Elucidating the level of developmental risk in a busy paediatric practice clinic from a middle-income country.

BACKGROUND: Identifying young children with serious developmental concerns is a common challenge in paediatric settings around the world. Elucidating parental concerns about their children's development is a useful predictor of developmental status. The aim of this study is to elucidate the level of developmental risk in a busy outpatient paediatric clinic using the Parents' Evaluation of Developmental Status (PEDS) and observe the associated factors in a middle-income country. METHODS: Parents attending a medical appointment for their children in a paediatric outpatient clinic were asked to complete the PEDS and a questionnaire pertaining to sociodemographic details. A total of 151 parents were eligible to participate in the study. Parents also rated the ease of completion of the test with the response options being 'difficult, a little difficult, easy, very easy'. RESULTS: In our total sample, 9.3% (n = 14) were at high risk, 16.6% (n = 25) were at moderate risk and the remainder were at low/no risk. Being at high or moderate risk (25.8%, n = 39) was higher in male gender (p = 0.046) and older age children (p = 0.004). Hospitalization in a neonatal intensive care unit longer than 3 days, maternal employment status/housewife, long duration of screen viewing were independent risk factors significantly associated with high or moderate risk in multivariable analyses. Among the participants, 98.7% of parents reported that the PEDS was easy or very easy to complete in the clinical setting. CONCLUSION: In this study, in a cosmopolitan city of a middle-income country, a quarter of children were observed to be at high or moderate risk. The findings highlight the importance of elucidating the prevalence of developmental concerns among the population to enable families to access universal high-quality early childhood services.

Communicative Environmental Factors Including Maternal Depression and Media Usage Patterns on Early Language Development.

INTRODUCTION: From the ecological perspective of multifactorial causal mechanism, the communicative interaction environment has been less studied in early childhood which is the most sensitive phase for language development. We aimed to research simultaneous communicative environmental factors including maternal depression and media usage patterns in young children aged 1-31/2 years. METHODS: One hundred and one participants were included in the study; fifty-one children with language delay as the case group and fifty children with typical development as the control group. Maternal depressive symptoms were evaluated by Beck Depression Inventory. The general development of each child was evaluated by Denver II Screening Test and Bayley-Third Edition. Language development was evaluated by the Preschool Language Scale-5. The questionnaire for the sociodemographic data and media usage patterns was prepared by the study team. RESULTS: Maternal depression scores, duration of TV viewing, background TV were higher in the children with language delay and they started earlier using screen devices in comparison with the control group (p < 0.05). The total amount of interaction time and co-viewing were less in children with language delay and more parents intended to keep their children occupied by watching in the case group (p < 0.05). Mother care-giving (p = 0.002, OR = 5.80, CI 1.93-17.4) and absence of co-viewing (p = 0.000, OR = 9.46, CI 2.69-33.3) were the significant factors associated with language delay. DISCUSSION: Young children with language delay were more exposed to communicative environmental risk factors than children with typical development. The integration of this perspective to child health care practices should be encouraged in early childhood.

Behavioral problems of preschool children with new-onset epilepsy and one-year follow-up - A prospective study.

OBJECTIVES: Childhood emotional/behavioral problems in children with epilepsy have been reported to be higher compared with those with typical development or with other nonneurologic health conditions. Increasing interest towards understanding these behavioral comorbidities is reflected in literature. However, longitudinal investigations regarding the course of behavioral problems in children with newly diagnosed epilepsy and normal development are rare, and majority of them involve school-aged children. We aimed to study the behavioral comorbidities of preschool children with newly diagnosed epilepsy and to explore the changes of behavioral problems after one year from the diagnosis in comparison with the healthy group and subsequently, to elucidate the potential developmental, neurologic, and social risk factors associated with these difficulties. METHODS: Participants were 83 patients, aged between 18 and 59 months, 43 of them were children with new-onset epilepsy, and 40 of them were healthy children as the comparison group. The Child Behavior Check List-1 1/2-5 (CBCL) was used to evaluate emotional/behavioral problems of the children. Maternal anxiety was analyzed by The State-Trait Anxiety Inventory (STAI). The general development of children was evaluated by the Denver-II-Developmental Screening Test (D-II-DST). Sociodemographic characteristics were also collected for all participants. Each evaluation was repeated after one year from the diagnosis. RESULTS: Internalizing, externalizing, and total problem scores were higher in children with epilepsy than the control group at baseline, and despite some reduction in several scales, the differences continued across groups after one year. The analysis for the course revealed that behavior problem scores reduced in children with new-onset epilepsy over a year, but it did not change in healthy children. Among the possible factors related to behavior problem scores, in correlation analysis, the duration of screen viewing, socioeconomic status, and maternal education were associated with behavior problem scores. There was no significant association between epilepsy-related variables and the behavior problem scores and the course. Among all possible risk factors in the regression analyses, maternal trait anxiety level was found to be significantly related to the total problems, internalizing, and externalizing scores in the group with epilepsy. CONCLUSION: Behavioral comorbidities of epilepsy are present very early and can be seen at the time of the diagnosis, however, they do not worsen over time in preschool children. Maternal anxiety should be considered as a risk factor for behavioral problems in preschool children with epilepsy. Assisting children and parents and ensuring necessary guidance and support should be a crucial part of epilepsy treatment initiated as soon as the time of diagnosis.

Developmental and Behavioral Problems of Preschool-Age Children with Chronic Rheumatic Diseases.

OBJECTIVE: Juvenile idiopathic arthritis (JIA) is the most common autoimmune and familial Mediterranean fever (FMF) the most common autoinflammatory chronic rheumatic disease in childhood. We aimed first to identify developmental and behavioral problems of preschool-age children with common chronic rheumatic diseases, second to compare the diagnostic categories, and third to elucidate the associated factors with these difficulties. METHOD: Of the 91 participants included in this study, 46 were children with rheumatic diseases (27 with JIA and 19 with FMF) and 45 were healthy children. The general developmental and emotional/behavioral problems of each child were evaluated by the Ages and Stages Questionnaire and Child Behavior Checklist-1½-5, respectively. The State-Trait Anxiety Inventory and Beck Depression Inventory were used for maternal well-being. RESULTS: Internalizing problem scores were increased, and the percentage of children who failed at least 1 developmental domain and experienced delays in fine motor and problem-solving domains were higher in children with chronic rheumatic diseases when compared with healthy children. Being in the group of rheumatic diseases, fewer maternal education years and higher screen time were found to be independent risk factors significantly associated with any developmental delay in the multivariable model. Maternal trait anxiety scores were positively associated with internalizing and total problems only in FMF. CONCLUSION: Preschool-age children with a diagnosis of chronic rheumatic diseases were more vulnerable for developmental and behavioral problems compared with healthy children. The management of chronic rheumatic diseases in the early years should include the screening of developmental and behavioral problems.

Developmental Concerns, Parental Perceptions and Missed Opportunities from Different Levels of Health Centers in a Middle-Income Country.

OBJECTIVE: To evaluate the concerns the parents have with the development of their children and related conditions and investigate how often these concerns are addressed at all levels of the healthcare system. Determining parental perceptions of these issues and highlighting missed opportunities is valuable for improving healthcare services. METHODS: A total of 451 parents attending a medical appointment for their children in outpatient clinics at tertiary, secondary and primary health centers were administered a questionnaire comprised of 45 questions pertaining to their concerns regarding the development of their children and related conditions, including sociodemographic characteristics, practices supporting child development, information resources and personal opinions, such as whether they had sufficient information. RESULTS: The parents of 130 children (28.8%) reported at least one developmental concern. Less than half of the concerned parents had visited a health center for these concerns. The area of greatest concern was language development, but the concerns differed based on setting. Among the related factors, having insufficient information (p = 0.000, OR: 0.375, CI: 0.24-0.58) and not playing with the child (p = 0.029, OR: 0.563, CI: 0.33-0.94) increased the risk of having developmental concerns. Only 15.5% of children were followed up in a developmental and behavioral manner. CONCLUSIONS: The authors observed many concerns and missed opportunities to address them at all levels of health centers. Family physicians were more effective at eliciting these issues than pediatricians. These issues need to be addressed in the health system with consideration of its complexity and integrated culture.

Comparison of the Parents' Evaluation of Developmental Status and Ages and Stages Questionnaire Developmental Screening Tests in a Eurasian Country.

OBJECTIVE: The Parents' Evaluation of Developmental Status (PEDS) and the Ages and Stages Questionnaire (ASQ) are developmental screening tools that are commonly used in pediatric practice worldwide. We aimed to compare the screening results of the PEDS and the ASQ in children with a wide range of ages and to evaluate the degree of agreement between the tests across the age groups. METHODS: The study was conducted with the participation of 327 children aged 3 to 72 months. Participants were administered the PEDS and then the ASQ. Children with known developmental disabilities were included in the study to represent a real-world clinical practice setting and evaluated with a clinical workup. RESULTS: The median age of the children was 35.1 months, with a range of 3 to 72 months. The percentage of children with known developmental disabilities was 16.5%. The actual agreement between the PEDS and ASQ was 74% with a concordance represented by Cohen κ of 0.422 (p < 0.001) in the total sample. Furthermore, the agreement was higher in children aged 25 to 36 months and 37 to 48 months than for the other ages. CONCLUSION: We compared the clinical features of the ASQ and PEDS across the age groups, and they demonstrated moderate agreement. The present study also showed the performance of the PEDS and suggests that it should certainly be used for developmental screening in routine child health care practice in Eurasia, thus supporting the use of such parent-completed developmental tools that should be encouraged for universal screening.

Do early parental postnatal depression, attachment style and perceived social support affect neurodevelopmental outcomes of premature infants?

BACKGROUND: The birth of a premature infant is both a stressful event for both parents and associated with an increased rate of postnatal depression (PND). Additionally some mothers may have delayed feelings of attachment to their babies because of the medical procedures or possible medical complications. Social support is known as an important factor for well-being in the postnatal period. However there is scarce data about these factors for fathers. We aimed to identify the impact of parental PND, attachment style and social support on premature infant development considering the prematurity degree and risk groups. METHODS: This prospective study was conducted by including 96 infants who were born preterm. Mothers and fathers were given Edinburgh Postnatal Depression Scale (EPDS), Adult Attachment Style Scale (AASS), and Multidimensional Scale of Perceived Social Support (MSPSS) to fill out when their infants' corrected age was 3 months. The developmental evaluation was conducted with Bayley III at the corrected 6 months and 18 months of age. RESULTS: Postnatal depression scores were more in mothers than fathers, the rates of secure attachment and social support were similar between mothers and fathers. Factors associated with the neurodevelopmental outcomes including prematurity degree and risk groups, EPDS, AASS and MSPSS scores were analyzed for both parents. In multivariate analysis, fathers' depression scores were inversely associated with cognitive development (p = 0.030, R2 = 0.080, B=-0.283) and mothers' anxious/ambivalent attachment style was inversely associated with language development (p = 0.011, R2 = 0.108, B=-0.329) at the age of corrected 6 months old. CONCLUSIONS: Our findings underscore that the efforts to improve developmental outcomes of premature infants should include parental well-being taking into account new fathers' depressive symptomatology and maternal anxious/ambivalent attachment.

Speech delay in toddlers: Are they only `late talkers`?

Zengin-Akkus P, Çelen-Yoldas T, Kurtipek G, Özmert EN. Speech delay in toddlers: Are they only `late talkers`?. Turk J Pediatr 2018; 60: 165-172. Speech delay is prevalent in toddlers. Although some children with speech delay are able to catch up with their peers with time, the delay might be part of a broader condition such as global developmental delay, which requires specific diagnostic work-up. The current study aimed to present the demographic features, developmental profiles of the first 100 preschool-aged children who were seen at Hacettepe University Ihsan Dogramaci Children`s Hospital-Developmental Pediatrics Unit with parental concern of speech delay. Moreover, risk factors associated with speech delay, possible diagnosis and intervention strategies are documented. Thirty-one of 100 children were diagnosed with autism spectrum disorder (ASD) and global developmental delay (GDD). The current study presented that 4 out of 5 toddlers exceeded the recommended TV watching time. Moreover, almost one third of children had a poor linguistic home environment. Three parents whose children were diagnosed with ASD or GDD, refused to be reported as `autism spectrum disorder` or `intellectual disability` with the anxiety of labeling their child. As a result, these children were unable to receive special education paid for by the government. This study presented 31 of 100 children needed further diagnostic work up and early intervention. Therefore, pediatricians should not underestimate speech delay. On the other hand, due to the fact that, the regulations to receive special education and therapy often create anxiety for the parents, we think that this system needs to be updated and special education support should be determined by the special needs of each child.