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Age group 0 to 5 years

Physical health

Physical health is a basic building block for children’s current wellbeing and future life outcomes. Being physically healthy includes being physically active, having a good diet and being in the healthy weight range.

Overview and areas of concern

This indicator considers some key measures of physical health for children including physical activity, screen time, diet, weight and long-term health issues.

Physical health is influenced by a range of factors including genetic, social and environmental influences. Research has found that Australian children living in areas with a high risk of social exclusion1 have, on average, worse health outcomes than children living in other areas.2 In particular, socioeconomic indicators such as having higher income and education levels are directly linked to better health outcomes.3

Data overview

Limited regularly collected data exists on the physical health of WA children aged 0 to five years.

Three-quarters (75%) of Kindergarten students are in the healthy weight range.

Proportion of Kindergarten children in Body Mass Index (BMI)* categories, in per cent, metropolitan Perth, 2018

Data source: Custom report provided by the WA Department of Health from the Child Development Information System (CDIS) from the School Entry Health Assessment [unpublished]

* It should be noted that BMI is not a diagnostic tool - if a child or young person has a high BMI for their age and sex they should be referred to a health professional for further assessment.

Areas of concern

Research suggests that many WA children aged 0 to five years may not be meeting the recommended physical activity guidelines, although more robust and regularly reported data is required.

In 2017, children aged from two to less than five years were less likely to meet the daily screen usage guidelines compared with children aged less than two years (24.8% compared to 63.8%).

Under 10 per cent of WA children aged four to seven years are eating the recommended number of serves of vegetables per day.

Other measures

Oral health is also an important measure of child wellbeing, as oral disease can cause pain, discomfort as well an increased risk of chronic disease in later life.4 While oral health is important for children and young people, it is not included in the Indicators of wellbeing.

The child health and development checks include an oral check and therefore are the primary mechanism for identifying issues with oral health. If children are attending the full complement of health checks (as reported in Indicator: Developmental screening), oral health issues should be identified.

For more information about oral health in Australia refer to the Australian Institute of Health and Welfare’s Oral health and dental care in Australia web report.

Endnotes

  1. In this research social exclusion comprised five domains: socioeconomic circumstances, education, connectedness, housing and health service access.
  2. Australian Institute of Health and Welfare (AIHW) and National Centre for Social and Economic Modelling (NATSEM) 2014, Child social exclusion and health outcomes: A study of small areas across Australia, Bulletin 121, June 2014
  3. World Health Organisation (WHO) 2008, The determinants of health, WHO.
  4. Australian Institute of Health and Welfare (AIHW) 2018, Oral health and dental care in Australia, AIHW.
Measure: Adequate physical activity

Physical activity makes an important positive contribution to the health and wellbeing of children. For children aged 0 to five years doing regular physical activity supports the development of healthy bones, muscles, joints, a healthy cardiovascular system and motor coordination. It is also an important element to achieving and maintaining a healthy weight.

Physical activity also enhances cognitive functioning including memory, concentration and the ability to learn.1 Furthermore, it is associated with social and emotional benefits including self-regulation and self-esteem.2

The current recommendations for physical activity every day for children aged 0 to five years are as follows:3

Australian 24-hour movement guidelines for the early years (birth to 5 years)

Under 1 year

1 to 2 years

3 to 5 years

Physical activity

Multiple times a day

180 minutes

180 minutes

Specific recommendations

30 minutes tummy time

Variety of activities including energetic play

At least 60 minutes of energetic play

Source: Australian 24-hour movement guidelines for the Early Years (birth to 5 years)

Measuring the physical activity of very young children is difficult. It generally relies on parent reported data collected from interviews or surveys (such as the WA Health and Wellbeing Surveillance system).

Research shows that while parent-reported data on physical activity for children under 12 years of age is valid, it has limitations depending on the questions asked (e.g. difficulty estimating unstructured play).4 In recent years more researchers are using devices such as accelerometers and other technology to gather more ‘objective’ data.5

There is limited recent data on the physical activity of 0 to five year-old WA children.

The WA Department of Health administers the WA Health and Wellbeing Surveillance system, which includes interviewing WA parents and carers with children aged 0 to 15 years.6 In this survey they ask parents and carers about their children’s activity levels and based on these responses determine the proportion of WA children meeting the physical activity guidelines. The survey questions for physical activity are only reported on for children aged five to nine and 10 to 15 years, therefore there is no publicly reported data for children under five years of age.

The Australian Bureau of Statistics 2011–12 National Nutrition and Physical Activity Survey (NNPAS) included data on the physical activity of children aged two to four years. This was based on an interview with an adult about one child (aged two years and over) in the household.

Only the total average time spent on physical activity was reported for WA and other jurisdictions.

Average time children aged 2 to 4 years spent on physical activity, in minutes, WA and other jurisdictions, 2011–12

Per week day

Per weekend day

Per day

WA

357

389

366

NSW

362

377

363

VIC

339

352

345

QLD

401

428

408

SA

384

385

383

TAS

369

365

370

NT

435

443

434

ACT

365

348

359

Australia

367

384

371

Source: Australian Bureau of Statistics 43640 Australian Health Survey - National Nutrition and Physical Activity Survey (NNPAS) 2011-12 – Table 22.1

Average time children aged 2 to 4 years spent on physical activity, in minutes, WA and other jurisdictions, 2011–12

Source: Australian Bureau of Statistics 43640 Australian Health Survey - National Nutrition and Physical Activity Survey (NNPAS) 2011–12 – Table 22.1

This survey found that Australian two to four year-olds spent an average of six hours and 12 minutes (372 minutes) per day engaged in physical activity with just under half (47%) of the physical activity coming from outside activities. WA children aged two to four years spent an average of 366 minutes per day engaged in physical activity, slightly less than the national average.

While most Australian two to four year-olds (84%) averaged three or more hours of physical activity per day, just under three-quarters (72%) were physically active for three hours or more per day on all seven days prior to the ABS survey, meeting the physical activity recommendation.7

This survey is not currently planned to be repeated.

The Australian Bureau of Statistics also conducts the Childhood Education and Care survey which captures data on parents’ participation in informal learning for 0 to two year-olds and three to eight year-olds. This includes parental involvement in physical activities with their children.

Proportion of children with parental involvement in physical activities last week by age group, in per cent, WA and Australia, 2011, 2014 and 2017

2011

2014

2017

0 to 2 years

WA

62.3

68.3

64.7

Australia

65.9

61.7

68.2

3 to 8 years

WA

87.0

89.0

85.6

Australia

82.2

82.1

85.2

Source: Australian Bureau of Statistics 2018, Childhood Education and Care, Australia, June 2014 and 2017, cat no. 4402.0, Western Australian and Australian Tables 19 and 20 Parental involvement in informal learning and Australian Bureau of Statistics custom report, June 2011 [unpublished]

Proportion of children with parental involvement in physical activities last week by age group, in per cent, WA and Australia, 2011, 2014 and 2017

Source: Australian Bureau of Statistics 2018, Childhood Education and Care, Australia, June 2014 and 2017, cat no. 4402.0, Western Australian and Australian Tables 19 and 20 Parental involvement in informal learning and Australian Bureau of Statistics custom report, June 2011 [unpublished]

Parents of WA children aged three to eight commonly engaged in sport or outdoor games (85.6%). Compared nationally, the proportions were largely similar in 2017, although WA parents of 0 to two year-olds were somewhat less likely to engage in physical activities (64.7% compared to 68.2%).

This survey does not report the number of hours of physical activity for WA children.

From 2015 to 2018 the University of WA conducted the Play Spaces and Environments for Children’s Physical Activity and Health (PLAYCE) study to report on how physically active WA pre-schoolers are on average. In total, 104 Early Childhood Education and Care (ECEC) services and 1,596 children and their families in the Perth metropolitan area took part in this study.8

Physical activity was measured using accelerometers worn by children over seven days. They found that only 34 per cent of children aged two to five years met the recommended 180 minutes of physical activity per day.9 This contrasts with the 2011–2012 NNPAS survey which reported that the majority (72%) of children met the recommended guidelines.

The PLAYCE study also found a significant gender gap, with only 12 per cent of female toddlers (two to less than three years) and 29 per cent of female pre-schoolers (three to five years) meeting the guidelines, compared to 25 per cent of male toddlers and 55 per cent of male pre-schoolers.10

A key goal of the PLAYCE study was to understand how physically active children are when at ECEC services. They concluded that based on an average eight-hour day at ECEC, less than 12 per cent of children aged two to five years met the recommended three hours of physical activity per day.11

The results from these studies suggest that many WA children aged 0 to five years may not be meeting the recommended physical activity guidelines, although more regularly reported data is required. There is also a clear gender gap in this age group where young girls are more likely to not meet the recommended activity levels.

There is limited regularly reported data on the physical activity of WA Aboriginal children or children in metropolitan, regional and remote locations. The WA Health and Wellbeing Surveillance System does not provide disaggregated information on physical activity for Aboriginal children or by geographic location.

In 2012–13, the Australian Bureau of Statistics conducted the Australian Aboriginal and Torres Strait Islander Health Survey: Physical activity to collect data on the physical activity of Aboriginal children across Australia. This data was not disaggregated by state. They found that 45.6 per cent of WA Aboriginal children and young people aged five to 17 years in non-remote areas met the physical activity recommendation compared with only 40.5 per cent of WA non-Aboriginal children and young people.12

In remote areas across Australia,13 just over four in five (86%) Aboriginal children aged five to eight years and an equivalent proportion of nine to 11 year-olds (87%) did more than 60 minutes of physical activity on the day prior to the interview.14

There is no data on physical activity of WA children under five years of age by regional location or Aboriginal status.

Endnotes

  1. WA Department of Sport and Recreation 2015, Brain Boost: how sport and physical activity enhance children’s learning, Centre for Sport and Recreation Research, Curtin University.
  2. Australian Institute of Health and Welfare (AIHW) 2018, Physical activity across the life stages, Cat No PHE 225, AIHW.
  3. Department of Health, The Australia’s Physical Activity and Sedentary Behaviour Guidelines for Children (5 – 12 years), Australian Government.
  4. Bauman A et al 2019, Physical activity measures for children and adolescents - recommendations on population surveillance: an Evidence Check rapid review, Sax Institute, p. 14.
  5. Sylvia LG et a 2013, Practical guide to measuring physical activity, Journal of the Academy of Nutrition and Dietetics, Vol 114, No 2.
  6. The WA Department of Health’s, Health and Wellbeing Surveillance System is a continuous data collection which was initiated in 2002 to monitor the health status of the general population. In 2016, over 800 parents/carers of children aged 0 to 15 years were randomly sampled and completed a computer assisted telephone interview between January and December, reflecting an average participation rate of just over 90 per cent. The sample was then weighted to reflect the WA child population.
  7. Australian Bureau of Statistics 2013, 4364.0.55.004 - Australian Health Survey: Physical Activity, 2011–12 – Summary of Children aged 2–4 years, ABS.
  8. Christian H et al 2018, A snapshot of the PLAYCE project: Findings from the Western Australian PLAY Spaces and Environments for Children’s Physical Activity Study, Supportive Childcare Environments for Physical Activity in the Early Years, The University of WA, School of Population and Global Health.
  9. Ibid, p. 7.
  10. Ibid, p. 7.
  11. Ibid, p. 9.
  12. Australian Bureau of Statistics, 4727.0.55.004 - Australian Aboriginal and Torres Strait Islander Health Survey: Physical activity, 2012–13, Table 9.3 Whether met physical and screen-based activity recommendations by Indigenous status by selected characteristics, Children aged 5–17 years in non-remote areas (proportion).
  13. Australian Bureau of Statistics note that testing indicated that the way the guidelines had been developed into a survey instrument for use in non-remote areas did not work well in more remote areas of Australia. As a result, in remote areas, minimal data was collected only for the day prior to the interview for a range of physical activities, with no measurement of the intensity of these activities.
  14. Australian Bureau of Statistics, 4727.0.55.004 - Australian Aboriginal and Torres Strait Islander Health Survey: Physical activity, 2012–13, Remote areas (5 years and over), Table 18.3 Physical activity and sedentary behaviour by age then sex, Aboriginal and Torres Strait Islander children aged 5–17 years in remote areas (proportion).
Measure: Screen time

Over the past decade, it has been increasingly recognised that while media devices provide significant opportunities for learning and development, high levels of screen‑based activities can be detrimental to children’s health and wellbeing.1 A high level of screen time is associated with sedentary behaviour, low quality sleep and obesity.2,3

The Australian 24-hour movement guidelines for the early years (birth to 5 years) provides recommendations on sedentary behaviour including screen time. Screen time is not recommended for children under two years of age and no more than one hour of screen time is recommended for children between two and five years of age.

Screen time is often used as a proxy for sedentary behaviour, however, it should be noted that screen-time does not report on overall levels of sedentary behaviour, which can include other activities such as sitting or lying down.4   

Children’s screen time can include a range of activities such as watching movies, television shows or YouTube videos, playing games, social networking and doing educational activities. This may be via a television, smart phone, tablet or gaming console.

While the screen time guidelines are specifically related to non-educational entertainment, estimates of children’s screen time will often include some educational activities.5 Therefore, the data may over-estimate the amount of non-educational screen time.

The WA Department of Health administers the WA Health and Wellbeing Surveillance system, interviewing WA parents and carers with children aged 0 to 15 years.6 In this survey they ask parents and carers about how many hours per week their child spends watching television or using electronic devices and the like, and based on these responses determine the proportion of WA children meeting the sedentary behaviour guidelines.

Proportion of children meeting the recommended guidelines for electronic media use by age group, in per cent, WA, 2012 to 2017

0 to < 2 years

2 to < 5 years

Meets guidelines

Does not meet guidelines

Meets guidelines

Does not meet guidelines

2012

49.4

50.6

28.3

71.7

2013

76.3

23.7*

25.5

74.5

2014

58.8

41.2*

36.4

63.6

2015

65.2

34.8

32.2

67.8

2016

50.4

49.6

30.1

69.9

2017

63.8

36.2*

24.8*

75.2

Source: Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health (and previous years’ reports)7

* Prevalence estimate has a relative standard error between 25 per cent and 50 per cent and should be used with caution.

Children aged from two to less than five years were significantly less likely to meet the daily screen usage guidelines compared with children aged less than two years (24.8% compared to 63.8% in 2017). The number of children meeting the guidelines increases again in the five to 15 year age group (77.4% in 2017).

The proportion of children who met the screen time recommended guidelines was similar among male and female children across age groups.8

The Australian Bureau of Statistics conducted the 2011–12 National Nutrition and Physical Activity Survey (NNPAS) throughout Australia from May 2011 to June 2012. NNPAS was collected as one of a suite of surveys conducted from 2011–2013, called the Australian Health Survey (AHS). This captures information on physical activity and sedentary behaviour of Australian children across jurisdictions.

In 2011–12, only 26 per cent of Australian children aged two to four years met the screen-based recommendations on all seven days prior to this survey.9 This is consistent with the results from the WA Health survey.

Average time children aged 2 to 4 years spent on sedentary screen-based activity, in minutes, WA and other jurisdictions, 2011–12

Per week day

Per weekend day

Per day

WA

90

94

91

NSW

80

83

81

VIC

84

87

85

QLD

80

89

82

SA

78

85

80

TAS

78

76

77

NT

81

84

82

ACT

75

73

74

Source: Australian Bureau of Statistics 43640 Australian Health Survey - National Nutrition and Physical Activity Survey (NNPAS) 2011–12 – Table 22.1

WA children aged two to four years spent a longer average time on sedentary screen-based activities than other Australian jurisdictions.

Longitudinal research using data from the Longitudinal Study of Australian Children data found that 44 per cent of Australian children aged four to five years are spending more than the two hours a day on screen-based activities,10 which is more than double the recommended screen time for this age group. The same research suggests that older children who enjoy doing physical activities will spend less time in front of screens.11 This highlights the importance of engaging young children in fun physical activities to provide the foundation for a more active childhood.

Endnotes

  1. Yu M and Baxter J 2016, Australian children’s screen time and participation in extracurricular activities, in The Longitudinal Study of Australian Children Annual Statistical Report 2015, Australian Institute of Family Studies.
  2. Laurson KR et al 2014, Concurrent associations between physical activity, screen time, and sleep duration with childhood obesity, International Scholarly Research Notices: Obesity, Vol 2014.
  3. Fuller C et al 2017, Bedtime Use of Technology and Associated Sleep Problems in Children, Global Pediatric Health, Vol 4.
  4. Department of Health 2019, Sedentary behaviour [website].
  5. Yu M and Baxter J 2016, Australian children’s screen time and participation in extracurricular activities, in The Longitudinal Study of Australian Children Annual Statistical Report 2015, Australian Institute of Family Studies.
  6. The WA Department of Health’s, Health and Wellbeing Surveillance System is a continuous data collection which was initiated in 2002 to monitor the health status of the general population. In 2017, 780 parents/carers of children aged 0 to 15 years were randomly sampled and completed a computer assisted telephone interview between January and December, reflecting an average participation rate of just over 90 per cent. The sample was then weighted to reflect the WA child population.
  7. This data has been sourced from individual annual Health and Wellbeing Surveillance System reports and therefore has not been adjusted for changes in the age and sex structure of the population across these years nor any change in the way the question was asked. No modelling or analysis has been carried out to determine if there is a trend component to the data, therefore any observations made are only descriptive and are not statistical inferences.
  8. Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health, p. 32.
  9. Australian Bureau of Statistics 43640 Australian Health Survey - National Nutrition and Physical Activity Survey (NNPAS) 2011–12 – Table 3.1 Summary activity indicators by sex, Children aged 2–4 years.
  10. Yu M and Baxter J 2016, Australian children’s screen time and participation in extracurricular activities, in The Longitudinal Study of Australian Children Annual Statistical Report 2015, Australian Institute of Family Studies, p. 102.
  11. Ibid, p. 119–120.
Measure: Healthy diet

Diet has a strong influence on wellbeing from birth. Children need to have a nutritious and balanced diet to grow and develop in a healthy way and to reduce the risk of developing chronic diseases later in life.

Research has shown that eating a wide variety of nutritious foods and limiting consumption of fatty and sugary foods is critical to healthy development and growth.1

The Australian government publishes the Australian Dietary Guidelines to provide guidance on foods, food groups and dietary patterns that protect against chronic disease and provide the nutrients required for optimal health and wellbeing. The guidelines are:

  1. To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your energy needs.
  2. Enjoy a wide variety of nutritious foods from the five food groups every day.
  3. Limit intake of foods containing saturated fat, added salt, added sugars and alcohol.
  4. Encourage, support and promote breastfeeding.
  5. Care for your food; prepare and store it safely.

A key component of the guidelines are the recommended daily serves of fruit and vegetables.

Australian dietary guidelines – Recommended serves of fruit and vegetables, 2013 by age group

2 to 3 years

4 to 8 years

9 to 11 years

12 to 13 years

14 to 18 years

Minimum recommended number of serves of vegetables and legumes/beans per day

Boys

2.5

4.5

5

5.5

5.5

Girls

2.5

4.5

5

5

5

Minimum recommended number of serves of fruit per day

Boys

1

1.5

2

2

2

Girls

1

1.5

2

2

2

Source: National Health and Medical Research Council 2013, Australian Dietary Guidelines, p. 42

The guidelines for fruit and vegetable consumption were revised by the National Health and Medical Research Council (NHMRC) in 2013. This had the effect of increasing the recommended serves of vegetables and reducing the recommended amount of fruit for some age groups.2

This change in the guidelines has significantly reduced the number of children meeting the recommended levels of vegetable consumption as outlined in the table below.

Proportion of children eating the recommended daily fruit and vegetable serves by age, in per cent, WA, 2012 to 2017

Consuming recommended
serves of fruit

Consuming recommended
serves of vegetables

2 to 3 years

4 to 7 years

2 to 3 years

4 to 7 years

2012

n/a

95.5

n/a

64.0

2013

n/a

98.6

n/a

62.4

2 to 3 years

4 to 8 years*

2 to 3 years

4 to 8 years*

2014

98.2

97.3

63.2

11.7

2015

98.7

99.2

56.8

24.5

2016

96.0

97.8

45.2

12.4

2017

99.1

98.5

41.6

7.4**

Source: Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health (and previous years’ reports)3

n/a – data not available - In 2012 and 2013, the survey only included children aged four to 15 years of age.

* The reporting methodology changed in 2013 to align with the age groups and recommended serves of the 2013 recommended guidelines.

** Prevalence estimate has a relative standard error between 25 per cent and 50 per cent and should be used with caution.

Notes: 

1. In 2012 and 2013 the recommended serves of vegetables for children aged four to seven years was two serves, from 2014 it increased to four and one-half serves for children aged four to eight years.

2. As the consumption of half serves is not captured in the questions currently asked in the WA Health survey, for the purposes of reporting, the recommended number of serves is rounded down to the nearest whole number.

A very high proportion of young children in WA are meeting the guidelines for fruit consumption.

In 2017, 53.9 per cent of WA children aged two to three years are only eating one serve of vegetables on a daily basis. This represents a significant decline in the number of children meeting the recommended number of serves for this age group (2.5 serves) since 2014.

Proportion of children aged 2 to 3 years eating vegetables by number of serves, in per cent, WA, 2014 to 2017

1 serve

2 serves

3 serves

4 serves
or more

2014

28.7

29.0

21.5*

12.8*

2015

41.4

33.4

12.3*

11.2*

2016

50.7

35.2

7.5*

2.6*

2017

53.9

20.4*

20.4*

n/a

Source: Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health (and previous years’ reports)4

* Prevalence estimate has a relative standard error between 25 per cent and 50 per cent and should be used with caution.

n/a - Prevalence estimate has a RSE greater than 50 per cent and is considered too unreliable for general use.

Only a small proportion of WA children aged four to eight years are meeting the recommended guidelines for vegetable consumption. A much larger number of WA children were eating the recommended serves of vegetables, prior to the change in the guidelines in 2013 from two serves to four and-one half serves per day for children aged four to eight years.

Proportion of children aged 4 to 8 years eating vegetables by number of serves, in per cent, WA, 2014 to 2017

Less than 1 serve

1 serve

2 serves

3 serves

4 serves
or more

2014

n/a

28.1

40.0

16.4

11.7

2015

4.7*

22.3

31.5

17.1

24.5

2016

9.0*

25.5

37.1

15.9

12.4

2017

3.6*

35.6

32.3

21.1

7.4*

Source: Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health (and previous years’ reports)5

* Prevalence estimate has a relative standard error between 25% and 50% and should be used with caution.

Proportion of children aged 4 to 8 years eating vegetables by number of serves, in per cent, WA, 2014 to 2017

Source: Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health (and previous years’ reports)

In 2001 and 2002 the Telethon Institute for Child Health Research (now Telethon Kids Institute) conducted the Western Australian Aboriginal Child Health Survey. This survey covered topics including diet and nutrition, chronic health conditions and injury.6 The survey found that most Aboriginal children (aged four to 17 years) were not meeting the recommended vegetable intake, and for the majority this was not because fresh vegetables were unavailable. However, they also noted that a greater proportion of non-Aboriginal children consumed no fresh vegetables or fresh fruit, than Aboriginal children (at that time).7

This survey has not been repeated.

The Australian Bureau of Statistics (ABS) conducted the National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey in 2012–13. They found that Aboriginal children across Australia aged four to eight years consumed an average of 0.9 serves of vegetables a day, which was 40 per cent fewer serves than non-Aboriginal children (1.5 serves).8

There is no more recent data on the diet of Aboriginal children in WA.

Refer to the following resource for a more detailed discussion on nutrition among Aboriginal communities:

Lee A and Ride K 2018, Review of nutrition among Aboriginal and Torres Strait Islander people, Australian Indigenous HealthInfoNet.

Guideline three of the Australian Dietary Guidelines also recommends that adults and children should limit intake of foods and drinks containing saturated fats and added sugars such as biscuits, cakes, confectionary, sugar-sweetened soft drinks and cordials, fruit drinks and sports drinks.9

Reducing young children’s sugar consumption has been highlighted as particularly critical. Sugar consumption in childhood is directly linked to overweight and obesity, and dental health conditions, both of which impact lifelong health.10 There is also strong evidence to suggest that foods and drinks consumed by children early in life establish their preferences for tastes (e.g. sweetness) later in life.11 

The Australian Infant Feeding Guidelines recommend that sugar (including honey) should not be added to an infant’s food and as children age they should avoid juices and sweetened drinks.12 Yet Australian research has found that one in five infants had consumed food or drink containing sugars by the time they were six to nine months. This study also reported that children born to mothers experiencing socio-economic disadvantage were more likely to be introduced early to foods and drinks containing sugar.13

Unlike serves of fruit and vegetables, the consumption of sugar is more complex to measure as sugar occurs naturally in many foods. The World Health Organization recommends reducing the intake of free sugars to less than 10 per cent of total energy intake in both adults and children.14

Australian recommendations are focused on reducing consumption of foods with added sugar including biscuits, cakes, soft drinks, cordial, fruit juice etc.

There is limited data on WA children’s consumption of sugar.

The ABS National Health Survey collects data on children’s consumption of sugar-sweetened drinks. In the 2017–18 survey they report that 81.8 per cent of Australian children aged two to three years did not consume any sugar-sweetened drinks on a daily basis, while only 69.4 per cent of children aged four to eight years did not consume any sugar-sweetened drinks on a daily basis.15

Similarly, 67.6 per cent of WA children aged four to eight years are reported to not consume any sugar-sweetened drinks on a daily basis. Approximately 67.7 per cent of two to three year-olds in WA are estimated to not consume any sugar-sweetened drinks on a daily basis.16 This proportion should be considered with caution as it has a 17.6 per cent margin of error.

Endnotes

  1. National Health and Medical Research Council 2013, Australian Dietary Guidelines: Providing the scientific evidence for healthier Australian diets, National Health and Medical Research Council.
  2. Prior to 2013, children aged 4 to 11 years of age were recommended to eat at least one serve of fruit each day, while 12 to 18 year-olds were recommended to eat three serves. While children aged 4 to 7 years of age were recommended to eat at least two serves of vegetables each day, 8 to 11 year-olds eat at least three serves a day and 12 to 15 year-olds eat at least four serves a day. NHMRC Australian dietary guidelines for children and adolescence 2003 (since rescinded).
  3. This data has been sourced from individual annual Health and Wellbeing Surveillance System reports and therefore has not been adjusted for changes in the age and sex structure of the population across these years nor any change in the way the question was asked. No modelling or analysis has been carried out to determine if there is a trend component to the data, therefore any observations made are only descriptive and are not statistical inferences.
  4. This data has been sourced from individual annual Health and Wellbeing Surveillance System reports and therefore has not been adjusted for changes in the age and sex structure of the population across these years nor any change in the way the question was asked. No modelling or analysis has been carried out to determine if there is a trend component to the data, therefore any observations made are only descriptive and are not statistical inferences.
  5. This data has been sourced from individual annual Health and Wellbeing Surveillance System reports and therefore has not been adjusted for changes in the age and sex structure of the population across these years nor any change in the way the question was asked. No modelling or analysis has been carried out to determine if there is a trend component to the data, therefore any observations made are only descriptive and are not statistical inferences.
  6. Zubrick S et al 2004, The Western Australian Aboriginal Child Health Survey: The Health of Aboriginal Children and Young People, Telethon Institute for Child Health Research.
  7. Ibid, p. 129.
  8. Australian Bureau of Statistics 2016, 4727.0.55.008 - Australian Aboriginal and Torres Strait Islander Health Survey: Consumption of Food Groups from the Australian Dietary Guidelines, 2012–13, Table 1.1 Mean consumption of the five food groups.
  9. National Health and Medical Research Council 2013, Australian Dietary Guidelines: Providing the scientific evidence for healthier Australian diets, National Health and Medical Research Council.
  10. Diep H et al 2017, Factors influencing early feeding of foods and drinks containing free sugars—a birth cohort study, International Journal of Environmental Research and Public Health, Vol 14 No 10.
  11. Ibid.
  12. National Health and Medical Research Council 2013, Australian Infant Feeding Guidelines, National Health and Medical Research Council.
  13. Diep H et al 2017, Factors influencing early feeding of foods and drinks containing free sugars—a birth cohort study, International Journal of Environmental Research and Public Health, Vol 14 No 10.
  14. World Health Organization (WHO) 2015, Guideline: Sugars intake for adults and children, WHO. Free sugars include monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.
  15. Australian Bureau of Statistics (ABS) 2018, National Health Survey, First Results 2017-18 – Australia, Table 17.3 Children's consumption of fruit, vegetables, and selected sugar sweetened and diet drinks, proportion of persons, ABS.
  16. Ibid.
Measure: Healthy weight

Being overweight or obese increases a child’s risk of poor physical health in both the short and long term. Being obese increases a child’s risk of a range of conditions such as asthma, Type 2 diabetes and cardiovascular conditions.1 Obesity in children is also associated with a number of psychosocial problems, including social isolation, discrimination and low self-esteem.2

Children who are overweight or obese are more likely to be overweight or obese in adulthood.3 Overweight or obese children who continue to be overweight or obese in adulthood face a higher risk of developing coronary heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis and endocrine disorders.4

The data item for this measure is the Body Mass Index (BMI), which is a common measure of assessing whether a person is at risk of being overweight or obese. The BMI is calculated by dividing weight in kilograms by the square of height in metres. BMI scores take into account the age and sex of the child, however, it is not recommended for children up to two years.5

The use of BMI to measure healthy weight is contested, particularly as it does not distinguish between fat and muscle or the location of the fat.6 BMI is not a diagnostic tool. If a child or young person has a high BMI for their age and sex they should be referred to a health professional for further assessment considering physical activity and diet, and using other measures such as skin fold thickness or dual energy X-ray absorptiometry (DEXA).7,8,9 BMI is, however, considered an appropriate tool for population level measurement and trend analysis.10

Data is collected on the BMI of children entering Kindergarten and Pre-primary as part of the School Entry Health Assessment. In 2018, 23,941 children enrolled in Kindergarten (93.6% of all enrolled children) in metropolitan Perth had a valid height and weight measurement through the School Entry Health Assessment. The median age for a child at this assessment was four years and six months.11

Number and proportion of Kindergarten children by Body Mass Index (BMI) categories, number and per cent, metropolitan Perth, 2018

Number

Per cent

Underweight (BMI percentile <5%)

691

3.0

Healthy weight (BMI percentile 5% - <85%)

17,993

75.0

Overweight (BMI percentile 85% - <95%)

3,198

13.0

Obese (BMI percentile ≥95%)

2,059

9.0

Data source: Custom report provided by the WA Department of Health from the Child Development Information System (CDIS) from the School Entry Health Assessment [unpublished]

Notes: BMI percentile for age and BMI category is calculated using the Centers for Disease Control and Prevention BMI Percentile Calculator.

Children may complete additional assessments where issues are identified for follow up. For children with multiple height and weight measures, the first measurement only has been included.

Proportion of Kindergarten children by Body Mass Index (BMI) categories, in per cent, metropolitan Perth, 2018

Data source: Custom report provided by the WA Department of Health from the Child Development Information System (CDIS) from the School Entry Health Assessment [unpublished]

Prior to 2018, height and weight were not universally measured and therefore may not provide accurate estimates of population prevalence and are not reported.

In 2018, three-quarters (75%) of Kindergarten students in the Perth metropolitan area were in the healthy weight range, while 22.0 per cent were in the overweight or obese categories.

The WA Country Health Service (WACHS) was unable to provide BMI data from School Entry Health Assessments conducted as the data was not collected in a single system. However, it is anticipated this will be available in the future as it will be captured in the recently implemented WACHS Community Health Information System across all seven WACHS regions.

The Australian Bureau of Statistics National Health Survey also collects data on rates of obesity or overweight for young children in WA. Considering the age ranges, these results are relatively consistent with the School Entry Health Assessment BMI data in metropolitan Perth.

In 2014–15, 11.6 per cent of WA children aged two to four years were categorised as overweight and 6.1 per cent as obese based on the BMI. A higher proportion of children were overweight or obese at aged five to seven years (20.2% to 10.8% respectively), although this then reduces for children aged eight to 11 years (18.7% to 2.9%).12

The WA data for children aged two to four years in the 2017–18 National Health Survey has a high margin of error and has not been reported here. To review this data refer to the National Health Survey 2017–18 – Table 24: Western Australia.

In 2017, AIHW presented a birth cohort analysis of prevalence of overweight and obesity for a particular group of people born in the same year. They noted that over the last 20 years (1995–2015) there has been no significant increase in rates of obesity or overweight in children aged two to five years or six to nine years. However, they reported that at ages 10 to 13 and 14 to 17 years, children and adolescents born most recently were significantly more likely to be overweight or obese than those born 20 years earlier.13 This will be discussed further in the Physical Health indicator  for the 12 to 17 years age group.

In 2012–13 the Australian Bureau of Statistics conducted the Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS). In this survey they measured the BMI of participating Aboriginal children and found that 15.8 per cent of two to four year-old Aboriginal children across Australia were overweight and 6.5 per cent were obese.14 Aboriginal children aged two to 14 years were more likely than non-Aboriginal children to be obese (8% compared to 5%) and less likely to be in the healthy weight range (62% compared to 70%).15

There is no recent data on the BMI (or other measures of healthy weight) of WA Aboriginal children.

Aboriginal adults are also 1.6 times more likely to be obese than non-Aboriginal adults indicating increased risk of developing chronic disease.16 It is therefore critical to address overweight and obesity for Aboriginal children in childhood.

Children living in areas of greater socioeconomic disadvantage are also more likely to be overweight or obese. In 2017, a significantly higher proportion of children aged five to 15 years living in the most disadvantaged areas of WA were overweight or obese compared with children living in the least disadvantaged areas of WA (44.9% compared with 19.3%).17 

Socioeconomic disadvantage influences children’s weight for multiple, intersecting reasons including limited access to affordable fresh fruit and vegetables and easy access to fast food, availability of primary health services and access to quality outdoor green spaces. Additionally, parents with a lower level of education often have less access to nutritional knowledge which also leads to less healthy dietary practices.18

Endnotes

  1. Australian Institute of Health and Welfare (AIHW) 2012, A picture of Australia’s children 2012, Cat No PHE 167, AIHW.
  2. ARACY 2008, ARACY Report Card, Technical Report: The Wellbeing of Young Australians, ARACY.
  3. Venn AJ et al 2007, Overweight and obesity from childhood to adulthood: a follow-up of participants in the 1985 Australian Schools Health and Fitness Survey, The Medical Journal of Australia, Vol 186, No 9.
  4. Australian Institute of Health and Welfare (AIHW) 2012, A picture of Australia’s children 2012, Cat No PHE 167, AIHW.
  5. National Health and Medical Research Council 2013, Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia, Australian Government, p. 84.
  6. There is also increasing evidence to suggest that the type of fat is more important than overall weight – for example fat around the stomach has been shown to be more harmful than fat in other locations. Therefore some research has shown that someone with a relatively high BMI can be healthier than someone with a BMI in the ‘healthy’ range. Refer to Tomiyama et al 2016, Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005–2012, The International Journal of Obesity, Vol 40, No 5.
  7. Centers for Disease Control and Prevention 2018, About Child and Teen BMI, National Center for Chronic Disease Prevention and Health Promotion [website].
  8. Nooyens AC 2007, Adolescent skinfold thickness is a better predictor of high body fatness in adults than is body mass index: the Amsterdam Growth and Health Longitudinal Study, The American Journal of Clinical Nutrition, Vol 85, No 6.
  9. Jensen NSO et al 2016, Review Paper: Comparison of methods to measure body fat in 7-to-10-year-old children: a systematic review, Public Health, Vol 133.
  10. Centers for Disease Control and Prevention 2018, Body Mass Index: Considerations for practitioners, Department of Health and Human Services USA.
  11. Custom report provided by the WA Department of Health from the Child Development Information System (CDIS) from the School Entry Health Assessment.
  12. Australian Bureau of Statistics 2015, National Health Survey: First Results, 2014–15 — Western Australia, Table 16.3 Children's Body Mass Index(a), Proportion of persons.
  13. Australian Institute of Health and Welfare (AIHW) 2017, An interactive insight into overweight and obesity in Australia, AIHW.
  14. Australian Bureau of Statistics 2014, 4727.0 Australian Aboriginal and Torres Strait Islander Health Survey: First Results, 2012–13 — Australia, Table 24.3 Body Mass Index of Aboriginal and Torres Strait Islander children(a) by age and sex, Proportion of persons.
  15. Department of Prime Minister and Cabinet, Aboriginal and Torres Strait Islander, Health Performance Framework 2014 Report [website].
  16. Ibid.
  17. Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health.
  18. NSW Council of Social Services (NCOSS) 2016, Overweight and Obesity: Balancing the scales for vulnerable children, NCOSS.
Measure: Long-term health issues or disabilities

The Australian Bureau of Statistics Disability, Ageing and Carers data collection reports that in 2015 approximately 5,100 WA children aged 0 to four years (3%) have a reported disability1 and approximately 2,600 children are living with ‘profound or severe core activity limitation’ which indicates that a person is unable to do, or always needs help with, a core activity task.2

This survey also reports that approximately 2.3 per cent of WA children aged 0 to four years have a long-term health condition.3

While the data should be used with caution, male children are more likely to have a reported disability or long-term health issue than female children at the age of 0 to four years.4

The rate of reported disability increases with age, from three per cent of WA children aged 0 to four years to 7.9 per cent of those aged five to 14 years.5

The types of disability (disability group) that are reported and diagnosed also vary with age. This is in part because as children age, developmental difficulties in certain areas (such as intellectual capacity) become more apparent. Furthermore, there is a lack of formal intellectual testing in very young children.6

Children with disability by disability group and age group, in number and per cent, Australia, 2009

0 to 4 years

5 to 14 years

Total number of children with disability

47,300

241,000

Sensory or speech disability

63.0%

37.0%

Intellectual disability

29.0%

61.0%

Physical disability

35.0%

27.0%

Source: Australian Bureau of Statistics 2013, Australian Social Trends: 2012, Children with a disability

Note: Children can have one or more types of disability.

The most commonly reported long-term health conditions for Australian children aged 0 to 14 years in 2009 were mental or behavioural disorders (increased from 53% of children with disability in 2003 to 63% in 2009), while asthma was also common (a reduction from 24% in 2003 to 18% in 2009). Autism and related disorders were the most commonly reported mental or behavioural disorders (13% of children with a disability in 2009, increased from 6.2% in 2003).7

One preventable condition that impacts an unknown number of WA children is Fetal Alcohol Spectrum Disorders (FASD) which is a ‘hidden’ disability, and easily confused with disobedience or conditions such as ADHD.8 FASD is an umbrella term which covers a range of possible birth defects and/or developmental disabilities that can be caused by exposure to alcohol prior to birth. It has a significant impact on mental health and increases the likelihood of social and emotional behavioural issues throughout life.9,10

The diagnosis of FASD is complex and until 2016 there was not an Australian diagnostic tool for practitioners.11 As such, FASD is a condition that is under-recognised in Australia and often goes undiagnosed.12 In 2016, The Australian Guide to the diagnosis of Fetal Alcohol Spectrum Disorder (FASD) was released which provides health professionals with the tools necessary to diagnose FASD.13 

It is generally recognised that many children and young people in out-of-home care and in contact with youth justice services are living with an undetected FASD.14 In 2017, a Telethon Kids Institute research team found that 89 per cent of young people in WA’s Banksia Hill Detention Centre had at least one form of severe neurodevelopmental impairment, while 36 per cent (36 young people) were found to have FASD. It is of significant concern that only two of the young people with FASD had been diagnosed prior to participation in the study.15

In the 2019 Inquest report into the deaths of 13 Aboriginal children and young people in the Kimberley, the WA State Coroner noted that a number of the children and young people were likely to have been on the spectrum for FASD, but that none had been formally diagnosed.16

Screening and assessment for FASD should occur as part of the universal child health checks and at key points across a child's life (e.g. Kindergarten, school entry), as well as when a child or young person enters the child protection or justice system. Any diagnosis needs to trigger appropriate referrals and be linked to clear supports and services, as without this, a diagnosis will have limited impact in terms of improving outcomes for children and young people.

Aboriginal children

There is limited robust data on the prevalence of disability among Aboriginal children. This is principally due to a lack of adequate sample size for Aboriginal populations in general surveys, and surveys are often not tailored to incorporate Aboriginal cultures and perspectives on health and wellbeing.17

The Western Australian Aboriginal Child Health Survey (WAACHS) was a comprehensive cross-sectional study of the health and development of a representative random sample of 5,300 Aboriginal and Torres Strait Islander children and young people aged 0 to 17 years living in 2,000 families across WA, including remote areas. The study was conducted in 2000–2001 and has not been repeated.18

The WAACHS asked questions about restrictions to WA Aboriginal children and young people’s core activities that included self-care, mobility and communication.19 While the data is not recent and the authors recognised limitations, in general the findings in that study suggested that rates of disability among Aboriginal children were similar to those reported in the non-Aboriginal population.20

However, more recent data from the ABS Survey of Disability, Ageing and Carers reports that Aboriginal children and young people across Australia are more likely to experience disability than non-Aboriginal children and young people.

Children aged 0 to 14 years living in households, by Aboriginal status and disability status, in per cent, Australia, 2015

Total

Aboriginal

Non-Aboriginal

Profound/severe core activity limitation

5.9

3.9

Moderate/mild core activity limitation

4.1

1.5

Schooling or employment restriction only

2.1

0.9

All with specific restrictions

11.0

6.3

Has disability but no specific restriction

2.6

0.9

All with reported disability

13.8

7.2

No reported disability

86.8

92.9

Total

100.0

100.0

Source: Australian Bureau of Statistics, 44300: Survey of Disability Ageing and Carers: Aboriginal and Torres Strait Islander People with Disability, 2015, Table 2.3 All persons living in households, Indigenous Status by Disability Status, Sex and Age – 2015

This data is not available for WA and there is no further breakdown by age group.

There are a range of intersecting social factors that contribute to the higher prevalence of disability in Aboriginal communities. These can include poverty, low birthweight, poor access to quality primary health care, high levels of alcohol consumption by some mothers during pregnancy and exposure to violence or injury.21

Endnotes

  1. ABS uses the following definition of disability: ‘In the context of health experience, the International Classification of Functioning, Disability and Health (ICFDH) defines disability as an umbrella term for impairments, activity limitations and participation restrictions. In this survey, a person has a disability if they report they have a limitation, restriction or impairment, which has lasted, or is likely to last, for at least six months and restricts everyday activities’. Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia, 2015, Glossary.
  2. Estimates are to be used with caution as they have a relative standard error of between 25 and 50 per cent. Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia, 2015: Western Australia, Table 1.1 Persons with disability, by age and sex, 2012 and 2015 estimate, and Table 1.3 Persons with disability, by age and sex, 2012 and 2015, proportion of persons and Table 3.1 All persons, disability status, by age and sex–2015, estimate.
  3. Estimates are to be used with caution as they have a relative standard error of between 25 and 50 per cent. Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia, 2015: Western Australia, Table 3.3 All persons, disability status, by age and sex–2015, proportion of persons.
  4. Ibid.
  5. Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia, 2015: Western Australia, Table 1.3 Persons with disability, by age and sex, 2012 and 2015, proportion of persons.
  6. Australian Bureau of Statistics 2013, Australian Social Trends: 2012, Children with a disability, ABS catalogue no. 4102.0, Commonwealth of Australia, p. 3.
  7. Ibid, p. 3–4.
  8. McLean S and McDougall S 2014, Fetal alcohol spectrum disorders: Current issues in awareness, prevention and intervention, CFCA Paper No 20, Child Family Community Australia (CFCA).
  9. Brown J et al 2018, Fetal Alcohol spectrum disorder (FASD): A beginner’s guide for mental health professionals, Journal of Neurological Clinical Neuroscience, Vol 2, No 1.
  10. Pei J et al 2011, Mental health issues in fetal alcohol spectrum disorder, Journal Of Mental Health, Vol 20, No 5, pp. 438–448.
  11. Bower C and Elliott EJ on behalf of the Steering Group 2016, Australian Guide to the diagnosis of Fetal Alcohol Spectrum Disorder (FASD), Telethon Kids Institute and University of Sydney, p. 4.
  12. Bower C and Elliott EJ on behalf of the Steering Group 2016, Australian Guide to the diagnosis of Fetal Alcohol Spectrum Disorder (FASD), Telethon Kids Institute and University of Sydney.
  13. Ibid.
  14. McLean S and McDougall S 2014, Fetal alcohol spectrum disorders: Current issues in awareness, prevention and intervention, CFCA Paper No 20, Child Family Community Australia (CFCA).
  15. Bower C et al 2017, Fetal alcohol spectrum disorder and youth justice: a prevalence study amount young people sentenced to detention in Western Australia, BMJ Open, Vol 8, No 2.
  16. WA State Coroner 2019, Inquest into the deaths of: Thirteen children and young persons in the Kimberley region, Western Australia, WA Government, p. 256.
  17. Zubrick SR et al 2004, The Western Australian Aboriginal Child Health Survey: The Health of Aboriginal Children and Young People, Telethon Institute for Child Health Research, p.157.
  18. Telethon uses the following definition of level of remote isolation (LORI) ‘LORI allows greater discrimination of the circumstances of survey respondents with respect to their isolation from population centres of various sizes and better differentiates between areas and communities that are extremely remote from major metropolitan centres’. Zubrick SR et al 2004, The Western Australian Aboriginal Child Health Survey: The Health of Aboriginal Children and Young People, Telethon Institute for Child Health Research, p.3.
  19. Ibid, p.157.
  20. Ibid, p.157.
  21. Department of Prime Minister and Cabinet 2014, Aboriginal and Torres Strait Islander: Health Performance Framework Report 2014, 1.14 Disability, Australian Government.
Children in care

There is no publicly available data on the physical health of children in care aged 0 to 5 years in WA.

At 30 June 2018 there were 1,229 WA children in care aged between 0 and four years, more than half of whom (58.0%) were Aboriginal.1

In 2016, the WA Department of Child Protection (now Department of Communities) published the Outcomes Framework for Children in Out-of-Home Care 2015–16 Baseline Indicator Report. The outcomes framework identified two indicators related to reviewing the physical health of children in out-of-home care.

The first indicator was the ‘proportion of children who had an initial medical examination when entering out-of-home care’. In 2015, 53.1 per cent of children entering out-of-home care had an initial medical examination.2

The second indicator was the ‘proportion of children who have had an annual health check of their physical development’. In this report they noted that there were limitations in data accuracy which prevented reporting on this indicator in 2015–16, however data would be reported in 2016–17.3 No data has been reported on this indicator as at publication date.

There is no data available on the physical activity levels, diet or weight of children in out-of-home care in WA.

The limited data being collected and reported on the physical health of children in care is of concern. 

Endnotes

  1. Department of Communities 2019, Child Protection Activity Performance Report 2017–18, WA Government p. 17.
  2. Department for Child Protection and Family Support 2016, Outcomes Framework for Children in Out-of-Home Care 2015–16 Baseline Indicator Report, p. 5.
  3. Ibid, p. 10.
Children with disability

Physical health is critical for children’s current wellbeing and also their future life outcomes. The physical health of children with disability is often viewed through the lens of their disability and other aspects of health can be overlooked.

There is a complex relationship between physical health and disability, however, adults with disability are more likely to have long-term chronic conditions including heart disease, stroke and diabetes.1

Children with disability who are able to participate in physical activities of some kind and have healthy diets are more likely to have better health outcomes over the longer term.2,3

The Australian Bureau of Statistics 2015 Disability, Ageing and Carers data collection reports that approximately 5,100 WA children (3%) aged 0 to four years have a reported disability.4,5

In 2013, the Commissioner consulted with children and young people with disability about the issues that were important to them. In this consultation, the children highlighted that there was a lack of access to activities including sports and other community activities outside of school.6

In 2006, the Physical Activity Study of Children and Adolescents with a Disability (PASCAD) was conducted to examine the physical activity of children/adolescents with a disability in metropolitan Perth. This study found that the majority of children and young people with a disability were not meeting the recommended physical activity guidelines. They also found that children with disability participated in a narrower range of activities, with very low participation rate in community-based team/group activities being the most noticeable difference.7

The children and young people in this study identified social barriers as one of the main obstacles to their physical activity. They reported that non-disabled peers and organisations did not know how to include them in physical activities.8

This study has not been repeated.

No other data exists on the physical health of WA children with disability.

Endnotes

  1. Australian Institute of Health and Welfare 2018, Chronic conditions and disability 2015, Cat no CDK 8, AIHW.
  2. Heller T et al 2011, Physical Activity and Nutrition Health Promotion Interventions: What is Working for People With Intellectual Disabilities?, Intellectual and Developmental Disabilities Vol 49, No 1.
  3. Australian Institute of Health and Welfare 2018, Chronic conditions and disability 2015, Cat no CDK 8, AIHW, p. 21.
  4. ABS uses the following definition of disability: ‘In the context of health experience, the International Classification of Functioning, Disability and Health (ICFDH) defines disability as an umbrella term for impairments, activity limitations and participation restrictions… In this survey, a person has a disability if they report they have a limitation, restriction or impairment, which has lasted, or is likely to last, for at least six months and restricts everyday activities’. Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia, 2015, Glossary.
  5. Estimate is to be to be used with caution as it has a relative standard error of between 25 and 50 per cent. Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia, 2015: Western Australia, Table 1.1 Persons with disability, by age and sex, 2012 and 2015 estimate, and Table 1.3 Persons with disability, by age and sex, 2012 and 2015, proportion of persons.
  6. Commissioner for Children and Young People 2013, Speaking Out About Disability: The views of Western Australian children and young people with disability, Commissioner for Children and Young People WA.
  7. Packer TL et al 2006, The Physical Activity Study of Children and Adolescents with a Disability, Curtin University of Technology.
  8. Ibid.
Policy implications

Most children in WA are healthy, however, a significant proportion of children are not consistently engaging in healthy activities such as doing regular physical activity, eating a healthy diet and limiting their screen time. This increases their risk of health issues during their childhood and into adulthood. Children who are overweight or obese in childhood are also more likely to have health issues as adults.

While there is limited data, the data that is available suggests that most WA children aged 0 to five years are not meeting the recommended physical activity guidelines. Female children are also less likely to be meeting the physical activity recommendations than male children, even at this young age.

A healthy diet is also critical for children aged 0 to 5 years. Only a small proportion of WA children aged four to eight years are meeting the recommended guidelines for vegetable consumption. At the same time, while there is limited data on sugar consumption in this age group, it is important to reduce the amount of sugar in all children’s diets.

Aboriginal children are at greater risk of having physical health issues, including obesity, over their lifetime which contributes to a higher risk of chronic disease. Life expectancy is 13.4 years lower for Aboriginal men, and 12.0 years lower for Aboriginal women than non-Aboriginal WA adults.1 The difference in life expectancy is largely due to a higher incidence of chronic diseases, including heart disease, diabetes and various cancers.2

Socioeconomic disadvantage, including income levels, education and access to health services have a significant influence on health in childhood.3 The data supports this finding, as Aboriginal people living in the most disadvantaged areas - a higher proportion of whom were living in remote Australia - have the lowest life expectancy.4

WA Department of Health’s strategy to improve health outcomes for Aboriginal children is encompassed in its WA Aboriginal Health and Wellbeing Framework 2015–2030.

Improving the physical health of children in WA will require multifaceted interventions where evidence-based community level programs are combined with population-level strategies. Some key policy strategies include:5

  • policies and programs which improve and promote access to recreational physical activity, including the creation of more community-based environments that provide space for accessible recreational activity and safe unstructured outdoor play
  • supporting all children and their parents, including those with disability and living in regional or remote areas, to overcome barriers to participation in playgroups, organised sport and other recreational activities
  • policies and programs to ensure all children and young people have access to adequate and sustainable supply of affordable, healthy, nutritious food
  • limiting the availability and appeal of unhealthy food and beverages through marketing regulations and taxation policies
  • programs and policies, including education and information campaigns, to inform and support parents and carers to maximise health, physical activity and good nutrition, and limit screen time for children
  • health advice and preventative services delivered to parents in primary healthcare settings
  • programs, guidelines and infrastructure to enable schools to support regular physical activity and healthy eating
  • broad strategies that address the social determinants of health including poverty and disadvantage.

Where possible, it is also important for the home environment to be supportive of outdoor play. Recent research in WA has shown that the main factor associated with increased playtime for children was the number of fixed play structures (such as, sandpits, swings etc.) at home, with each additional piece of equipment adding an average of five minutes to a child’s daily playtime.6 When outdoor play at home is restricted, community parks with play equipment are essential.

Policies which aim to address rates of overweight or obese young children must also be formulated and voiced in ways which are sensitive and safe and give serious consideration to potentially harmful impacts on future self-esteem and body image.7,8

Data gaps

Limited robust and regular data is collected on the physical health of WA children aged 0 to 5 years. Patterns of nutrition and exercise behaviours are typically established in early childhood9 and it is important to collect and report this data.

The existing WA Department of Health, Health and Wellbeing Surveillance System collects data on nutrition and screen time for very young children, but does not include data for physical activity for children under five years of age. Including survey questions related to children aged two to five years should be considered.

More information is needed on the prevalence of FASD in WA and greater awareness and knowledge of FASD in healthcare and family services is necessary to ensure children are properly diagnosed and able to be treated as early as possible.

There is very limited data on WA Aboriginal children’s physical health. In 2001 and 2002 the Telethon Institute for Child Health Research (now Telethon Kids Institute) conducted the Western Australian Aboriginal Child Health Survey. However, this survey has not been repeated. The Australian Bureau of Statistics conducted the National Aboriginal and Torres Strait Islander nutrition and physical activity survey (NATSINPAS) in 2011–2013. This survey provided limited data broken down by Australian jurisdiction. This survey has also not been repeated since.

The lack of data on WA Aboriginal children’s health is a significant gap given the considerably worse lifetime health outcomes of Aboriginal peoples compared to non-Aboriginal peoples.10 

The limited data being collected and reported on the physical health of WA children in care is of concern. That 53.1 per cent of children entering out-of-home care had an initial medical examination in 2015 and the lack of publicly available data needs to be urgently addressed.

Endnotes

  1. Australian Bureau of Statistics 2018, 3302.0 Life Tables for Aboriginal and Torres Strait Islander Australians, 2015–2017, ABS.
  2. Australian Institute of Health and Welfare (AIHW) 2010, Contribution of chronic disease to the gap in adult mortality between Aboriginal and Torres Strait Islander and other Australians, Cat No IHW 48, AIHW.
  3. Australian Institute of Health and Welfare (AIHW) 2017, Australia’s Health 2016: 4.2 Social determinants of Indigenous health, AIHW.
  4. Australian Bureau of Statistics 2018, 3302.0 Life Tables for Aboriginal and Torres Strait Islander Australians, 2015–2017, ABS.
  5. For more information refer: Preventative Health Taskforce 2008, Australia: The Healthiest Country by 2020: A discussion paper prepared by the National Preventative Health Taskforce and Public Health Advocacy Institute of WA, Obesity [website].
  6. Armstrong G 2019, Associations between the home yard and preschoolers’ outdoor play and physical activity, Public Health Research & Practice, Vol 29, No 1.
  7. Russell-Mayhew S 2012, Mental Health, Wellness, and Childhood Overweight/Obesity, Journal of Obesity, Vol 2012.
  8. O’Dea JA 2012, Studies of obesity, body image and related health issues among Australian adolescents: how can programs in schools interact with and complement each other?, Journal of Student Wellbeing, Vol. 4 No 2.  
  9. Murphey D et al 2011, Early Childhood Policy Focus: Healthy Eating and Physical Activity, Early Childhood Highlights: Child Trends, Vol 2, No 3.
  10. Australian Institute of Health and Welfare (AIHW) 2015, The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples: 2015 – Health and disability key points [website].
Further resources

For further information on physical health for young children refer to the following resources: