Residential mobility interacts at neighbourhood, family and individual levels in cumulative and compounding ways with significance for the wellbeing of children. High frequency residential change is potentially a useful marker for the clinical risk of behavioural and emotional problems. The evidence supports the reorientation of health services effectively to engage these residentially mobile children for whom health and psychological needs may be identified. The impact of housing and economic policies on childhood residential mobility should be evaluated considering this evidence.

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Aim Describe paediatricians' experience of adverse health outcomes for children during the New Zealand‐wide level 4 lockdown in response to the COVID‐19 pandemic. Methods Weekly national survey of paediatricians with an open‐ended questionnaire. Results During the 6‐week study survey period, the New Zealand Paediatric Surveillance Unit received 33 reports about 55 instances where paediatricians believed care may have been compromised, about half (56%) relating to infants aged from birth to 6 weeks. Compromised care was for acute presentations in 75%, acute complications of a chronic illness in 14%, with 11% for chronic conditions. Paediatricians reported the outcome as moderately severe (short‐term morbidity, increased length of stay, higher level of care) in 38 cases (69%) and in a further 4 (7%) as severe (potential to be life‐threatening or result in permanent disability). Conclusion Despite clear messaging, hospital avoidance and reduced access to primary and secondary care were associated with significant potential harm for children in New Zealand during a strict lockdown, with newborn infants disproportionately affected. During the implementation of interventions to eliminate community transmission of COVID‐19, New Zealand paediatricians note the importance of face‐to‐face post‐natal visits for newborns and primary care services for children with acute illness, to avoid preventable harm.

One half of cases in Auckland are acquired either from Pacific or locally. Similarities mean that disease acquired locally is likely of Pacific origin.

Pre-school dental caries is a significant public health problem and may be associated with the growth and nutritional status of children. This study aimed to investigate the association between body mass index (BMI) and early childhood caries (ECC) among pre-school children. Methods: This population-based retrospective study involves all 5-year-old children who resided in northern New Zealand and received school entry dental examinations between 1 January 2014 and 31 December 2015. ECC status was determined with the decayed missing filled teeth (dmft) score obtained from a routinely collected regional dental data set. Objectively measured BMI information was obtained from the 'Before School Check' (B4SC) Programme. Logistic regression analyses were used to assess the association between BMI and the occurrence of ECC (dmft score ≥ 1). Ethnic subgroup analyses were also conducted. Results: Of the 27 333 children involved in this analysis, 11 173 (40.9%) had ECC with a mean dmft score of 1.85, and 3948 (14.4%) were overweight and 2964 (10.8%) were obese at school entry. The prevalence of ECC was higher in overweight and obese children but in subgroup analyses by ethnicity, this positive association was observed in European children only (adjusted odds ratio for overweight children compared to normal weight children: 1.16; 95% CI: 1.02, 1.32 and adjusted odds ratio for obese children: 1.20; 95% CI: 1.00, 1.45). Conclusion: ECC is highly prevalent in New Zealand children and associated with higher BMI in children of European ethnicity.

Eczema is a frequent childhood manifestation and a few atopic children are allergic to certain foods or aeroallergens. Anxious parents of atopic children often have a fear of topical steroid-related side-effects, and some may try a range of elimination diets to avoid allergies. Elimination diets increase the risk of anaphylaxis on re-exposure to previously tolerated foods from the loss of oral tolerance. Unbalanced diets together with an inadvertent excessive consumption of fruits and vegetables may lead to carotenemia from the carotenoids in the plant foods. Carotenemia is benign but unusual diets and the consumption of preformed vitamin A in health supplements can lead to vitamin A toxicity. We discuss a child with eczema on an exclusion diet presenting with anaphylaxis to dairy food. He had carotenemia with hepatomegaly, which resolved on dietary management.

ObjectivesFirst, to investigate whether there is a relationship between a family being known to child protective services or police at the time of birth and the risk of abusive head trauma (AHT, formerly known as shaken baby syndrome). Second, to investigate whether data from child protective services or police improve a predictive risk model derived from health records.DesignRetrospective case control study of child protective service and police records.SettingNine maternity hospitals.Participants142 consecutive cases of AHT admitted to a tertiary children’s hospital from 1991 to 2010 and born in one of the nine participating maternity hospitals. 550 controls matched by the date and hospital of birth.Outcome measureAbusive head trauma.ResultsThere is a relationship between families known to child protective services or police and the risk of AHT. Notification to child protective services: univariable OR 7.24 (95% CI 4.70 to 11.14). Involvement with youth justice: univariable OR 8.94 (95% CI 4.71 to 16.95). Police call-out for partner violence: univariable OR 3.85 (95% CI 2.51 to 5.91). Other violence offence: univariable OR 2.73 (95% CI 1.69 to 4.40). Drug offence: univariable OR 2.82 (95% CI 1.63 to 4.89). However, in multi-variable analysis with data from perinatal health records, notification to child protective services was the only one of these variables to remain in the final model (OR 4.84; 95% CI 2.61 to 8.97) and had little effect on overall predictive power. The area under the receiver operating characteristic curve was 89.5% (95% CI 86.6 to 92.5) using variables from health data alone and 90.9% (95% CI 88.0 to 93.7) when notification was added.ConclusionsFamily involvement with child protective services or police is associated with increased risk of AHT. However, accessing such data at the time of birth would add little predictive power to a risk model derived from routine health information.

Aim Pre‐school wheeze is a common hospital presentation in Australasia. The aim of this study was to describe the regional hospital presentation and cost of pre‐school wheeze. Methods Audit of children diagnosed with pre‐school wheeze at two hospitals in Auckland, New Zealand from October 2017 to September 2019. Guideline adherence was determined. Results One hundred and ninety‐two children made 247 pre‐school wheeze hospital presentations. Pre‐school wheeze accounted for a larger proportion of acute hospital presentations for Māori versus non‐Māori children (rate ratio 1.76, 95% confidence intervals 1.32–2.31). Hospital representations with pre‐school wheeze occurred in 38/192 (20%) children. The proportion with a pre‐school wheeze representation was larger for Māori than non‐Māori (30% vs. 16%, P = 0.02). Pre‐school wheeze event median length of stay increased as household deprivation increased (P = 0.01). Clinical severity of 247 pre‐school wheeze episodes was mild (n = 64, 26%), moderate (n = 153, 62%) and severe (n = 30, 12%). Of 244 episodes, inhaled bronchodilators only were given for 149 (61%), oxygen for 54 (22%) and intravenous treatment for 41 (17%). Hospital guideline use was evident in 164/247 (66%) episodes. Neither clinical severity nor treatment intensity varied with child sex, age or ethnicity or household deprivation. The estimated median (interquartile range) direct medical costs of each pre‐school wheeze episode were NZ$1279 (NZ$774–2158). Conclusions In Auckland, pre‐school wheeze accounts for a larger proportion of acute hospital presentations for Māori compared with non‐Māori and Māori children have increased odds of pre‐school wheeze readmissions. Length of hospital stay for pre‐school wheeze episodes increased with household deprivation. In this audit pre‐school wheeze guideline adherence was poor.