Health for all Children

Chapter 4 References

Where possible we have provided additional details of websites referenced, see the Support Directory.

page page
77 Immunisation coordinator 86 Injury surveillance systems
79 ‘Getting Ahead of the Curve’ Doh 2002 93 Prevention of fire
79 Immunisation of premature babies 95 Accidental injury task force
80 Tuberculosis: British Thoracic Society 96 Breast feeding
80-81 Hepatitis B prevention 98 UNICEF baby friendly initiative
82 Prevention of other infectious diseases 99 Vitamin K
82 Sudden infant death 100 Wealth fare clinic scheme
84 Baby check 100 Vitamin supplements
84 Smoking prevention 101 Dental Disease
85 Giving up smoking 104 CONI – care of next infant

Page 77: Immunisation coordinator
Peckham, C.S., Bedford, H.E., Senturia, Y.D. & Ades, A.E. (1989). The National Immunisation Study: factors influencing immunisation uptake in childhood (the Peckham Report). Action Research for the Crippled Child, London;
Baxter, D.N. (1994). Pertussis immunisation of children with histories of neurological problems. British Medical Journal309, 1619;
Simpson, N., Lenton, S., & Randall, R. (1995). Parental refusal to have children immunised: extent and reasons. British Medical Journal 310, 227.
Newport M.J., and Conway, S.P. (1993). Experience of a specialist service for advice on childhood immunisation. Journal of Infection26, 295-300.
The importance of making additional effort to reach children in deprived situations is highlighted in: Reading, R., Colver, A., Openshaw, S., and Jarvis, S. (1994). Do interventions that improve immunisation uptake also reduce social inequalities in uptake? British Medical Journal308, 1142-4.
Elliman D, Moreton J. The District Immunisation Co-ordinator. Archives of Disease in Childhood 2000;82(4):280-2. Commentary by Hall DBM.

Page 79: ‘Getting Ahead of the Curve’ Department of Heath 2002
Getting Ahead of the Curve. A strategy for combating infectious diseases (including other aspects of health protection) A report by the Chief Medical Officer. Department of Health. 2002.

Page 79: Immunisation of premature babies
Botham S J, Isaacs D, Burgess M A. Immunisation of preterm infants. Communicable Disease Intelligence 1998;22(1):218-20.
Ramsay M E B, Corbel M J, Redhead K, Ashworth L A E, Begg N T. Persistence of antibody after accelerated immunisation with diphtheria/tetanus/pertussis vaccine. BMJ 1991;302:1489-91.

Page 80: Tuberculosis: advice of the British Thoracic Society
BCG, TB and the UK. Drugs and Therapeutics bulletin 2002 (Oct) 40, no 10, 78-80.
Control and prevention of Tuberculosis in the United Kingdom: code of practice 2000. Joint Tuberculosis Committee of the British Thoracic Society. Thorax 2000, 55, 887-901

Page 80-81: Hepatitis B prevention
‘Children in need and blood-borne viruses: HIV and hepatitis’. Department of Health,

Page 82: Prevention of other infectious diseases
This part of Wired for Health has specific pages for teachers relating to a number of communicable diseases they may encounter

Page 82: Sudden infant death
Foundation for the Study of Infant Deaths –
Sudden unexpected deaths in infancy the CESDI-SUDI studies 1993-1996.
Confidential Enquiry into Stillbirths and Deaths in Infancy. Ed. Fleming P. The Stationery Office 2000. ISBN 0113222998.

Page 84: Baby check
Morley, C.J., Thornton, A.J., and Cole, T.J. (1991). Baby Check: a scoring system to grade the severity of acute systemic illness in babies under 6 months old. Archives of Disease in Childhood66, 100-5.
For further reviews – work in progress.

Page 84: Smoking prevention
Chapman, S. (1993). Unravelling gossamer with boxing gloves: problems in explaining the decline in smoking. British Medical Journal 307, 429?432. This article takes smoking as an example and explores the influences that determine how and when health education is effective in an individual’s life: recommended!

Page 85: Giving up smoking
Poswillo, D. and Alberman, E. (1992). Effects of Smoking on the Fetus, Neonate and Child. OUP, Oxford. (A useful symposium covering the main aspects of smoking and its impact on children’s health). See also “Smoking and pregnancy: guidance for purchasers and providers”, Health Education Authority, London (1994); Women and Smoking, Guidelines for health promotion no. 39 (1995). Faculty of Public Health Medicine, London.

Page 86: Injury surveillance systems
‘What works in preventing unintentional injuries in children and young adolescence’. Towner E et al. 2001. Health Development Agency, London.
The prevention of childhood unintentional injury – Towner E and Towner J. Current Paediatrics 2001, 11.
Information about the prevention of skin cancer –
Carbon monoxide – the forgotten killer. Letter from the chief medical officer and chief nursing officer, 22nd February 2002.
Too high a price – injuries and accidents in London. The London Health Observatory (2002).
Child Accident Prevention Trust
Preventing Accidental Injury – Priorities for action. Report to the Chief Medical Officer from the Accidental Injury Task Force. Department of Health,
Measuring and Monitoring Injury. Report to the Accidental Injury Task Force from The Measuring and Monitoring Injury working Group. Department of Health,

Page 93: Prevention of fire – articles on smoke alarms etc, also articles on drowning
Recent articles on smoke alarms and drowning.
DiGuiseppi C, Roberts I, Wade A, Sculpher M, Edwards P, Godward C, Pan H, Slater S.
BMJ 2002; 325: 995. Incidence of fires and related injuries after giving out free smoke alarms: cluster randomised controlled trial
Rowland D, DiGuiseppi C, Roberts I, Curtis K, Roberts H, Ginnelly L, Sculpher M, Wade A. Prevalence of working smoke alarms in local authority inner city housing: randomised controlled trial. BMJ 2002; 325: 998-1001.
Sibert J R, Lyons R A, Smith, Cornall P, Sumner V, Craven M A, Kemp A M. Preventing deaths by drowning in children in the United Kingdom: have we made progress in 10 years? Population based incidence study
BMJ 2002; 324: 1070-1071.
Brenner R A. Childhood drowning is a global concern. BMJ 2002; 324: 1049-1050.

Page 95: Accidental injury force
Accidental Injury Task Force

Page 96: Breast feeding
Promotion of breast-feeding intervention trial (PROBIT) Kramer M S et al. Journal of the American Medical Association 2001, 285, 413-420.
Sikorski J, Renfrew MJ, Pindoria S, Wade A. Support for breastfeeding mothers. Cochrane Database Syst Rev. 2002;(1):CD001141
Fairbank L, O’Meara S, Renfrew MJ, Woolridge M, Sowden AJ, Lister-Sharp D. A systematic review to evaluate the effectiveness of interventions to promote the initiation of breastfeeding. Health Technol Assess. 2000;4(25):1-171.
Renfrew MJ, Lang S, Martin L, Woolridge MW. Feeding schedules in hospitals for newborn infants.
Cochrane Database Syst Rev. 2000;(2): CD000113.
Hypernatraemic dehydration and breast feeding: a population study. Oddie S, Richmond S, Coulthard M. Arch. Dis. Child. 2001 85: 318-320.
Hypernatraemia: why bother weighing breast fed babies? Harding D, Cairns P, Gupta S, Cowan F. Arch. Dis. Child. Fetal Neonatal Ed. 2001 85: F145.
The UNICEF UK Baby Friendly Initiative –

Page 98: UNICEF baby friendly initiative
The UNICEF UK Baby Friendly Initiative –

Page 99: Vitamin K
Vitmain K for Newborn Babies. PL/CMO/98/3, PL/CNO/98/4. Department of Health,
Parent’s leaflet on vitamin K –

Page 100: Wealth fare clinic scheme. Articles on rickets
‘Healthy start’ – proposals for reform of the wealth fare food scheme. October
Poverty bites: Food, health and poor families. Dowler E, Turner S and Dobson B. Child Poverty Action Group, 2001. ISBN 1 901698 45 9 –
Important book about the food industry – ‘Fast food nation’. Schlosser. Penguin books, 2002.

Page 100: Vitamin supplements
David Hall received a query from a reader who wondered about the evidence base for the advice given on page 100 of HFAC4 regarding vitamin supplements. The following reply was received from a nutrition expert who confirms that the advice is indeed correct and current:

“The recommendation is still active and it applies to breastfed infants from 6-months (or earlier if in a high-risk group); bottle fed babies from 12-months.

There is plenty of evidence to support the practice, particularly in the case of vitamin D (see recent Lancet review by Brian Wharton and Nick Bishop). Essentially the justification lies in the DRV handbook “Dietary Reference Values for food energy and nutrients in the United Kingdom”, Rep. Hlth Soc Subj 1991: 41. This sets out briefly the reason that a Reference Nutrient Intake is set for any nutrient, and specifically why these amounts of vitamin A, D and C.

There is a perception that eating a “balanced” diet supplies enough vitamins, but a). this is untrue in the case of vitamin D and b). We know that many toddlers do not eat diets that include a variety of foods, and therefore may not ensure adequate intakes of all nutrients particularly some vitamins and minerals. The National Diet and Nutrition Surveys (NDNS) of 1-1/2 – 4-1/2 shows that a significant proportion of toddlers are at risk of deficiency. In particular intakes below LRNI were reported for:

  • vitamin A in 7-9% of children
  • iron in 12-24% of children
  • zinc 14-15% of children
  • vitamin C in 33% of children
  • calcium intakes in 10% of children
Almost 100% had intakes of Vitamin D that fell short of requirements set for children up to 3-years of age. Although exposure to sunshine during summer months is the main source of Vit D, there are many who are known have inadequate status particularly children of South Asian origin and those who do not take enough outdoor activity. Therefore prevalence of vitamin D deficiency is still an acknowledged problem.

Where vitamin A is concerned of course we don’t see night blindness or keratomalacia(!), but marginal status could impact upon such things as immunity – and status is very difficult to measure (retinol levels being a very poor indicator). In the case of vitamin C the same sources (NDNS surveys) suggest an inverse gradient of plasma concentration with social class.

The recommendation about vitamin supplements is therefore a population measure intended to provide a “safety net” – though it is clearly one which is full of holes.

In many aspects of nutrition looking for the RCT will be fruitless – but evidence of a different kind is there. You may have noticed that NICE has fallen into the same trap in their review of antenatal care by saying that on the basis of Cochrane Reviews of two studies that there is no evidence to support the use of vitamin D supplements in pregnancy! If that is so, one has to ask why in a recent study from South Wales in BJOG almost half the women from some ethnic groups had 25-OH D levels indicative of deficiency.

To summarise:

  • Between the ages of one to five years, vitamins A and D supplements should be given unless adequate vitamin status can be assured from a diverse diet containing vitamins A and D rich foods and from moderate exposure to sunlight
  • Vitamin C in adequate amounts should be ensured to assist absorption of iron”

Page 101: Dental disease. Survey on dental health 1993. Work on fluoride. SIGN guideline.
Modernising NHS Dentistry – Implementing the NHS Plan. Department of Health 2000
Dental Health. Children’s dental health in the United Kingdom 1993. Department of Health, 1994.
Preventing Dental Caries in Children at High Caries Risk. Targeted prevention of dental caries in the permanent teeth of 6-16 year olds presenting for dental care. – Scottish Intercollegiate Guidelines Network (SIGN) Publication No. 47. 2000. ISBN 1899893 32
Dental Registrations – Dental Practice Board –
‘Water fluoridation and health’, Medical Research Council working group report. September 2002.
The question of fluoridation has also been reviewed recently in Ireland. See

Page 104: CONI – care of next infant
Details of the CONI scheme can be obtained from The Foundation for the Study of Infant Deaths –