Infectious Disease and Malnutrition

Infectious Disease and Malnutrition

Infectious Disease and Malnutrition.
Hal’s reaction to the measles is commonplace in developing nations, where a large proportion of the population lives in poverty and many children do not receive routine immunizations. Illnesses such as measles and chicken pox, which typically do not appear until after age 3 in industrialized nations, occur much earlier. Poor diet depresses the body’s immune system, making children far more susceptible to disease. Of the 7.5 million annual deaths of children under age 5 worldwide, 98 percent are in developing countries and 65 percent are due to infectious diseases (World Health Organization, 2012a ).

Disease, in turn, is a major contributor to malnutrition, hindering both physical growth and cognitive development. Illness reduces appetite and limits the body’s ability to absorb foods, especially in children with intestinal infections. In developing countries, widespread diarrhea, resulting from unsafe water and contaminated foods, leads to growth stunting and nearly 1 million childhood deaths each year (World Health Organization, 2012a ). Studies carried out in the slums and shantytowns of Brazil and Peru reveal that the more persistent diarrhea is in early childhood, the shorter children are in height and the lower they score on mental tests during the school years (Checkley et al., 2003 ; Niehaus et al., 2002 ).

Most developmental impairments and deaths due to diarrhea can be prevented with nearly cost-free oral rehydration therapy (ORT), in which sick children are given a solution of glucose, salt, and water that quickly replaces fluids the body loses. Since 1990, public health workers have taught nearly half the families in the developing world how to administer ORT. Also, supplements of zinc (essential for immune system functioning), which cost only 30 cents for a month’s supply, substantially reduce the incidence of severe diarrhea (Aggarwal, Sentz, & Miller, 2007 ). Infectious Disease and Malnutrition

Immunization.
In industrialized nations, childhood diseases have declined dramatically during the past half-century, largely as a result of widespread immunization of infants and young children. Hal got the measles because, unlike his classmates from more economically advantaged homes, he did not receive a full program of immunizations.

About 30 percent of U.S. preschoolers lack essential immunizations. The rate rises to 32 percent for poverty-stricken children, many of whom do not receive full protection until age 5 or 6, when it is required for school entry (U.S. Department of Health and Human Services, 2010e ). In contrast, fewer than 10 percent of preschoolers lack immunizations in Denmark and Norway, and fewer than 7 percent in Canada, the Netherlands, Sweden, and the United Kingdom (World Health Organization, 2010 ).

Why does the United States lag behind these countries in immunization? As noted in earlier chapters, many U.S. children do not have access to the health care they need. In 1994, all medically uninsured children in the United States were guaranteed free immunizations, a program that has led to gains in immunization rates.

Inability to pay for vaccines is only one cause of inadequate immunization. Parents with stressful daily lives or without health benefits of their own often fail to schedule vaccination appointments, and those without a primary care physician do not want to endure long waits in crowded U.S. public health clinics (Falagas & Zarkadoulia, 2008 ). Some parents have been influenced by media reports suggesting a link between a mercury-based preservative used for decades in vaccines and a rise in the number of children diagnosed with autism. But large-scale studies show no association with autism and no consistent effects on cognitive performance (Richler et al., 2006 ; Stehr-Green et al., 2003 ; Thompson et al., 2007 ). Still, as a precautionary measure, mercury-free versions of childhood vaccines are now available.

In areas where many parents have refused to immunize their children, outbreaks of whooping cough and rubella have occurred, with life-threatening consequences (Kennedy & Gust, 2008 ; Tuyen & Bisgard, 2003 ). Public education programs directed at increasing parental knowledge about the importance and safety of timely immunizations are badly needed.Infectious Disease and Malnutrition

Childhood Injuries
More than any other child in the preschool classroom, 3-year-old Tommy had trouble sitting still and paying attention. Instead, he darted from one place and activity to another. One day, he narrowly escaped serious injury when he put his mother’s car into gear while she was outside scraping ice from its windows. The vehicle rolled through a guardrail and over the side of a 10-foot concrete underpass, where it hung until rescue workers arrived. Police charged Tommy’s mother with failure to use a restraint seat for a child younger than age 8.

Unintentional injuries are the leading cause of childhood mortality in industrialized nations. As Figure 7.3 reveals, the United States ranks poorly in these largely preventable events. About 20 percent of U.S. childhood deaths and 50 percent of adolescent deaths result from injuries (Centers for Disease Control and Prevention, 2012b ). And among injured children and youths who survive, thousands suffer pain, brain damage, and permanent physical disabilities.

FIGURE 7.3 International death rates due to unintentional injury among 1- to 14-year-olds.
Compared with other industrialized nations, the United States has a high injury rate, largely because of widespread childhood poverty and shortages of high-quality child care. Injury death rates are many times higher in developing nations, where poverty, rapid population growth, overcrowding in cities, and inadequate safety measures endanger children’s lives.

(Adapted from World Health Organization, 2008.)

Auto and traffic accidents, drownings, and burns are the most common injuries during early and middle childhood (Safe Kids USA, 2011b). Motor vehicle collisions are by far the most frequent source of injury across all ages, ranking as the leading cause of death among children more than 1 year old.

Factors Related to Childhood Injuries.
The common view of childhood injuries as “accidental” suggests they are due to chance and cannot be prevented (Sleet & Mercy, 2003 ). In fact, these injuries occur within a complex ecological system of individual, family, community, and societal influences—and we can do something about them.

Because of their higher activity level and greater impulsivity and risk taking, boys are 1.5 times more likely to be injured than girls (Safe Kids USA, 2008 ). Children with certain temperamental and personality characteristics—inattentiveness, overactivity, irritability, defiance, and aggression—are also at greater risk (Ordonana, Caspi, & Moffitt, 2008 ; Schwebel & Gaines, 2007 ). As we saw in Chapter 6 , these children present child-rearing challenges. They are likely to protest when placed in auto seat restraints, to refuse to take a companion’s hand when crossing the street, and to disobey even after repeated instruction and discipline. Infectious Disease and Malnutrition

Childhood injury rates are especially high in developing countries with weak public safety measures. These Cambodian children play un-supervised in a poverty-stricken, rundown neighborhood near a former dump site.

Poverty, single parenthood, and low parental education are also strongly associated with injury (Dudani, Macpherson, & Tamim, 2010 ; Schwebel & Brezausek, 2007 ). Parents who must cope with many daily stresses often have little energy to monitor the safety of their children. And their rundown homes and neighborhoods pose further risks (Dal Santo et al., 2004 ).

Broad societal conditions also affect childhood injury. In developing countries, the rate of death from injury before age 15 is five times as high as in developed nations and soon may exceed disease as the leading cause of childhood mortality (World Health Organization, 2008 ). Rapid population growth, overcrowding in cities, and heavy road traffic combined with weak safety measures are major causes. Safety devices, such as car safety seats and bicycle helmets, are neither readily available nor affordable.

Childhood injury rates are high in the United States because of extensive poverty, shortages of high-quality child care (to supervise children in their parents’ absence), and a high rate of births to teenagers, who are not ready for parenthood. But U.S. children from advantaged families are also at considerably greater risk for injury than children in Western Europe (World Health Organization, 2008 ). This indicates that besides reducing poverty and teenage pregnancy and upgrading the status of child care, additional steps are needed to ensure children’s safety. Infectious Disease and Malnutrition

Preventing Childhood Injuries.
Childhood injuries have many causes, so a variety of approaches are needed to reduce them. Laws prevent many injuries by requiring car safety seats, child-resistant caps on medicine bottles, flameproof clothing, and fencing around backyard swimming pools (the site of 50 percent of early childhood drownings) (Brenner & Committee on Injury, Violence, and Poison Protection, 2003 ). Communities can help by modifying their physical environments. Playgrounds, a common site of injury, can be covered with protective surfaces (Safe Kids USA, 2008 ). Free, easily installed window guards can be given to families in high-rise apartment buildings to prevent falls. And media campaigns can inform parents and children about safety issues.

But even though they know better, many parents and children behave in ways that compromise safety. About 27 percent of U.S. parents (like Tommy’s mother) fail to place their preschoolers in car safety seats. And 84 percent of infant seats and 40 percent of child booster seats are improperly used (Safe Kids USA, 2011a ). American parents, especially, seem willing to ignore familiar safety practices, perhaps because of the high value they place on individual rights and personal freedom (Damashek & Peterson, 2002 ).

Furthermore, many parents begin relying on children’s knowledge of safety rules, rather than controlling access to hazards, as early as 2 or 3 years of age—a premature transition associated with a rise in home injuries (Morrongiello, Ondejko, & Littlejohn, 2004 ). But even older preschoolers spontaneously recall only about half the safety rules their parents teach them. And even with well-learned rules, they need supervision to ensure they comply (Morrongiello, Midgett, & Shields, 2001 ).

Parent interventions that highlight risk factors and that model and reinforce safety practices are effective in reducing home hazards and childhood injuries (Kendrick et al., 2008 ). But attention must also be paid to family conditions that can prevent childhood injury: relieving crowding in the home, providing social supports to ease parental stress, and teaching parents to use effective discipline—a topic we take up in Chapter 8 .

ASK YOURSELF
REVIEW To effectively prevent childhood injury, why are diverse approaches essential? Cite examples at several levels of the ecological system.

CONNECT Using research on malnutrition, show how physical growth and health in early childhood result from a continuous, complex interplay between heredity and environment.

APPLY One day, Leslie prepared a new snack to serve at preschool: celery stuffed with ricotta cheese. The first time she served it, few children touched it. How can Leslie encourage her students to accept the snack? What tactics should she avoid?

REFLECT Ask a parent or other family member whether, as a preschooler, you were a picky eater, suffered from many infectious diseases, or sustained any serious injuries. In each instance, what factors might have been responsible?