Intended for healthcare professionals

Education And Debate

Children in an ageing society

BMJ 1999; 319 doi: (Published 20 November 1999) Cite this as: BMJ 1999;319:1356
  1. D M B Hall, professor of community paediatrics (
  1. Community Health Sheffield and University of Sheffield, Community Sciences Building, Northern General Hospital, Sheffield S5 7AU

    Western society is changing not only in its age distribution but in many other ways. Separating out the importance of each factor is all but impossible. The demographic patterns prevalent in the Western world must be unique in human history, so we have few data on which to base any firm predictions about children in an ageing society. The phenomena producing the change in demographic pattern may be more important for children and services than the age distribution itself Increased life span is not the only reason for the changing distribution; fewer children are born, fewer die, and parents are older when they have their children. In this article I will consider three implications for children and paediatric practice: the social class differences in child bearing patterns; the particular issues related to disability; and the distribution of resources between the age groups.

    Summary points

    Women are now having children at an older age than at any time in the past 50 years

    Delayed childbearing and voluntary childlessness are especially prevalent among highly educated women

    Changing patterns of childbearing may increase health and wealth inequalities

    There will be an increasing number of very old parents caring for ageing severely disabled offspring

    The needs of the elderly population may drain resources from children's services

    Child bearing and social class

    Although mortality in children is low in Western countries, the decrease has been more than matched by the fall in birth rate, leading to a net fall in the number of children. In the developing world it is often said that parents have many children in the hope that some at least may survive, and improved child survival has been seen as one key to successful population control and family planning. In the rich world, parents can readily control their fertility, and as they expect each child to survive they …

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