[Feasibility of the 'Uitblinkers' intervention to improve toothbrushing among children: a pilot study]. / Toepasbaarheid van de 'Uitblinkers-interventie' om tandenpoetsen bij kinderen te verbeteren: een pilotonderzoek.

In 2017, the 'Uitblinkers' intervention was developed to improve toothbrushing behaviour among young children. This interview method focuses on identifying parents' barriers to brushing their children's teeth, and promoting parenting strategies to tackle the identified barriers. Twenty-one trained dental therapists from twelve dental practices applied the 'Uitblinkers' intervention among parents of three-year-old children. Nine months after the training, focus group- and telephone interviews were conducted to evaluate the feasibility and appreciation of the intervention in dental practice. Findings of this study show that the 'Uitblinkers' intervention offers a feasible approach to improve children's toothbrushing behaviour. Dental therapists were generally positive about the interview method, the supporting materials and the reactions of parents. Some (logistic) barriers to adoption were identified which, if resolved, would improve the implementation of the intervention in dental practice.

Parental perception of weight and weight-related behaviour in 2- to 4-year-old children in the eastern part of the Netherlands.

Parental perception of weight status and weight-related behaviour of their toddler was determined through a questionnaire survey in child health care centres (CHCs). Complete data on weight, length, sex and age were available for 635 of 682 children (93.1%). The median age of the children was 37.0 months (range 24-56 months). Of all 635 children, 76.5% were normal weight, 16.2% underweight and 7.2% overweight. Parents' perception of the weight of their child compared with their peers was moderately related to the actual weight status. Of the parents of overweight and underweight children, 87.0% and 89.3%, respectively, were not concerned. Only the parents' perception of the amount of food eaten by their child was significantly related to the weight status. The primary goal of CHC workers should be to create parental awareness in case of their child being overweight or underweight and to support them in accomplishing a healthy lifestyle.

[Overweight and obesity in preschool children (0-4 years): behaviour and views of parents]. / Overgewicht en obesitas bij jonge kinderen (0-4 jaar): gedrag en opvattingen van ouders.

OBJECTIVE: Description of unhealthy behaviour and views regarding nutrition, physical exercise and education in families with young children, in relation to specific groups with a high risk of overweight. DESIGN: Cross-sectional study. METHOD: In wellbaby clinics for infants and toddlers in various sites in The Netherlands 534 parents were requested to fill in questionnaires on nutrition, physical exercise and education. Enquiry into background characteristics took place and several hypotheses were tested. Using a bivariate and multivariate analysis each hypothesis was examined with regard to linkage of the answers to specific high-risk groups. RESULTS: 73% (390 parents) responded. Overweight was found in 15% of the 2-4-year-olds, this included 3.7% with obesity. Relatively often, parents held views and showed behaviour characteristic of an unhealthy lifestyle for young children. For example, approximately 1 out of 7 families was not used to having breakfast. 43% of the respondents considered sweetened milk products approprite substitutes for milk and 39% of the children always had soft drinks at their disposal. One fifth of the parents indicated that they did not have enough time to go out with their child. Approximately 1 out of 10 toddlers aged 2-4 years had a TV in their own room; 22% were allowed to determine whether they wanted to watch TV or not and 9% were allowed to decide how long they watched. Such specific high-risk behaviour was seen in particular in families with non-western mothers, mothers with a low level of education or mothers living on social security. Regular use of child care or a nursery seemed to have some protective effect. CONCLUSION: In families with children aged 0-4 years, behaviour patterns related to overweight at a later age were frequently observed. In view of the increased incidence of overweight and obesity in young children, initiation of research aimed at optimisation of education is warranted, which should include special attention for the behaviour of parents with regard to 5 spearheads: breast-feeding, more outside play and more physical exercise, a regular wholesome breakfast, less consumption of sweetened drinks and less TV and computer use. Implementation of interventions in young age groups is able to prevent the development of unhealthy lifestyle and childrearing styles.

Comparison of behavior modification with and without swaddling as interventions for excessive crying.

OBJECTIVE: To test the hypothesis that swaddling is an effective method to reduce crying, we compared a standardized approach of regularity and stimulus reduction with the same approach supplemented with swaddling. STUDY DESIGN: Healthcare nurses coached 398 excessively crying infants up to 12 weeks of age for 3 months. Outcome measurements were crying as measured by Barr's 24-hour diary and parental perception of crying. RESULTS: Crying decreased by 42% in both groups after the first intervention week. Swaddling had no added benefit in the total group. Young infants (1-7 weeks of age at randomization) benefited significantly more from swaddling as shown by a larger decrease of crying over the total intervention period. Older infants (8-13 weeks of age at randomization) showed a significantly greater decrease in crying when offered the standardized approach without swaddling. The actual difference in crying time was 10 minutes. CONCLUSION: For older babies, swaddling did not bring any benefit when added to regularity and stimuli reduction in baby care, although swaddling was a beneficial supplementation in excessively crying infants <8 weeks of age.

Should pacifiers be recommended to prevent sudden infant death syndrome?

OBJECTIVES: Our aim was to review the evidence for a reduction in the risk of sudden infant death syndrome (SIDS) with pacifier ("dummy" or "soother") use, to discuss possible mechanisms for the reduction in SIDS risk, and to review other possible health effects of pacifiers. RESULTS: There is a remarkably consistent reduction of SIDS with pacifier use. The mechanism by which pacifiers might reduce the risk of SIDS is unknown, but several mechanisms have been postulated. Pacifiers might reduce breastfeeding duration, but the studies are conflicting. CONCLUSIONS: It seems appropriate to stop discouraging the use of pacifiers. Whether it is appropriate to recommend pacifier use in infants is open to debate.

Infant care practices related to cot death in Turkish and Moroccan families in the Netherlands.

From 1979 to 1993 Turkish infants had a significantly higher cot death risk compared to Dutch infants. In contrast Moroccan infants had a risk of cot death that was approximately three times lower compared to Dutch infants during the same period. This study shows that these differences have disappeared, while differences still exist in infant care practices between these ethnic groups. At 28 well-baby clinics, questionnaires were distributed for this sample selection. The response was 82%. Data were collected on 55 Turkish, 54 Moroccan, and 210 Dutch families. Less than 7% of these three ethnic groups still placed infants in the prone position. Moroccan mothers hardly smoked. Turkish people used pillows and Moroccan people used soft mattresses more often. Moroccan families practised swaddling more widely. Length of maternal residence influenced some care giving practices. As a result of this study, subgroup specific intervention campaigns for safe sleeping can be developed for Turkish and Moroccan families.

Dummy use, thumb sucking, mouth breathing and cot death.

UNLABELLED: In the Netherlands a case control study into cot death was undertaken as part of the European Concerted Action on sudden infant death syndrome. Children between 1 week and 2 years of age who died suddenly and unexpectedly were reported. Non cot death cases were excluded after a consensus by three pathologists. The study comprised 73 cot death cases and two controls per case, matched for date of birth. Compared to national data, the coverage was 91%. We investigated whether in the Netherlands new risk or preventive factors might have emerged. The present report focuses on the relative risks of dummy use, thumb sucking, breast versus bottle feeding, and sleeping with the mouth open. CONCLUSION: Dummy use seems to be an important preventive factor for cot death in the Netherlands, independent of other risk factors such as prone sleeping and bedding. We recommend dummy use at least for bottle-fed infants. We found no indication that dummies influence the frequency or duration of breast feeding but more data are needed. Mouth breathing appears to be associated with an increased risk for cot death, but again further research is needed.

Risk and preventive factors for cot death in The Netherlands, a low-incidence country.

UNLABELLED: In the Netherlands an 18 months case control study into cot death was undertaken as part of the European Concerted Action (ECAS) on sudden infant death syndrome to determine the relative risk of prone sleeping and other sleep practices. Physicians in the Netherlands were asked to report to the study centre all sudden and unexpected deaths of children between 1 week and 2 years of age. Non cot death cases were deleted from further analysis after a consensus was reached by three pathologists, not primarily involved in the post mortem diagnosis. A positive response of families was achieved in 91% of cases registered in the Central Bureau of Statistics. The study comprised 73 cot deaths and 146 controls, two for each case and matched for date of birth. All families were visited at home for completion of a questionnaire. The cot death rate has dropped considerably over the past 10 years after the recommendations on supine sleeping to a low of 0.26 per 1000 live born infants. In addition to the ECAS objective, we wanted to establish whether previously found risk factors are still valid in the present situation or that new factors might have emerged, some of them possibly protective. CONCLUSION: Placing an infant prone or on side on last occasion, secondary prone position (not placed prone but turned to prone), inexperienced prone sleeping and use of a duvet, leading to head and body being covered, were shown to be risk factors. Preventive factors were using a cotton sleeping-sack and a dummy. Even in a low incidence country, such as the Netherlands, there are indications that further prevention is possible.

Sudden unexpected death in infancy: epidemiologically determined risk factors related to pathological classification.

Infants that died suddenly and unexpectedly were studied as part of the European Concerted Action on sudden infant death syndrome (SIDS). Three paediatric pathologists, first independently of each other and later in a consensus meeting, classified 63 cases into 3 groups: SIDS (19 cases), borderline SIDS (30 cases) and non-SIDS (14 cases). The interobserver agreement among the pathologists before the consensus meeting was moderate (Kappa = 0.41) and jointly it was higher (Kappa = 0.83). The distribution of epidemiologically determined risk factors was studied over these three groups. Maternal smoking after birth, low socioeconomic status and thumb sucking were found more often in SIDS than in the other cases. Inexperienced prone sleeping was a determinant for SIDS, but not for non-SIDS. Previous hospital admission, low birthweight and/or short gestation were associated with borderline SIDS. Non-SIDS cases received more breastfeeding, the parents hardly smoked during pregnancy and after birth, a firm mattress had been used, and more often signs of illness had been reported by the parents, compared with the SIDS and borderline SIDS cases. Bedding factors and both primary and secondary prone sleeping were equally distributed over the three groups which supports the hypothesis that, in SIDS and borderline SIDS, as well as in non-SIDS cases, some similar external and preventable factors might influence the events leading to death. Research should therefore focus on all sudden unexpected deaths, after which subgroups such as SIDS cases can be separately analysed. The postmortem is an essential part of the whole work-up of each case and the results should be interpreted with all other available data to arrive at a sound evaluation of cases and thus form the basis for the prevention of all sudden unexpected infant death.

Case-control study of current validity of previously described risk factors for SIDS in The Netherlands.

This study aimed to assess whether previously established risk factors for sudden infant death syndrome (SIDS) are still valid now that the incidence in the Netherlands has dropped to 0.26 per 1000 liveborn infants. A distinction was made between immutable and mutable risk factors. This case-control study (part of the European Concerted Action on SIDS) comprised 73 SIDS cases and 146 controls and lasted from March 1995 to September 1996. Adjustments were made for sleeping position and bedding factors by treating them as covariables. Apart from these factors, well known risk factors that remain of importance in the Netherlands are: male sex, young maternal age, twins, and low socioeconomic status. These factors are largely immutable. Other well known risk factors which might reflect attitudes to child care and could possibly be mutable are: smoking, alcohol consumption by the mother, bottle feeding, and change of babycare routine. Intervention strategies should focus on early signalling, thereby assisting parents in changing these unfavourable parenting attitudes. Information on optimal child care and extra support by public health nurses specifically aimed at families at risk could help to decrease further the incidence of SIDS in the Netherlands.

Parental management of infants born following a cot-death victim who were monitored compared to infants who, despite similar histories, were not monitored: a controlled study.

We studied 93 families who had previously lost a baby to cot-death. Of these, 31 chose cardiorespiratory monitoring (CRM) for their next child and were compared to 62 families who, despite similar histories, decided not to monitor their subsequent infant. A control group consisted of 50 families without history of cot death. The three objectives of this retrospective study were: (1) to gain insight into psychological factors which differentiate between parents who insist on monitoring their infant and those who do not; (2) to explore how parents of both groups cope with their feelings of anxiety and stress and; (3) to examine the effect of psychological factors on parental reactions to monitor alarms. Infants of the monitor group and the nonmonitor group were matched to the age reached by the previous cot-death victims at the moment of death. Parents who had experienced cot-death (91%) and 37% of the control group parents completed the State-Trait Anxiety Inventory (STAI) and a questionnaire, consisting mainly of multiple-choice questions. Results show that monitor parents and nonmonitor parents differ greatly in their expectations of and attributions to the equipment and in the way they process information about monitoring. More monitor parents attribute a protective value to CRM. Monitor parents reported to have been more stressed during pregnancy. Postnatally, monitor parents and nonmonitor parents did not experience different anxiety levels. Nonmonitor parents experienced a slight decrease of feelings of happiness over time. Mothers with high state anxiety scores noted more false bradycardia alarms than mothers with low scores.(ABSTRACT TRUNCATED AT 250 WORDS)

[Care for brothers and sisters of crib death children. Evaluation of a support project as an alternative to home monitoring]. / Zorg voor broertjes en zusjes van wiegedood-kinderen. Evaluatie van een begeleidingsproject over een alternatief voor de home-monitor.

A pilot-study was carried out on support measures chosen by 40 families having a subsequent child after their experience with a cot-death infant. Cardio-respiratory monitors were used in one group and weighing scales in the other. General support measures given to both groups included the keeping of symptom charts and weekly visits by health-nurses. Parents who used a home-monitor relied upon the medical-technical approach of the problem, while parents using scales were mainly given confidence by the personal attention of the health-nurse. Monitor-parents more often called the paediatrician for advice than parents using weighing-scales. Especially parents who used weighing-scales commented on the great value of the symptom diary and the weekly home-visit of the health-nurse.

[Home monitoring of infants: a literature review (1972-1987)]. / Home-monitoring van zuigelingen: een literatuuroverzicht (1972-1987).

In the Netherlands home-monitoring of infants has been used since 1978, although not as widely as in other countries. For years it has been discussed whether a cardio-respiratory monitor can prevent SIDS. Controversies still exist about the criteria for home-monitoring and the reliability of the device. In this article, the history of debates on home-monitoring since 1972 is reviewed as well as current opinions and controversies.