Innovative qualitative research methods with children aged 4-7 years

There is a growing body of knowledge that uses innovative qualitative methods to support and facilitate the involvement of young children, aged 7 years and under, in the research process. Across several fields of study the recent growth in research that engages with young children stands in sharp contrast with the situation just a few years ago where there was a dearth of activity and knowledge in this area. Designed to seek their views, experiences and perspectives the range of methods is now burgeoning. This chapter explores reasons for the growth in the use of innovative qualitative methods, the underlying principles through which the engagement of young children has been achieved and the different types of method with detailed case examples. For each method the main critical issues regarding their effectiveness are identified and discussed in further detail. The latter sections of the chapter focus on contemporary issues regarding the use of innovative methods. Highlighted, in particular, are some of the common concerns and criticisms with regards to the trustworthiness, reliability, validity and generalizability of the data that is collated using innovative qualitative methods.

Encouraging children to think counterfactually enhances blocking in a causal learning task

According to a higher order reasoning account, inferential reasoning processes underpin the widely observed cue competition effect of blocking in causal learning. The inference required for blocking has been described as modus tollens (if p then q, not q therefore not p). Young children are known to have difficulties with this type of inference, but research with adults suggests that this inference is easier if participants think counterfactually. In this study, 100 children (51 five-year-olds and 49 six- to seven-year-olds) were assigned to two types of pretraining groups. The counterfactual group observed demonstrations of cues paired with outcomes and answered questions about what the outcome would have been if the causal status of cues had been different, whereas the factual group answered factual questions about the same demonstrations. Children then completed a causal learning task. Counterfactual pretraining enhanced levels of blocking as well as modus tollens reasoning but only for the younger children. These findings provide new evidence for an important role for inferential reasoning in causal learning.

Quantitative correlation of aflatoxin biomarker with dietary intake of aflatoxin in Tanzanian children

The association between aflatoxin intake from maize-based weaning food and aflatoxin albumin adducts (AF-alb) was investigated in 148 Tanzanian children aged between 12 and 22 months, at 2 visits 6 months apart. At the first visit (storage season) there was a significant correlation at the individual level between AF-alb (geometric mean 43.2 pg/mg albumin) and aflatoxin intake (geometric mean 81.7 ng/kg b.w./d) through maize-based weaning food (r = 0.51, p < 0.01). Overall, this correlation was r = 0.43 (p < 0.01). The AF-alb level in weaning-age children in Tanzania closely reflects aflatoxin intake from maize in weaning food. Exposure levels suggest children may be at risk from aflatoxin associated health effects.

Mathematics and reading difficulty subtypes: Minor phonological influences on mathematics for 5-7 year olds

Linguistic influences in mathematics have previously been explored throughsubtyping methodology and by taking advantage of the componential nature ofmathematics and variations in language requirements that exist across tasks. Thepresent longitudinal investigation aimed to examine the language requirements of mathematical tasks in young children aged 5-7 years. Initially, 256 children were screened for mathematics and reading difficulties using standardised measures. Those scoring at or below the 35th percentile on either dimension were classified as having difficulty. From this screening, 115 children were allocated to each of the MD (n=26), MDRD (n=32), reading difficulty (RD, n=22) and typically achieving (TA, n=35) subtypes. These children were tested at four time points, separated by six monthly intervals, on a battery of seven mathematical tasks. Growth curve analysis indicated that, in contrast to previous research on older children, young children with MD and MDRD had very similar patterns of development on all mathematical tasks. Overall, the subtype comparisons suggested that language played only a minor mediating role in most tasks, and this was secondary in importance to non-verbal skills. Correlational evidence suggested that children from the different subtypescould have been using different mixes of verbal and non-verbal strategies to solve the mathematical problems.

Blood eosinophils as a marker of likely corticosteroid response in children with preschool wheeze: time for an eosinophil guided clinical trial?

Childhood wheezing is common particularly in children under the age of six years and in this age-group is generally referred to as preschool wheezing. Particular diagnostic and treatment uncertainties exist in these young children due to the difficulty in obtaining objective evidence of reversible airways narrowing and inflammation. A diagnosis of asthma depends on the presence of relevant clinical signs and symptoms and the demonstration of reversible airways narrowing on lung function testing, which is difficult to perform in young children. Few treatments are available and inhaled corticosteroids are the recommended preventer treatment in most international asthma guidelines. There is however considerable controversy about its effectiveness in children with preschool wheeze and a corticosteroid responder phenotype has not been established. These diagnostic and treatment uncertainties in conjunction with the knowledge of corticosteroid side-effects, in particular the reduction of growth velocity, has resulted in a variable approach to inhaled corticosteroid prescribing by medical practitioners and a reluctance in carers to regularly administer the treatment. Identifying children who are likely responders to corticosteroid therapy would be a major benefit in the management of this condition. Eosinophils have emerged as a promising biomarker of corticosteroid responsive airways disease and evaluation of this biomarker in sputum has successfully been employed to direct management in adults with asthma. Obtaining sputum from young children is time-consuming and difficult and it is hard to justify more invasive procedures such as a bronchoscopy in young children routinely. Recently, in children, interest has shifted to assessing the value of less invasive biomarkers of likely corticosteroid response and the biomarker 'blood eosinophils' has emerged as an attractive candidate. The aim of this review is to summarise the evidence for blood eosinophils as a predictive biomarker for corticosteroid responsive disease with a particular focus on the difficult area of preschool wheeze. 

Exposure to children and risk of active trachoma in Tanzanian women

The authors surveyed the trachoma status of 515 women aged 18-60 years and 527 children aged 1-7 years in the trachoma hyperendemic region of Kongwa, Tanzania, in 1989 to further describe the importance of exposure to young children as a risk factor for active trachoma in women. The women were identified as caretakers, who currently cared for children aged 1-7 years; noncaretakers, who lived with, but did not care for, children aged 1-7; or those without children aged 1-7 in the household. The age-adjusted odds ratios for active trachoma seemed to rise with greater exposure to young children, from 1.00 for women without such children, to 1.63 for noncaretakers and 2.43 for caretakers (trend test, p = 0.08). Among those who lived in households with young children, the prevalence of active trachoma in women increased with the total number of young children cared for and with the number of infected children cared for. The prevalence of active trachoma was 40% (6 of 15) for caretakers of three or more infected children, compared with 0 (0 of 88) for caretakers with no infected children (p < 0.0001). Caring for infected children also appeared to be associated with signs of chronic trachoma in caretakers. Noncaretakers who lived with infected children were not at a significantly increased risk for trachoma compared with noncaretakers who were not exposed to such children (5.4% (three of 56) vs. 5.6% (one of 18); p > 0.4). None of the facial signs observed in the children (flies on the face, nasal discharge, etc.) appeared to increase the odds ratio of active trachoma in caretakers beyond the increase associated with trachoma alone in the child. These data support the hypothesis that active disease in women is associated with direct caretaking of young children with active disease. Strategies that interrupt household transmission may affect the binding sequelae of trachoma in women.

Validation of night blindness reports among children and women in a vitamin A deficient population in rural Tanzania.

OBJECTIVE: This study validates different definitions of reported night blindness (XN) in a vitamin A deficient African population with no local term for XN. DESIGN: Case-control study with follow-up after treatment. SETTING: Eight primary schools and health centres in rural Tanzania. SUBJECTS: A total of 1214 participants were screened for reported XN and other eye signs of xerophthalmia: 461 children aged 24-71 months, 562 primary school-age children and 191 pregnant or breast-feeding women. All 152 cases of reported XN were selected for the validation study and group matched with 321 controls who did not complain of XN. XN reports were validated against serum retinol concentrations and pupillary dark adaptation measurements in cases and controls. INTERVENTION: All children and women who reported XN or had other signs of active xerophthalmia were treated with vitamin A and followed up 3-4 weeks later. Half of the untreated control group who had their serum retinol examined in the baseline examination were also followed up. RESULTS: The overall prevalence of reported XN was 12.5%. At baseline, mean pupillary threshold (-1.52 vs -1.55 log cd/m(2), P=0.501) and median serum retinol concentrations (0.95 vs 0.93 micromol/l, P=0.734) were not significantly different in cases and controls either overall or in each population group. More restricted case definitions reduced the prevalence of reported XN to 5.5% (P<0.001), but there was still no significant difference between cases and controls although the results were in the expected direction. After treatment, the median serum retinol concentration improved significantly only in the most deficient group, the young children. Dark adaptation improved in all the subgroups but the difference was only significant for young children and primary school-age children when the restricted case definitions were used. CONCLUSIONS: XN reports are a poor indicator of vitamin A deficiency in this population. SPONSORSHIP: Task Force Sight and Life, Basel, Switzerland.

Corneal biomechanics, refractive error, and axial length in Chinese primary school children.

PURPOSE: Low corneal hysteresis is associated with longer axial length in Chinese secondary school children. The authors sought to explore this association in primary school children. METHODS: LogMAR presenting visual acuity, cycloplegic refractive error, ocular biometry, central corneal thickness (CCT), and corneal hysteresis (CH) was assessed for children in grades 1 to 3 at an academically competitive urban school in Shantou, China. RESULTS: Among 872 eligible children (mean age, 8.6 ± 2.1 years), 651 (74.7%) completed the examination. Among 1299 examined eyes, 111 (8.5%) had uncorrected vision ≤6/12. Mean spherical equivalent refractive error for all eyes was +0.26 ± 1.41 D, and axial length (AL) was 22.7 ± 0.90 mm. CH for the lowest (mean AL, 21.7 ± 0.39 mm), two middle (mean AL, 22.4 ± 0.15 and 22.9 ± 0.15 mm), and highest quartiles (mean AL, 23.7 ± 0.74 mm) of AL were 10.6 ± 2.1 mm Hg, 10.4 ± 2.1 mm Hg, 10.3 ± 2.3 mm Hg, and 10.2 ± 2.3 mm Hg respectively (age- and gender-adjusted Pearson's correlation coefficient r = -0.052; P = 0.001). In generalized estimating equation models adjusting for age, gender, and CCT, lower CH was significantly associated with longer AL (P < 0.001) and more myopic refractive error (P = 0.001). CONCLUSIONS: CH measurement is practical in young children because this is when myopia undergoes its most rapid progression. Prospective follow-up of this cohort at high risk for myopia is under way to determine whether low CH is predictive, or a consequence, of long AL.

Respiratory virus-associated severe acute respiratory illness (SARI) and viral clustering in Malawian children in a setting with a high prevalence of HIV, malaria and malnutrition

BACKGROUND:  We used four years of paediatric severe acute respiratory illness (SARI) sentinel surveillance in Blantyre, Malawi to identify factors associated with clinical severity and co-viral clustering.

METHODS:  From January 2011 to December 2014, 2363 children aged 3 months to 14 years presenting to hospital with SARI were enrolled. Nasopharyngeal aspirates were tested for influenza and other respiratory viruses. We assessed risk factors for clinical severity and conducted clustering analysis to identify viral clusters in children with co-viral detection.

RESULTS:  Hospital-attended influenza-positive SARI incidence was 2.0 cases per 10,000 children annually; it was highest children aged under 1 year (6.3 cases per 10,000), and HIV-infected children aged 5 to 9 years (6.0 cases per 10,000). 605 (26.8%) SARI cases had warning signs, which were positively associated with HIV infection (adjusted risk ratio [aRR]: 2.4, 95% CI: 1.4, 3.9), RSV infection (aRR: 1.9, 95% CI: 1.3, 3.0) and rainy season (aRR: 2.4, 95% CI: 1.6, 3.8). We identified six co-viral clusters; one cluster was associated with SARI with warning signs.

CONCLUSIONS:  Influenza vaccination may benefit young children and HIV infected children in this setting. Viral clustering may be associated with SARI severity; its assessment should be included in routine SARI surveillance.

The VLT-FLAMES survey of massive stars: stellar parameters and rotational velocities in NGC 3293, NGC 4755 and NGC 6611

An analysis is presented of VLT-FLAMES spectroscopy for three Galactic clusters, NGC3293, NGC4755 and NGC6611. Non-LTE model atmosphere calculations have been used to estimate effective temperatures (from either the helium spectrum or the silicon ionization equilibrium) and gravities (from the hydrogen spectrum). Projected rotational velocities have been deduced from the helium spectrum (for fast and moderate rotators) or the metal line spectrum (for slow rotators). The origin of the low gravity estimates for apparently near main sequence objects is discussed and is related to the stellar rotational velocity. The atmospheric parameters have been used to estimate cluster distances (which are generally in good agreement with previous determinations) and these have been used to estimate stellar luminosities and evolutionary masses. The observed Hertzsprung-Russell diagrams are compared with theoretical predictions and some discrepancies including differences in the main sequence luminosities are discussed. Cluster ages have been deduced and evidence for non-coeval star formation is found for all three of the clusters. Projected rotational velocities for targets in the older clusters, NGC3293 and NGC4755, have been found to be systematically larger than those for the field, confirming recent results in other similar age clusters. The distribution of projected rotational velocities are consistent with a Gaussian distribution of intrinsic rotational velocities. For the relatively unevolved targets in the older clusters, NGC3293 and NGC4755, the peak of the velocity distribution would be 250 km s(-1) with a full-width-half-maximum of approximately 180 km s(-1). For NGC6611, the sample size is relatively small but implies a lower mean rotational velocity. This may be evidence for the spin-down effect due to angular momentum loss through stellar winds, although our results are consistent with those found for very young high mass stars. For all three clusters we deduce present day mass functions with Gamma-values in the range of -1.5 to -1.8, which are similar to other young stellar clusters in the Milky Way.

Maternal mental health and non-organic failure to thrive.

This study reports on the first phase of a large-scale, longitudinal, multidisciplinary community study examining the growth, learning and development of young children with a particular focus on failure to thrive without organic cause. However, the group identified in this study may be better described as weight faltering. This paper examines the psychological data collected using the Parenting Stress Index, Rosenberg Self-Esteem and the General Health Questionnaire in relation to child growth. There were no significant differences between the mothers of the weight faltering and control children in terms of parenting stress, maternal depression, maternal perceptions of their parenting competence or maternal self-esteem. Maternal sensitivity to comments about child size, regardless of direction, had a negative impact on mood.

Developmental changes in the response to obstacles during prehension

Adults are proficient at reaching to grasp objects of interest in a cluttered workspace. The issue of concern, obstacle avoidance, was studied in 3 groups of young children aged 11-12, 9-10, and 7-8 years (n = 6 in each) and in 6 adults aged 18-24 years. Adults slowed their movements and decreased their maximum grip aperture when an obstacle was positioned close to a target object (the effect declined as the distance between target and obstacle increased). The children showed the same pattern, but the magnitude of the effect was quite different. In contrast to the adults, the obstacle continued to have a large effect when it was some distance from the target (and provided no physical obstruction to movement).

Recent policy initiatives in early childhood and the challenges for the social work profession

The Labour Government in the UK has announced, as part of its launch of The Children's Plan, that it 'wants to make this country the best place in the world for children and young people to grow up' in. This latest Plan is further evidence of the surge of interest that there has been in children (and, in particular, early childhood) over the last ten years in the UK and indeed elsewhere. Many of the recent policy and practice initiatives have implications for social workers working with young children. Yet, social work as a profession, in comparison with education, has remained relatively silent on these initiatives and it is hard to find any critical analysis of these developments in terms of either their underlying discourses or their implications for social workers. This article sets out to address these gaps by providing a critical analysis of: what types of knowledge regarding the early years have gained political currency; why and how this is the case; and what the implications are for the role and practices of social workers. The article proposes that discourses of 'need' and 'provision' mask more powerful discourses of economics, social control and risk avoidance, and it concludes by advocating more critically reflexive social work practice with young children and their families.

Detecting motor abnormalities in preterm infants

As a consequence of the fragility of various neural structures, preterm infants born at a low gestation and/or birthweight are at an increased risk of developing motor abnormalities. The lack of a reliable means of assessing motor integrity prevents early therapeutic intervention. In this paper, we propose a new method of assessing neonatal motor performance, namely the recording and subsequent analysis of intraoral sucking pressures generated when feeding nutritively. By measuring the infant's control of sucking in terms of a new development of tau theory, normal patterns of intraoral motor control were established for term infants. Using this same measure, the present study revealed irregularities in sucking control of preterm infants. When these findings were compared to a physiotherapist's assessment six months later, the preterm infants who sucked irregularly were found to be delayed in their motor development. Perhaps a goal-directed behaviour such as sucking control that can be measured objectively at a very young age, could be included as part of the neurological assessment of the preterm infant. More accurate classification of a preterm infant's movement abnormalities would allow for early therapeutic interventions to be realised when the infant is still acquiring the most basic of motor functions. (C) Springer-Verlag 2000.

Bronchoalveolar lavage findings suggest two different forms of childhood asthma

Background: It seems plausible that children with atopy and persistent asthma symptoms will, like their adult counterparts, have chronic airways inflammation. However, many young children with no other atopic features have episodic wheezing that is triggered solely by viral respiratory infections. Little is known as to whether airways inflammation occurs in these two asthma patterns during relatively asymptomatic periods.

Methods: Using a non-bronchoscopic bronchoalveolar lavage (BAL) procedure on children presenting for an elective surgical procedure, this study has investigated the cellular constituents of BAL fluid in children with a history of atopic asthma (AA) non-asthmatic atopic children (NAA) or viral associated wheeze (VAW).

Results: A total of 95 children was studied: 52 with atopic asthma (8.0 years, range 1.1-15.3, 36 male), 23 with non-asthmatic atopy (median age 8.3 years, range 1.7-13.6, 11 male) and 20 with VAW (3.1 years, range 1.0-8.2, 13 male). No complications were observed during the lavage procedure and no adverse events were noted post-operatively. Total lavage fluid recovered was similar in all groups and the total cell numbers were higher in the VAW group. Eosinophil (P< 0.005) and mast cell (/'<0.05) numbers were significantly elevated in the group with atopic asthma.

Conclusions: During relatively asymptomatic periods there is on-going airways inflammation, as demonstrated by eosinophil and mast cell recruitment, in children with asthma and atopy but not in children with viral associated wheeze or atopy alone. This strongly suggests that there are different underlying pathophysiologicai mechanisms in these two groups of children who wheeze.