Early childhood caries (ECC) refers to the condition when a child has at least one decayed baby or primary tooth. This used to be called “baby bottle tooth decay” but it is now known that ECC has many risk factors. These include exposure to bacteria and sugar (from prolonged feeding or sipping from a bottle or sippy cup with sugary drinks), low socio economic status, behavioural factors such as oral hygiene and dental visits and others. Indigenous children have higher rates of ECC. It has been estimated that 18.5% of First Nations infants and 31% of preschoolers 3 to 5 had a tooth affected by baby bottle tooth decay. 85.3% of Inuit preschoolers aged 3 to 5 had one or more cavities. In 2008/10, First Nations children who were bottle fed, obese and lived in crowded homes tended to have higher rates of ECC than other First Nations children. Breastfeeding contributed to lower rates. The risk of ECC is higher among children who drink fruit juices, canned milk, iron-fortified formula, tea, soft drinks and powdered drinks than among those who do not. This is worrisome, since studies have shown that over 50% of First Nations, Métis and Inuit children aged 2 to 5 years drink two or more servings of soft drinks and/or juice each day.
Unintentional injuries are a leading cause of death and morbidity for Indigenous (and non-Indigenous) young children in Canada. In 2008/10, among First Nations children age 0 to 11, the most common form of injury was minor scrapes, cuts and bruises, accounting for about 43% of all injuries. Another 23% involved broken bones. In 2007/08, cuts and lacerations were the most common types of injuries among Inuit children aged 3 to 5.
Alcohol is a known teratogen, and Fetal Alcohol Spectrum Disorder (FASD) is the leading known cause of preventable developmental disability among Canadians. In 2006, the proportion of Aboriginal children under 6, living off reserve, who were diagnosed with Fetal Alcohol Spectrum Disorder (FASD*) was 0.7%. That proportion varied between provinces. Only 50% of those children who were diagnosed received treatment.
The majority of Indigenous young children participate in cognitive/academic skills regularly. In 2006, over 80% of Inuit, Métis and First Nations children age 2 to 5 practiced their numeracy skills once a day through counting. The large majority also read or looked at books daily and heard stories. Inuit children age 2 to 5 read or looked at books and heard stories less often than Métis and First Nations children the same age.
Who Are Canada’s Indigenous Children?
Indigenous children constitute a significant proportion of young children living in Canada – according to the 2011 Census, over 7% of all Canadian children under age 5 were Indigenous. There were over 136,000 Indigenous children in Canada. Two thirds (90,995) were First Nations children; about a quarter Métis; and 5% were Inuit.
Overall, about 5% of all Canadian children under 5 were First Nations, almost 2% were Métis and 0.4% were Inuit. However, those proportions vary by province and territory. In Manitoba almost 20% of children under 5 were First Nations and almost 9% were Métis. In Saskatchewan 21% of children under 5 were First Nations and 7% were Métis. In Nunavut almost 90% of children under 5 were Inuit. In the Yukon, 25% of children under 5 were First Nations and almost 40% of Northwest Territories children 0 to 4 were First Nations.
The vast majority of young (under 5) Indigenous children live with at least one of their parents. The majority (70%) of First Nations children under 5 live with both parents as do more than half (53%) of First Nations children living off reserve. About 40% of First Nations children under 5 live with lone parents as do 30% of Métis children and 28% of Inuit children. A very small proportion live with grandparents.
Indigenous women tend to start having their children under the age of 25 – more than half of First Nations and Métis women had their first babies between the ages of 19 and 24 and the majority of Inuit women had their first babies when they were less than 18.
The fertility rate among Indigenous women is higher than that of non-Indigenous Canadian women – 2.2 babies per woman compared with 1.6. The fertility rate varies among Indigenous groups.
The negative health effects of smoking during pregnancy on the unborn baby are well documented – increased risk of low birth weight, still births, spontaneous abortions, decreased fetal growth, premature births, placental abruption, and sudden infant death syndrome (SIDS). Almost half – 47% – of First Nations women smoked during pregnancy in 2008/10. Only 33% smoked throughout their pregnancy – 9% quit in the first trimester and 5% quit subsequently during the pregnancy. The smoking rate had increased from 2002/03. Older mothers were more likely to smoke than were younger mothers. Mothers with a university education were less likely to smoke than were those with less than a high school education. Mothers with lower income were more likely to smoke than were mothers with higher income. The majority (83%) of Inuit mothers reported they smoked during pregnancy. The rate of smoking among First Nations and Inuit pregnant women is much higher than that of Non-Indigenous women.
The benefits of breastfeeding for both the mother and baby are well documented and accepted. The majority of Indigenous women initiate breastfeeding – 86% of First Nations women aged 15 to 24 as did 81% of Métis women and 77% of Inuit women (in 2007-10). That is very similar to the rate of non-Indigenous women. The rate for older women (25 to 44 years) was slightly less than the 15 to 24 year age group for First Nations and Métis women and the same for Inuit women. The World Health Organization, along with many Canadian professional organizations, recommend that women exclusively breastfeed for the first six months of life. About 20% of First Nations women (15 to 24) did so compared with only 14% of non-Indigenous identity women. Older First Nations women tend to breastfeed longer than do older women.
Determinants of Health and Well-Being
In 2006, First Nations children under 6 were more likely to live in low-income families than were non-Indigenous children. Those with status living off reserve were the most likely to live in low-income families (55%). In contrast, only 18% of non-Indigenous children lived in low-income families. There are differences according to where the children live. Those First Nations living in urban communities (off reserve) were twice as likely as those living in rural communities to live in low-income families – 54% versus 27% respectively. This urban/rural difference was the same for non-Indigenous children. And those First Nations children under 6 living in large cities (urban census metropolitan areas) were more likely to live in low income than those who were in smaller urban centres. While that is the case for non-Indigenous children as well, fewer of them lived in low income. In 2006, 32% of Métis children under 6 lived in low-income families. Rural Métis children were less likely to live in low-income families (20%) compared to urban Métis children (36%). In 2006, almost half (45%) of Inuit children outside of Inuit Nunaat under 6 living in census metropolitan areas were living in low-income families. This is more than twice as much as non-Indigenous children under six living in Census Metropolitan Areas (CMAs) (21%).
Food and food insecurity
Access to adequate food is an important determinant of health. To have food security, families must have confidence that they have and will continue to have enough money to buy an adequate amount of nutritious food to feed all their members. In addition, access to culturally appropriate food is important for Indigenous people.
In 2004, one-third of Indigenous households (off reserve) reported food insecurity. That compared with 9% of non-Indigenous households. Families with three or more children under 18, families living in low income and lone parent families are most likely to report food insecurity. In Nunavut in 2007/08, more than half (56%) of Inuit children 3 to 5 years were food insecure – one-quarter were severely food insecure.
Parents have a variety of ways to cope with food insecurity. According to research among Inuit children (3 to 5 years) who were moderately food insecure, 95% of parents fed their children with less expensive food and 64% said their children did not eat enough. Among severely food insecure children, 90% went hungry and three-quarters skipped meals.
In spite of these challenges, parents of young Indigenous children do their best to provide healthy food. According to recent surveys, the majority of First Nations, Métis and Inuit young children (2 to 5 years) regularly ate traditional or country foods. The majority of First Nations, Métis and Inuit children 2 to 5 years ate the amount of meat and milk products recommended in national guidelines for Indigenous people. Over 60% of First Nations and Métis children aged 2 to 5 ate at least one vegetable serving per day and over 50% have at least one fruit serving. That is slightly less for Inuit children. Only 20% of First Nations and Métis children and 9% of Inuit children ate the recommended 3 or more servings of vegetables per day – vegetables are often expensive and difficult to access for some families. A large number of young Indigenous children ate “junk” food regularly. The majority – over half of First Nations, Métis and Inuit children regularly ate fast or processed food, drank soft drinks and/or soda twice or more a day and ate salty snacks, sweets and desserts every day. “Junk” food or processed food can often be less expensive than healthier foods.
In 2006, over 85% of parents and guardians of First Nations, Inuit and Métis children under 6 years of age reported their child’s general health was good, very good or excellent. This was very similar to that of Non-Indigenous children under age 6.
In spite of that, young Indigenous children face risks of a number of health issues – such as low birth weight, chronic health conditions, respiratory conditions, obesity, unintentional injuries, fetal alcohol spectrum disorder and dental caries.
Babies who are born low birth weight have higher risk of a number of health problems such as sudden infant death syndrome, chronic illnesses and developmental problems. Women who are First Nations off reserve (without status), Inuit and Métis all had higher rates of low birth rate than did the Canadian population. Status First Nations women who are off reserve and on-reserve First Nations women had rates equal or very slightly lower than the Canadian average. All Indigenous groups had higher rates of high birth weight babies than the Canadian population.
In 2006, 30% of First Nations children under 5 with registered (or treaty) status (on/off reserve) had a chronic health condition and the rate was 28% for those without status and Inuit and Métis children. Among First Nations children under 12, allergies and asthma were the most diagnosed chronic health conditions. According to the 2008/2010 Regional Health Survey (RHS), the average age of diagnosis for asthma was 2.3 years of age. Boys were almost twice as likely as girls to have asthma. In 2007/08, 42% of Inuit children 3 to 5 years of age living in Nunavut went to a health centre or hospital over the last 12 months for a respiratory illness.
Young children who are overweight or obese are at increased risk of health problems in childhood and into adulthood. The rates of overweight and obesity among First Nations children aged 2 to 11 were 20% and 42% respectively in 2008/2010. The rate of obesity had increased by 17% since 2002/2003. In 2007/2008, 30% of Inuit girls and 24% of Inuit boys aged 3 to 5 were overweight.