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Children's health, including mental health

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Presentation on theme: "Children's health, including mental health"— Presentation transcript:

1 Children's health, including mental health
What I need to grow up

2 Learning outcomes To recognise signs and symptoms of children and young people who are, or may be, being neglected P4 Children's health, including mental health

3 Nutritional neglect Indicators Begging for or stealing food.
Frequently hungry. Rummaging through rubbish bins for food. Gorging self, eating in large gulps. Hoarding food. Obesity. Overeating junk food. P4 Children's health, including mental health

4 Medical neglect Denial of health care. Delay in health care.
Indicators of poor health drowsiness, easily fatigued puffiness under the eyes frequent untreated upper respiratory infections itching, scratching, long existing skin eruptions frequent diarrhoea bruises, lacerations or cuts that are infected untreated illnesses physical complaints not responded to by parent. P4 Children's health, including mental health

5 Mental health Neglected children have an increased risk of developing PTSD. BUT other variables also play a part. Neglected children are at increased risk for early behavioural problems and conduct disorder. Effects on lifestyle and behaviour may expose individuals to higher risks. P4 Children's health, including mental health

6 Environment and hazards
Exposure to hazards Safety hazards. Smoking. Weapons. Unsanitary household conditions. Lack of car safety restraints. P4 Children's health, including mental health

7 Disability and neglect
International research shows that disabled children are more likely to be maltreated than others. Disabled children are 3.8 times more likely to be neglected. Parenting capacity may be diminished. (Sullivan and Knutson 2000) P4 Children's health, including mental health

8 Disability and neglect
There is a lack of general awareness of disabled children’s vulnerability. Growth, behaviour and other problems may be seen to be the result of the disability. Professionals need to be vigilant about feeding regimes. (Sullivan and Knutson 2000) P4 Children's health, including mental health

9 Weight faltering Organic/nonorganic debates.
(Previously known as) Failure to thrive (FTT) Organic/nonorganic debates. Failure to meet expected weight and growth norms or developmental milestones. 5% of all children have faltering growth; 25% of children who are abused or neglected have faltering growth. Routine growth monitoring is important: height, weight, BMI and head circumference. Health visitors are the crucial first link. Dietetic and paediatric assessment next. P4 Children's health, including mental health

10 Child death related to neglect
Lack of supervision (most deaths occur from this category). Malnutrition or poor care can lower resistance to infection. Failure to respond to illness in child - sudden infant death. Failure to use preventive health care; for example, immunisation. Parental use of drugs - intoxicated adult/lack of supervision, accidental ingestion. (Brandon, Bauley and Belderson 2010) NB! Under-reporting and under-recognition of neglect in child death are both common P4 Children's health, including mental health

11 Clinical presentation
Severe and persistent infestations (for example, scabies or lice). Consistently inappropriate clothing. Persistently dirty and smelly. Faltering growth because of inadequate or inappropriate diet. (NICE 2009) P4 Children's health, including mental health

12 Clinical presentation
Home reports which indicate a poor standard of hygiene, which will affect the child’s health. Inadequate provision of food and living environment unsafe for child’s developmental age. Parent/carers fail to seek medical advice for their child to the extent health and wellbeing are compromised, including if the child has ongoing pain. (NICE 2009) P4 Children's health, including mental health

13 Clinical presentation
If explanation of injury suggests a lack of appropriate supervision (for example, sunburn, ingestion of harmful substance). Repeated failure by parents/carers to administer essential prescribed treatment. Repeated failure by parents/carers to attend essential follow-up appointments. P4 Children's health, including mental health

14 Clinical presentation
Repeated failure by parents/carers to engage with relevant health promotion programmes; for example, immunisation, screening and health and development reviews. If parents/carers have access to, but persistently fail to obtain NHS treatment to their child for dental tooth decay. P4 Children's health, including mental health

15 The ACE study (Adverse Childhood Experiences)
Adverse Childhood Experiences and their relationship to Adult Health and Wellbeing. Child abuse and neglect. Growing up with domestic violence, substance abuse, mental illness, crime. 18,000 participants. 10 years. (Anda et.al. 2008) P4 Children's health, including mental health

16 P4 Children's health, including mental health

17 Increased risk of: Some findings so far... lung cancer
auto immune disease prescription drug use chronic obstructive airways disease poor health-related quality of life. P4 Children's health, including mental health

18 An introduction to brain development and neglect
Brain plasticity. Neurobiology. The Romanian orphanage studies. Perry and the Child Trauma Academy. P4 Children's health, including mental health

19 Brain plasticity During the development of the brain, there are critical periods during which certain experiences are expected in order to consolidate pathways – for example, the sensitivity and regularity of the interaction which underpins attachment with the caregiver. Negative experiences, such as trauma and abuse, also influence the brain’s final structure. In cases of severe emotional neglect some pathways will die back. The child’s brain will be smaller. P4 Children's health, including mental health

20 Neglect and the brain The ‘new neurobiology’: traumatology (especially PTSD) and developmental neuroscience. Neurobiological treatment goals. Brain plasticity. Differences between neglect and abuse (Glaser ). Genetic and environmental modifications. P4 Children's health, including mental health

21 Neglect and the brain Developments in neuroscience have given us a greater understanding of the developing brain and the impact of abuse and neglect. Genetic and environmental modifications. Our brains expect to have experiences. Our brains are experience dependant. P4 Children's health, including mental health

22 Neurobiology Structures tend to be fixed by birth, but the connections and functions carry on being sorted until early adulthood. P4 Children's health, including mental health

23 Chugani et.al. (2001) Romanian Orphans.
Persistent specific behavioural and cognitive deficits. Brain glucose metabolism. Significantly decreased metabolism. P4 Children's health, including mental health

24 P4 Children's health, including mental health

25 Child Trauma Academy The Child Trauma Academy (Perry et al.).
The Child who was Reared as a Dog (Perry & Szalavitz 2007). Neglect: the absence of critical organising experiences at key times during development. Non-human animal studies. Institutional deprivation. Recovery after safe placement. Corroboration: Romanian orphans. Brain scans. (see P4 Children's health, including mental health

26 Perry (2002) Early trauma and abuse Sequelae Environment and parenting
Cumulative Impact Environment and parenting Risk taking behaviours P4 Children's health, including mental health

27 Possible points of intervention (A public health approach?)
Social inequalities Institutional power Neighbour- hood Risk indicators Morbidity & Injury Mortality Educational initiatives Lobbying Parenting support Risk reduction programmes Trauma recovery programmes Community based primary prevention Poverty, housing Upstream (primary protection) Midstream (secondary prevention) Downstream (tertiary intervention) P4 Children's health, including mental health


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