Profile of children assisted in a teaching outpatient clinic of developmental disabilities in São Paulo, Brazil.

OBJECTIVE: To analyze the epidemiological and clinical profile of patients with developmental disabilities followed in a university clinic in Brazil. METHODS: Descriptive, retrospective study, based on medical records. Children aged zero to 18 years with developmental problems, firstly evaluated between 2009 and 2018, were included. Patients with missing data or out of the age and time period established were excluded. There were nine losses and 374 patients constituted the final sample. Linear regression models were performed. RESULTS: The mean age at the first assessment was 52.2±39.7 months and the age when the parents perceived the symptoms was 20.9±23.8 months. The most common impairment was motor associated with language delay (28.3%). The interval between the parents' perception and the first consultation was associated with the mothers' education and number of pregnancies. The age at first assessment was associated with the disability type. The number of pregnancies was associated with the child's age when the parents noticed the symptoms and at the first consultation. CONCLUSIONS: Parents' recognition of the symptoms occurred early, however, there was a delay until the arrival at the clinic. Higher maternal education was associated with a shorter gap between perception of the developmental disability and consultation. A greater number of pregnancies was associated with a later perception of the developmental delay by the parents as well as a delay in the assessment and a wider interval between them. Motor problems were the most common in younger children, and language complaints in older ones.

Profile of children assisted in a teaching outpatient clinic of developmental disabilities in São Paulo, Brazil / Perfil das crianças atendidas em um ambulatório de ensino de alterações do desenvolvimento em São Paulo, Brasil

Abstract Objective: To analyze the epidemiological and clinical profile of patients with developmental disabilities followed in a university clinic in Brazil. Methods: Descriptive, retrospective study, based on medical records. Children aged zero to 18 years with developmental problems, firstly evaluated between 2009 and 2018, were included. Patients with missing data or out of the age and time period established were excluded. There were nine losses and 374 patients constituted the final sample. Linear regression models were performed. Results: The mean age at the first assessment was 52.2±39.7 months and the age when the parents perceived the symptoms was 20.9±23.8 months. The most common impairment was motor associated with language delay (28.3%). The interval between the parents' perception and the first consultation was associated with the mothers' education and number of pregnancies. The age at first assessment was associated with the disability type. The number of pregnancies was associated with the child's age when the parents noticed the symptoms and at the first consultation. Conclusions: Parents' recognition of the symptoms occurred early, however, there was a delay until the arrival at the clinic. Higher maternal education was associated with a shorter gap between perception of the developmental disability and consultation. A greater number of pregnancies was associated with a later perception of the developmental delay by the parents as well as a delay in the assessment and a wider interval between them. Motor problems were the most common in younger children, and language complaints in older ones.

Resumo Objetivo: Estabelecer o perfil clínico-epidemiológico de pacientes com alterações do desenvolvimento acompanhados em uma clínica universitária brasileira. Métodos: Estudo descritivo, retrospectivo, baseado em prontuários. Foram incluídas crianças de zero a 18 anos com alterações do desenvolvimento, primeiramente avaliadas entre 2009 e 2018. Foram excluídos pacientes com dados ausentes ou fora da idade e do período estabelecidos. Houve nove perdas, e 374 pacientes constituíram a amostra final. Modelos de regressão linear foram executados. Resultados: A média de idade na primeira avaliação foi de 52,2±39,7 meses, e a média de idade quando os pais perceberam os sintomas foi de 20,9±23,8 meses. O comprometimento mais comum foi o motor associado ao da linguagem (28,3%). O intervalo entre a percepção dos pais e a primeira consulta esteve associado à escolaridade materna e ao número de gestações. A idade da primeira avaliação foi relacionada ao tipo de comprometimento. O número de gestações foi associado à idade da criança quando os pais notaram os sintomas e na primeira consulta. Conclusões: O reconhecimento dos sintomas pelos pais foi pontual, porém houve demora até a chegada à clínica. Maior escolaridade materna foi associada a menor defasagem entre a percepção da deficiência e a consulta. Maior número de gestações foi associado a uma percepção tardia dos pais com relação aos sintomas e ao atraso na primeira avaliação, bem como ao maior intervalo entre elas. Os sintomas motores foram os mais comuns nas crianças mais novas, e as queixas de linguagem nas mais velhas.

The impact of the environment on neurodevelopmental disorders in early childhood.

OBJECTIVES: To review the literature about the environmental impact on children's mental, behavior, and neurodevelopmental disorders. SOURCES OF DATA: A nonsystematic review of papers published on MEDLINE-PubMed was carried out using the terms environment and mental health or psychiatric disorders or neurodevelopmental disorders. SUMMARY OF FINDINGS: Psychopathology emerges at different developmental times as the outcome of complex interactions between nature and nurture and may impact each person in different ways throughout childhood and determine adult outcomes. Mental health is intertwined with physical health and is strongly influenced by cultural, social and economic factors. The worldwide prevalence of psychiatric disorders in children and adolescents is 13.4%, and the most frequent are anxiety, disruptive behavior disorders, attention deficit hyperactivity disorder and depression. Neurodevelopment begins at the embryonic stage and continues through adulthood with genetic differences, environmental exposure, and developmental timing acting synergistically and contingently. Early life experiences have been linked to a dysregulation of the neuroendocrine-immune circuitry which results in alterations of the brain during sensitive periods. Also, the environment may trigger modifications on the epigenome of the differentiating cell, leading to changes in the structure and function of the organs. Over 200 million children under 5 years are not fulfilling their developmental potential due to the exposure to multiple risk factors, including poverty, malnutrition and unsafe home environments. CONCLUSIONS: Continued support for the promotion of a protective environment that comprises effective parent-child interactions is key in minimizing the effects of neurodevelopmental disorders throughout the lifetime.

The impact of the environment on neurodevelopmental disorders in early childhood

Abstract Objectives: To review the literature about the environmental impact on children's mental, behavior, and neurodevelopmental disorders. Sources of data: A nonsystematic review of papers published on MEDLINE-PubMed was carried out using the terms environment and mental health or psychiatric disorders or neurodevelopmental disorders. Summary of findings: Psychopathology emerges at different developmental times as the outcome of complex interactions between nature and nurture and may impact each person in different ways throughout childhood and determine adult outcomes. Mental health is intertwined with physical health and is strongly influenced by cultural, social and economic factors. The worldwide prevalence of psychiatric disorders in children and adolescents is 13.4%, and the most frequent are anxiety, disruptive behavior disorders, attention deficit hyperactivity disorder and depression. Neurodevelopment begins at the embryonic stage and continues through adulthood with genetic differences, environmental exposure, and developmental timing acting synergistically and contingently. Early life experiences have been linked to a dysregulation of the neuroendocrine-immune circuitry which results in alterations of the brain during sensitive periods. Also, the environment may trigger modifications on the epigenome of the differentiating cell, leading to changes in the structure and function of the organs. Over 200 million children under 5 years are not fulfilling their developmental potential due to the exposure to multiple risk factors, including poverty, malnutrition and unsafe home environments. Conclusions: Continued support for the promotion of a protective environment that comprises effective parent-child interactions is key in minimizing the effects of neurodevelopmental disorders throughout the lifetime.

BEHAVIORAL CHARACTERISTICS OF CHILDREN WITH SICKLE CELL DISEASE.

OBJECTIVE: To evaluate sociodemographic and clinical aspects of children with sickle cell disease (SCD) and their behavioral characteristics. METHODS: Interview with parents of patients with SCD from four to ten years old, addressing socioeconomic aspects and other health conditions, and using the Strengths and Difficulties Questionnaire (SDQ). Clinical data were obtained from medical records. Exclusion criteria were the use of hydroxyurea, previous diagnosis of stroke, chronic encephalopathy and/or intellectual disability. RESULTS: 45 patients (19 girls and 26 boys) were assessed. The median age was seven years. Diagnosis of SCD: 26 hemoglobinopathy SC; 19 hemoglobinopathy SS. Socioeconomic class: D: 24.4%; C2: 44.4%; C1: 28.9%; B2: 2.2%. Clinical history: acute chest syndrome: 40%; transfusions: 66.7%; hospitalizations: 82.2%. SDQ findings: 88.9% clinical impact (emotional subscale: 68.9%); total score: impact in 48.9%. It was not possible to establish a relation between the severity of the disease and the results of the SDQ. Regarding socioeconomic class: among individuals of classes B2 and C1, 21.4% had impact at the total score; in classes C2 and D, this percentage was 61.3%. Regarding the schooling of the head of the family, with Elementary School at least, 39.3% of the children had impacts; for fewer education, this percentage was 64.7%. CONCLUSIONS: Behavioral impacts are highly prevalent in children with SCD. Individuals in socioeconomic classes C2 and D suffered more behavioral impacts than individuals in classes B2 and C1.

Behavioral characteristics of children with sickle cell disease / Características comportamentais de crianças com doença falciforme

ABSTRACT Objective: To evaluate sociodemographic and clinical aspects of children with sickle cell disease (SCD) and their behavioral characteristics. Methods: Interview with parents of patients with SCD from four to ten years old, addressing socioeconomic aspects and other health conditions, and using the Strengths and Difficulties Questionnaire (SDQ). Clinical data were obtained from medical records. Exclusion criteria were the use of hydroxyurea, previous diagnosis of stroke, chronic encephalopathy and/or intellectual disability. Results: 45 patients (19 girls and 26 boys) were assessed. The median age was seven years. Diagnosis of SCD: 26 hemoglobinopathy SC; 19 hemoglobinopathy SS. Socioeconomic class: D: 24.4%; C2: 44.4%; C1: 28.9%; B2: 2.2%. Clinical history: acute chest syndrome: 40%; transfusions: 66.7%; hospitalizations: 82.2%. SDQ findings: 88.9% clinical impact (emotional subscale: 68.9%); total score: impact in 48.9%. It was not possible to establish a relation between the severity of the disease and the results of the SDQ. Regarding socioeconomic class: among individuals of classes B2 and C1, 21.4% had impact at the total score; in classes C2 and D, this percentage was 61.3%. Regarding the schooling of the head of the family, with Elementary School at least, 39.3% of the children had impacts; for fewer education, this percentage was 64.7%. Conclusions: Behavioral impacts are highly prevalent in children with SCD. Individuals in socioeconomic classes C2 and D suffered more behavioral impacts than individuals in classes B2 and C1.

RESUMO Objetivo: Avaliar aspectos sociodemográficos e clínicos de crianças com doença falciforme (DF) e suas características comportamentais. Métodos: Aplicação de entrevista sobre aspectos socioeconômicos e outras condições de saúde e do questionário de capacidades e dificuldades (SDQ) em pais de pacientes de quatro a dez anos com DF, em um ambulatório de referência. Dados clínicos foram obtidos dos prontuários médicos. Critérios de exclusão: uso de hidroxiureia, diagnóstico prévio de acidente vascular cerebral, encefalopatia crônica e/ou deficiência intelectual. Resultados: Analisados 45 pacientes (19 meninas e 26 meninos). Mediana de idade=7 anos. Diagnóstico da DF=26 hemoglobinopatia SC; 19 hemoglobinopatia SS. Classe econômica (SES): D=24,4%; C2=44,4%; C1=28,8%; B2=2,2%. Antecedentes clínicos: síndrome torácica aguda=40%; transfusões=66,7%; internações=82,2%. Achados SDQ=88,9% alteração clínica (subescala emocional=68,9%); pontuação total=alterada em 48,9%. Não foi possível estabelecer relação entre gravidade da doença e os resultados do SDQ. Com relação à SES, entre indivíduos das classes B2 e C1, 21,4% tiveram alteração na pontuação total; nas classes C2 e D, esse percentual foi de 61,3%. Quanto à escolaridade do chefe da família, com no mínimo ensino fundamental completo, 39,3% das crianças tiveram alteração; para menor escolaridade, esse percentual foi 64,7%. Conclusões: Alterações comportamentais são altamente prevalentes em crianças com DF. Indivíduos das classes C2 e D tiveram mais alterações comportamentais em relação aos indivíduos das classes B2 e C1.

An epidemiological study of childhood development in an urban setting in Brazil.

OBJECTIVE: Mental illness is an important public health concern, often starting early in life and particularly impacting children from low-and middle-income countries. Our aims were to 1) determine, in a representative sample of public preschool 4- to 5-year old children in Brazil, the prevalence of internalizing and externalizing disorders and socioemotional development delays; and 2) to identify modifiable risk factors associated with mental, behavioral, or developmental disorders (MBDD), such as microsystem (i.e., parent-child relationship), mesosystem (social support), and macrosystem contextual factors (neighborhood disadvantage). METHODS: A random sample of public preschool children was recruited in the city of Embu das Artes (São Paulo metropolitan area) (n=1,292 from 30 public preschools). Six-month prevalence of MBDD was measured using the Child Behavior Checklist (CBCL) and the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE). RESULTS: Six-month prevalence estimates were 25.4% for internalizing disorders, 12.1% for externalizing disorders, and 30.3% for socioemotional development delays. MBDD prevalence estimates were higher in families with stressful relationships and parental depression or anxiety, and in families with lower social capital. CONCLUSION: At least 25% of preschool children living in an urban area in Brazil presented a mental health disorder. These mental disorder were associated with modifiable factors such as stressful family relationships and lower social capital. Prevention and intervention measures such as family therapy are needed to decrease such high prevalence.

Care needs of children with disabilities - Use of the Pediatric Evaluation of Disability Inventory / Necessidades de assistência à criança com deficiência - Uso do Inventário de Avaliação Pediátrica de Incapacidade

Abstract Objective: To describe the care needs reported by caregivers of children with disabilities going through the school inclusion process using the Pediatric Evaluation of Disability Inventory. Methods: Cross-sectional study with 181 children aged 7-10 years with physical or mental disabilities, undergoing the inclusion process in elementary school in 2007. Location: 31 schools of the Regional Education Board-District of Penha, East Side the city of São Paulo. The children's care needs according to the caregivers were assessed in three areas-self-care, mobility and social function, using the Pediatric Evaluation of Disability Inventory, according to the following score: 5, Independent; 4, Supervision; 3, Minimum Assistance; 2, Moderate Assistance; 1, Maximum Assistance and 0, Total Assistance. For statistical analysis, we used Student's t-test and analysis of variance (ANOVA), with p<0.05 being statistically significant. Results: The lower means, with statistically significant differences, were observed for the items related to social function (55.8-72.0), followed by self-care functions (56.0-96.5); for all types of disabilities, except for children with physical disabilities, who had lower means for self-care (56.0) and mobility (63.8). Conclusions: Social function was the area referred to as the one that needed a higher degree of assistance from the caregiver and the Pediatric Evaluation of Disability Inventory is a tool that can help identify these needs and develop a more targeted intervention.

Resumo Objetivo: Descrever as necessidades de assistência referidas por cuidadores de crianças com deficiência em processo de inclusão escolar, por meio do Inventário de Avaliação Pediátrica de Incapacidade. Métodos: Estudo transversal com 181 crianças de 7-10 anos com deficiências físicas ou mentais, que se encontravam em processo de inclusão escolar no ciclo Fundamental I, em 2007. Local: 31 escolas da Diretoria Regional de Ensino - Distrito Penha, Zona Leste do Município de São Paulo. Foram avaliadas as necessidades de assistência do cuidador da criança em três áreas - autocuidado, mobilidade e função social, por meio do Inventário de Avaliação Pediátrica de Incapacidade, segundo a seguinte pontuação: 5 Independente, 4 Supervisão, 3 Assistência mínima, 2 Assistência moderada, 1 Assistência máxima e 0 Assistência total. Para análise estatística, usou-se o teste t de Student e análise de variância (Anova) e foi significativo p<0,05. Resultados: As menores médias, com diferença estatística, foram observadas para os itens relacionados à função social (55,8-72), seguidas das funções de autocuidado (56-96,5) para todos os tipos de deficiência, com exceção das crianças com deficiência física que apresentaram menores médias para autocuidado (56) e mobilidade (63,8). Conclusões: A função social foi a área referida como a que necessita de maior assistência do cuidador e o Inventário de Avaliação Pediátrica de Incapacidade é um instrumento que pode contribuir para identificar essas necessidades e para o desenvolvimento de uma intervenção mais dirigida.

Care needs of children with disabilities - Use of the Pediatric Evaluation of Disability Inventory. / Necessidades de assistência à criança com deficiência ­ Uso do Inventário de Avaliação Pediátrica de Incapacidade.

OBJECTIVE: To describe the care needs reported by caregivers of children with disabilities going through the school inclusion process using the Pediatric Evaluation of Disability Inventory. METHODS: Cross-sectional study with 181 children aged 7 to 10 years with physical or mental disabilities, undergoing the inclusion process in Elementary school in 2007. LOCATION: 31 schools of the Regional Education Board - District of Penha, East Side the city of São Paulo. The children's care needs according to the caregivers were assessed in three areas - self-care, mobility and social function, using the Pediatric Evaluation of Disability Inventory, according to the following score: 5, Independent; 4, Supervision; 3, Minimum Assistance; 2, Moderate Assistance; 1, Maximum Assistance and 0, Total Assistance. For statistical analysis, we used Student's t-test and analysis of variance (ANOVA), with p<0.05 being statistically significant. RESULTS: The lower means, with statistically significant differences, were observed for the items related to social function (55.8 to 72.0), followed by self-care functions (56.0 to 96.5); for all types of disabilities, except for children with physical disabilities, who had lower means for self-care (56.0) and mobility (63.8). CONCLUSIONS: Social function was the area referred to as the one that needed a higher degree of assistance from the caregiver and the Pediatric Evaluation of Disability Inventory is a tool that can help identify these needs and develop a more targeted intervention.

Habilidades funcionais de crianças com deficiências em inclusão escolar: barreiras para uma inclusão efetiva / Functional skills of children with deficiencies in school inclusion: barriers to effective inclusion

O objetivo deste artigo é descrever as incapacidades de alunos em processo de inclusão por meio do PEDI (Inventário de Avaliação Pediátrica de Incapacidades). Estudo transversal analítico. População: 181 alunos (7-10 anos) de 31 escolas municipais de São Paulo. Por meio de questionário aplicado ao cuidador, foram avaliadas 197 atividades nas áreas de autocuidado, mobilidade e função social. Diferenças (p < 0,05) no desempenho dos alunos, segundo o PEDI, foram observadas entre as séries nas escalas de autocuidado (média de 77,8% na 1ª série e de 95,2% na 4ª série) e mobilidade (média de 90,0% na 1ª série e 99,8% na 4ª série); a função social apresentou as menores médias, exceção ao grupo com deficiência física, cuja área mais afetada foi a mobilidade (média de 62,7%). O PEDI permitiu a identificação de incapacidades por grupo de deficiências e individual, podendo constituir instrumento importante para intervenção direcionada e acompanhamento na escola.

The scope of this article is to describe the disabilities of students in the process of inclusion by means of the PEDI - Pediatric Evaluation of Disability Inventory. A cross-sectional analysis was conducted. The population studied included 181 students (7-10 years old) from 31 public schools in São Paulo. Using a questionnaire applied to the caregiver, 197 activities were evaluated in the areas of self-care, mobility and social function. In accordance with the PEDI, differences (p < 0.05) in student performance were observed between grades in the scales of self-care (average of 77.8% in the 1st grade and 95.2% in the 4th grade) and mobility (average of 90% in the 1st grade and 99.8% in the 4th grade); social function had the lowest averages, except for those with physical disabilities, in which the most affected area was mobility (average of 62.7%). The PEDI enabled the identification of disabilities per group and individual disability, which may constitute an important tool for targeted intervention and follow-up at school.

[Functional skills of children with deficiencies in school inclusion: barriers to effective inclusion]. / Habilidades funcionais de crianças com deficiências em inclusão escolar: barreiras para uma inclusão efetiva.

The scope of this article is to describe the disabilities of students in the process of inclusion by means of the PEDI - Pediatric Evaluation of Disability Inventory. A cross-sectional analysis was conducted. The population studied included 181 students (7-10 years old) from 31 public schools in São Paulo. Using a questionnaire applied to the caregiver, 197 activities were evaluated in the areas of self-care, mobility and social function. In accordance with the PEDI, differences (p < 0.05) in student performance were observed between grades in the scales of self-care (average of 77.8% in the 1st grade and 95.2% in the 4th grade) and mobility (average of 90% in the 1st grade and 99.8% in the 4th grade); social function had the lowest averages, except for those with physical disabilities, in which the most affected area was mobility (average of 62.7%). The PEDI enabled the identification of disabilities per group and individual disability, which may constitute an important tool for targeted intervention and follow-up at school.

Childcare and children's healthcare: historical factors and challenges / Puericultura e a atenção à saúde da criança: aspectos históricos e desafios

This paper reviews the history of puericulture and attention to children's health in Brazil and establishes relationships between this history and the concept of childhood at different times and within different sociocultural contexts, and between this history and the way in which the Brazilian healthcare system has been organized. The characteristics of the Brazilian educational process, the state's role in healthcare, the creation of the national health system and the creation of the children's and adolescent's laws are highlighted as determinants of healthcare that consider children and their families as subjects under the law. These important achievements within Brazilian society have stimulated changes in clinical practice and, especially, in childcare. Today, the state no longer has a controlling role over families' childcare through regulation of individuals' conduct. Rather, childcare is undertaken scientifically, through a multiprofessional team in partnership with families and communities.(AU)

O artigo faz uma revisão sobre a história da puericultura e da atenção à saúde da criança no Brasil, estabelecendo relações dessa história com a concepção de infância em diferentes momentos e contextos sócio-culturais, bem como com a organização do sistema de saúde no país. Destacam-se características do processo de formação do povo brasileiro, o papel do Estado na saúde, a criação do Sistema Único de Saúde e o Estatuto da Criança e do Adolescente como fatores determinantes de uma atenção à saúde que considera a criança e sua família como sujeitos de direito. Essas importantes conquistas de nossa sociedade tem impulsionado mudanças na prática clínica e na puericultura, em especial. A puericultura, hoje, deixa de cumprir um papel controlador do Estado sobre as famílias e normalizador das condutas das pessoas, firmando-se com caráter científico, desenvolvida por uma equipe multiprofissional, em parceria com as famílias e comunidades.(AU)

Puericultura e a atenção à saúde da criança: aspectos históricos e desafios / Childcare and children's healthcare: historical factors and challenges

O artigo faz uma revisão sobre a história da puericultura e da atenção à saúde da criança no Brasil, estabelecendo relações dessa história com a concepção de infância em diferentes momentos e contextos sócio-culturais, bem como com a organização do sistema de saúde no país. Destacam-se características do processo de formação do povo brasileiro, o papel do Estado na saúde, a criação do Sistema Único de Saúde e o Estatuto da Criança e do Adolescente como fatores determinantes de uma atenção à saúde que considera a criança e sua família como sujeitos de direito. Essas importantes conquistas de nossa sociedade tem impulsionado mudanças na prática clínica e na puericultura, em especial. A puericultura, hoje, deixa de cumprir um papel controlador do Estado sobre as famílias e normalizador das condutas das pessoas, firmando-se com caráter científico, desenvolvida por uma equipe multiprofissional, em parceria com as famílias e comunidades.

Risk factors associated with developmental abnormalities among high-risk children attended at a multidisciplinary clinic.

CONTEXT AND OBJECTIVE: Knowledge of risk factors associated with child development disorders is essential for delivering high-quality childcare. The objective here was to evaluate the relationships between risk factors and occurrences of developmental abnormalities among children attended at a reference clinic for children at risk of developmental abnormalities. DESIGN AND SETTING: Retrospective study at a multidisciplinary reference center, Embu, São Paulo. METHODS: All cases followed up for more than three months between 1995 and 2003 were reviewed. The risk factors assessed were low birth weight, gestational age, length of stay in neonatal ward, perinatal asphyxia, mothers age < 18 years, congenital infections, malformations and low mothers education level. Developmental abnormalities were defined according to developmental tests and assessments by the clinics professionals. The statistical analysis consisted of the chi-squared test for comparing categorical variables and a logistic regression model for multivariate analysis. RESULTS: 211 children were followed up for more than three months. Developmental abnormalities occurred in 111 (52.6%). Univariate analysis showed significant relationships between developmental abnormality and low birth weight, perinatal asphyxia, length of stay > 5 days, prematurity and mothers age 18 years and older. Low birth weight, history of perinatal asphyxia and mothers age continued to be significant in multivariate analysis. CONCLUSIONS: Special attention must be paid to the development of low birth weight infants and/or infants with histories of neonatal complications. Low birth weight is easily assessed and should be considered to be an important marker when defining guidelines for following up child development.

Risk factors associated with developmental abnormalities among high-risk children attended at a multidisciplinary clinic

CONTEXT AND OBJECTIVE: Knowledge of risk factors associated with child development disorders is essential for delivering high-quality childcare. The objective here was to evaluate the relationships between risk factors and occurrences of developmental abnormalities among children attended at a reference clinic for children at risk of developmental abnormalities. DESIGN AND SETTING: Retrospective study at a multidisciplinary reference center, Embu, São Paulo. METHODS: All cases followed up for more than three months between 1995 and 2003 were reviewed. The risk factors assessed were low birth weight, gestational age, length of stay in neonatal ward, perinatal asphyxia, mother’s age < 18 years, congenital infections, malformations and low mother’s education level. Developmental abnormalities were defined according to developmental tests and assessments by the clinic’s professionals. The statistical analysis consisted of the chi-squared test for comparing categorical variables and a logistic regression model for multivariate analysis. RESULTS: 211 children were followed up for more than three months. Developmental abnormalities occurred in 111 (52.6 percent). Univariate analysis showed significant relationships between developmental abnormality and low birth weight, perinatal asphyxia, length of stay > 5 days, prematurity and mother’s age 18 years and older. Low birth weight, history of perinatal asphyxia and mother’s age continued to be significant in multivariate analysis. CONCLUSIONS: Special attention must be paid to the development of low birth weight infants and/or infants with histories of neonatal complications. Low birth weight is easily assessed and should be considered to be an important marker when defining guidelines for following up child development.

CONTEXTO E OBJETIVOS: O conhecimento dos fatores de risco associados a distúrbios do desenvolvimento é fundamental para a qualidade dos cuidados prestados à criança. O objetivo deste estudo foi analisar a associação entre fatores de risco para atraso de desenvolvimento e as alterações observadas em crianças acompanhadas num ambulatório multidisciplinar. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo desenvolvido em ambulatório multidisciplinar de referência, Embu, São Paulo, Brasil. MÉTODO: Revisaram todos os prontuários das crianças acompanhadas por mais de três meses entre 1995 e 2003. Fatores de risco analisados: baixo peso ao nascer, idade gestacional, tempo de permanência no berçário, asfixia perinatal, idade materna < 18 anos, infecção congênita, malformação e baixa escolaridade materna. A alteração do desenvolvimento foi definida pela realização de testes padronizados e pela avaliação dos profissionais envolvidos. Análise estatística: na comparação das variáveis categóricas, utilizou-se o Teste Qui-Quadrado. Para análise multivariada, utilizou-se o modelo de regressão logística. RESULTADOS: 211 crianças foram acompanhadas por mais de três meses. Alterações do desenvolvimento ocorreram em 111 crianças (52,6 por cento). Na análise univariada, baixo peso ao nascer, asfixia perinatal, tempo de permanência no berçário > 5 dias, prematuridade e mães > 18 anos apresentaram relação significante com alterações do desenvolvimento. Na análise multivariada, asfixia perinatal, baixo peso ao nascer e idade materna mantiveram essa associação. CONCLUSÕES: Especial atenção deve ser dada ao desenvolvimento das crianças com baixo peso ao nascer e/ou história de intercorrências neonatais. O baixo peso ao nascer deve ser considerado importante marcador ao definir-se diretrizes para o acompanhamento do desenvolvimento das crianças.

Fatores de risco associados a alterações no desenvolvimento da criança / Risk factors associated with developmental abnormalities in children

Objetivo: avaliar os principais fatores de risco associados a alterações do desenvolvimento infantil. Fontes pesquisadas: as bases de dados MEDLINE, LILACS e SciELO entre janeiro de 1985 e janeiro de 2007. Síntese dos dados: os avanços tecnológicos das últimas décadas amplificaram o entendimento acerca do desenvolvimento infantil...

Objective: to evaluate the main risk factors associated with changes in child development. Data sources: Medline, Lilacs and Scielo databases between January 1985 and January 2007. Data synthesis: the technological advance over the last few decades increased our understanding about child development...