Training and confidence in undertaking child protection work as reported by New Zealand paediatricians.

AIM: In New Zealand and rural Australia, general paediatricians undertake the majority of child protection (CP) medical assessments. This study aimed to document what New Zealand paediatricians think about their role in CP and their perceived preparedness for this work. METHODS: A 43-item SurveyMonkey questionnaire was sent to paediatricians working in CP. Questions explored demographic detail, CP work undertaken clinically and with regard to teaching and paediatrician confidence and experience in areas of CP. A separate questionnaire documented organisational CP work. RESULTS: A total of 79 paediatricians, 45 (57%) female, responded from 15 of 20 District Health Boards. For 73%, CP was less than 10% of their weekly workload, with 42% indicating they had been the lead paediatrician for fewer than five cases in the preceding 12 months. Paediatricians were more confident managing physical abuse than sexual abuse cases with regard to initial assessments, report writing and appearances in court. Just over a third reported at least once feeling personally threatened or unsafe while involved in a CP case. Only 29% were satisfied with their level of training, and 73% agreed they would like more CP training. CONCLUSIONS: Paediatricians undertake a number of roles in CP but do not feel confident in all these roles. More attention needs to be given to training in CP in general paediatric physician training in New Zealand.

Community-based screening to detect school readiness problems in very preterm children.

AIM: Very preterm (VPT) children (≤32 weeks) have school readiness difficulties across multiple domains, but routine follow-up is often limited. We assessed the performance of VPT children on the Before School Check (B4SC), a community-based screening programme of school readiness at 4 years of age. METHODS: VPT children discharged from Wellington and Auckland Neonatal Intensive Care Units (2005-2009) were compared to a national control cohort born during the same period. Outcome measures included Parental Evaluation of Developmental Status (PEDS), parent and teacher versions of the Strengths and Difficulties Questionnaire (SDQ-P and SDQ-T) and vision and hearing screening, and were related to perinatal and demographic characteristics obtained from the Australia and New Zealand Neonatal Network database. RESULTS: Of 1105 VPT children, 920 were matched to the B4SC database, of whom 814 (88%) had one or more B4SC screening outcomes recorded. Compared with controls, VPT children were more likely to have abnormal PEDS (odds ratio (OR) = 1.79, 1.53-2.10), SDQ-P (OR = 1.82, 1.49-2.23), SDQ-T (OR = 1.51, 1.10-2.06), vision (OR = 2.00, 1.54-2.60) and hearing (OR = 1.95, 1.65-2.31) screen outcomes. While VPT children with an abnormal screen were more likely to be referred for further assessment, only 34%, 22%, 94% and 51% with abnormal PEDS, SDQ or vision and hearing screen, respectively, had evidence of appropriate referral. School readiness difficulties were significantly associated with birthweight z-score ≤ -1, vaginal delivery, significant cranial ultrasound abnormalities, younger maternal age, higher deprivation neighbourhood and ventilation ≥72 h. CONCLUSION: Community-based screening may be useful for identifying VPT children with school readiness difficulties, but low referral rates may limit the effectiveness of such programmes.

Overweight and obesity in 4-5-year-old children in New Zealand: results from the first 4 years (2009-2012) of the B4School Check programme.

AIM: We describe the prevalence of overweight and obesity in four-year-old children in New Zealand, variations with ethnicity and socio-economic status, and changes over the study duration using body mass index (BMI) measurements collected as part of the B4School Check programme. METHODS: Demographic and BMI data were extracted for all children measured between 2009 and 2012. Overweight and obesity rates were estimated using International Obesity Task Force (IOTF) 2012 standards and the 85th (overweight) and 95th (obese) percentiles for BMI-for-age of the World Health Organization (WHO) 2006, Centers for Disease Control and Prevention 2000 and UK 1990 reference standards. RESULTS: A total of 168,744 BMI measurements were included in the analysis with a coverage rate of 66.5%. Mean BMI was 16.30 kg/m(2) in girls and 16.44 kg/m(2) in boys. Mean BMI z-score (WHO 2006 standards) was 0.601 in girls and 0.785 in boys. Using WHO 2006 standards, 16.9% of girls and 19.6% of boys were overweight and 13.8% of girls and 18.7% of boys were obese. Using IOTF standards, 18.3% of girls and 16.2% of boys were overweight and 5.7% of girls and 4.7% of boys were found obese. Prevalence of overweight and obesity was higher in Pacific and Maori children and those living in more socio-economically deprived areas than other children. No definite time-trends were observed over the study duration. CONCLUSIONS: The study reaffirms the high prevalence of overweight and obesity in pre-school children in New Zealand, and demonstrates the variations in prevalence when using different reference standards.

Rapid national survey of renal stones in New Zealand infants.

AIM: The aim of this study was to determine if there have been recent serious renal problems because of melamine among infants in New Zealand. METHODS: New Zealand paediatricians were surveyed in October 2008 using the New Zealand Paediatric Surveillance Unit network. RESULTS: Two cases of renal stones and none of unexplained renal failure in the previous 12 months were reported. Both cases of renal stones had an identifiable cause, and neither had features of melamine-related stones. CONCLUSION: This survey confirmed the expectation that this was not a discernible problem of recent serious melamine-associated renal damage in New Zealand. The method did however prove to be an effective way of undertaking a rapid determination of a possible recent serious health problem among children.