AT RISK CHILDREN

At Risk Children

At Risk Children

Introduction

A decline in infant mortality and deaths from infectious diseases together with evidence that children today are born healthier than ever before creates a paradox in which, despite significant advances in services for children and child health, more children are being admitted to hospital than ever before. Several researchers have documented large rises in paediatric hospital admissions in the United Kingdom, and in a landmark study Hill reported an 88 per cent increase in paediatric medical admissions between 1975 and 1985. Although there are no recent studies which have attempted to assess whether these secular changes are persisting in the 1990s, anecdotal evidence together with continued pressure on emergency admissions suggest that paediatric admissions in the United Kingdom are continuing to increase. The reasons for the documented rise in admissions have been attributed to several causes. These include an increase in early diagnoses, treatment of previously untreatable problems, risk of legal claims, and poor social circumstances(Ham 2008 9-14.). Other factors including changing morbidity, shorter lengths of stay and decreasing threshold of admission have also been suggested, but the relative importance of these factors is not clear. The role of inappropriate admissions and variations in care as an explanation for increasing hospital admissions has been extensively investigated, especially in UK. A large literature on the variations in appropriateness of care has been published21-27 but little work has been carried out in relation to paediatrics, especially in the United Kingdom. Werneke and MacFaul28 have provided a useful summary of the rationale behind the assessment of appropriateness in paediatric admissions for the United Kingdom(Ham 2008 9-14.) 

Children at risk

A recent study estimated that approximately 64,000 people in the UK die prematurely from heart and lung disease every year due to particulate air pollution -- more people than die each year in car accidents. Among children, air pollutants are associated with increased acute respiratory illness, increased incidence of respiratory symptoms and infections, episodes of longer duration, and lowered lung function.

Asthma, the most common chronic disorder of childhood, is on the rise in the UK and in other industrialized nations. During the 1980s, the prevalence of childhood asthma increased nearly 40 percent. Many different factors have been associated with asthma, including genetic makeup, environmental tobacco smoke, dust mites, cockroach allergens, and air pollution, both indoor and outdoor. Several studies have linked ozone and particulate air pollution with exacerbations of asthma in children afflicted with the disease. (Anderson 2000 1191-1200.)

Due to their greater respiratory rates, children breathe a proportionately greater volume of air than adults. As a result, children inhale more pollutants per pound of body weight. They also spend more time engaged in vigorous activity than adults. In addition, because of young children's height and play habits (crawling, rolling) they are more likely to be exposed to pollutants or aerosols that are heavier than air and tend to concentrate in their breathing zone near ground level(Fink Kosecoff Chassin Brook 2004 979-983). Children's physiological vulnerability to air pollution arises from their narrower airways and the fact that their lungs are still developing. Irritation caused by air pollutants that would produce only a slight response in an adult can ...