Scope of health care benefits for children from birth through age 26

The optimal health of all children is best achieved with access to appropriate and comprehensive health care benefits. This policy statement outlines and defines the recommended set of health insurance benefits for children through age 26. The American Academy of Pediatrics developed a set of recommendations concerning preventive care services for children, adolescents, and young adults. These recommendations are compiled in the publication Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, third edition. The Bright Futures recommendations were referenced as a standard for access and design of age-appropriate health insurance benefits for infants, children, adolescents, and young adults in the Patient Protection and Affordable Care Act of 2010 (Pub L No. 114-148).     

Anemia in children under 3 years of age in public day care centers

OBJECTIVE: To study the prevalence of anemia in children aged less than 36 months in public day care centers in the city of Cuiabá, state of Mato Grosso, Brazil. METHODS: Cross-sectional study with all children (n=271) less than 36 months of age who attended public day care centers in mid-1997. Children were evaluated as to their hemoglobin levels (venous blood, analyzed at the Central State Laboratory) and anthropometric indicators (weight/age, height/age, weight/height). RESULTS: A high prevalence (63%) of anemia associated with age, weight and height deficit, and time of admittance at kindergarten was observed. The prevalence of malnutrition was 0.8% according to the weight/height ratio, 5.0% according to weight/age deficit, and showed an inadequacy of 10.3% as to the height/age ratio. Thus, the percentage of anemic children was six times higher than the height deficit and twelve times higher than the weight deficit. Malnutrition was not in fact associated with anemia, but at extreme anthropometric cut-off points of height and weight for age (< -2 z score), there is an association between these conditions. CONCLUSION: The high prevalence of anemia is regarded as a severe public health problem among preschool children in the city of Cuiabá.     

Skeletal maturity at birth and at the age of 3 years of infants malnourished in utero

Twenty five term infants malnourished in utero and 25 matched controls were studied at birth and at $\text{2}\text{1}\text{2}$-$\text{3}\text{1}\text{2}$ years of age. At birth the infants malnourished in utero had a significant retardation in skeletal maturity in comparison with the control group. At $\text{2}\text{1}\text{2}$-$\text{3}\text{1}\text{2}$ years of age the average skeletal maturity of the intrauterine malnourished children approached that of the controls. However, those with a length below the national 10th centile still showed a retarded skeletal growth 'in comparison with those who had reached a length above the 10th centile for age.     

Parental protection of extremely low birth weight children at age 8 years

OBJECTIVE: To examine parent protection and its correlates among 8-year-old ELBW children compared with normal birth weight (NBW) controls. METHODS: The population included 217 eight-year-old ELBW children born 1992-1995 (92% of the surviving birth cohort; mean birth weight, 811 g; mean gestational age, 26.4 weeks) and 176 NBW controls. The primary outcome measure, the Parent Protection Scale (PPS), included a total score and four domains including Supervision, Separation, Dependence, and Control. Multivariate analyses were performed to examine the predictors of parental protection and overprotection. RESULTS: After adjusting for socioeconomic status (SES), race, sex, and age of the child, parents of ELBW children reported significantly higher mean total Parent Protection Scale scores (31.1 vs 29.7, p = .03) than parents of NBW children and higher scores on the subscale of Parent Control (8.0 vs 7.5, p = .04). These differences were not significant when the 36 children with neurosensory impairments were excluded. Parents of ELBW children also reported higher rates of overprotection than controls (10% vs 2%, p = .001), findings that remained significant even after excluding children with neurosensory impairments (8% vs 2%, p = .011). Multivariate analyses revealed lower SES to be associated with higher total Parent Protection Scale scores in both the ELBW (p < .001) and NBW (p < .05) groups. Additional correlates included neurosensory impairment (p < .05) and functional limitations (p < .001) in the ELBW group and black race (p < .05) and maternal depression (p < .01) in the NBW group. Lower child IQ was significantly associated with higher PPS scores only in the neurosensory impaired subgroup of ELBW children. CONCLUSIONS: Longer term follow-up will be necessary to examine the effects of the increased parent protection on the development of autonomy and interpersonal relationships as the children enter adolescence.     

Primary care services promoting optimal child development from birth to age 3 years: review of the literature.

OBJECTIVE: To examine the evidence base for primary health care services promoting the optimal development of typically developing children aged birth to 3 years. DATA SOURCES: Peer-reviewed publications addressing clinical evaluations of primary care services from the MEDLINE and PsychINFO databases. STUDY SELECTION: Criteria for selection were as follows: (1) publication between 1979 and 1999; (2) evaluation of efficacy or effectiveness of education, intervention, and care coordination services or validation of assessment approaches; (3) services applicable to an office practice setting; (4) target population including children aged birth to 3 years; and (5) publication in English. DATA EXTRACTION: A total of 312 publications were abstracted and reviewed by both of us; 47 were selected for inclusion. DATA SYNTHESIS: Assessments of parental concerns and psychosocial risk factors using validated approaches seem to be more accurate in identifying developmental problems than clinicians' appraisals. In general, study results support the efficacy of (1) primary care educational efforts toward promoting optimal parent-child interaction, parents' understanding of child temperament, book-sharing activities, and approaches to healthy sleep habits and (2) office interventions such as counseling for the management of excessive infant crying and sleep problems. CONCLUSIONS: The literature suggests that many primary care activities promoting the optimal development of children are efficacious. Evaluations of developmental assessment and services in primary care should be expanded in depth and breadth. The implications for clinical practice, training, and health care policy are discussed.     

0～7岁儿童生长曲线的制定及其应用

目的：制订一套0-7岁儿童的百分位生长曲线图供儿童保健及临床工作使用。方法：根据1995年第三次中国九城市城郊7岁以下儿童体格发育横断面调查所获得的数据，采用9个市城区0-7岁79154名健康男女儿童（其中0-3岁儿童53954名）的年龄别身高（3岁以下为身长）、年龄别头围的平均值、标准差以及年龄别体重和身高别体重的百分位数，先用多项式方程将他们修匀，然后修匀后的值计算各百分位并绘制曲线图。结果：为0-3岁男女儿童制定了各自的年龄别体重、年龄别身高和身高别体重的3、10、25、50、75、90及97百分位曲线图。结论：使用简便、直观的生长标准曲线图有利于个体儿童的生长监测，早期识别生长偏离的现象，为促进儿童生长和健康服务。     

Risk of injury to children less than 5 years of age in day care versus home care settings

Recent studies have suggested that day care may be a relatively unsafe environment. In this population-based study, the incidence of injuries in day care and home care were evaluated based on the number of hours children were exposed to each environment. In this population, 43.6% of children less than 5 years of age spent part of the year in day care. The rate of injuries in day care was 2.50 per 100,000 child-hours of exposure compared with a rate of 4.88 per 100,000 child-hours of exposure in the home environment. There were no differences in overall severity of injuries in the two groups. It was concluded that children are at no greater risk of injury in day-care settings than in the home environment.     

The effect of day care attendance on infant and toddler’s growth

Aim: We aimed to study the association between day care attendance and changes in the height, weight and weight/height ratio over a 6‐month period. Methods: Data were retrieved from three maternal and child health care centres. Parents were asked to fill a short questionnaire regarding the infant/toddler life style, the day care facilities and the family demographic information. Results: One hundred and seventy infants participated in the study. The research group consisted of 85 infants that had placed in day care centre prior to the age of 18 months. The control group consisted of 85 infants who had placed in day care at a later age. The research group had significantly shorter stature 3 months after day care enrolment (mean height percentiles of 56.9 versus 66.3, respectively, p = 0.024,). This trend was more pronounced after 6 months (mean height percentiles of 52.3 versus 63.7, p = 0.022). We could not, however, demonstrate a concomitant significant deceleration in weight or weight/height percentiles. Conclusions: The explanation for this rather dramatic finding remains speculative. Possible mechanisms are stress‐related growth hormone suppression. Our findings reinforce the importance of monitoring infant/toddler weight and height growth velocities, especially when he/she is introduced to day care.     

Influence of early feeding style on adiposity at 6 years of age

In a previous study we found that a vigorous infant feeding style measured in the laboratory at 2 and 4 weeks of age predicted the degree of adiposity at 1 and 2 years of age. A follow-up of this cohort of infants at 3 and 6 years of age is now reported. Factors predicting adiposity, measured by body mass index at 3 years of age, were pressure of suckling, with high-pressure sucking (denoting a vigorous feeding style) associated with greater adiposity, and time of introduction of solid food, with delayed introduction of solid food or breast-feeding longer than 5 months, or both, being associated with greater adiposity. Predictive factors at 6 years of age were adiposity at birth, with greater adiposity at birth predicting greater fatness at 6 years, parental education, with less education associated with fatness, and a prolonged period of breast-feeding with delayed introduction of solid food. These factors accounted for 40.4% of the variance in adiposity at 3 years of age and 31.2% at 6 years. The effects of social learning on body mass index, indicated by parental educational level, appear to strengthen over time, whereas the effects of the vigorous feeding style wane.     

Maturation of nerve conduction velocity from birth to 5 years of age

The Hoffmann monosynaptic reflex was recorded in the soleus muscle in 105 healthy children aged between 2 days and 5 years. From this the nerve conduction velocity in the proximal segment of the sciatic nerve was calculated. The tibial nerve conduction velocity (motor) was also measured in 59 of these children. The conduction velocity in the proximal and distal parts of the nerve develop in parallel and in an exponential manner but the conduction velocity in the reflex arc (afferent and efferent) is always faster than the motor conduction. Conduction time slightly but significantly decreases during the first year despite the increase in length of the nerve. Thereafter the conduction time slowly increases and by 5 years the values are similar to those in the neonatal period.