UK – Ofsted to issue accident guidance

Following a successful appeal by a nursery owner, Ofsted is planning to issue precise guidance on what constitutes a ’serious’ accident requiring notification.

The owner of a Yorkshire setting had been given notice to improve by Ofsted because she did not notify child protection agencies when a child fell and cut her lip.

The dispute between Ofsted and Granby House Nurseries, which has four settings in Rotherham and Worksop, has prompted the inspectorate to publish new guidance for nurseries on what should be regarded as a serious accident.

The guidance is expected to be sent to providers in the autumn. The notice to improve has been removed from the nursery’s Ofsted report.

The child, who fell while walking inside the Wickersley nursery, Rotherham, went to hospital for the cut to her lip, which required stitches. The incident was reported to Ofsted, but while an inspector concluded that the accident could not have been avoided, she said that the nursery should have informed child protection agencies, as it is an EYFS requirement to report serious accidents or injuries to children in its care.

Jo Gray (pictured), owner of Granby House, said that the EYFS guidance does not define what a serious accident or injury is.

Ms Gray complained to Ofsted after speaking to Rotherham Safeguarding Unit, which advised her it was not general practice to contact it in such situations. In a letter dated 25 August, Ofsted notified Ms Gray her complaint had been upheld.

The letter said, ‘Arrangements have been put in place to devise a factsheet for staff and providers on what is a serious accident, and for any where referrals are to be made to child protection agencies.’

It added, ‘There is no clear guidance or clear definition in the EYFS of what is a serious accident or when they should be referred to child protection agencies. There was no reference to possible child protection concerns in the regulatory inspector’s report and she did not discuss this with you. Therefore, this aspect of your concern is upheld and the outcome summary report is to be updated to reflect that no further action is required and there was no breach in the EYFS Welfare requirements.’

Ms Gray said, ‘I hope that, following my complaint, there will be detailed guidance issued as to what constitutes a serious accident to ensure providers don’t go through the same ordeal we have. Now we have had this notice to improve removed, we can carry on doing what we do best: providing quality care for all our children.’

http://www.nurseryworld.co.uk/news/bulletin/NurseryWorldUpdate/article/1025134/?DCMP=EMC-CONNurseryWorldUpdate

NZ – Safety a burning issue

Firefighters, the Rodney District Council and ACC have teamed up to make Rodney safer for children for this week’s Safety New Zealand Week.

Rodney fire services visited childcare providers around the district to present information packs to children and their parents on home safety.

The pack contains pamphlets on hot water and fire safety, home safety tips, Firewise balloons and stickers, as well as discount vouchers for smoke detectors.

Children under the age of five have the highest incidence of burns of all types, Silverdale station senior officer Vaughan Mackereth says. Between the years 2004 to 2008, an average of 1100 children annually have been admitted to hospitals with burns.

Around half of the patients were between the ages of one and two, who were victims of hot water or hot liquid spillage.

Young skin burns quicker and deeper at a lower temperature than adult skin.

ACC is encouraging people to make one simple change during the week to make their homes safer.

Visit www.homesafety.co.nz for information and a quiz on how you can make your home a safer.

http://www.stuff.co.nz/auckland/local-news/rodney-times/4084315/Safety-a-burning-issue

Childhood obesity is rising rapidly in Mumbai: Dr Sanjay Borude

On Monday, Dongri resident Nazir Abdul Ahmad Rehman, 53, left his 100-sq metre tenement for the first time in five years. He underwent a three-hour-long bariatric surgery, which will finally enable him to lead a normal life. Dr Sanjay Borude of Breach Candy hospital, who performed the surgery successfully on Rehman, spoke to DNA on the growing obesity problem in the city.

Borude is the former vice president of Obesity Surgery Society of India and is currently the Asia-Pacific representative, International Federation of Surgery for Obesity.

Rehman, at 190 kilos, has not been able to walk for a long time. Post surgery, how soon will he experience noticeable weight-loss?
He will be able to go for a routine walk six months after the surgery. In six months, he will reduce almost 40 kilograms.

What is the success rate of bariatric surgery?
I have been performing this surgery for the past ten years, and have operated on more than 1,000 patients. I have not seen a single mortality in this procedure. However, there is a risk involved of less than 1%, due to some complication that may occur.

Who is an eligible candidate for obesity surgery?
People with a body mass index (BMI) of more than 37.5 due to weight are eligible for this surgery. I see a lot of female patients who come for this surgery before marriage. I have performed more than 40-50 surgeries on patients of marriageable age and post surgery their lives have changed.

Is childhood obesity on the rise?
In a city like Mumbai, childhood obesity is rising rapidly. My youngest patient is a 14-year-old who weighs 120kg. But after the surgery, he weighs 80-85 kg. Now, after increasing awareness about surgery as an option to lose weight, more and more parents are approaching the hospital with queries. I see a lot of teenagers between 14 and 18 years who are morbidly obese. Some of these children are also diabetic.

How many days of hospital stay is required post surgery? What kind of surgeries are available for obesity?
There are two options available for obesity surgery: Sleeve gastrectomy and gastric bypass. Sleeve gastrectomy is a restrictive form of weight-loss surgery in which approximately 85% of the stomach is removed, leaving a cylindrical or sleeve-shaped stomach. This has a capacity ranging from about 60 to 150cc. The removal of the major part of the stomach results in virtual elimination of ghrelin hormones which stimulate hunger. As the new stomach continues to function normally, there are far fewer restrictions on the food which patients can consume after surgery, though the quantity of food eaten will be considerably reduced.

What kind of tests are done before weight-loss surgery?
Certain basic tests are done prior to surgery: A complete blood count (CBC), urinalysis, and a chemistry panel, which gives a readout of about 20 blood chemistry values. Often a glucose tolerance test is done to evaluate for diabetes, which is very common in overweight persons. All barring the very young will have to get a chest X-ray and an electrocardiogram done. Women may have to go for a vaginal ultrasound to look for abnormalities of the ovaries or uterus.

http://www.dnaindia.com/mumbai/interview_childhood-obesity-is-rising-rapidly-in-mumbai-dr-sanjay-borude_1432334

Early and late birth ups cerebral palsy risk

Full-term babies born a bit on the early or late side are at higher risk of cerebral palsy, according to a new study in nearly 1.7 million Norwegian children.

“It is important to emphasize that the absolute risk is still very low and the vast majority of children being born some weeks away from 40 weeks (full-term) will not develop cerebral palsy,” Dr. Dag Moster of the University of Bergen in Norway, one of the study’s authors, told Reuters Health.

Cerebral palsy is a collective term for several disorders that involve the brain and nervous system that first appear in early childhood. It is the most common reason for disability in childhood and is thought to occur because the brain has been damaged during fetal development or early infancy.

According to the March of Dimes, two to three out of every 1,000 children born have cerebral palsy; the non-profit group estimates that there are 800,000 children and adults with the condition in the United States.

Preterm birth is well known to increase cerebral palsy risk, but most children with the condition aren’t born prematurely, Moster and his colleagues point out in the latest issue of the Journal of the American Medical Association.

To investigate whether being born later might influence risk as well, they looked at nearly 1.7 million children born in Norway at 37 to 44 weeks’ gestation between 1967 and 2001. A total of 1,938 of these children were known to have cerebral palsy.

The lowest risk of cerebral palsy, the researchers say, was seen in children born at term (40 weeks), with about one in every 1,000 of these children having cerebral palsy.

The risk of having cerebral palsy was higher with earlier or later delivery. The risk for children born at 37 weeks was nearly 2 in 1,000; it was 1.25 in 1,000 for children born at 38 weeks; 1.36 in 1,000 for children born at 42 weeks; and 1.44 for children born after 44 weeks.

The reason for these increased risks at 37 or 38 weeks’ gestation, or at 42 weeks or beyond, are not clear, Moster said.

One possibility is that a newborn’s brain may be more vulnerable if he or she is born shortly before or after the normal 40-week mark. “An alternative explanation may be that fetuses prone to develop cerebral palsy have a disturbance in timing of birth making them more prone to be delivered either early or late,” Moster said.

Until the biological reason for the link between pregnancy duration and cerebral palsy risk becomes clear, the researchers say, “it would be hasty to assume that interventions on gestational age at delivery could reduce the occurrence of cerebral palsy.”

“Women having a normal delivery outside 40 weeks,” Moster said, “still have a very small risk…that their child will develop cerebral palsy.”

SOURCE: link.reuters.com/vah58n JAMA/Journal of the American Medical Association, September 1, 2010.

http://uk.reuters.com/article/idUKTRE67U5FH20100831

US – Kindergarten Boot Camp?

In Murrieta Valley, California, parents are offered the option of enrolling their children in “kindergarten boot camp,” a summer program designed to help them survive the treacherous transition from home or child care to kindergarten. Children work on letter, number, and shape recognition, school routines, and other skills they are expected to know.

Similar programs are popping up all over the country, in response to parents’ anxiety about their youngsters’ ability to deal with the harsh realities of today’s kindergartens. One such boot camp in Nebraska lasts all year. “Boot Camp will help your child master important pre-reading and pre-writing skills,” says the web site of the children’s museum that sponsors it.

At the kindergarten boot camp of the Harlem Success Academy, a high-pressure charter school in New York City, young children are drilled on how to move through the “zero noise” corridors in straight lines with their mouths shut and their arms at their sides.

In many communities, children starting kindergarten are expected to know the alphabet, count accurately to 10 or higher, know the days of the week, recognize colors and shapes such as cones and spheres, and be able to complete worksheets on these and other concepts.

Many of the academic tasks kindergartners are now expected to master were previously reserved for first or second grade. As a result, today’s classrooms are often tightly structured. Some even require teachers to follow scripts designed to drill children on literacy and math skills, with frequent tests. At one Milwaukee school, kindergartners take nearly 160 required tests during the year, in reading, writing, spelling, math, social studies, science, and health.

Intense Academics in Kindergarten Have Not Produced Good Results

Has this massive change in the nature of kindergarten over the last generation produced positive results? Increasingly, researchers, educators, and children’s advocates say no.

“Evidence is mounting that intensive didactic approaches in kindergarten have not yielded long-term gains,” says Joan Almon, executive director of the nonprofit Alliance for Childhood. “The most reliable and valid tests, like the National Assessment of Educational Progress, show little or no progress. And for many children, these ramped-up expectations are actually causing harm.”

“That the image of ‘boot camp’ for young children has caught on in so many places is telling,” says Edward Miller of the Alliance. “Kindergarten was designed as a place to introduce children to the pleasures of learning and exploring the wider world, mainly through play and discovery. Now we talk in terms of preparing them for combat—as if school is a war zone, or a prison.”

Almon and Miller are co-authors of the 2009 report “Crisis in the Kindergarten: Why Children Need to Play in School.” It documents the importance of free play in early education and the extent to which play has been pushed out of kindergarten. The authors argue that the push for early academics is based on unproved assumptions.

For example, they point to recent research in England and New Zealand that compared children who were taught to read at age five with those taught to read at seven. By age eleven there was no difference in reading ability between the two groups.

These findings complement earlier studies in the U.S. and Germany comparing children in play-based preschool and kindergarten classrooms with others in programs focused on academic skills. Within a few years the children in playful programs were significantly ahead of the others in academic achievement.

“Crisis in the Kindergarten” argues that a gross overemphasis on high-stakes tests of reading and math skills has contributed to the loss of play in early childhood education and created a false sense of progress. That argument was bolstered by this summer’s testing debacle in New York, which revealed that several years of increasing proficiency scores were illusory. Nevertheless, policymakers and commentators have responded to the latest news by calling for more academics and tougher tests. In other words, more boot camp for young children.

The Connection Between Play Deprivation and Behavior Problems

Almon and Miller of the Alliance point to evidence that inappropriate expectations and play deprivation contributes to behavioral problems, especially in young boys. In a 2005 study, Walter Gilliam of Yale University found that public preschools were expelling students at an alarmingly high rate, and that 4.5 times as many boys as girls were affected. Gilliam also noted a striking relationship between play and expulsion: preschools with the least amount of time for dramatic play had the highest rates of expulsion.

“Years of research on the role of play in early childhood shows that it contributes to self-control, problem solving, empathy, cooperation, and communication skills,” says Joan Almon. “By depriving children of play, we rob them of the chance to develop the tools they need to get along with others and succeed in school and in life.”

Kindergarten teachers who were surveyed in a study conducted by Jennifer Astuto of New York University expressed concerns about the lack of time for play and the pressures to do academic work.

“The school day is very structured and is run on a tight schedule,” wrote one teacher. “The students are not given snack, play, or nap time.”

“They move from mini lessons conducted on the carpet to follow up work at their desks,” said another. “Our day is very intense and provides very little free play, choice time, or any arts and crafts time.”

“Many kindergarten students are missing out on socializing with their peers,” wrote a third. “They need to learn about sharing, caring, and being a good friend and respect for people and things.”

This pressure-cooker atmosphere has led increasing numbers of parents to “redshirt” their five-year-olds, holding them back from starting kindergarten until they are six. The most recent census data, for 2008, shows that 17 percent of children entering kindergarten were six or older.

The loss of play, active learning, and discovery in kindergarten may well be related to a disturbing decline in measures of creativity in American children, says the Alliance for Childhood. “We know that play fosters creativity,” says Ed Miller. “And we have been hearing the same complaint from veteran teachers and others who work with young children: today’s children have very little imagination. That’s scary.”

“It’s high time for early childhood education to do an about-face,” says Joan Almon, “and reject the boot-camp mentality. Young children don’t need to be coerced into learning. They love hands-on exploration and play. Teachers need to work with the grain and support that way of learning, while setting age-appropriate goals for achievement.”

http://www.healthnewsdigest.com/news/Children_s_Health_200/Kindergarten_Boot_Camp.shtml

India – Billabong High school arranges Nutrition Seminar for preschool parents

The objective of this seminar was to create awareness on the importance of nutrition and to provide useful insights on a preschooler’s nutritional requirement for enhancing the physical and intellectual development of the child.

Billabong High International School, Malad in association with the Indian Dietetic Association and Cadbury Bournvita conducted a nutrition seminar for the parents and students of its preschool, Kangaroo Kids. The objective of this seminar was to create awareness on the importance of nutrition and to provide useful insights on a preschooler’s nutritional requirement for enhancing the physical and intellectual development of the child.

According to the National Family Health Survey (1992-93), more than half (53%) of children below four years of age were under nourished. In 1998, 29.1% children between 1-5 years of age suffered from moderate and 12.3% from severe under-nutrition and one of the major reasons for this being lack of awareness. 45.9% of India’s under-three kids were found underweight as per NFHS – 3, 2005-06.

The awareness seminar highlighted the nutritional requirements of kids in the age group of 1 – 5 years and the various dietary ingredients which can help the overall growth and development among children. The parents were asked to fill a form with details regarding their child’s diet, height, weight and age, the information was analyzed and basis the same a personalized diet regime was shared with them.

The seminar was conducted by . Priya Kathpal, a Clinical and Sport nutritionist from IDA, one of the largest bodies in India of dietitians. Sharing her insights on nutritional requirements for kids, . Kathpal said, “As preschool-aged children go through remarkable physical changes of all kinds, their food intake becomes a critical aspect of this growth and development; 75% of the total brain development occurs between 6 months – 5 years.

Recent research shows that nourishing food not only makes a child healthier, it makes him emotionally more stable, and it improves school performance. It is up to the parents to, first of all, be clever about insinuating nutritious foods into the family menus and, secondly, take a reasonable but hard line when other approaches fail. To make sure that they are successful in doing so they need to be aware of the nutrient requirements of the child and that is exactly what the seminar aimed at.”

Manju Borkar, Principal of Billabong High International School, Malad, said “We feel it is imperative for the parents to be aware of the nutritional requirements of children especially of younger children where nutrition plays a critical role in the child’s development across facets. The seminar was very useful and enlightening and the parents were very appreciative of it; they were particularly enthusiastic to receive the personalized nutritional diet chart for each child.”

The seminar will also highlight the anxiety in parents related to food likes, dislikes and requirements which change on continuous basis among preschool and toddlers. Understanding that these changes are a normal part of development, and understanding the nutritional requirements for this age group, will help parents make educated decisions.

http://www.indiainfoline.com/Markets/News/Billabong-High-school-arranges-Nutrition-Seminar-for-preschool-parents/4919286911

US – Understanding the High C-section Rate in the US

The percentage of babies born by Cesarean section remains high, with one in three first-time moms giving birth via the surgical method according to the latest government study.

Scientists belonging to the Consortium on Safe Labor, a research project supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, conducted a detailed analysis of when C-sections were performed to deliver more than 220,000 infants in 19 hospitals between 2002 and 2008. Overall, 30.5% of births were by Cesarean, and one third of first time mothers delivered their babies this way. Another third of Cesarean deliveries occurred in women undergoing a repeat, pre-labor Cesarean after delivering this way previously.

The high rate among new mothers was surprising to lead author Dr. Jun Zhang, who noted that factors contributing to the trend could include everything from the older age of mothers, higher BMI and greater multiple births. While the study did not specifically address these factors, other analyses have also pointed to issues such as rising malpractice rates for obstetricians which can push doctors to be more conservative in advising women who are older or have any chance of developing complications during delivery to chose C-section instead of vaginal delivery.

The current study seems to support that explanation, as among women who began labor and ended up having a C-section, many had the surgery when they were only 6 cm dilated, which is considered to still be an early stage of labor. The authors also found that 43% of women attempting vaginal delivery were induced, another trend that suggests physicians and patients are less likely to wait for a potentially lengthy labor to take its course. “It’s something that is important for practicing clinicians to know, that as long as maternal and fetal health are doing well in labor, they can wait longer and perhaps reduce the Cesarean rate,” says study co-author Dr. Katherine Laughon.

In a telebriefing, the authors noted that their findings point to several factors that may lower C-section rates in the US. For example, the success rate of women delivering vaginally after a prior C-section was nearly 60%, suggesting that more women could avoid C-sections as long as their physicians were competent and comfortable with allowing them to attempt vaginal delivery. Yet less than 39% of women who had had a prior C-section attempted to deliver their next child vaginally. The findings support recommendations by the American College of Obstetricians and Gynecologists which earlier this year noted that 60% to 80% of women who attempt to deliver vaginally after a previous C-section will be successful.

http://wellness.blogs.time.com/2010/08/31/understanding-the-high-c-section-rate-in-the-us/

US – Widespread Parental Misuse of Medication Puts Children at Risk

Many children are taking greater doses of over-the-counter medicine than is safely recommended, and parents and child-care employees could be unintentionally to blame, new research finds.

Lead researcher Dr. Rebekah Moles, of the University of Sydney in New South Wales, says that both errors in judgment surrounding proper dosage and the types of medicine resulted in a large amount of emergency medical center visits in Australia.

The findings, which will be presented today at the annual meeting of the International Pharmaceutical Federation, show that not only were children being overmedicated, but they were also sometimes given the inappropriate type of medicine by parents and other caregivers.

“We were surprised and concerned to find that some people thought that medicines must be safe because you can buy them without prescription,” Moles says in a news release.

A similar study was conducted in the U.S. in 2008 and found that improper dosing of medication sends about 7,000 children in this country to the hospital each year.

Ninety-seven adults — parents and day-care staff — were followed for five months as well as participating children between the ages of 4 and 5. Several scenarios were presented, such as describing a child’s symptoms as feeling hot and seeming irritable while still eating, drinking and playing normally. Then the adults were given several common over-the-counter medicines, and were asked how they would handle the situation.

The adults recorded if and at what stage the children would receive the medicine, what type and how much they would be given.

The researchers say after combining the results from all the scenarios, 44 percent of adults would have given an inaccurate dose, as only 64 percent were able to correctly measure the dose they intended to give the child.

Sixty-one percent of the time, adults would have given the kids Tylenol to treat coughs, colds and fevers, regardless of whether or not a fever was present, findings show. Only 14 percent of professional childcare workers were able to handle fevers appropriately.

The youngest children seemed to be most greatly affected, as 80 percent of those overdoses were related to those under 3.

“Given these figures and our findings, there is an urgent need to review the use of children’s OTC medicines by parents,” Moles says in a new release. “However, the most important thing is to improve carers’ understanding of when and how to give medication.”

“It is vital that parents worldwide should understand the proper usage of medicines so that they do not continue to put their children’s health at risk,” he adds.

http://www.aolhealth.com/2010/08/30/widespread-parental-misuse-of-medication-puts-children-at-risk/

Ireland – Infants’ diet raises risk of obesity and illness

A SIGNIFICANT proportion of six-month-old infants in Ireland are regularly consuming foods high in sugar, fat and salt, putting them at risk of becoming overweight and obese later in life, a new study reveals.

The study has also found that the majority of Irish babies are weaned onto solids far too early – some as early as 12 weeks – and often on the advice of the maternal grandmother.

Dr Roslyn Tarrant, clinical research dietitian at Our Lady’s Children’s Hospital, Crumlin, carried out the study of weaning practices in Irish infants which was published in the latest issue of The British Journal of Nutrition.

“The findings highlight the need for a national standardised weaning policy that ensures all parents receive information on healthy infant-feeding practices by 12 weeks post-partum and even as early as ante-natally. This is a major preventative measure that needs to be taken if we are to address childhood obesity in Ireland,” Dr Tarrant said.

The results indicate that younger and less educated mothers are more likely to offer their infants non-recommended snacks, including chocolates, biscuits, crisps and ice-cream.

The study of more than 400 mothers recruited from the Coombe Hospital in Dublin found that only one mother complied with the World Health Organisation and Irish Department of Health recommendation to exclusively breastfeed up to six months.

A significant 75 per cent of infants had been weaned onto solids before the minimum recommended time of four months and of even greater concern was the finding that 22.6 per cent of babies were weaned as early as 12 weeks post-partum.

Mothers reported that their principal source of advice on infant feeding and weaning was the maternal grandmother. However, the influential role of the public health nurse in delaying the introduction of solids was evident.

Dr Tarrant said infants weaned onto solids before four months were at greater risk of diarrhoea, allergy and eczema and were more likely to visit their GP. Weaning too early has also been shown to increase body fat and weight during childhood, as well as the probability of respiratory illness.

The study also highlighted a high consumption of non-recommended sugary snacks and drinks by infants as well as the inappropriate addition of salt and sugar to baby foods. In particular, sweet varieties of commercially prepared infant-specific desserts such as apple crumble, chocolate pudding and jelly with ice-cream were consumed by almost one-third (31.6 per cent) of the infants as the usual evening meal.

The majority of the infants consumed three meals a day and at least one snack in addition to their main milk drink which, Dr Tarrant said, meant they were consuming excessive calories.

http://www.irishtimes.com/newspaper/health/2010/0831/1224277901376.html

India – Obese teens go under knife to lose weight

As the incidence of childhood obesity rises across Mumbai — and the rest of urban India — teenagers are increasingly turning to radical weight-loss surgeries as a quick, easy solution. The most popular weight-loss procedure today, say surgeons, is bariatric surgery, where an average teenage stomach — about the size of a football — is reduced to the size of an egg.

Though some parents are also bringing in obese children as young as seven, doctors say they only operate in critical cases.

“There has been a steady rise in the number of teenagers coming in with their parents and opting for such surgery,” said Dr Sanjay Borude, an obesity surgeon with Breach Candy and Jaslok Hospital, adding that a third of his patients are now morbidly obese teenagers between the ages of 14 and 18.

The downside of such surgery is that it changes the adolescent’s digestive system, often permanently. Most patients can never have a full meal again.

Surgeons like Dr Ramen Goel, a bariatric surgeon with Bombay Hospital, also warn that the radical procedure is not a permanent solution.

“Without a healthy, nutritional diet, these youngsters can still regain all that weight,” he said.

http://www.hindustantimes.com/Obese-teens-go-under-knife-to-lose-weight/Article1-593269.aspx