9. Child and adolescent health

Child health
- Definitions
  - Early childhood – age 0 to 4
  - Childhood – age 5 to 14
  - Adolescence – age 15 to 19
  - Youth – age 20 – 24
- Causes of death in children < 5 years
  - 45% occur during neonatal period
  - 55% occur during the remaining period
    - Pneumonia
    - Diarrhoeal diseases
    - Congenital anomalies
    - Injuries
  - 80% are due to preventable causes
- School
  - School health services are essential in child health
- Prevention of childhood diseases
  - Good antenatal care
  - Exclusive breastfeeding for 6 months
  - Discourage maternal alcohol and smoking
  - Regular health checks
  - Vaccination
  - Provide healthy, safe environments
Adolescent health
- Most adolescent deaths are due to preventable or treatable causes
- Diseases during adolescence affect the adolescent during this period and later in life
- Causes of adolescent death
  - Road traffic injuries
  - HIV/AIDS
  - Suicide
  - Pneumonia
- Causes of adolescent disability or illness
  - Depression
  - Road traffic injuries
  - Anaemia
  - HIV/AIDS
- At this age it’s important to engage them in their own care, as this lays the foundation for future health
- Mental health in adolescents
  - Depression is top cause of disability
  - Suicide is third cause of death
  - Violence, poverty, humiliation, bullying, etc. – increase risk
- Road traffic injuries in adolescents
  - Young are less able to assess risk, they like to test their boundaries and they overestimate their abilities
  - Young drivers are inexperienced drivers
  - Males are much more likely to be involved in road traffic injuries than females
- Epigenetic regulation of glucocorticoid receptor (GR)
  - Glucocorticoids are involved in perception of stress
  - Methylated gene for GR – anxiety (in rat experiment)
  - Unmethylated gene for GR – no anxiety (in rat experiment)
  - This epigenetic pattern can be modified by environmental and behavioural factors
  - Shows one mechanism by which the environment may cause mental health problems
- Prevention of adolescent diseases
  - Make health services free/affordable, available, and adapted to adolescents
  - Prevent drug use at the national, local, and school level
  - Provide free/affordable and available sexual prevention
  - Health workers should be competent in working with adolescents
  - Promote nurturing family relationships
  - Enhance social skills, problem-solving skills and self confidence