Physical health of care-experienced young children in high-income countries: a scoping review.

BACKGROUND: Good health in the early years lays the foundation for lifelong health. Children with experience of extraparental care (eg, foster, kinship, residential) have poorer outcomes than children without such experience. Common health conditions in high-income countries differ from those in low-income and middle-income countries. Health conditions also vary substantially with age. The literature examining physical health conditions affecting young care-experienced children in high-income countries has not been previously reviewed. This review addresses this gap to better understand the health needs of these children. METHODS: In this scoping review, we used a broad range of search terms in MEDLINE, CINAHL, and Web of Science Core Collection databases to identify studies of (1) care-experienced children, (2) physical health outcomes, and (3) children aged 6 years or younger. Intersecting search results were retained for screening. Results were restricted to peer-reviewed journal articles indexed before Sept 1, 2022, with titles in English. Grey literature was excluded. No restriction was placed on study design. Results were narratively synthesised and categorised by health condition. FINDINGS: Searches yielded 15 639 results, and 33 articles were ultimately included, covering 11 countries. Studies were concentrated in the USA (n=18, 55%) and Europe (including UK; n=10, 30%). Most studies investigated a specific health outcome or set of outcomes (n=23, 70%) with many of the remaining studies carrying out broader health reviews (n=8, 24%). Height and weight were the most frequently reported outcomes (n=10, 30%) followed by vision (n=7, 21%) and dental health (n=7, 21%). Nine studies (27%) compared outcomes in care-experienced children with outcomes in non-care-experienced controls. Synthesis of results identified poor physical development, poor dental health, low rates of immunisation, dermatological conditions, and anaemia to be substantial health problems among young children with care experience. INTERPRETATION: Poor physical development and anaemia suggest efforts are required to improve care-experienced children's diet. Dermatological conditions and poor dental health can be managed by additional health-care support to care-experienced children and caregivers. A strength of this work is the standardised methodology. This work is limited by the exclusion of grey literature and restriction to high-income countries. FUNDING: Medical Research Council, Economic and Social Research Council, and Chief Scientist Office (Scotland).

Do comprehensive schools reduce social mobility?

This paper investigates the claim that the shift from a selective to a comprehensive school system had a deleterious effect on social mobility in Great Britain. Using data from the National Child Development Study, we compare the chances, for both class and income mobility, of those who attended different kinds of school. Where media attention focuses exclusively on the chances for upward mobility of those children from lowly origins who were (or would have been) judged worthy of selection into a grammar school, we offer more rounded analyses. We match respondents in a way that helps us to distinguish those inequalities in mobility chances that are due to differences between children from those due to differences between the schools they attended; we look at the effects of the school system on the mobility chances of all children, not merely those from less advantaged origins; and we compare comprehensive- and selective-system schools, not merely comprehensive and grammar schools. After matching, we find, first, that going to a grammar school rather than a comprehensive does not make low-origin children more likely to be upwardly mobile but it helps them move further if they are; second, that grammar schools do not benefit working-class children, in terms of class mobility, more than they benefit service-class children, but, in terms of income mobility, such schools benefit low-income children somewhat more than they benefit higher-income children - that benefit relating only to rather modest and limited movements within the income distribution. Finally, however, the selective system as a whole yields no mobility advantage of any kind to children from any particular origins: any assistance to low-origin children provided by grammar schools is cancelled out by the hindrance suffered by those who attended secondary moderns. Overall, our findings suggest that comprehensive schools were as good for mobility as the selective schools they replaced.