Claes Sundelin

Feeding problems in an affluent society. Follow-up at four years of age in children with early refusal to eat.

Twenty‐four children, previously investigated at 3–12 months of age for refusal to eat during at least four weeks with no apparent medical cause, were followed up prospectively and reinvestigated at four years of age. Comparisons were made with 38 controls, selected from the same child health care districts. Information was obtained from parental interviews, medical records and assessments by a speech therapist. At four years of age, 17 of the 24 children with early refusal to eat (71%) were reported by the parents to still have feeding problems and 10 (42%) were reported as hyperactive. Compared to the controls, the children with early refusal to eat seemed to have an equally good prognosis with respect to health, growth and development, but were at risk of later problems with their eating patterns and behaviour.

Early and Late Discharge after Hospital Birth: Breastfeeding

Breastfeeding was studied among women discharged early and late after normal delivery in a hospital. Early discharge was defined as leaving the hospital 24–48 h after delivery in combination with domiciliary visits, and late discharge as the regular hospital postpartum care (mean 6 days). 164 women interested in participating in the early discharge study were randomly allocated in late pregnancy to a group offered early discharge (Experimental group = EG) or a group offered the traditional later discharge (Control group = CG). After medical exclusions and non‐medical withdrawals, 50 mother‐infant couples remained in EG and 54 in CG. Regular breastfeeding at 6 months after birth was reported by 63% of the multiparae in EG and 41% in CG (p=0.06). Thirty‐three per cent of the primiparae in each group were still breastfeeding at 6 months. 2% of the infants in EG and 72% in CG received supplementary breastmilk at least once during their first week of life. Infants discharged early were breastfed more often on the 2nd (NS), 3rd (p<0.05) and 4th day (p<0.001) after birth, compared with infants who stayed longer in hospital. There were no statistically significant differences between EG and CG women in their experiences of success in breastfeeding according to daily records from the first 14 days after the birth.

Overweight more prevalent among children than among adolescents.

Aims: To study if there is a change in paediatric overweight/obesity prevalence from 1982 to 2002 in a population with a high proportion of post‐graduate education.

Characteristics of School Children who are Choosy Eaters

Choosiness, manifested in refusal of foods, eating little, and disinterest in food, was studied with regard to prevalence, stability, sociodemographic characteristics, health problems, weight, and associated problem behaviors in a sample of 240 Swedish primary school children. Questionnaires were used, and data on sociodemographic variables, health problems, weight, and height were collected from child health-care and school health records. Choosiness was present in one third of the children, but only 8% showed choosy behavior both at home and in school. The choosy children had no more health problems than others, nor were they significantly thinner. Choosiness was not related to gender, social class, or ethnic background. The choosy children had modestly elevated levels of externalizing, hyperactive, and internalizing behavior. The choosy children with a history of refusal to eat in infancy or preschool age had more pronounced choosy behavior and had more problem behaviors than the other choosy children. Choosiness can not easily be categorized within an eating disorders or main problem syndromes of childhood frame of reference.

Children with early refusal to eat: follow-up during primary school.

Dahl M, Rydell A‐M, Sundelin C. Children with early refusal to eat: follow‐up during primary school. Acta Paediatr 1994;83:54–8. Stockholm. ISSN 0803–5253

Maternal and neonatal factors and mortality in children with Down syndrome born in 1973-1980 and 1995-1998

Aims: To investigate maternal and neonatal factors in Down syndrome (DS) at birth, the impact of a congenital heart defect (CHD) on these factors and changes over time. Methods: Medical data of children with DS born in northern Sweden in the periods 1973–1980 (n= 219) and 1995–1998 (n= 88) obtained from the Swedish Medical Birth Register were compared. A comparison with the general population on a group level was also made. Results: The main finding was a reduction in infant mortality in DS, from 14.2% to 2.3% in 1995–1998 (p < 0.001), but this was still significantly higher than in the general population. The rate of Caesarean sections increased over time (from 14.5% to 27.3%, p < 0.05) even after adjustment for increased maternal age. No change over time was detected in the following rates: premature birth (gestational age ±36) (25%); asphyxia (5‐min Apgar score ±6) (8%); low birthweight (<2500g) (14%); or small for gestational age (SGA) (14%); all rates were significantly higher than those of the general population. A CHD did not seem to influence the rates of these factors in a logistic regression model.

Early and Late Discharge after Hospital Birth. Health of Mother and Infant in the Postpartum Period

Early discharge, defined as hospital leave 24-48 hours after birth, was introduced at Falun Hospital in 1984. 164 women interested in participating in an evaluative study of the program were randomly allocated in late pregnancy to an Experimental group (EG) offered early discharge, and a Control group (CG) offered the regular postpartum care in hospital. After medical and other withdrawals 24 h after the birth, 50 women remained in EG and 54 in CG. Infant morbidity and number of prescribed medicaments during the first 6 months after the birth were lower in EG than in CG, but the difference was not statistically significant. EG mothers made fewer visits to the Child Health Centre nurse than did CG mothers (p less than 0.05). No significant difference in puerperal complications was demonstrated, but the intake of sedatives by EG mothers was smaller than that of CG mothers during the first puerperal week (p less than 0.01).

Could SF-36 be used as a screening instrument for depression in a Swedish youth population?

OBJECTIVE Depression among youth is a condition associated with serious long-term morbidity and suicide. The aim of this study was to investigate whether a HRQoL instrument, the short form 36 version 1.0 (SF-36), could be used to screen for depression in a clinical Youth Centre (YC). A second purpose was to describe self-reported health and depression. SETTING A clinical YC at a University hospital. DESIGN A sample of 660 youths, 14-20 years old was assessed with SF-36 and Montgomery Åsberg Depression Rating Scale, self-screening version (MADRS-S). Answers to all the questions in both instruments were given by 79% (519/660; 453 women and 66 men). Mean age in the sample was 17.5±1.6 years. RESULTS Strong correlations were found between all the SF-36 subscales and the depression ratio scale MADRS-S. Receiver operating characteristic (ROC) curve analysis confirmed that the SF-36 subscales mental health (MH) and vitality (VT) could correctly predict depression on the individual level with Area Under the ROC Curve values 0.87 and 0.84 in ROC curves. Individuals scoring 48 or lower on MH and 40 or lower on VT should be followed up with a clinical interview concerning possible depressive disorder. Mild to moderate depression was common (35.5%), especially among women (37.5%). Men scored higher than women on all SF-36 subscales except for physical functioning. CONCLUSIONS The SF-36 can be used to screen for suspect depression in a youth population followed by interview. This gives an opportunity to detect and treat emerging depressive symptoms early.

Comorbidity in children with severe developmental language disability

In a cohort of 2359 children, screened for severe developmental language disability (DLD) at 3 y of age, 45 children were identified as true positives. The development, concerning DLD and comorbidity of 41 of these children still living in the municipality of Uppsala was followed up to school start. Criteria for comorbidity were: (a) suspected or diagnosed neuropsychiatric/neuro‐developmental disability according to information from the Child Habilitation Centre and the Child Psychiatric Centre or (b) low performance IQ, signs of activity/distractibility problems according to a psychologists examination. By school start, 61% of the children with severe DLD were identified with comorbidity.

Effect of degree of urbanisation on age and sex-specific asthma prevalence in Swedish preschool children

BackgroundThere are few studies on age and sex-specific asthma prevalence in the age range 1–6 years. The purpose of this report was to estimate age and sex specific asthma prevalence in preschool children and to analyse the influence of possible demographic and geographic determinants.MethodsAll 70 allergen avoidance day-care centres and 140 matched ordinary day-care centres across Sweden were sampled. The parents of all 8,757 children attending these day-care centres received the International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire, supplemented with questions on medical treatment, physician assessed asthma diagnosis, and other asthma related questions. The response rate was 68%.ResultsThe age specific asthma prevalence, adjusted for the underlying municipality population size, was among boys 9.7% at age 1, 11.1% at age 2, 11.4 at age 3, 10.5 at age 4, 8.7 at age 5, and 6.4 at age 6. The corresponding proportions among girls were 8.9%, 9.9%, 9.8%, 8.8%, 7.0%, and 5.0%, on average 9.6% for boys and 8.2% for girls, altogether 8.9%. In addition to age and sex the prevalence increased by municipality population density, a proxy for degree of urbanisation. Moreover, there was a remaining weak geographical gradient with increasing prevalence towards the north and the west.ConclusionThe age-specific asthma prevalence was curvilinear with a peak around age 3 and somewhat higher for boys than for girls. The asthma prevalence increased in a slowly accelerating pace by municipality population density as a proxy for degree of urbanisation.