Health of children

In a national study of Australian children’s perspectives, health ranked as the second most important domain, after family, for having a good life (Redmond et al. 2016). Good health influences how children feel and go about their daily lives, as it can affect participation in family life, schooling, social and sporting activities.

The foundations for good health start during the antenatal period and early years and can have long-term impacts on a child’s later life – see Health of mothers and babies. Targeting risk factors in children can reduce preventable chronic disease in adulthood and equips children with the best life chances (AIHW 2022a; Department of Health 2019). Investment in early years of child development also provides an opportunity for substantial health gains across their lifespan (Department of Health 2019).

The COVID-19 pandemic has had an impact on aspects of children’s health and wellbeing. Further monitoring is required to understand any long-term impacts.

Profile of children

At 30 June 2021, an estimated 4.8 million children aged 0–14 lived in Australia. Boys made up a slightly higher proportion of the population than girls (51% compared with 49%) (ABS 2021c).

The number of children in Australia is projected to reach 6.4 million by 2048 (ABS 2018c). However, due to sustained low fertility rates and increasing life expectancy, the number of children as a proportion of the entire population has steadily fallen, from 29% in 1968 to 19% in 2021 (ABS 2021c). In 2018, the proportion was projected to fall to 18% by 2048 (ABS 2018c). The COVID-19 pandemic caused significant disruptions to Australian population trends and these changes may affect subsequent projections.

Health status

Burden of disease

The burden of disease is the quantified impact of a disease or injury on a population, which captures health loss, or years of healthy life lost through premature death or living with ill health (see Burden of disease). For infants and young children aged under 5, the leading causes of total burden of disease were mainly infant and heart conditions, with similar leading causes for both boys and girls (Figure 1). Among children aged 5–14, asthma was the leading cause of total burden, followed by four mental health conditions: anxiety disorders, depressive disorders, conduct disorder and autism spectrum disorders (AIHW 2021b). The leading causes of total burden among boys and girls aged 5–14 differed slightly, with asthma contributing the most burden to boys (14%) and anxiety disorders contributing the most for girls (12%) (Figure 1).

Mental health

The latest national data on child and adolescent mental health was collected in 2013–14 in the Australian Child and Adolescent Survey of Mental Health and Wellbeing (also known as the Young Minds Matter survey). In 2013–14, 1 in 7 (14%) children aged 4–11 experienced a mental disorder in the 12 months prior to the survey. Boys were more commonly affected than girls (17% compared with 11%), particularly in relation to Attention Deficit Hyperactivity Disorder (ADHD) (11% compared with 5.4%) (Table 1) (Lawrence et al. 2015).

Table 1: Prevalence of mental disorders among 4–11-year-olds, by sex, 2013–14

Disorder	Boys (%)	Girls (%)	Children (%)
ADHD	10.9	5.4	8.2
Anxiety disorders	7.6	6.1	6.9
Conduct disorder	2.5	1.6	2.0
Major depressive disorder	1.1	1.2	1.1
Any mental disorder(a)	16.5	10.6	13.6

(a) Totals are lower than the sum of disorders as children may have had more than 1 class of mental disorder in the previous 12 months.

Source: Lawrence et al. 2015.

Among children aged 4–11 with some form of mental disorder, almost 3 in 4 (72%) had mild disorders, 1 in 5 (20%) had moderate disorders and around 1 in 12 (8.2%) had severe disorders. Severe disorders were more common among boys (9.9%) than girls (5.6%) (Lawrence et al. 2015).

See Mental health.

Impacts of the COVID-19 pandemic on mental health

In October 2021, a review of research undertaken since the COVID-19 pandemic began found substantial deterioration of children’s mental health, particularly during periods of lockdown and for children with pre-existing conditions and families in financial distress (Renshaw and Seriamlu 2021).

In August 2021, as part of the Australian National University Centre for Social Research and Methods’ COVID-19 Impact Monitoring Survey Program, parents/carers of children aged 2 and over reported the impact of the COVID-19 pandemic on their child’s mental health: 61% experienced a negative impact, 35% experienced no impact and 5.0% experienced a positive impact (Biddle et al. 2021).

A higher proportion of children in older age groups were reported to have experienced negative impacts on their mental health: 71% for children aged 15–18 compared with 63% of children aged 10–14, 62% of children aged 5–9 and 40% of children aged 2–4 (Biddle et al. 2021).

A comparison with a similar survey in July 2020 suggests the proportion of children aged 3–17 who experienced any negative effect had increased as the pandemic continued (from 36% in July 2020 to 61% in August 2021) according to parent/carer reports (Biddle et al. 2021).

In a survey in September 2020 on the impacts of remote learning due to COVID-19, parents/carers reported that more than 1 in 3 children aged 5–18 (35%) experienced a negative impact on their mental health, with higher proportions in Victoria (56%) than New South Wales (34%) or other states and territories combined (26%) (RCHpoll 2021). Some reported a positive impact, with around 1 in 3 (29%) children in New South Wales and around 1 in 5 in Victoria (21%) and other states and territories (21%). Children in Victoria were still engaged in both lockdowns and remote learning in September 2020, while those from other states/territories had returned to face-to-face learning (RCHpoll 2021).

Disability

According to the ABS 2018 Survey of Disability, Ageing and Carers, around 1 in 13 (7.6% or an estimated 356,000) Australian children aged 0–14 have disability (ABS 2019c). More boys (9.6%) than girls (5.7%) have disability. Around 1 in 20 (4.5%, or an estimated 210,000) children had a severe or profound core activity limitation and 7.8% (an estimated 241,000) of children aged 5–14 had a schooling restriction. Schooling restrictions are determined based on whether a person needs help, has difficulty participating, or uses aids or equipment in their education because of their disability. Boys aged 5–14 were more likely than girls to have a schooling restriction (9.9% compared with 5.6%).

The prevalence of disability has remained relatively stable over time for children. Since 2003, there has been little change in the prevalence for children aged 0–4 (4.3% in 2003 compared with 3.7% in 2018) or children aged 5–14 (10% in 2003 compared with 9.6% in 2018) (ABS 2019a).

Effects of the COVID-19 pandemic on children with disability

A review of the existing research released between March 2020 and June 2021 suggests the COVID-19 pandemic has exacerbated existing problems with support for children with disability including:

• access to inclusive information
• access to health and social opportunities, including medical services
• issues with the flexibility of systems to adjust to the additional needs and complexity of children with disability’s lives (Renshaw and Goodhue 2021).

Children with disability also experienced uncertainty about education and access to appropriate learning materials – in a survey in April–June 2020, families of children with disability reported that only half (50%) had received accessible learning materials and curriculum (Dickinson et al. 2020).

Chronic conditions

According to self-reported data from the ABS 2020–21 National Health Survey (NHS), an estimated 2 in 5 (44%) children aged 0–14 had one or more chronic conditions (ABS 2022). Chronic conditions, also known as long-term conditions or non-communicable diseases, refer to a wide range of conditions, illnesses and diseases that tend to be long-lasting with persistent effects. Chronic disease can interrupt a child’s normal development and can increase the risk of being developmentally vulnerable at school entry (Bell et al. 2016).

According to the 2020–21 NHS, the most common chronic conditions among children aged 0–14 were:

• hay fever and allergic rhinitis (11%) and asthma (8.7%), both diseases of the respiratory system
• allergies (including food, drug and undefined) (7.8%)
• anxiety related disorders (7.1%) and problems of psychological development (6.8%); both mental and behavioural conditions (ABS 2022).

Injuries

In 2019–20, there were around 62,100 hospitalised injury cases among children aged 0–14, a rate of around 1,300 per 100,000 children (AIHW 2022b). Hospitalised injury cases exclude presentations to emergency departments that are not admitted to hospitals. For more information on non-admitted patient services, see Hospitals.

Overall, boys were 1.5 times as likely as girls to sustain an injury that resulted in hospitalisation (around 1,500 and 1,000 per 100,000, respectively) (AIHW 2022b). These differences varied by age, from 1.3 times as likely for children aged 0–4 to 1.8 times for 10–14-year-olds.

In 2019–20, the leading causes of hospitalised injuries among children were falls, contact with objects (such as being struck or cut by something other than another human or animal) and transport accidents (Figure 2).

During 2018–2020, injuries contributed to 502 deaths of children aged 0–14, a rate of 3.5 per 100,000 children (AIHW 2022a).

Deaths

In 2020, there were 943 deaths of infants under the age of one, a rate of 3.2 per 1,000 live births (ABS 2021a). Infant deaths accounted for 7 in 10 (71%) deaths among all children aged 0–14. The leading causes of infant deaths were: perinatal conditions (56%), congenital conditions (26%) and symptoms, signs and ill-defined conditions, including Sudden Infant Death Syndrome (11%) (ABS 2021a). The infant death rate fell from 5.0 deaths per 1,000 live births in 1998 to 3.2 per 1,000 in 2020 (AIHW 2022a).

In 2020, there were 386 deaths of children aged 1–14, a rate of 8.6 per 100,000 children. The leading causes of child deaths were: land transport accidents (13%), malignant brain tumours (8.3%) and congenital conditions (8.3%) (ABS 2021a). The death rate for children aged 1–14 fell from 19.7 deaths per 100,000 in 1998 to 8.6 per 100,000 in 2020 (AIHW 2022a).

See Life expectancy and causes of death.

As of 24 May 2022, since the COVID-19 pandemic began, there have been 8 deaths due to COVID-19 among children aged 0–9 and 6 deaths among children aged 10–19 (Department of Health 2022a). For the most recent data on cases and deaths, see the Department of Health’s Coronavirus (COVID-19) case numbers and statistics.

Health risk factors

Nutrition

Good nutrition is key to supporting children’s growth and development (NHMRC 2013).

According to self-reported data from the ABS 2017–18 NHS:

• About 7 in 10 (72%) children aged 5–14 met the recommended guidelines for fruit consumption.
• About 1 in 25 (4.4%) children aged 5–14 met the recommended guidelines for vegetable consumption (ABS 2019e).

It was also estimated that almost half (45%) of children aged 5–14 consumed either sugar-sweetened drinks or diet drinks at least once a week. The proportion was higher for children aged 10–14 (53%) than children aged 5–9 (33%) (ABS 2019e).

See Diet.

Eating behaviour during the COVID-19 pandemic

In a survey in June 2020, parents/carers reported that, compared with before the pandemic, over 1 in 4 (26%) children had eaten more in general and 1 in 4 (25%) ate more unhealthy food since the pandemic began (RCHpoll 2020). About 2 in 5 (43%) children were reported to have consumed sugary drinks or ‘treat food’ on most days of the week during the 2 weeks prior to the survey.

Physical activity

In addition to good nutrition, participating in physical activity and limiting sedentary behaviour is critical to a child’s health, development and psychosocial wellbeing. The most recent data available on physical activity and sedentary screen time for children are self-reported from the ABS 2011–12 National Nutrition and Physical Activity Survey.

In 2011–12, among children aged 2–4:

• Most (72%) met the recommended 180 minutes of physical activity each day.
• Just over one-quarter (26%) met the screen-based activity guideline of no more than 60 minutes per day (ABS 2013).

In 2011–12, among children aged 5–14:

• Less than one-quarter (23%) undertook the recommended 60 minutes of physical activity every day.
• Less than one-third (32%) met the screen-based activity guidelines.
• Only 1 in 10 (10%) met both sets of guidelines each day (ABS 2013).

On average, children aged 5–14 spent around 2 hours (123 minutes) each day sitting or lying down for screen-based activities, with only 3.5 minutes of this being for homework. Children aged 10–14 spent more time in front of screens (145 minutes) on average in a day than children aged 5–9 (102 minutes) (ABS 2013).

See Insufficient physical activity.

Effects of COVID-19 on physical health

In June 2020, parents/carers reported that only 1 in 10 (10%) children aged 5–18 met the recommended activity guidelines in the 2 weeks prior to the survey (RCHpoll 2020). About 2 in 5 children aged 3–18 were reported to have spent less time being outdoors (42%) and physically active (42%) in a typical week during the pandemic compared with before the pandemic. More teenage children (44%) spent less time being physically active than primary or pre-school aged children (37%). Many children aged 3–18 (51%) were reported to have spent more time on screens for entertainment. More than one-third (36%) of parents said their own or their child’s concern about catching COVID-19 was a barrier to their child engaging in exercise or physical activity outdoors (RCHpoll 2020).

Overweight and obesity

Based on measured data from the 2017–18 NHS, the majority of children aged 5–14 (67% or an estimated 2 million) were a normal weight and around 1 in 4 (24% or an estimated 746,000) were overweight or obese (ABS 2019d). Almost 1 in 13 (7.7%) children aged 5–14 were obese. The prevalence of overweight and obesity:

• was similar for boys and girls across age groups
• remained relatively stable between 2007–08 and 2017–18 (ABS 2019d).

For further detail of how overweight and obesity is defined and measured, see Overweight and obesity.

Health care

Immunisation

Measuring childhood immunisation coverage helps track how protected the community is against vaccine-preventable diseases, and reflects the capacity of the health care system to effectively target and provide vaccinations to children.

In 2021, more than 9 in 10 (93%) children aged 2 were fully immunised. Coverage rates for 2-year-olds are slightly lower than for 1-year-olds (95%) and 5-year-olds (95%) due to changes to the National Immunisation Program Schedule in December 2014 and March 2017 (Department of Health 2022c).

The proportion of children fully immunised at 2 years old was relatively stable at around 91–93% between 2009 and 2021, dropping slightly to 89% in 2015 and 90% in 2017 (Department of Health 2022c).

See Immunisation and vaccination.

COVID-19 vaccination rates

As of 30 April 2022, about half (53%) of children aged 5–11 had one dose of the COVID-19 vaccine and 37% were fully vaccinated (Department of Health 2022b). Most children aged 12–15 have had one dose (85%) or have been fully vaccinated (80%). For the most recent vaccination data, see the Department of Health’s COVID-19 vaccination – vaccination data.

Medicare-subsidised mental health-specific services

In 2019–20, 1 in 100 children aged 0–4 (1.0% or 15,600) and 1 in 15 children aged 5–11 (6.8% or 154,000) received Medicare-subsidised mental health-specific services (AIHW 2022c). Of all people receiving Medicare-subsidised mental health-specific services, children aged 0–11 made up 6.2%, with those aged 25–34 making up the greatest proportion of patients (20%). The most common provider type for children was general practitioners (0.7% of all children aged 0–4 and 5.2% of all children aged 5–11) (AIHW 2022c).

COVID-19 impact on mental health services

In August 2021, a survey of parent and carers of children aged 0–18 found that around 1 in 5 (21%) needed mental health support for their child/ren and 73% of those sought help (Biddle et al. 2021). Of those who sought help, 2 in 5 (40%) reported it was difficult or very difficult to access mental health support services for their child.

Kids Helpline reported that nationally the number of duty of care interventions to protect children and young people between December 2020 and 31 May 2021 was nearly twice as high as the same period a year ago (an increase of 99%) (yourtown 2021). This increase in contact to police, child safety or ambulance services was largely due to interventions for suicide attempts (38%) and child abuse (35%).

Where do I go for more information?

For more information on the health of children, see:

• Australia’s children
• National Action Plan for the Health of Children and Young People: 2020–2030
• National framework for protecting Australia’s children indicators
• Children’s headline indicators

Visit Children & youth for more on this topic.