Else Marie Olsen

Failure to thrive: the prevalence and concurrence of anthropometric criteria in a general infant population

Background: Failure to thrive (FTT) in early childhood is associated with subsequent developmental delay and is recognised to reflect relative undernutrition. Although the concept of FTT is widely used, no consensus exists regarding a specific definition, and it is unclear to what extent different anthropometric definitions concur. Objective: To compare the prevalence and concurrence of different anthropometric criteria for FTT and test the sensitivity and positive predictive values of these in detecting children with “significant undernutrition”, defined as the combination of slow conditional weight gain and low body mass index (BMI). Methods: Seven criteria of FTT, including low weight for age, low BMI, low conditional weight gain and Waterlow’s criterion for wasting, were applied to a birth cohort of 6090 Danish infants. The criteria were compared in two age groups: 2–6 and 6–11 months of life. Results: 27% of infants met one or more criteria in at least one of the two age groups. The concurrence among the criteria was generally poor, with most children identified by only one criterion. Positive predictive values of different criteria ranged from 1% to 58%. Most single criteria identified either less than half the cases of significant undernutrition (found in 3%) or included far too many, thus having a low positive predictive value. Children with low weight for height tended to be relatively tall. Conclusions: No single measurement on its own seems to be adequate for identifying nutritional growth delay. Further longitudinal population studies are needed to investigate the discriminating power of different criteria in detecting significant undernutrition and subsequent outcomes.

The Copenhagen County child cohort: Design of a longitudinal study of child mental health

Background: Epidemiological studies of psychopathology in the first years of life are few, and the association between mental health problems in infancy and psychiatric disturbances later in life has not been systematically investigated. The aim of the present project was to study mental health problems and possibilities of intervention from infancy and onward. Methods: The basic study population consists of a birth cohort of 6,090 children born in the year 2000 in the County of Copenhagen, the Copenhagen County Child Cohort, CCCC 2000. At stage one CCCC 2000 was established on data from the Civil Registration System, Danish national registers, and standardized, longitudinal data from the first year of living obtained by public health nurses. At stage two a subsample was assessed at 1½ years of age concerning child psychiatric illness and associated factors in a case-control study nested in the cohort, including a random sample. Participation rate at stage one was 92%. Perspectives: Ongoing studies of CCCC 2000 include studies of failure to thrive, register studies, and studies of the predictive validity of public health screening. A follow-up study concerning the prevalence of psychopathology at age 5 is planned. Summary: The Copenhagen County Child Cohort CCCC 2000 is a longitudinal study of mental health from infancy investigating psychopathology in early childhood. Results from this study will add to the knowledge of risk factors and course of mental health problems in childhood and contribute to the validation of the mental health screening made by public health nurses.

Eating patterns in a population-based sample of children aged 5 to 7 years: association with psychopathology and parentally perceived impairment.

Objective: There is still a lack of research on childhood eating patterns and their correlates in relation to psychopathology and parentally perceived impact in general population samples. We aimed to determine which eating patterns were more likely to be identified as problematic by parents, and their impact and association with childhood psychopathology (emotional, behavioral, and pervasive developmental disorders) in a general population child cohort. Methods: We collected data as part of the 5- to 7-year-old follow-up of a randomly derived subsample of the Copenhagen Child Cohort 2000. Of the eligible 2912, 1327 (45.6%) children and parents participated in the study. Parents were interviewed using a composite instrument assessing eating behaviors and their impact. Associations with contemporaneous psychopathology were determined using logistic regression. Results: Five eating patterns were identified (good eating/overeating, picky eating, slow/poor eating, delayed eating behaviors, and snacking behaviors); among these, picky eating and slow/poor eating were described as a problem by more than half of parents and they also had high impact. Picky eating was associated with psychopathology across disorders. Emotional undereating was associated with emotional and functional somatic symptoms. A quarter of parents described at least one eating behavior as a problem. Conclusions: Eating behaviors in a general population cohort were differentially associated with impact and psychopathology. Picky eating was highlighted among other behaviors as having negative correlates. Better knowledge of how childhood eating behaviors impact on children and their association with psychopathology will aid adequate assessment and treatment.

Infant behaviors are predictive of functional somatic symptoms at ages 5-7 years: results from the Copenhagen Child Cohort CCC2000.

OBJECTIVE To investigate infancy predictors of impairing functional somatic symptoms (FSS) at child ages 5-7 years with a focus on problems with feeding, sleep, and tactile reactivity. STUDY DESIGN This study is part of a longitudinal birth cohort study, Copenhagen Child Cohort CCC2000. Child health, development, and functioning were assessed by community health nurses at 4 home visits from birth to age 10 months. FSS at ages 5-7 years were measured by the Soma Assessment Interview in 1327 children. Sociodemographic data and information on maternal psychiatric illness were obtained from the Danish National Registers. RESULTS Multiple logistic regression analysis controlled for maternal psychiatric illness and annual household income revealed that combined infancy regulatory problems (ie, at least 2 of 3 problems of feeding, sleeping, or tactile reactivity during the first 10 months of living) predicted impairing FSS at 5-7 years (aOR = 2.9, 95% CI: 1.3-6.6). Maternal psychiatric illness during the childs first year of living was also associated with later child FSS (aOR = 7.1, 95% CI: 1.8-27.8). CONCLUSION Regulatory problems may be an early marker of disturbed sensory reactivity in young children, which together with maternal psychiatric problems, point to possible early risk mechanisms of impairing FSS in childhood.

Can a general health surveillance between birth and 10 months identify children with mental disorder at 1½ year?

UNLABELLED Mental health surveillance in infancy was studied in an existing child health surveillance programme with child psychiatric disorder at 1(1/2) year as the outcome. METHODS Children considered of concern by community health nurses were cases in a case control study nested in the Copenhagen Child Cohort (CCC 2000). Outcome was mental health status at 1(1/2) year assessed by clinical and standardised strategies, including videotape recordings, parent interviews and the instruments: CBCL 1(1/2)-5, ITSCL, CHAT, Bayley Scales of Infant Development II, PC ERA and PIR-GAS. RESULTS The positive predictive value of concern in the first 10 months of living was 24% (CI 17.0-31.9), the negative predictive value was 85% (CI 77.9-89.6) and the sensitivity was 56% (CI 42.4-69.0). Concern about development was significantly associated with the child having a neuro-developmental disorder at 1(1/2) year, and concern about mother-child relationship was associated with emotional, behavioural, eating, and sleeping disturbances. CONCLUSIONS A general health surveillance program seems to have potentials to identify infants at risk for mental health problems provided standardised measures and specific training of the involved health professionals.Mental health surveillance in infancy was studied in an existing child health surveillance programme with child psychiatric disorder at 1½ year as the outcome. Methods Children considered of concern by community health nurses were cases in a case control study nested in the Copenhagen Child Cohort (CCC 2000). Outcome was mental health status at 1½ year assessed by clinical and standardised strategies, including videotape recordings, parent interviews and the instruments: CBCL 1½-5, ITSCL, CHAT, Bayley Scales of Infant Development II, PC ERA and PIR-GAS. Results The positive predictive value of concern in the first 10 months of living was 24% (CI 17.0–31.9), the negative predictive value was 85% (CI 77.9–89.6) and the sensitivity was 56% (CI 42.4–69.0). Concern about development was significantly associated with the child having a neuro-developmental disorder at 1½ year, and concern about mother–child relationship was associated with emotional, behavioural, eating, and sleeping disturbances. Conclusions A general health surveillance program seems to have potentials to identify infants at risk for mental health problems provided standardised measures and specific training of the involved health professionals.

Risk factors for weight faltering in infancy according to age at onset

The aim of this study was to identify risk factors for failure to thrive (FTT) or weight faltering according to age of onset. The study is part of a Danish longitudinal population study of early risk mechanisms in child psychiatric disorders, The Copenhagen Child Cohort, which consists of a birth cohort of 6090 children born during the year 2000 and followed prospectively from birth. Weight faltering/FTT was defined as slow conditional weight gain, and divided into subtypes according to age of onset in the first year of life: birth to 2 weeks, 2 weeks to 4 months, and 4-8 months. Regardless of the age of onset, slow weight gain was found to be strongly associated with feeding problems, but the risk factors involved differed according to age of onset. Thus, onset within the first weeks of life clearly differed from faltering later on, the former being strongly associated with low birthweight and gestational age, with single parenthood and with mother having smoked during pregnancy. Onset between 2 weeks and 4 months was associated with congenital disorders and serious somatic illness, and with deviant mother-child relationship, whereas, onset between 4 and 8 months seemed to represent a group of children with feeding problems arising de novo in otherwise healthy children. In conclusion, weight faltering in infancy is clearly associated with contemporary measured feeding problems, but the risk mechanisms involved differ in early vs. late onset.

The growth pattern of 0–1-year-old Danish children, when screened by public health nurses—The Copenhagen County Child Cohort 2000

Background: Using inadequate growth references when screening child health could lead to false conclusions concerning individual growth. We were concerned that this might apply to the official Danish growth reference. Aim: The study aimed to describe the current growth pattern of 0–1-year-old children in Denmark and compare it with national and international references, especially concerning differences that might cause misclassification regarding growth. Subjects and methods: The study population comprised the Copenhagen County Child Cohort 2000 (CCCC2000) birth cohort, which consisted of 6090 children born during the year 2000. Weight and length measurements were obtained from the National Birth Registry and from standardized records of public health nurses. Anthropometric measurements were available from 99% of the birth cohort. Growth curves were constructed using Coles LMS method. The curves were compared with Danish and international references, including the NCHS, the CDC and the Euro Growth references. Results: The CCCC2000 curves differed from all the chosen references. The CCCC2000 children were heavier and longer and with a substantially higher weight-for-age gain between 1 and 6 months. Shape-wise, the CCCC2000 weight curves resemble the new Euro Growth reference. Conclusions: The degree of differences concerning weight curves is large enough to cause misclassification and there seems to be a need for updated growth curves concerning infancy.

Early Predictors of Childhood Restrictive Eating: A Population-Based Study.

Objective: Childhood eating problems, in particular restrictive eating, are common. Knowledge and understanding of risk mechanisms is still scarce. We aimed to investigate prospective early risk factors for restrictive eating across child, maternal, obstetric, and sociodemographic domains in a population-based sample of Danish 5 to 7 year olds. Method: Data on restrictive eating patterns (picky eating, slow/poor eating, and emotional undereating) collected on 1327 children from the Copenhagen Child Cohort 2000 were linked with registered and routinely collected health nurse data (during the first year of life). Prospective risk factors were investigated in univariable and multivariable regression models. Results: Feeding problems in infancy were prospectively associated with childhood picky eating (odds ratio [OR] = 2.02, 95% confidence interval [CI], 1.20–3.40) and emotional undereating (OR = 1.49, 95% CI, 1.05–2.11). A high thriving index in infancy was inversely associated with both picky and slow/poor eating. Having 2 non-Danish-born parents predicted slow/poor eating (OR = 5.29, 95% CI, 1.16–24.09) in multivariable analyses, as did maternal diagnosis of a psychiatric disorder before child age 5 years in univariable analyses (OR = 6.08, 95% CI, 1.70–21.72). Conclusions: Feeding problems and poor growth in the first year of life show high continuity into childhood restrictive eating. Maternal psychopathology is an important and modifiable risk factor. These findings confirm that early signs of poor eating and growth are persistent and might be useful in predicting eating problems in mid-childhood.

What's in a Self‐report? A Comparison of Pregnant Women with Self‐reported and Hospital Diagnosed Eating Disorder

The aim of this study was to examine how similar pregnant women with self-reported lifetime eating disorder (ED) were to pregnant women with a hospital diagnosis of ED. A total of 83 731 pregnant women enrolled in the Danish National Birth Cohort reported on ED, and by linkage to the Danish health registers, hospital diagnoses of ED were obtained. Characteristics of women with self-reported ED, hospital diagnosed ED and without ED were compared using chi-square tests, t-test and logistic regression models with robust standard errors. In total, 4.8% women reported ED, and 0.5% had a hospital diagnosis of ED recorded in the health registers. Women with self-reported ED were comparable with women with hospital diagnosed ED on most reproductive and health characteristics, while they differed from women without ED concerning all characteristics studied. Our findings highlight that women with self-reported ED have impaired function and adverse health outcomes, consistent with diagnosable ED. Copyright

Eating behaviours in preadolescence are associated with body dissatisfaction and mental disorders – Results of the CCC2000 study

Preadolescence is a key period in the early stages of eating disorder development. The aim of the present study was, firstly, to investigate restrained, emotional and external eating in a general population-based sample of 11-12 year olds. Secondly, we sought to explore how these eating behaviours are associated with possible predictors of eating disorders, such as body dissatisfaction, weight status and mental disorders. A subsample of 1567 children (47.7% boys; 52.3% girls) from the Copenhagen Child Cohort (CCC2000) completed web-based questionnaires on eating behaviours and body dissatisfaction using The Eating Pattern Inventory for Children (EPI-C) and The Childrens Figure Rating Scale. Mental disorders were assessed using the online version of the Development and Well-Being Assessment (DAWBA) based on parental replies with final DSM-IV diagnoses determined by experienced child- and adolescent psychiatrists. Height and weight were measured at a face-to-face assessment. The results showed that restrained eating was significantly associated with overweight, body dissatisfaction and emotional disorders in both genders. Emotional eating showed similar associations with overweight and body dissatisfaction in both genders, but was only associated with mental disorders in girls. External eating was significantly associated with body dissatisfaction and neurodevelopmental disorders in both genders, but was only associated with overweight in girls. Our findings show that problematic eating behaviours can be identified in preadolescence, and co-exist with weight problems and mental disorders. Thus restrained, emotional and external eating was, in different ways, associated with overweight, body dissatisfaction and mental disorders. Our findings point to significant eating behaviours in preadolescence, which could constitute potential predictors of later eating disorder risk.