Lewis King has the healthy colouring of someone who has spent the previous nine months of his life in Spain. But the 11-year-old, who moved to the Granada region from Bristol last year, is happy to return to his place of birth, combining a trip to see his great gran with his annual health check at the Children of the 90s study.
Lewis has continued to contribute to the project because "it might help other people, and I find it fun". His altruism isn't unusual, however.
While some of the children attending their annual checks admit that it gets them an afternoon off school, they are also aware of the project's undoubted ability to improve the health of future generations.
In fact, it's now almost 20 years since the World Health Organisation asked a university professor, Jean Golding, a question that has kept her busy to this day: what are the current problems in child health and development and how may they be prevented? As scientific and executive director of Children of the 90s - or, to give it its full name, the Avon Longitudinal Study of Parents and Children - Golding has overseen a research project that has far-reaching implications, and which has no, not even similar, counterpart around the world.
Scientific breakthroughs
The number and quality of the project's scientific breakthroughs demonstrate just how far-reaching the research actually is. Children of the 90s has published more than 160 scientific papers, the most recent of which is the discovery of a new way of predicting which young people are most at risk of eventually contracting diabetes. Researchers from Cambridge University looked at more than 1,000 children from the project and found that small babies who quickly catch up in size - and who are born with the insulin gene - may be at the greatest risk of developing diabetes and heart problems in later life.
For Golding, however, the most significant finding came in the early 90s. At the time, the common view was that the best way to get babies to go to sleep was to put them on their front. But Peter Fleming, a Bristol professor, suggested that it was better that they slept on their back, and used data collected by Children of the 90s to prove that there were no adverse effects. His findings persuaded the Department of Health to change its guidance, and between 1991 and 1992 this led to a halving in the number of sudden infant deaths.
However, before such important discoveries could be made, a huge amount of work had to go into setting up the project. It started in earnest by signing up 14,541 pregnant women living in the Bristol area who had an estimated day of delivery between 1 April 1999 and 31 December 1992. The mothers-to-be didn't know then that the project would be long term, but almost 14,000 of the children born in that time period are still available to the study - which now employs 180 staff - and 7,850 children attended their half-day health check in the 10+ category, when they reached 10 and a half years of age.
While it's not unusual for several children in one school class to be part of the project, it's not just children living in Bristol that still participate in the research. A waiting room wall map at the study's Bristol University headquarters shows just how far-flung its participants have become - 36 families involved in the project now live in the US, one lives in Mauritius, and one child's family is based on the South Pacific island of New Caledonia, while others come from across Europe and the Middle East for their annual check-up.
Testing times
There's a welcoming and informal atmosphere in the reception areas as children arrive for these checks.
On this Thursday afternoon, two groups, Focus 11+ (of eight 11-year-olds) and TeenFocus 1 (of eight 12-year-olds), will be examined. Each child will attend eight 20-minute sessions, including tests on hearing and vision in Focus 11+, and reading, motor skills and one-to-one interviews in TeenFocus 1. The 11-year-olds also undergo a battery of anthropometry tests, including a full-body scan using a DXA scanner that measures bone mineral density and fat distribution. Each child receives a picture of their skeleton, which goes down well.
Parents are also complimentary about the project. For Andrew Woodgate, whose son Samuel is in for his 11+ check: "There are benefits for us, like if Samuel's hearing was up the creek we would know about it early," he explains, "but it's more important that the project's predicting things."
However, divulging information is not a straightforward issue. The project's ethics and law advisory committee, which is chaired by a professor of law and also counts a philosopher, GP, school nurses and two of the study's mothers among its members, has decided on six areas where the researchers are allowed to feed back data to parents: deficient hearing, deficient eyesight, scoliosis (curved spine), low haemoglobin, high blood pressure, and zygosity determination for twins (identical or not).
Also, to ensure anonymity, each child has been given an ID number that's attached to their data. Only a handful of people can match names with data. These distinctions don't appear to worry the children, though. In the 11+ waiting room, receptionist Jan Jenkin is showing 11-year-old Chris Stanway how to work his activity monitor. He will have to wear the movement detector, which turns on and off automatically, for five days.
Chris' mum, Sue, used to be a health visitor and is now a local college lecturer in child health, where she's used some of the project's findings in her classes. "I remember when I was pregnant with Chris it was just a little survey," she recalls, "but it has just grown." Julie Strange, whose daughter Hannah is now 12, says: "I didn't think it would last this long, but we're participating in something that's quite an achievement."
Meanwhile, downstairs in the Teen Focus 1 group, clinic assistant Colin Gill, who is also doing a part-time Masters degree in exercise and health, is setting 12-year-old Ryan Morgan a number of tasks, including a standing long jump and throwing and catching a ball, as he looks to measure his motor skills.
Coming of age
According to Golding, it's thanks to these "wonderful" staff that the study has continued to be successful. "Most of them stay with us and have this terrific facility of really getting on with children," she says.
Another result of this success is that universities and other organisations pay to use the data collected, while Government projects have helped to fund some work. The core funding, however, comes from the Medical Research Council, the Wellcome Trust and the University of Bristol, and Golding is in talks over the next round of money, which will last for five years.
She believes the next few years will be very significant. Most of the study's findings so far have concentrated on health but, as the children go through adolescence, researchers will look in greater detail at their mental development. "At this age, you reject everything you are advised to do," explains Golding, "so we have to make sure they don't reject us at the same time. We hope that by being very interested in what they are doing, and what their attitudes and difficulties are, they will see us as friends."
For now, staff say goodbye to the children leaving the centre at the end of their checks for another year. Every morning and afternoon six days a week this process is repeated, which highlights the sheer scale of the project.
Golding admits that, after the World Health Organisation first approached her in 1985, she "didn't dare to think beyond getting the project going, as nobody believed it was feasible to enrol that many people". But now she wants to track the children until they turn 70.
Further information To find out more about Children of the 90s and to keep track of developments, go to www.alspac.bristol.ac.uk/welcome/index.shtml
KEY FINDINGS
- Children brought up in very hygienic homes are more likely to develop asthma (1998)
- Infants who used dummies were more likely to suffer ill health including fever and colic (1999)
- Some vegetarian diets during pregnancy may not be good for the developing foetus (2000)
- Pregnant mothers who suffer anxiety have a much higher risk of having a child with severe behavioural problems or hyperactivity (2001)
- Frequent cannabis use during pregnancy may affect the growth of unborn child (2002)
- High Paracetamol use during late pregnancy may increase the risk of asthma in a child (2002).
