Mental health of internally displaced preschool children: a cross-sectional study conducted in Bogotá, Colombia

A causa de los conflictos armados, como el de Colombia, se han desplazado por la fuerza a millones de personas, entre ellas una importante parte de la población infantil. Este estudio tuvo como objetivo evaluar la salud mental de los niños desplazados internos en edad preescolar en Bogotá Colombia, e identificar los determinantes de la salud mental en estos niños. Métodos: Estudio transversal realizado entre 279 niños que asisten a cuatro jardines infantiles en un barrio marginal de Bogotá. La salud mental infantil se evaluó con el instrumento validado de Comportamiento Infantil (CBCL) 1,5-5 años, aplicados a padres y cuidadores. Se realizo un análisis univariado y multivariado de regresión logística para evaluar la asociación entre el desplazamiento y la salud mental de los niños y para identificar las relaciones con la salud mental en los niños desplazados. Resultados: los Niños desplazados (n = 90) se identificaron con más frecuencia sobre los puntos de corte límite para las escalas CBCL que los no desplazados (n = 189) (por ejemplo, problemas totales 46,7 vs 22,8%;p \ 0,001). La asociación entre el desplazamiento y la presencia de problemas CBCL totales se mantuvo después del ajuste por factores socio-demográficos (OR Ajustado 3.3 del 95%: 1,5; 6,9). Donde la salud mental del cuidador explica en parte la asociación. En los niños desplazados, la salud mental del cuidador (p \ 0,01) y el funcionamiento familiar (p \ 0,01) se asociaron independientemente con la salud mental de los niños. La exposición a eventos traumáticos y el apoyo social también se asociaron con la salud mental del niño, sin embargo, las asociaciones no fueron independientes. Conclusión: En este barrio marginal de Bogotá, los niños en edad preescolar registrados como desplazados internos presentan peor salud mental que los no desplazados. El funcionamiento familiar y la salud mental del cuidador fueron fuerte e independientemente asociados con la salud mental de los niños y niñas desplazados.

Presión arterial en preescolares de la localidad de Usaquén en Bogotá

Introducción: La hipertensión arterial es un problema de salud pública tanto en países industrializados como en vía de desarrollo. Su prevalencia en la infancia viene en aumento por lo que es relevante determinarla en niños preescolares a nivel local. Objetivo: Determinar la prevalencia de hipertensión arterial en niños de tres a cinco años de una cohorte de 14 hogares infantiles del ICBF de la localidad de Usaquén en Bogotá. Materiales y métodos: Se realizó un estudio de corte transversal analítico, utilizando la base de datos de un ensayo aleatorizado y controlado del año 200913, y se evaluaron las cifras de tensión arterial de acuerdo a sexo, edad, talla y su correlación con el IMC con un nivel de confianza del 95% y precisión del 1%. Se calcularon las medias, desviaciones estándar, percentiles y prevalencia. Resultados: Se obtuvo una muestra de 1035 casos, encontrándose una prevalencia de 4,5% de HTA sistólica, 10,4% de diastólica, ambas en estadio I; teniendo en cuenta tanto sistólica como diastólica, fue de 11,6% en estadio I. Se determinaron los valores de presión arterial sistólica y diastólica en cuartiles de acuerdo a edad, sexo y talla. El coeficiente de correlación entre el IMC y los niveles de presión arterial sistólica y diastólica fueron de 0.0992 y 0.0362 respectivamente. Conclusión: La prevalencia de HTA general fue de 11,6%, predominando la diastólica en estadio I en niños preescolares. No se encontró correlación entre el IMC y las cifras de tensión arterial sistólica y diastólica.

Habilidades lingüísticas orales y escritas para la lectura y escritura en niños preescolares

Los niños preescolares ya poseen nociones de lectura y escritura porque han desarrollado habilidades lingüísticas orales y escritas que se relacionan entre sí y, a su vez, con la adquisición de la lectura y la escritura convencionales. Este artículo de revisión tiene como objetivos (a) Describir las relaciones existentes entre lenguaje oral y escrito en los años preescolares, y (b) Identificar las habilidades concretas del lenguaje del niño preescolar que posibilitan la adquisición de la lectura y escritura convencionales. Se hizo una búsqueda en las bases de datos ERIC y OVID de emergent literacy, phonological awareness, vocabulary, reading, writing, preschoolers y language skills, la cual aportó los componentes del lenguaje oral –habilidades fonológicas y semánticas– que se relacionan con la adquisición de la lectura y escritura convencionales, así como una propuesta de análisis en la que se enfatiza el proceso de las habilidades lingüísticas orales y escritas para la lectura y escritura en niños preescolares.

Factores asociados a deficiencia de zinc en niños colombianos entre 1 y 4 años de edad

Introducción: Las deficiencias de micronutrientes continúan siendo un problema de salud pública en la población infantil, dentro de las ellas se ha encontrado a la deficiencia de zinc causa importante de morbi-mortalidad en los países en desarrollo, la nutrición adecuada de zinc es esencial para un crecimiento adecuado, inmunocompetencia y desarrollo neuroconductual; se dispone de información insuficiente sobre el estado de zinc en la población preescolar lo cual dificulta la expansión de las intervenciones para el control de su deficiencia. Colombia presenta una deficiencia de este micronutriente, considerándose a nivel mundial como un problema de salud pública moderado a severo. Una evaluación sobre la prevalencia y factores determinantes asociados puede proporcionar datos sobre el riesgo de deficiencia de zinc en una población, considerando factores demográficos, sociales y nutricionales que podrían predisponer a la población preescolar colombiana a sufrir este déficit. Metodología: Estudio observacional de corte transversal que incluyó 4275 niños entre 1 y 4 años, utilizando datos de la Encuesta Nacional de Situación Nutricional (ENSIN-2010). Se realizaron análisis bivariados y multivariados para determinar factores asociados positiva y negativamente con deficiencia de zinc. Resultados: El 49,1% de los niños encuestados cursaban con deficiencia de zinc. Los factores de riesgo asociados a deficiencia de zinc encontrados fueron menor edad, peso y talla bajos, vivir en región Atlántica, región Central, Territorios Nacionales, vivienda en área de población dispersa, pertenencia a etnia afrocolombiana, pertenencia a etnia indígena, estar afiliado a régimen subsidiado, no estar afiliado a ningún régimen de salud, madre sin educación, no asistencia a programa de alimentación dirigido y el grado severo de inseguridad Conclusiones: El déficit de zinc en los niños entre 1 y 4 años de edad es multifactorial, siendo un reflejo probable de la situación de inequidad de la población colombiana, en especial, la más pobre y vulnerable. Palabras clave: Zinc, Deficiencia de zinc, factores asociados, niños entre 1 y 4 años, Colombia

Pre-school contributions to future achievements

This paper provides recent evidence about the beneÖts of attending preschool on future performance. A non-parametric matching procedure is used over two outcomes: math and verbal scores at a national mandatory test (Saber11) in Colombia. It is found that students who had the chance of attending preschool obtain higher scores in math (6.7%) and verbal (5.4%) than those who did not. A considerable fraction of these gaps comes from the upper quintiles of studentís performance, suggesting that preschool matters when is done at high quality institutions. When we include the number of years at the preschool, the gap rises up to 12% in verbal and 17% in math.

'Word-learning wizardry' at I;6

This article explores whether infants are able to learn words as rapidly as has been reported for preschoolers. Sixty-four infants aged 1;6 were taught labels for either two moving images or two still images. Each image-label pair was presented three times, after which comprehension was assessed using an adaptation of the intermodal preferential looking paradigm. Three repetitions of each label were found to be sufficient for learning to occur, fewer than has previously been reported for infants under two years. Moreover, contrary to a previous finding, learning was equally rapid for infants who were taught labels for moving versus still images. The findings indicate that infants in the early stages of acquiring a vocabulary learn new word-referent associations with ease, and that the learning conditions that allow such learning are less restricted that was previously believed.

Social approach in preschool children with Williams syndrome: the role of the face

Background Indiscriminate social approach behaviour is a salient aspect of the Williams syndrome (WS) behavioural phenotype. The present study examines approach behaviour in preschoolers with WS and evaluates the role of the face in WS social approach behaviour. Method Ten preschoolers with WS (aged 3-6 years) and two groups of typically developing children, matched to the WS group on chronological or mental age, participated in an observed play session. The play session incorporated social and non-social components including two components that assessed approach behaviour towards strangers, one in which the stranger’s face could be seen and one in which the stranger’s face was covered. Results In response to the non-social aspects of the play session, the WS group behaved similarly to both control groups. In contrast, the preschoolers with WS were significantly more willing than either control group to engage with a stranger, even when the stranger’s face could not be seen. Conclusion The findings challenge the hypothesis that an unusual attraction to the face directly motivates social approach behaviour in individuals with WS.

Understanding play: the implications for play assessment

This article reviews the current literature on play and play assessment in occupational therapy. The concept of play and play theories are examined and reasons are investigated for the low use of play assessment in paediatric occupational therapy practice. Within contemporary occupational therapy practice, the concept of play is being readdressed and play behaviour is understood to be important in child development. Available assessments of play in occupational therapy assess the child in a familiar environment to the child. Since many paediatric occupational therapists work in clinical settings, it is concluded that a clinically viable assessment of observation of play behaviour is required within occupational therapy. Parameters for such an assessment are proposed.

Influences on preschool children's physical activity

This study explored mothers' perceptions of influences on preschoolers' physical activity. Six semistructured focus groups with 23 mothers were conducted across a range of socioeconomic position locations. Mothers identified 4 key areas of influence: child fundamentals (eg, sex, personality), parent power (eg, rules, support), people to share with (eg, peers, adults), and places and things (eg, physical environments, toys). No substantial differences in themes were identified among socioeconomic position groups. Influences on preschoolers' physical activity are multidimensional, multifactorial, and support the use of ecological models to conceptualize and understand the influencing factors. Associations among factors influencing preschoolers' physical activity should be further investigated through quantitative research.

The Cool Little Kids randomised controlled trial population-level early prevention for anxiety disorders

Background: The World Health Organization predicts that by 2030 internalising problems (e.g. depression and anxiety) will be second only to HIV/AIDS in international burden of disease. Internalising problems affect 1 in 7 school aged children, impacting on peer relations, school engagement, and later mental health, relationships and employment. The development of early childhood prevention for internalising problems is in its infancy. The current study follows two successful ‘efficacy’ trials of a parenting group intervention to reduce internalising disorders in temperamentally inhibited preschool children. Cool Little Kids is a population-level randomised trial to determine the impacts of systematically screening preschoolers for inhibition then offering a parenting group intervention, on child internalising problems and economic costs at school entry.
Methods/Design: This randomised trial will be conducted within the preschool service system, attended by more than 95% of Australian children in the year before starting school. In early 2011, preschool services in four local government areas in Melbourne, Australia, will distribute the screening tool. The ≈16% (n≈500) with temperamental inhibition will enter the trial. Intervention parents will be offered Cool Little Kids, a 6-session group program in the local community, focusing on ways to develop their child’s bravery skills by reducing overprotective parenting interactions. Outcomes one and two years post-baseline will comprise child internalising diagnoses and symptoms, parenting interactions, and parent wellbeing. An economic evaluation (costconsequences framework) will compare incremental differences in costs of the intervention versus control children to incremental differences in outcomes, from a societal perspective. Analyses will use the intention-to-treat principle, using logistic and linear regression models (binary and continuous outcomes respectively) to compare outcomes between the trial arms.
Discussion: This trial addresses gaps for internalising problems identified in the 2004 World Health Organization Prevention of Mental Disorders report. If effective and cost-effective, the intervention could readily be applied at a population level. Governments consider mental health to be a priority, enhancing the likelihood that an effective early prevention program would be adopted in Australia and internationally.

Physical activity in young children : a systematic review of parental influences

The primary aim of this review was to identify and evaluate the strength of associations of the key parental factors measured in studies examining early childhood physical activity (PA). A systematic review of the literature, using databases PsychINFO, Medline, Academic Search Complete, PSYCHinfo, and CINHAL, published between January 1986 and March 2011 was conducted; 20 papers were relevant for the current review. While 12 parenting variables were identified, only 5 of these had been investigated sufficiently to provide conclusive findings. There were inconsistencies in the findings involving the social learning variable parental enjoyment and variables involving parental behaviours such as maternal depression and self-efficacy, and rules for sedentary behaviour, and parental perceptions, which included perceived importance of PA, fear of safety, and perception of child’s motor competence. Given these inconsistencies, a metaanalysis was conducted to determine whether the method of measuring PA (objective or subjective) influenced the strength of associations between the parental factors and young children’s PA. There was no difference in the strength of associations in the studies that used objective or subjective measurement (via parent self-report). Further investigation is needed to clarify and understand the specific parental influences and behaviours that are associated with PA in young children. In particular, longitudinal research is needed to better understand how parental influences and PA levels of children during the formative preschool and early elementary school years are associated.

Recommendations for a trans-European dietary assessment method in children between 4 and 14 years

Background/Objectives: The main objective of European Food Consumption Validation (EFCOVAL)-child Project is to define and evaluate a trans-European methodology for undertaking national representative dietary surveys among children in the age group of 4–14 years. In the process of identifying the best dietary assessment methodologies, experts were brought together at a workshop. The paper presents the discussion of the best available method and the final recommendations for a trans-European dietary assessment method among 4- to 14-year-old children.
Subjects/Methods: The starting point was to investigate whether the method (two non-consecutive 24-h dietary recalls (24-HDRs)) suggested for the adults in European Food Consumption Survey Method (EFCOSUM) would be usable for children in
the age group between 4 and 14 years. However, all available dietary assessment methods were included in the discussion to ensure that the final recommendation would be based on the best evidence. Six criteria were defined and used as additional
guidance in the process.
Results: The literature does not give a clear recommendation on the dietary assessment methods that are most suitable for children in the age group of 4–14 years. Nevertheless, on the basis of the literature, the recommendations were separated for preschoolers (4–6 years) and schoolchildren (7–14 years).
Conclusion: For preschoolers, two non-consecutive days of a structured food record are recommended, using a (for children adapted) picture booklet and household measures for portion-size estimation. For schoolchildren, repeated 24-HDRs are recommended, using a picture booklet and household measures for portion-size estimation. In addition, the child should bring a booklet to register what is eaten out of home. One parent should assist the schoolchild at the 24-HDR interview, and therefore face-to-face interviews are required.

Maternal predictors of preschool child-eating behaviours, food intake and body mass index : a prospective study

This study extends McPhie et al. (2011)'s [Maternal correlates of preschool child eating behaviours and body mass index: A cross-sectional study. International Journal of Pediatric Obesity, Early Online, 1–5.] McPhie et al. (2011)’s cross-sectional research, by prospectively evaluating maternal child-feeding practices, parenting style and mother–child interactions as predictors of child-eating behaviours, food habits and weight. A sample of 117 mothers of preschoolers (63 girls, 54 boys) participated at two time-points, Time 1 (T1) and Time 2 (T2), 12 months apart. Results from the two path models revealed maternal pressure to eat at T1 positively predicted change in child enjoyment of food. Maternal warmth at T1 negatively predicted child unhealthy food habits at T2. At T1, family income and maternal control negatively predicted change in child body mass index z-scores (BMIz); maternal pressure to eat at T1 also positively predicted change in child BMIz. There were significant results specific to each model. Both final path models provided an adequate fit. Our findings suggest childhood obesity is predicted by a complex interplay of demographic, maternal and child variables.

The association between television viewing and preschool child body mass index : a systematic review of english papers published from 1995 to 2010

This paper is a conceptual and methodological review of the literature on the impact of TV on preschoolers' weight status. A systematic search, of papers published between January 1995 and January 2010, identified twenty-six relevant studies. Fifteen of these were cross-sectional in design and eleven adopted a prospective design; a positive association between hours of TV and child adiposity was found in all but three studies. Although assessed in a limited number of studies, diet may mediate the relationship between TV viewing and BMI. Another likely mediator may be the content of TV programs watched; only three studies examined this association and findings were inconsistent. Our review revealed that research examining mediating effects is limited, focusing more on simple cross-sectional or prospective relationships between TV habits and child body mass index. Further investigation of the mechanisms by which TV viewing affects preschool weight gain is needed.

Improving outcomes of preschool language delay in the community : protocol for the Language for Learning randomised controlled trial

Background

Early language delay is a high-prevalence condition of concern to parents and professionals. It may result in lifelong deficits not only in language function, but also in social, emotional/behavioural, academic and economic well-being. Such delays can lead to considerable costs to the individual, the family and to society more widely. The Language for Learning trial tests a population-based intervention in 4 year olds with measured language delay, to determine (1) if it improves language and associated outcomes at ages 5 and 6 years and (2) its cost-effectiveness for families and the health care system.

Methods/Design

A large-scale randomised trial of a year-long intervention targeting preschoolers with language delay, nested within a well-documented, prospective, population-based cohort of 1464 children in Melbourne, Australia. All children received a 1.25-1.5 hour formal language assessment at their 4th birthday. The 200 children with expressive and/or receptive language scores more than 1.25 standard deviations below the mean were randomised into intervention or ‘usual care’ control arms. The 20-session intervention program comprises 18 one-hour home-based therapeutic sessions in three 6-week blocks, an outcome assessment, and a final feed-back/forward planning session. The therapy utilises a ‘step up-step down’ therapeutic approach depending on the child’s language profile, severity and progress, with standardised, manualised activities covering the four language development domains of: vocabulary and grammar; narrative skills; comprehension monitoring; and phonological awareness/pre-literacy skills. Blinded follow-up assessments at ages 5 and 6 years measure the primary outcome of receptive and expressive language, and secondary outcomes of vocabulary, narrative, and phonological skills.

Discussion

A key strength of this robust study is the implementation of a therapeutic framework that provides a standardised yet tailored approach for each child, with a focus on specific language domains known to be associated with later language and literacy. The trial responds to identified evidence gaps, has outcomes of direct relevance to families and the community, includes a well-developed economic analysis, and has the potential to improve long-term consequences of early language delay within a public health framework.