Child Community Health Services May 2018 1

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Contents – ‘Ctrl Click’ to jump directly to the subject area you want

Healthcare Guidance Systematic Reviews Article Abstracts

New Library Resources

Key Journals - ‘Ctrl Click’ to jump directly to the journal’s website

Archives of Disease in Childhood (monthly) Some articles available with OpenAthens

British Journal of School Nursing (10 issues annually)

Child and Family Social Work (quarterly)

Child: Care, Health and Development (bimonthly)

Child Development (quarterly)

Children's Health Care (quarterly)

Community Practitioner (monthly)

Health and Social Care in the Community (6 issues annually)

Journal of Child and Family Studies (6 issues annually)

Journal of Child Health Care (quarterly)

Journal of Family Health (bimonthly)

Current Awareness Bulletin

CHILD COMMUNITY HEALTH SERVICES

May 2018

Child Community Health Services May 2018 2

Journal of Paediatrics and Child Health (monthly)

Pediatrics (monthly)

Healthcare Guidance

Childhood obesity is everyone’s business

Parliament.uk

The Government must change the narrative around childhood obesity to make it clear that this is everyone's business, say the Health and Social Care Committee in their report into childhood obesity.

Health protection in schools and other childcare facilities

Public Health England

A practical guide for staff on managing cases of infectious diseases in schools and other childcare settings.

Measles outbreaks across England

Public Health England

Public Health England is advising the public to ensure they have had 2 doses of MMR vaccine after outbreaks of measles are confirmed across England.

Systematic Reviews

Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under

D Arikpo, E Edet, M Chibuzor, F Odey, D Caldwell

Cochrane Systematic Review

Abstract

Background Although complementary feeding is a universal practice, the methods and manner in which it is practiced vary between cultures, individuals and socioeconomic classes. The period of complementary feeding is a critical time of transition in the life of an infant, and inappropriate complementary feeding practices, with their associated adverse health consequences, remain a significant global public health problem. Educational interventions are widely acknowledged as effective in promoting public health strategy, and those aimed at improving complementary feeding practices provide information about proper complementary feeding practices to caregivers of infants/children. It is therefore important to summarise evidence on the effectiveness of educational interventions to improve the complementary feeding practices of caregivers of infants.

Objectives To assess the effectiveness of educational interventions for improving the complementary feeding (weaning) practices of primary caregivers of children of complementary feeding age, and related health and growth outcomes in infants.

Search methods In November 2017, we searched CENTRAL, MEDLINE, Embase, 10 other databases and two trials registers. We also searched the reference lists of relevant studies and reviews to identify any additional studies. We did not limit the searches by date, language or publication status.

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Selection criteria Randomised controlled trials (RCTs), comparing educational interventions to no intervention, usual practice, or educational interventions provided in conjunction with another intervention, so long as the educational intervention was only available in the experimental group and the adjunctive intervention was available to the control group. Study participants included caregivers of infants aged 4 to 24 months undergoing complementary feeding. Pregnant women who were expected to give birth and commence complementary feeding during the period of the study were also included.

Data collection and analysis Two review authors independently extracted data on participants, settings, interventions, methodology and outcomes using a specifically-developed and piloted data extraction form. We calculated risk ratios (RR) and 95% confidence intervals (CIs) for dichotomous data, and mean differences (MD) and 95% CIs for continuous data. Where data permitted, we conducted a meta-analysis using a random-effects model. We assessed the included studies for risk of bias and also assessed the quality of evidence using the GRADE approach.

Main results We included 23 studies (from 35 reports) with a total of 11,170 caregiver-infant pairs who were randomly assigned to receive an educational intervention delivered to the caregiver or usual care. Nineteen of the included studies were community-based studies while four were facility-based studies. In addition, 13 of the included studies were cluster-randomised while the others were individually randomised. Generally, the interventions were focused on the introduction of complementary feeding at the appropriate time, the types and amount of complementary foods to be fed to infants, and hygiene. Using the GRADE criteria, we assessed the quality of the evidence as moderate, mostly due to inadequate allocation concealment and insufficient blinding.

Educational interventions led to improvements in complementary feeding practices for age at introduction of complementary foods (average RR 0.88, 95% CI 0.83 to 0.94; 4 studies, 1738 children; moderate-quality evidence) and hygiene practices (average RR 1.38, 95% CI 1.23 to 1.55; 4 studies, 2029 participants; moderate-quality evidence). For duration of exclusive breastfeeding, pooled results were compatible with both a reduction and an increase in the outcome (average RR 1.58, 95% CI 0.77 to 3.22; 3 studies, 1544 children; very low-quality evidence). There was limited (low to very low-quality) evidence of an effect for all growth outcomes.

Quality of evidence There is moderate to very low-quality evidence that educational interventions can improve complementary feeding practices but insufficient evidence to conclude that it impacts growth outcomes.

Authors' conclusions Overall, we found evidence that education improves complementary feeding practices.

Interventions for increasing fruit and vegetable consumption in children aged five years and under

R Hodder, K O'Brien, F Stacey, R Wyse, T Clinton-McHarg, F Tzelepis, E James, K Bartlem, N Nathan, R Sutherland, E Robson, S L Yoong, L Wolfenden

Cochrane Systematic Review

Abstract

Background Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden.

Objectives To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children

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aged five years and under.

Search methods We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2018. We searched Proquest Dissertations and Theses in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials.

Selection criteria We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements.

Data collection and analysis Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures.

Main results We included 63 trials with 178 trial arms and 11,698 participants. Thirty-nine trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fourteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Nine studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. We judged 14 of the 63 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.

There is very low quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 3.50 g as-desired consumption of vegetables (SMD 0.33, 95% CI 0.13 to 0.54; participants = 1741; studies = 13). Multicomponent interventions versus no intervention may have a very small effect on child consumption of fruit and vegetables (SMD 0.35, 95% CI 0.04 to 0.66; participants = 2009; studies = 5; low-quality evidence), equivalent to an increase of 0.37 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; participants = 3078; studies = 11; very low-quality evidence). Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for four studies reporting industry funding.

Authors' conclusions Despite identifying 63 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low- and low-quality evidence respectively that child-feeding practice and multicomponent interventions may lead to very small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up is required and future research should adopt more rigorous methods to advance the field.

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Face-to-face interventions for informing or educating parents about early childhood vaccination

J Kaufman, R Ryan, L Walsh, D Horey, J Leask, P Robinson, S Hill

Cochrane Systematic Review

Abstract

Background Early childhood vaccination is an essential global public health practice that saves two to three million lives each year, but many children do not receive all the recommended vaccines. To achieve and maintain appropriate coverage rates, vaccination programmes rely on people having sufficient awareness and acceptance of vaccines. Face-to-face information or educational interventions are widely used to help parents understand why vaccines are important; explain where, how and when to access services; and address hesitancy and concerns about vaccine safety or efficacy. Such interventions are interactive, and can be adapted to target particular populations or identified barriers.

This is an update of a review originally published in 2013.

Objectives To assess the effects of face-to-face interventions for informing or educating parents about early childhood vaccination on vaccination status and parental knowledge, attitudes and intention to vaccinate.

Search methods We searched the CENTRAL, MEDLINE, Embase, five other databases, and two trial registries (July and August 2017). We screened reference lists of relevant articles, and contacted authors of included studies and experts in the field. We had no language or date restrictions.

Selection criteria We included randomised controlled trials (RCTs) and cluster-RCTs evaluating the effects of face-to-face interventions delivered to parents or expectant parents to inform or educate them about early childhood vaccination, compared with control or with another face-to-face intervention. The World Health Organization recommends that children receive all early childhood vaccines, with the exception of human papillomavirus vaccine (HPV), which is delivered to adolescents.

Data collection and analysis We used standard methodological procedures expected by Cochrane. Two authors independently reviewed all search results, extracted data and assessed the risk of bias of included studies.

Main results In this update, we found four new studies, for a total of ten studies. We included seven RCTs and three cluster-RCTs involving a total of 4527 participants, although we were unable to pool the data from one cluster-RCT. Three of the ten studies were conducted in low- or middle- income countries. All included studies compared face-to-face interventions with control. Most studies evaluated the effectiveness of a single intervention session delivered to individual parents. The interventions were an even mix of short (ten minutes or less) and longer sessions (15 minutes to several hours).

Overall, elements of the study designs put them at moderate to high risk of bias. All studies but one were at low risk of bias for sequence generation (i.e. used a random number sequence). For allocation concealment (i.e. the person randomising participants was unaware of the study group to which participant would be allocated), three were at high risk and one was judged at unclear risk of bias. Due to the educational nature of the intervention, blinding of participants and personnel was not possible in any studies. The risk of bias due to blinding of outcome assessors was judged as low for four studies. Most studies were at unclear risk of bias for incomplete outcome data and selective reporting. Other potential sources of bias included failure to account for clustering in a cluster-RCT and significant unexplained baseline differences between groups. One cluster-RCT was at high risk for selective recruitment of participants.

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We judged the certainty of the evidence to be low for the outcomes of children's vaccination status, parents' attitudes or beliefs, intention to vaccinate, adverse effects (e.g. anxiety), and immunisation cost, and moderate for parents' knowledge or understanding. All studies had limitations in design. We downgraded the certainty of the evidence where we judged that studies had problems with randomisation or allocation concealment, or when outcomes were self-reported by participants who knew whether they'd received the intervention or not. We also downgraded the certainty for inconsistency (vaccination status), imprecision (intention to vaccinate and adverse effects), and indirectness (attitudes or beliefs, and cost).

Low-certainty evidence from seven studies (3004 participants) suggested that face-to-face interventions to inform or educate parents may improve vaccination status (risk ratio (RR) 1.20, 95% confidence interval (CI) 1.04 to 1.37). Moderate-certainty evidence from four studies (657 participants) found that face-to-face interventions probably slightly improved parent knowledge (standardised mean difference (SMD) 0.19, 95% CI 0.00 to 0.38), and low-certainty evidence from two studies (179 participants) suggested they may slightly improve intention to vaccinate (SMD 0.55, 95% CI 0.24 to 0.85). Low-certainty evidence found the interventions may lead to little or no change in parent attitudes or beliefs about vaccination (SMD 0.03, 95% CI -0.20 to 0.27; three studies, 292 participants), or in parents’ anxiety (mean difference (MD) -1.93, 95% CI -7.27 to 3.41; one study, 90 participants). Only one study (365 participants) measured the intervention cost of a case management strategy, reporting that the estimated additional cost per fully immunised child for the intervention was approximately eight times higher than usual care (low-certainty evidence). No included studies reported outcomes associated with parents’ experience of the intervention (e.g. satisfaction).

Authors' conclusions There is low- to moderate-certainty evidence suggesting that face-to-face information or education may improve or slightly improve children's vaccination status, parents' knowledge, and parents' intention to vaccinate. Face-to-face interventions may be more effective in populations where lack of awareness or understanding of vaccination is identified as a barrier (e.g. where people are unaware of new or optional vaccines). The effect of the intervention in a population where concerns about vaccines or vaccine hesitancy is the primary barrier is less clear. Reliable and validated scales for measuring more complex outcomes, such as attitudes or beliefs, are necessary in order to improve comparisons of the effects across studies.

Working and caring for a child with chronic illness: A review of current literature

A Kish, P Newcombe, D Haslam

Child: Care, Health and Development

Abstract

Background Advances in medical knowledge have contributed to the increase in the number of

children living with some form of long‐term chronic illness or condition. As a consequence of these advancements, treatments that are more accessible and easier to administer, usually within a child's home, have been developed. However, this may mean that parents take on greater treatment responsibility and require extra time and energy to meet these tasks, additional to other responsibilities. This review paper aims to summarize and critique existing literature on working parents of children with a chronic condition, by focusing on patterns of

parent work, the challenges experienced, and the flow‐on consequences to well‐being.

Methods Employing a narrative, meta‐synthesis of the current literature, this review identified 3 key themes related to working parents of children with chronic illness.

Results The paper first identifies that although employment is less common, these parents are not necessarily nonworking. Second, these parents experience numerous challenges including balancing work and family, time constraints, stress, and feelings of “doing it all.” And third, the above challenges lead to additional impacts on parental quality of life.

Conclusions This review summarizes what is currently known about work patterns, challenges,

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and consequences in parents of children with chronic conditions. Employment is clearly impacted for these parents. Although workplace challenges have been extensively researched,

other challenges (eg, personal and family) and impacts on their well‐being have not. This review discusses the present standing of this research. It outlines the strengths and limitations of the current literature, makes recommendations for future research, and suggests theoretical and practical implications of the further findings.

Article Abstracts

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Parent-reported prevalence and persistence of 19 common child health conditions

T Liu, R Lingam, K Lycett, F Mensah, J Muller, H Hiscock, M H Huque, M Wake

Archives of Disease in Childhood

Abstract

Objective To estimate prevalence and persistence of 19 common paediatric conditions from infancy to 14–15 years.

Design Population-based prospective cohort study.

Setting Australia.

Participants Parallel cohorts assessed biennially from 2004 to 2014 from ages 0–1 and 4–5 years to 10–11 and 14–15 years, respectively, in the Longitudinal Study of Australian Children.

Main outcome measures 19 health conditions: 17 parent-reported, 2 (overweight/obesity, obesity) directly assessed. Two general measures: health status, special health care needs. Analysis: (1) prevalence estimated in 2-year age-bands and (2) persistence rates calculated at each subsequent time point for each condition among affected children.

Results 10 090 children participated in Wave 1 and 6717 in all waves. From age 2, more than 60% of children were experiencing at least one health condition at any age. Distinct prevalence patterns by age-bands comprised eight conditions that steadily rose (overweight/obesity, obesity, injury, anxiety/depression, frequent headaches, abdominal pain, autism spectrum disorder, attention-deficit hyperactivity disorder). Six conditions fell with age (eczema, sleep problems, day-wetting, soiling, constipation, recurrent tonsillitis), three remained stable (asthma, diabetes, epilepsy) and two peaked in mid-childhood (dental decay, recurrent ear infections). Conditions were more likely to persist if present for 2 years; persistence was especially high for obesity beyond 6–7 (91.3%–95.1% persisting at 14–15).

Conclusions Beyond infancy, most Australian children are experiencing at least one ongoing health condition at any given time. This study’s age-specific estimates of prevalence and persistence should assist families and clinicians to plan care. Conditions showing little resolution (obesity, asthma, attention-deficit hyperactivity disorder) require long-term planning and management.

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Physical activity at age 11 years and chronic disabling fatigue at ages 13 and 16 years in a UK birth cohort

S Collin, T Norris, K Deere, R J, A Ness, E Crawley

Archives of Disease in Childhood

Abstract

Objective To investigate associations of physical activity at age 11 years with chronic disabling fatigue (CDF) at ages 13 and 16 years.

Design Longitudinal birth cohort.

Setting South-West England.

Participants Adolescents enrolled in the Avon Longitudinal Study of Parents and Children.

Outcomes and exposures We identified adolescents who had disabling fatigue of >6 months' duration without a known cause at ages 13 and 16 years. Total and moderate-to-vigorous physical activity and sedentary time at age 11 years were measured by accelerometry over a 7-day period.

Results A total physical activity level 100 counts/min higher at age 11 years was associated with 25% lower odds of CDF at age 13 years (OR=0.75 (95% CI 0.59 to 0.95)), a 1% increase in the proportion of monitored time spent in moderate-to-vigorous activity was associated with 16% lower odds of CDF (OR=0.84 (95% CI 0.69 to 1.01)) and a 1-hour increase in sedentary time was associated with 35% higher odds of CDF (OR=1.35 (95% CI 1.02 to 1.79)). Disabling fatigue of only 3–5 months’ duration at age 13 years had weaker associations with physical activity, and CDF at age 16 years was not associated with physical activity at age 11 years.

Conclusions Children who had chronic disabling fatigue at age 13 years had lower levels of total and moderate-to-vigorous physical activity and more sedentary time 2 years previously, but this association could be explained by reverse causation.

Effects of a physical activity programme in the school setting on physical fitness in preschool children

P Latorre‐Román, D Mora‐López, F García‐Pinillos

Child: Care, Health and Development

Abstract

Aim The purpose of this study was to examine the effects of a 10‐week aerobic games programme on physical fitness.

Methods One hundred eleven children, aged 3 to 6 years, participated in this study; 60 children were male (age: 4.28 ± 0.61 years old), and 51 were female (age 4.59 ± 0.49 years old). Participants were randomly assigned to an experimental group (EG; n = 56) and a control group (CG; n = 55). A fitness test battery previously validated for preschoolers was used. The children

in the EG performed 3 weekly training sessions of physical activity in a classroom during a 10‐week period. Every EG session lasted about 30 min.

Results There were no significant differences in any variable in the pretest between groups. In the posttest, the EG achieved better results in horizontal jump and sprint. In relation to posttest–pretest differences, the EG showed a greater increase in horizontal jump, sprint, and endurance.

Conclusion An aerobic games programme in the school setting improved physical fitness in preschool children.

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The utility of the Children’s Sleep Habits Questionnaire: Associations between parental report and an objective measure of sleep behavior

K Duraccio, K Carbine, K Barnett, K Stevens, C Jensen

Children’s Healthcare

Abstract

We examined associations between the Children’s Sleep Habits Questionnaire (CSHQ) and sleep parameters assessed via actigraphy in a community sample of 111 children. Hypothesized correlations between CSHQ subscales and actigraphy data were not statistically significant, except for the association between CSHQ daytime sleepiness and actigraphy minutes asleep (r = −0.25, p < 0.05). Children with CSHQ scores above the clinical cutoff demonstrated more significant sleep problems, as assessed by actigraphy. Our findings suggest that while the CSHQ may not be as accurate for assessing specific sleep parameters (e.g., sleep duration), it provides a useful indicator of whether children are at risk for sleep problems in general and whether they experience daytime sleepiness.

Association between seizure frequency and fatigue levels in children with epilepsy

H Kanemura, F Sano, T Ohyama, K Sugita, M Aihara

Journal of Paediatrics and Child Health

Abstract

Aim The purpose of this study was to examine the association between seizure‐related features and fatigue levels in children with epilepsy.

Methods All children were classified into three subgroups based on the state of their seizure

control: well‐controlled epilepsy (WCE; seizure‐free), intermediate‐controlled epilepsy (ICE; seizure frequency < 1×/month) and uncontrolled epilepsy (UCE; seizure frequency > 1×/month).

Participants were asked to rate on a 7‐point scale, from 1 (strongly disagree) to 7 (strongly agree), how often they felt the ways described by nine items on the Fatigue Severity Scale (FSS). A higher score is suggestive of greater fatigue.

Results The study participants comprised 58 children with epilepsy and 15 children without

seizures, who served as the healthy (non‐epilepsy) group. The mean FSS scores of the children with epilepsy were significantly higher than those of the healthy (non‐epilepsy) group (4.40 vs. 1.55, respectively; P < 0.0001). Multiple linear regression analysis showed that seizure frequency was the only characteristic significantly associated with fatigue (P < 0.0001). In the

three epilepsy subgroups, the mean FSS scores for the WCE, intermediate‐controlled epilepsy and UCE groups were 2.30, 3.97 and 6.28, respectively. A higher seizure frequency was associated with more severe fatigue. In particular, children in the UCE group had significantly more severe fatigue than those in the WCE group (P < 0.0001).

Conclusions The results suggest that seizure frequency is also associated with fatigue in children with epilepsy. Improved control of seizures may help reduce fatigue levels and improve the quality of life of children with epilepsy.

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Parent-Provider Communication of HPV Vaccine Hesitancy

L Shay, A Baldwin, A Betts, E Marks, R Higashi, R Street Jr, D Persaud, J Tiro

Pediatrics

Abstract

Objectives To prevent human papillomavirus (HPV)–related cancers, providers must effectively communicate with HPV vaccine–hesitant parents. Here, we developed a typology characterizing parent-provider communication around HPV vaccine hesitancy.

Methods We audio-recorded 43 visits with unvaccinated adolescents at 6 pediatric clinics in Dallas, Texas in which parents were undecided about HPV vaccination. We qualitatively coded how parents verbally expressed hesitancy (assertive response, asking a question, or expressing concern) and whether providers responded with acquiescence (agree to defer vaccination) and/or persistence (continue discussion). We described the frequency of parent and provider communication codes and same-day vaccination.

Results Among the 43 visits, 37 parents expressed hesitancy ≥1 times in many ways. Assertive responses were most common (27 visits), followed by questions (16 visits), and concerns (12 visits). When the first expression of hesitancy was a question or concern, 71% and 75% of adolescents, respectively, received same-day vaccinations, whereas 33% of adolescents who received an initial assertive response were vaccinated. Providers responded with only persistence in 18 visits, a mix of acquiescence and persistence in 13 visits, and only acquiescence in 6 visits. When providers only used persistence, 17 of 18 adolescents were vaccinated; when providers responded with only acquiescence, no adolescents received the vaccine.

Conclusions Our exploratory analysis reveals that providers engaging hesitant parents and addressing their concerns can lead to same-day HPV vaccination. Data reveal that even parents making assertive statements are amenable to influence by providers. Our findings reveal an important missed opportunity when providers simply acquiesce to parental hesitation.

Adolescent Consumption of Sports Drinks

K Cordrey, S Keim, R Milanaik, A Adesman

Pediatrics

Abstract

Background Sports drinks are aggressively marketed to teenagers to replenish fluids and/or electrolytes. According to the American Academy of Pediatrics, typical adolescent physical activity does not require sports drink rehydration. Given US obesity rates and that sugar-sweetened sports drinks add superfluous calories to the diet, it is important to assess adolescent sports drink consumption and changes over time.

Methods Researchers in the 2015 Youth Risk Behavior Survey and 2010 National Youth Physical Activity and Nutrition Survey collected nationally representative samples of US high school students about sports drink consumption. Respondent characteristics and health behaviors were examined relative to sports drink consumption by using multivariable survey logistic regression. χ2 tests were used to compare the 2 samples and examine changes over time.

Results The 2015 Youth Risk Behavior Survey and 2010 National Youth Physical Activity and Nutrition Survey had national samples of 15 624 and 11 458 respondents, respectively. Sports drink consumption in the previous week increased from 56% (2010) to 57.6% (2015; P = .0002). However, comparisons of daily sports drink consumption revealed reductions for all age groups, sexes, race and/or ethnicity categories, and levels of physical activity. The greatest reductions were for non-Hispanic African Americans and for children with overweight. Daily sports drink consumption did not decrease for children with obesity and increased for children who watched

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>2 hours per day of television. In 2015, boys, non-Hispanic African Americans, Hispanics, and tobacco users exhibited higher odds of consuming sports drinks daily.

Conclusions Although daily consumption of sports drinks has decreased overall, sugar-sweetened sports drinks remain popular, with the majority of high school students drinking them at least weekly. Of concern, daily consumption increased among teenagers watching television >2 hours per day. Pediatricians should counsel adolescents about the American Academy of Pediatrics’ recommendations regarding sports drinks.

‘Knowing where I am’: self-monitoring of blood glucose in diabetes

D Meetoo, L Wong, T Fatani

British Journal of Nursing

Abstract

Although the prevalence of all types of chronic conditions is increasing, diabetes is one of the few long-term metabolic disorders that individuals can successfully manage, monitor and control on a day-to-day basis. Self-monitoring of blood glucose (SMBG) is considered an essential component of diabetes self-care management. When used appropriately, SMBG can help to identify factors associated with hyper- and hypoglycaemia, facilitate learning, and empower people with diabetes to make changes to improve their glycaemic control. SMBG can be a useful tool for healthcare providers, who can teach individuals to monitor glucose at specific times to assess the effectiveness of medications and guide medication management. However, there is an ongoing debate regarding whether, as is the case with type 1 diabetes, all people with type 2 diabetes should also be given the opportunity to learn about the value of, and skills required to, monitor blood glucose as appropriate to their specific needs.

Why do mothers stop breastfeeding before 6 months? A literature review

A Wray, J Garside

Journal of Health Visiting

Abstract

Breastfeeding has many psychological, physical and emotional benefits for both the mother and infant that increase and strengthen with its prolonged duration. This review was conducted with the aim of understanding the prevalent factors in breastfeeding discontinuation before 6 months. Seven studies met the search criteria following analysis and four themes emerged: lack of support; physical or emotional health of the mother; maternal choice; and insufficient milk supply. It became apparent that each of these themes was underpinned by a lack of support. The views of mothers crossed a range of sociodemographic differences and, although their views were based on their individual experiences, the value of support from health professionals, family and peers appears to be crucial.

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Library Resources

Health visiting: A rediscovery

K. Luker, J. Orr, G. McHugh

This new edition of an established and well–regarded text is essential reading for those training to become health visitors and those who are practitioners working with and in the community.

Health Visiting: A Rediscovery has been thoroughly revised and updated to reflect the many new developments in health policy, public health priorities and health visiting practice. The focus of the book, however, remains the same: placing the health visitor at the forefront of supporting and working with children and families, ensuring the child has the best possible start in life. The increasing importance of working with communities and reaffirming the public health role of the health visitor are discussed and debated. The new edition takes into account the challenges and increasing need for health visitors to engage with research evidence and to evaluate their practice.

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