Written by Stacy John-Legere
This past week the media has vividly shown us the true cost of crisis, upheaval and political and economic instability - a picture of a policeman carrying the dead body of a young boy - a child, fleeing his homeland with his family, in search of better. Also this past week, nestled amongst the inner pages of our local papers, there were reports of two London teenagers killed in separate instances of violence.
This was also the week I introduced new paediatric trainees to child safeguarding. They learned that not only do children die; but in many circumstances at the hands of their parents/ carers. As I delivered that lecture I paused to think - what have I done - what can I do- what will I do- to prevent children dying? How can I as a community paediatrician work to reduce deaths that are preventable or modifiable? After all, I no longer run along to crash bleeps and impress with my resuscitation skills.
Reflecting on the reference material used to prepare for the talk above, I was once again struck by the preventable nature of much of child death and its close relationship to child public health. Working Together to Safeguard Children 2015 defines preventable child deaths as those “in which modifiable factors may have contributed to the death. These are factors defined as those, where, if actions could be taken through national or local interventions, the risk of future child deaths could be reduced”.1
Over recent years there has been much success in reducing under 5 child mortality. The WHO notes that “Since 1990 the global under-five mortality rate has dropped from 90 deaths per 1000 live births in 1990 to 46 in 2013” 2. Globally, however, children continue to die in mainly modifiable situations - malnutrition, infectious diseases and as a consequence of war or deprivation which gives rise to these situations. The WHO also notes that “Children are at greater risk of dying before age five if they are born in rural areas, poor households, or to a mother denied basic education.”2
This theme of social inequality as a factor in child death is also seen in the report “Why Children Die, 2014” published jointly by RCPCH and NCB. Highlights from the report3 include:
- The overall UK childhood mortality rate is higher than in some other European countries.
- The key areas where the UK rates appear to be relatively high are infant deaths and deaths among children and young people who have chronic conditions.
- Injuries are the most frequent cause of death in children after their first year of life, and although unintentional injuries are the most common, the failure to reduce intentional injury deaths among young people recently is also a pressing concern.
- Several reports have shown that health services do not always deliver optimal care for children and young people, and lives may be lost as a result.
- There are marked social inequalities in death rates.
Indeed the last parliamentary report on the UK’s compliance with the UN Convention on the Rights of the Child stated that child poverty should be regarded as a child rights issue.4 Moreover the ONS report on violent crime5 noted that in cases of homicides, the under 1 age group was over represented - comprising 3% of homicides but 1% of the population. In the 16 and under age group - more children were killed by a parent/step parent than by a stranger. Additionally, the report covering Child Death Reviews in 2013/20146 noted that 22% of child death reviews identified the death as having modifiable factors, whilst 67% of serious case reviews related to a child death identified modifiable factors.
These reports may seem far removed from the everyday reality of the clinic/ward, since child death is encountered relatively infrequently by most paediatricians. However, much of my caseload (as most caseloads around the UK) includes the poor, the vulnerable, and the displaced. As a community paediatrician, my specialism involves the care of disabled children along with the socially vulnerable. And as such, I will meet children whose life experiences fit within the identified predisposing factors for preventable child death.
So I ask - As public outcry is leading to public action on refugees, what can we do to address the larger problem of child death? What will we do for those children whose pictures have not made it to the front page? How can we ensure that their siblings and those in similar circumstances do not die? I believe it is my duty as a paediatrician, and member of the public, to work to prevent all modifiable child deaths and I will embed this focus into my clinical practice.
Actions I can take:
- Listen to the child and to the parents – Think Family7
- Consider each consultation an opportunity for health promotion
- Get involved:
- Contribute to local commissioning strategies – encourage use of the Family Friendly Framework8
- Join campaigns such as the RCPCH Why Children Die campaign9
- Participate in local initiatives and innovations
What will you do?
- Working together to safeguard children 2015 http://www.workingtogetheronline.co.uk/chapters/chapter_five.html#definition_prev
- Children: reducing mortality Fact sheet N°178 Updated September 2014 WHO http://www.who.int/mediacentre/factsheets/fs178/en/
- Why children die: death in infants, children and young people in the UK, Part A, May 2014, RCPCH and NCB http://www.rcpch.ac.uk/improving-child-health/child-mortality/child-mortality#A
- House of Lords, House of Commons Joint Committee on Human Rights: The UK’s compliance with the UN Convention on the Rights of the Child Eighth Report of Session 2014–15http://www.publications.parliament.uk/pa/jt201415/jtselect/jtrights/144/144.pdf
- Crime Statistics, Focus on Violent Crime and Sexual Offences, 2013/14 http://www.ons.gov.uk/ons/rel/crime-stats/crime-statistics/focus-on-violent-crime-and-sexual-offences--2013-14/index.html
- Child Death Reviews – Year ending March 2014 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/332619/SFR21_2014_revised.pdf
- Think Family http://www.local.gov.uk/documents/10180/5756320/The+Care+Act+and+whole+family+approaches/080c323f-e653-4cea-832a-90947c9dc00c
- Introducing the Family Friendly Framework, 2014, BACCH and BACAPH http://bacaph.org.uk/images/documents/baccaph_family_friendly_framework_final.pdf
- Why Children Die - RCPCH campaign http://www.rcpch.ac.uk/news-campaigns/campaigns/why-children-die/why-children-die-rcpch-campaign
Dr. Stacy John-Legere
Consultant Community Paediatrician
BACAPH executive committee member