Can foster care ever be justified for weight management?

Article nine of the UN Convention of the Rights of the Child states that 'Children must not be separated from their parents unless it is in the best interests of the child.' We describe the impact that placing a child into care can have on long-standing and intractable obesity when this is a component of a child safeguarding strategy. Significant weight loss was documented in a male adolescent following his placement into foster care due to emotional harm and neglect within his birth family. The child's body mass index (BMI) dropped from a peak of 45.6 to 35 over 18 months. We provide brief details of two further similar cases and outcomes. Childhood obesity is often not the sole concern during safeguarding proceedings. Removal from an 'obesogenic' home environment should be considered if failure by the parents/carers to address the obesity is a major cause for concern. It is essential that all other avenues have been explored before removing a child from his birth family. However, in certain circumstances we feel it may be justified.

The influence of head growth in fetal life, infancy, and childhood on intelligence at the ages of 4 and 8 years.

OBJECTIVE: We investigated the effects of head growth prenatally, during infancy, and during later periods of development on cognitive function at the ages of 4 and 8 years. METHODS: We studied 633 term-born children from the Avon Longitudinal Study of Parents and Children cohort whose head circumference was measured at birth and at regular intervals thereafter. Their cognitive function was assessed with the Wechsler Preschool and Primary Scale of Intelligence at the age of 4 years and with the Wechsler Intelligence Scale for Children at the age of 8 years. Linear regression analysis was used to calculate postnatal head growth between successive time points, conditional on previous size, and to examine the relationship between head growth during different periods of development and later IQ. RESULTS: When the influence of head growth was distinguished for different periods, only prenatal growth and growth during infancy were associated with subsequent IQ. At 4 years, after adjustment for parental characteristics, full-scale IQ increased an average of 2.41 points for each 1-SD increase in head circumference at birth and 1.97 points for each 1-SD increase in head growth during infancy, conditional on head size at birth. At 8 years, head circumference at birth was no longer associated with IQ, but head growth during infancy remained a significant predictor, with full-scale IQ increasing an average of 1.56 points for each 1-SD increase in growth. CONCLUSION: The brain volume a child achieves by the age of 1 year helps determine later intelligence. Growth in brain volume after infancy may not compensate for poorer earlier growth.

Community based, effective, low cost approach to the treatment of severe malnutrition in rural Jamaica

Moderate and severe malnutrition are endemic in much of the developing world and in association with pockets of deprivation in the developed world. The cost in terms of individual and social development is high. The principles of effective management are clearly documented. A low cost, community based treatment programme for moderately and severely malnourished children under three years of age was established at a health center in rural Jamaica. Children were followed up monthly and defaulters were rigorously recalled. Management consisted of carefully delivered dietary advice, antibiotics, anthelminthics and vitamin supplements. All children improved and the response of 36 children, who were treated in the first year, showed an accelerated weight gain. There was a significant increase in the weight for age, at 1.9 percent per month over six months, which exceeds the rate reported with food supplementation programmes and nutrition rehabilitation centers. (AU)

The Kingston Project: VII. The point prevalence of helminths and parasites, and morbidity in malnourished children failing ambulatory treatment with a high energy supplement and a course of metronidazole - abstract

In a prospective study, 163 moderately malnourished children, living in the slums of Kingston, were followed up for one year. The anthropometric measurements in weight and length in those children receiving a High Energy Supplement (HES), and in wasting in those receiving, additionally, a course of metronidazole (MET) have been previously reported. The point prevalence as assessed by positive stool tests for helminths and parasites of the children treated with metronidazole, and if deemed necessary with mebendazole, increased significantly over the period of one year concurrent with improvement of their nutritional status (chi-2 = 13.57; p < .001). A significant increase was observed in both the supplemented and unsupplemented group (chi-2 = 3.98; p < .05 and chi-2 = 5.31; p < .05 respectively). Children receiving health care (HC) only, or health care and a high energy supplement (HC/HES) failed more than twice (17 per cent) as often the community-based management as those receiving additional metronidazole (HC/MET and HC/HES/MET) (8 per cent). Admissions to hospital for full nutritional and clinical recovery in the HC/HES group were mostly for enteric infections and septicaemia, while children in the MET groups were admitted for respiratory tract infections leading to anorexia. Malnourished children, managed in the community, are less likely to be admitted for failure if a course of metronidazole and mebendazole is given combined with their rehabilitation, using HES. This treatment reduces social and nutritional costs to the child, as well as costs to the public health service (AU)