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Early years (0-4 years)

Leicester Children's Joint Strategic Needs Assessment (JSNA). Health and social care needs associated with the early years of life (0 to 4 years).

A child’s experience during the early years is critical to their physical, cognitive and social development. During this development phase the groundwork is laid for the rest of the child’s life. During the early years it is important that every child has the optimum conditions for success.

During the early years there are a variety of factors that are important for long term health and wellbeing. Breastfeeding is a key determinant of health for both the child and the mother. Nutrition behaviours and habits are established during the early years and are likely to influence eating patterns into adulthood. Deprivation plays a role in dental decay which is a largely preventable burden on children. Many of the issues facing young children are influenced to some degree by deprivation.

Population profile

Children aged 0-4 years old living in Leicester made up 7.6% (25,884) of the total population in 2015. There is a larger proportion of males in Leicester’s 0 to 4 years population compared to females (51% and 49%, respectively). Asian/Asian British children aged 0 to 4 years constitute a significantly larger proportion (36.9%) of this age group compared to the East Midlands (8.3%) and England (10.8%) averages.

Who is at risk and why

The main risk factors that can adversely affect longer term health and wellbeing outcomes for children aged 0-4 years are as follows:

  • Deprivation
  • Ethnicity
  • Area of residence
  • Obesity
  • Readiness for school
  • Lifestyle
  • Parenting

The level of need in the population

Outcomes

Child Mortality

The Child Death Overview Panel (CDOP) for Leicester, Leicestershire and Rutland found that children aged 1 to 4 years contributed 13% of all child deaths between 2009/10 and 2014/15. This is significantly more deaths in this age group when compared to England (7%).

Healthy Weight and Nutrition

Nutrition and dietary behaviours and habits are established during the early years and are likely to influence eating patterns into adulthood.

Breastfeeding and deprivation are key determinants of health for both the child and the mother. The proportion of women in Leicester initiating breastfeeding at time of delivery is better (76.9%) than the England average (74.3%), but the areas with the highest level of deprivation have the lowest rates of breastfeeding initiation.

Breastfeeding rates at 6 to 8 weeks after birth in Leicester are reported as 62.1%. This is significantly higher than the England average (43.8%).

Injuries

Intentional injuries are a major cause of morbidity and mortality during the early years of life.

Leicester has a rate of 78.7 per 1000 children aged 0 to 4 years (2014/15) who are admitted to hospital due to accidental and deliberate injuries. This rate is significantly lower than the England average.

Oral Health

Dental decay for young children in Leicester is significantly higher than the average for England. In addition to the risk of dental diseases for the general population of children, children taken into the care system are at an increased risk of poor dental health.

'Delivering Better Oral Health' recommends the application of fluoride varnish twice a year for all children from age 3 years (with increased applications for those with higher need) for preventative purposes. Although the national guidance states that fluoride varnish should be applied from 3 years, only 14.4% of eligible children in Leicester received fluoride varnish applications in 2014/15.

School Readiness

School readiness is a determinant of a child’s future health and well-being across the life course. Improved school readiness and better educational attainment influence one’s physical and mental health, positive peer relations, confidence, and ability to earn a high wage

Early Education

Access to good quality early education programmes is a determinant for longer term educational attainment and wages. All 3 and 4 year olds are entitled to access a FEEE place. Take up of this offer by three year olds in Leicester is fairly high, but is lower than the England average.

Language Development

A child’s ability to communicate verbally is important for his/her confidence and success at school. Poor language development can impact school performance, social inclusion and self esteem. Children who do not speak English as their first language are less likely to be school ready.

Children’s Speech and Language Therapy (SALT) is provided by Leicestershire Partnership Trust to work in settings across the city clinics, CYPFCs, nurseries and schools. The caseload in 2014/15 was 1,055 (of children aged 0-4 years).

Emotional Health

Children with poor socio-emotional skills, low self-esteem or low confidence are more likely to find transition to school very difficult.

There are relatively little data about prevalence rates for mental health disorders in pre-school age children. It is estimated that 3,740 children aged 2 to 5 years in Leicester have a mental health disorder.

Determinants of health

Immunisations

The World Health Organisation (WHO) recommends a threshold of 95% for all vaccinations, and Leicester achieves this threshold except for the 1st and 2nd doses of MMR and the 5 year Hib/MenC booster. However, Leicester’s overall performance is above (or comparable to) the regional and England averages.

Safeguarding

Children, Young People and Family Centres (CYPFCs) work with families to provide a range of services aimed at ensuring the best start for children

The Local Safeguarding Children Boards (LSCB) works to coordinate local work to safeguard and promote the welfare of children and to ensure the effectiveness of member organisations’ work individually and together.

Projected Service Use

The 0-4 year old population in Leicester has increased by 16.3% over the last 10 years, which is significantly higher than the national and regional averages. The latest population projections from the Office of National Statistics predict that by 2037 the 0 to 4 year- old population will increase by an additional 13.6%.

Recommendations

Recommendations based on the findings of this JSNA.

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