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Shift towards preventative approach needed

'Many babies in the womb today are receiving unbalanced and inadequate diets'

For a country that holds the presidency of the G8 nations, the BMA's new report can make for difficult reading.

The UK is ranked 24th out of 27 countries in terms of the social pressures felt on families, it points out, and has the highest proportion of children living in a household where no one is employed.

Life does not seem to have improved greatly since a UNICEF report placed the UK at the bottom of 20 countries for child well-being in 2007. Growing up in the UK points out that there have been cuts to child benefits since the coalition government was formed and the closure of Sure Start centres, which provide childcare for working mothers and other support and interventions to improve early years education and reduce reliance on social services.



In addition, regressive tax policies have been implemented that differentially affect women and children. 'To date, the current administration's policies are unlikely to be described by health policy analysts as family-friendly,' it says.

The BMA Board of Science report identifies parenting as key to ensuring a healthy future for children, stressing its vital role in social and emotional development, and points to evidence suggesting that the parent-child relationship may determine health throughout a person's life.

It says universal and targeted public health interventions are needed to improve this relationship.

Parenting skills can be strengthened with education, and training support and research suggests that income has a direct impact on parenting and child health and well-being.

Hardship has been linked to harsh parenting practices while unemployment, poor housing and financial difficulties for parents can also impact on a child's mental health and are often associated with alcohol and drug misuse as adolescents prepare for adulthood.


Case for law change

The report calls for legislation against smacking as well as reductions in child poverty and improved support for parents with a focus on preventive and family welfare services.

'The research evidence favours a shift towards a public health, preventive approach to child maltreatment, away from a forensic approach focused on immediate safety and culpability,' according to London public health researcher Jenny Woodman and London professor of clinical epidemiology Ruth Gilbert, who contributed the report chapter on a public health approach to tackling child maltreatment.

GPs in particular could have a 'pivotal role' in dealing with the poor treatment of children through their insight into risk and protective factors, and contact through primary care. In this way, they are 'well placed to monitor and respond to domestic violence, depression, drug or alcohol abuse, and signs in family members of stress, trauma or failing parenting'.

Dr Woodman and Professor Gilbert mention the 'troubled' past decade for paediatricians involved in child protection in England and say that as a result the development of a preventive approach has been limited.

'As with GPs, service configuration limits the paediatrician's preventive role and their ability to respond to risk factors in the family or environment,' they point out, adding that healthcare professionals have difficulty in directly accessing therapeutic or supportive intervention.


Women's health

Another way to improve the health of the nation's children would be action on the diets of young women to increase their intake of fruit and vegetables, starchy food and oily fish while limiting fat, salt and added sugar. 'Many babies in the womb in the western world today are receiving unbalanced and inadequate diets,' the report maintains, pointing out that this is because their mothers are chronically malnourished.

'Protecting the nutrition and health of girls and young women should be the cornerstone of public health,' it insists. 'Not only will it prevent chronic disease but it will produce new generations who have better health and well-being through their lives.'

The authors suggest encouraging people to choose healthier foods by, for example, changing the location of fruit and vegetables in supermarkets.

In addition, interventions that combine supplements, nutritional counselling and referral to health and social services can lead to women's diets improving during pregnancy, increasing maternal weight gain and breastfeeding rates.

They call for continued investment in UNICEF 'baby friendly' accreditation of acute trusts and community providers to ensure progress made in breastfeeding is not lost and improved quality of drop-in services through Sure Start and Children's Centres, with proper recognition of the efficacy of health visitors and others in this area.

'The promotion, protection and support of breastfeeding, coupled with appropriately paced diversification of the diet to encourage acceptance of a wide range of healthy foods, is fundamental to the prevention of obesity in later life.'