside nationally for the promotion of breastfeeding was pulled entirely earlier this year. This is alarming as research evidence suggests that breastfeeding is not only a protective factor against childhood obesity but also plays a pivotal role in the prevention of chronic diseases including diabetes (Victoria, 2016; Yan et al. 2014). Worrying then is it that a Childhood Obesity Surveillance Initiative (COSI) report (2017) highlights that at least one in five children are overweight or obese, which ranks Ireland in fifth place among 27 EU countries. Childhood obesity is a multifaceted issue in the population health and well-being, and in Ireland, this issue needs to be addressed as a research and implementation priority to tackle the causes and adopt preventive measures. Otherwise, this will have far reaching consequences for the population health and putmore financial burden and resource constraints on our health care system.
Another important issues is that of children living with life-limiting conditions such as rare diseases and genetic disorders. The prevalence of children and young people with life-limiting conditions have been increasing dramatically (Fraser et al. 2011, 2012, 2015; Ling et al. 2015) due to improvements in technology and better clinical management of certain conditions. Even though individual diagnosis for life limiting conditions is spread out across various rare diseases, collectively children requiring complex care for these conditions are of a larger proportion than any other chronic conditions (Royal College of Paediatrics and Child Health, 2014). In Ireland, there are approximately 3,840 children living with a life-limiting condition (Ling et al. 2015) and in the region of 490 deaths per year (DOHC,
2010). The former Department of Health and Children (DOHC, 2010) recommended multidisciplinary research initiatives to develop an evidence-based contribution to children’s palliative care in Ireland.
Strengthening national research capacities to respond to local health needs is fundamental for the implementation and sustainability of research findings at population level. In response to Ireland’s changing health and wellbeingneeds, the government has introduced many initiatives to tackle Ireland’s current needs to promote child health. Healthy Ireland‘s framework envisions “a Healthy Ireland; where everyone can enjoy physical and mental health and well-being to their full potential; where well-being is valued and supported at every level of society and is everyone’s responsibility”(HSE, 2017). The National Healthy Childhood Programme is another initiative and has a key role in supporting families so that young children are enabled to realise their full potential and grow into healthy adults. Recently, the Irish National Clinical Programme for Paediatric and Neonatology have developed the Paediatric Early Warning System (PEWS) which provides a framework for care and empowers clinicians to act on behalf of any child with signs of deterioration or about whom they have a clinical concern (RCPI, 2017). These programmes are some recent key priorities set by the government
agencies and funding bodies.
At international level, Every Woman Every Child is a multi-stakeholder movement enlisted into action under the Global Strategy for Women’s, Children’s and Adolescent’s Health (2016–2030), by the UN Secretary-General in September 2015. It calls on all partners to unite and take coordinated action to achieve real progress for every woman, child and adolescent everywhere. To achieve optimum health for children and their families, government agencies and policy makers need to ensure that children are offered a better place for their healthy growth and development, reducing child morbidity and mortality, creating awareness of children’s protection and safety as well as supporting children and their families’ psychosocial needs. To maximise efficiency and effectiveness of research into child health and development, it is essential to draw research priorities based on population needs. This should be based on evidence and ethical considerations to offer collaborations between national and international agencies toimprove health and well-being for children and their families. Government policies in Ireland recognise the need for early intervention and prevention programmes in contributing to better population health and in tackling inequalities in health (Department of Health, 2013; DHSSPS, 2010). Mc Avoy et al. 2013, reported that there is a need for “Integrated child development and health services in the community and linked to the family home present opportunities for multidisciplinary working and synergies in the delivery of child services” and continues “Further reflection is required in terms of supporting appropriate prevention and early intervention approaches in the school setting”. (pp.3).
Apart from early intervention, prevention and nutrition, it is paramount to understand the concept of genetics and genomics, epidemiology, diseases management, outcome measurements and impact of illness on children and their families. “The family is an integral part of how children and young people experience and engage in society and health care” (Bernie et al. 2014, pp.9). Imagine if you are a parent of a child with a serious-acute chronic illness and how stressful it will be for you to undergo the complicated process of caring for your sick child on a day-to-day basis. This editorial is also a call for more programmes of research which will examine the impact of illness on families’ day-to-day lives, and their physical, mental and psychological health, so that research evidence can support implementation of improvement plans including therapeutic conversations between families and professionals and how to disclose genetic diagnosis to a family. As health care professionals working with children, we should strive to support this improvement through more research and surveillance, clinical and service standards, quality improvement, clinical audit and policy and practice development.
Research has resulted in substantial progress in child health and quality of life over the number of years, however, many problems remain to be tackled to improve child health globally. The concept of involving children in research has gained credibility recently (Kellet, M. 2010). As co-investigators they attempt to demonstrate a unique “insider” perspective on their status in the society as children or young people. This participatory approach in health care research will offer an accurate picture of children’s role as consumers in health care systems and their rights as children. It has also resulted in some reported benefits for children themselves, for example in promoting well-being and resilience, including self-esteem, self-efficacy, self-control, sensitivity to the perspectives of others, hope for the future, democratic decision making, and active citizenship (Malone & Hartung 2010). A dynamic interaction between researchers, policy makers, advocacy groups, and funding institutions, within developing as well as developed nations, is essential to ensure that priorities in child research are based on sound evidence and remain at the top of the international development agenda.
The articles in this volume represent the broad spectrum of research that is ongoing and necessary in relation to child health. Articles start from a focus on health promotion in the early years and turn to mental health in college students, the challenges of labels and accurate diagnoses, quality improvement initiatives in health care systems, children and parents’ experiences of rare and life-limiting conditions as well as an overview of health service use and planning and include international perspectives on some of these issues, including on the important problem of medical poverty.