Preventing overweight and improving parenting skills from birth to age 3 years: preliminary results

Background. Parenting has been associated with child weight status. This study aims to evaluate the effects on parenting skills and BMI-SDS of the BBOFT+ overweight prevention program, compared to care-as-usual (CAU). Method. In a cluster-randomized trial, 2500 parents participated. Parent-reported weight and length were used. Parenting was measured with subscales control and reinforcement of the parenting strategies for eating and activity scale (PEAS) and the warmth subscale from the Child Rearing Questionnaire. Results. The first univariate analyses show that at age 15 months, no statistically significant differences in BMI- SDS, parental control, reinforcement or warmth were found between the BBOFT+ and the CAU group. Further cluster analyses need to be conducted. Results from age 36 months will be presented during the conference, which will include all subscales of the PEAS and an assessment of parenting styles. Conclusion. The intervention does not seem to have an effect on BMI-SDS or parenting

Survey of prevalence of protective and risk factors for SIDS in the Netherlands

BACKGROUND: From 1987 on, surveys have been conducted in the Netherlands to monitor babycare habits and target safe sleeping prevention campaigns. The last survey was conducted in 2011. In the Netherlands, the 2016 incidence of SIDS (R95) was 0.075/1000 live births (n=13); taking into account adjacent categories the SUDI incidence was 0.15/1000 (n=26). This low incidence, the lowest in the Western world, may result in decreased parental awareness of SIDS risks and complacency regarding preventive messages. Therefore, a new survey was conducted. OBJECTIVES: 1) To measure the prevalence of protective and risk factors for SIDS in the Netherlands in 2017 including new customs of babycare. 2) To compare 2011 prevalences with 2017. 3) To investigate why parents do not follow recommendations regarding safe sleep position and location. METHODS: A cross-sectional study was conducted using an online questionnaire (52 questions). The study population encompassed parents/caregivers of infants up to 1 year of age living in the Netherlands. Between February 12 – April 30, 2017, invitations with a link to the questionnaire were distributed to 9000 parents visiting 17 child healthcare organizations. In healthcare centers in socially more deprived neighborhoods research assistants helped parents fill out the online questionnaire. In May and June, invitations to participate were also communicated using social media. We used SPSS 24 to calculate prevalence rates and performed a content analysis of answers on open-ended questions on reasons for not following SIDS prevention advice. RESULTS: In total 1289 questionnaires were filled out, of which 80 were excluded, mostly because the child was too old. The study population was comparable to the Dutch population in terms of sex ratio, preterm infants, and parents with a lower education. First-born infants and parents with a higher education were overrepresented, families with a migration background were underrepresented. Sleeping prone increased from 3.1% of infants when 0-2 months old to 13.6% at 9-11 months. Infants aged 0-2 months slept in a separate room in 31.5%, roomshared with parents in 52.3%, slept in an attached bedside sleeper in 9.7% and with their parent(s) in bed in 6.3%. For age 7-8 months this was respectively 71.2%, 15.2%, 4.0% and 8%. Only 4.5% of infants used a duvet. The typical Dutch sleeping sack (wearable blanket) was used for 55.8% of infants. Only 50% of infants 0-2 months and 23.6% of infants 5-6 months were breastfed exclusively. Of all mothers, 4z had smoked during pregnancy; of all infants 21.3% were exposed to parents’ smoking. CONCLUSIONS: The number of infants that sleep prone is comparable to 2011, with still significant room for improvement. Roomsharing with infants 0-2 months has increased significantly since 2011, but so has bedsharing. These data are important for future preventive campaigns

Evaluation of a training program for general ultrasound screening for developmental dysplasia of the hip in preventive child health care

Background: A research study in the Netherlands showed that general ultrasound (US) screening was cost-effective in the detection of developmental dysplasia of the hip (DDH). This study was followed by a pilot implementation study. Part of this pilot implementation study is to investigate whether professionals of the infant health care (IHC) system, with no previous US experience, would be able to perform US of the hip. Objective: This study looks at health care worker ability to classify US images into a modified Graf system. Materials and methods: After theoretical and practical training, seven nurses and physicians of the participating IHC centers reported their findings on sonographic images of 80 children. This was repeated five months later. From the two evaluation moments the intraobserver agreement and the interobserver agreement was determined. Results: The average estimated interobserver Cohen’s kappa for both sessions was for nurses 0.6 and for physicians 0.5. The second evaluation showed a decrease from an average of 4.3% missed cases per screener to 2.3% and an increase of an average of 5% false positives per screener to 9.1%. Conclusion: The inter- and intra-observer agreement is comparable to similar studies in which the participants had a professional background in US examination. The level of agreement of the trainees in the perspective of the screening process was considered sufficient for the pilot implementation project

A qualitative exploration of factors that facilitate and impede adherence to child abuse prevention guidelines in Dutch preventive child health care

Rationale, aims and objectives In the Netherlands, evidence-based child abuse prevention (CAP) guidelines have been developed to support child health care professionals (CHPs) in recognizing and responding to suspected child abuse. The aim of this study was to identify factors related to characteristics of the guidelines, the user, the organization and the socio-political context that facilitate or impede adherence to the CAP guidelines. Methods Three semi-structured focus groups including 14 CHPs working in one large Dutch child health care organization were conducted in January and February 2012. Participants were asked questions about the dissemination of the guidelines, adherence to their key recommendations and factors that impeded or facilitated desired working practices. The interviews were audiotaped and transcribed. Impeding and facilitating factors were identified and classified. An innovation framework was used to guide the research. Results CHPs mentioned 24 factors that facilitated or impeded adherence to the CAP guidelines. Most of these factors were related to characteristics of the user. Familiarity with the content of the guidelines, a supportive working environment and good inter-agency cooperation were identified as facilitating factors. Impeding factors included lack of willingness of caregivers to cooperate, low self-efficacy and poor inter-agency cooperation. Conclusions The results indicate that a broad variety of factors may influence CHPs' (non-)adherence to the CAP guidelines. Efforts to improve implementation of the guidelines should focus on improving familiarity with their contents, enhancing self-efficacy, promoting intra-agency cooperation, supporting professionals in dealing with uncooperative parents and improving inter-agency cooperation. Recommendations for future research are provide

In-house consultation to support professionals’ responses to child abuse and neglect:Determinants of professionals’ use and the association with guideline adherence

This study examined the presence and strengths of determinants associated with consultation of an in-house expert on child abuse and neglect (CAN) by preventive child health care professionals who suspect CAN. This study also assessed the relationship between in-house CAN expert consultation and professionals’ performance of six recommended activities described in a national guideline on preventing CAN for preventive child health care professionals. A total of 154 professionals met the study’s inclusion criteria. They filled in a questionnaire that measured in-house consultation practices and twelve determinants associated with the professional, the in-house expert, and the organizational context. Bivariate and multivariate regression analyses were performed. Almost half of the participants (46.8%) reported to consult the in-house expert in (almost) all of their suspected CAN cases. Professionals who reported better recollection of consulting the in-house expert (i.e. not forgetting to consult the expert) (p = .001), who were more familiar with consultation (p = .002), who had more positive attitudes and beliefs about consultation (p = .011) and who reported being more susceptible to the behavior (p = .001) and expectations/opinions (p = .025) of colleagues regarding in-house expert consultation were more likely to consult the in-house expert. Furthermore, in-house expert consultation was positively associated with two of six key guideline activities: consulting the regional child protection service and monitoring whether support was provided to families. The implications of these results for improving professionals’ responses to CAN are discussed

Overgewicht en obesitas bij jonge kinderen (0-4 jaar): gedrag en opvattingen van ouders

Doel. Beschrijven van risicogedrag en opvattingen over voeding, beweging en opvoeding in gezinnen met jonge kinderen, in relatie tot specifieke risicogroepen voor overgewicht. Opzet. Dwarsdoorsnedeonderzoek. Methode. Op consultatiebureaus voor zuigelingen en peuters verspreid over het land werden 534 ouders benaderd voor het invullen van vragenlijsten over voeding, beweging en opvoeding. Er werd gevraagd naar achtergrondkenmerken en ook werd een aantal stellingen getoetst. Via een bivariate en multivariate analyse werd per stelling onderzocht of de antwoorden gekoppeld waren aan specifieke risicogroepen. Resultaten. De respons bedroeg 73 (390 ouders). Bij 15 van de 2-4-jarigen was er sprake van overgewicht, inclusief 3,7 met obesitas. De ouders hadden relatief vaak opvattingen en gedragingen die kenmerkend zijn voor een ongezonde leefstijl van jonge kinderen. Zo was men in 1 op de 7 gezinnen niet gewend om te ontbijten. Van de respondenten beschouwde 43 gezoete melkdrank als een goede vervanger voor melk en had 39 van de kinderen altijd frisdrank binnen handbereik. Een vijfde van de ouders gaf aan niet voldoende tijd te hebben om met hun kind naar buiten te gaan. Ongeveer 1 op de 10 peuters van 2-4 jaar had een tv op de eigen kamer; 22 mocht zelf bepalen of hij of zij tv keek en 9 hoelang dat gebeurde. Vooral in gezinnen met niet-westerse moeders, laagopgeleide moeders of moeders met een uitkering kwamen deze specifieke risicogedragingen frequenter voor. Het gebruikmaken van kinderopvang of peuterspeelzaal leek op enkele punten beschermend te werken. Conclusie. In gezinnen met kinderen van 0-4 jaar kwam frequent gedrag voor dat op latere leeftijd in verband staat met overgewicht. Gezien de toename van overgewicht en obesitas bij jonge kinderen is het starten van onderzoek waarin opvoeding wordt geoptimaliseerd gerechtvaardigd, met speciale aandacht voor het gedrag van ouders ten aanzien van 5 speerpunten: borstvoeding, meer buiten spelen en bewegen, regelmatig en goed ontbijten, minder consumeren van gezoete drank en minder tv-kijken en computeren. Door interventies in te zetten bij jonge leeftijdsgroepen kan worden voorkomen dat ongezonde leef- en opvoedingsstijlen ontstaa

Rechtstreeks verwijzen door de jeugdarts bij verdenking op heupdysplasie: het perspectief van ouders

Doel: Rechtstreeks verwijzen door de jeugdarts naar de tweede lijn lijkt zinvol bij verdenking op heupdysplasie. Screening op heupdysplasie vindt plaats door lichamelijk onderzoek en de identificatie van risicofactoren. Echografische screening blijkt medisch en economisch gezien te leiden tot betere uitkomsten. Als onderdeel van een studie naar de haalbaarheid van implementatie van echografische screening in Nederland is onderzocht hoe ouders het verwijstraject beoordelen afhankelijk van de manier waarop zij naar de orthopaedisch chirurg zijn verwezen - rechtstreeks of via de huisarts - bij verdenking op heupdysplasie. Methode: Een vragenlijst is ontwikkeld om de ervaring van ouders die verwezen zijn te meten. In totaal is de vragenlijst gestuurd naar 355 ouders van kinderen die verwezen zijn tussen januari 2008 en november 2008. Resultaten: De respons op de vragenlijst was 46,5%. Ouders waren meer tevreden wanneer zij door de jeugdarts rechtstreeks waren verwezen dan wanneer dat via de huisarts plaatsvond. De tijd tussen de verwijzing en de eerste afspraak bij de orthopaedisch chirurg was korter als kinderen rechtstreeks werden verwezen. Tot slot waren ouders meer tevreden als zij het verwijstraject als niet stressvol ervoeren en als het traject soepel verliep. Conclusie: Gebaseerd op de perceptie van ouders, geeft dit onderzoek een eerste indicatie dat, met inachtneming van een aantal belangrijke randvoorwaarden, rechtstreeks verwijzen in het geval van heupdysplasie wenselijk is