FNU Social Determinants of Child and Adolescent Health Status Discussion 1. Identify and discuss major indicators of child and adolescents health status.

FNU Social Determinants of Child and Adolescent Health Status Discussion 1. Identify and discuss major indicators of child and adolescents health status.

2. Describe and discuss the social determinants of child and adolescent health.

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3. Mention and discuss at least 2 public programs and prevention strategies targeted to children’s health.

4. Mention and discuss the individual and societal costs of poor child health status.

APA, Minimum 700 words, A minimum of 2 evidence-based references. NO PLAGIARISM, RAN THROUGH TURN-IT-IN 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.
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.
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 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

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