Child development - issues in early detection

Child development is a complex, non-linear process affected by multiple factors. In addition, there is a large degree of individual variation. Developmental delay is present when a child does not reach developmental milestones at the expected age (with adequate leeway for the broad variation among normal children). Although delay may result primarily from a biological factor such as a chromosomal disorder, or an environmental factor such as maternal depression, the principal model for the causes of developmental delay is a ‘transactional’ one. The process of development is viewed as a transaction between the child and the environment, in which each can have profound effects on the other. About 15% of children have developmental delay. Many, however, are not detected before commencing school, mainly because the disabilities are mild or because they relate to tasks only then attempted by the child. Of the 15%, a much smaller proportion has more severe disability. This group is more likely to present earlier because of the severity of their problems, because there is more often an associated medical condition, and because a number of them (such as those with extreme prematurity) are picked up by at-risk screening programs.&nbsp

Building early detection systems for child development problems and normal toddler eating

There is substantial research about the importance of identifying problems early, before they become entrenched. Intervening early in the course of a condition or problem increases the chance of there being a positive outcome; the earlier intervention is commenced, the more likely it is to be effective and less expensive.  Since early childhood is a time of rapid development in many domains (especially cognition, language, and social-emotional development), delay or dysfunction in these domains at this age is a strong predictor of problems at school and beyond. While significant developmental delay and serious health problems are usually detected in the first years of life, more subtle problems, especially of development and behaviour, are often not detected until the child is entering preschool, or until he/she begins school.  -------------------------- Feeding young children a healthy diet can be a challenge. Common problems may emerge later in the second year even in children who ate well previously. The developmental progress of the child will influence eating behaviours, with increasing independence and control played out at the dinner table. A decrease in growth velocity after the first year also means the quantity of food required relative to the child’s body size is reduced. To ensure enjoyable and healthy long term eating patterns, parents of toddlers need to make adjustments for the physical, social and emotional needs of their child. Many toddlers are picky eaters and food often becomes a source of conflict. Some commonly expressed concerns about toddler eating include: Multiple food dislikes, even when they have previously enjoyed a food A refusal to try new foods – \u27food neophobia\u27 A refusal to increase the texture of foods and gagging or lack of chewing. A preference for fluids and minimal solids Eating little at some meals Meal time tantrums  Getting up and down from the table frequently Needing to be bribed or distracted to eat It is uncommon for these behaviours to result in growth faltering or nutritional deficiencies in the short term. The recognition that early development of poor eating habits may progress and impact on the incidence of diet related lifestyle diseases means parents should manage these behaviours in a positive and effective way early on.&nbsp

Associations between early childhood temperament clusters and later pychosocial adjustment

The study adopted a person-centered approach to examine whether clusters of children could be identified on the basis of temperament profiles assessed on four occasions from infancy to early childhood, and if so whether differing temperament clusters were associated with subsequent differences in behavior problems, social skills, and school adjustment in middle and late childhood. Parent, teacher, and self-report data were obtained from a large community-based cohort sample of Australian children, followed prospectively from infancy to late childhood. Four temperament clusters were identified. Children in the clusters labeled as reactive/inhibited and poor attention regulation tended to have higher levels of later behavior problems than children in clusters labeled nonreactive/outgoing and high attention regulation. Results suggested that a person-oriented clustering approach can identify children on the basis of early temperament who are at greater risk for behavioral, academic, and social difficulties four to eight years later.<br /

Parent-centred and culturally-competent literacies for health promotion with newly arrived African communities : a literature review

When considering culturally competent health literacy in newly arrived communities the following key concepts are important: Health literacy and literacy - People practice and use literacy in many ways. People use text or the written word, oral literacy (or the spoken word), visual literacy (or images) and technological literacy (through the use of information and communication technologies). They also draw on other people who mediate health-related information. People’s identities and their access to social networks shape their use of literacy practices and their engagement with health promoting activities. Literacy practices are not static. Initiatives to improve health literacy need to be responsive to the social context (e.g. migration experience; life history; gender; ethnicity; religion; life stage; education) and integrate expertise from both the health promotion and the adult literacy fields. Collectivism and authoritarianism - Most western cultures, such as Australia, support an environment that promotes individualism. With parenting, this translates to parenting styles that place high priority on children’s autonomy, individual achievement, self-expression and egalitarianism. However, African (and other) cultures place a high priority on collectivism and authoritarianism as the norm. Authoritarianism is characterized by the imposition of an absolute set of standards, the valuing of obedience and respect for authority. In this sense the collectivist cultures discourage self-assertion and autonomy, and the goal of parenting is the promotion of interdependence, cooperation, compliance without discussion, and inhibition of personal wishes. Acculturation - Acculturation of immigrants and refugees is a complex and dynamic interaction that takes place between groups settling in the host country and the people, culture, environment, politics and systems of the new country. The impact of acculturation on the health and wellbeing of new arrivals is significant and there are several models of acculturation described in the literature. A way to support health appears to be through a combination of maintenance of beneficial traditional elements of life as well as adopting useful host cultural skills. Cultural competence - The literature frames ‘cultural competence’ as the evolution of the terms cultural sensitivity and cultural awareness. The concept is important as it shifts focus from the individual to the organisation and systems. The ethos of cultural competence is a reflective practice and ongoing process of learning, valuing and interacting crossculturally at an individual, organisation and system level

Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomised controlled trial

OBJECTIVE: To examine whether behavioural strategies designed to improve children\u27s sleep problems could also improve the symptoms, behaviour, daily functioning, and working memory of children with attention deficit hyperactivity disorder (ADHD) and the mental health of their parents. DESIGN: Randomised controlled trial. SETTING: 21 general paediatric practices in Victoria, Australia. PARTICIPANTS: 244 children aged 5-12 years with ADHD attending the practices between 2010 and 2012. INTERVENTION: Sleep hygiene practices and standardised behavioural strategies delivered by trained psychologists or trainee paediatricians during two fortnightly consultations and a follow-up telephone call. Children in the control group received usual clinical care. MAIN OUTCOME MEASURES: At three and six months after randomisation: severity of ADHD symptoms (parent and teacher ADHD rating scale IV-primary outcome), sleep problems (parent reported severity, children\u27s sleep habits questionnaire, actigraphy), behaviour (strengths and difficulties questionnaire), quality of life (pediatric quality of life inventory 4.0), daily functioning (daily parent rating of evening and morning behavior), working memory (working memory test battery for children, six months only), and parent mental health (depression anxiety stress scales). RESULTS: Intervention compared with control families reported a greater decrease in ADHD symptoms at three and six months (adjusted mean difference for change in symptom severity -2.9, 95% confidence interval -5.5 to -0.3, P=0.03, effect size -0.3, and -3.7, -6.1 to -1.2, P=0.004, effect size -0.4, respectively). Compared with control children, intervention children had fewer moderate-severe sleep problems at three months (56% v 30%; adjusted odds ratio 0.30, 95% confidence interval 0.16 to 0.59; P&lt;0.001) and six months (46% v 34%; 0.58, 0.32 to 1.0; P=0.07). At three months this equated to a reduction in absolute risk of 25.7% (95% confidence interval 14.1% to 37.3%) and an estimated number needed to treat of 3.9. At six months the number needed to treat was 7.8. Approximately a half to one third of the beneficial effect of the intervention on ADHD symptoms was mediated through improved sleep, at three and six months, respectively. Intervention families reported greater improvements in all other child and family outcomes except parental mental health. Teachers reported improved behaviour of the children at three and six months. Working memory (backwards digit recall) was higher in the intervention children compared with control children at six months. Daily sleep duration measured by actigraphy tended to be higher in the intervention children at three months (mean difference 10.9 minutes, 95% confidence interval -19.0 to 40.8 minutes, effect size 0.2) and six months (9.9 minutes, -16.3 to 36.1 minutes, effect size 0.3); however, this measure was only completed by a subset of children (n=54 at three months and n=37 at six months). CONCLUSIONS: A brief behavioural sleep intervention modestly improves the severity of ADHD symptoms in a community sample of children with ADHD, most of whom were taking stimulant medications. The intervention also improved the children\u27s sleep, behaviour, quality of life, and functioning, with most benefits sustained to six months post-intervention. The intervention may be suitable for use in primary and secondary care.Trial registration Current Controlled Trials ISRCTN68819261

Population health and wellbeing: identifying priority areas for Victorian children

BackgroundPopulation health information, collected using soundly-designed methodologies, is essential to inform policy, research, and intervention programs. This study aimed to derive policy-oriented recommendations for the content of a health and wellbeing population survey of children 0&ndash;12 years living in Victoria, Australia.ResultsQualitative interviews were conducted with 54 academic and policy stakeholders, selected to encompass a wide breadth of expertise in areas of public health and inter-sectoral organisations relevant to child health outcomes, including universities, government and non-government agencies across Victoria. These stakeholders were asked to provide advice on strategic priorities for child health information (data) using a structured interview technique. Their comments were summarised and the major themes were extracted. The priority areas of health and wellbeing recommended for regular collection include obesity and its determinants, pregnancy and breastfeeding, oral health, injury, social and emotional health and wellbeing, family environment, community, health service utilisation, illness, and socioeconomic position. Population policy questions for each area were identified.ConclusionIn contrast to previous population survey programs nationally and internationally, this study sought to extract contemporary policy-oriented domains for inclusion in a strategic program of child health data collection, using a stakeholder consultation process to identify key domains and policy information needs. The outcomes are a rich and relevant set of recommendations which will now be taken forward into a regular statewide child health survey program.<br /

The Australian temperament project: the first 30 years

The Australian Temperament Project (ATP) is a longitudinal study of the psychosocial development of a large and representative sample of Australian children born in the state of Victoria, Australia between September 1982 and January 1983.The study aims to trace the pathways to psychosocial adjustment and maladjustment across the lifespan, and to investigate the contribution of personal, family and environmental factors to development and wellbeing.<br /

Study protocol: the sleeping sound with attention-deficit/hyperactivity disorder project

<p>Abstract</p> <p>Background</p> <p>Up to 70% of children with Attention-Deficit/Hyperactivity Disorder (ADHD) experience sleep problems including difficulties initiating and maintaining sleep. Sleep problems in children with ADHD can result in poorer child functioning, impacting on school attendance, daily functioning and behaviour, as well as parental mental health and work attendance. The Sleeping Sound with ADHD trial aims to investigate the efficacy of a behavioural sleep program in treating sleep problems experienced by children with ADHD. We have demonstrated the feasibility and the acceptability of this treatment program in a pilot study.</p> <p>Methods/Design</p> <p>This randomised controlled trial (RCT) is being conducted with 198 children (aged between 5 to 12 years) with ADHD and moderate to severe sleep problems. Children are recruited from public and private paediatric practices across the state of Victoria, Australia. Upon receiving informed written consent, families are randomised to receive either the behavioural sleep intervention or usual care. The intervention consists of two individual, face-to-face consultations and a follow-up phone call with a trained clinician (trainee consultant paediatrician or psychologist), focusing on the assessment and management of child sleep problems. The primary outcome is parent- and teacher-reported ADHD symptoms (ADHD Rating Scale IV). Secondary outcomes are child sleep (actigraphy and parent report), behaviour, daily functioning, school attendance and working memory, as well as parent mental health and work attendance. We are also assessing the impact of children's psychiatric comorbidity (measured using a structured diagnostic interview) on treatment outcome.</p> <p>Discussion</p> <p>To our knowledge, this is the first RCT of a behavioural intervention aiming to treat sleep problems in children with ADHD. If effective, this program will provide a feasible non-pharmacological and acceptable intervention improving child sleep and ADHD symptoms in this patient group.</p> <p>Trial Registration</p> <p>Current Controlled Trials ISRCTN68819261.</p> <p> ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN68819261">ISRCTN68819261</a></p

Vitamin K and atopic eczema

Vitamin K has been routinely given to newborn infants in Australia for several decades. It has been administered soon after birth to prevent Haemorraghic Disease of the Newborn (HDN), a rare but potentially fatal bleeding disorder which may present in the first few months of life. Following a 1992 report in the British Medical Journal suggesting that children given intramuscular Vitamin K had a two fold risk of cancer compared to those given Vitamin K orally or not at all, an expert panel was established to respond to the findings. Atopic eczema is a common skin condition affecting about 3% of children, however approximately 85% of children will grow out of eczema by 5 years of age