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Growing Up in Scotland: Year 2: Results from the second year of a study following the lives of Scotland's children

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CHAPTER 6 CHILD HEALTH AND DEVELOPMENT

6.1 Introduction

This chapter focuses on parental perceptions of their child's health and compares sweep 1 and 2 results as well as data from the two cohorts. An overall measure of parental perceived general health is used as well as a measure of long standing illness or disability and its functional effects. Additionally, respondents were asked about health problems and about accidents and injuries requiring NHS contact. Service use was measured relating to visits to Accident and Emergency departments and contact with health professionals. Toothbrushing information was sought as was data on what sources of advice or help the respondent used. Lastly, respondent perceptions of their child's development were collected and two developmental scales, one for each cohort, were administered.

This chapter focuses on similar issues to the ones covered in the child health chapter in the GUS sweep 1 report. However, in sweep 2 new questions were added or existing questions were modified in order to increase our understanding of particular issues, such as in the child development section.

6.1.1 Types of analysis

The tables and figures in this chapter present the following main types of analysis:

  • Comparisons of the answers given by the main respondent at sweep 1 and sweep 2 (where the same questions were asked at both sweeps). This includes both straightforward comparisons of the proportions giving particular responses at each sweep, and analysis of whether the answers given by individual respondents changed between sweeps or not.
  • In instances where the question was new or was a modified version of a sweep 1 question, analyses tend to be reported for sweep 2 only by cohort or sex of child.
  • Analysis of the answers of respondents by factors that might help explain these results (for example, household income groups or educational background of the respondent).

6.2 General health of children

6.2.1 Parental perceptions of health of children

Table 6.1 shows that although the vast majority of respondents in both sweeps thought that the health of their child was at least good, respondents in sweep 1 were more likely to rate their child's health as being 'very good' in particular. There was also a slight increase in the percentage of respondents stating that the children in both cohorts had fair to very bad health in sweep 2. In sweep 2, respondents with female offspring, higher levels of household income or who were part of couple families tended to rate the general health of their children more highly, as was the case in sweep 1. However, there would appear to be a trend towards a widening gap in the reported general health of children when comparisons are made between those in lone or couple families or from different ends of the household income scale in both sweeps. For example, at sweep 2, in the child cohort only 57% of lone parents compared with 69% of couple family parents perceived that their child's health was very good - in sweep 1, 66% of lone parents compared with 75% of couple parents said that this was the case.

Table 6.1 Perceptions of general health of child by cohort

Child health

Cohort (%)

Birth cohort

Child cohort

Sweep 1

Sweep 2

Sweep 1

Sweep 2

Very good

74.6

66.9

72.9

66.4

Good

19.6

25.6

21.6

26.1

Fair to very bad

5.8

7.5

5.5

7.5

Bases

Weighted

4511

4510

2500

2499

Unweighted

4511

4510

2500

2499

6.2.2 Long-standing illness and disabilities

The respondents were asked whether their child had any long-standing illness (lsi) or disability - the definition of these illnesses or disabilities being any ailment that had troubled or was likely to affect the child over a period of time. In total, 11% and 16% of the birth and child cohorts respectively were reported as having such a health problem in sweep 2 (see Table 6.2), a slightly higher percentage of children were reported as having these problems in sweep 1, although the question asked was slightly different, asking specifically about health problems which had lasted or were expected to last for at least 1 year. It was also the case that lsi and disabilities were more commonly reported in lone parent compared with couple families, with some evidence that the gap between these two groups might be increasing when the two sweeps are compared. In addition, in sweep 2, boys in both cohorts were more likely than girls to be reported as having more lsi and disabilities. In sweep 1 this increased reporting of health problems in boys compared with girls was only observed in the birth cohort.

Table 6.2 Child with long-standing illness or disability by cohort and other factors

Percentage with long-standing illness or disability

All
sample
Sweep 2

All
sample
Sweep 1

Family Type
(at Sweep 2)

Sex of child

Lone parent

Couple

Boy

Girl

Birth cohort

10.9

13.1

14.2

10.1

12.9

8.8

Bases

Weighted

4507

4506

894

3613

2334

2173

Unweighted

4507

4506

746

3761

2324

2183

Child cohort

15.6

16.9

19.8

14.3

16.5

14.6

Bases

Weighted

2499

2497

701

2157

1287

1212

Unweighted

2499

2497

502

1997

1284

1215

The relationship between the presence of lsi or disability and the family household income can be seen in Figure 6-A. Respondents from households with lower levels of income were more likely to report that their children had experienced an lsi or disability at both sweeps 1 and 2 compared with those living in households with higher levels of income. It can also be seen that the proportion reporting such health problems changed very little in the lowest income category when the two sweeps of data collection are compared, whereas in the birth cohort, incidence decreased between sweeps amongst children in the highest household income category.

Figure 6-A Child having long-standing illness/disability by cohort and annual household income

Figure 6-A Child having long-standing illness/disability by cohort and annual household income

Figure 6-B demonstrates that over three-quarters of respondents reported that their child had not experienced a long-standing illness in either sweep. As might be expected given their greater age, the child cohort was about twice as likely to be reported as having such an illness in both sweeps when compared with the birth cohort. Also, as the results in Table 6.2 would suggest, it was more likely that children of couple families were said to have experienced no long-standing illness at either sweep. Females in the birth cohort were more commonly reported as not experiencing a long-standing illness during both sweeps, but this difference was no longer observed in the child cohort. This relates to findings from sweep 1, where there were no significant differences in the extent to which parents of male and female children in the child cohort reported long-standing illness or disability, suggesting that differences in long-standing illness by gender narrow as children age.

Figure 6-B Change in long-standing illness ( LSI) by cohort

Figure 6-B Change in long-standing illness (LSI) by cohort

Respondents were asked for details of up to three long-standing illnesses or disabilities per cohort child in sweep 2, and asked if these limited their offspring's ability to carry out day-to-day activities. Only a few respondents mentioned more than one such ailment per child. However, of those who were reported as having at least one such longstanding illness, 18% and 19% of the birth and child cohorts respectively were said to be limited in their activity as a result (about 2% of all children in the birth cohort and 3% of all children in the child cohort). This finding is very similar to that reported by wave 2 of the Millennium Cohort Study; at age 3, researchers found that around 20% of children with a long-standing illness (3% of all children) were limited in some way by that illness (Hansen and Joshi, 2007).

6.3 Health problems since sweep 1 interview

Respondents were asked if their child had experienced any health problems or illnesses since their previous interview, excluding the long-standing illnesses covered above. It should be noted that in sweep 1 this question was slightly different - it asked for problems which had required contact with the NHS, including visits to the GP, accident and emergency or making a call to NHS 24. This requirement was not included at sweep 2. This resulted in the reporting of a large number of low-level illnesses not considered serious enough for medical attention and thus an increase in the incidence of such problems between sweeps.

Figure 6-C shows that fewer than 5% of respondents said that their child had experienced no health problems or illnesses since the sweep 1 interview. A majority of respondents reported at least two such health problems for their offspring, and 45% of birth cohort compared with 37% of child cohort children were said to have had at least three illnesses. Although there was little difference noted between lone and couple families in terms of children experiencing no health problems, the children of lone families appeared to have had more of these types of illness on four or more occasions (e.g child cohort: 24% 'lone parent' versus 17% 'couples' had experienced four or more illnesses). Male children from the birth cohort were also said to have had four or more illnesses more commonly than their female counterparts, but this difference was no longer observed in the child cohort, again suggesting a narrowing of gender-related health differences as children age already seen in relation to long-standing illness above.

Figure 6-C Number of short-term health problems by cohort

Figure 6-C Number of short-term health problems by cohort

It can be seen in Table 6.3 that by far the most common illness or health problem in children that was reported by respondents was in the 'coughs, colds or fever' category. The next most commonly reported ailments in the whole sample were as a result of skin problems. Table 6.3 also shows that the main reported problems were more common in the birth cohort, with the exception of chickenpox.

Table 6.3 Nature of short-term health problems by cohort

Nature of health problem

Cohort (%)

Birth

Child

Coughs, colds or fevers

89.1

85.1

Skin problems

23.5

19.1

Ear infections

22.6

19.7

Chest infections

20.3

14.6

Chickenpox

14.7

20.0

Sleeping problems

15.7

10.6

Infection of nose or throat, croup, flu, etc.

11.9

11.7

Constipation

11.1

9.3

Bases

Weighted

4511

2500

Unweighted

4511

2500

6.4 Accidents and injuries requiring NHS contact

In addition to health problems, respondents were also asked if the child had experienced one or more accidents or injuries which had required NHS contact since the sweep 1 interview. During the sweep 1 survey, accidents were more commonly reported in the child cohort. Figure 6-D shows that this trend has now reversed with those in the birth cohort experiencing more accidents when compared with those in the child cohort. This reflects the particular developmental stages of the children in each cohort at each sweep and suggests that accidents peak between the ages of 2 and 3. Boys in both cohorts were more likely to require NHS attention as a result of having an accident when compared with their female counterparts (in the birth cohort: 21% versus 16%), a trend also evidenced in sweep 1 data.

Figure 6-D One or more accidents requiring NHS visit by cohort and sex of child

Figure 6-D One or more accidents requiring NHS visit by cohort and sex of child

Table 6.4 shows that increased percentages of birth cohort children with lone parents, from households of lower socio-economic status and lower income households were reported as having accidents requiring a visit to NHS facilities or professionals. However, these factors did not appear to have the same influence on accidents requiring NHS attention in the child cohort. In sweep 1, accidents necessitating contact with the NHS were more commonly reported in lone parent and lower socio-economic status households for both the birth and child cohorts.

Table 6.4 Child having accidents requiring NHS contact by cohort and other factors

Percentage having 1 accident or more in the last year

All sample

Family Type

Household
NS-SEC

Household Income

Lone parent

Couple

Category 1

Category 5

Up to £14999

£44000 and above

Birth cohort

22.8

30.7

20.9

19.7

26.9

28.5

19.1

Bases

Weighted

4511

895

3616

2204

872

1184

891

Unweighted

4511

747

3764

2376

749

1020

996

Child cohort

18.6

19.5

18.4

18.3

19.5

20.4

19.2

Bases

Weighted

2497

581

1916

1220

512

660

512

Unweighted

2497

501

1996

1306

454

575

566

Respondents were asked about the nature of the injury or accident which had required NHS contact - respondents were able to give more than one example but the most serious injuries were to be coded first. Table 1.6 shows that the most common type of the most serious accident experienced by both cohorts was due to a bang on the head. This was also the case in sweep 1 - indeed the nature of the accident and the order of frequency in which these were reported changed little between sweeps. However, the proportions reporting these injuries did change between sweeps. For example, injuries due to a bang on the head were more frequently reported in sweep 1 for both cohorts whereas cuts or broken bones were more prevalent in sweep 2 in the birth cohort only (there was actually a slight decrease observed in the child cohort), as would be expected given the greater mobility of the birth cohort in sweep 2. It can be seen in Table 6.5 that about three-quarters of both cohorts visited casualty as a result of the most serious accident, and that fewer than 5% of respondents' children were reported as requiring in-patient admission. It should be noted that there was little difference observed between the two cohorts in relation to percentages requiring hospital treatment as a result of the most serious accident.

Table 6.5 Nature of first/most serious accident requiring NHS contact by cohort

Nature of accident

Cohort (%)

Birth

Child

Bang on head

43.8

29.8

Cut or graze

12.6

10.5

Cut needing stitches

7.9

13.7

Broken bone

5.8

10.1

Knock/fall (non-penetrating accident)

6.1

7.1

Burn or scald

7.7

4.5

Injury to mouth/face ( e.g. nosebleed)

3.8

6.8

Bases

Weighted

1005

465

Unweighted

1005

465

Note: percentages do not add up to 100% as respondents were able to report on more than one accident

Figure 6-E Percentage of children requiring hospital treatment as a result of most serious accident by cohort

Figure 6-E Percentage of children requiring hospital treatment as a result of most serious accident by cohort

6.4.1 Use of Accident and Emergency departments

Those respondents who reported that their child had visited a casualty department in the previous 6 months were asked to state both what health problem was responsible for the visit (or most recent problem if the child had more than one visit) and why they had visited A&E for medical advice.

Table 6.6 lists the most recent causes of accident and emergency department visits. By far the most frequent reason was because the cohort child had suffered a bang on the head, as would be expected given the results in Table 6.5 above.

Table 6.6 Health problem resulting in most recent visit to Accident and Emergency by cohort

Child's health problem resulting in A&E visit

Cohort (%)

Birth

Child

Bang on the head

23.9

22.5

Cut or graze

7.5

9.2

Coughs, colds or fevers

6.9

4.8

Broken bone

5.5

8.2

Cut needing stitches

5.1

8.8

Persistent or severe vomiting

5.7

3.4

Wheezing or asthma

4.2

6.4

Bases

Weighted

905

360

Unweighted

891

358

Note: percentages do not add up to 100% as respondents were able to report on more than one option, most popular responses listed only

Table 6.7 shows that the most commonly-cited reason for visiting A&E for medical advice was that the treatment or service needed for the child's health problem was only available at such a facility. About one-quarter of those who had recently visited a casualty department had been advised to do so by NHS 24. It is also worth noting that about 10% of those who answered this question said that the opening hours in A&E were more convenient. Other (less frequent) reasons for visits to casualty not listed in the table included the perception that the GP would not be able to assist with the problem and the wait to see the GP was too long.

Table 6.7 Reason for most recent visit to Accident and Emergency by cohort

Main reason for A&E visit

Cohort (%)

Birth

Child

Treatment/service only available at A&E ( e.g. X-Ray)

27.8

32.0

Advised to go by NHS 24

26.6

23.1

Thought the child would receive better care/treatment

14.7

12.3

Advised to go by GP

12.7

10.5

Opening hours were more convenient

10.2

8.5

I couldn't get hold of the GP

6.7

10.6

Bases

Weighted

913

365

Unweighted

899

363

Note: percentages do not add up to 100% as respondents were able to report on more than one option, most popular responses listed only

6.5 Anthropometric measurements, overweight and obesity

Overweight and obesity are terms that refer to an excess of body fat and they usually relate to an increased weight-for-height ratio. The two terms, however, denote different degrees of excess adiposity, and overweight can be thought of as a stage where an individual is at risk of developing obesity (Barlow and Dietz, 1998). The adverse health consequences associated with obesity are related to an increased adiposity rather than an increased weight per se (Taylor et al. 2002) and it is therefore important that any indicator of obesity reflects this increased adiposity. Body mass index ( BMI) takes into account weight and height: it is calculated as weight (kg) divided by squared height (m 2) and it is the key overweight and obesity measure in this chapter.

The main child overweight and obesity prevalence estimates in this section have been produced using the International Obesity Taskforce cut-offs. These cut-offs are based on BMI reference data from six different countries around the world (over 190,000 subjects in total aged 0-25 from UK, Brazil, Hong Kong, the Netherlands, Singapore, and the United States). In summary, the BMI percentile curves that pass through the values of 25 and 30 kg/m 2 (standard adult cut-off points for overweight and obesity, respectively) at age 18 were smoothed for each national dataset and then averaged. The averaged curves were then used to provide age and sex-specific BMI cut-off points for children and adolescents aged 2-18. By averaging the distribution curves from each reference country, the international cut-offs for children purport to be representative of the countries but independent of the overweight or obesity level in each country. One of the benefits of using these international standards is the possibility of making international comparisons. However, the international classification is not without problems: international reference data differ from those for the UK population, and this is reflected in the sex-specific overweight and obesity estimates produced by the International classification.

In light of this lack of consensus on its use, key results have also been produced using the 85th (overweight cut-off)/95th (obesity cut-off) BMI percentiles of the UK reference curves (referred to as the National BMI percentiles classification). The National BMI percentiles classification has been used in the past to describe childhood overweight and obesity prevalence trends in the UK. However, the National BMI percentiles classification were not selected as the primary measure in this report as they are based on the arbitrary assumption that the prevalence of overweight and obesity at the point when the reference data were compiled was 15% and 5%, respectively. Furthermore, there seems to be no indication that these cut-off points relate directly or indirectly to any physiological outcomes or health or disease risks. It is worth noting that the UK component of the International classification used the same sample as that used to construct the UK reference BMI data.

Height and weight measurements were taken of the child cohort only and therefore the analysis in this section is based on the results of measurements for children aged 3-4.

6.5.1 Response to anthropometric measures

The majority of respondents in the child cohort who completed an interview at sweep 2 also gave permission for their child's height and weight to be measured. Overall, 89% of children provided valid measurements and from these the children's Body Mass Index ( BMI) was calculated.

As would be expected for this age, mean heights and weight for boys and girls were almost identical. The mean height for boys was 102 cm and for girls, 101 cm. The mean weights were 17.5 kg for boys and 17.0 kg for girls.

The majority of children of both sexes were of 'normal weight' ( i.e. fell below the 85% percentile). By the International standards this meant that 23% of children in GUS were overweight (including obese). These results are similar to those reported by researchers on sweep 2 of the Millenium Cohort Study for 3 year olds covering the whole of the UK.

6.5.2 Variations in BMI, and in overweight and obesity prevalence, by demographic and socio-economic chracteristics

Girls were more likely than boys to be overweight (19% compared with 16% of boys) and more likely to be obese (7% compared with 5% of boys). Overall, 79% of boys and 74% of girls in the GUS sample were of normal weight, as Figure 6-F demonstrates.

Figure 6-F BMI categories by sex

Figure 6-F BMI categories by sex

Children living in lone parent families were more likely to be overweight or obese than were children in couple families: Twenty-six percent of children in lone parent households were overweight or obese compared with 23% in couple households. However, when girls in both types of households are examined, we see that almost double the proportion of girls in lone parents households are obese (Figure 1-B). Evidence from the birth cohort at sweep 2 suggests that children in lone parent families are more likely to be eating unhealthy foods and drinks on a daily basis (see section 4.4 for further information). Although this data is not yet available for the child cohort, this does suggest that the higher proportion of overweight children amongst lone parent families may be, in part, due to the higher consumption of these foodstuffs by this group of children.

Figure 6-G Obesity prevalence by sex and family type

Figure 6-G Obesity prevalence by sex and family type

Interestingly, there were no significant differences in the prevalence of obese or overweight children by socio-economic group, income or household employment status.

Children who were classified as white, were more likely to be overweight or obese than their non-white peers; 24% of white children were overweight or obese in contrast to just 14% of non-white children.

Figure 6-H BMI categories by ethnic group

Figure 6-H BMI categories by ethnic group

Concerns about childhood obesity stem primarily from worries about the health effects of obesity in adulthood and the resulting pressure on the NHS. It is thought that at least 70% of obese children will become obese adults (Reilly, 2007) and so limiting the childhood obesity epidemic has become a major priority for policy-makers. But what can GUS tell us about the current effects on children's health?

As maybe expected at this stage, parents of overweight and normal weight children were both likely to report their child's health as being good or very good (94% and 92% respectively). However, children who were obese were slightly more likely to have a long-standing illness than overweight (not including obese) or normal weight children (18% of obese children compared with 15% of non-obese children). Despite this, obese children were less likely to have seen a doctor in the last six months than non-obese children - 57% of obese children had visited their doctor in the last six months in contrast to 64% of non-obese children. It will be interesting to track both the prevalence of obesity in these children in future sweeps, as well as exploring the possible health effects of obesity in childhood.

6.6 Contact with health professionals

The interviewees were asked if their child's health had resulted in the respondent or a member of their household contacting or visiting a range of health professionals and services (from the GP or health visitor to NHS 24 or a casualty department) in the last six months.

Figure 6-I shows that 10% of respondents in both cohorts said that they had not contacted any of the designated professionals or hospital services on behalf of their child in the six months prior to the sweep 2 interview. However, 46% of birth cohort parents compared with 38% of child cohort parents reported that they had contacted or visited health professionals or services at least twice due to a concern related to their child's health.

Figure 6-I Percentage of children having one or more contact with health professional or health service by cohort

Figure 6-I Percentage of children having one or more contact with health professional or health service by cohort

Table 6.8 shows that, in both cohorts, a GP had been contacted by over 60% of respondents or household members on at least one occasion in relation to the cohort child, this was more common in the birth cohort. Indeed, most of the named professionals or services had been contacted more frequently in the birth cohort as a result of a health problem in the birth cohort child. The major exception to this, as would be expected, was that 66% of child cohort compared with 43% of birth cohort respondents reported that their child had been in contact with a dentist, presumably for a dental check-up as well as dental health problems experienced by the relevant child. The 'other' category included, for example, unspecified consultants or specialists, paediatricians and opticians.

There was no notable variation in the number of different services used by different sets of parents. For example, mothers in the youngest age group and those in the lowest income group were almost just as likely to have accessed the same number of health services in relation to the cohort child's health as older mothers and those on higher incomes.

Table 6.8 Professional or service contacted on at least one occasion due to child health problem by cohort

Professional or service contacted on at least one occasion

Cohort (%)

Birth

Child

GP or family doctor

69.1

60.3

Dentist

43.0

66.0

NHS 24

34.5

23.8

Health visitor

35.9

19.3

Hospital Accident and Emergency Dept

20.2

14.6

Practice Nurse

14.4

8.5

Other

8.5

11.5

Bases

Weighted

4507

2495

Unweighted

4507

2495

Note: percentages do not add up to 100% - respondents were able to report on more than one option

6.7 Dental health

More frequent toothbrushing was reported in the child cohort, with 84% in this sample having their teeth brushed at least two times per day compared with 72% in the birth cohort (see Table 6.9). Relatively few respondents stated their child was brushing his or her teeth less frequently than daily. It is possible that a greater percentage in the birth cohort had not developed a full set of milk teeth and thus were not having their teeth brushed as often as those in the child cohort. More frequent toothbrushing was reported as being more common among girls in both cohorts and in higher income households, for example, child cohort respondents from the lowest income households were twice as likely to report lower frequency of brushing compared with their counterparts in the highest income category (see Figure 6-J). However, over 99% of respondents who said that their child did have their teeth brushed at least some of the time said that they used toothpaste. About 90% of interviewees also stated that they had first used toothpaste when brushing their child's teeth by the time the child was 1 year old.

Table 6.9 Frequency of toothbrushing by cohort

Frequency of toothbrushing

Cohort (%)

Birth

Child

Twice a day or more

72.0

84.1

Once a day

24.1

14.7

Less than once a day/rarely/not at all

3.8

1.2

Bases

Weighted

4511

2499

Unweighted

4511

2499

Figure 6-J Percentage of children brushing less frequently than twice per day by cohort, sex and household income

Figure 6-J Percentage of children brushing less frequently than twice per day by cohort, sex and household income

As would be expected, respondents of birth cohort children were more likely to be involved in actively brushing their child's teeth than the respondents of the child cohort sample (Table 6.10). There was also some evidence to suggest that children in lower income households or of lone parent families were more likely to be involved in brushing their own teeth. For example, when the results of the child cohort are looked at, 9% of those in the lowest income households said that their child brushed his/her own teeth compared with 1% of the children in the highest income sub-group.

Table 6.10 Supervision and conduct of toothbrushing by cohort

Organisation of toothbrushing

Cohort (%)

Birth

Child

Respondent cleans teeth

33.8

16.7

Respondent supervises and does most brushing

42.5

42.4

Respondent supervises but child does most of brushing

17.9

30.7

Respondent supervises but child does all brushing

3.6

5.8

Child brushes by him/herself

2.3

4.4

Bases

Weighted

4476

2494

Unweighted

4481

2494

6.8 Sources of help, information and advice on child's health

All parents were asked about the sources of help, information and advice they had used in the last year when they had concerns over the sample child's health. The list of sources presented to respondents included formal services such as family doctors, telephone helplines (such as NHS 24) and health visitors, and informal resources such as the child's grandparents, other family members or the respondent's friends. Parents could list as many sources of help as they wished. They could also indicate that they had had no concerns over the child's health and behaviour in the last year and had therefore not drawn on any person or service for help or advice on these matters.

Nineteen percent of respondents reported that they had no concerns about their child's health during the previous year for which they needed to seek help, information or advice (17% for birth cohort and 24% for child cohort children.) The proportions of respondents in both cohorts using the main types of reported information and advice sources are detailed in Figure 6-K below. A majority of respondents had sought advice and information from at least one source, with the family doctor or GP being the most popular source of help. The respondent's parents, NHS 24, health visitors and other family members or friends with children were also popular sources of advice. As may be expected, the particular sources used for information or advice on child health are quite different to those used for help and advice on children's diets, eating habits and healthy eating (see section 4.6). Whereas in relation to children's diets paper sources are preferred, parents are much more likely to seek the advice of a person, particularly a GP, about their child health concerns. Notably however, informal sources, such as family and friends, feature prominently in both situations.

Parents in the birth cohort were more likely to have used each source of information than their counterparts in the child cohort. Also, it is evident that many respondents had used more than one source of help. Some differences in use of particular sources were noted. For example, those in the lowest household income group were less likely to say that they had sought help from books, leaflets and the internet compared with those in the highest income quartile. Also, in the birth cohort 79% in the highest income group compared with 67% in the lowest income group reported seeking help from a GP, but this difference was not observed in the child cohort. This reflects not only fewer health problems observed in the older cohort (as illustrated in Figure 6-C above) but also perhaps a growing confidence among parents in their ability to diagnose and treat common and trivial illnesses in their children without the need to seek help or advice from others. In similarity to findings around advice seeking around children's diets in section 4.6, differences were also noted by level of maternal education. Again, compared to those with no qualifications, mothers educated to Standard grade, Higher grade or beyond were more likely to have sought advice and to have consulted more sources.

Figure 6-K Percentage of parents using each source for help, information or advice on sample child's health by cohort

Figure 6-K Percentage of parents using each source for help, information or advice on sample child's health by cohort

6.9 Child development

6.9.1 Concerns about child's development and behaviour

Figure 6-L demonstrates that, as was the case in sweep 1, respondents were more likely to express concern about the development and behaviour of child cohort children than of birth cohort children (19% versus 12%). This is to be expected given the increased capacity of children in the older cohort to demonstrate developmental milestones and express themselves behaviourally. As a result, if both sweeps are compared, the level of concern expressed is similar for the child cohort (19% at both sweeps) but has increased in the birth cohort (from 8% to 12%), as the younger age group are now able to meet more developmental milestones. Figure 6-L also shows that parents were more likely to express concerns about the development and behaviour of male than female children in both cohorts - in sweep 1 this trend was only detected in the child cohort. Concerns about the development of children in both cohorts was more commonly expressed by lone parent families compared with couple family respondents, as well as in lower income households.

Figure 6-L Concern about child's development, learning and behaviour by cohort, sex and family type

Figure 6-L Concern about child's development, learning and behaviour by cohort, sex and family type

Figure 6-M Concern about child's development, learning and behaviour by sex and sweep: child cohort

Figure 6-M Concern about child's development, learning and behaviour by sex and sweep: child cohort

Figure 6-M shows that 12% of male children in the child cohort were reported as causing some developmental and behavioural concern in both sweeps compared with only 6% of girls. It should also be noted that in the birth cohort 13% of boys compared with only 6% of girls were said to be the source of general developmental concern in sweep 2 only. In addition, those in lower income households or in lone parent households were more likely to report concerns in both sweeps (in both cohorts) than their counterparts in higher income or couple households ( e.g. child cohort: 'any concerns in either sweep': lowest income group = 39%, highest income group = 21%).

6.9.2 Speech and language development

Figure 6-N shows that the great majority of interviewees said that their offspring in the child cohort could make themselves understood by the respondents, by other friends or family members and by strangers. As would be expected, given the age of those in the birth cohort, lower percentages were reported as being able to make themselves understood by the same groups, although this ranged from 84% of respondents compared with only 36% of strangers mostly understanding what children in this cohort were saying. There was evidence to suggest that girls, and children in couple family and higher income households were more likely to be able to make themselves understood by respondents, family members and strangers. It should be noted that only the child cohort respondents were asked these questions during sweep 1.

Figure 6-N Children mostly able to make themselves understood by respondents, friends/family and strangers by cohort

Figure 6-N Children mostly able to make themselves understood by respondents, friends/family and strangers by cohort

Table 6.11 shows that there was an increase in respondents stating that their child in the older cohort could make him/herself mostly understood by respondents, but particularly by friends and family and strangers, as relatively low percentages of these groups were said mostly to comprehend the child in sweep 1. For example, 63% of boys in sweep 1 were said to be mostly understood by strangers compared with 75% of the boys in the sweep 2 survey. The table also demonstrates that girls were more able to make themselves understood than were boys in both survey sweeps - this was also true amongst the birth cohort at sweep 2.

Table 6.11 Percentage of children able to make themselves understood by respondents, friends/family and strangers by sex and sweep (child cohort)

Children able to make themselves understood by:

Child's sex and sweep (%)

Boys sweep 1

Boys sweep 2

Girls sweep 1

Girls sweep 2

Respondents

94.9

96.9

97.7

98.8

Friends and family

78.5

84.7

87.5

92.7

Strangers

62.9

74.9

73.7

84.3

Bases

Weighted base

1285

1287

1212

1212

Unweighted base

1283

1284

1215

1215

It can be seen in Table 6.12 that the vast majority of respondents in both cohorts expressed no concerns about their child's speech and language. In the child cohort however, there was a slight increase in concern between sweeps. For example, 9% of respondents thought that their child was pronouncing words poorly in sweep 2 compared with 6% reporting this at sweep 1.

Table 6.12 Concern about cohort child's speech and language by cohort

Type of concern

Cohort (%)

Birth cohort

Child cohort

Sweep 1

Sweep 1

Sweep 2

No concerns

85.0

85.0

83.2

Language is developing slowly

12.7

7.9

6.3

Child pronounces words poorly

2.1

5.6

8.7

Hard for others to understand child

3.3

4.4

4.9

Child stutters

0.04

1.0

1.3

Child doesn't hear well

0.2

0.7

0.8

Child doesn't seem to understand others

0.3

0.3

0.5

Other

1.1

0.9

2.3

Bases

Weighted

4484

2483

2483

Unweighted

4512

2499

2499

Girls in the child cohort were less likely than boys to cause their parents concern in relation to the development of their speech and language (Figure 6-O). Around 84% of parents of girls in the older cohort reported no concerns in this regard in both survey sweeps. In addition, parents in lower income households or lone parent families were more likely to report this type of concern than those in higher income or couple family households were; 72% of parents in the lowest income group had no concerns at either sweep compared with 82% in the highest income group. This pattern is similar to the one observed in relation to general developmental and behavioural concerns in section 6.9.1 above.

Figure 6-O Concern about child's speech and language by sex and sweep

Figure 6-O Concern about child's speech and language by sex and sweep

6.9.3 Development scales

In sweep 2, within the self-completion section of the interview, respondents had to complete questions which assessed their child's communication, emotional development, understanding and interaction with peers. Questions for parents in the birth cohort form the Infant/Toddler checklist of the Communication and Symbolic Behaviour Scales ( CSBS) (Wetherby and Prizant, 2001), whereas parents in the child cohort completed the Strengths and Difficulties Questionnaire ( SDQ) (Goodman, 1997).

The CSBS Infant/Toddler checklist is designed for use with children aged between 6 and 24 months and can help identify children at risk of developmental delay. Results from the checklist are used to produce three composite scores each assessing different aspects of the child's development - social communication, expressive speech/language and symbolic functioning. 12 A total score can also be calculated by summing the three composite scores. Those children who score below a certain level on the scale are considered to be 'of concern' in relation to their development.

Table 6.13 shows the percentage of children who returned a score which placed them in the 'concern' category for the different and total composite scores. It is evident that boys were more likely than girls to fall into the developmental concern category, particularly in relation to speech development. For example, 20% of boys in the birth cohort were classed as 'of concern' in the speech composite compared with 12% of girls. This is similar to the finding in section 6.9.2 above where parents of male children were more likely to be concerned about their child's speech and language development than were parents of female children. Indeed, children whose parents noted concern about their speech and language produced a lower mean average score on both the speech composite (9.0 compared with 11.6) and the overall CSBS scale (45.2 compared with 49.8) than children whose parents had no concerns. However, parental notions of concern did not always match up with results from the CSBS scale. For example, only 39% of children whose parents were concerned about their speech and language actually fell into the concern category of the speech composite.

Table 6.13 Percentage of children in CSBS 'concern' category by sex (birth cohort)

Birth cohort: % in concern category:

Child's sex (%)

Boys

Girls

Social composite

8.0

6.0

Speech composite

19.5

11.7

Symbolic composite

10.3

4.7

Total composite

11.2

5.5

Bases (for total composite)

Weighted

2138

1997

Unweighted

2137

2011

Lower scores on the total scale were returned by parents in lower income households and by those who had no educational qualifications. For example, 16% of children of respondents with no educational qualifications were rated as being in the overall concern range compared with 7% of children of respondents with at least Higher grade qualifications (see Figure 6-P). This matches general patterns in the parental concern data seen above. This trend by household income and maternal education was also discernible in the individual composite scores, and it is worth noting that 28% of children of respondents with no qualifications were in the concern range in terms of the speech composite rating.

Figure 6-P CSBS Infant/Toddler Checklist: Percentage of children in 'concern' group for total composite by annual household income, highest educational qualification of respondent and sex (birth cohort)

Figure 6-P CSBS Infant/Toddler Checklist: Percentage of children in 'concern' group for total composite by annual household income, highest educational qualification of respondent and sex (birth cohort)

Parents in the child cohort completed the Strengths and Difficulties Questionnaire ( SDQ). The SDQ is a brief behavioural screening questionnaire designed for use with 3-16 year olds. The scale includes 25 questions which are used to measure five aspects of the child's development - emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and pro-social behaviour. A score is calculated for each aspect, as well as an overall 'difficulties' score which is generated by summing the scores from all the scales except pro-social. For all scales, except pro-social where the reverse is true, a higher score indicates greater evidence of difficulties. To simplify analysis and provide a general overview, a mean score was generated for the whole cohort on each of the five scales and the overall difficulties scale. The analysis below focuses on those groups who were more or less likely to score below or above the mean.

Table 6.14 demonstrates that male children, and children of respondents in lower income households or with no educational qualifications had, on average, higher mean SDQ scores, indicating that they were more likely to exhibit difficult behaviour, than female children and those living in higher income households or whose parents had educational qualifications.

Table 6.14 Mean SDQ total difficulties scale score by sex, household income and educational qualifications (child cohort)

Sample characteristics

Mean difficulties score

Bases

Weighted

Unweighted

All children in child cohort

8.2

2464

2465

Sex

Boys

8.7

1267

1197

Girls

7.7

1264

1201

Household income

Up to £14,999

9.8

647

562

From £15,000 to £25,999

8.1

492

489

From £26,000 to £43,999

7.8

649

688

£44,000 and above

6.8

511

565

Respondent educational qualifications

No qualifications

10.8

249

221

Standard grade or other

8.9

440

413

Highers or above

7.7

1771

1827

6.10 Key points

  • The vast majority of respondents said their child's health was at least good, although between sweeps 1 and 2 there was some decrease in the proportion of parents using 'very good' and some increase in the proportion using 'fair', 'bad' or 'very bad', to describe their child's health.
  • In total, 11% and 16% of the birth and child cohorts respectively were reported as having a long-standing health illness or disability. In both cohorts, long-standing illness was more common in boys than girls. Less than 10% of children in the child cohort, and less than 5% in the birth cohort were reported to have a long-standing illness at both sweeps.
  • Data from the two sweeps suggest that accidents amongst young children are most common between the ages of 2-3 years. At sweep 2, parents of boys continued to be more likely to report their child had had an accident than parents of girls.
  • Nine out of ten parents in both cohorts had been in contact with a health professional in relation to their child's health at least once in the six months prior to their interview, and around two-fifths had done so on two or more occasions.
  • GPs continued to be the main source of information or advice on child health. However, some key differences were identified across the sample in the extent to which this, and other, sources of information were likely to be used. For example, those in higher household income groups were more likely to say that they had sought help from books, leaflets, the internet (both cohorts) and the GP (birth cohort only) compared with those in lower household income groups.
  • In both cohorts, boys were shown to perform less well than girls on the child development scales. Some stark differences in levels of communication skills and problematic behaviour were also evident by household income and maternal education.

6.11 Conclusion

Overall, children of this age are reported as being healthy, with only a small percentage reporting their children's health to be fair to very bad. However, there was a slight increase in this proportion in both cohorts across the two sweeps. There was also a slight increase in the percentage of children reported as having a long-standing illness or disability, and evidence of a income gradient - those in higher income households were less likely to report a child with long standing illness or disability. Differences were also apparent between lone parent and couple families; however, this association will be confounded by socio-economic status. We are thus likely to see the gradual emergence of a gradient for these health related measures according to socio-economic status; further analytical work will be able to unpack the importance of different measures of disadvantage.

As would be expected, respondents reported a large number of minor illnesses, which they dealt with themselves, with lone parents reporting more of such health problems. Only 10% of respondents in both cohorts had not contacted a health professional in relation to their child's health in the preceeding six months with the most common contact being a GP. GPs were also the most frequently cited source of advice about a child's health. This suggests that primary care remains a very important resource for parents and their children.

The prevalence of accidents is related to a child's age, and these findings show that the number of children having accidents that required an NHS visit increased in the birth cohort and decreased slightly for the child cohort in the second sweep. Gender differences persisted, with boys being more likely to have accidents than girls. A higher proportion of children in more disadvantaged circumstances experienced accidents and injuries.

In relation to child development, we can see quite clear differences by measures of advantage and disadvantage and family type. Also, parents were more likely to express concerns about the development and behaviour of boys than girls. With the child cohort nearly one-fifth expressed concern about their child's development, learning or behaviour. The results of the CSBS for the birth cohort showed that lower scores (therefore in the 'concern' range) on the total scale were returned by parents in lower income households and by those with no educational qualifications. The SDQ for the child cohort also identified some differences in the mean scores by household income and level of education - namely that higher scores (suggesting more difficulties) were evident in lower income households and among children whose mothers had no qualifications. These results suggest that educational level of the respondent is very important, and as reported in other chapters, this is emerging as a crucial site for intervention if adverse outcomes for parents and children are to be avoided or ameliorated.