Role of fathers in overweight prevention: an analysis of a Caribbean cohort

OBJECTIVE: To investigate the role of parental characteristics and maternal perceptions of ways fathers might influence risk of overweight in Caribbean infants. DESIGN AND METHODS: Data from participants in a three island parenting intervention study were analyzed. Maternal and paternal characteristics were obtained by questionnaire at enrolment (infant age 6-10 weeks). At 18 months, 501 infants (82.9% of cohort) had weight and length measured using standardized methods and body mass index (BMI-Z scores) calculated. Participants with Z scores ≥1 were classified as at risk of overweight. Multi-level logistic regression analyses were utilized to assess the effect of parents’ characteristics on the risk of infant overweight. Additionally data from 4 focus group discussions among mothers with infants (6 - 24 months) in Jamaica were used to explore how any effects might be mediated. RESULTS: Overall 20.6% of the children were classified as at risk of overweight. The father was present in 52% of households. Fathers’ presence and higher paternal occupation level were associated with reduced risk of overweight after controlling for maternal age, education, occupation, receptive vocabulary and SES score. The presence of the father in the home (OR[95% CI] =0.78 (0.62 - 0.99)) decreased the odds of overweight in these infants. From focus group discussions mothers reported that the majority of fathers encouraged breastfeeding, healthier meal choices and discouraged use of unhealthy snacks. CONCLUSION: More information on paternal characteristics should be collected in future studies of childhood obesity. Interventions to address childhood overweight should include fathers as part of the strategy.

A parenting intervention delivered at routine primary health visits improved child cognitive development and parenting knowledge

OBJECTIVE: Several agencies have recommended integrating early child development interventions with health services. We developed and evaluated a parent training programme integrated into primary health visits. DESIGN AND METHODS: A cluster randomised trial conducted in Jamaica, Antigua and St Lucia with health centre as the unit of randomization. Fifteen centres were randomised to control (n=250 mother-child pairs) and 14 to intervention (n=251). Participants were recruited at the 6-8 week child health visit. Intervention was provided at routine health visits from age 3-18 months and comprised short films of child development messages followed by discussion and demonstration led by community health workers, and mothers’ practice of activities. Nurses distributed message cards and a few play materials. Primary outcomes were child development, measured 2 weeks after the 18 month visit, with the Griffiths Mental Development Scales and the Communicative Development Inventory (CDI). RESULTS: 85% of enrolled children were tested (control = 210; intervention=216). Loss did not differ by group. Multilevel analyses showed significant intervention benefits for cognitive development, (3.09 points; 95% CI 1.31, 4.87), effect size 0.30 SD. There were no benefits to language or hand and eye subscales, or CDI vocabulary score. Of six secondary outcomes there was a significant benefit to parenting knowledge, treatment effect 1.59 (95% CI 1.01 to 2.17), effect size 0.40. CONCLUSION: An innovative parenting intervention, requiring no additional clinic staff or mothers’ time, can be integrated into health services, with benefits to cognitive development and parent knowledge.

How kids develop

Children really want to become adults. It's what they're set up for. Despite being born with an impressive number of physiological adaptations that help survive, e.g. extra water in their cells at birth so they can survive a short period of starvation, the ability to cling on to fingers so strongly that you can lift them up, and an amazing cry which has been called one of the most stimulating calls to action that any adult human will ever hear, babies are still quite helpless. Innate in a healthy baby is the ability to develop her brain as long as she is given the opportunity to do so. like dogs, which adapted very successfully to humans 15,000 years ago, babies are the keenest observers of human behaviour and body language. That's why they observe us so closely. That's why they imitate us so much. They are trying to learn new skills. That's called development and it is related to those amazing connections between brain cells that develop as soon as the baby is born and is exposed to increasing variety of sounds, sights, smells, tastes and emotions. Most children learn these skills in an orderly, progressive fashion - one following an building on the other. First the child learns to say 'Da Da', then she learns 'Bye Bye' and after some time she learns to say 'Bye Bye, Da Da'. These skills are called developmental milestones and they are points of progress that we can observe and measure on the child's route to adulthood. When a child does not attain one of these milestones at the proper time, there is a possibility that the child has some form of disability, some of which can be very subtle.

The effect of maternal nutrition on foetal growth and blood pressure at age 2 years

This study was designed to examine the effects of maternal nutritional status on foetal growth and blood pressure at 2 years of age. It was a prospective study of women attending antenatal clinic at the University Hospital of the West Indies. 500 women attended the antenatal clinic and had six ultrasound measurements between 14 and 35 weeks gestation. The infants were followed at three-months intervals to 2 years. Main outcome measures were birth weight, head circumference, crown heel length, blood pressure. Measurements of the baby at birth were strongly related to maternal weight, BMI, weight gain in pregnancy (between 8 and 35 weeks), and triceps skinfold thickness. Relationships were strongest with booking weight and BMI. Women who weighed 55kg or less had the smallest, lightest babies and placentae. Placental volume was lower in the lighter women at both 17 and 20 weeks. Differences in abdominal circumference were not discernable until 35 weeks. The ratio of placental volume : abdominal circumference at 14 weeks as well as their relative rates of change between 14, 17 and 20 weeks gestation were different between the two groups of women. In the lighter women relative growth of placenta between 14 and 17 weeks was less than in the heavier women, suggesting poorer placental growth in underweight mothers. The data show that there is a relationship between maternal anthropometry, intrauterine growth, postnatal growth and blood pressure(AU)

Exercise in the treatment of children with diabetes

The normal development of children should be first and foremost, and secondly physical education and sport should be regarded as fun along with the competitive aspect, which makes sport exciting. The same principles which apply to normal children apply to children with diabetes. This means considering their developmental stage, physiological development and physical capabilities, as well as the organisation of sport, suitability of equipment, appropriate coaching strategies and parental guidance. The benefits and risks of exercise for the child with diabetes are similar to those for adults. Evidence is lacking as to whether long-term control as a result of exercise is probable and whether there will be retardation or progression of complications. Young children with diabetes should be in optimal metabolic control to benefit from participation in sport.(AU)

Health needs of a place of safety for children in Kingston metropolitan (Glenhope Hospital)

This cross-sectional study was based on determining the health needs of children at a place of safety in Kingston metropolitan namely Glenhope Nursery. The level of care being provided for the children at the institution as well as the children's physical, mental and social health status were determined. The institution suffered from overcrowding and shortage of caregivers and was inadequate in meeting some of the children's needs. The most important need of the children as perceived by the caregivers (83 percent) was "someone to talk to". All the caregivers (n=18) stated that of the needs that were not adequately addressed by the institution the physical need was most outstanding. The high prevalence of common illness (skin infection, ear, nose and throat infection and upper respiratory infection) indicate that overcrowding was a contributing factor. The Denver II Development Screening Test showed that 88 percent of the children had a language development problem and that a significant amount of the children had personal - social and motor developmental problems. Anthropometry revealed that there was a moderately high level of malnutrition. The dietary survey showed that the diet was deficient in some nutrients while excessive in others. Because of the small population of caregivers and childern whatever significant association was made could not be considered as being final.(AU)

Nutrition, health, and child development: research advances and policy recommendations

This book examines the role of various nutritional and other health problems on child development and provides an excellent overview of results of early childhood supplementation and stimulation programs. Echoing one of the workshop's undercurrents, the chapters in this book emphasize the importance of approaching child development in an integrated way that considers how its building blocks-health, nutrition, and psychosocial stimulation-interact with one another. For if we are to truly help these children who lag behind, our interventions must embrace not only their physical health, but also their functional well-being. PAHO is proud to issue this joint publication with TMRU and the World Bank. Policy-makers, international agencies, nutrition researchers, and program developers and managers should all find useful information here as we work together to enhance our Region's human capital (Director-PAHO)

Health statistics from the Americas

Health Statistics from the Americas, 1998 Edition, is the fourth in a series begun in 1991 to complement the quadrennial publication Health in the Americas. Initially conceived as a yearbook, this publication is now produced every two years. This edition is the first to include a section devoted to a special topic-health during early childhood-which comprises Part I of this book and represents the collaborative efforts of several programs, specialized centers, and divisions of the Pan American Health Organization. As did previous editions, this volume also presents, in Part III, summarized mortality data by age group and sex for all country-years received after publication of the 1995 edition, using the 6/61 list of cause groups. It also serves to re-emphasize the importance of addressing deficiencies in data coverage and quality, so as to attain greater reliability and enhance the usefullness of mortality information (Preface)

The neuro-development abilities of very low-birth-weight children in Trinidad - abstract

In this study of neuro-development ability of very low-birth-weight (VLBW) Trindadian children, 33 randomly selected matched pairs of classmates who were either term or VLBW at birth were tested at age 68 to 88 months using the McCarthy Scales of Children's Abilities. Index and control children showed no difference in gender, ethnicity or growth retardation. The 1-minute Apgar score was significantly lower in the index children (6.5[SD1.0] vs 7.7[1.2], p<0.01. The results show that the index children had significantly lower scores in perpetual performance, quantitative, motor and GCI sub-tests and these differences may be a reflection of the method of teaching primary schools or child rearing practices in Trinidad or the test being inappropriate for our population. It is planned to reassess the study children at 9 years of age. (AU)

Outcome of teenage pregnancy in St. Vincent: neonatal outcome and adequacy of milk from teenage mothers

In a longitudional study, pregnancy, neonatal outcome and lactation performance of adolescent and adult primigravidae were examined and compared in 33 randomly selected women (14-25 years) in St. Vincent. The whole group of women were subdivided into three sub-groups: Group I (n=10, age 14-16 years), Group II (n=12, age 17-18 years), and Group III (n=11, age 19-25 years). Detailed data on obstetrical and neonatal (neurological) outcome were collected. After birth, information was obtained on early infant growth, maternal dietary intake and breast milk composition. Milk samples (transitional and mature milk) and maternal dietary information and neonatal anthropometric measurements were collected twice during the first month after birth through home visits. Between the 3 groups no significant differences in obstetric conditions, birthweight and early infant growth were found. The Neurological Optimality Score (NOS) was comparable for all groups, but a trend of more infants diagnosed as neurologically "suspect" infants in the younger age group shows the urgent need for more research in this field. Regarding the analysis of breastmilk samples, apart from lactose content, no major differences in the composition of macro-nutrients were found. Concerning the fatty acid composition of the milk fat, no major differences between the groups occurred, although a small number of individual fatty acids were different between the groups. Early infant growth patterns were similar in all groups. It is concluded that previously reported perinatal problems of healthy teenage primigravidae (14-16 years) were not substantiated fully in this series but neonatal outcome of infants of these mothers suggests that careful developmental follow-up of these children is indicated (AU)

Low plasma levels of insulin-like factor-1 among children affected by trichuris dysentery syndrome

Children with the Trichuris Dysentery Syndrome (TDS) are both stunted and wasted. Following treatment, these children show rapid gain in height and weight. Levels of insulin-like growth factor-1 (IGF-1), the main mediator of growth hormone (GH) in plasma, have been related to growth velocity. We therefore looked at the relationship between IGF-1 and the anthropometric and biochemical indices of growth in a group of 14 children (2-10 years old) affected by TDS (cases). We also looked at the same indices in 28 unaffected (control) children matched by age, gender, neighbourhood and socio-economic status. The cases were admitted to the Tropical Metabolism Research Unit (TMRU) and treated with albendazole and iron. The following series of anthropometric measurements: height (Ht), weight (Wt), head circumference (HC), mid-upper arm circumference (MCA), triceps and subscapular skinfold thicknesses were made at predetermined intervals for one year. On each measuring day, blood samples were drawn for plasma IGF-1 determination by radioimmunoassay (RIA). On admission, the mean levels of plasma IGF-1 were significantly lower in the cases than in the controls. More than half of the individual cases (57 percent) fell below the IGF-1 assay reference levels for their age and gender, the others were at the low end of the range. All of the control levels were within the reference range. Three weeks after hospital discharge (approximately 4 weeks after worm expulsion) the cases had a significant rise in levels of plasma IGF-1: mean = 13.09, SD = 2.97, SEM = 0.86, but were still significantly lower than the controls, 95 percent CI (-11.34, -2.19), p = 0.008. Three months after treatment, there was no significant difference in mean plasma IGF-1 levels between the cases and the controls. This study indicates that low circulating IGF-1 is associated with reduced collagen synthesis. Levels of plasma IGF-1 are correlated with the anthropometric indices of growth and nutrition and reflect the severity of disease in these children (AU)

Breastfeeding prevalence among six-week infants at University Hospital of the West Indies

Eighty-five (85) mothers attending postnatal and well baby clinics were interviewed at six weeks post-partum regarding breastfeeding. An overall prevalence of 98.8 percent at six weeks of age was seen, with an exclusive breastfeeding rate of 37.6 percent. Older maternal age and multiparity favoured exclusive breastfeeding. There was no significant association between pattern of breastfeeding (exclusive versus partial) and employment or union status. Breastfeeding was found to favour good weight gain in normal birthweight babies. Normal birthweight babies who were exclusively breastfed had a higher mean weight gain than the exclusively breastfed low birthweight infants, who in turn had better weight gain when partially breastfed (AU)

Stunting and mental development in children

Stunting is the nutritional indicator most consistenly correlated with children's mental development. In Third World countries stunting is usually associated with poor development in older children. Moreover, stunting in young children predicts poor later development. Generally, when social background is controlled for, the association between stunting and poor development remains. In a recent Jamaican study, nutritional supplementation given to stunted children for 2 years produced an improvement in psychosocial development. Supplementation and linear growth had shared and independent effects on change in development. There was also a significant relationship between change in developemnt and growth over the 2 year period. It is therefore probably that at least part of the poor development found in stunted children is due to poor nutrition. (AU)