The Well-Being of Canada's Young Children - Government of Canada Report 2008

Chapter 3 — How Healthy Are our Young Children?

3.1 Birth-Related Indicators

3.1.1 Healthy Birth Weight

…More than eight out of ten children were born at a healthy weight

In 2004, 81.8% of children were born at a healthy weight. For those children not born at a healthy birth weight, the proportion born at low birth weight (weighing less than 2,500 grams) increased, from 5.8% in 2002 to 5.9% in 2004, while the proportion born at high birth weight (weighing more than 4,000 grams) decreased, from 13.2% in 2002 to 12.3% in 2004.

The incidence of being born at a low birth weight has been consistently higher for females than for males. In 2004, 6.3% of females were born at low birth weight, compared to 5.6% of males.

By contrast, males are consistently born at a higher birth weight than females. In 2004, 15.1% of males were born at high birth weight, compared with 9.2% of females.

Text description of Figure 2

…while internationally

The OECD average for babies born at a low birth weight was 6.6% in 2005. Canada ranked 9th out of 30 OECD countries in terms of low birth weight at 5.9%, lower than the OECD average.⁷ The Nordic countries (Iceland, Finland, Sweden, Norway and Denmark), along with Korea, Luxembourg and Ireland had the fewest number of babies born at a low birth weight, with rates of 5% or less. By comparison, Turkey, Japan, Greece, Mexico, Hungary and the United States had the highest number of babies born at a low birth weight, with rates of 8% or higher.

The change in the proportion of low birth weight in Canada between 2000 and 2005 (7% increase) is comparable to the OECD average (5% increase), and identical to the increase seen in the United States (7% increase). Several factors may have contributed to the increase of low birth weight, including the steady rise in the number of multiple births, partly as a result of the rise in fertility treatments, older age at childbearing and increases in the use of delivery management techniques such as induction of labour and caesarean delivery.⁸

Text description of Figure 3

Why is this important?

Low birth weight is considered an important indicator of overall health. Risk factors for low birth weight include low parental socioeconomic status, increased maternal age and multiple fertility, harmful behaviours such as smoking, excessive alcohol consumption and poor nutrition, as well as a poor level of prenatal care.⁹ Furthermore, low birth weight might also be influenced by differences in education, income and associated living conditions.¹⁰

There are two possible causes for a baby to born at a low birth weight – it could be the result of a pre-term birth or due to restricted fetal (intrauterine) growth.¹¹ Low birth weight due to restricted fetal growth has been shown to negatively affect development throughout life, and is linked to a higher incidence of adult diseases, such as type 2 diabetes, hypertension and cardiovascular disease.¹²

High birth weight has been identified as a risk factor for a number of immediate and long-term health concerns, including complications with childbirth, shoulder dystocia, increased rate of caesarean delivery, diabetes and obesity through childhood to adulthood.¹³ High birth weight has also been associated with maternal obesity, prolonged gestation and maternal diabetes (including gestational, chemical, or insulin dependent diabetes).¹⁴ An analysis of NLSCY data found that boys, second- or later-born children, children born to older, more educated and non-smoking mothers, children from two-parent families or those from higher socioeconomic status families were more likely to have a high birth weight.¹⁵ Maternal health was also related to high birth weight (e.g., not suffering from postpartum depression; not having hypertension nor taking prescription drugs during pregnancy).¹⁶

3.1.2 Pre-Term Birth Rate

…The pre-term rate continues to increase

The pre-term birth rate represents the percentage of births with a gestational age at birth of less than 37 completed weeks (or 259 days). In 2004, 7.9% of births were pre-term, an increase from 7.5% in 2002. Of the remaining 92.1% of babies, 91.1%, were at term (births with a gestational age of 37 through 41 completed weeks), 0.6% were post-term (births with a gestational age of 42 weeks or more), and 0.3% of births did not have the gestational age stated.¹⁷

Males are more likely to be born premature – in 2004, 8.4% of males were born pre-term, compared to 7.5% of females.

Text description of Figure 4

Why is this important?

Babies born pre-term remain an unresolved challenge in perinatal medicine.¹⁸ In Canada, as in other developed countries, pre-term birth is the leading cause of infant death, illness and disability.¹⁹ Of babies born early, those born before 32 weeks are at a greater risk of dying and having poor health outcomes. Babies born between 32 and 36 weeks, which make up the greatest number of pre-term births, are still at higher risk for health and developmental problems compared to those born full term. Specifically, these babies are more likely to have health complications, such as respiratory, gastrointestinal, immune system, central nervous system, hearing, and vision problems. Long-term problems may include cerebral palsy, mental retardation, visual and hearing impairments, behavior and social-emotional concerns, learning difficulties, and poor health and growth.²⁰

3.1.3 Infant Mortality Rate

…Canada's infant mortality rate remains relatively stable

The infant mortality rate refers to the number of infants who die in the first year of life, per 1,000 live births. In 2004, the infant mortality rate was 5.3 deaths per 1,000 live births. Following a dramatic decline in infant mortality in Canada during the 20^th century, the infant mortality rate has stabilized, remaining around 5.3 deaths per 1,000 live births since 1998.

The infant mortality rate among males is consistently higher than for females. In 2004, the infant mortality rate for males was 5.5 deaths per 1,000 live births compared with 5 deaths per 1,000 live births for females.

…while internationally

The OECD average for infant mortality was 5.4 deaths per 1,000 live births in 2005. Canada ranked 24 out of 30 OECD countries in terms of infant mortality. Infant mortality rates in OECD countries ranked from a low of between 2 to 3 deaths per 1,000 live births in Japan, Nordic countries (except Denmark) and Luxembourg, to a high of 19 and 24 deaths per 1,000 live births in Mexico and Turkey respectively.²¹

Some of the variation in infant mortality rates may be due to variations among countries in registering practices of premature infants (whether they are reported as live births or fetal deaths). In several countries, such as in Canada, the United States, Japan and the Nordic countries, very premature babies with relatively low odds of survival are registered as live births, which increase mortality rates compared with other countries that do not register them as live births.

Why is this important?

The infant mortality rate is often used as a measure of the state of a country's health or development. In the developing world, in particular, it reflects the extent to which the basic needs of children are being met, such as adequate nutrition, clean water, safe sanitation, and basic preventative health services.²² The infant mortality rate can also be interpreted as a measure of “how well each country lives up to the ideal of protecting every pregnancy.” ²³ This includes protecting pregnancies among marginalized populations as well as taking all necessary precautionary and preventative measures – from regular antenatal check-ups to the ready availability of emergency obstetric care.

In a number of higher-income countries, there has been a levelling-off of the downward trend in infant mortality rates over the past few years. This may be attributed to an increasing number of women deferring childbearing and the rise in multiple births linked with fertility treatments, which resulted in an increase in the number of pre-term births. Approximately two-thirds of the deaths that occur during the first year of life are neonatal deaths, that is, they occur during the first four weeks. In OECD countries, congenital malformations, prematurity and other conditions arising during pregnancy are the principal factors contributing to neonatal mortality. For deaths beyond a month, there tends to be a greater range of causes – the most common being Sudden Infant Death Syndrome (SIDS), birth defects, infections and accidents.²⁴

3.2 Allergies and Asthma

3.2.1 Allergies

…10% of young children have at least one allergy

In 2004/05, 10% of children from birth to 5 years of age had at least one reported allergy, a decline from 10.7% in 2000/01. Of those reported, food allergies were the most common.

Allergies are more common among males than females, with 11.2% of males from birth to 5 years of age year olds reporting at least one allergy, compared with 8.7% of females.

Table 1 - Prevalence of Reported Allergies Among Children from Birth to 5 Years of Age (%)

	2000/01	2002/03	2004/05
Source: National Longitudinal Survey of Children and Youth, Cycles 4 (2000/01) through 6 (2004/05).
Children with at least one reported allergy	10.7	10.2	10
Respiratory Allergy	2.8	2.2	2.3
Food and Other Allergy	7.9	8	7.7
Food Allergy	3.9	4.5	5
Other Allergy	5.4	5	4.3
Children with no reported allergies	89.3	89.8	90

3.2.2 Asthma

…The number of young children with medically diagnosed asthma continues to decline

In 2004/05, 8.8% of children from birth to 5 years of age were reported as having asthma that was diagnosed by a physician, a decline from 9.9% in 1998/99.

Asthma continued to be more prevalent among males (11.2%) than females (6.2%). Asthma also continued to be more prevalent in urban centres than in rural areas, with 11.5% of males and 6.3% of females living in urban centres reported as having asthma, compared to 8.6% of males and 5.9% of females in rural areas. Since 1998/99, the prevalence of asthma has decreased for all groups, with the exception of females from birth to 5 years of age living in rural areas.

Children who have one parent who smokes are more likely to have asthma than children without parents who smoke.²⁵

Text description of Figure 5

3.2.3 Why Is This Important?

The frequency of all allergic diseases has risen dramatically over the past few decades.²⁶ Allergic diseases occur when the immune system becomes unusually sensitive and overreacts to common substances that are normally harmless, such as pollens, moulds, animal dander, dust or foods, insect venoms and drugs; and include diseases of the atopic diathesis (i.e. allergic diseases with genetic factors, such as hay fever, asthma and atopic dermatitis) as well as diseases that may have an allergic component (rhinitis, conjunctivitis, asthma, dermatitis, urticaria and anaphylaxis).²⁷

Allergic diseases negatively impact quality of life and escalate healthcare costs.²⁸ For children, allergies cause time lost from school and leisure activities as well as restricting activities. However, allergic diseases and their symptoms can be controlled, prevented, and minimized by learning what triggers allergies and understanding how to treat allergic diseases.²⁹ Research has also shown that the prevalence of asthma in high-risk children can be reduced through early developmental interventions (before birth and during the first year of life).³⁰

3.3 Childhood Cancer

…Leukemia is the most common type of cancer for children from birth to 4 years of age

In 2004, approximately 370 new cases of cancer were diagnosed in children from birth to 4 years of age. The most common types of cancer were leukemia, central nervous system tumours, neuroblastoma, Wilms tumor, retinoblastoma and lymphomas. Combined, these cancers accounted for over 85% of all newly diagnosed cases in children from birth to 4 years of age.

Table 2 - Incidence of New Cases of Cancer Among Children from Birth to 4 Years of Age (per 100,000 population)

	1998	1999	2000	2001	2002	2003	2004
Source: Public Health Agency of Canada using data from the Canadian Cancer Registry, Statistics Canada, Health Statistics Division. The International Classification of Childhood Cancer ICCC-3 (based on ICD-O-3) was used to classify cancer categories.
Leukemia	9.1	10.3	8.7	8.5	7.6	8.2	8.3
Central nervous system tumors	4.5	2.5	4.0	3.7	3.4	3.0	3.6
Neuroblastoma	3.2	2.6	2.3	3.0	3.4	3.0	2.8
Wilms tumors	2.7	2.0	1.3	1.6	1.9	2.0	1.9
Retinoblastoma	1.0	1.1	1.5	1.0	1.0	0.8	1.0
Lymphomas	0.8	1.4	1.2	1.1	0.9	1.2	0.9
All childhood cancers	24.3	23.4	21.9	22.1	21.2	21.3	21.6

The overall incidence rate for new cases of the cancers has been consistently higher among males than females since 1998. In 2004, the incidence rate for all childhood cancers for males from birth to four years of age was 22.9 new cases per 100,000 compared with 20.2 per 100,000 for females.

Why is this important?

Cancer is rare in children and adolescents, accounting for about 1% of all newly diagnosed cases of cancer.³¹ It is however the leading cause of disease-related death in Canadian children,³² with the incidence rate being highest in the first five years of life.³³

Cancer in children is more diverse than cancer in adults, and includes a much higher proportion that are of hematopoietic (blood and lymphatic) origin. The treatment of cancer has improved dramatically in recent years. A recent study found that the predicted five-year survival rates for childhood and adolescent cancers have improved substantially in Canada since the late 1980s, rising to 82%.³⁴ Improvements in survival rates may generally be attributed to a number of changes in the management of childhood cancers.

3.4 Injury Hospitalization Rate

… The proportion of children requiring visits to the hospital because of unintentional injuries rate has decreased drastically, both for children less than one year of age and those between 1 to 4 years of age.

In 2004/05, there were a total of 1,171 children under one year of age who were hospitalized for the treatment of unintentional injuries, representing an injury hospitalization rate of 348.1 per 100,000 children. This is a decline from the rate in 1998/99 of 438.9 per 100,000 children.

In order of prevalence, the four most common causes of unintentional injuries requiring hospitalization for children under one year of age, accounting for close to 70% of cases, were falls,³⁵ poisoning, suffocation and contact with a hot object or substance.

For children from 1 to 4 years of age, in 2004/05, there were a total of 4,995 who were hospitalized for the treatment of unintentional injuries, representing an injury hospitalization rate of 365 per 100,000 children. This is a decline from the rate in 1998/99 of 465.3 per 100,000 children.

For these children, two causes consistently accounted for the vast majority of injuries (over 55%) requiring hospitalization: falls and poisoning.

For both age groups, the injury hospitalization rate is consistently higher for males.

Table 3: Hospitalization due to Unintentional Injury, by age group, 2004/05, rate per 100,000 (All Unintentional Injuries and National Leading Causes)

	Children Less than 1 Year of Age			Children 1-4 Years of Age, Inclusive
	Both Sexes	Female	Male	Both Sexes	Female	Male
Note: Unintentional injuries = accident: An unforeseen incident, where the intent to cause harm, injury or death was absent, but which resulted in injury. Falls exclude fractures where the cause was unspecified. F Too unreliable to be published. Source: Public Health Agency of Canada analysis of data from the Canadian Institute for Health Information's Hospital Morbidity Database (fiscal year 2004/2005).
All unintentional injuries	348.1	322.1	372.8	365.0	322.3	405.8
Leading Causes:
Falls	1 (172.1)	1 (154.6)	1 (188.7)	1 (148.1)	1 (133.4)	1 (162.2)
Poisoning	2 (29.4)	2 (31.8)	2 (27.2)	2 (56.2)	2 (52.8)	2 (59.4)
Suffocation	3 (19.3)	4 (15.9)	3 (22.6)	6 (6.4)	6 (4.5)	6 (8.3)
Contact with hot object/substance	4 (18.1)	3 (17.1)	4 (19.1)	4 (20.3)	3 (18.4)	4 (22.2)
Struck by/against an object, person or animal	5 (9.5)	5 (9.2)	5 (9.8)	3 (20.8)	5 (16.3)	3 (25.2)
Natural/environmental	6 (3.6)	F	F	5 (18.8)	4 (16.9)	5 (20.6)

Why is this important?

Injuries are the leading cause of death for children, and also a leading cause of disability earlier in life.³⁶ For every injury-related death, there are 40 hospitalizations and an estimated 670 emergency room visits for treatment of injuries.³⁷ Injuries to children alone are estimated to cost about $4 billion.³⁸ Children who are permanently disabled by injury may experience lifelong pain or suffer permanent loss of motor or cognitive functioning.³⁹

Research shows that the majority of injuries can be prevented. Strategies that combine efforts in education, environment changes and enforcement are most effective in preventing injuries. Proven strategies include using the appropriate passenger restraints in cars, legislating helmet use for bike riding and designing safer products.⁴⁰

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• ⁷ Organization for Economic Co-operation and Development (OECD) (2007). Health at a Glance 2007: OECD Indicators. ^{Click to return to reference}
• ⁸ Organization for Economic Co-operation and Development (OECD) (2007). Health at a Glance 2007: OECD Indicators. ^{Click to return to reference}
• ⁹ Ibid. ^{Click to return to reference}
• ¹⁰ Ibid. ^{Click to return to reference}
• ¹¹ Kramer, M.S.(1987). “Determinants of Low Birth Weight: Methodological Assessment and Meta-Analysis.” In Bulletin of the World Health Organization, 65(5): 663 – 737. ^{Click to return to reference}
• ¹² UNICEF and WHO (2004). Low Birthweight: Country, Regional and Global Estimates, New York: UNICEF. ^{Click to return to reference}
• ¹³ Dubois, L., M. Girard and F. Tatone-Tokuda (2007). “Determinants of High Birth Weight by Geographical Region in Canada.” In Chronic Diseases in Canada, 28(1-2). ^{Click to return to reference}
• ¹⁴ Dyck, R. F. and L.Tan (1995). “Differences in High Birthweight Rates between Northern and Southern Saskatchewan: Implications for Aboriginal Peoples.” In Chronic Diseases in Canada, 16(3). ^{Click to return to reference}
• ¹⁵ Dubois, L., M. Girard and F. Tatone-Tokuda (2007). “Determinants of High Birth Weight by Geographical Region in Canada.” In Chronic Diseases in Canada, 28(1-2). ^{Click to return to reference}
• ¹⁶ Ibid. ^{Click to return to reference}
• ¹⁷ Statistics Canada, Vital Statistics – Birth Database. (Table 102-4512 Live Births, by Weeks of Gestation and Sex, Canada, Provinces and Territories, Annual). ^{Click to return to reference}
• ¹⁸ Pregenia (Preterm Birth and Genetics International Alliances) website. Available at http://www.pregenia.org. ^{Click to return to reference}
• ¹⁹ Public Health Agency of Canada (2005). Make Every Mother and Child Count – Report on Maternal and Child Health in Canada, 2005. Available at http://www.phac-aspc.gc.ca/rhs-ssg/pdf/whd_05epi_e.pdf. ^{Click to return to reference}
• ²⁰ Institute of Medicine, Report Brief (July 2006). Preterm birth: Causes, Consequences, and Prevention. Washington: The National Academies Press. ^{Click to return to reference}
• ²¹ Organization for Economic Co-operation and Development (OECD) (2007). Health at a Glance 2007: OECD Indicators. ^{Click to return to reference}
• ²² United Nations Children's Fund (UNICEF) (2007). “Child Poverty in Perspective: An Overview of Child Well-Being in Rich Countries A Comprehensive Assessment of the Lives and Well-Being of Children and Adolescents in the Economically Advanced Nations,” in Innocent Research Centre, Report Card 7. ^{Click to return to reference}
• ²³ Ibid. ^{Click to return to reference}
• ²⁴ Organization for Economic Co-operation and Development (OECD) (2007). Health at a Glance 2007: OECD Indicators. ^{Click to return to reference}
• ²⁵ National Longitudinal Survey of Children and Youth, Cycle 6 (2004/05). ^{Click to return to reference}
• ²⁶ Canadian Society of Allergy and Clinical Immunology. ^{Click to return to reference}
• ²⁷ Ibid. ^{Click to return to reference}
• ²⁸ Ibid. ^{Click to return to reference}
• ²⁹ The Allergy Report. Available at http://www.theallergyreport.com/reportindex.html. ^{Click to return to reference}
• ³⁰ M. Chan-Yeung, A. Ferguson, W. Watson, H. Dimich-Ward, R. Rousseau, M. Lilley, A. DyBuncio, A. Becker (2005). “The Canadian Childhood Asthma Primary Prevention Study: Outcomes at 7 years of age”, in Journal of Allergy and Clinical Immunology, Volume 116, Issue 1, Pages 49-55 ^{Click to return to reference}
• ³¹ Statistics Canada (July 24, 2007). “Study: Childhood and Adolescent Cancer Survival: 1999 to 2003”, in The Daily. Available at: http://www.statcan.ca/Daily/English/070724/d070724e.htm. ^{Click to return to reference}
• ³² Rusen ID MCGA. Measuring Up: A health surveillance update on Canadian children and youth. 1999. Health Canada. ^{Click to return to reference}
• ³³ The Canadian Childhood Cancer Surveillance and Control Program: Facts and Figures. Available at http://www.phac-aspc.gc.ca/ccdpc-cpcmc/program/cccscp-pcslce/facts_e.html. ^{Click to return to reference}
• ³⁴ Statistics Canada (July 24, 2007). “Study: Childhood and Adolescent Cancer Survival: 1999 to 2003”, in The Daily. Available at: http://www.statcan.ca/Daily/English/070724/d070724e.htm. ^{Click to return to reference}
• ³⁵ Excluding fractures, cause unspecified. ^{Click to return to reference}
• ³⁶ Canadian Institutes of Health Research. Health Research - Investing in Canada's Future 2004-2005. Available at http://www.cihr-irsc.gc.ca/e/28903.html. ^{Click to return to reference}
• ³⁷ Health Canada (1999). Measuring Up: A Health Surveillance Update on Canadian Children and Youth Health Canada, 1999. ^{Click to return to reference}
• ³⁸ Safe Kids Canada, Enhancing Productivity through Public Health: Investing in Human Capital with A Pan-Canadian Injury Prevention Strategy. A Contribution from Safe Kids Canada The National Injury Prevention Program of the Hospital for Sick Children to the Standing Committee on Finance. October 31, 2005. ^{Click to return to reference}
• ³⁹ Miller, T.R., E. O. Romano, and R. S. Spicer, “The Cost of Childhood Unintentional Injuries and the Value of Prevention.”. ^{Click to return to reference}
• ⁴⁰ Safe Kids Canada, Enhancing Productivity through Public Health: Investing in Human Capital with A Pan-Canadian Injury Prevention Strategy. A Contribution from Safe Kids Canada The National Injury Prevention Program of the Hospital for Sick Children to the Standing Committee on Finance. October 31, 2005. ^{Click to return to reference}