This year’s National Children’s Day focused on the importance of a healthy childhood, and how we need to protect the rights of children to ensure that they can grow into happy, healthy adults. This month, we’ve updated and expanded our indicators relating to children and young people. They span measures from early childhood such as breastfeeding and low birth weight, to teenage and young adult measures such as smoking and sexual health.
Measuring how childhood vaccination coverage is changing over time is particularly important, as there are currently global outbreaks of measles in regions of low coverage. The World Health Organisation concluded that measles elimination is greatly under threat. In March, the Chief Executive of NHS England warned that “vaccination deniers” were gaining traction on social media, and more recently the Health Secretary did not rule out compulsory immunisation as a way of boosting England’s vaccination levels.
Overall, this QualityWatch update highlights the worrying increase in childhood obesity, the stalling in rates of infant mortality, and an increase in hospital admissions as a result of self-harm. There have, however, been some promising improvements, including a reduction in smoking among young people and a decrease in teenage pregnancy. Below is a summary of our children and young people indicators, with links to more detailed content and analysis.
For more information about how the health outcomes for children and young people in the UK compare with other similar countries, see the recent Nuffield Trust reports:
- International comparisons of health and wellbeing in early childhood
- International comparisons of health and wellbeing in adolescence and early adulthood
Infant mortality
- Between 1990 and 2017, the infant mortality rate decreased considerably in all UK countries. However, the rate of decline of infant mortality has slowed in recent years.
- In England, the infant mortality rate remained at 3.9 deaths per 1,000 live births between 2013 and 2016, before increasing to 4.0 deaths per 1,000 live births in 2017; this was the highest of the four UK countries.
Low birth weight
- In 2016, 6.9% of live births in the UK were babies weighing less than 2,500 grams – a small improvement from 7.5% in 2000. Compared with similar OECD countries, the UK lies around the middle of the range of values.
Breastfeeding
- In England, the proportion of new mothers initiating breastfeeding (within the first 48 hours of birth) increased from 66% in 2005/06 to 74% in 2010/11. It has remained stable since then.
- The percentage of infants totally or partially breastfed at six to eight weeks decreased from 47% in 2011/12 to 43% in 2017/18.
Smoking in pregnancy
- In 2006/07, 16% of women were smokers at the time of delivery and this decreased to 11% in 2016/17. But the reduction in smoking rates among pregnant women has slowed in recent years, with a percentage decrease of only 0.3% in 2016/17 and a percentage increase of 0.1% in 2017/18.
- Provisional data for 2018/19 shows that the percentage of pregnant women who smoke will continue to decrease. However, if the 6% target is to be met by 2022 the rate of decline will need to increase considerably.
Teenage pregnancy
- Between 1990 and 2017, the under-18 conception rate decreased by 62%, from 48 per 1,000 women to 18 per 1,000 women.
- In 2017, 52% of under-18 conceptions resulted in an abortion, which is the highest percentage in over 25 years.
Vaccination coverage for children and mothers
- Coverage for all of the childhood vaccinations plateaued between 2011-12 and 2013-14, and has since declined.
- MMR vaccination coverage fell for the fourth successive year. Uptake was 91.2% in 2017-18, down from 91.6% in 2016-17 and the lowest level since 2011-12.
- Between 1st January 2018 and 31st October 2018, there were 913 laboratory-confirmed measles cases in England. This is a steep rise in cases compared to the 259 confirmed measles cases in 2017.
- Uptake of the HPV vaccination has declined slightly over the last couple of years, with 89% coverage for the first dose and 84% for two doses in 2017/18.
Childhood obesity
- The proportion of children in Reception (aged 4-5 years) who are overweight and obese has remained relatively unchanged since 2006/07. However, obesity in children in Year 6 (aged 10-11 years) has increased by 2.6 percentage points over the same time period.
- One in five children in Year 6 (aged 10-11 years) were obese in 2017/18.
- In 2017/18, in both Reception and Year 6 children the obesity prevalence was over twice as high in the most deprived areas than the least deprived areas.
Smoking among young people
- Between 2000 and 2016, the proportion of 15 year old pupils who were regular smokers decreased from 23% to 6.7%.
- If the 2022 target is to be met, the proportion of young people who smoke must decrease by a further 3.7 percentage points.
Sexual health
- Between 2008 and 2017, rates of new STI diagnoses increased for chlamydia, gonorrhoea, genital herpes and syphilis, but decreased for genital warts.
- The proportion of the population aged 15 to 24 screened for chlamydia decreased from 27% in 2012 to 19% in 2017.
Self-harm in children and young people
- Between 2011/12 and 2017/18, the rate of hospital admissions as a result of self-harm in children and young people (aged 10 to 24 years) increased from 347 per 100,000 population to 421 per 100,000 population – a 21% increase.
Eating disorder waiting times
- Between Q1 2016-17 and Q4 2018-19, the percentage of children and young people with an eating disorder starting urgent treatment within one week of referral increased from 65% to 81%.
- The percentage of routine/non-urgent cases starting treatment within four weeks of referral also increased over time, from 65% in Q1 2016-17 to 82% in Q4 2018-19.
- Despite this improvement, progress has stalled in recent quarters and waiting times need to be reduced further if the 95% target is to be met in 2020.
Emergency admissions for children with chronic conditions
Asthma
- Between 2008/09 and 2017/18, the rate of emergency admissions for asthma in children and young people aged 0 to 19 remained relatively constant. But the rate in children aged 0 to 4 years decreased considerably. This could largely be due to a reduction in overdiagnosis of asthma in young children by clinicians.
- In 2017/18, the rate of emergency admissions for asthma in children aged 5 to 9 was over 1.5 times as high as the rate in children aged 10 to 14, and 2.5 times as high as the rate in young people aged 15 to 24.
Diabetes
- The rates of emergency admissions for type 1 diabetes have been stable or have decreased for younger children aged 0 to 14.
- There has been a striking increase in emergency admissions for diabetes in young people aged 20 to 24. The worsening trend is likely to be explained by fragmented and variable service quality, as young people with diabetes transition to adult services.
Epilepsy
- Overall, emergency admissions for epilepsy have reduced over time for children and young people. Young children aged 0 to 4 have the highest emergency admission rate for epilepsy, at 88 per 100,000 population in 2017/18.