Relationships matter: How clinicians can support positive parenting in the early years.

A secure attachment relationship with at least one healthy adult is essential for a child to develop optimal coping abilities. Primary care providers like paediatricians and family physicians can help by supporting parents in practice settings. Every clinician encounter is an opportunity to ask parents about children's relationships and their behaviour, daily routines, and overall family function. This statement, which focuses on children aged 0 to 6 years, describes basic principles in support of positive parenting and recommends in-office practices to promote secure parent-child relationships, engage families and build trust with parents. Crying, sleep, and difficult behaviours are described as opportunities for clinicians to provide anticipatory, responsive guidance to parents.

Evaluation of the revised Nipissing District Developmental Screening (NDDS) tool for use in general population samples of infants and children.

BACKGROUND: There is widespread interest in identification of developmental delay in the first six years of life. This requires, however, a reliable and valid measure for screening. In Ontario, the 18-month enhanced well-baby visit includes province-wide administration of a parent-reported survey, the Nipissing District Developmental Screening (NDDS) tool, to facilitate early identification of delay. Yet, at present the psychometric properties of the NDDS are largely unknown. METHOD: 812 children and their families were recruited from the community. Parents (most often mothers) completed the NDDS. A sub-sample (n = 111) of parents completed the NDDS again within a two-week period to assess test-retest reliability. For children 3 or younger, the criterion measure was the Bayley Scales of Infant Development, 3rd edition; for older children, a battery of other measures was used. All criterion measures were administered by trained assessors. Mild and severe delays were identified based on both published cut-points and on the distribution of raw scores. Sensitivity, specificity, positive and negative predictive values were calculated to assess agreement between tests. RESULTS: Test-retest reliability was modest (Spearman's rho = .62, p < 001). Regardless of the age of the child, the definition of delay (mild versus severe), or the cut-point used on the NDDS, sensitivities (from 29 to 68 %) and specificities (from 58 to 88 %) were poor to moderate. CONCLUSION: The modest test-retest results, coupled with the generally poor observed agreement with criterion measures, suggests the NDDS should not be used on its own for identification of developmental delay in community or population-based settings.

Ontario and the enhanced 18-month well-baby visit: Trying new approaches.

In Ontario, the 18-month well-baby visit is the last scheduled primary care visit before school entry. Recognizing the importance of this visit and the role that primary care plays in developmental surveillance, an Ontario expert panel recommended enhancing the 18-month visit. Their recommendations are based on evidence from multiple disciplines, which underscore the reality that the quality of the early years experience establishes trajectories of health and well-being for children. An underlying premise of the recommendations is that when there are collaborations among parents, primary care, community health and child development services, the outcomes for children will be improved. The present article focuses on two Ontario pilot projects that were funded to discover how, in real life primary care settings, the recommendations could be implemented and outcomes measured. Findings and insights were significant, and future directions are clear, as the strategy for an enhanced 18-month well-baby visit is implemented in the future for Ontario.

Concurrent validity of the Ages And Stages Questionnaires and Bayley Developmental Scales in a general population sample.

OBJECTIVE: Developmental delay is relatively common and produces serious impairment. Efforts to screen for delay often include parent-completed instruments. We evaluated the agreement between the most popular such instrument, the Ages and Stages Questionnaires (ASQ) and the third edition of the Bayley Scales of Infant Development (BSID-III). METHODS: We analyzed a community sample of 587 children aged 1 month to 36 months who received both the ASQ and the BSID-III. We calculate sensitivity, specificity, and positive and negative predictive values. Because published BSID-III norms produced unexpectedly low prevalences, we also derived a set of distribution-based thresholds using quantile regression, and we repeated the validation analysis using these results. RESULTS: BSID-III prevalence was 2.9% (95% confidence interval [CI] 1.7-4.6) with published norms and 7.7% (95% CI 5.6-10.1) with distribution-based thresholds, while 18.2% (95% CI 15.2-21.6) of children were positive on the ASQ. For published BSID-III norms, sensitivity was 41% (95% CI 18-67) and specificity 82% (95% CI 79-85). Results with distribution-based thresholds were essentially identical. Performance was somewhat better among children over 1 year (sensitivity 50%, specificity 87%). For subscales, sensitivities were generally lower (range 0-50%) and specificities higher (range 92-96%). CONCLUSIONS: Agreement between the ASQ and BSID-III was relatively poor. Previous studies have reported somewhat better agreement. There are numerous possible explanations for differences, including the age ranges used, the risk profile of children, and differences in the ASQ administration. Results raise concerns about the performance of this instrument in primary care and community settings.

Getting it right at 18 months: In support of an enhanced well-baby visit.

Evolving neuroscience reveals an ever-strong relationship between children's earliest development/environment and later life experience, including physical and mental health, school performance and behaviour. Paediatricians, family physicians and other primary care providers need to make the most of well-baby visits-here a focus on an enhanced 18-month visit-to address a widening 'opportunity gap' in Canada. An enhanced visit entails promoting healthier choices and positive parenting to families, using anticipatory guidance and physician-prompt tools, and connecting children and families with local community resources. This statement demonstrates the need for measuring/monitoring key indicators of early childhood health and well-being. It offers specific recommendations to physicians, governments and organizations for a universally established and supported assessment of every Canadian child's developmental health at 18 months.

Measuring in support of early childhood development.

A child's early experiences and environments have a significant, measurable effect on later life trajectories of health and well-being. Each child's own world, especially parents and other caregivers, literally sculpts the brain and impacts stress pathways. Effective early childhood interventions exist that can improve adult and societal outcomes. In this statement, the Canadian Paediatric Society calls on federal and provincial/territorial governments to measure and monitor the developmental progress of children in Canada, which can vary widely among communities and demographic groups. The statement explores the objectives for collecting quality information about early child development, its determinants and long-term outcomes. It also examines four approaches to collecting population-based, person-specific and longitudinal data, both in young children and later in life. A key outcome of monitoring development is timely intervention. Linking individual data to the home and community levels is a critical step, so that communities and governments can monitor and take actions that support early child development.

How has the science of early child development informed a child psychiatrist's practice?

Information on the science of early child development has become increasingly available to the public at large. Physicians have an important role in translating the science into accessible language as well as activities for parents and caregivers to foster healthy development. A strategy to engage primary care in Ontario through the use of an enhanced 18-month well-baby visit is described.