Effect of psychosocial stimulation on mental development of severely malnourished children: an interim report

The effect of adding psychosocial stimulation to the treatment of severely malnourished children was studied. The study period covered children from the time they left the hospital to 24 months later. The children's developmental levels (DQs) were compared with those of two other groups who were in the hospital--an adequately nourished group with diseases other than malnutrition, and a severely malnourished group who received standard hospital care only. The children receiving intervention had structured play sessions in the hospital and were visited weekly for 2 years after returning home. During the visits paraprofessionals showed mothers how to continue structured play with their children. The malnourished children who did not receive intervention showed a marked deficit in developmental level compared with that of control children throughout the study. The control children showed a decline in developmental level with age, which is characteristic of disadvantaged children. The children receiving intervention showed marked improvements and by 24 months were ahead of the children who did not receive intervention in every subscale and were head of the adequately nourished children in two subscales. Both groups of malnourished children remained behind the control children in nutritional status and locomotor development.     

Impact of delayed development in premature infants on mother-infant interaction: a prospective investigation

We examined events that precede a diagnosis of developmental delay by comparing 16 very low birth weight premature infants whose condition was diagnosed as developmental delay at 18 months corrected age with 16 matched developmentally normal infants. All infants were observed with their mothers during maternal visits to the nursery and during home visits 1, 3, 6, and 9 months after discharge. The mothers' reactions to their infants were rated at these times. All the children were followed up at a neonatal clinic, and detailed clinic records were used to document the time when a physician first suspected a delay and when this delay was first mentioned to the mother. The results indicate that parents had usually been told of their child's handicap by the time the child was 6 to 9 months old; yet mothers of the delayed children changed the interaction with their children as early as 1 month after discharge from hospital. These mothers initially touched, smiled at, and talked to their developmentally delayed infants significantly more often, but by 9 months they did so much less often than mothers of nondelayed children. The degree of change in mothers' behavior was related to their psychosocial background, with better-adjusted mothers showing the most change. We conclude that mothers' statements about their infants are usually valid and that physicians may share their potential concerns about infants more freely.     

Effects of maternal depression on cognitive development of children over the first 7 years of life

The effects of postnatal depression on cognitive test scores at 20 months and 4; 8 years of age as well as the timing (onset in the early postnatal period versus later), severity, number of episodes, duration of longest phase, recency, and chronicity of material depression on children's cognitive scores at 6; 3 years was investigated. In South Bavaria, Germany, 1,329 mothers of singletons were screened when the children were 6; 3 years of age for the presence of depressive symptoms since the birth of their infant. A standard interview (SADS-L) was used to ascertain DSM-IV diagnosis and details of depressive episodes. Ninety-two mothers were diagnosed as having suffered DSM-IV defined depression (7%). Seven hundred and twenty-one mothers had no depressive episodes or symptoms from their children's birth until 6; 3 years and were used as control group. The children had been assessed with the Griffiths Scales of Babies' Abilities (20 months), the Columbia Mental Maturity Scales (CMM) at 4; 8 years, and the Kaufman Assessment Battery for Children (K-ABC) at 6; 3 years. No significant main effects of severity, timing of onset, duration, or chronicity of depression of the child's cognitive development were found. Significant interactions of gender with chronicity of maternal depression (i.e. early-onset major and repeated episodes) were detected. Low SES boys or boys born at neonatal risk of mothers with chronic depression had lower Achievement Scores in the K-ABC at 6; 3 years than children of mothers with less severe depression or controls. It is concluded that maternal depression per se has negligible effects on children's cognitive development. Long-term effects may be found when maternal depression is chronic, the child is a boy and neonatal risk-born, or the family suffers other social risks.     

A study of feeding patterns in young infants

With the aim of studying the feeding patterns in infants under 6 months of age, 451 mothers attending the children's clinic in two university hospitals in the north of Tehran were interviewed. All babies had been born in hospital and > 98 per cent had been breastfed during the first few hours of birth. The rate of full breastfeeding at 6 months of age, with no introduction of the bottle, was 83 per cent; approximately 6.5 per cent of infants were fed on breast and bottle concomitantly, and in about 10.5 per cent breastfeeding had been discontinued before 6 months and the babies were fed on bottle only. About 60 per cent of mothers who stopped breastfeeding, did so during the first postnatal month and another 20 per cent during the 2nd and 3rd month after the babies' birth. The mother's age, education or parity, did not affect the rate of breastfeeding. Low birthweight, especially birthweight less than 2 kg, was a risk factor for early termination of breastfeeding. Caesarean delivery and hospitalization of the infant during the neonatal period was also associated with a higher rate of bottlefeeding compared with newborns who had been delivered normally, discharged early, and nursed at home. Although breastfeeding rates are high, the finding that the majority of mothers who give up breastfeeding do so in the early weeks, calls for better support to all mothers by committed health personnel during the period when breastfeeding is being established, and for extra assistance to women whose infants are hospitalized or have a low birthweight.     

Somatic growth and developmental functioning in children receiving prolonged home total parenteral nutrition

Growth and psychomotor development in nine infants receiving prolonged home total parenteral nutrition (TPN) were studied longitudinally from infancy to 3 years of age. Although these children had received TPN for, on average, 79% of their lives, normalization of somatic growth occurred by 2 years of age in all of them. Three children maintained average or above average levels of developmental performance over the 3-year study period. Another four children had initially delayed development but average or above average developmental scores by 18 months. In two children the rate of development gradually slowed without obvious cause, so that by 3 years they functioned in the below average to mildly retarded range.     

The effect of early stimulation on maternal depression: a cluster randomised controlled trial.

AIM: To determine the effect of early childhood stimulation with undernourished children and their mothers on maternal depression. METHODS: Mothers of 139 undernourished children (weight for age < or =-1.5 z-scores) aged 9-30 months were recruited from 18 government health centres in the parishes of Kingston, St Andrew, and St Catherine, Jamaica. They received weekly home visits by community health aides for one year. Mothers were shown play activities to do with their child using home made materials, and parenting issues were discussed. Frequency of maternal depressive symptoms was assessed by questionnaire. Child development was also measured. RESULTS: Mothers in the intervention group reported a significant reduction in the frequency of depressive symptoms (b = -0.98; 95% CI -1.53 to -0.41). The change was equivalent to 0.43 SD. The number of home visits achieved ranged from 5 to 48. Mothers receiving > or =40 visits and mothers receiving 25-39 visits benefited significantly from the intervention (b = -1.84, 95% CI -2.97 to -0.72, and b = -1.06, 95% CI -2.02 to -0.11, respectively) while mothers receiving <25 visits did not benefit. At follow up, maternal depression was significantly negatively correlated with children's developmental quotient for boys only. CONCLUSIONS: A home visiting intervention with mothers of undernourished children, with a primary aim of improving child development, had significant benefits for maternal depression. Higher levels of maternal depression were associated with poorer developmental levels for boys only.     

Evidence for horizontal and not vertical transmission of human herpesvirus 8 in children born to human immunodeficiency virus-infected mothers.

A survey of antibody responses to human herpesvirus 8 (HHV-8) was undertaken to examine the mode of transmission of this virus to children born to mothers with HIV. Methods. Serum samples from a cohort of 92 mother-infant pairs and a cross-sectional cohort of 100 children (median age, 4 years) were tested. In the cohort of mother-infant pairs, 14 infants were HIV-infected, 72 were not and the HIV status was unknown for 6. In the cohort of children 70 were HIV-infected and 30 were vertically exposed but uninfected. Serologic responses to two HHV-8 antigens, latency-associated nuclear antigen and the structural antigen encoded by open reading frame 65 were detected by immunofluorescent antibody test and enzyme-linked immunoassay. Results were confirmed by Western blot. Results. All HHV-8-seropositive mothers were African (17 of 92, 18.5%). Six of their infants were HHV-8-seronegative and 11 had at least 1 HHV-8-seropositive sample. One of the 11 infants tested only at birth had a lower antibody titer than the mother; the remaining 10 infants had decreasing titers up to 7 months of age and 6 became seronegative. No infants born to HHV-8-seronegative mothers had antibodies to the virus. The seroprevalence to HHV-8 was 6% in the cohort of children. All had African mothers and their median age was greater than that of the cohort (8.4 vs. 4.0 years). Five were coinfected with HIV. Conclusions. HHV-8 was not vertically transmitted by any of the HIV-coinfected mothers. Acquisition of antibody to HHV-8 occurred in older children, implying a horizontal route of transmission.     

The effect of a child's disability on mother's mental health

The prevalence of maternal depression was investigated in the mothers of 96 children: 30 premature infants at risk for the development of cerebral palsy; 35 premature infants considered not to be at risk for the development of cerebral palsy; and 31 healthy fullterm infants. There were equally high levels of depression in all three groups of mothers, regardless of birth status, prediction of disability, or presence of actual disability, throughout the first year of the children's lives. Depressed mothers were, however, found to have significantly more psychosocial stress. An early physiotherapy intervention had no effect on the prevalence of depression in mothers whose children were at risk for the development of cerebral palsy.     

Maternal withdrawal from handicapped toddlers

Videotaped observations of the free-play interaction of mothers and (a) 12 physically handicapped, (b) 14 premature and (c) nine healthy 2-year-olds were evaluated. Mothers of handicapped toddlers were significantly more likely to ignore their children at 24 months than were mothers in other groups. Further, although children's Bayley scores had not differed when seen previously at 1 year, children of mothers who ignored at 2 years had lower concurrent 2-year IQ scores and experienced an average 30-point drop between the two evaluations. These results support clinical reports of maternal withdrawal from handicapped young children and suggest that the mother-child dyad in such cases may be at continuing risk throughout the early years.     

Mothers' perceptions of problems of feeding and crying behaviors. A prospective study

During early infancy, problems of crying, colic, spitting, and feeding difficulties often provoke anxiety and lack of self-confidence in parents. We studied prospectively what proportion of mothers felt that their infants had problems of this type and determined risk factors for perceived problems identified in the early postnatal period. The mothers of 189 breast-fed and 184 formula-fed infants completed questionnaires post partum and responded to a follow-up interview at four months. Thirty-five percent of mothers in each group reported that their infants had moderate or severe problems of feeding or crying behavior. Risk factors for perceived problems were identified using stepwise logistic regression analyses. Inquiry about, and early attention to, risk factors may alleviate the parents' concerns and possibly affect the development of these problems.     

Knowledge of physician prescriptions and adherence to treatment among children with cystic fibrosis and their mothers.

This investigation examined factors related to adherence to treatment regimens for children with cystic fibrosis (CF) and their mothers. Subjects were 45 children with CF who ranged in age from 6 to 10 years and their mothers. Findings revealed that children's and parents' reports of level of adherence were related to their knowledge of the specific details associated with medically prescribed treatments. In this sample, 12% to 32% of mothers did not have an accurate understanding of physician recommendations for their children's treatments. When controlling for individual differences in the prescribed treatment regimens, parents' and children's knowledge of what had been prescribed accounted for a significant portion of the variance in the children's reported treatment-related behaviors. Results are discussed in terms of implications for future intervention research aimed at enhancing adherence to treatment as well as for future directions for clinical efforts in this area.     

Relating intimate partner violence to heath-care utilisation and injuries among Pacific children in Auckland: The Pacific Islands Families Study

Aim:   Despite well-known emotional and behavioural sequela, few studies investigate health-care utilisation and injury impacts of children exposed to intimate partner violence (IPV). This study examines the association between mothers' IPV experience and general practitioner (GP) and hospital presentations by their children within the first 6 years of life.
Methods:   In 2000, a cohort of Pacific infants born in Auckland was established. At 6 weeks, 2 years and 6 years post-partum, maternal home interviews were conducted and IPV experience elicited using the Conflict Tactic Scale, together with reports of children's GP and hospital visitations.
Results:   At 6 weeks, 2 years and 6 years, 1098, 921 and 799 participating mothers were in intimate relationships. Severe physical IPV was reported by 22.1, 23.0 and 7.1% of mothers, respectively, and minor IPV was reported by another 18.7, 16.9 and 6.1%, respectively. Compared with children without maternal physical IPV exposure, children of mothers disclosing severe physical IPV were 1.19 (95% confidence interval (CI): 1.08–1.31) times as likely to visit GPs, and children of mothers disclosing minor physical IPV were 1.13 (95% CI: 1.02–1.25) times as likely to visit GPs, after adjusting for socio-demographic, maternal mental health and other confounding factors. No significant association was found between maternal IPV and children's hospital visits, or GP or hospital visits for injury.
Conclusions:   IPV is common for many mothers of Pacific children, and is associated with significantly more GP visits for exposed children. Identification of maternal IPV during mothers' and children's GP and hospital visits may help guide services to prevent future presentations to children.     

The Parenting Responsibility and Emotional Preparedness (PREP) Screening Tool: A 3-Item Screen That Identifies Teen Mothers at High Risk for Nonoptimal Parenting

OBJECTIVE To test the ability of a 3-item screening tool (Parenting Responsibility and Emotional Preparedness [PREP]) to detect adolescent mothers at elevated risk for nonoptimal parenting and poor child development outcomes at 2 years of age. DESIGN A 4-site prospective cohort study conducted from December 2001 to August 2007 of adolescent mothers recruited in the third trimester of pregnancy and followed up at 4, 8, 18, and 24 months post partum. SETTING Community clinics and home settings in Birmingham, Alabama; Kansas City, Kansas and Missouri; South Bend, Indiana; and Washington, DC. PARTICIPANTS A total of 270 first-time adolescent mothers (aged 15-19 years) and their infants (birth to 2 years of age). MAIN EXPOSURES Naturalistic observations of parent-child interactions and quality of home environment during the first 2 years of life. OUTCOME MEASURES Maternal mental health and cognitive indicators, positive mother-child interactions, quality of home environment, child social-emotional development, and child cognitive development (Bayley scales). RESULTS PREP scores identified adolescent mothers with significantly elevated depressive symptoms and childhood trauma and lower scores of knowledge of infant development and maternal IQ. PREP predicted significantly lower quality of home environments and higher levels of nonoptimal mother-child interactions at 4, 8, and 18 months. PREP also predicted significantly lower child outcomes at 2 years of age for cognitive scores and higher levels of depressive and withdrawal symptoms and dysregulation and negative emotionality. CONCLUSIONS PREP is a low-cost, easily administered, nonstigmatizing screening tool that identifies adolescent mothers who self-recognize that they need help to meet their infants' social, emotional, and cognitive needs.     

Increased frequency of cytomegalovirus infection in children in group day care

The prevalence of cytomegalovirus (CMV) infection in 103 children attending a single day care center was compared with that of 62 children kept at home. Demographic features of the day care group were similar to those of the home care group; in both groups, most of the children were white, were from middle-income families with two or fewer children, and had parents with 15 or more years of education. Ten of 57 (18%) children in home care had serum antibody to cytomegalovirus (CMV) and 2/25 (8%) had viruria. In contrast, 59/103 (57%) of children from the day care center were shedding CMV in urine or saliva. Although less than 10% of infants aged less than 1 year were excreting CMV, 78% of infants studied between 12 and 18 months of age had CMV isolated from a saliva or urine specimen. Group day care appears likely to result in early acquisition of CMV. Excretion of CMV by children in day care centers could result in transmission of the virus to susceptible day care workers or mothers, with the potential risk of fetal infection.     

Breast feeding and weaning practices among urban Muslims of district Lucknow.

Data on 73 Moslem women living in an urban area of District Lucknow, India were analyzed to determine duration and frequency of breast feeding, child spacing, and their beliefs about advantages and disadvantages of breast feeding. Physicians attended 78.9% of the deliveries. Nurse-midwives and trained traditional birth attendants delivered the remaining infants. The woman had a average 5.9 children. All women breast fed their infants from day 1. The mothers were more likely to breast feed sons longer than daughters (24.9 months vs. 21.3 months). Median breast feeding duration was 22.4 months compared with 23.8 months for Moslem women in Bangladesh. It declined with parity except for the 1st child which was 23 months and the 5th child which was 17 months (26.7 months for parity 2, 25.6 for parity 3, 14.8 for parity 4, and 11 for parity 6). Infants 3 months old received more feeds each day than those 3 months old (7.5 vs. 5.3). 50% of mothers who breast fed for 12-17 months had a 2-year birth interval and those who breast fed for 2 years had an interval of about 4 years. While 100% of the noneducated mothers and 72.7% of the educated mothers knew that breast feeding maintains a child's health only 36.3% of educated mothers and none of the noneducated mothers knew that it conferred immunity. Mothers began giving their infants other liquids at a mean of 1.4 months. These liquids were water, diluted milk, toned milk, barley water, and pulse's water. The average age for introduction of solid foods (rice, kheer, porridge, bread, biscuits, boiled eggs, egg yolks, bananas, pudding, curd, and wheat) was 8.2 months.     

AMPHETAMINE ADDICTION AND PREGNANCY

Abstract. Billing, L., Eriksson, M., Larsson, G. and Zetterström, R. (Department of Paediatrics, Karolinska Institute, St. Göran's Children's Hospital, Stockholm, Sweden). Amphetamine addition and pregnancy. Acta Paediatr Scand, 69: 675, 1980.—Sixty-six infants born to amphetamine-addicted mothers were followed during their first year of life. The children were divided into three groups, according to whether or not the mother stopped her abuse in early pregnancy (Group I) or continued (Group II) and whether or not the latter children were placed in foster homes immediately after birth (Group III). All but 2 of 16 mothers in Group I stayed off drugs and mostly met non-addicted friends. In Group II, on the contrary, all but 2 of 36 mothers continued their abuse one year after delivery. At the age of one year, all but one child in Group I were in their mothers' custody and all children in Group III had remained in foster care. In Group II one-third of the children lived in foster homes after revocation of the maternal custody. Several infants in Group II had experienced multiple transfers between the biological home and different foster homes. There were indicators that maternal amphetamine abuse causes temporary drowsiness in the infants during the first months after birth. However, all children at the age of 12 months, regardless of group, had a somatic and psychomotor development in accordance with the normal Swedish standard. In all groups there was an increased rate of medical care mainly because of infections. Some infants in Group II compared to none in Groups I and III were hospitalized be-cause of failure to thrive or suspected physical abuse. Symptoms indicating emotional disturbance were more common in infants of Group II than in infants of Groups I and III.     

Formative research for the development of a market-based home fortification programme for young children in Niger

The objective of this formative research was to assess the acceptability of a micronutrient powder (Sprinkles(?)) and a lipid-based nutrient supplement (Nutributter(?)), and to explore people's willingness to pay for these products in a resource-poor context like Niger. In four sites, 84 focus group discussions among mothers, fathers and grandmothers of children 6-23 months were conducted, as well as 80 key informant interviews of mothers who participated in a home study where their children 6-23 months were given either Sprinkles(?) or Nutributter(?) to use either for a period of 4 weeks, or they were given both products over the 4-week period, i.e. Sprinkles(?) for 2 weeks and Nutributter(?) for an additional 2 weeks. The mothers understood how to use the products and generally used the products correctly. Both products were highly acceptable to adults and most children. In Niamey, where the 4-week home study used both products for 2 weeks each, the mothers tended to prefer Nutributter(?). The mothers who used either product were pleased with the improvements they saw in their children's health, including increased appetite, weight gain and increased energy and activity. A few mothers were concerned with how they would be able to provide for their child's increased appetite. Most participants across all four sites reported that they would be willing and able to afford to buy a single sachet of either Sprinkles(?) at a cost of US$0.03 or Nutributter(?) at a cost of US$0.08 several times a week. This study provides evidence that both of these products were are highly acceptable in different settings in Niger and suggests that delivery of Nutributter(?) or Sprinkles(?) at a low or subsidized cost through a market-based system may be possible in Niger, if an appropriate distribution system can be identified.     

The clinical and health economic burden of respiratory syncytial virus disease among children under 2 years of age in a defined geographical area.

AIMS: To describe the clinical and health economic impact of respiratory syncytial virus (RSV) disease in children under 2 years of age. METHODS: Hospitalised children less than 2 years of age with a respiratory illness were studied over three consecutive RSV seasons (1996-99). RESULTS: The rates (per 1000 infants under 1 year of age) of hospitalisations from bronchiolitis and RSV illness were 30.8 and 24.4 respectively. The rates of death, intensive care admission, and need for ventilatory assistance during RSV related hospitalisation were 0.2%, 2.7%, and 1.5% respectively. From a cohort of 841 preterm infants, 6.3% had an RSV related hospitalisation during the study period, with the rate rising to 9.2% among those who were either born before 36 weeks gestation and were under 6 months of age at the onset of the RSV seasons, or were less than 2 years of age with chronic lung disease needing home oxygen therapy. Eight of 25 children on home oxygen therapy had RSV related rehospitalisation. Need for assisted ventilation during the neonatal period and discharge home on oxygen therapy were significantly associated with the risk of subsequent RSV related hospitalisation in preterm infants less than 6 months of age. The direct health authority cost of all RSV hospitalisations was pound 542 203, while the currently recommended immunoprophylaxis for the high risk infants would have cost pound 652 960. CONCLUSIONS: Preterm infants receiving assisted ventilation and those on home oxygen therapy are particularly at risk of RSV related hospitalisation. Serious adverse outcomes are however uncommon even among these high risk infants.     

The clinical and health economic burden of respiratory syncytial virus disease among children under 2 years of age in a defined geographical area

Aims: To describe the clinical and health economic impact of respiratory syncytial virus (RSV) disease in children under 2 years of age. Methods: Hospitalised children less than 2 years of age with a respiratory illness were studied over three consecutive RSV seasons (1996–99). Results: The rates (per 1000 infants under 1 year of age) of hospitalisations from bronchiolitis and RSV illness were 30.8 and 24.4 respectively. The rates of death, intensive care admission, and need for ventilatory assistance during RSV related hospitalisation were 0.2%, 2.7%, and 1.5% respectively. From a cohort of 841 preterm infants, 6.3% had an RSV related hospitalisation during the study period, with the rate rising to 9.2% among those who were either born before 36 weeks gestation and were under 6 months of age at the onset of the RSV seasons, or were less than 2 years of age with chronic lung disease needing home oxygen therapy. Eight of 25 children on home oxygen therapy had RSV related rehospitalisation. Need for assisted ventilation during the neonatal period and discharge home on oxygen therapy were significantly associated with the risk of subsequent RSV related hospitalisation in preterm infants less than 6 months of age. The direct health authority cost of all RSV hospitalisations was £542 203, while the currently recommended immunoprophylaxis for the high risk infants would have cost £652 960. Conclusions: Preterm infants receiving assisted ventilation and those on home oxygen therapy are particularly at risk of RSV related hospitalisation. Serious adverse outcomes are however uncommon even among these high risk infants.     

Outcome after developmental intervention in the neonatal intensive care unit for mothers of preterm infants with low socioeconomic status.

The efficacy of developmental intervention in the neonatal intensive care unit for mothers of preterm infants with low socioeconomic status was evaluated. Mothers were assigned to an experimental group in which they met at least weekly with an infant-development specialist or to a control group in which they did not. During the sessions, they participated in a structured developmental and behavioral assessment of their infants, with the goal of enhancing their ability to provide appropriate interactions and environmental stimulation for their infants. When the infants were 4 and 8 months of age, follow-up home visits by a nurse who was unaware of group assignment showed that the experimental-group infants performed more optimally on the Bayley Mental scale (Bayley Scales of Infant Development) at 4 and 8 months of age and on the Bayley Motor scale at 4 months. In addition, the home environment was more developmentally appropriate at 4 months of age, and the mothers rated their babies as temperamentally less difficult at 4 and 8 months. We conclude that a mother-focused, neonatal intensive care unit-based program that utilizes the assessment process in a therapeutic way is an effective strategy in the initiation of interventions for families of low socioeconomic status whose infants were born prematurely.