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1.  Does maternal feeding restriction lead to childhood obesity in a prospective cohort study? 
Archives of disease in childhood  2010;96(3):265-269.
Background
Some studies show that greater parental control over children’s eating habits predicts later obesity, but it is unclear whether parents are reacting to infants who are already overweight.
Objective
To examine the longitudinal association between maternal feeding restriction at age 1 and body mass index (BMI) at age 3 and the extent to which the association is explained by weight for length (WFL) at age 1.
Methods
We studied 837 mother–infant pairs from a prospective cohort study. The main exposure was maternal feeding restriction at age 1, defined as agreeing or strongly agreeing with the following question: “I have to be careful not to feed my child too much.” We ran multivariable linear regression models before and after adjusting for WFL at age 1. All models were adjusted for parental and child sociodemographic characteristics.
Results
100 (12.0%) mothers reported feeding restriction at age 1. Mean (SD) WFL z-score at age 1 was 0.32 (1.01), and BMI z-score at age 3 was 0.43 (1.01). Maternal feeding restriction at age 1 was associated with higher BMI z-score at age 3 before (β 0.26 (95% CI 0.05 to 0.48)) but not after (β 0.00 (95% CI −0.17 to 0.18)) adjusting for WFL z-score at age 1. Each unit of WFL z-score at age 1 was associated with an increment of 0.57 BMI z-score units at age 3 (95% CI 0.51 to 0.62).
Conclusions
We found that maternal feeding restriction was associated with children having a higher BMI at age 3 before, but not after, adjusting for WFL at age 1. One potential reason may be that parents restrict the food intake of infants who are already overweight.
doi:10.1136/adc.2009.175240
PMCID: PMC3703750  PMID: 21081589
2.  Fetal head circumference growth in children with specific language impairment 
Objective
To characterise fetal brain growth in children with specific language impairment (SLI).
Design
A nested case–control study.
Setting
Perth, Western Australia.
Participants
Thirty children meeting criteria for SLI at age 10 years were individually matched with a typically developing comparison child on sex, non-verbal ability, fetal gestational age, maternal age at conception, smoking and alcohol intake during pregnancy.
Main outcome measures
Occipitofrontal head circumference (HC) was measured using ultrasonography at approximately 18 weeks gestation. Femur length provided a measure of fetal length. Occipitofrontal HC was measured at birth and at the 1-year postnatal follow-up using a precise paper tape measure, while crown-heel length acted as an index of body length at both time points. Raw data were transformed to z-scores using reference norms.
Results
The SLI group had a significantly smaller mean HC than the typically developing comparison children at birth, but there was no group difference at 18 weeks gestation or at the 1-year postnatal follow-up. Individual analyses found that 12 SLI children had an HC z-score less than −1 at birth, with three of these cases meeting criteria for microcephaly. There was no group difference in the indices of overall body size at any time point.
Conclusions
Children with SLI are more likely to have a small HC at birth but not at 18 weeks gestation or infancy, suggesting growth asynchrony in brain development during the second half of pregnancy.
doi:10.1136/adc.2009.180331
PMCID: PMC3704335  PMID: 20921240
3.  Perinatal interventions and survival in resource-poor settings: which work, which don’t, which have the jury out? 
Archives of disease in childhood  2010;95(12):1039-1046.
Perinatal conditions make the largest contribution to the burden of disease in low-income countries. Although postneonatal mortality rates have declined, stillbirth and early neonatal mortality rates remain high in many countries in Africa and Asia, and there is a concentration of mortality around the time of birth. Our article begins by considering differences in the interpretation of ‘intervention’ to improve perinatal survival. We identify three types of intervention: a single action, a collection of actions delivered in a package and a broader social or system approach. We use this classification to summarise the findings of recent systematic reviews and meta-analyses. After describing the growing evidence base for the effectiveness of community-based perinatal care, we discuss current concerns about integration: of women’s and children’s health programmes, of community-based and institutional care, and of formal and informal sector human resources. We end with some thoughts on the complexity of choices confronting women and their families in low-income countries, particularly in view of the growth in non-government and private sector healthcare.
doi:10.1136/adc.2009.179366
PMCID: PMC3428881  PMID: 20980274
4.  Autism, language and communication in children with sex chromosome trisomies 
Archives of disease in childhood  2010;96(10):954-959.
Purpose
Sex chromosome trisomies (SCTs) are found on amniocentesis in 2.3–3.7 per 1000 same-sex births, yet there is a limited database on which to base a prognosis. Autism has been described in postnatally diagnosed cases of Klinefelter syndrome (XXY karyotype), but the prevalence in non-referred samples, and in other trisomies, is unclear. The authors recruited the largest sample including all three SCTs to be reported to date, including children identified on prenatal screening, to clarify this issue.
Design
Parents of children with a SCT were recruited either via prenatal screening or via a parental support group, to give a sample of 58 XXX, 19 XXY and 58 XYY cases. Parents were interviewed using the Vineland Adaptive Behavior Scales and completed questionnaires about the communicative development of children with SCTs and their siblings (42 brothers and 26 sisters).
Results
Rates of language and communication problems were high in all three trisomies. Diagnoses of autism spectrum disorder (ASD) were found in 2/19 cases of XXY (11%) and 11/58 XYY (19%). After excluding those with an ASD diagnosis, communicative profiles indicative of mild autistic features were common, although there was wide individual variation.
Conclusions
Autistic features have not previously been remarked upon in studies of non-referred samples with SCTs, yet the rate is substantially above population levels in this sample, even when attention is restricted to early-identified cases. The authors hypothesise that X-linked and Y-linked neuroligins may play a significant role in the aetiology of communication impairments and ASD.
doi:10.1136/adc.2009.179747
PMCID: PMC3182523  PMID: 20656736
5.  Psychometric profile of children with auditory processing disorder and children with dyslexia 
Archives of Disease in Childhood  2010;95(6):432-436.
Objective
The aim was to address the controversy that exists over the extent to which auditory processing disorder (APD) is a separate diagnostic category with a distinctive psychometric profile, rather than a reflection of a more general learning disability.
Methods
Children with an APD diagnosis (N=25) were compared with children with dyslexia (N=19) on a battery of standardised auditory processing, language, literacy and non-verbal intelligence quotient measures as well as parental report measures of communicative skill and listening behaviour. A follow-up of a subset of children included a parent report screening questionnaire for Asperger syndrome (Childhood Asperger Syndrome Test).
Results
There were similarly high levels of attentional, reading and language problems in both groups. One peculiarity of the APD group was a discrepancy between parental report of poor communication and listening skill disproportionate to expectations based on standardised test performance. Follow-up assessment suggested high levels of previously unrecognised autistic features within the APD group.
Conclusions
Children diagnosed by audiological experts as having APD are likely to have broader neurodevelopmental disorders and would benefit from evaluation by a multidisciplinary team.
doi:10.1136/adc.2009.170118
PMCID: PMC3576918  PMID: 20501538
6.  Patient characteristics associated with in-hospital mortality in children following tracheotomy 
Archives of disease in childhood  2010;95(9):703-710.
Objectives
To identify children at risk for in-hospital mortality following tracheotomy.
Design
Retrospective cohort study.
Setting
25 746 876 US hospitalisations for children within the Kids’ Inpatient Database 1997, 2000, 2003 and 2006.
Participants
18 806 hospitalisations of children ages 0–18 years undergoing tracheotomy, identified from ICD-9-CM tracheotomy procedure codes.
Main outcome measure
Mortality during the initial hospitalisation when tracheotomy was performed in relation to patient demographic and clinical characteristics (neuromuscular impairment (NI), chronic lung disease, upper airway anomaly, prematurity, congenital heart disease, upper airway infection and trauma) identified with ICD-9-CM codes.
Results
Between 1997 and 2006, mortality following tracheotomy ranged from 7.7% to 8.5%. In each year, higher mortality was observed in children undergoing tracheotomy who were aged <1 year compared with children aged 1–4 years (mortality range: 10.2–13.1% vs 1.1–4.2%); in children with congenital heart disease, compared with children without congenital heart disease (13.1–18.7% vs 6.2–7.1%) and in children with prematurity, compared with children who were not premature (13.0–19.4% vs 6.8–7.3%). Lower mortality was observed in children with an upper airway anomaly compared with children without an upper airway anomaly (1.5–5.1% vs 9.1–10.3%). In 2006, the highest mortality (40.0%) was observed in premature children with NI and congenital heart disease, who did not have an upper airway anomaly.
Conclusions
Congenital heart disease, prematurity, the absence of an upper airway anomaly and age <1 year were characteristics associated with higher mortality in children following tracheotomy. These findings may assist provider communication with children and families regarding early prognosis following tracheotomy.
doi:10.1136/adc.2009.180836
PMCID: PMC3118570  PMID: 20522454
7.  Maternal Depression, Perceptions of Children’s Social Aptitude, and Reported Activity Restriction among former Very Low Birth Weight Infants 
Archives of disease in childhood  2010;95(7):521-525.
Objective
Maternal depression is common among mothers of very low birth weight (VLBW) infants. In a cohort of mother-VLBW infant dyads followed to preschool age, we assessed the impact of maternal depression on mothers’ perceptions of their children’s social aptitude, and reported participation in age-appropriate preschool activities.
Methods
Longitudinal multivariable analysis of a nationally representative sample of VLBW infants in the United States. Models were adjusted for children’s developmental abilities according to the Bayley Scales of Infant Development, Mental Development Index.
Results
800 VLBW singletons (mean gestational age 28.9 weeks) were analyzed. During the preschool years, depressed mothers perceived their children’s social abilities more negatively than non-depressed mothers. Specifically, they saw their children as less likely to be able to share with others (aOR 0.37, 95% CI 0.14, 0.96), make friends (aOR 0.58 95% CI, 0.35, 0.96), or play independently (aOR 0.30 95% CI, 0.16, 0.58). These negative perceptions were not shared by the children’s preschool teachers. Children of depressed mothers were also less likely to participate in age-appropriate preschool activities (aOR 0.30 95% CI, 0.16, 0.58). Each of these associations either lost significance or were substantially attenuated in a separate population of former healthy term infants.
Conclusion
Among former VLBW infants, maternal depression is associated with negative perceptions of children’s social abilities and decreased participation in preschool activities. Maternal mental health should be considered in ongoing efforts to maximize the social-emotional development of preterm infants.
doi:10.1136/adc.2009.181735
PMCID: PMC3158425  PMID: 20522473
prematurity; maternal depression; vulnerable child
8.  Hurricanes and child health: lessons from Cuba 
Archives of Disease in Childhood  2010;96(4):328-329.
doi:10.1136/adc.2009.178145
PMCID: PMC3056292  PMID: 20861403
9.  The association between birth condition and neuropsychological functioning and educational attainment at school age: a cohort study 
Objective
Poor condition at birth may impact on IQ, although its effect on other measures of neurodevelopment is unclear. The authors' aim was to determine whether infants receiving resuscitation after birth have reduced scores in measures of attention, memory and language skills or the need for educational support at school even in the absence of clinical encephalopathy.
Methods
Three groups of term infants were identified from the Avon longitudinal study of parents and children: infants resuscitated at birth but asymptomatic for encephalopathy (n=612), infants resuscitated who developed symptoms of encephalopathy (n=40) and the reference infants who were not resuscitated and had no further neonatal care (n=8080). Measures of attention, language, memory and the need for educational support were obtained for children between 8 years and 11 years. Test results (standardised to a mean of 100 and SD of 15) were adjusted for clinical and social covariates. Missing covariate data were imputed using chained equations.
Results
Infants asymptomatic after resuscitation had similar scores to those not requiring resuscitation for all measures while infants who developed encephalopathy had lower working memory (−6.65 (−12.34 to −0.96)), reading accuracy (−7.95 (−13.28 to −2.63)) and comprehension (−9.32 (−14.47 to −4.17) scores and increased risk of receiving educational support (OR 6.24 (1.52 to 26.43)) than infants thought to be well at birth, although there was little evidence for an association after excluding infants who developed cerebral palsy.
Conclusions
The authors found no evidence that infants who were resuscitated but remained well afterwards differed from those not requiring resuscitation in the aspects of neuropsychological functioning assessed in this study. Infants who developed neonatal encephalopathy had evidence of worse functioning, particularly in language skills and were more likely to receive educational support at school.
doi:10.1136/adc.2009.176065
PMCID: PMC3015086  PMID: 20705720
10.  Overweight in older children and adolescents: treatment or prevention? 
doi:10.1136/adc.2009.157677
PMCID: PMC2857966  PMID: 20040679

Results 1-10 (10)