introduction

Healthy beginnings matter because what happens in childhood will have a lasting impact on one's life circumstances. Life course epidemiology seeks to identify the ways in which disease patterns that become apparent in adulthood are attributable to incidents or exposures that have occurred many years before. The first of the three articles in this section of the report introduces some of the key ideas informing life course epidemiology.

Once we acknowledge the importance of child health experiences on adult health outcomes, we must try to identify what we can do to ensure that all children's health opportunities are maximised. Research shows that maternal health is absolutely critical as children born to mothers with substance misuse problems, to mothers who smoke or to mothers who suffer from preeclampsia, are particularly likely to be more susceptible to a range of chronic diseases when they are adults. Our second article describes the PrePare scheme which is an example of an intensive antenatal and post-natal support programme designed to help both substance misusing expectant mothers and their babies.

The PrePare team provides one example of the way we care for vulnerable children in Lothian. At any one time 10 - 20% of children experience health problems, disabilities, family or social circumstances that give cause for concern and mean that they need extra help and support to become, or stay, healthy.

Of course, children are also patients in their own right. In Scotland, there is massive concern about the increase in child obesity, our higher than average rates of self-harm and suicide and our poor levels of child physical activity. A new children and young people's health strategy for Lothian is being developed at present. The strategy focuses on the future for the Royal Hospital for Sick Children and specialist services throughout Lothian. It has been important to get input from children themselves about the services they feel are important and the way in which they would like their health care to be provided. The final article in this section describes how this was achieved.

Key messages

The health of children is absolutely vital. Many of our children are very healthy and life expectancy now is the best it has ever been. Some children need more support and we are there to help.

More work is needed to identify effective interventions for vulnerable parents and children. Solutions work best when they involve professionals from the NHS, councils, voluntary and community agencies working to meet shared objectives with clear management and specific outcomes.

Improvements in material and social circumstances, antenatal nutrition and general support are necessary at population level.