Early solid feeding and recurrent childhood eczema: a 10-year longitudinal study.

The relationship between early solid feeding practices and risks of recurrent or chronic eczema in childhood was examined in a birth cohort of New Zealand children studied to the age of 10. By the age of 10 years, 7.5% of children had chronic or recurrent eczema. There were clear and consistent associations between the diversity of the child's diet during the first 4 months and risks of eczema. Even when due allowance was made for a range of confounding factors--including parental atopic illness, atopic illness in siblings, the child's early milk diet, and family social background--children exposed to four or more different types of solid food before 4 months had risks of recurrent or chronic eczema that were 2.9 times those of children who were not exposed to early solid feeding. It is concluded that early exposure to a diet diverse in potential food antigens may act to predispose susceptible children to recurrent or chronic childhood eczema.

Secondary enuresis in a birth cohort of New Zealand children.

The development of secondary enuresis was examined in a birth cohort of New Zealand children studied to the age of 10 years. By this age, 7.9% of children had developed secondary enuresis. Analysis suggested two risk factors were involved in secondary enuresis. First, children who were late to attain nocturnal bladder control had significantly higher risks of secondary enuresis than children who attained early nocturnal bladder control. Secondly, the child's level of exposure to adverse life events was associated with the onset of secondary enuresis. Children who attained bladder control after 5 years were 3.39 (1.76-6.56) times more likely to develop secondary enuresis than those who attained bladder control before the age of 3 years (P less than 0.001); children who were exposed to four or more life events in a given year were 2.56 (1.18-5.50) times more likely to develop secondary enuresis in that year (P less than 0.05). These results suggest that the rate at which the child acquires primary bladder control acts as a vulnerability factor which determines the child's susceptibility to developing secondary enuresis when exposed to stress.

Medical insurance and childhood general practitioner contacts.

The relationships between the duration of medical insurance coverage and rates of general practitioner consultations for morbidity were examined for a birth cohort of children studied to ten years. This showed that children from insured families had higher consultation rates even when due allowance was made for known social and economic factors correlated with the ownership of insurance. During the period from birth to five years children who were insured throughout the period made a mean of 19.16 consultations compared to 15.38 for the uninsured (p less than 0.001); during the period from five to ten years the insured made 13.07 contacts compared to 9.38 for the uninsured (p less than 0.001). The net effects of these trends were that children whose families had been insured throughout the ten year study period made a mean of nine more general practitioner consultations by the age of ten years than children from uninsured families. It is concluded that the presence of private medical insurance encourages the development of inequalities in childhood access to health care with children from insured families having greater access to care than children from uninsured families.

The Christchurch Child Development Study: a review of epidemiological findings.

The Christchurch Child Development Study is a longitudinal study of a birth cohort of 1265 New Zealand children who have been studied over an 11-year period using data from multiple sources including parental interview, medical records, teacher questionnaires and direct testing of children. The article provides a review of the major lines of epidemiological research examined in the Study. These include: breast feeding and child health; parental smoking and child health; the effects of low level lead exposure; childhood asthma; nocturnal bladder control; the effects of early hospital admission; the distribution of child health services; and the consequences of private medical insurance. In addition a number of general topics (sample attrition, measurement error, individual differences and causal inference) relating to longitudinal designs are discussed briefly. It is concluded that the longitudinal design is a powerful and cost-effective method of gathering data for general paediatric epidemiological purposes but that research in this area would benefit from an increased use of emerging methods of statistical modelling.

Patient perceptions of general practitioner fees.

General practitioner fees were surveyed in a sample of 1033 families with eleven year old children. The median fee paid for a child consultation was $12.00 and for an adult consultation $22.00. The majority of respondents were of the opinion that these fees were too high: over half said this about child fees and over two thirds believed adult fees were too high. Patient estimates of reasonable fees were, on average, $8.00 for a child and $15.00 for an adult. There were clear and consistent dose/response relationships between the fee level charged and the likelihood that the fee would be described as too high. Comparisons of the fees paid by this cohort in 1980 with fees in 1988 indicated that child fees had increased at an average rate of 24% per annum during this period. The implications of these findings for health care delivery are discussed and the possible impact of recent increases in GMS benefits on levels of dissatisfaction with fees are examined.

Morbidity from 5 to 10 years.

The prevalence and incidence of illness was examined in a birth cohort of Christchurch children studied during the age range of 5-10 years. At this age, children had an average of 12 consultations with family doctors; 26% were admitted to hospital and 53% made one or more attendances at hospital outpatient departments. The majority of general practitioner contacts involved five groups of conditions: respiratory illness; integumental lesion; accidents; gastrointestinal conditions; and hearing problems. Hospital admissions were dominated by five types of admission: respiratory illness; accidents; gastrointestinal conditions; genito-urinary problems; musculoskeletal problems. More than two-thirds of outpatient attendances were accounted for by accidents, respiratory illness, musculoskeletal problems, vision problems, and hearing problems. Trends in rates of medical consultation for accidents and respiratory illness during the period from birth to 10 years are described and the implications of the findings are discussed.

The diseases of childhood.

Superficially it would seem no great challenge to predict the pattern of research likely to benefit the future health of New Zealand children. However, the protean nature of those things which influence child health, together with an appreciation of resource limitations, dictate that only a personal perception of priorities is put forward. These are molecular and cellular biology, cot death, asthma and some aspects of health care delivery consequent on social change.

Neonatal circumcision and penile problems: an 8-year longitudinal study.

The prevalence of penile problems was examined in a birth cohort of more than 500 New Zealand children studied from birth to 8 years of age. By 8 years, circumcised children had a rate of 11.1 problems per 100 children, and uncircumcised children had a rate of 18.8 per 100. The majority of these problems were for penile inflammation including balanitis, meatitis, and inflammation of the prepuce. However, the relationship between risks of penile problems and circumcision status varied with the child's age. During infancy, circumcised children had a significantly higher risk of problems than uncircumcised children, but after infancy the rate of penile problems was significantly higher among the uncircumcised. These associations were not changed when the results were adjusted statistically for the effects of a series of potentially confounding social and perinatal factors.

Breastfeeding and subsequent social adjustment in six- to eight-year-old children.

The relationship between breastfeeding practices and measures of conduct disorder was examined, prospectively, in a birth cohort of New Zealand children studied up to the age of eight years. While there were significant associations between the duration of breastfeeding and maternal and teacher ratings of conduct disorder obtained at six, seven and eight years, these correlations appeared largely spurious arising from the effects of errors of measurement and confounding factors which were correlated with both breastfeeding and conduct disorder measures. When errors of measurement and confounding factors were accounted for the correlations between breastfeeding and measures of conduct disorder tended to become both small and statistically non-significant. The study provides no evidence to suggest that breastfeeding makes a major contribution to the subsequent social adjustment of children.

Factors related to the age of attainment of nocturnal bladder control: an 8-year longitudinal study.

The age of attainment of nocturnal bladder control was studied in a birth cohort of New Zealand children. By 8 years of age, but all 3.3% of children had attained such control, but because some children had relapsed subsequent to the attainment of control, 7.4% of children had nocturnal enuresis. It was estimated that from 5 years of age onward between one half to two thirds of children experiencing nocturnal enuresis did so as a result of failure to attain nocturnal control and the remaining children had secondary or onset enuresis. Factors predictive of the age of attainment of nocturnal bladder control were a family history of enuresis, the child's developmental level at 1 and 3 years of age, and the child's early sleeping patterns. The age of attainment of bladder control was unrelated to a broad range of psychosocial factors including family social and economic background, family life-event measures, changes in parents in the family, and residential changes. These results favor the view that the etiology of primary enuresis is mainly biologic and that psychosocial factors play little role in this aspect of bed-wetting.

Exposure to fluoridated public water supplies and child health and behaviour.

The relationship between duration of exposure to fluoridated public water supplies and measures of child health and behaviour was studied for a birth cohort of Christchurch children. This study showed no association between exposure to fluoridated water and a large range of measures of child health and behaviour taken during the period from birth to seven years, even when the possible effects of family social background were taken into account statistically.

The pattern of acute medical admission to a children's unit.

A study of 607 consecutive acute medical admissions to a children's unit, revealed a dominance of acute asthma and acute respiratory infection. The patterns of illness reflected previous community based studies in the area. These patterns prevailed irrespective of whether the child came from a one or two parent family. Admission tended to be out of normal working hours. The significance of these findings is discussed.

Reasons for holding health insurance: a study of a group of Christchurch families.

The reasons for holding private medical insurance were studied in a sample of 495 insured Christchurch families having school aged children. In one-third of these families health insurance was provided by an employer. Two major reasons for holding insurance were cited by those whose insurance was not provided by an employer: three-quarters of these families stated that health insurance helped them meet medical bills and nearly two-thirds claimed that insurance provided them with access to immediate health care if this was needed. A minority (24%) of those holding health insurance believed that public sector services were inadequate to provide health care but only 9% of families were able to cite some specific shortcoming of public sector services which had impelled them to take out insurance cover. It is concluded that the rapid rise of private health insurance in New Zealand is likely to have arisen from the net effects of the promotional activities of insurance companies, the declining real contribution of State health care funding and the effects of growing public uncertainty about the ability of public sector services to deliver health care.

Social and family factors in childhood hospital admission.

The relation between social, economic, and family life event measures and rates of hospital admission during the period from birth to 5 years was studied in a birth cohort of New Zealand children. Both family social background and family life events made a significant contribution to the variability in the risk of hospital admission. However, economic factors made no significant contribution to rates of admission when the correlated effects of family social background and life events were taken into account. In addition, the effects of family life events on risks of admission appeared to be far more marked than the effects of family social background. Possible explanations of the consistent association between life events and rates of morbidity during early childhood are discussed.

Social and familial factors in the development of early childhood asthma.

The role of social and familial factors in the development of childhood asthma by age 6 years was studied in a birth cohort of New Zealand children. Rates of asthma varied markedly with the child's sex; boys had twice the rate of asthma as girls. In addition, the factors associated with asthma varied with the child's sex. For boys, wheeze during infancy, early eczema, and parental asthma were all significant risk factors; for girls, the only risk factor was early eczema. Proportional hazards modeling of the data failed to show any significant associations between the development of asthma and a large range of other social and familial factors including breast-feeding, parental smoking habits, pets in the child's family, stress in the family, or family social background. It was concluded that asthma in early childhood appeared to be inherited to some extent, its age of expression was related to the child's sex, and it had a complex interaction with other forms of allergic disease. There was no evidence to suggest that the structure, practices, or dynamics of the child's family played a significant role in the development of asthma for children in this birth cohort.

Family life events, maternal depression, and maternal and teacher descriptions of child behavior.

The relationship between family life events, maternal depression, and teacher and maternal ratings of child behavior was studied in a birth cohort of New Zealand children. Analysis of variance and multiple regression analysis showed that for maternal ratings of child behavior, both maternal depression and family life events made significant independent contributions. For teacher ratings of child behavior, the only significant predictor was family life events. These results persisted when appropriate controls for family social, economic, and demographic characteristics were taken into account. The theoretical implications of these findings are discussed.

Morbidity during the preschool years.

The prevalence of illness was studied in a birth cohort of Christchurch children during the period from birth to 5 years. By 5 years children had made an average of 18.0 family doctor consultations for morbidity and a further 4.7 for preventive health care procedures; 38% had been admitted to hospital on at least one occasion and 62% had made one or more attendances at a hospital outpatient department. The majority of general practitioner consultations involved four major groups of conditions: respiratory illness; integumental lesions; gastrointestinal illness and accidents. Hospital admissions were dominated by six groups of conditions: respiratory illness, minor surgery, accidents, feeding and management problems, admissions relating to the child's home environment and gastrointestinal illness. Two thirds of hospital outpatient attendances were accounted for by five groups of conditions: accidents; musculoskeletal conditions; respiratory illness; vision problems and congenital heart murmur.

Early hospital admissions and subsequent behaviour problems in 6 year olds.

The relation between admission to hospital during the preschool years and teacher and maternal ratings of child behaviour problems at age 6 years was studied in a birth cohort of New Zealand children. There was a slight but consistent trend for reported behaviour problems to increase with increasing length of hospital stay, however, control for family and social factors suggested that this correlation was spurious. Children admitted to hospital tended to come from socially disadvantaged backgrounds and from families reporting large numbers of life events, and independently of this social background and life events were related to childhood behaviour problems. When the effects of family social background and life events were controlled for, there was no significant association between duration of hospital stay and reports of child behaviour problems. It is concluded that there is little evidence to suggest that in a modern paediatric setting, admission to hospital has any significant effect on the child's subsequent behavioural pattern.

Relationship of family life events, maternal depression, and child-rearing problems.

The relationship between maternal reports of child-rearing problems, family life events, and maternal depressive symptoms was studied in a birth cohort of children in New Zealand. Rates of child-rearing problems showed a steady increase with both increasing levels of family life events and maternal depressive symptoms. Log-linear modeling of the results suggested that the apparent correlation between family life events and reports of child-rearing problems was mediated by the effects of maternal depression so that women subject to large numbers of adverse life events suffered increased rates of depression and in turn reported higher rates of problem behavior in their children. There was no significant correlation between family life events and reports of child-rearing problems when the effects of maternal depressive symptoms were taken into account. The findings tend to suggest that the previously reported association between family life events and child-rearing problems arises because life events provoke depressive symptoms in women and in turn this alters the way in which they perceive or evaluate their children's behavior.