Parents' perceptions of their child's weight among children in their first year of primary school: a mixed-methods analysis of an Australian cross-sectional (complete enumeration) study.

BACKGROUND/OBJECTIVES: To describe trends in overweight/obesity in early childhood for all children and those whose parents are concerned about their weight. To describe parents' perceptions of their child's weight and differences by their child's anthropometric and sociodemographic factors. SUBJECTS/METHODS: Analysis of the Kindergarten Health Check, a survey of all children enrolled in their first year of primary education in the Australian Capital Territory. Analysis of detailed data for 2014-2017, including qualitative analysis of parents' comments on weight, and trends for 2001-2017. RESULTS: 71,963 children participated in the survey between 2001 and 2017 (20,427 between 2014 and 2017). The average age of children (2001-2017) was 5 years and 9.6 months at the time of their physical health check. 2377 children (3.5%) were classified as obese based on measured body mass index (BMI) between 2001 and 2017, and a further 7766 (11.6%) overweight. Similar proportions were seen for 2014-2017. Among children with overweight/obesity in 2014-2017, 86.4% of parents (2479/2868) described their children's weight as healthy and 13.3% (382/2868) as overweight/obese. Just 11.5% (339/2946) of parents whose children were later measured with overweight/obesity identified having a concern about their child's weight. Parental comments varied widely and were often incongruent with the known health risks associated with their child's measured BMI. Comments from parents whose children were measured as obese often were normalising e.g., "born big, always big. Definitely NOT overweight, just bigger all over", whilst parents of children in the healthy range expressed concerns about underweight. CONCLUSION: Parents do not accurately perceive their child's weight and few document concerns, even among children measuring in the obese BMI category. This lack of concern makes early interventions challenging as parents are in the "pre-contemplative" stage of behaviour change and may see public health campaigns or clinicians' attempts to address their child's weight as irrelevant or unhelpful.

Physical activity and risk of behavioural and mental health disorders in kindergarten children: analysis of a series of cross-sectional complete enumeration (census) surveys.

OBJECTIVES: There is mixed evidence on the relationship between physical activity and behavioural and mental health. We aimed to estimate the association between physical activity and risk of behavioural and mental health disorders in early school-aged children. DESIGN: A series of cross-sectional complete enumeration (census) surveys. SETTINGS: All primary schools in the Australian Capital Territory, 2014-2016. PARTICIPANTS: All children enrolled in their first year of full-time primary education (kindergarten) were invited to participate. Of the 16 662 eligible kindergarten children, 15 040 completed the survey for the first time. OUTCOME MEASURES: Average daily physical activity participation and prevalence of risk of behavioural and mental health disorders derived from parent-reported data and the Strengths and Difficulties Questionnaire (SDQ). Characteristics associated with SDQ Total difficulties and subscales were estimated using logistic regression. RESULTS: 8340 (61.7%) children met physical activity targets (60 min or more daily) and 709 (4.8%) were at clinically significant risk of behavioural and mental health disorders (Total difficulties).Known sociodemographic correlates were also those variables associated with high risk of behavioural and mental health disorders (Total difficulties): Aboriginal and Torres Strait Islander status (OR 2.72, 95% CI 1.78-4.16), relative socioeconomic disadvantage (most disadvantaged vs least disadvantaged, OR 1.86, 95% CI 1.38-2.50) and male sex (OR 1.80, 95% CI 1.49-2.17). Average daily physical activity was not significant, despite the highest levels of physical activity (90 min or more daily) being reported in boys, Aboriginal and Torres Strait Islander children and those from more disadvantaged areas. CONCLUSIONS: Our study provides comprehensive cross-sectional data on the relationship between physical activity participation and the risk of behavioural and mental health disorders in a large cohort of early school-aged Australian children. Aboriginal and Torres Strait Islander children, boys and those from the most disadvantaged socioeconomic group were at greatest risk of clinically significant behavioural and mental health disorders.

Respiratory outcomes study (RESPOS) for preterm infants at primary school age.

OBJECTIVE: Pulmonary function abnormalities and hospital re-admissions in survivors of neonatal lung disease remain highly prevalent. The respiratory outcomes study (RESPOS) aimed to investigate the respiratory and associated atopy outcomes in preterm infants <30 weeks gestational age (GA) and/or birth-weight (BWt) <1000 g at primary school age, and to compare these outcomes between infants with and without chronic lung disease (CLD). METHODS: In the RESPOS 92 parents of preterm infants admitted to the Neonatal unit in Canberra Hospital between 1/1/2001 and 31/12/2003 were sent a questionnaire regarding their respiratory, atopy management and follow-up. RESULTS: Fifty-three parents responded, including 28 preterm infants who had CLD and 25 who had no CLD. The gestational age was significantly lower in the CLD group compared to the non-CLD group [26.9 (26.3-27.5) CLD and 28.6 (28.3-29.0) non-CLD] [weeks [95% confidence interval (CI)]], as was the birth weight [973 (877.4-1068.8) CLD versus 1221 (1135.0-1307.0) non-CLD] [g (CI)]. CLD infants compared to non-CLD infants were significantly more likely to have been: given surfactant, ventilated and on oxygen at 28 days and 36 weeks. These neonates were also more likely to have: been discharged from the neonatal unit on oxygen, exhibit a history of PDA or sepsis and to have a current paediatrician. However, despite these differences, there was no significant difference in the proportion of asthma or atopic disease between the two groups. CONCLUSIONS: The RESPOS could not demonstrate respiratory and/or atopy differences between the CLD and the non-CLD groups at primary school age.

The prevalence of overweight and obesity in Indigenous kindergarten children--a cross sectional population based study.

BACKGROUND: This study investigated the prevalence of overweight and obese Indigenous kindergarten children in the Australian Capital Territory. METHODS: A retrospective analysis was performed on data collected as part of the Kindergarten Health Check, a cross sectional population based survey conducted in the ACT from 2004 to 2008. RESULTS: The prevalence of overweight and obesity was statistically significantly higher among Indigenous (18%) compared to non-Indigenous kindergarten children (14%) (p=0.02, OR=1.40, 95% CI=1.051-1.862). Ten percent of parents of normal weight children, and 16% of parents of overweight or obese children, reported concerns about weight and eating habits, with no significant difference between Indigenous and non-Indigenous parents. DISCUSSION: The low level of parental concern about obesity suggests that general practitioners should persist with screening for, and managing, overweight and obesity in kindergarten-aged children in similar jurisdictions on a proactive basis.

Obesity and asthma at school entry: co-morbidities and temporal trends.

AIM: A decline in asthma prevalence from 2000 to 2005 was reported previously. The objective is to examine the temporal trends for the prevalence of obesity and other childhood disorders and consider the extent to which associations between asthma and other co-morbidities can be accounted for by body mass index. METHODS: Serial cross-sectional surveys of primary school entrants (n = 18,999) in the Australian Capital Territory between 2001 and 2005 were used. Asthma, recent respiratory symptoms and diabetes data were extracted from parental reports. Anthropometric measurements were obtained from health assessments by school nurses. Child obesity was defined using the age and sex-specific Cole criteria. Time trends for the prevalence of obesity and other disorders, and the association between 'current asthma' and co-morbidities were analysed using multiple logistic regression and other analyses. RESULTS: Obesity prevalence was 5.24% in 2001 decreasing to 3.60% in 2005 (test of linear trend P = 0.02). Overweight (adjusted odds ratio (AOR) 1.30 (95% confidence interval (CI) 1.16, 1.46), P < 0.001) and obese (AOR 1.36 (95% CI 1.13, 1.62), P = 0.001) children were more likely to report 'asthma ever'. Children with diabetes (AOR 9.35 (95% CI 3.11, 28.12, P < 0.001)) and attention deficit (AOR 3.39 (95% CI 2.04, 5.64), P < 0.001) were more likely to report 'current asthma'. CONCLUSIONS: The pattern of association with co-morbidities was different for asthma and obesity. The temporal decline/plateau effect in 'current asthma' could not be explained by concurrent body mass index changes. The decline in obesity was largely driven by the 2005 findings. Longer term trends need to be evaluated further.

Infant Feeding Practices and Nut Allergy over Time in Australian School Entrant Children.

Aim. To measure the association between infant feeding practices and parent-reported nut allergy in school entrant children. Method. The Kindergarten Health Check Questionnaire was delivered to all 110 Australian Capital Territory (ACT) primary schools between 2006 and 2009. Retrospective analyses were undertaken of the data collected from the kindergarten population. Results. Of 15142 children a strong allergic reaction to peanuts and other nuts was reported in 487 (3.2%) and 307 (3.9%), children, respectively. There was a positive association between parent reported nut allergy and breast feeding (OR = 1.53; 1.11-2.11) and having a regular general practitioner (GP) (OR = 1.42; 1.05-1.92). A protective effect was found in children who were fed foods other than breast milk in the first six months (OR = 0.71; 0.60-0.84). Conclusion. Children were at an increased risk of developing a parent-reported nut allergy if they were breast fed in the first six months of life.

Inequality in provider continuity for children by Australian general practitioners.

BACKGROUND: There is little published on provider continuity in Australian general practice and none on its effect on inequality of care for children. METHOD: Questionnaire administered to parents of the ACT Kindergarten Health Screen asking the name of their child's usual GP and practice address between 2001 and 2008. RESULTS: Parents of 30,789 children named 433 GPs and 141 practices. In each year, an average of 77% of parents could name both the GP and the practice, an average of 11% of parents could name only the practice, and an average of 12% of parents could name neither. In each year, 25% of parents could not name a usual GP for children of Aboriginal or Torres Straight Islander descent, or children born outside of Australia, compared to 10% of all other children (p = < 0.0001). The frequency of GPs displaying continuity of care varied over time with 19% of GPs being present in the ACT in only one year and 39% of GPs being present in every year over the eight years of study. GPs displayed two different forms of transience either by working in more than one practice in each year (5% of GPs), or by not being present in the ACT region from one year to the next (15% of GPs). Fewer parents nominated transient GPs as their child's GP compared to choosing GPs who displayed continuity (p < 0.001). CONCLUSIONS: Many GPs (39%) were reported to provide continuity of care for in the ACT region and some GPs (20%) displayed transient care. Indigenous children or children born outside of Australia had less equity of access to a nominated GP than all other children. Such inequity might disappear if voluntary registration of children was adopted in Australian general practice.

Children in the ACT with asthma--are they taking preventer medication according to guidelines?

AIM: To ascertain whether children with asthma in the Australian Capital Territory were taking preventer medications in accordance with National Asthma Council Australia guidelines. METHODS: Questionnaires were distributed to all parents who indicated in an ACT wide survey of school entry children in 2005 that their child had asthma (n=435), or experienced asthma symptoms/took asthma medication (n=501), exploring dose, frequency and mode of delivery of preventer their child was currently taking. RESULTS: Data were available for 256 children (response rate 27%). Of the children with parent reported asthma (n=435) the response rate was 42%. Eighty-three (32%) children were currently taking preventers; complete medication details were provided for 60 children. A total of 32% of children on preventers were taking doses of preventers not in accordance with guidelines, while 80% of children were taking their medications at frequencies, or using delivery devices, not in accordance with guidelines. DISCUSSION: This study suggests that home medical management of asthma with preventers for children may not be optimal.

The parent-reported prevalence and management of peanut and nut allergy in school children in the Australian Capital Territory.

AIM: To describe parent-reported prevalence and management of peanut and nut allergy in school entrant children. METHOD: A population-based, cross-sectional study in the Australian National Capital. RESULTS: Out of 3851 children, parents reported 127 had a strong allergic reaction to peanuts and 19 to other nuts ever. Nut allergy ever prevalence was 3.8% (95% confidence interval 3.2-4.4%), and of peanut allergy ever 3.3% (2.8-3.9%). Children with nut allergy were more likely to have a general practitioner (odds ratio 2.64, 1.16-6.03), hay fever (3.78, 2.67-5.36), eczema (4.54, 3.15-6.56) and wheeze in the last 12 months (3.19, 2.22-4.59) and have been breastfed (2.68, 1.26-5.77) than those who did not. At follow up of 109 children with parent-reported allergy (75% response), 70% had diagnostic test-confirmed sensitisation, 32% had been prescribed an adrenalin autoinjector (6% had used one) and 46% were not eating peanut. Increasing severity of reported symptoms following consumption of peanut was associated with an increasing likelihood of recommended management. Based on parent report, the projected estimated diagnostic test-confirmed prevalence of peanut sensitisation was 2.4% (1.9%, 3.0%) for the entire sample. CONCLUSION: Among a highly representative sample of children at school entry, 1 in 30 parents reported their child to have a strong allergic reaction to nuts and over 1 in 50 are estimated to have diagnostic test-confirmed peanut sensitisation, based on parent report.

A temporal decline in asthma but not eczema prevalence from 2000 to 2005 at school entry in the Australian Capital Territory with further consideration of country of birth.

BACKGROUND: Asthma prevalence has declined in some countries over the past 10 years. Most reports have been based on population surveys conducted at two points of time in a given location. Comparisons across countries and time periods can be limited by differences in study methodology or disease diagnostics in different communities. Here, we examined trends in asthma prevalence using serial annual data and further examine the importance of country of birth. METHODS: The source population has children aged 4-6 commencing school in the Australian Capital Territory from 2000 to 2005 inclusive. Over 80% of these children and their families completed a health questionnaire on asthma, other atopic disease and respiratory symptoms using some questions from the International Study of Asthma and Allergies in Childhood (n = 22 882). Current asthma has been previously validated against physician assessment in this setting. RESULTS: The prevalence of current asthma declined (P < 0.001) but eczema ever increased (P < 0.001) from 2000 to 2005. The asthma decline was predominantly linear in form, and accompanied by a reduction in night cough and shortness of breath but not recent wheeze. Compared with Australian-born children, children from New Zealand and the United Kingdom had a similar prevalence of asthma, hay fever and eczema history. However, children born in other countries, such as Asia, generally had a lower prevalence of these disorders. The temporal trends for atopic disorders or respiratory symptoms did not differ for overseas-born compared with Australian-born children. CONCLUSION: The decline in current asthma prevalence from 2000 to 2005 was linear in form and appeared uncoupled from trends in child eczema. Country of birth was associated with marked variation in atopic disorder prevalence. The similar temporal trends for Australian vs overseas-born children indicate that the factors underlying the asthma prevalence decline are unlikely to be only in the pre-natal period.

Trends in medication use for asthma in school-entry children in the Australian Capital Territory, 2000-2005.

OBJECTIVE: To analyse trends in asthma medications used by school-entry children whose parents report they have asthma. DESIGN AND SETTING: Annual cross-sectional study of all school-entry children (about 4400 each year) in the Australian Capital Territory in 2000-2005, by means of a questionnaire for parents on child health status and medication use; and a cross-sectional study of asthma prescriptions for children aged 5 years obtained from the Medicare Australia database for 2002-2005. PARTICIPANTS: All school-entry children in the ACT with parent-reported asthma (numbers in the years 2000-2005 ranged between 435 and 589). MAIN OUTCOME MEASURES: Changes in the use of different medications; changes in delivery devices for asthma; changes in the potency of inhaled fluticasone. RESULTS: Response rates to kindergarten health screening were in the range 85%-89% for 2000-2005. Parent-reported asthma prevalence ranged from 11% to 15%. Each year, around 35% of children with asthma (age range, 4-6 years) used inhaled corticosteroids. An increase in the use of fluticasone (from 11% to 33% of children with asthma) was offset by decreases in beclomethasone use (from 14% to 3%) and budesonide (from 14% to 4%). Use of cromoglycate and nedocromil fell from 46% to 16%. Nebuliser use decreased (from 45% to 20%), while the use of spacer devices increased (from 70% to 83%). Use of combined salmeterol/fluticasone increased from 8% (in 2002) to 20% (in 2005) of children with parent-reported asthma. These trends were mirrored in Medicare Australia data for 5-year-old children in the ACT. CONCLUSIONS: There was marked volatility in the types of asthma medication used over the 6 years. Reciprocal trends leading to increased use of spacers and decreased use of nebulisers are in accord with national guidelines for better asthma management. The increasing use of products containing a combination of salmeterol and fluticasone requires ongoing monitoring.