Dagmar Lagerberg

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.

Child health services in transition: I. Theories, methods and launching

Aim: To describe an evidence‐based model for preventive child health care and present some findings from baseline measurements. Methods: The model includes: parent education; methods for interaction and language training; follow‐up of low birthweight children; identification and treatment of postnatal depression, interaction difficulties, motor problems, parenthood stress, and psychosocial problems. After baseline measurements at 18 mo (cohort I), the intervention was tested on children from 0 to 18 mo at 18 child health centres in Uppsala County (cohort II). Eighteen centres in other counties served as controls. Two centres from a privileged area were included in the baseline measurements as a “contrasting” sample. Data are derived from health records and questionnaires to nurses and mothers. Results: Baseline experiment (n= 457) and control mothers (n= 510) were largely comparable in a number of respects. Experiment parents were of higher educational and occupational status, and were more frequently of non‐Nordic ethnicity. Mothers in the privileged area (n= 72) differed from other mothers in several respects. Experiment nurses devoted considerably fewer hours per week to child health services and to child patients than did control nurses.

Secondary prevention in child health: effects of psychological intervention, particularly home visitation, on children's development and other outcome variables

This paper reviews interventions targeting socially deprived families, families with low birth‐weight/premature children, and some other problems (child abuse, sensitivity/attachment, postnatal depression). Conclusions are mainly based on randomized controlled trials. Earlier reviews in the field have emphasized the importance of intensive, enduring home visitation and of early education programmes for young children. Home visitation may positively effect several outcomes, including health behaviour, child safety and stimulation. Rates of child abuse and neglect have proven difficult to influence, but home visitation may result in other gains such as fewer accidents and serious injuries, and greater home safety. The cognitive development of low birthweight and premature children may be positively influenced by home visitation, particularly in combination with an early stimulation programme in the neonatal unit and pre‐school placement. Postnatally depressed mothers have been shown to improve substantially from nurse counselling once a week for 6–8 wk.

Drawing the line in the Edinburgh Postnatal Depression Scale (EPDS): a vital decision.

Abstract Background: The Edinburgh Postnatal Depression Scale (EPDS) is widely used in early child health care. This study examined the appropriateness of the recommended EPDS cut-off score 11/12. Methods: Two main analyses were performed: 1. Associations between EPDS scores and maternal health behaviour, stress, life events, perceived mother-child interaction quality and child behaviour. 2. Screening parameters of the EPDS, i.e., sensitivity, specificity and positive predictive value. EPDS scores were available for 438 mothers and maternal questionnaires for 361 mothers. Results: Already in the EPDS score intervals 6–8 and 9–11, there were notable adversities, according to maternal questionnaires, in stress, perceived quality of mother-child interaction, perceived child difficultness and child problem behaviours. Using maternal questionnaire reports about sadness/distress postpartum as standard, the recommended EPDS cut-off score 11/12 resulted in a very low sensitivity (24%). The cut-off score 6/7 yielded a sensitivity of 61%, a specificity of 82% and a positive predictive value of 61%. Conclusions: In terms of both clinical relevance and screening qualities, an EPDS cut-off score lower than 11/12 seems recommendable.

Child health and maternal stress: does neighbourhood status matter?

Abstract The purpose of this cross-sectional questionnaire study was to explore neighbourhood-level differences in health behaviour, maternal stress and sense of coherence, birth weight, child health and behaviour, and childrens television watching habits. In total, 2006 pairs of Swedish mothers and children, aged approximately 20 months, from the general population participated in the study. A total of 1923 lived in neighbourhoods of average socioeconomic status in six counties, and 83 in a high-status neighbourhood in one of the counties. Data were collected in 2002–2003 and 2004–2005 through the Child Health Services. Socio-demographic confounders were adjusted for in multiple logistic regressions (maternal age, country of birth, education, marital status and parity). Compared with their counterparts in average neighbourhoods, mothers in the high-status neighbourhood were less frequently smokers and had been breastfeeding their children more. They felt less stress from social isolation and had a higher sense of coherence. All these differences except lower social isolation were non-significant after adjusting for socio-demographic characteristics. Privileged mothers felt more restricted by their parenting tasks (unadjusted comparison), and more privileged children were frequent television watchers. Child birth weight, health and behaviour were no better in the privileged than in average neighbourhoods. This paper adds to previous knowledge by showing that status-based geographic differences in important parenting and health parameters can be non-significant in an equitable society such as Sweden, where all families with young children have access to free high-quality health services. Individual characteristics could provide better explanations than neighbourhood status.

Utilization of child health services, stress, social support and child characteristics in primiparous and multiparous mothers of 18-month-old children

Aim: Traditionally, the child health services have laid emphasis on first-time mothers. Some researchers have argued that the needs of multiparous mothers must be considered equally important. The aim of this paper was to analyse parity-related characteristics in pairs of mothers and 18-month-old children. Methods: The study was population-based and cross-sectional. 586 primiparous mothers and 821 mothers with at least one previous child completed a questionnaire. Additional information was extracted from the child health records by the nurses. Data were collected in 2002–2003 and 2004–2005. Results: Compared to multiparous mothers, primiparous mothers had a higher utilization of child health services. Multiparous mothers scored higher on parental incompetence stress and felt that their work load was more demanding. Multiparous mothers reported less social support, particularly in practical respects such as baby-sitting. They considered their interaction with the child as less satisfactory than did primiparous mothers; their children participated less in shared reading and had a more restricted vocabulary. Fewer multiparous mothers assessed their own and their child’s total situation as very good. Conclusions: The child health services should develop competence and methods to support multiparous mothers and alleviate their workload when caring for several children.

Early signs and symptoms in neglected children

Abstract Since the beginning of 1976, a multi-disciplinary study of children at risk of physical and emotional damage in their homes has been in progress in Uppsala, Sweden. In this paper an account is given of disturbances and symptoms shown by the children.∗ The term “neglect” is used as a common designation for abuse, neglect and unfavourable home conditions.

Relationship Between Breastfeeding and Early Childhood Obesity: Results of a Prospective Longitudinal Study from Birth to 4 Years

AIM To study a potential link between breastfeeding in infancy and obesity at age 4. MATERIALS AND METHODS A total of 30,508 infants born during 2002-2007 from the databases of the Preventive Child Health Services in two Swedish counties and from national registers were studied. The outcome variable was obesity at age 4. Analyses were conducted by logistic regression models using the methodology of generalized estimating equations. Analyses were adjusted for child sex and maternal anthropometric and sociodemographic variables. RESULTS In unadjusted analyses, any breastfeeding up to 9 months was linked to successively decreasing odds ratios (ORs) for obesity at age 4 (ORs 0.78-0.33), however, not significantly for 1 week and 2 months of breastfeeding. In adjusted analyses, the same pattern remained statistically significant for breastfeeding for 4 (OR 0.51), 6 (OR 0.55), and 9 (OR 0.47) months. Child sex, maternal education, maternal body mass index, and maternal smoking additionally influenced child obesity. CONCLUSION Breastfeeding duration for at least 4 months may contribute independently to a reduced risk for childhood obesity at 4 years.

Sexually transmitted diseases in children: a serious consequence of sexual abuse and an indication of possible victimization of other children.

Sexually transmitted diseases in children : a serious consequence of sexual abuse and an indication of possible victimization of other children

Parents' observations of sexual behaviour in pre-school children

This commentary on the Larsson and Svedin study of sexual behaviour in pre‐school children, published in the present issue of Acta Paediatrica (1), centres around three questions: 1. How can normal sexual behaviour in children be distinguished from problematic behaviour? 2. What characterizes the sexual development of the normal child? 3. Can knowledge about normal and problematic sexual behaviour be used to screen for sexual abuse or to confirm cases of sexual victimization? It is recommended that the inventory used by the authors be standardized on a representative sample of Swedish children, because this would enhance its usefulness in distinguishing normal from problematic behaviour. It is further recommended that research about sexual development in children be based on person‐oriented rather than on variable‐oriented analyses. It is finally argued that knowledge about normal and problematic sexual behaviour may not contribute to more effective screening or confirmation procedures in suspicions of sexual abuse. However, knowledge about normal sexual behaviour is valuable in studies of sexual behaviour in different categories of children, e.g. in the developmentally delayed or psychosocially deprived.