Key Summary Report from Wave 1   

Maternal health

Maternal health has implications for the wellbeing of mothers and their children. The Council of Australian Governments (COAG 2009), for example, predicts that improved maternal health will contribute to the achievement of its target to ‘halve the gap in mortality rates for Indigenous children under five within a decade’. Two measures important for maternal health are antenatal care and tobacco smoking during pregnancy (SCRGSP 2009). Both were explored in Wave 1 of Footprints in Time.

Antenatal care refers to the care given to the mother during the entire term of her pregnancy. Regular visits to health professionals are an important component of antenatal care. Increased antenatal visits have an impact on the health of pregnant women, foetuses, infants and young children by enabling health risk factors to be identified and addressed (Eades 2004). They also provide a means through which education, such as the benefits of breastfeeding, can be provided to mothers. The World Health Organisation (WHO) recommends that mothers in low risk categories should have at least four checkups, with the first occurring early in the first trimester (WHO 2009).

Most mothers (97 per cent) of the Study children had checkups while pregnant, and the majority (79 per cent) had had their first check up in the first trimester. About 95 per cent (824) of these mothers had checkups that occurred at least once every two months.

Smoking is another important factor in antenatal health. Smoking during pregnancy has been shown to increase the risk of complications in pregnancy and has been linked to premature births and low birth weight (ABS & AIHW 2008). Half of the parents reported that birth mothers smoked (or chewed tobacco) during their pregnancy with the Study child. Of these mothers 51 per cent reported that they smoked less while pregnant. Twenty–two per cent of parents reported that the birth mother drank alcohol while pregnant with the Study child.

Birth weight and gestational age

Birth weight is a key indicator of the general health of a child. Low birth weight (less than 2,500 grams) occurs because of poor foetal growth and/or premature birth (36 weeks or less). Low birth weight increases the risk of illness and death in early life and the development of chronic diseases such as diabetes in adulthood (ABS & AIHW 2008; Eades 2004; SCRGSP 2009).

A small number of Study children (12 per cent)12 weighed less than 2,500 grams when they were born. This is similar to other figures of Indigenous birthweights (AIHW, 2009). Likewise, a small number (11 per cent) were born prematurely (four or more weeks premature). Not surprisingly, there was a moderately strong correlation between low birth weight and premature birth (r=0.5, p<0.001). Approximately half (86 children) of the children who had low birth weights were born prematurely.

Mothers who smoked or drank alcohol during their pregnancy had slightly higher rates of either a premature birth or a low birth weight baby compared to mothers who did not smoke or drink alcohol during their pregnancy (see Figure 8). However, it should be noted that most mothers who smoked or drank alcohol still gave birth to babies with healthy weights and who were full-term.

Figure 8: Proportion of underweight/premature births for mothers who used alcohol or cigarettes during pregnancy

Figure 8 description: This graph presents a breakdown of the proportion of babies who were born premature or underweight for mothers who smoked or drank alcohol during the pregnancy compared with mothers who did not.The horizontal axis compares mothers’ use of alcohol / cigarettes during pregnancy with the birth weight and term of the pregnancy. The vertical axis depicts the percentage of parents in each category.
For mothers who drank alcohol during pregnancy: Premature birth 13.4%; Underweight baby 15.3%;
For mothers who did not drink alcohol: Premature birth 10.6%; Underweight baby 11.3%
For mothers who drank smoked during pregnancy: Premature birth 12.1%; Underweight baby 15.8%
For mothers who did not smoke: Premature birth 10.4%; Underweight baby 9.0%

Breastfeeding

There are many health benefits of breastfeeding for both mother and child, and breastfeeding is becoming recognised as fundamental to long-term health (NHMRC 2000). Breast milk better meets the nutritional requirements of developing infants than other milk products (Eades 2004). Australian guidelines recommend that breastfeeding is to be continued beyond 12 months, and where this is not possible formula should be used as the main source of milk (NHMRC 2003).

Many Study children (80 per cent) were breastfed at some point in their early years. Of the total sample, 21 per cent (about 33 per cent of the Baby cohort) were still being breastfed at the time of the interview. For those who had completely stopped breastfeeding (1,049 mothers in the sample) there was a wide range in the age of the Study child when he/she stopped being breastfed (0 to 209 weeks), with the median length of breastfeeding being 21 weeks. Approximately 22 per cent of children were breastfed for at least 12 months.

The main reason mothers gave for stopping breastfeeding was not enough milk (29 per cent) and the mother reporting that the child was old enough to stop (16 per cent). There was a small positive correlation (r=0.15, p<0.001) between the length of breastfeeding and the level of relative isolation. Children were breastfed slightly longer, on average, in more remote areas. Rates of breastfeeding were also slightly higher in remote areas (see Table 5). Apart from breast milk, most children (83 per cent) had formula as their first kind of other milk. A number of children (167 children) have not had any milk or formula apart from breast milk.

Nutrition and health

The types of food that children eat impacts upon their physical wellbeing and development. As well as helping children grow and go about their day, nutrients from food assist with recovery from illnesses and injury (NHMRC 2000). The National Health and Medical Research Council (NHMRC 2003) recommends consuming a variety of nutritious foods, such as fruit and vegetables (which can act as a protective factor against many diseases) and moderating intake of total and saturated fat.

A regular breakfast is also very important, and increasingly so for those children preparing for, and attending, school. Almost all (96 per cent) parents of children in the Child cohort reported their child usually eats breakfast. Parents were also asked what their child had eaten the previous day for each time period during the morning, afternoon and evening.¹³ Table 6 shows the dietary intake of the Child cohort across some of the major food groups by their level of relative isolation. Approximately 77 per cent of children had consumed at least some fruit and vegetables during the previous day; however, there was a difference in the incidence of fruit and vegetable intake between those children who lived in city areas (81 per cent) and those who live in remote areas (71 per cent). This difference was particularly pronounced for dairy consumption with children living in remote areas (38 per cent) less likely to consume dairy products than children living in cities (63 per cent). Children living in remote areas, however, also consumed far fewer snacks (including chips, biscuits and lollies) than children living in cities (37 per cent compared to 62 per cent). There was also a reduction in the proportion of children consuming processed meat (such as meat pies, hamburgers, hot dogs) as the level of relative isolation increased (with the exception of children who lived in high–extreme remote areas).

Note: ^a Based on reports by Parent 1 on previous day’s food intake.

Health conditions

Health, both of the Study children and their parents, is another important aspect of Aboriginal and Torres Strait Islanders’ emotional and physical wellbeing.

Almost all parents (97 per cent) rated their children’s health as either excellent, very good or good. The most common health problems experienced by the children were with their ears (20 per cent), in particular runny ear. Chest infections (15 per cent), asthma (13 per cent) and eczema (11 per cent) were also reasonably common among the children of both cohorts.

Dental health

Dental health is a good indicator of general physical health. If left untreated, tooth decay can lead to the development or exacerbation of diseases (SCRGSP 2009). Poor dental health can also affect speech and language development, school attendance and performance, self-esteem, employment and social wellbeing (NACOH 2004). Learnt preventative behaviours such as brushing and flossing are one aspect of maintaining healthy teeth.

For children from the Child cohort and Baby cohort who had teeth (1,585 children), over half (57 per cent) have their teeth cleaned once or twice (or more) a day. Approximately one quarter of parents reported, however, that their child’s teeth were never or rarely cleaned. Lower incidences of teeth brushing tended to be reported in more remote areas. Study children in areas of moderate remoteness were the least likely to brush their teeth (47 per cent reported brushing rarely or never) compared to those in low remote (24 per cent) or non-remote areas (16 per cent).

Hospitalisation

Children often participate in activities that result in injuries. The most common cause of death among Indigenous children is external causes such as injury (ABS & AIHW 2008). COAG (2009) found that Indigenous children were more likely to be hospitalised for preventable diseases and injuries than non-Indigenous children.

Parents were asked if their child had been hospitalised due to sickness, injury or because the child required surgery. About 21 per cent of children (352 children) had been hospitalised as least once in the previous year, or, in the case of those in the Baby cohort, since they were born. The most common length of time spent in hospital was usually between two and five nights.

Language and development

Parents were asked if they had concerns about their child’s language and development. These questions were adapted from ‘Parent’s Evaluation of Developmental Status’ (PEDS), the Australian version, with the assistance of the Centre for Community Child Health.¹⁴ PEDS is used as a screening tool to identify children from 0 to 8 years old at risk for school problems and undetected developmental and behavioural disabilities. Early intervention increases the likelihood of positive outcomes such as improved school attendance and holding down a job in later life.

Most parents did not have any concerns about their child’s language and development. For those who did have concerns, parents were most frequently concerned with how their child talks and makes speech sounds (13 per cent). The most common reason for concern for parents of children in both cohorts was that speech was not clear, either to family (73 children) or to those outside the family (106 children). These concerns were reported more frequently by parents of children in the Child cohort.

A smaller number (97 parents) were concerned with how well their child understands what is said to them; again, mostly reported for children in the older cohort. The most common area of concern about children’s understanding for parents of children in both cohorts was the child having difficulty understanding what was said to them.

Some parents (12 per cent or 208 parents) also had concerns about their child’s behaviour, again mostly among parents of the older cohort children. Fewer parents (8 per cent or 136 parents) had concerns about how their child gets along with others; however, this was more predominant among parents of children in the Baby cohort.

Sleep

Parents were asked about their child’s sleep patterns. Of the children in the Baby cohort, 68 per cent of children had a routine for going to bed, compared to 60 per cent of Child cohort children. Parents of children in the Baby cohort (29 per cent) were more likely to report their child having trouble getting to sleep or staying asleep in the month prior to the interview, compared to parents of the older children (18 per cent). There were also differences in the reasons that children were having getting to sleep or staying asleep (see Figure 9).

Figure 9: Reasons children had trouble getting to sleep or staying asleep

Figure 9 description: This graph depicts the factors that impacted on children having trouble getting to sleep or staying asleep. These factors are identified on the vertical axis. The horizontal axis depicts the percentages of affirmative responses.
Teething: Baby cohort 40%, Child cohort 0%
Illness or pain: Baby cohort 11%, Child cohort 4%
Overexcited: Baby cohort 10%, Child cohort 26%
Sleep during day: Baby cohort 7%, Child cohort 13%
Too hot or too cold: Baby cohort 5%, Child cohort 5%
Household noise: Baby cohort 5%, Child cohort 4%
Nightmares: Baby cohort 4%, Child cohort 16%
Fears: Baby cohort 4%, Child cohort 8%

13. Parents were not asked how much or how many times the food was eaten during each time period
14. Parent’s Evaluation of Developmental Status (PEDS), the Australian Version. Centre for Community Child Health, Royal Children’s Hospital, Melbourne 2005. Adapted with permission from Frances Page Glascoe, Ellsworth and Vandermeer Press Ltd.