Differences in breastfeeding rate between mothers delivering by caesarean section and those delivering vaginally.

Aim: The aim of the study was to analyse the impact of delivery on breastfeeding at 6 months, with special focus on caesarean section combined with established breastfeeding at 2 months. Methods: Delivery mode and breastfeeding at 2 and 6 months were studied in a database of 130,993 infants from two Swedish counties between 1990-2011. Results: The difference in breastfeeding rates at 6 months between children delivered by caesarean section and children delivered vaginally was smaller in a subpopulation of children with established breastfeeding at 2 months compared to all children. The impact of delivery method on breastfeeding at 6 months was independent of child gender, mother's first child, maternal smoking and maternal education. Conclusions: Breastfeeding in mothers giving birth by caesarean section is more likely to continue until (at least) 6 months if established early (at 2 months). It may be worthwhile to promote breastfeeding for mothers who deliver by caesarean section.

Identifying language disorder in bilingual children aged 2.5 years requires screening in both languages.

AIM: Bilingual children are at risk of being overlooked for early identification of language difficulties. We investigated the accuracy of four screening models for children aged 2.5. The first model screened the child using their mother tongue, the second screened in Swedish, and the third screened in both languages used by the child. The fourth model consisted of direct screening in Swedish and using parental information about the child's language development in their mother tongue. METHODS: Overall, 111 bilingual children (51% girls), 29-33 months, were recruited from three child health centres in Gävle, Sweden, from November 2015 to June 2017. All children were consecutively assessed by a speech and language pathologist, blinded to the screening outcomes. RESULTS: Developmental language disorder was confirmed in 32 children (29%). Only the third model, based on direct assessment using the two languages used by the child, attained adequate accuracy; 88% sensitivity, 82% specificity, 67% positive and 94% negative predictive values. CONCLUSION: Bilingual children should be screened directly in both their languages in order to achieve adequate accuracy. Such screening procedure is particularly important for children from families with low socio-economic status living in complex linguistic environments.

Modifying a language screening tool for three-year-old children identified severe language disorders six months earlier.

AIM: We examined if routine Swedish language screening for developmental language disorder (DLD) carried out at three years of age could be performed as effectively six months earlier. METHODS: This study observed 105 monolingual Swedish-speaking children (53% boys) aged 29-31 months at three Swedish child health centres. We compared their ability to combine three words, as per the existing protocol, and two words. They also underwent a comprehension task. Speech and language pathologists clinically assessed the children for DLD and their results were compared with the nurse-led screening. RESULTS: The results for the three-word and two-word criterion were the following: sensitivity (100% versus 91%) specificity (81% versus 91%), positive predictive (38% versus 56%) and negative predictive value (100% versus 99%). The three-word criterion identified 29 children with possible DLD, including 11 cases later confirmed, and the two-word criterion identified 18 possible cases, including 10 confirmed cases. DLD was overrepresented in the 10% of children who did not cooperate with the nurse-led screening. CONCLUSION: Changing the required word combinations from three to two words worked well. The three-word test identified one extra confirmed case, but resulted in 10 more false positives. Lack of cooperation during screening constituted an increased risk for DLD.

Utilization of child health services, stress, social support and child characteristics in primiparous and multiparous mothers of 18-month-old children.

AIM: Traditionally, the child health services have laid emphasis on first-time mothers. Some researchers have argued that the needs of multiparous mothers must be considered equally important. The aim of this paper was to analyse parity-related characteristics in pairs of mothers and 18-month-old children. METHODS: The study was population-based and cross-sectional. 586 primiparous mothers and 821 mothers with at least one previous child completed a questionnaire. Additional information was extracted from the child health records by the nurses. Data were collected in 2002-2003 and 2004-2005. RESULTS: Compared to multiparous mothers, primiparous mothers had a higher utilization of child health services. Multiparous mothers scored higher on parental incompetence stress and felt that their work load was more demanding. Multiparous mothers reported less social support, particularly in practical respects such as baby-sitting. They considered their interaction with the child as less satisfactory than did primiparous mothers; their children participated less in shared reading and had a more restricted vocabulary. Fewer multiparous mothers assessed their own and their child's total situation as very good. CONCLUSIONS: The child health services should develop competence and methods to support multiparous mothers and alleviate their workload when caring for several children.

Infant gender and postpartum sadness in the light of region of birth and some other factors: a contribution to the knowledge of postpartum depression.

The purpose of this paper is to analyse postpartum depressive symptoms as related to baby gender, maternal region of birth, stress, perception of child difficult temperament and some demographic factors. The setting was 36 Swedish child health centres. Mothers of 1,848 19-month-old children completed a questionnaire, including an item about recall of postpartum sadness. A subsample of 360 answered the Edinburgh Postnatal Depression Scale (EPDS). Overall, significantly more mothers of boys than of girls recalled postpartum sadness. The same was found in mothers born in Sweden and in other regions, except for the Middle East (no significant result). Among those born in Sweden and in other regions, more mothers of boys than of girls scored ≥12 on the EPDS, except for Middle East mothers with the opposite pattern (no significant finding). More mothers of "difficult" boys than of "difficult" girls recalled postpartum sadness. Our findings are tentative but may inspire future research. Immigrant mothers in Sweden seem rather like the majority population, possibly with the exception of Middle East mothers. The significance of parents' knowledge of their child's gender in advance is an important area for research. Future parents could benefit from discussing gender expectations with a nurse or other professional.

Organizational differences in early child health care -- mothers' and nurses' experiences of the services.

AIM: The aim of this study was to evaluate parents' and nurses' perceptions of the child health services (CHS) in relation to whether the nurse worked exclusively with children (focused-child health centre, CHC) vs. with people of all ages (mixed-CHC). METHOD: Information about parents' perceptions about the CHS was acquired by a questionnaire intended for the mothers of 18-month-old children. One thousand thirty-nine answered in the baseline 2002-2003 and 996 in the follow-up 2004-2005. The nurses answered a special questionnaire aimed to obtain knowledge about their satisfaction with their work. Eighteen CHCs were chosen from the county of Uppsala and eighteen from other Swedish counties. The CHCs were chosen from areas with poor psycho-social status. The data were collected by questionnaires to mothers and nurses, and the analysis used the chi-square test, t-test and logistic regression. The study was approved by the Research Ethics Committees of the universities involved. RESULTS: Mothers were more satisfied, and the nurses found their work tasks easier, at CHCs where the child health nurse worked exclusively with children, compared with mothers and nurses belonging to CHCs where the nurses provided care to people of all ages. CONCLUSION: The findings indicated that nurses working exclusively with children, being able to concentrate their time and knowledge on a specialized field, develop a more solid child health competence. There are strong reasons to consider introducing 'exclusive' CHCs in psycho-socially vulnerable areas, which would probably make the services more effective. However, intensified education may modify the drawbacks of mixed-CHCs.

Drawing the line in the Edinburgh Postnatal Depression Scale (EPDS): a vital decision.

BACKGROUND: The Edinburgh Postnatal Depression Scale (EPDS) is widely used in early child health care. This study examined the appropriateness of the recommended EPDS cut-off score 11/12. METHODS: Two main analyses were performed: 1. Associations between EPDS scores and maternal health behaviour, stress, life events, perceived mother-child interaction quality and child behaviour. 2. Screening parameters of the EPDS, i.e., sensitivity, specificity and positive predictive value. EPDS scores were available for 438 mothers and maternal questionnaires for 361 mothers. RESULTS: Already in the EPDS score intervals 6-8 and 9-11, there were notable adversities, according to maternal questionnaires, in stress, perceived quality of mother-child interaction, perceived child difficultness and child problem behaviours. Using maternal questionnaire reports about sadness/distress postpartum as standard, the recommended EPDS cut-off score 11/12 resulted in a very low sensitivity (24%). The cutoff score 6/7 yielded a sensitivity of 61%, a specificity of 82% and a positive predictive value of 61%. CONCLUSIONS: In terms of both clinical relevance and screening qualities, an EPDS cut-off score lower than 11/12 seems recommendable.

Child health and maternal stress: does neighbourhood status matter?

The purpose of this cross-sectional questionnaire study was to explore neighbourhood-level differences in health behaviour, maternal stress and sense of coherence, birth weight, child health and behaviour, and children's television watching habits. In total, 2006 pairs of Swedish mothers and children, aged approximately 20 months, from the general population participated in the study. A total of 1923 lived in neighbourhoods of average socioeconomic status in six counties, and 83 in a high-status neighbourhood in one of the counties. Data were collected in 2002-2003 and 2004-2005 through the Child Health Services. Socio-demographic confounders were adjusted for in multiple logistic regressions (maternal age, country of birth, education, marital status and parity). Compared with their counterparts in average neighbourhoods, mothers in the high-status neighbourhood were less frequently smokers and had been breastfeeding their children more. They felt less stress from social isolation and had a higher sense of coherence. All these differences except lower social isolation were non-significant after adjusting for socio-demographic characteristics. Privileged mothers felt more restricted by their parenting tasks (unadjusted comparison), and more privileged children were frequent television watchers. Child birth weight, health and behaviour were no better in the privileged than in average neighbourhoods. This paper adds to previous knowledge by showing that status-based geographic differences in important parenting and health parameters can be non-significant in an equitable society such as Sweden, where all families with young children have access to free high-quality health services. Individual characteristics could provide better explanations than neighbourhood status.

Relationship Between Breastfeeding and Early Childhood Obesity: Results of a Prospective Longitudinal Study from Birth to 4 Years.

AIM: To study a potential link between breastfeeding in infancy and obesity at age 4. MATERIALS AND METHODS: A total of 30,508 infants born during 2002-2007 from the databases of the Preventive Child Health Services in two Swedish counties and from national registers were studied. The outcome variable was obesity at age 4. Analyses were conducted by logistic regression models using the methodology of generalized estimating equations. Analyses were adjusted for child sex and maternal anthropometric and sociodemographic variables. RESULTS: In unadjusted analyses, any breastfeeding up to 9 months was linked to successively decreasing odds ratios (ORs) for obesity at age 4 (ORs 0.78-0.33), however, not significantly for 1 week and 2 months of breastfeeding. In adjusted analyses, the same pattern remained statistically significant for breastfeeding for 4 (OR 0.51), 6 (OR 0.55), and 9 (OR 0.47) months. Child sex, maternal education, maternal body mass index, and maternal smoking additionally influenced child obesity. CONCLUSION: Breastfeeding duration for at least 4 months may contribute independently to a reduced risk for childhood obesity at 4 years.

[Surname as a marker of ethnicity. A study from child health services shows that immigrant respective Swedish families seem to be isolated in different ways]. / Efternamn som markör för etnicitet. Studie inom barnhälsovården visar att invandrarfamiljer och svenska familjer tycks vara isolerade på olika sätt.

A practical method was tested for identifying ethnicity through family names in the absence of precise demographic information. In a questionnaire study of children covered by the Swedish child health services in some different counties, all potential participants (the children's mothers) were classified as "Swedish" or "non-Swedish" using family names. Inter-rater reliability was assessed by comparing the scores of two independent raters (Cohen's kappa: 0.89). Cases in which the raters did not agree were settled through discussion. The method's validity was roughly measured by comparing assigned classifications against ethnicity information provided by the 63.8 percent of the mothers who returned the questionnaire (1039 of 1628). Assigned and self-reported classifications were the same in 86.5 percent of the cases. Information from child health services about mothers who had agreed to participate in the study revealed health-related differences between those who returned the questionnaires and those who did not. The family name classification method indicated an ethnic selectivity in drop-out rates, which was helpful in interpreting these health differences.

How can we identify vulnerable mothers who do not reach the cut off 12 points in EPDS?

The aim was to investigate the correspondence between 352 mother's self-reports about postpartum distress in a questionnaire including an item about distress 18 months after birth and their earlier scores within, on average, 2.5 months of childbirth from a screening with the Edinburgh Postnatal Depression Scale (EPDS). Mothers who did not reach the EPDS score of 12 points, but reported that they had been sad/depressed after childbirth, were similar in socio-demographic variables to mothers with no outcomes in sadness/depression issues. In items related to negative parenting and perceptions of the child, they presented the same picture as those with high EPDS scores who also reported having been depressed. These results suggest that EPDS does not identify all vulnerable mothers. Complementary methods for detecting mothers at risk of stress and depression need to be developed.

Parental assessment of developmental delay in children: some limitations and hazards.

UNLABELLED: According to a study published in the present issue of Acta Paediatrica, mothers' reports of developmental delays in children of preschool age were associated with socio-economic factors. CONCLUSION: For the present, developmental screening procedures using parental assessments cannot be considered evidence based. National health service systems ensuring preventive health care for all children, regardless of socio-economic background, will form a more solid basis for early detection and treatment.

Physical activity and mental health in schoolchildren: a complicated relationship.

UNLABELLED: According to a study by Parfitt and Eston, physical activity was positively associated with child mental health and self-esteem. In this commentary, gender differences, causal links and implications for prevention are discussed. CONCLUSION: The relationship between physical activity and mental health is not as simple as to say that activity will invariably lead to improved mental health. For youngsters to be engaged in physical exercise, it is important that the needs of the particular child be taken into account. Forced and frightening activities should be avoided. The context should be one of enjoyment rather than of harsh discipline and skill-dependent games where many children are apt to fail.