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Current Literature

What works in strategic partnerships for children: a research


review.
Percy-Smith J (2006) Children and Society, 20, 313323
DOI: 10.1111/j.1099-0860.2006.00048.

When is lack of supervision neglect?


Hymel K.P. & The Committee on Child Abuse and Neglect
(2006) Pediatrics, 118, 12961298.
DOI: 10.1542/peds.2006-1780.

Strategic partnerships have a key role to play in delivering


the governments Every Child Matters agenda. There is a
developing body of research and other evidence and practiceinformed literature about what works in relation to partnership working. Drawing on a research review commissioned by
Barnardos on strategic partnership working for children, this
study summarizes research findings from a number of sectors
relating to the development, delivery and review of effective
partnerships. Although there is widespread consensus within
the research on the factors contributing to effective partnership
processes, there is, currently, relatively little evidence that partnerships lead to positive outcomes for children and young
people.

Occasionally, paediatricians become aware of children who are


inadequately supervised. More frequently, paediatricians treat
children for traumatic injuries or ingestions that they suspect
could have been prevented with better supervision. This clinical
report contains guidance for paediatricians considering a referral to a child protective services agency on the basis of suspicion
of supervisory neglect.

The rather dry title to this paper conceals a well-written, interesting, relevant and easily read account of research and other
evidence about what factors facilitate effective working in strategic partnerships for children. The paper first describes the
sources of evidence which includes official publications, guidance and theoretical discussions, as well as research-based evidence. It then discusses definitions which is where some of the
problems start because partnerships mean different things to
different constituencies. Next, the body of the review describes
the fairly large literature on factors which facilitate or inhibit the
development of functioning partnerships, contrasting this with
the lack of evidence that partnerships actually deliver positive
outcomes for children or families.
There are a number of important points made. First, that
creating effective partnerships is time-consuming, costly,
requires active senior management commitment and will have a
number of predictable barriers to overcome. If short-term gains
are required, partnership working is not the way to get them!
Second, that the assumption that partnership working is a good
thing requires to be challenged. There is a lack of evidence of
positive outcomes, and a pressing need for well-conducted
outcome research into the effect of strategic partnerships on
children. Not included in the review because the data were not
available at the time is the outcomes from the Sure Start programme, which although showing a modest beneficial outcome
overall, showed a deleterious effect on the most disadvantaged
families. This illustrates the complex nature of the potential
relationships between the delivery of services from strategic
partnerships and the outcomes in children which may vary in
unpredictable ways among different groups in the population.
This paper has vital messages for public policy relating to
children, for child public health and for academic research into
complex services.

Richard Reading

This brief clinical report from the American Academy of


Pediatrics addresses an issue which taxes all paediatricians as
well as many other child care professionals. There is never going
to be a definitive answer to this question, and the report does not
attempt to be dogmatic. Instead, it offers a number of suggestions for consideration which might help to give a more
informed answer. For example, it suggests considering the
caregivers reasoning and understanding of the situation, past
allegations of supervisory neglect, and the age-appropriateness
of the responsibilities expected of the child. The report also
reminds us to remember the emotional burden on the caregiver
if an act of omission has led to an injury in the child.
Although this is not a definitive list, nor does it provides any
systematic way of answering the question, if all the guidance is
followed, it will help paediatricians be a lot more confident that
they have addressed the right questions and have at least made
an informed decision. This is a short paper that would be a
useful addition to your office child protection file.

Richard Reading
Effect of breast feeding on intelligence in children:
prospective study, sibling pairs analysis, and meta-analysis.
Der G., Batty G.D. & Deary I.D. (2006) British Medical
Journal, 333, 945.
DOI: 10.1136/bmj.38978.699583.55 (published 4 October
2006).
Objective To assess the importance of maternal intelligence,
and the effect of controlling for it and other important confounders, in the link between breastfeeding and childrens
intelligence.
Design Examination of the effect of breastfeeding on cognitive
ability and the impact of a range of potential confounders, in
particular maternal IQ, within a national database. Additional
analyses compared pairs of siblings from the sample who were
and were not breastfed. The results are considered in the context
of other studies that have also controlled for parental intelligence via meta-analysis.

2007 The Authors


Journal compilation 2007 Blackwell Publishing Ltd, Child: care, health and development, 33, 1, 109112

Current Literature 111

Setting 1979 US national longitudinal survey of youth.


Subjects Data on 5475 children, the offspring of 3161 mothers
in the longitudinal survey.
Main outcome measure IQ in children measured by Peabody
individual achievement test.
Results The mothers IQ was more highly predictive of breastfeeding status than were her race, education, age, poverty status,
smoking, the home environment, or the childs birthweight or
birth order. One standard deviation advantage in maternal IQ
more than doubled the odds of breastfeeding. Before adjustment, breastfeeding was associated with an increase of around 4
points in mental ability. Adjustment for maternal intelligence
accounted for most of this effect. When fully adjusted for a
range of relevant confounders, the effect was small (0.52) and
non-significant (95% confidence interval -0.19 to 1.23). The
results of the sibling comparisons and meta-analysis corroborated these findings.
Conclusions Breastfeeding has little or no effect on intelligence
in children. While breastfeeding has many advantages for the
child and mother, enhancement of the childs intelligence is
unlikely to be among them.
A number of papers over the last few years have presented evidence for and against the effect of breastfeeding on subsequent
intelligence. This follows the fairly robust findings of Lucas et al.
from randomized trial in preterm infants which showed a small
but important improvement in IQ in preterm babies fed with
breast milk. Subsequent studies have looked at the evidence for
term infants and have found equivocal results. The problem, as
described in this paper, is that any observational study is confounded by many other social, genetic and cultural factors, not
the least being mothers intelligence.
Although this is a further observational study, these authors
have taken extra care to adjust for a much wider range of preexisting factors which might confound the relationship between
breastfeeding and intelligence. They have included their findings
in a meta-analysis which also shows that there may have been a
publication bias in previous studies. They argue strongly, on the
basis of their results and of the accompanying meta-analysis,
that there is no evidence of an effect of breastfeeding, and more
importantly, that there is sufficient evidence to show there is no
effect.
Will this be the last word on the subject? Probably not. The
same criticisms of other studies that they make may be levelled
against their study. However, they are able to defend their findings with strong methodology. Naturally, they end their paper
with an endorsement of the World Health Organization statement that breastfeeding remains an unequalled way of providing ideal food for the healthy growth and development of
infants.

Richard Reading

When home is where the stress is: expanding the dimensions


of housing that influence asthma morbidity.
Sandel M. & Wright R.J. (2006) Archives of Disease in
Childhood, 91, 942948.
DOI: 10.1136/adc.2006.098376.
The influence of physical housing quality on childhood asthma
expression, especially the effect of exposure to moulds, allergens
and pollutants, is well documented. However, attempts to
explain increasing rates and severity of childhood asthma solely
through physical environmental factors have been unsuccessful,
and additional exposures may be involved. Increasing evidence
has linked psychological stress and negative affective states to
asthma expression. At the same time, recent scholarship in the
social sciences has focused on understanding how social environments, such as housing, get under the skin to influence
health, and suggests that psychological factors play a key role.
While there is relevant overlapping research in social science,
psychology, economics and health policy in this area, findings
from these disciplines have not yet been conceptually integrated
into ongoing asthma research. We propose to expand the
dimensions of housing considered in future asthma research to
include both physical and psychological aspects which may
directly and indirectly influence onset and severity of disease
expression. This synthesis of overlapping research from a
number of disciplines argues for the systematic measure of
psychological dimensions of housing and consideration of the
interplay between housing stress and physical housing characteristics in relation to childhood asthma.
This thought-provoking paper describes research in disparate
fields which have a bearing on the links between housing quality
and asthma. The authors main contention is that research so far
on environmental factors which might exacerbate or protect
against asthma has concentrated on the physical environment.
For instance, air pollution, pollen exposure, and, in the context
of housing, smoke, damp and mould. However, psychological
factors are also known to influence asthma, and the paper postulates that these may be seen analogously as toxic emotional
influences. For instance, . . . psychological stress has been conceptualised as a social pollutant that . . . may disrupt biological
systems through inflammatory processes.
The authors cite research linking housing with mental states
in adults and children, the relationship between parental and
child stress with asthma morbidity and control, the biological
studies showing neuro-endocrine and immunological effects of
stress, and the increasing research disentangling area and neighbourhood influences on health from household and family
influences. In contract, there is relatively little research linking
non-physical aspects of housing and the household environment with asthma. However, a good case is made for developing
this area of research.

2007 The Authors


Journal compilation 2007 Blackwell Publishing Ltd, Child: care, health and development, 33, 1, 109112

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