The Parliamentary Information Office of the Parliamentary Yearbook examines the findings of a report on child deaths in the UK by the Royal College of Paediatrics and Child Health.
The Healthcare Quality Improvement Partnership (HQIP) was established in 2008 to promote quality in healthcare with a specific focus on increasing the impact that clinical audit has on healthcare quality. The HQIP – on behalf of the four U.K. departments of Health (England, Scotland, Wales and Northern Ireland) – commissioned a study of deaths in children within the UK as part of the Clinical Outcome Review Programme: Child Heath Reviews – UK.
This major new study into child mortality, conducted by The Royal College of Paediatrics and Child Health (RCPCH) was published at the end of September. The RCPCH report, ‘Overview of child deaths in the four UK countries’, was commissioned as part of a programme to help inform clinical practice and improve the healthcare provided to children and young people.
The research was led by Professor Ruth Gilbert, Professor of Clinical Epidemiology, Medical Research Council Centre for Epidemiology for Child Health, Institute of Child Health, University College London. It had two main aims. Firstly, to inform policy about variation between UK countries respecting which children die, what conditions they die with and their causes of death. Secondly, to examine the usefulness of routinely collected data for evaluating child deaths.
The RCPCH had previously observed that the only national overview of underlying condition and causes of death in children was based on information recorded on death certificates, published by the Office for National Statistics (ONS). It noted that these data were not sufficient to provide clinicians and policy makers with a clear overview of the types of children most likely to die, or an understanding of how mortality rates for different groups of children are changing over time.
The RCPCH study is based on routinely collected vital statistics and administrative healthcare data. Specifically, it linked ONS death certificate data with longitudinal hospital admissions information for UK children between January 1980 and December 2010. This helped to establish a new category of ‘underlying condition’ for children who die.
The main findings are summarised below.
- Two thirds of children who die have a chronic condition
- Overall child mortality has declined by over 50% in the last 30 years
- Injuries account for the single biggest cause of child deaths
- Young maternal age remains a risk factor throughout childhood.
The findings have important implications for revising policy.
With respect to the finding that 60-70% of children who died had a chronic condition, the report concludes that more information is needed on the proportion of children who have chronic conditions that are terminal. It states that such information can help to improve end of life care for these children and their families.
Despite a decline in the overall child mortality rate and a decline in deaths due to accidents, injury remains the most frequent underlying cause of death. Injury accounts for between 31-48% of deaths in children aged 1-18 years, with the number of children dying from intentional injuries – through self harm or assault – remaining unchanged over 30 years. In terms of these findings, Dr Hilary Cass, RCPCH President, said: “Injuries remain the biggest cause of child deaths but are declining, so we need to continue to build upon public policy interventions such as traffic calming. The lack of decline in intentional injuries calls for a concerted focus on reducing violence and self harm in older children.”
The findings relating to young maternal age reveal that children born with the same birth weight were more likely to die if they were born to mothers aged under 30 years than if they were born to mothers aged 30-34 years. Commenting on the policy implications of this finding, Professor Gilbert said: “Universal policies are needed to address these disparities. Targeting support only at first-time teenage mums misses most of the problem.”