I am a paediatrician and epidemiologist who has developed an internationally recognised programme of research into growth, nutrition and screening in early childhood, which has provided important evidence to underpin child health practice worldwide. My interest in nutrition began with the study failure to thrive but now extends to all aspects of growth and feeding in preschool children and obesity in older children.
In the past I have run two non-drug randomised trials one of them multi- centre as well as a before-and-after intervention study. I have run two large, long-term cohorts studies. The first, which attracted two Wellcome Trust grants, followed over three thousand subjects for up to 12 years. In the latest we recruited a thousand subjects (via their mothers) immediately after birth and have maintained contact with them though infancy and into childhood. This cohort study (Gateshead Millennium Study) has already attracted nearly £1 million in research funding and is now run as a consortium between Newcastle and Glasgow University.
I hold an honorary contract as a Consultant in Community Child Health with a special interest in Nutrition. I run a tertiary feeding clinic for children with severe feeding problems, usually related to long term artificial feeding and have also established a primary care network for the management of weight faltering (failure to thrive). I also have a long standing interest in the forensic assessment of sexual assault.
Growth charts are used in almost all children worldwide to assess the normality of weight gain and identify children at risk. The newly published WHO charts now provide a standard for how all children under five should grow. The UK was one of the first developed countries to adopt the WHO standard. The Royal College of Paediatrics and Child Health (RCPCH) was commissioned by the Department of Health to design new growth charts using the standard and to develop evidence-based instructions and supporting educational materials.
I lead the expert group which designed the charts. The charts and supporting materials were published in May 2009 (downloadable from www.rcpch.ac.uk/Research/UK-WHO-Growth-Charts) for use by all new births in the UK. A new round of work to develop charts for 4-20 year olds began in April 2010.
The charts already produced are now being used for preschool children throughout the UK, were described recently in a BMJ article and were also adopted by New Zealand in July 2010. The project generated a great deal of research data and secondary analyses that is currently under submission or still being written up. The design process has revealed a lack of evidence for many aspects of chart use as well fundamental questions about their usefulness as clinical tools. This has stimulated a new Glasgow based research collaboration, between Child Health, Nutrition and Medical statistics which will gather the evidence needed to design more effective growth charts for use worldwide.
We are also using data from the Southampton Womens’ study and ALSPAC to examine the extent to which the new WHO charts fit UK children in terms of head growth and weight gain.
Collaborators: Linda Haines RCPCH; Tim Cole ICH UCL; Tony Williams, St Georges; John McColl, Glasgow University; Hazel Inskip and Keith Godfrey, MRC Epidemiology Resource Centre, University of Southampton.
We have recently published our experience of withdrawing tube feeding in these children and have also studied their energy regulation. Further studies in this clinic population are a planned to look at the impact of high energy supplement drinks.
Feeding videos from the GMS cohort (see below) have been analysed using the Mellow Parenting assessment and most recently using a new observational measure of infant feeding. Questionnaire data from the whole cohort have also been used to develop a new infancy eating assessment scale and this will be further tested in at risk groups.
Collaborators: Christine Puckering, Andrea Sherriff, Helen Minnis, Glasgow University
We have analysed Biolectrical impedance (BIA) data collected in mid-childhood from the Avon Longitudinal Study Of Pregnancy And Childhood (ALSPAC) in order to establish BIA norms and explore the extent to which adiposity tracks over time. We are currently working on data from the Gateshead Millennium Study (see below) examining the relationship between growth and eating behaviour in infancy and later adiposity, as well as using maternal data to explore the validity of BIA in adulthood.
Collaborators: Andy Ness, Bristol University; John Reilly, John McColl, Andrea Sherriff, Glasgow University; Mark Pearce, Newcastle University.
MRC West of Scotland 11-16 Study
This analysis of existing health and lifestyle survey data for 2196 teenagers at ages 11 and 15 years explored patterns of weight gain and loss and their lifestyle and emotional correlates. This led to an MRC studentship to explore factors that lead teenagers to become fat or slim down. Emily Smith, a PhD student, undertook a qualitative study of factors related to weight loss and gain in obese or formerly obese members of the cohort, now aged 22 years.
Collaborators: Helen Sweeting, Helen Minnis, Glasgow University.
Greater Glasgow and Clyde NHS have just established a new large scale intervention programme (ACES) which offers locally based group interventions for children and their families, designed to incorporate the best evidenced components of previous experimental programmes. A PhD student will be helping analysis demographic data from the study and surveying families and professionals about the programme.
Collaborator: Anne Scoular.
With support from NHS greater Glasgow we have developed a Paediatric Malnutrition Screening tool (PYMS) for use in children admitted to hospital to identify those at most nutritional risk. New PhD work is now beginning to extend this screening to infancy and to test which measures most reliably predict nutritional risk in this age group.
Collaborator: Kostas Geramasimidis.
The Gateshead Millennium Study
This is a prospective study of infancy and early childhood. From June 1st 1999 to May 31st 2000 the study recruited 1029 babies at birth, who comprised 80% of babies born during recruiting weeks and resident in Gateshead. They were first studied via parental and staff questionnaires and the first phase of the main study closed with a health check at 13 months. A wide range of data were collected with a main purpose being to study feeding behaviour from birth and relate this to growth, as well as exploring the influence of social deprivation, maternal well being and child temperament. This phase of the study also provided detailed information on correlates of breast feeding cessation and the weaning process. In addition a number of other research questions were explored in the same cohort, including the prevalence of accidental injury, correlates of iron deficiency and use of and satisfaction with local services. Analyses of the infancy data are still continuing, particularly the videos of meals (see above) collected as part of a nested cases control study.
In 2006, after the subjects had all entered school funding was obtained from a consortium headed by the MRC to undertake an extensive follow-up of the whole cohort in 2006/2007 looking at body composition, activity and diet, and the data collection was completed in December 2007. As well as supporting staff in Newcastle, there was also funding to support statistical work in Glasgow and to use data from the infancy phase to develop a new infancy feeding and eating assessment scale.
Collaborators: Ashley Adamson, Kathryn Parkinson, Anne Le Couteur, Newcastle University; Robert Drewett, Durham University; John McColl, Glasgow University.