The UN Convention on the Rights of the Child provides a framework for improving children's lives around the world. It covers both individual child health practice and public health and provides a unique and child‐centred approach to paediatric problems. The Convention applies to most child health problems and the articles are grouped into protection, provision and participation. Examples of the first are the right to protection from abuse, from economic exploitation and from illicit drugs. We examine one particular problem in each of these categories, specifically child labour, services for children with a disability and violence against children. The role of the paedialrician in applying a children's rights approach is discussed. Children's rights are increasingly being accepted around the world but still there is much more rhetoric paid to their value than genuine enforcement. Paediatricians can make a difference to the status of children worldwide by adopting a rights‐based approach.
Paediatricians should recognise the influence of infant formula milk companies and avoid intentionally or inadvertently promoting them
breast feeding; conflict of interest; infant formula; nutrition
AIMS—To describe the work, family
socioeconomic characteristics, and growth of a representative sample of
working children in Jordan.
METHODS—In a cross sectional survey
of growth and health, 135 working children (aged 10-16 years) were
studied in the areas of Irbid, Jarash, and North Jordan Valley. The
children and their parents were interviewed and data collected on
length of working week, income earned by the child, duration of work in
years, age of starting work, type of work, child's smoking status, and
family socioeconomic status.
RESULTS—The mean age of the
children was 13.3 years; 14.8% had started work before the age of 10 and 12.6% had been working for more than four years. Mean income was
34 Jordanian Dinars but 6.7% were unwaged; 34% were working more than
60 hours per week, and 85.9% more than 40 hours. Monthly income and
working hours were positively correlated with the age of the child.
There was no correlation between age and smoking status; 37.8% smoked
more than five cigarettes per day. Mean height and weight z scores were
−0.365 and −0.081 of the UK standard respectively. Packed cell
volume was within the anaemic range in 34.1% of children.
CONCLUSIONS—In Jordan many children
start work at an early age and work long hours for little or no income.
Stunting and anaemia are common and many are established smokers.
Relevance of these findings for social policy and health care of
working children in Jordan and elsewhere is discussed.
AIMS—To ascertain the
type and extent of problems requiring advocacy in paediatrics. To
develop an approach for analysing problems according to their root
causes and the level of society at which advocacy is needed.
paediatricians kept detailed clinical diaries for two weeks to identify
problems. Classifications were developed to categorise problems by
cause and the level of society at which they needed to be addressed.
The press was surveyed for one week for childhood issues attracting
requiring advocacy were identified. Root causes included failures
within agencies, between agencies, and inadequate provision. In
addition to advocacy required individually, "political" action was
needed at the community level (16 issues), city level (16 issues), and nationally (15 issues). 103 articles were found in the
press, these did not relate closely to issues identified by clinicians.
opportunities for advocacy arise in the course of daily work. A
systematic way of analysing them has been developed for use in planning
action. To optimise the health and health care of children, there is a
need to train and support paediatricians in advocacy work for local as
well as national issues. Ten issues were identified that might be
prioritised by paediatricians working on an agenda for action.
OBJECTIVE—To test the efficacy of an information
booklet to increase the duration of breast feeding.
RESEARCH DESIGN—Randomised design, stratifying by
maternal residence and working activity. Two hundred women were
recruited, 103 received the booklet and verbal counselling and 97 verbal counselling only.
POPULATION—Infants observed from 15 September
1993 to 15 June 1994 in the well baby outpatient clinic of the
Paediatric Institute of the Catholic University of Rome, Italy.
MAIN RESULTS—No statistically significant
difference was found between the two groups in the prevalence of
exclusive or complementary breast feeding at 6 months of age: 48.5%
and 59.2% in the intervention group, 43.7% and 51.5% in the control
group. The median duration of exclusive or complementary breast feeding
was 24 and 27 weeks in the treated group, 22 and 25 in the control group.
CONCLUSIONS—The information booklet alone does
not seem to increase the duration and the prevalence of breast feeding
at 6 months of age. The use of written material with a more
individualised support and more extensive use of randomised clinical
trials in the evaluation of health promoting programmes is recommended.
The British (Tanner and Whitehouse) and American (National Center for Health Statistics, NCHS) growth standards are widely used internationally, although the data are now over 30 years old. Routine weight data was retrieved from the child health records of a complete annual cohort of 3418 children aged 18-30 months to test the validity of these standards for modern infants. Compared with the Tanner and Whitehouse standards, Newcastle children rose initially and then fell a mean of 0.7 SDs between 6 weeks and 18 months, resulting in a threefold difference in the proportion of children below the 3rd centile at different ages. NCHS standards showed a similar pattern. When compared with modern standards from the Cambridge growth study, there was a much closer match, although Newcastle children showed a slight gain by the age of 1 year. Existing standards for weight introduce inaccuracy into the estimation of centile position in the early months of life. As both standards show similar problems this probably represents a real secular change due to changes in infant nutrition. These findings support the need to develop new national growth reference standards.