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First Screening In Italy On Children's Health In Prison

April 8, 2009
Catholic University of Rome
A group of pediatricians have evaluated the health of babies living in prison with their mothers in the main jail of Rome, Rebibbia. It's the first time a study on the health conditions of these patients has been published in Italy. Despite the problems encountered, pediatricians are optimistic: the health system in prison works.

They do not go to parks over the weekend or to the beach in summer. They do not receive gifts under the Christmas tree. They only see the sun behind the bars. Until before 2006 (the year the parliament granted a major pardon which decreased the number of prisoners), children up to three years of age living with their mothers in prison were around one hundred. Italian law states that, in order to avoid the trauma of mother-child separation, mothers sentenced to prison or awaiting trial can bring with them their children in specific nest areas of the jail.

Of course little ones living in such an inconvenient situation still face many problems. For the first time in Italy, physicians of the Institute of Paediatric Clinic of the Catholic University of Rome – Policlinico Agostino Gemelli entered in the Casa di reclusione di Roma Rebibbia, the main prison of Rome, where the majority of these unfortunate children live, to assess their health conditions. The paper has been published on the last issue of the Scandinavian Journal of Public Health.

"When we first began this study", explains Pietro Ferrara, researcher of the Institute of Paediatric Clinic of the Catholic University of Rome, and one of the authors of the article, "thanks to the collaboration of the managers of the prison, we had access to all the clinical diaries of the children who had lived in the prison within one and a half year, beginning from January 2003 to mid-2005".

The total number of children amounted to 150. For comparison, researchers also used the data of around 150 children of the same age who had visited the paediatric surgeries of the Gemelli Hospital and those of around a hundred children of immigrant parents living in Italy.

The first data measured was the gestational age, which is the length of the pregnancy. A good 20% of the children who had lived in a jail had had a gestational age lower than 37 weeks (the average length of a pregnancy). As a comparison, 9% of the children of immigrants were born before time, whereas only 5% of the Italian children are premature. Why do we see this difference?

"Of course", answers Ferrara, "environmental risk factors play an important role. Often women who end up in prison are subjected to infections, have wrong habits, like smoking or the intaking of narcotics, and frequently pregnancy is not properly taken care of".

Another important factor is the breast-feeding. Around 70% of the mothers of all three groups decide to nurse their babies. This is not surprising: all mothers want to care for their children. But the time of weaning in jail comes earlier. Both Italian mothers and foreign mothers by and large cease breast-feeding after 5 months. In jail, on the other hand, the weaning takes place before. "An early weaning – reminds Ferrara – can predispose to the risk of hypertension and obesity. Early interruption of the contact with mother's milk can also lead to sensitization towards food antigens, predisposing to allergies, and increasing the risk of intoxication of substances like preservatives or food colouring agents. In newborns, as a matter of fact, the detoxification processes are still not well developed".

Yet what mostly differentiates the health of children in or outside a prison is certainly the immunization status. "When we realized this, we were really shocked", tells Ferrara. "In Italian children the rate of vaccinal coverage is about 100%, which means that nearly all of them are correctly vaccinated. Immigrants' children, who live through greater logistical and cultural hitches, still reach more than 80%. On the other hand, not more than 14% of the children in jail have been correctly vaccinated. Of course, we are talking about few children over all, but let's not forget that these small ones are taking a very dangerous risk".

Even so, Pietro Ferrara and his colleagues paediatricians are very optimist. "First of all, because we have verified that today even inside a prison there is a good level of health assistance", comments Ferrara. "Also, doctors make a very good work of prevention. Mothers explained how to wean, children are correctly vaccinated and the percentage of vaccinated babies has doubled. Of course, there's room for improvement, but let's not forget that children remain in a prison for a variable amount of time, and it's hard to keep track of them once they are out. The idea is to extend to mothers in prison the health care education programs we routinely perform to evaluate with a paediatrician the health of the child, to talk about prevention and to give suggestions to the parents".

Up to some time ago, this was a taboo topic, insomuch that this is the first time a study like this is performed in Italy. "Many colleagues from other countries have written to us saying that they were happy that finally some data about Italy was made available", says Ferrara. "We found a situation which of course still could be enhanced. For example, it would be useful to computerize the clinical diaries, so that we could save us from sifting through the pages, or to transform the meetings with the mothers into regular ones. Yet we can state that preventive and therapeutic assistance in jail is of a good level: a level that many of these children would never have had access to. If I did not fear to be misunderstood, I could nearly say that it was good for these children to have spent some time in prison", concludes the paediatrician.

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