Ann-Cathrine Bramhagen

Iron status of children in southern Sweden: effects of cow's milk and follow-on formula

Aim. The objective of the study was to investigate iron status in children in relation to intake of cows milk and follow‐on formula. Methods. In all, 367 healthy 2.5‐y‐old children were enrolled in the study. The amounts of cows milk and formula consumed were recorded. B‐haemoglobin, S‐ferritin, S‐iron, total iron binding capacity and mean corpuscular volume were analysed. Results. Seven percent of the children had iron deficiency anaemia (Hb <110 g/l) and 10% had S‐ferritin <12 μg/1. Furthermore, 10% of the children were iron deficient, with or without anaemia. Children with iron deficiency had a higher intake of cows milk (382 ml, 95% confidence interval (CI) 294‐496, vs. 257 ml, CI 232–272, p< 0.0001), and fewer consumed follow‐on formula (11% vs. 43%, p = 0.0002) compared to those with sufficient iron. Conclusion. Iron deficiency is still common during childhood in Sweden. Intake of cows milk is significantly higher in children with iron deficiency. In contrast, iron deficiency is less frequent among those consuming follow‐on formula.

Antibiotic use among 8-month-old children in Malmö, Sweden – in relation to child characteristics and parental sociodemographic, psychosocial and lifestyle factors

BackgroundIn the county of Scania, Sweden, antibiotic use among small children is among the highest in the country. The aim of this study was to investigate the associations between antibiotic use among 8-month-old children in Malmö and characteristics of the child as well as parental sociodemographic characteristics, lifestyle factors, and psychosocial support.MethodsThe study was a population-based cross-sectional survey. The study population consisted of children who visited the Child Health Care (CHC) centres in Malmö for their 8-month health checkup during 2003–2006 and whose parents answered a self-administered questionnaire (n = 7266 children). The questionnaire was distributed to parents of children registered with the CHC and invited for an 8-month checkup during the study period.ResultsThe odds of using antibiotics increased as parental educational level decreased. Using high educational level as a reference group, low maternal educational level was associated with an increased antibiotic use for the child, odds ratio (OR) = 1.61 (95% CI: 1.34–1.93). Furthermore, children whose parents were born outside Sweden showed higher antibiotic use, OR = 1.43 (95% CI: 1.24–1.65), in comparison with children whose parents were born in Sweden. Exposure to environmental smoking, parental experience of economic stress, and a low level of emotional support increased the odds for antibiotic use. Boys had higher odds of use of antibiotics than girls, OR = 1.40 (95% CI: 1.25–1.57). Having a low birth weight, having an allergy and having siblings also increased the odds for early antibiotic use, while breastfeeding seemed to have a protective role.ConclusionThere were clear associations between parental factors such as sociodemographic, psychosocial and lifestyle factors and antibiotic use at this early stage of life. Several characteristics of the child also affected the use of antibiotics.

Swedish Child Health Care nurses conceptions of overweight in children: a qualitative study

BackgroundRegistered Sick Children’s Nurses and District Nurses employed at Child Health Care centres are in a position to help prevent childhood overweight and obesity. Prevention of this challenging public health threat could be improved through having a better understanding of how this group of nurses perceives childhood obesity. The aim of this study was to elucidate the conceptions of childhood overweight, including obesity, among nurses working in Child Health Care.MethodA qualitative study using a phenomenographic approach, based on open-ended interviews with 18 Child Health Care nurses (CHC-nurses) strategically selected from 17 Child Health Care Centres in the southern part of Sweden.ResultsFour categories of description emerged from the data: Perception of childhood overweight changes, Overweight in younger children a neglected concern, Overweight a delicate issue and Importance of family lifestyle. The participating CHC-nurses conceived overweight in children, primarily obesity in children to be an extensive and serious problem which affects children, families and the surrounding society. Overweight in children was further perceived as a consequence of their parent’s lifestyle and their awareness of the problem, which was considered by the CHC-nurses as a sensitive and a provoking issue. It was also perceived that overweight in children is not taken seriously during the pre-school period and that concerns regarding overweight in younger children were mainly about the appearance and not the health of the child. The CHC-nurses perceived that the proportion of overweight children has increased, which Swedish society and the CHC-nurses have adapted to. This adaptation makes it difficult for CHC-nurses to define those children who are overweight.ConclusionCHC-nurses provide a comprehensive and complex picture of childhood overweight, which includes several difficulties dealing with this issue. Attention to CHC-nurse’s conceptions of overweight in children is important since it can affect the parent-nurse relationship and thereby the nurse’s, as well as the parent’s efforts to influence the children’s weight. It is suggested that CHC- nurses should work with person centered counseling and empowerment concerning parent to child relations in cases involving overweight.

Precautions taken by mothers to prevent burn and scald injuries to young children at home: An intervention study

Aim: The aim of this study was to investigate to what extent individual-based extended information given to mothers from city parts of low education can improve precautions taken by them to prevent burn and scald injuries involving young children in the home and further to compare the results with a group of mothers who had not received extended information. Methods: This intervention study, with a comparison group, has a quasi-experimental design. Individual-based information, with an empowerment approach, was given to a group of mothers living in two separate areas of a city in southern Sweden with a low level of education. In total, 99 mothers of children under the age of 7 months participated. The mothers were selected through the local child healthcare authorities. Observations were made and bivariate analyses were established. Results: The results showed that the intervention had a significant impact on improving the precautions the participating mothers introduced to protect their children against burn and scald injuries in the home and further, in relation to a comparison group. Conclusions: Through empowerment, workshops, and home visits aimed to increase their consciousness and knowledge, the participating mothers’ precautions taken against child injuries in the home improved. It is of great importance that a framework for considering the problem of burn and scald injuries to children is presented from a preventive perspective which, in combination with evidence-based interventions, may enable the creation of injury prevention programmes for implementation by the community health care.

Factors influencing iron nutrition among one-year-old healthy children in Sweden

AIMS AND OBJECTIVES To describe possible social, nutritional and biological factors influencing iron intake and iron status among healthy one-year-old children in southern Sweden. BACKGROUND Iron deficiency is one of the most important nutritional disorders and increases the risk of delayed mental and motor development. Children are at risk because of rapid growth, which entails relatively high requirements of iron. DESIGN A prospective study using survey methods. METHOD Randomly selected one-year-old children (n = 90) and their parents participated. Parents answered a questionnaire enquiring about demographic data and the childs feeding and health during the first year. The childs total food intake and blood samples (haemoglobin, mean corpuscular volume, S-ferritin and transferring receptor) were obtained. Results.  Twenty-seven per cent of the children had an iron intake below the Nordic Nutrition Recommendations of 8 mg/day (NNR 2004). Follow-on formula and iron-fortified porridge contributed to 64% of the childs total iron intake. Partial breastfeeding and low maternal education correlated negatively with iron intake from complementary food. In total, 10·3% (n = 9) of the children were found to be iron-depleted (S-ferritin ≤ 12 μg/l), and 2·3% (n = 2) had iron deficiency with or without anaemia (Hb ≤ 100 g/l). CONCLUSIONS One-year-old children in Sweden may be at risk of developing iron deficiency, but information about iron-rich food can improve iron status. RELEVANCE TO CLINICAL PRACTICE Knowledge about factors influencing childrens iron intake and iron status may improve the nutritional advice and education from the Child Health Services to prevent or detect iron deficiency.

Transfer to Adult Care—Experiences of Young Adults with Congenital Heart Disease

More than 90% of children born with congenital heart disease survive into adulthood due to successes of cardiac surgery and medical management. Interviews with 16 young adults with congenital heart disease to explore their experiences of transfer from pediatric to adult care were performed. The analysis identified five themes; Feeling secure during the transfer process, Experiencing trust in the care, Expecting to be involved, Assuming responsibility for ones health is a process and Lack of knowledge leads to uncertainty. In conclusion; a structured and gradual transfer process was necessary to enable the informants to shoulder the responsibility for self-care.

Transferrin receptor in children and its correlation with iron status and types of milk consumption

Aim: This study compared transferrin receptor (TfR) concentrations with iron parameters relative to a childs intake of cows milk and follow‐on formula. Methods: TfR, β‐haemoglobin, serum ferritin and mean corpuscular volume (MCV) of red blood cells were analysed in a study population of 263 children aged 2.5 y. The amounts of cows milk and follow‐on formula consumed were recorded. Results: There was a significant difference in concentrations of TfR/log ferritin between children whose milk intake was <500 ml and those with a milk intake ≥500 ml (p= 0.003). There were significantly higher values of TfR/log ferritin in children whose MCV of red blood cells was ≤75 fl than in those with >75 fl (p < 0.0001). The TfR concentrations were significantly lower after iron therapy than before treatment.

Obstacles to the prevention of overweight and obesity in the context of child health care in Sweden

BackgroundOverweight and obesity in younger children could better be brought in focus through a deeper understanding of how Child Health Care nurses (CHC-nurses) perceive their work with the problems of overweight at the CHC Centers. The aim of this study was to elucidate the CHC-nurses conceptions of their preventive work with childhood overweight and obesity in Child Health Care.MethodA qualitative study, based on open-ended interviews, involving 18 CHC-nurses strategically selected from 17 CHC Centres in the southern part of Sweden using a phenomenographic approach.ResultsTwo categories of description emerged from the data: (i) Internal obstacles to the CHC- nurses’ work with overweight in children and (ii) External obstacles to the management of overweight in children. The CHC-nurses conceived their work with overweight in Child Health Care to be complicated and constrained by several obstacles depending on the nurses’ personal priorities, knowledge, responsibility and the absence of resources and cooperation, as well as the lack of uniform guidelines for preventing and managing childhood overweight and further a deficient management organisation.ConclusionNurses’ attention to monitoring overweight in children, and their initiative for prevention, is based on their conceptions of the obstacles that hinder them in their efforts. An increased awareness of the CHC-nurses conceptions of the priorities, their sense of responsibility and prevention practices is warranted. If measures in this direction are not taken there is a growing risk that overweight children will pass through the CHC without any formal recognition of their situation. There is an indication that the present level of the CHC-nurses’ preventive work with childhood overweight has room for improvement in several areas. It is suggested that the specialist education of these health care professionals should be supplemented and that organisation of the management of childhood overweight should be also revised at the primary health care level.

Self-reported post-operative recovery in children : development of an instrument

Rationale, aims and objectives According to the United Nations (1989), children have the right to be heard and to have their opinions respected. Since post-operative recovery is an individual and subjective experience and patient-reported outcome measures are considered important, our aim was to develop and test an instrument to measure self-reported quality of recovery in children after surgical procedures. Methods Development of the instrument Postoperative Recovery in Children (PRiC) was influenced by the Quality of Recovery-24, for use in adults. Eighteen children and nine professionals validated the items with respect to content and language. A photo questionnaire was developed to determine whether the childrens participation would increase compared with the text questionnaire. The final instrument was distributed consecutively to 390 children, ages 4–12 years, who underwent tonsil surgery at four hospitals in Sweden. Results A total of 238 children with a mean age of 6.5 years participated. According to the parents, 23% circled the answers themselves and 59% participated to a significant degree. However, there was no significant difference in participation between those who received a photo versus a text questionnaire. Psychometric tests of the instrument showed that Cronbachs alpha for the total instrument was 0.83 and the item-total correlations for 22 of the items were ≥0.20. Conclusion Our results support use of the PRiC instrument to assess and follow-up on childrens self-reported post-operative recovery after tonsil operation, both in clinical praxis as well in research.RATIONALE, AIMS AND OBJECTIVES According to the United Nations (1989), children have the right to be heard and to have their opinions respected. Since post-operative recovery is an individual and subjective experience and patient-reported outcome measures are considered important, our aim was to develop and test an instrument to measure self-reported quality of recovery in children after surgical procedures. METHODS Development of the instrument Postoperative Recovery in Children (PRiC) was influenced by the Quality of Recovery-24, for use in adults. Eighteen children and nine professionals validated the items with respect to content and language. A photo questionnaire was developed to determine whether the childrens participation would increase compared with the text questionnaire. The final instrument was distributed consecutively to 390 children, ages 4-12 years, who underwent tonsil surgery at four hospitals in Sweden. RESULTS A total of 238 children with a mean age of 6.5 years participated. According to the parents, 23% circled the answers themselves and 59% participated to a significant degree. However, there was no significant difference in participation between those who received a photo versus a text questionnaire. Psychometric tests of the instrument showed that Cronbachs alpha for the total instrument was 0.83 and the item-total correlations for 22 of the items were ≥0.20. CONCLUSION Our results support use of the PRiC instrument to assess and follow-up on childrens self-reported post-operative recovery after tonsil operation, both in clinical praxis as well in research.

Polyethylene Glycol- or Sodium Picosulphate-Based Laxatives Before Colonoscopy in Children

Objectives: The purpose of this randomised study was to compare the quality of bowel cleansing using either polyethylene glycol (PEG) or sodium picosulphate (NaPico) (primary outcome) in relation to the tolerability and acceptance of these laxatives among children and their caregivers (secondary outcome). Methods: The study was a randomised controlled trial that was conducted as an investigator-blinded study within the Department of Paediatrics of Skåne University Hospital in Malmö, Sweden. A total of 72 children (10–18 years of age) were randomly placed into 1 of 2 groups (PEG or NaPico). The Ottawa Bowel Preparation Quality Score was used to evaluate the quality of bowel cleansing. A total of 2 different questionnaires were used to evaluate both the acceptability and tolerability of the laxatives. Results: In total, 71 children completed the bowel cleansing. Of these 71 cleanses, 67 protocols were analysed according to the Ottawa Bowel Preparation Quality Score. No significant difference in bowel cleansing quality was detected between the 2 groups. Rates of acceptability and tolerability were significantly higher in the NaPico group than in the PEG group. Conclusions: In the present study, both laxatives were found to be satisfactory in terms of aiding the performance of an uncomplicated and successful colonoscopy. NaPico was, however, more tolerable to the children than PEG, and both, the children and their caregivers, were more accepting of NaPico than of PEG. Consequently, NaPico can be recommended as the option for bowel cleansing in children ages 10 years and older.