Notes from Dr MacIntyre on the meeting held on 26th November 2009

The 2nd Ordinary Meeting of the session was held in the Walton Suite at the Southern General Hospital. Perhaps partly for this reason and because of inclement weather, the attendance was very poor – only 10 members. The catering was not of the standard generally provided by the Catering Department at the Victoria. Despite this, those present enjoyed an informative evening with much discussion.

The President introduced three speakers contributing to a seminar on “Understanding Children’s Well-being”. Professor Charlotte Wright based at Yorkhill has been Project Lead in the UK for introduction of new WHO growth charts for children up to the age of four. These are to be introduced in January. They are based on growth patterns of healthy breast-fed children in non-smoking and non-deprived backgrounds in six different venues covering North and South America, Europe, Africa and Asia. Intriguingly the range of birth weights and the growth patterns of these children are identical in terms of height, though in the UK babies show a tendency to weight gain so that 6% are above the 98th centile at the end of the first year. Introduction of the charts includes detail for pre term infants and associated gestational adjustment, charts for parents allowing estimation of eventual height, and detail on measurement and use of the charts for health professionals.

Dr Helen Minnis is also based in Child Psychiatry at Yorkhill. The underlying theme of the whole evening was the importance of the first year of life and Dr Minnis started by pointing out the extent to which brain development takes place during that year and can therefore be susceptible to damage. Three identified mechanisms of this are simple delay in normal development, change in susceptibility to stress (particularly gluco-corticoid receptors), and influences on new neuronal development. This can affect different parts of the brain – thus for example the corpus callosum which probably has a role in integrating logical activity in the left hemisphere with perception and intuition on the right. Measurements of cortisol levels can be used as a marker of HPA axis activity. Studies have shown that the normal diurnal variation was lost in Romanian orphanage children and in maltreated children – with cortisol levels particularly suppressed in the latter. Intervention with improved individual child care during the first year reversed this biochemical pattern. It is thought that care and support which eases times of distress is particularly important. The term “reactive attachment disorder” was coined to describe characteristics of the children who have suffered this pattern of neglect. Some of these children are inhibited in all relationships. Others showed disinhibition in reaction to strangers, becoming over-friendly. Work currently underway in Glasgow is aimed at identifying at an early stage children at risk of this type of neglect and attempting close intervention through the usual agencies such as health visiting.

Dr Kerry Milligan’s background is in General Practice but particularly working with homeless and at risk families and in the area of child protection. Recent publicity over cases such as Victoria Climbie and Baby P have made this a difficult area of work with heavy workloads for staff, exacerbated by recruitment problems. Inevitably most of the attention in child protection work is directed at these high profile or crisis situations. Reporting on child protection is dominated by disasters or examples of bad practice. There has been a gradual increase in child protection registrations, particularly in relation to emotional abuse and physical neglect. Against this background there is a need for much more attention to the more general area of child protection. Risk factors can be identified – families where there is substance abuse, homelessness or poverty, young carers, asylum seekers. Early signs of behavioural disturbance are often present, both before and at school age. These can be picked up particularly if there is regular contact with families. Dr Milligan quoted an individual case report from 1945 which illustrated how little change there may have been in the problems and issues of child protection. However the opportunity is there through early identification and intervention with at risk families to improve outcomes.

Following a period of discussion Dr Kennedy Roberts thanked the speakers for their contributions to a small but clearly interested audience.