养育环境与儿童早期发展的相关性

目的探讨儿童养育环境的影响因素及其与儿童早期发展的相关性。方法采用分层整群随机抽样方法,于2017年在上海16个区抽取187所幼儿园共22 509名新入园儿童,对其家长进行问卷调查。采用育儿环境指数(ICCE)评估儿童家庭养育环境,采用人类早期能力指数了解儿童早期发展情况。根据ICCE分数在人群中的分布将被调查儿童分为4组,家庭养育环境最差组(≤10分)、中下组(11分)、中上组(12分)、最好组(13分)。分别使用线性回归模型和Logistic回归模型分析影响养育环境的相关因素以及养育环境对儿童早期发展的影响。结果共22 067名儿童完成本次调查, 年龄(44±7)月龄, 男11 425名(51.8%),女10 642名(48.2%)。多元线性回归分析结果显示,女孩、母亲教育程度高、家庭年收入高、独生子女、父母非离异及早期母乳喂养经历是新入园学龄前儿童家庭养育环境的保护因素[β=0.064、0.238、0.119、0.096、0.113、0.032,95%可信区间(CI): 0.020～0.108、0.175～0.302、0.058～0.180、0.046～0.146、-0.012～...     

儿童个性特征与其父母养育方式的相关性

目的：探讨儿童个性与父母养育方式的相关性。方法：抽取某中学一年级283名学生，采用父母养育方式评价量表和艾森克个性问卷（儿童版）对其中279名有效问卷进行独立样本t检验、Pearson相关分析。结果：儿童人格中精神病倾向与父母亲的惩罚、严厉、过分干涉、拒绝、否认及父亲过度保护呈显著正相关，与情感温暖因子呈负相关。内、外向与父母亲情感温暖、偏爱被试呈显著正相关。神经质与父母亲的惩罚、严厉、过分干涉及母亲偏爱被试呈显著正相关，与情感温暖呈显著负相关。掩饰度与父母亲情感温暖呈显著正相关，与惩罚、严厉、拒绝及母亲的过度干涉呈显著负相关。结论：父母的养育方式与儿童的个性密切相关，提示父母的养育方式对其子女人格形成有重要影响。     

生理成熟度与儿童早期发育

儿童早期发育备受儿科研究者和广大家长的关注。儿童早期发育是一个生命现象,从生物进化史的角度来看,儿童早期发育的本质依然是获得生存适应能力（生物一生命生存和社会一文化生存）和潜能的最佳表达。从这个基点出发,我们有必要在科学方法学和学科分类学的领域里进行讨论。     

家庭养育环境对发育性语言障碍儿童语言发育和社会情绪的影响

目的探讨家庭养育环境对发育性语言障碍(DLD)儿童语言发育和社会情绪的影响。方法采用1~3岁儿童家庭养育环境量表、Gesell发育诊断量表和1~3岁幼儿情绪及社会性发展量表对125例DLD儿童进行测评。130例年龄、性别匹配的语言发育正常的儿童作为对照组。结果 DLD组儿童的家庭养育环境中不良环境所占比例显著高于对照组,家庭养育环境中的各领域得分均显著低于对照组(P0.05)。DLD儿童的家庭养育环境得分与儿童的语言发育水平(r=0.536,P0.01)、社会情绪中的能力域得分(r=0.397,P0.01)呈正相关,与社会情绪中的外显行为域、内隐行为域、失调域得分呈负相关(r分别为-0.455、-0.438、-0.390,P0.01)。DLD儿童的家庭养育环境对儿童的语言发育水平有直接的影响,也通过社会情绪的中介效应影响儿童的语言发育水平。结论家庭养育环境影响DLD儿童的语言发育和社会情绪;社会情绪在儿童家庭养育环境和语言发育中起部分中介效用。     

高血压儿童腰围发育曲线及其与高血压相关性的研究

目的 了解高血压儿童腰围发育曲线特点,探讨与儿童高血压相关的腰围正常值合理切点.方法 研究对象为安徽省北、中、南3个地市的8194名7～17岁汉族城乡中小学生,测量腰围与血压.以LMS( lambda-mu-sigma)法拟合腰围随年龄变化的百分位数曲线.建立Logistic回归模型,计算不同百分位数腰围学生发生高血压的OR值.结果 高血压男生的腰围发育曲线明显向上平行偏离总体男生标准曲线,而高血压女生腰围发育曲线在12岁前向上逐渐偏离总体女生标准曲线,之后逐渐回归.男生腰围上升至同年龄别第60百分位数、女生腰围上升至同年龄别第70百分位数时,高血压发生风险即开始显著增加,男生腰围p60～组、P70～组、P80～组和P90～组的OR值从1.88(95％CI:1.18 ～2.99)逐渐上升至4.87(95％CI:3.31 ～7.16),女生腰围P70～组、P80～组和P90～组的OR值从1.71 (95％CI:1.07～2.73)逐渐上升至3.32(95％ CI:2.16～5.09).结论 高血压男生和女生的腰围发育曲线轨迹明显不同.从第85百分位数向下适当降低儿童腰围正常值切点有利于儿童心血管疾病风险的预防.     

Williams综合征儿童早期运动发育特征

目的 分析Williams综合征(Williams syndrome,WS)儿童的早期运动发育情况,为临床早期干预提供依据。方法 对2018年9月至2021年8月间59例0～24月龄的WS儿童的临床资料进行回顾性分析,其中男40例,女19例。根据Peabody运动发育量表(Peabody Developmental Motor Scale Ⅱ)测试结果,分析不同年龄患儿的运动发育情况。结果 男女儿童月龄和运动商的比较差异均无统计学意义(P>0.05)。<6月龄组、6～<12月龄组、12～<18月龄组和18～24月龄组的粗大运动商分别为94±5、78±11、71±8、63±8,精细运动商分别为94±5、80±10、74±9、65±9,粗大运动商和精细运动商随着月龄增长逐渐下降(P<0.05)。<6月龄组、6～<12月龄组、12～<18月龄组和18～24月龄组的粗大运动发育异常率分别为0%、53%、87%、93%,精细运动发育异常率分别为0%、47%、67%、93%,粗大运动和精细运动发育异常率均随月龄增长而上升(P<0.05)。结论 ...     

家庭环境与学龄前儿童发育性协调障碍的相关性

目的探讨家庭环境对学龄前儿童发育性协调障碍(DCD)的影响。方法按分层随机整群方法抽取4~6岁儿童1 727例,应用"儿童运动协调能力成套评估工具"对其进行DCD筛查;采用"城市学龄前儿童运动发育家庭环境量表"及自行设计的问卷评估儿童家庭环境状况。结果 117例儿童确诊为DCD。DCD组和正常对照组儿童在母亲文化程度、家庭结构的比较中差异有统计学意义。家庭环境因素中"让孩子管理自己的日常物品"和"包办孩子一切事务"两项得分在DCD组和正常对照组儿童之间差异有统计学意义。在控制儿童性别、年龄情况下,多因素logistic回归分析显示,"母亲文化程度""家庭结构""让孩子管理自己的日常物品"及"包办孩子一切事物"是影响儿童DCD发生的主要因素(均P0.05)。结论家庭环境对学龄前儿童DCD的发生存在影响,家长在养育孩子的过程中,不要包办孩子一切事务,应为儿童提供更多的管理自己日常生活的机会,以促进其早期运动协调能力的发展,预防DCD的发生。     

早期潜能开发促进正常儿童智能发育的研究

目的研究早期潜能开发促进正常儿童智能的发育的综合方法，建立一套完整的资料。方法将我市出生的新生儿随机分为潜能开发组和对照组。潜能开发组由儿保医师对其家长进行潜能开发及疾病预防措施指导，由家长对孩子实施一些措施；对照组婴幼儿进行常规保健指导。两组婴幼儿定期进行体格发育、营养状况及精神发育评估，并于出生后1．5岁、2岁用中国儿童发展中心婴幼儿智力量表（CDCC）进行智力测试。结果潜能开发组1．5岁、2岁时智力发育指数（MDl）及心理运动发育指数（PDI）明显高于对照组（P〈0．01）；体格发育主要指标（身高、体重）差异无显著性。结论早期潜能开发能促进正常儿童的智能发育。     

2007年国际环境与儿童健康研讨会征文通知

会议主题：环境污染对胎儿及儿童发育的影响：全球所面临的问题；主办单位：全球儿科研究规划组织（PGPR）、中华医学会儿科分会；承办单位：上海交通大学医学院附属新华医院、浙江大学医学院附属儿童医院；会议地点：中国杭州黄龙饭店；会议时间：2007年10月26～27日。     

2000～2005年秦淮区儿童健康发展状况

目的为了系统全面地了解2000～2005年南京市秦淮区儿童健康状况及动态变化，为上级卫生行政部门提供政策依据，以便更好地为辖区内儿童提供保健服务。方法对2000～2005年全区《江苏省儿童保健手册》、《南京市3岁以下儿童系统管理手册》、《江苏省7岁以下儿童保健工作调查表》以及南京市集体儿童和散居儿童保健工作台账等资料进行整理分析。结果6年中秦淮区儿童系统管理率呈上升趋势，而死亡率和发病率明显下降；儿童营养状况明显改善，营养不良、缺铁性贫血明显下降，而肥胖的发生率则逐年上升。结论只有提高儿童保健系统管理率和儿童保健质量，普及科学育儿知识和推广儿童保健适宜技术，才能更好地为儿童服务，保障儿童身心健康，从而降低儿童死亡率和发病率。     

Social paediatrics and early child development: Part 1

Diseases of modernism, rather than infectious diseases and chronic medical conditions, increasingly cause childhood morbidity and mortality. Thus, the goal of enhancing life outcomes for all children has become imperative. Paediatricans may begin with a renewed interest in social paediatrics – the care of the disadvantaged child in Canada, requiring a focus on all the complex factors that impact families and the community. New paediatricians need the tools to impact both social determinants of health and political policies to support health for all. Such interest is as old as the field of paediatrics (social medicine began with the great pathologist, Virchow, in the 1800s). The new neuroscience of experience-based brain and biological development has caught up with the social epidemiology literature. It is now known from both domains that a child’s poor developmental and health outcomes are a product of early and ongoing socioeconomic and psychological experiences. In the era of epigenetics, it is now understood that both nature and nurture control the genome. Future paediatricians need to understand the science of experience-based brain development, and the interventions demonstrated to improve life trajectories. A challenge is to connect the traditional population health approach with traditional primary care responsibilities. New and enhanced collaborative interdisciplinary networks with, for example, public health, primary care, community resources, education and justice systems are required.     

Influences of early child nutritional status and home learning environment on child development in Vietnam

Early childhood development plays a key role in a child's future health, educational success, and economic status. However, suboptimal early development remains a global challenge. This study examines the influences of quality of the home learning environment (HOME) and child stunting in the first year of life on child development. We used data collected from a randomized controlled trial of preconceptional micronutrient supplementation in Vietnam (n = 1,458). The Bayley Scales of Infant Development‐III were used to assess cognition, language, and motor development domains at 2 years. At 1 year, 14% of children were stunted, and 15%, 58%, and 28% of children lived in poor, medium, and high HOME environments, respectively. In multivariate generalized linear regression models, living in a high HOME environment was significantly associated with higher scores (0.10 to 0.13 SD) in each of the developmental domains. Stunted children scored significantly lower for cognitive, language, and motor development (?0.11 to ?0.18), compared to nonstunted children. The negative associations between stunting on development were modified by HOME; the associations were strong among children living in homes with a poor learning environment whereas they were nonsignificant for those living in high‐quality learning environments. In conclusion, child stunting the first year of life was negatively associated with child development at 2 years among children in Vietnam, but a high‐quality HOME appeared to attenuate these associations. Early interventions aimed at improving early child growth as well as providing a stimulating home environment are critical to ensure optimal child development.     

Patterns of reporting by health care and nonhealth care professionals to child protection services in Canada

BACKGROUND:

All Canadian jurisdictions require certain professionals to report suspected or observed child maltreatment. The present study examined the types of maltreatment, level of harm and child functioning issues (controlling for family socioeconomic status, age and sex of the child) reported by health care and nonhealth care professionals.

METHODS:

χ² analyses and logistic regression were conducted on a national child welfare sample from the 2003 Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003), and the differences in professional reporting were compared with its previous cycle (CIS-1998) using Bonferroni-corrected CIs.

RESULTS:

Analysis of the CIS-2003 data revealed that the majority of substantiated child maltreatment was reported to service agencies by nonhealth care professionals (57%), followed by other informants (33%) and health care professionals (10%). The number of professional reports increased 2.5 times between CIS-1998 and CIS-2003, while nonprofessional reports increased 1.7 times. Of the total investigations, professional reports represented 59% in CIS-1998 and 67% in CIS-2003 (P<0.001). Compared with nonhealth care professionals, health care professionals more often reported younger children, children who experienced neglect and emotional maltreatment, and those assessed as suffering harm and child functioning issues, but less often reported exposure to domestic violence.

CONCLUSION:

The results indicate that health care professionals play an important role in identifying children in need of protection, considering harm and other child functioning issues. The authors discuss the reasons why under-reporting is likely to remain an issue.     

Parental alcoholism and early child development

In a cohort of 532 pregnant women from the general population, it was found by compilation of the results from interviews, police records, hospital records and social welfare records that 23 mothers and 51 fathers in 64 families (12%) were suffering from alcoholism/heavy drinking. In these 64 families, the mother was an addict in only 13 families, both parents were addicts in 10 families, and in the remaining 41 families only the father was an addict. Pregnancy, delivery, the newborn child and the child's development until their fourth year of life have been described using a multidisciplinary approach and a longitudinal prospective design. An hypothesis on mental and physical development, and the occurrence of psychopathological symptoms in the children was tested. None of the children of the 13 alcoholic mothers was born with foetal alcohol syndrome, but foetal hazard was indicated by lower birth weight and a higher rate of perinatal deaths. Children of alcoholic parents had retarded mental development and showed more behavioural problems until 4 years of age than controls, but the differences related to physical development during the first year of life had then disappeared. Boys were found to be more vulnerable than girls. The consequences of behaviour seemed to be more pronounced when both parents were alcoholics. No obvious deviation was found when only the father was addicted. Regarding mental development, it appears that factors related to parental alcoholism, including genetic and social factors, and the sex of the child, are of greater importance than the neonatal score on reduced optimality.     

Health care professionals' grief after the death of a child

OBJECTIVES:

To evaluate the intensity of grief experienced by health care professionals (HPs) after the death of a child, to explore factors associated with a memorable death (defined as an unforgettable child’s death that has touched them in their career) and to identify the needs of HPs.

METHODS:

A cross-sectional study was performed to assess emotional reactions, coping strategies and perceived needs of paediatric HPs in a general hospital.

RESULTS:

One hundred one HPs (46 nurses, 22 paediatric physicians, 11 paediatric residents, 13 respiratory therapists and nine ‘others’) completed the questionnaire. The level of grief experienced by HPs after a memorable death was intense. Respiratory therapists showed the highest mean (± SD) intensity of grief after a memorable death versus other HPs, as measured by the Texas Revised Inventory of Grief (TRIG) (29±15 versus 16±14; P=0.002). Younger HPs (20 to 25 years of age) reported higher early grief intensity than older ones (older than 50 years of age) (22±16 versus 10±8; P=0.01). There was no significant association between the TRIG score and an HP being a parent, having received palliative care training or the length of his/her relationship with the child and family. Seventy per cent of HPs spoke with their colleagues after the death of a child and 48% with family and friends. Many participants (37%) believed that this social support helped them the most.

CONCLUSION:

Grief after a child’s death is intense for HPs. This emotional intensity and difference between professions raises issues about the emotional support received following the death of a patient.     

A perfect 10: Why Sweden comes out on top in early child development programming

Sweden ranked first in the United Nations Children's Fund 2008 league table of early childhood education and care. In a book published 74 years previously, Crisis in the Population Question, Alva and Gunnar Myrdal outlined many of the features that were later assessed by the United Nations Children's Fund. Three aspects may have affected the implementation of Myrdal's ideas. First, the Social Democratic Party has been in power for 85% of the time since 1932. They often had to form coalitions with other parties that supported a nonpartisan stance. Second, according to evidence from the World Values Survey, Swedes are more individualistic than people in any of the other 64 societies included in that study. The State is expected to create social conditions on equal terms for individuals to realize their own goals. Finally, schools and other social services are managed by 290 semi-independent municipalities. Thus, reforms can be tested in a few municipalities before others follow suit.     

Moderate alcohol consumption during pregnancy and child development

On the basis of prospectively collected data from 7,525 pregnancies it was examined whether moderate but daily alcohol consumption during pregnancy has consequences for child development during the first 3 years. The women were taken into the study during the first trimester of pregnancy and were seen every 4 weeks. Some 4.7% (353) of the total stated that they drank moderate quantities of alcohol every day; 275 of the 353 pregnant women stopped drinking during the first trimester of pregnancy or for a time, but 78 did not change their drinking habits in general. About 75% of the children were followed up to their 3rd birthday with examinations at birth, 6 weeks, and 9, 18 and 36 months. It was found that in growth and psychomotor development the exposed children did not differ from the the control group. The number of minor and major congenital anomalies was not increased.In general, moderate alcohol consumption during pregnancy does not seem to have any markedly adverse influence on the later development of children. However, an upper limit for apparently safe alcohol consumption cannot be given.Dedicated to Prof. Dr. H.-R. Wiedemann on the occasion of his 65 th birthday     

An integrated scientific framework for child survival and early childhood development

Building a strong foundation for healthy development in the early years of life is a prerequisite for individual well-being, economic productivity, and harmonious societies around the world. Growing scientific evidence also demonstrates that social and physical environments that threaten human development (because of scarcity, stress, or instability) can lead to short-term physiologic and psychological adjustments that are necessary for immediate survival and adaptation, but which may come at a significant cost to long-term outcomes in learning, behavior, health, and longevity. Generally speaking, ministries of health prioritize child survival and physical well-being, ministries of education focus on schooling, ministries of finance promote economic development, and ministries of welfare address breakdowns across multiple domains of function. Advances in the biological and social sciences offer a unifying framework for generating significant societal benefits by catalyzing greater synergy across these policy sectors. This synergy could inform more effective and efficient investments both to increase the survival of children born under adverse circumstances and to improve life outcomes for those who live beyond the early childhood period yet face high risks for diminished life prospects.     

IL1R1基因多态性与儿童哮喘的相关性

目的 探讨我国中部地区儿童IL1R1 基因的两个SNP 位点(rs1558641 和rs949963)的多态性与哮喘易感性的相关性。方法 采用病例-对照的研究方法,选取来自于我国中部地区的208 例哮喘患儿(哮喘组)和223 例同时期体检正常的儿童(健康对照组)作为研究对象。利用限制性片段长度多态性分析(PCRRFLP)的方法检测IL1R1 基因两个SNP 位点(rs1558641 和rs949963)的多态性分布;酶联免疫吸附试验(ELISA)测定血清中IL1R1 的水平。结果 哮喘组患儿SNP 位点(rs1558641)的基因型及等位基因频率与健康对照组相比差异无统计学意义。而哮喘组患儿SNP 位点(rs949963)GG 基因型的比例显著高于健康对照组(P=0.031),且两组等位基因频率差异也有统计学意义(P=0.018)。哮喘组血清IL1R1 的水平明显高于健康对照组(P=0.011),且SNP 位点(rs949963)GG 基因型的患儿血清IL1R1 水平高于其他基因型(AA+AG)的患儿(P=0.028)。结论 IL1R1 基因SNP 位点(rs949963)的多态性与我国中部地区儿童哮喘的易感性相关,且该位点的多态性可能影响患儿血清中IL1R1 的表达水平。