Frank Ramsey

The Influence of Early Malnutrition on Subsequent Behavioral Development: II. Classroom Behavior

The classroom behaviors of 129 Barbadian children (77 boys and 52 girls) aged 5 to 11 years, who suffered from moderate-severe protein-energy malnutrition in the first year of life were compared with those observed in children with no history of malnutrition. The data were gathered from questionnaires administered to teachers who were unaware of the childs previous nutritional history. The results demonstrated that the previously malnourished children had attention deficits, reduced social skills, poorer physical appearance and emotional instability when compared to the matched comparison children. These behavioral deficits associated with prior malnutrition were independent of IQ and were experienced to a greater extent by boys. Socioeconomic conditions at the time of the study contributed little to the behavioral deficits of the previously malnourished children, as compared with the large contribution of the history of early malnutrition or the conditions producing it.

The Influence of Early Malnutrition on Subsequent Behavioral Development: I. Degree of Impairment in Intellectual Performance

The intellectual performance of 129 Barbadian children (52 girls and 77 boys), aged 5 to 11 years, with histories of moderate to severe protein-energy malnutrition in the first year of life was compared to that of matched comparison cases with no such history, using a modified version of the WISC. IQ scores of boys and girls with a history of malnutrition were significantly lower than those of the comparison children. IQ was examined in relation to current socioeconomic conditions of the family, including degree of crowding, income and physical resources of the home. In this study, socioeconomic differences between the two groups were not significantly associated with the reduction in IQ performance. This study supports the important relationship between the early history of malnutrition and conditions associated with this event with later IQ deficits at school age.

Maternal Depressive Symptoms Affect Infant Cognitive Development in Barbados

This longitudinal study is part of a series examining the relationships between maternal mood, feeding practices, and infant growth and development during the first 6 months of life in 226 well-nourished mother-infant dyads in Barbados. In this report, we assessed maternal moods (General Adjustment and Morale Scale and Zung Depression and Anxiety Scales), feeding practices (scales describing breast-feeding and other practices associated with infant feeding in this setting), and infant cognitive development (Griffiths Mental Development Scales). Multivariate analyses, with and without controlling for background variables, established significant relationships between maternal moods and infant cognitive development. Infants of mothers with mild moderate depression had lower Griffiths scores than infants of mothers without depression. Maternal depressive symptoms and lack of trust at 7 weeks predicted lower infant social and performance scores at 3 months. Maternal moods at 6 months were associated with lower scores in motor development at the same age. Although no independent relationships emerged between feeding practices and infant cognitive development, the combination of diminished infant feeding intensity and maternal depression predicted delays in infant social development. These findings demonstrate the need to carefully monitor maternal moods during the postpartum period, in order to maximize the benefits of breast-feeding and related health programs to infant cognitive development.

Maternal moods predict breastfeeding in Barbados.

This study was designed to identify psychosocial variables affecting early infant feeding practices in Barbados. The sample included 93 healthy women and infants born at the Queen Elizabeth Hospital who were extensively evaluated 7 weeks, 3 months, and 6 months after birth. Maternal moods were assessed with the Zung Depression and Anxiety Scales and the General Adjustment and Morale Scale. Feeding practices were evaluated using a questionnaire developed for this population. The prevalence of mild depression in this population was 16% at 7 weeks and increased to 19% at 6 months, whereas there were very few cases of moderate-to-severe depression. Disadvantaged environmental conditions, including less information-seeking by the mother, lower family income, and poor maternal health, were closely associated with increased symptoms of depression and anxiety in all women. However, significant predictive relationships between mood and feeding practices remained even when the effects of the home environment were controlled. Specifically, depressive symptoms at 7 weeks postpartum predicted a reduced preference for breastfeeding at current and later infant ages. Conversely, feeding practices did not predict maternal moods at later ages. These findings have important implications for public policy dealing with programs promoting breastfeeding. Early interventions designed to treat mild postnatal depression should be instituted early in the postpartum period to improve the chances for successful breastfeeding.

A Follow-up Study of the Influence of Early Malnutrition on Development: Behavior at Home and at School

A follow-up study of home and classroom behavior was conducted on 216 children, 9 through 15 years of age, half of whom had histories of moderate-severe protein energy malnutrition (marasmus) during the first year of life. Behavior was measured by two rating scales, administered to teachers and parents of the children. Observations made by teachers and parents were significantly correlated on 33% of the 41 overlapping items in the two questionnaires. The history of malnutrition had a significant association with attention deficits in children up to 15 years reported by parents and teachers, even when the effects of socioeconomic and home environmental factors were controlled. It was concluded that interventions specifically focussed on these attentional deficits should be considered early in life for children exposed to infantile malnutrition in order to prevent behavioral disorders in adolescence.

The Influence of Early Malnutrition on Subsequent Behavioral Development III. Learning Disabilities as a Sequel to Malnutrition

Summary: The academic performance of 129 Barbadian children (77 boys and 52 girls), who were 5-11-yr-old and suffered moderate to severe protein-energy malnutrition in the first year of life, was compared with the performance of matched comparisons, children who had no history of malnutrition. Children with a history of malnutrition were found to have lower performance on eight out of nine academic subject areas, namely, language arts, mathematics, general science, social science, reading, health, religion, and arts/crafts. Socioeconomic factors in the backgrounds of the children were also examined. A model is presented clarifying the interrelationships of malnutrition, socioeconomic status and school performance. Reduced school performance in the previously malnourished children can be largely accounted for by deficits in classroom behavior, and, to a lesser extent by a reduction in I.Q. Current socioeconomic status is not directly involved in altering academic performance whereas the early history of malnutrition and its accompanying conditions at the time of the illness are leading contributors to altered behavioral outcome and school performance.

The Long-Term Effects of Early Kwashiorkor Compared with Marasmus. IV. Performance on the National High School Entrance Examination

ABSTRACT: This is one of a series of studies on the long-term effects of early childhood malnutrition in Barbadian school children. This is the first report of the relationship between early malnutrition and later performance on a national examination administered to all 11-y-old children in Barbados to assign high school seats. We compared scores achieved on the 11-plus examination by 103 boys and girls with histories of marasmus or kwashiorkor with those obtained by 63 healthy comparison children and also with scores obtained by the total island population of children during the same years. We report that children with histories of either type of malnutrition confined to infancy had significantly lower scores on the national high school examination than healthy comparison children. Reduced 11-plus scores were closely associated with teacher reports of attention deficits in the classroom documented when the children were as young as 5 to 8 y of age and also with IQ and academic performance. Early malnutrition had independent effects on performance on the 11-plus examination even when home environmental conditions were controlled for. These findings have important implications for future opportunities available to children with histories of infantile malnutrition.

Long-term effects of early kwashiorkor compared with marasmus. II. Intellectual performance

Intellectual performance including IQ (Wechsler Intelligence Scale for Children-Revised) and conservation was measured at ages 11-18 years in a follow-up study of Barbadian girls and boys who had histories of kwashiorkor (n = 53) or marasmus (n = 55) in their first year of life. They were compared with healthy neighborhood children matched by sex and age who had normal patterns of growth in early childhood (n = 58). On both IQ and conservation tests, children with previous kwashiorkor or marasmus had similar scores, which were significantly lower than scores of healthy comparison children. These findings were examined in relationship to current environmental conditions, which were similar in children with histories of kwashiorkor or marasmus and somewhat less advantaged than those of the comparison children. The effect of early malnutrition and related conditions at the time of episode still emerged as significant even when the current environmental factors were controlled for.

Long-term effects of early kwashiorkor compared with marasmus. I. Physical growth and sexual maturation.

Summary Physical growth and sexual maturation were measured in a follow-up study of Barbadian girls and boys aged 11–18 years with histories of kwashiorkor (n 54) or marasmus (n 56) in their first year of life. They were compared with healthy neighborhood children matched by sex and age who had normal patterns of growth in early childhood (n 59). Girls with histories of marasmus hail significant delays in the onset of menarche compared with healthy comparison girls. However, their rate of growth during the previous 2 years was accelerated, and the differences in size were smaller than at the earlier testing, confirming catch-up. This pattern was not evident for girls with histories of kwashiorkor, who did not differ from the healthy comparison girls on either onset of menarche. Tanner ratings of sexual maturation, or measures of physical growth. In contrast, boys with histories of kwashiorkor or marasmus did not differ from healthy comparison boys in physical growth or Tanner ratings at these ages.

The influence of early malnutrition on subsequent behavioral development. IV. Soft neurologic signs.

Summary: Soft neurologic signs were evaluated in 101 Barbadian school children, ages 4-11 years, who were malnourished in the first year of life, and 101 comparison children matched for age, sex, and handedness, but who had no history of malnutrition. Previously malnourished children performed significantly slower than comparison children on several timed motor tasks when using the nondominant hand only. Boys were found to perform significantly slower than girls, and younger (4-7 years of age) children performed slower than older (8-11 years of age) children. A model is presented that displays interrelationships among previous malnutrition, soft neurologic signs, classroom behavior, intelligence, and physical growth. In summary, slow motor performance was associated with lower verbal and performance IQ and the presence of attention deficit disorder, as assessed by the childs teacher. The time to perform the motor tests was unrelated to measures of physical growth.