AN EPIDEMIOLOGICAL STUDY OF CHILD HEALTH AND NUTRITION IN A NORTHERN SWEDISH COUNTY

The health and nutritional status of 1 401 children aged 4, 8 and 13 years in one urban area and two rural areas of a northern Swedish county were studied. In none of the age groups was there any undernutrition. Anthropometrical measurements reflected the good nutritional status, with height and weight generally conforming to current values of a Swedish urban population. The girls had significantly thicker skinfolds than the boys. The children in the city of Umea had thicker skinfolds than the children in the mountain foreland and were also significantly taller. There was a rather high frequency of subclinical upper respiratory infections among the children, especially among the 4-year-olds.     

PAEDIATRIC SERVICES WITHIN THE PRIMARY HEALTH CARE SYSTEM IN SUBURBAN AREAS

Abstract. Höjer, B. and Olin, P. (Department of Paediatrics, Huddinge Hospital, Sachsska Children's Hospital and St. Goran's Children's Hospital, Stockholm, Sweden). Paediatric services within the primary health care system in suburban areas. Results from a few studies on community paediatrics in suburbs of Stockholm are presented. Pattern of diagnoses, utilization of care and social and psychological team work are discussed. Goals of the paediatric service in the primary care are set up and a distribution of duties between different professionals is suggested.     

HEALTH AND BEHAVIOUR IN FOUR-YEAR-OLD CHILDREN

ABSTRACT: Köhler, E.-M. and Köhler, L. (Department of Paediatrics, University Hospital, Lund, Sweden). Health and behaviour in four-year-old children. Acta Paediatr Scand, 64:225, 1975.–A health control of an unselected population of 2447 4-year-oId-children included a thorough somatic examination as well as an analysis of child upbringing practice and problems. The relation between the children's physical health, as defined by presence or absence or "functionally important health problems" and the children's behaviour, as reported by their mothers, was elucidated. On the whole, children with health problems were not perceived as more troublesome, although children with some special kinds of disturbances, e.g. neurological and dental, constituted problems in certain areas, e.g. toilet training and hyperactivity. The use of blame as a method of upbringing was very frequent and especially frequent in children with dental defects and visual disturbances. The perception of behaviour problems and the use of methods in upbringing were the same in children with newly detected health problems as in children with previously known health problems. The implications for the Child Health Service are to identify these risk-groups, to advice and support them in order to reduce parent-child conflicts.     

CHILD-ENVIRONMENT SUPERVISORS—A NEW STRATEGY FOR PREVENTION OF CHILDHOOD ACCIDENTS

Abstract. Gustafsson, L. H. et al. (Department of Paediatrics, University Hospital, Uppsala, Sweden). Child-environment supervisors—a new strategy for prevention of childhood accidents. This paper is a provisional report from an ongoing field experiment in Uppsala, Sweden, with the aim to reduce the number of serious childhood accidents. Groups of parents have been systematically trained to function as child-environment supervisors. The experiences have been very positive so far. The child-environment supervisors have proved to possess good knowledge about how to prevent accidents. A large number of hazards have been detected and successfully eliminated. The groups are now taking an active part in the planning of new housing estates. The findings also indicate that the Child Health Organization should be able to play a more active role in the work of environmental improvement for the safety of children. A suggestion for a collective strategy for such activity has been worked out.     

SCREENING FOR BEHAVIOUR PROBLEMS IN NURSERIES: THE RELIABILITY AND VALIDITY OF THE PRESCHOOL BEHAVIOUR CHECKLIST

The development of the Preschool Behaviour Checklist, for screening emotional and behavioural problems in preschool children in group settings, is described. Inter-rater reliability and internal consistency was established, and its validity was shown using a variety of methods. These include observations of the children, interviews with staff, comparison between clinic and nonclinic populations, factor and cluster analysis and comparison with another screening questionnaire. Uses of the PBCL for training and inservice work are outlined. The limitations of screening as a method of identifying children with behaviour problems are discussed.     

Shy Girls and Boys: A New Look

A new took at shyness in young children involves selecting for shyness, using criteria involving both natural and laboratory contexts, categorizing children (including a group between the two extremes), and including the sex of the child in analyses. Children of both sexes differed significantly across low, medium, and high shy groups, with negative mood, worries and fears, and problem behaviour in preschool being associated with high shyness. Although boys in general and high shy boys in particular had the highest problem behaviour scores in preschool (including acting out behaviour), maternal interactions with high shy boys were positive: significantly more positive than with boys who were high shy in natural settings but low shy in the laboratory, or with high shy girls. Of the girls, maternal style was most positive for the medium shy girls , who also received the highest relative frequency of positive maternal actions during a brief task–significantly higher than medium shy boys, as well as high shy girls.     

THE VOLUME OF TRAPPED GAS: A NEW AND SENSITIVE TEST FOR THE DETECTION OF EXERCISE-INDUCED BRONCHOSPASM IN CHILDREN

ABSTRACT. The volume of trapped gas (VTG) was measured at the end of a nitrogen multiple breath wash out procedure in 16 asthmatic and 10 healthy children before and after exercise. When compared to conventional spirometric variables VTG was the most sensitive test for detection of exercise-induced asthma (EIA). The VTG was significantly higher before exercise in the asthmatic children and increased significantly after exercise, while it did not change in the healthy controls. The significance of changes caused by EIA increased if VTG/TLC% or VTG/VC% were used. Salbutamol inhalation normalized the VTG in all the asthmatic children.     

Can severe language disability be identified in three‐year‐olds? Evaluation of a routine screening procedure

This study evaluates the predictability of a new language screening procedure in 3-y-olds. It is used in several Child Health Centres (CHC) in Sweden and has the character of a field study involving more than 60 CHC nurses. The main questions concern the (i) development in 3-y-olds assessed as severely language delayed and (ii) whether there are any earlier unknown severely disabled children identified at 4 y of age. Ninety-six percent of the original study population participated in the follow-up. The calculations are based on results from 2237 children. A well-established screening routine, which has been shown capable of predicting the risk of not being able to follow expected schooling, and case records were used as an acceptable proxy outcome measure, pending a better gold standard. In the group of severely disabled 3-y-olds, sensitivity, specificity and positive predictive values were 86, 99 and 43%, respectively. Finally, three false-negatives were identified. In light of the present results, continued application of the 3-y screening is discussed.     

Early childhood aetiology of mental health problems: a longitudinal population-based study

Background: Mental health problems comprise an international public health issue affecting up to 20% of children and show considerable stability. We aimed to identify child, parenting, and family predictors from infancy in the development of externalising and internalising behaviour problems by age 3 years. Methods: Design Longitudinal, population‐based survey completed by primary caregivers when children were 7, 12, 18, 24 and 36 months old. Participants 733 children sequentially recruited at 6–7 months from routine well‐child appointments (August–September 2004) across six socio‐economically and culturally diverse government areas in Victoria, Australia; 589 (80%) retained at 3 years. Measures 7 months: sociodemographic characteristics, maternal mental health (Depression Anxiety Stress Scale (DASS)), substance misuse, home violence, social isolation, infant temperament; 12 months: partner relationship, parenting (Parent Behavior Checklist (PBC)); 18, 24 and 36 months: child behaviour (Child Behavior Checklist 1½–5 (CBCL)), PBC, DASS. Results: Sixty‐nine percent of all families attending well‐child clinics took part. The consistent and cumulative predictors of externalising behaviours were parent stress and harsh discipline. Predictors of internalising behaviours included small family size, parent distress, and parenting. Twenty‐five percent of variation in early externalising behaviour and 17% of variation in early internalising behaviour was explained. Conclusions: Effective and cost‐efficient population approaches to preventing mental health problems early in childhood are urgently needed. Programmes must support parents in reducing personal stress as well as negative parenting practices.     

CHILD HEALTH IN EUROPE: A Review of WHO Activities

Abstract. Petersson, P. O. and Ichimura, K. (Administration, University Hospital, Uppsala, Sweden). Child health in Europe—A review of WHO activities. Review of the activities in maternal and child health arranged in recent years by the European Office of the World Health Organization.     

Extremely low birthweight infants at 3 years: A developmental profile

This study documents the neurodevelopmental outcome at 3 years of 52 of 55 extremely low birthweight (ELBW) survivors (survival rate 49%) born in a tertiary maternity centre from July 1985 through December 1988, and examines more closely the developmental profile of the neurologically normal survivors. At 3 years, 6 (12%) children had severe neurodevelopmental impairment (severe cerebral palsy, blindness, deafness or a General Quotient (GQ)<70 on the Griffiths Scales), 11 (21 %) had mild to moderate impairment and 35 (67%) had no neurosensory impairment and normal development (GQ≥ 85). Significant risk factors for severe impairment were stage 3 or 4 retinopathy of prematurity (odds ratio [OR] 21.5), treatment with postnatal steroids (OR 21), grade III or IV intraventricular haemorrhage (OR 11) and supplemental oxygen at 'term'(OR 6.4). The developmental profile of the 35 neurologically normal children revealed a significant weakness in eye and hand coordination skills and a relative strength in hearing and speech skills. Early recognition of this developmental profile may allow implementation of more appropriate preschool programmes for ELBW children.     

Parental assessment of developmental delay in children: some limitations and hazards

According to a study published in the present issue of Acta Paediatrica, mothers' reports of developmental delays in children of preschool age were associated with socio-economic factors.

Conclusion: For the present, developmental screening procedures using parental assessments cannot be considered evidence based. National health service systems ensuring preventive health care for all children, regardless of socio-economic background, will form a more solid basis for early detection and treatment.