Predictors of early life milestones: Results from the Copenhagen Perinatal Cohort

Predictors of early child development for screening pregnant women most in need of support in Brazil

Background

Home visiting programmes can support child development and reduce inequalities, but failure to identify the most vulnerable families can undermine such efforts. We examined whether there are strong predictors of poor child development that could be used to screen pregnant women in primary health care settings to target early interventions in a Brazilian population. Considering selected predictors, we assessed coverage and focus of a large-scale home visiting programme named Primeira Infância Melhor (PIM).

Methods

We undertook a prospective cohort study on 3603 children whom we followed from gestation to age four years. We then used 27 potential socioeconomic, psychosocial, and clinical risk factors measurable during pregnancy to predict child development, which was assessed by the Battelle Developmental Inventory (BDI) at the age of four years. We compared the results from a Bonferroni-adjusted conditional inference tree with exploratory linear regression and principal component analysis (PCA), and we conducted external validation using data from a second cohort from the same population. Lastly, we assessed PIM coverage and focus by linking 2015 cohort data with PIM databases.

Results

The decision tree analyses identified maternal schooling as the most important variable for predicting BDI, followed by paternal schooling. Based on these variables, a group of 214 children who had the lowest mean BDI (BDI = -0.48; 95% confidence interval (CI) = -0.63, -0.33) was defined by mothers with ≤5 years and fathers with ≤4 years of schooling. Maternal and paternal schooling were also the strongest predictors in the exploratory analysis using regression and PCA, showing linear associations with the outcome. However, their capacity to explain outcome variance was low, with an adjusted R2 of 5.3% and an area under the receiver operating characteristic curve of 0.62 (95% CI = 0.60, 0.64). External validation showed consistent results. We also provided an online screening tool using parental schooling data to support programme's targeting. PIM coverage during pregnancy was low, but the focus was adequate, especially among families with longer enrolment, indicating families most in need received higher dosage.

Conclusions

Information on maternal and paternal schooling can improve the focus of home visiting programmes if used for initial population-level screening of pregnant women in Brazil. However, enrolment decisions require complementary information on parental resources and direct interactions with families to jointly decide on inclusion.

Socio-familial environment influence on cognitive and language development in very preterm children

BACKGROUND

Preterm children are at increased risk of cognitive and language delay compared with term-born children. While many perinatal factors associated with prematurity are well established, there is limited research concerning the influence of the socio-familial environment on the development of preterm children. This study aims to assess the relative impact of perinatal and socio-familial risk factors on cognitive and language development at 2 years corrected age (CA).

METHOD

This retrospective cross-sectional study included preterm infants with a gestational age <32 weeks and/or a birth weight <1500 g, who underwent neurodevelopmental assessment at 2 years CA. Cognitive and language scores were assessed using the Bayley Scales of Infant-Toddler Development, third edition. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated using a multivariable model to examine the relationship between developmental delays and perinatal and socio-familial factors.

RESULT

The prevalence of language delay was negatively associated with daycare attendance (aOR: 0.25, 95% CI: 0.07-0.85, p < 0.05) and high maternal educational levels (aOR: 0.24, 95% CI: 0.05-0.93, p < 0.05) and positively associated with bilingual environments (aOR: 5.62, 95% CI: 1.46-24.3, p < 0.05). Perinatal and postnatal risk factors did not show a significant impact on cognitive or language development.

CONCLUSION

The development of language appears to be more influenced by the socio-familial environment than by early perinatal and postnatal factors associated with prematurity. These findings highlight the importance of considering socio-familial factors in the early identification and intervention of language delay among preterm children.

Early child development and its determinants: Findings from a large cohort of healthy children growing up in a low-risk environment

BACKGROUND

Despite numerous studies on early child development, there is still much to be discovered about the significance of possible risk factors. This study examines cognitive, motor, and language development of healthy children growing up in a low-risk environment and how various individual and environmental factors are associated with it. The study also considers whether the importance of particular parameters changes depending on child age.

METHODS

Within the framework of the LIFE Child study in Leipzig, Germany, 481 children participated in a total of 832 visits between 1 and 36 months of age. Developmental status was assessed using the Third Edition of the Bayley Scales of Infant and Toddler Development. Linear regression analyses were applied to examine the associations between child development and sex, gestational age, birth weight, birth mode, overweight, height, and parental education.

RESULTS

Mean Bayley composite scores for cognitive, language, and motor development were close to the standard value of 100. Poorer developmental outcomes were significantly associated with lower gestational age, vacuum cup/forceps birth, being overweight, small height, and lower parental education, although some of the associations became insignificant after applying multivariate models. While the association between gestational age and language development became weaker with advancing age, our interaction models found disparities related to parental education to become more apparent in older children across all three domains of early child development.

CONCLUSIONS

Several factors were identified to be associated with early child development. As children grow older, obstetric parameters, for example, gestational age, might become less relevant compared with sociodemographic factors, for example, parental education.

Vulnerabilities Prompting Use of Technology and Screen by Mothers of Autistic Children in India: Lived Experiences and Comparison to Scientific Literature

Technology and screen media has its place in every home, yet the influences of the same are less known. This research aims to explore the vulnerabilities that prompt the mothers to use screen media for their children, prior to a diagnosis of autism for their child. It also aims to explore literature the influence of screen media on speech and language development in children. This study combined semi-structured interviews with 16 mothers of autistic children in Southern India and a scoping literature review that resulted in 24 articles. The literature refers to a positive influence when co-viewing with the child, and it predominantly highlights improvements in speech and not in language. The interviews revealed that screens were used as a means of support, a language and learning development tool, or as a calming technique. Thus, the study shows that the mothers resorted to screen use for their children more out of helplessness, and not as an informed choice. Mothers of autistic children clearly express their vulnerabilities and indicate feelings of being lost without advice, with regard to use of screen-time. This suggests a need for more research into how they can be supported.

Child health screening program in French nursery schools: Results and related socioeconomic factors

Objectives

The study aims to describe the output of routine health screening performed in French nursery schools by the maternal and child health services among children aged 3-4 years and to quantify the level of early socioeconomic health disparities.

Methods

In 30 participating départements, data on screening for vision and hearing impairments, overweight and thinness, dental health, language, psychomotor development, and immunizations were collected for children born on specific dates in 2011 and enrolled in nursery school in 2014-2016. Information was collected on the children, their socioeconomic characteristics and on the school attended. Odds of abnormal screening results were compared for each socioeconomic factor by logistic regressions adjusted for age, sex, prematurity and bilingualism.

Results

Among the 9,939 children screened, prevalence of disorders was 12.3% for vision, 10.9% for hearing, 10.4% for overweight, 7.3% for untreated caries, 14.2% for language and 6.6% for psychomotricity. Newly detected visual disorders were more frequent in disadvantaged areas. Children with unemployed parents were three time more likely to have untreated caries and twice as likely to present language or psychomotor impairments; 52% were referred to a health professional following screening compared to 39% of children with employed parents. Except for children in disadvantaged areas, vaccine coverage was lower among disadvantaged groups.

Conclusion

The prevalences of impairments, which are higher among disadvantaged children, highlight the potential preventive impact of systematic screening under the comprehensive maternal and child healthcare program. These results are important to quantify early socioeconomic inequalities in a Western country known for its generous social welfare system. A more holistic approach to child health is needed with a coherent system involving families and aligning primary care, local child health professionals, general practitioners, and specialists. Further results are needed to evaluate its impact on later child development and health.

Achievement of Developmental Milestones Recorded in Real Time: A Mobile App-Based Study

OBJECTIVE

To clarify the characteristics of milestone achievement of Japanese infants using data assessed and recorded in real time via a Web-based app by caregivers.

STUDY DESIGN

Between 2014 and 2019, the achievement of developmental milestones of 16 627 Japanese infants were recorded via the mobile app Papatto Ikuji along with pertinent information including sex, birth date, anthropometric measurements, and information on feeding. The milestones consisted of 20 items belonging to 4 domains: personal-social, fine motor-adaptative, language, and gross motor. The distribution of age at milestone achievement was compared with 4 conventional normative data. Subgroup analyses according to sex, season of birth, and feeding methods were performed with restricted mean survival time analysis.

RESULTS

Age distributions of milestone achievement were generally similar in the app-based and conventional data. The exception was "Smile responsively," for which the age at achievement seemed higher in the app-based data. Subgroup analyses showed female-dominant sex differences in the achievement of person-social and language milestones. The results also showed seasonality in achievement of gross motor milestones, with earlier achievement in infants born in winter compared with those born in summer.

CONCLUSIONS

We describe mobile app-based data on developmental milestone achievements that were recorded in real time. The app-based data were generally comparable with conventional normative data, suggesting that its potential to assess the development of children in real time. This could be used complementarily with the current well-child visits at scheduled time points.

The Role of the Maternal and Child Health Handbook in Developmental Surveillance: The Exploration of Milestone Attainment Trajectories

Despite the pivotal role of developmental surveillance in pediatric practice for the early detection of neurodevelopmental disorders (NDDs), there are several barriers, including scarcity of time and staff availability, to its implementation. Additionally, inadequate parental knowledge on what to expect about their child's development contributes to potential delays in the early identification of NDDs. Home-based records (HBRs) are widely used in both high-income and low- and middle-income countries, allowing caregivers to prospectively chart the child's development, including milestone attainment, and thus can be a useful tool for developmental surveillance. Therefore, we analyzed data on milestone attainment from birth to 5 years of age obtained through the home-based records (the Maternal Child Health Handbook: MCHH) in 720 children who attended the Hirosaki Five-year-old children Developmental Health Check-up Study in Hirosaki, Japan to identify trajectory patterns of milestone attainment. Parallel process latent class growth analysis on four milestone domains (motor, social interaction, communication, and self-care) revealed three different trajectories (Class 1: "Consistent milestone attainment" group; 42%, Class 2: "subtle initial delay and catch-up" group; 45%, Class 3: "Consistent failure to attain expected milestones" group; 13%). In Class 3, 90% of children were diagnosed with at least one NDDs at age 5 and approximately 65% of children had autism spectrum disorder and/or intellectual disability, the rate of which was higher than that in the other two classes. Boys and preterm-born children were more likely to be assigned to classes with less favorable trajectories of milestone attainment. Although the use of the MCHH alone does not substitute diagnostic evaluation for NDDs, our study findings suggest the potential utility of the MCHH as a tool to educate parents on what longitudinal patterns of milestone attainment are concerning and require prompt visits to professionals.

Double Jeopardy in Contemporary China: Intersecting the Socioeconomic Gradient and Geographic Context on Early Childhood Development

Family socioeconomic status (SES) differences in early childhood development (ECD) are well documented, as are the neighborhood effects in early development outcomes. However, little is known about whether the SES gradient in ECD outcomes varies across geographic contexts by county-level variables in contemporary China. This study examines the effects of county-level socioeconomic background on inequalities in the developmental outcomes of young Chinese children. Individual-level child development data based on four early development milestones—taking a first step, first sentences, counting 10 objects, fully independent toileting—were combined with family- and county-level socioeconomic data from the China Family Panel Studies (CFPS). Using a hierarchical linear model (HLM) to examine how the broader socioeconomic context plays a role in the attainment of developmental milestones at expected times as young children grow and develop, we have found significant cross-level interaction effects between family SES and county-level variables in relation to developmental milestone attainment. The family SES gradient in the achievement of children’s developmental milestones is steeper for those in the under-developed regions than their counterparts in the more developed regions. Our findings suggest that low-SES children who are living in socioeconomically deprived regions suffer from a double disadvantage in terms of early development outcomes. Further research would be needed to contextualize the observed interactions and better explain the underlying mechanisms.

Socioeconomic and Familial Factors Associated with Gross Motor Skills among US Children Aged 3-5 Years: The 2012 NHANES National Youth Fitness Survey

The first aim of this study was to examine the prevalence of below average gross motor skills in a representative sample of US children aged 3 to 5 years. The second aim was to identify socioeconomic and familial characteristics that are associated with below average gross motor skills. Secondary analysis was conducted using the datasets from the 2012 National Health and Examination Survey National Youth Fitness Survey (NNYFS). The NNYFS assessed gross motor skills among 329 children aged 3-5 years, using the Test of Gross Motor Development-Second Edition (TGMD-2). Socioeconomic and familial characteristics of interest, such as family income and family structure, were asked in an in-person interview. This study estimated that one in three US children age 3 to 5 years old (33.9%) scored below average for gross motor quotient. In the gross motor subsets, one in four (24.4%) scored below average for locomotion and two in five (39.9%) scored below average for object control. Children living below the poverty threshold were more likely to have a higher gross motor quotient (odds ratio, OR = 2.76; 95% confidence interval, CI = 1.09-7.00). Girls were more likely to have a higher locomotor score (OR = 2.17; 95% CI = 1.10-4.25). Those living with other child(ren) aged ≤5 years were more likely to have a higher locomotor score (OR = 2.36; 95% CI = 1.01-5.54), while those living with child(ren) aged 6-17 years were more likely to have a higher object control score (OR = 1.83; 95% CI = 1.24-2.69). This study revealed risk factors associated with poor gross motor development, furthering our understanding of gross motor development in early childhood.