Health and Development in the Early Years: Health Outcomes Consolidated Results

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Obesity is becoming a considerable public health problem in Canada. In 2004, 25% of boys 2 to 5 years were overweight, 12% were obese; and 22% of girls were overweight, 9% were obese. Being physically active and not sedentary are important protective factors against the development of obesity. Between 2009 and 2013, about three-quarters of 3 to 4 year-olds and only 30% of 5 year-olds met the recommended guidelines for daily physical activity. Fewer young children who were overweight or obese met the guidelines for physical activity than those with a healthy weight. Only 22% of 3 to 4 year-olds met the recommended guidelines for daily screen time as did three-quarters of 5 year-olds.  Children in households with a lower level of parental education were less likely than those in higher level of education households to meet the guidelines for screen time.

According to The National Epidemiologic Database for the Study of Autism in Canada (NEDSAC), their best estimate of the prevalence of autism spectrum disorders in Canada is 1 in 94 children 6 to 9 years of age. Based on the information collected by NEDSAC since 2003, the prevalence of autism appears to be increasing. Some of the increase could be a result of more children on the autism spectrum being identified.

Mental health
The early years lay the foundation for life-long mental health.  Mental health problems often originate in the early years of children’s development and can prevent children from reaching their full potential.  Mental health problems experienced in early life can affect children throughout their lives – impacting their health, happiness and productivity.

According to survey data, in 2010/11, 7% of 2 to 5 year-olds scored high on the emotional disorder – anxiety score (up from 6% in 2002/03), while 6% scored high on the hyperactivity/inattention score (down from approximately 8% in 2002/03). The incidence of these emotional/behavioural problems varied between provinces. Urban children, children in a visible minority group and children who were recent immigrants were more likely to score high on the emotional disorder-anxiety scale, as were children living in low income.

The health and well-being of infants and young children lay the foundation for lifelong health and well-being.  While most Canadian infants and young children are healthy, there are also some worrisome indicators.

Pregnancy/birth – mothers
More women are having babies over the age of 35 in Canada today – and they have different pregnancy and birth experiences than do their younger counterparts. Older women (having their first baby at 35+) are more likely to have a chronic or health problem before their pregnancy and to have a cesarean birth.  Younger women are more likely to gain more weight during their pregnancy compared to older women. Older women are more likely to know about the benefits of folic acid and to take it before pregnancy.  They are also less likely to smoke during pregnancy.

Multiple births
Multiple births are associated with the use of assisted reproductive technologies (such as fertility drugs and in vitro fertilization) in response to infertility. Although most of these babies are healthy, there are health concerns associated with multiple births.  Multiples, particularly higher order multiples (triplets, quadruplets, etc.), are much more likely than single babies to be born preterm and at a low birth weight. The rate of multiple births as a result of using assisted reproductive technology varies from 18% to 33% depending on the age of the mother and the type of reproductive technology.

Infant health issues
The majority of infants in Canada are born healthy and continue to thrive during infancy. For those babies not born healthy, low birth weight and congenital anomalies are important problems.

Low birth weight (under 2,500 grams) contributes to illness and death among infants and is associated with a higher rate of long-term health problems. Low birth weight is a persistent challenge in Canada. Between 2000/02 and 2010/12 the low birth weight rate increased from 5.6% to 6.1%, and it varied between provinces and territories.

Babies who are born low birth weight can either be preterm (before 37 weeks of gestation) or small for their gestational age (SGA) or both.  In 2014/15, the preterm birth rate in Canada was 7.8% – stable since about 2010/11. The preterm birth rate varied between the provinces and territories. Between 2006 and 2009 the rate of preterm birth increased with maternal age. In addition, younger mothers (under 20 years) had higher rates of small-for-gestational-age births than older mothers.

Congenital anomalies remain a leading cause of health problems in infancy. The most common congenital anomalies are not life threatening. However, severe congenital anomalies remain an important cause of potential years of life lost among children. In 2010, there were 11,441 babies born with congenital anomalies in Canada – the rate has declined since 2001. Older mothers are more likely to have babies with congenital anomalies. Congenital heart defects are the most common congenital anomalies. In Canada, 1 in 100 to 150 babies are born with a congenital heart defect – the rate is decreasing. There has been progress in the early diagnosis and surgical treatment of congenital heart defects that has resulted in a decrease in death and illness. The rate of neural tube defects has generally been declining since 1995. Much of the decline is attributed to policy-making and education initiatives surrounding the preventative role of folic acid. The rate of neural tube defects varied by province and the territories.

Infant deaths
In 2012, the infant death rate in Canada was 4.8 deaths per 1,000 live births. 1,849 babies under a year died that year. The infant death rate has declined somewhat since 2008 but continues to vary between provinces and territories. The majority of infant deaths are due to congenital anomalies or conditions related to short gestation and low birth weight. The infant death rate is higher among families living in low income neighbourhoods. Canada does not do well internationally with regards to infant mortality – ranking 30 out of 35 OECD countries.

Perinatal mortality (stillbirths and early neonatal deaths, before the seventh completed day of life) is considered a better indicator than infant mortality in countries with low infant mortality. Perinatal mortality is influenced by such factors as the age of the mother, her health, and her socioeconomic status as well as gestation and birth weight. The perinatal death rate was 6 per 1,000 total births in 2011. 49% of these deaths were stillbirths and 51% were early neonatal deaths. The rate was stable between 2007 and 2011.

Each year, a number of babies die from Sudden Infant Death Syndrome (SIDS) – it is the 6th leading cause of infant death. However, the death rate due to SIDS has declined in recent decades. This is likely due to a number of factors – a decrease in smoking during pregnancy, a known risk factor, and an increase in having babies sleep on their backs and breastfeeding – known protective factors. The rates of SIDS deaths vary widely between the provinces and territories. Babies in the poorest neighbourhoods have the highest rates of SIDS deaths.

Young child deaths
Between 2002 to 2012, the death rate for children aged 1 to 4 in Canada was stable at 0.2 per 1,000 population. In 2012, 263 children aged 1 to 4 died. Unintentional injuries were the leading cause, accounting for 35% of all deaths, followed by congenital malformations and chromosomal abnormalities, accounting for 25% of deaths; cancer accounted for 13% of deaths.

Hospitalization – infants and young children
In Canada, there were over 62,000 hospitalizations among infants in 2013/14. The rate varied among provinces and territories. Hospitalization rates are not entirely explained by variations in the rate of illnesses – they also reflect factors such as provincial/territorial approaches to the management of care, health practitioner availability and accessibility, and provincial demographics. The most common cause was perinatal causes – accounting for 30% of all hospitalizations. Next was respiratory system diseases (25%) followed by congenital anomalies (9%).

In Canada, in 2013/14, there were almost 56,000 hospitalizations among children ages 1 to 4 years. That rate varied among provinces and territories. In 2009/10, the most common cause of hospitalization of this age group was respiratory disease – accounting for 41%, followed by infectious diseases (13%) and unintentional injuries (8%).

Injuries are the leading cause of death for young children 1 to 4 years and the 8th leading cause of deaths for infants. They are the 8th leading cause of hospitalization for infants and the 3rd for young children.

Between 2009 and 2013, the most common cause of unintentional injury deaths among children 1 to 4 was transport collisions. In 60% of these transport collisions the children were pedestrians and in 36%, they were occupants in a car, truck or other vehicle (e.g., ATV). The next most common cause of unintentional injury death among young children was drowning, followed by suffocation.

In 2014/15, there were over 57,000 emergency room visits among 0 to 4 year-olds because of falls. About one-third of the falls happened at home.

Injury deaths of young children can be prevented through a number of strategies.  Use of an appropriate automobile restraint system for infants and children is one example. According to the Canadian National Survey on Child Restraint Use, 2010, 90% of infants were in the appropriate system, as were 82% of 1 to 3 year-olds but only 32% of 4 to 8 year-olds.  This varied between provinces and territories.

Health problems among young children
Young children in Canada are generally healthy. However, there are some areas of concern. Asthma makes an appearance in the early years – in 2006/07 about 7% of all children under 6 had asthma (diagnosed by a physician). Boys are more likely than girls to have asthma. Asthma, along with other chronic conditions, contributes to the overall rate of respiratory illness. Respiratory illness is, in general, the greatest single cause of hospitalization among preschoolers.

Although the prevalence is low, childhood cancer is the most common life-threatening disease affecting children in Canada. Between 2006 and 2012, neuroblastomas were the most common kinds of cancer in infants less than 1 year old and leukemias were the most common kinds of cancer among children aged 1 to 4 years. Death rates due to cancer among children are decreasing, but incidence rates are increasing  … continued