Preschool children perceived by mothers as irregular eaters: physical and psychosocial predictors from a birth cohort study

OBJECTIVE: Parents often report their children display irregular eating patterns. Our aim is to describe the stability of maternal-perceived irregular eating of their offspring from 6 months to 2-4 years of age and to investigate factors that are associated with maternal perceived irregular eating of their 2-4 year old offspring. METHODS: A longitudinal mother-child linked analysis was carried out using 5 year follow-up data from a population-based prospective birth cohort of 5122 mothers who were participants in the Mater-University Study of Pregnancy, Brisbane. Measures included responses to standardized questionnaires, pediatrician review and standardized measures such as the Peabody Picture Vocabulary Test-Revised and the Child Behavior Checklist. RESULTS: 20.2% and 7.6% of mothers respectively stated their 2-4 year old was sometimes or often an irregular eater. Continuity of feeding difficulties from age 6 months was prominent: 48% of 6 month olds with a feeding problem were 'sometimes' or 'often' irregular eaters at age 2-4 years. From a multivariable analysis, both child-intrinsic factors (chronic physical morbidity, sleeplessness and anxiety-depressive symptoms) and factors that impinge upon the child (poor maternal health and maternal depression and anxiety) independently contributed to irregular eating status at age 2-4 years. CONCLUSIONS: We conclude that approximately one third of mothers had some concern with their child's irregular eating, 7.6% of mothers were often concerned. Irregular eating children were usually physically well, more likely to have persisting feeding problems, sleeplessness, behavioral problems and lived with mothers with perceived poor physical and mental health. Intervention strategies should be family orientated and include child, mother and mother-child psychosocial approaches.     

Maternal separation anxiety as a regulator of infants' sleep

Background:  The regulation of infants' sleep is determined not only by biological factors but by relational aspects too. This study focused on maternal separation anxiety and examined its association with sleep–wake regulation at 10 months of age.
Method:  In a community sample comprising 52 infants and their mothers, sleep was measured objectively with an activity monitor, as well as through questionnaires. The mothers reported on their own separation anxiety and on the child's perceived distress.
Results:  The main finding was that maternal seperation anxiety was linked to settling to sleep routines and to night-waking. The contribution of the mothers' own sepration anxiety to their infants' night-waking remained significant after controlling for the child's fussiness.
Conclusions:  Consistent with the transactional perspective, the current research documented an interplay between maternal separation anxiety and aspects of the child's sleep–wake transitions.     

Depression and anxiety symptoms: onset, developmental course and risk factors during early childhood

Background:  Depressive and anxiety disorders are among the top ten leading causes of disabilities. We know little, however, about the onset, developmental course and early risk factors for depressive and anxiety symptoms (DAS).
Objective:  Model the developmental trajectories of DAS during early childhood and to identify risk factors for atypically high DAS.
Method:  Group-based developmental trajectories of DAS conditional on risk factors were estimated from annual maternal ratings (1½ to 5 years) in a large population sample ( n  =   1759).
Results:  DAS increased substantially in two of the three distinct trajectory groups identified: High-Rising (14.7%); Moderate-Rising (55.4%); and Low (29.9%). Two factors distinguished the High-Rising group from the other two: Difficult temperament at 5 months (High-Rising vs Moderate-Rising: OR = 1.32; 95% CI = 1.13–1.55; High-Rising vs Low: OR = 1.31, CI = 1.12–1.54) and maternal lifetime major depression (High-Rising vs Moderate-Rising: OR = 1.10; CI = 1.01–1.20; High-Rising vs Low: OR = 1.19; CI = 1.08–1.31). Two factors distinguished the High-Rising group from the Low group: High family dysfunction (OR = 1.24; CI = 1.03–1.5) and Low parental self-efficacy (OR = .71; CI = .54–.94).
Conclusions:  DAS tend to increase in frequency over the first 5 years of life. Atypically high level can be predicted from mother and child characteristics present before 6 months of age. Preventive interventions should be experimented with at risk infants and parents.     

Early parental depression and child language development

Objective:  To examine the effects of early maternal and paternal depression on child expressive language at age 24 months and the role that parent-to-child reading may play in this pathway.
Participants and methods:  The 9-month and 24-month waves from a national prospective study of children and their families, the Early Childhood Longitudinal Study – Birth Cohort (ECLS-B), provided data on 4,109 two-parent families. Depressive symptoms were measured with a short form of the Center for Epidemiologic Studies Depression Scale (CES-D). Parents reported on positive parent–infant interactions, child expressive vocabulary, and demographic and health information at child age 9 and 24 months. Linear regression was used to estimate associations between depression, parenting, and child vocabulary. Structural equation modeling was used to test the hypothesis that parent reading behavior mediates the parent depression to child vocabulary pathway. These models were adjusted for demographic indicators.
Results:  As previously reported from this national sample, 14% of mothers and 10% of fathers exhibited elevated levels of depressive symptoms at 9 months. For both mothers and fathers, depression at 9 months was negatively associated with contemporaneous parent-to-child reading. Only for fathers, however, was earlier depression associated with later reading to child and related child expressive vocabulary development. A model describing this pathway demonstrated a significant indirect pathway from depression to vocabulary via parent reading to child.
Conclusions:  Depression is a significant problem among both mothers and fathers of young children, but has a more marked impact on the father's reading to his child and, subsequently, the child's language development.     

Psychological vulnerability in children next-born after stillbirth: a case–control follow-up study

Background:  Case studies and anecdotal accounts suggest that perinatal loss may impact upon other children in the family, including those born subsequent to loss. However, there is a dearth of systematically collected quantitative data on this potentially vulnerable group.
Methods:  Case-controlled follow-up of 52 mothers with history of stillbirth with their next-born children aged 6–8 years, and 51 control mother–child dyads. Previously reported baseline data included maternal antenatal and postnatal psychological assessment, and infant security of attachment at 12 months. Follow-up assessments included maternal psychiatric and socio-demographic data, mother and teacher-rated scales of the child's strengths and difficulties, child IQ, observer-rated mother–child interaction and maternal reports of child health.
Results:  There were no significant between-group differences in child cognitive or health assessments, or in teacher-rated child difficulties. However, mothers with history of stillbirth (the index group) reported increased child difficulties, in particular peer problems, and more adverse interaction was observed in respect of higher levels of maternal criticism of the child's actions, more overall controlling behaviour by the mother, a less harmonious emotional atmosphere and a lower level of maternal engagement with the child. Some of these effects appeared to be mediated by maternal perinatal psychological symptoms and family breakdown.
Conclusions:  This study provides no evidence to suggest that siblings born after stillbirth are clinically at risk but does lend empirical support to clinical reports that such children are seen by their mothers as having problems and that they are exposed to less optimal interaction with their mothers. Possible interpretations of these findings are discussed in the context of theoretical accounts of 'replacement child' and 'vulnerable child' syndromes.     

Early risk indicators of internalizing problems in late childhood: a 9-year longitudinal study

Background:  Longitudinal studies on risk indicators of internalizing problems in childhood are in short supply, but could be valuable to identify target groups for prevention.
Methods:  Standardized assessments of 294 children's internalizing problems at the age of 2–3 years (parent report), 4–5 years (parent and teacher report) and 11 years (parent and teacher) were available in addition to risk indicators from the child, family and contextual domain.
Results:  Low socioeconomic status, family psychopathology at child age 2–3, parenting stress at child age 4–5 years, and parents' reports of child internalizing problems at age 4–5 years were the strongest predictors of internalizing problems at the age of 11. If these early risk factors were effectively ameliorated through preventive interventions, up to 57% of internalizing cases at age 11 years could be avoided.
Conclusions:  Predictors from as early as 2–5 years of age are relevant for identifying children at risk of internalizing problems in late childhood. The methodological approach used in this study can help to identify children who are most in need of preventive interventions and help to assess the potential health gain and efficiency of such interventions.     

Emotional reactivity in infants with congenital heart defects: findings from a large case-cohort study in Norway

Aim:  Advances in medical treatment in recent years have led to dramatically improved survival rates of children with severe congenital heart defects (CHD). However, very little is known about the psychological consequences for these children, particularly during and after the early period of invasive treatment. In this study, we investigated the extent to which the severity of the CHD affects the child's emotional reactivity at 6 months of age.
Method:  We linked prospective data from the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health with a nationwide medical CHD registry and identified 212 infants with CHD in a cohort of 61 299 infants. Mothers reported on their child's emotional reactivity at age 6 months by means of a standardized questionnaire.
Results:  Infants with severe to moderate CHD had 60% higher odds for severe emotional reactivity (cut-off at the 85 percentile) compared with healthy infants, after controlling for important maternal and child confounders.
Conclusion:  Our study is the first to show elevated emotional reactivity in children with moderate to severe CHD, suggesting a need for special parental attention to soothe their distress. Follow-up studies will show whether this emotional reactivity is transient or an early marker of continuing emotional or behavioural problems.     

Small body size at birth and behavioural symptoms of ADHD in children aged five to six years

Background:  Behavioural disorders with a neurodevelopmental background, such as attention deficit hyperactivity disorder (ADHD), have been associated with a non-optimal foetal environment, reflected in small body size at birth. However, the evidence stems from highly selected groups with birth outcomes biased towards the extreme low end of the distribution in birth weight. Whether a similar association exists among the normal range of term birth is unclear.
Methods:  The ADHD Rating Scale was filled in by the biological mothers and fathers of children aged five to six years who were born healthy at term. Information on weight (kg), height (cm), head circumference (cm), and gestational age at birth were obtained from hospital records, and the ponderal index (kg/m³), a commonly used measure of thinness, and head circumference-to-length ratio were calculated.
Results:  Behavioural symptoms of ADHD were predicted by a lower ponderal index, a smaller head circumference, and a smaller head circumference-to-length ratio ( β 's: −.12 to −.14, p 's < .05). Adjustments for length of gestation, mother's age, tobacco and alcohol use during pregnancy, pre-pregnancy body mass index (BMI), or parity, the monthly gross income of the family, child's BMI at the age of five to six years or gender did not change the associations.
Conclusion:  These results suggest that physiological adaptation in utero , indicated by small body size at birth, within term gestational range may increase the susceptibility to behavioural symptoms of ADHD.     

Fetal origins of child non-right-handedness and mental health

Background:  Environmental risk during fetal development for non-right-handedness, an index of brain asymmetry, and its relevance for child mental health is not fully understood.
Methods:  A Swedish population-based prospective pregnancy–offspring cohort was followed-up when children were five years old ( N  =   1714). Prenatal environmental risk exposures were the number of ultrasound examinations and maternal distress during pregnancy. Child mental health, including symptoms of attention deficit hyperactivity disorder (ADHD), language difficulties, and care-seeking for child behavior problems, was assessed via maternal and/or kindergarten teacher's ratings.
Results:  Prenatal exposure to maternal depressive symptoms and critical life events were associated with increased risk of child non-right-handedness and mixed handedness, after adjustment for parity, maternal age, birth outcomes, infant sex, and parental handedness. No association was found between handedness and number of ultrasound examinations. Non-right and mixed-handedness, rather than left-handedness, were associated with increased risk of language difficulties and particularly with ADHD symptoms, after adjustment for current parental ADHD symptoms, current maternal depressive symptoms, birth outcomes, smoking during pregnancy, depressive symptoms and critical life events. Problems were significant enough to prompt mothers to seek care for children's behavioral problems, and parents were more likely to have received advice from the children's kindergarten teachers to seek care.
Conclusions:  This study suggests that mixed-handedness, i.e., reflecting atypical brain laterality, can be a marker of both severity of prenatal exposure to maternal distress and of increased risk of ADHD symptoms in childhood. Our results support the idea that the fetal environment plays a role in subsequent child mental health.     

Adolescent childbearing revisited: the age of inner-city mothers at delivery is a determinant of their children's self-sufficiency at age 27 to 33

OBJECTIVES: Data from recent interviews with 1758 inner-city children, born between 1960 to 1965 and followed with their mothers in the Pathways to Adulthood Study to age 27 to 33 years, were used to address two related questions. 1) Is maternal age, across the reproductive age range, a determinant of child's adult outcome? and 2) Do covariates of maternal age at delivery reduce or eliminate the effect of maternal age on child's adult outcome? METHODS: An intergenerational life course model of development identified significant maternal and child characteristics at birth associated with the child's self-sufficient outcomes in adulthood: education (more than or equal to a high school diploma); financial independence of public support; and delay of first birth until age 20 or older. Bivariate and multiple logistic regression techniques were used to identify independent relationships between dependent and independent variables and to adjust the outcomes to compensate for the effect of possible confounding of maternal age at delivery by maternal education, parity, poverty status, and the child's race and gender. RESULTS: Each covariate was independently associated with maternal age at delivery. Adjustment for their effects reduced, but did not eliminate, the association between maternal age at birth and the child's outcome at age 27 to 33 years. As a group, children of the oldest mothers (>/=25 years of age) had the most favorable outcomes, and those of teenage mothers (<20 years of age) had the least favorable outcomes; 22% of daughters and 6% of sons of the oldest mothers versus 38% and 18%, respectively, of the youngest mothers became teenage parents. CONCLUSION: The mother's age at delivery is an independent determinant of the child's adult status.     

Which mothers wean their babies prematurely from full breastfeeding? An Australian cohort study

Aim:  To identify the maternal and infant characteristics associated with an early transition from full breastfeeding to complementary or no breastfeeding during the first 2 months of life in a large, representative cohort of Australian infants.
Method:  Multinomial logistic modelling was performed on data for infants with complete breastfeeding and sociodemographic data (N = 4679) including maternal age, education, smoking, employment, pregnancy and birth outcomes.
Results:  Ninety-one percent of women initiated breastfeeding. Sixty-nine percent of infants were being fully breastfed at 1 month, and 59% were fully breastfed at 2 months. Maternal characteristics – age less than 25 years, smoking in pregnancy, early full-time postnatal employment and less educational attainment – were associated with early breastfeeding cessation. Infant factors – multiple birth, caesarean birth, infant or first birth – were associated with a transition to complementary breastfeeding in the first postnatal month.
Conclusion:  Breastfeeding duration is substantially affected by breastfeeding outcomes in the first postpartum month. The first month is an important window for evidence-based interventions to improve rates of full breastfeeding in groups of women identified as at risk of early breastfeeding cessation.     

Increased waking salivary cortisol and depression risk in preschoolers: the role of maternal history of melancholic depression and early child temperament

Background:  Elevated morning cortisol is a prospective predictor of major depression and may serve as a vulnerability marker. We examined the relation between morning cortisol and two prominent risk factors for depression in preschool-aged children: maternal depression and child temperament. We also explored whether maternal depression during the child's life, parental hostility and life stress explained these associations.
Methods:  Ninety-four children provided a morning salivary cortisol sample, and 92 children provided an evening sample. Child temperament and parenting were assessed using observational measures, and maternal depression and life stress were assessed with clinical interviews.
Results:  Maternal history of melancholic depression and child temperamental low positive emotionality were significantly associated with higher morning cortisol. These relations persisted after controlling for children's negative emotionality and concurrent depressive symptoms, parental hostility, and life stress.
Conclusions:  Our findings support the hypothesis that elevated morning cortisol may serve as an early-emerging vulnerability factor for depression, and highlight the importance of anhedonia in risk for depression.     

Predictors (0-10 months) of psychopathology at age 11/2 years - a general population study in The Copenhagen Child Cohort CCC 2000

Background:  Epidemiological studies of mental health problems in the first years of life are few. This study aims to investigate infancy predictors of psychopathology in the second year of life.
Methods:  A random general population sample of 210 children from the Copenhagen Child Birth Cohort CCC 2000 was investigated by data from National Danish registers and data collected prospectively from birth in a general child health surveillance programme. Mental health outcome at 1½ years was assessed by clinical and standardised measures including the Child Behavior Check List 1½–5 (CBCL 1½–5), Infant Toddler Symptom Check List (ITSCL), Checklist for Autism in Toddlers (CHAT), Bayley Scales of Infant Development (BSID II), Mannheim Eltern Interview (MEI), Parent Child Early Relational Assessment (PC ERA) and Parent Infant Relationship Global Assessment Scale (PIR-GAS), and disordered children were diagnosed according to the International Classification of Diseases (ICD-10) and Diagnostic Classification Zero to Three (DC: 0–3).
Results:  Deviant language development in the first 10 months of life predicted the child having any disorder at 1½ years, OR 3.3 (1.4–8.0). Neuro-developmental disorders were predicted by deviant neuro-cognitive functioning, OR 6.8 (2.2–21.4), deviant language development, OR 5.9 (1.9–18.7) and impaired social interaction and communication, OR 3.8 (1.3–11.4). Unwanted pregnancy and parents' negative expectations of the child recorded in the first months of the child's life were significant predictors of relationship disturbances at 1½ years.
Conclusions:  Predictors of neuro-developmental disorders and parent–child relationship disturbances can be identified in the first 10 months of life in children from the general population.     

Which children receive grandparental care and what effect does it have?

Background:  Grandparents are increasingly involved in the care of young children, but little is known about factors associated with this type of care, or its implications for children's behavioural development.
Methods:  We used information collected from 8752 families in the Avon Longitudinal Study of Parents and Children (ALSPAC) on grandparent involvement when the study children were aged 8, 15 and 24 months; potential maternal and family predictors of grandparent care; and behavioural outcomes at age 4 years.
Results:  Forty-four percent of children were regularly cared for by grandparents at each age. Throughout the sample, key correlates of grandparent care were maternal age and education. In families without access to paid help with childcare, the child's ordinal position, maternal employment, the mother's recall of parenting by her own mother and the reasons for choosing the type of childcare were also associated with variations in grandparent care. Grandparent care was associated with some elevated rates of hyperactivity and peer difficulties at age 4, but these were largely attributable to variations in the types of families using grandparent care.
Conclusions:  The popular belief that the extended family is no longer an important part of British life is not borne out by this study. Grandparents played a significant role in the care of their young grandchildren. The modest behavioural sequelae of extensive grandparental care differ from those reported for group-based day care.     

Relationship between body image and lifestyle factors in Japanese adolescent girls

Background:  Body image, defined here as an inaccurate perception of personal bodyweight, plays a significant role in the development of obesity, eating problems and eating disorders. Certain lifestyle factors may influence an individual's body image, but current knowledge is based mainly on studies in Western populations.
Methods:  The associations between body image and lifestyle factors were investigated in samples of the Japanese female adolescent population.
Results:  Respondents who reported that they ate meals slowly (odds ratio [OR] 1.81, P  < 0.001) or only consumed small amounts of food (OR 3.17, P  < 0.001) were more likely to underestimate their body image, as determined by their body mass index, than eaters who had average behavior for this age group. Individuals who reported eating faster (OR 1.47, P  < 0.001) or consuming large amounts (OR 1.67, P  < 0.001); those who do not eat breakfast on a daily basis (OR 1.35, P  = 0.006); those who go to bed later than the average time for this age group (OR 1.38, P  < 0.001) or sleep <7 h (OR 1.40, P  < 0.001) and those individuals who rarely exercise (OR 1.27, P  = 0.03) were more likely to overestimate their body image, as determined by BMI, compared with those who had average eating, sleeping and exercise behaviors for this age group.
Conclusions:  Variation from the norm in eating, sleeping and exercise behaviors showed a relationship with a distorted perception of body image in Japanese adolescent girls. These findings are of potential importance in understanding the underlying mechanisms involved in the development of body image and for exploring interventional approaches.     

Prevalence and determinants of cytomegalovirus infection in pre-school children

Aim:   The aim of this study is to measure the seroprevalence of cytomegalovirus (CMV) infection in 3.5-year-old children, and identify the determinants of seropositivity.
Methods:   A total of 1714 children were enrolled at birth. Approximately half were small for gestational age and half were appropriate for gestational age. Information on the children was collected at birth, 1 year and 3.5 years. At 3.5 years blood was collected and tested for CMV-specific immunoglobulin by an enzyme-linked immunosorbent assay in 530 children.
Results:   The weighted seroprevalence of CMV was 32.8% (95% confidence interval (CI) 27.4–38.1%). The seroprevalence of CMV varied markedly by ethnicity (European: 26.5% (95% CI 20.9–32.2%); Maori: 68.0% (44.0–92.0%); Pacific: 74.5% (56.3–92.6%); Indian: 50.0% (20.2–79.8%); Chinese: 47.2% (10.8–83.5%); Other: 21.9% (0.0–52.7%); P < 0.001). Socio-economic factors, number of siblings, day care centres attendance, maternal smoking, breastfeeding and other factors examined were not related to CMV seropositivity.
Conclusions:   The seroprevalence of CMV in New Zealand pre-school children is similar to that reported from other developed countries. The finding of marked ethnic differences is unexplained by socio-economic factors, or other factors that were examined.     

Growth, energy intake, and meal pattern in five-year-old children considered as poor eaters

OBJECTIVE: To investigate whether 5-year-old children considered poor eaters differ from their peers regarding growth, intake of energy and nutrients, or meal pattern.Study design Parental evaluations of children's (n=494) eating at age 5 years were collected using questionnaires, and energy and nutrient intakes and meal pattern of the children were assessed using 4-day food records. Weight and height were measured at birth and at ages 7 and 13 months, and 2, 3, 4, and 5 years. Of the children 30.2% (149) were poor eaters according to the parents. The rest of the sample (n=345) formed the comparison group. RESULTS: Poor eaters were on average lighter and shorter at birth (P=.026 and P=.020, respectively), and at age 5 years (P<.001 for both weight and height) than the comparison children. At age 5 years the poor eaters on average received less of their daily total energy from warm meals (P=.044) and more from snacks (P=.013) than the comparison group, but the mean daily weight-adjusted intake of energy showed no difference between the groups (P=.153). CONCLUSIONS: There appears not to be reason for serious concern about growth and diet of preschool-aged children considered as poor eaters by parents.     

Concern for privacy in relation to age during physical examination of children: an exploratory study

Objectives:  To explore whether physicians behave differently regarding ethics and respect for privacy depending on children's age. We explored whether physician behaviours contributed to child uneasiness.
Study design:  Observational study of 21 children (0–12 years; 18 boys; mean age 3.2) undergoing evaluation for inguinal hernia. Specific physician-initiated verbal and nonverbal behaviours were coded from digital video discs of the consultations.
Results:  Physician intrusiveness (i.e. approaching the child suddenly or in an uninvited way) during the physical examination was related to concurrent child uneasiness (r = 0.42, p < 0.06) and lasted through the postexamination phase of the consultation (r = 0.52, p < 0.01). Child mood during the examination strongly predicted postexamination mood (r = 0.69, p < 0.0001). Neither the total number of physician-initiated positive behaviours or privacy-related behaviours was associated with child age. Negative physician behaviours were strongly related to negative mood in the child (r = 0.72, p < 0.0001) at the close of the consultation.
Conclusion:  Although physicians were more likely to provide information to older than younger children, their behaviours regarding privacy did not differ by child age. We found that intrusiveness was rather common and related to child uneasiness that has implications for the ethical practice and a child's willingness to be examined.     

Inconclusive Cystic Fibrosis neonatal screening results: long-term psychosocial effects on parents

Aim:  Cystic Fibrosis (CF) Newborn Screening occasionally identifies neonates where a CF diagnosis can neither be confirmed nor excluded. To assess how parents of these infants cope with this ambiguous situation.
Methods:  Parents of 11 children with Ambiguous Diagnosis (group AD) were compared with parents of 11 children diagnosed with CF through neonatal screening [group Cystic Fibrosis Diagnosis (CFD)] and with parents of 11 Healthy Control children (group HC) matched for gender and age.
Results:  The emotional reaction to the inconclusive result was less pronounced in AD than in CFD (p = 0.003), and AD parents considered their infants as healthy as controls. Parents' anxiety about their child's health is stronger in CFD than in AD (p < 0.05) and HC (p < 0.001). Long-term emotional distress was rated similarly in AD and CFD, and greater than in HC (p = 0.0003). The parent/child relationship was less influenced in AD than in the CF group (p = 0.03). Seven AD and CFD parents changed their family planning projects.
Conclusion:  Inconclusive neonatal screening results appear to be understood and associated with lower anxiety levels than CF diagnosis. Concern about the child's health is similar to healthy controls and lower than in parents of CF children.