Child Development Center Research Articles

The Technologies of Performing Social Services in Russia by Social Service Institutions (Evidence from Kursk and Belgorod Regions)

Social service is an integral part of social protection of the sick, the handicapped, the senior, etc. It relates to many categories of citizens who need governmental help. Providing this support acts as a guarantee for observance of social, human, freedom and civil rights. The social service system is organized in such a way that enables to provide help for everyone who needs it. Only in this case it meets the interests of the society.In Kursk and Belgorod regions the local social service systems are presented by various types of institutions. In the Kursk region these institutions are: general and psychoneurological care homes, social rehabilitation centres for minors, social assistance centres for families and children, medical social rehabilitation centers, social shelters for children and adolescents, social professional centre. In the Belgorod region these are: general and psychoneurological care homes, social rehabilitation centres for minors, women’s refuges, child development and socialization centres, rehabilitation centre for children and adolescents with limited health capacities, geriatric center, child guidance and family counselling centre, a special care-home for the senior and the handicapped. The comparative analysis of social service systems in Kursk and Belgorod regions revealed that in both regions their social service systems are fully formed and provide services in institutional, non-institutional and partially inpatient forms. The network of social service institutions in Kursk and Belgorod regions is widely presented by various types of institutions, but in the Belgorod region it is wider and has a bigger variety of the institutions. It is likely to be explained by the attention that local authorities pay to this problem and the funding level for it from the regional budget.

Quality of Life in Indian Children with Cerebral Palsy Using Cerebral Palsy-quality of Life Questionnaire.

Background:Quality of life (QOL) in children with cerebral palsy (CP) needs to be measure by CP-specific questionnaire. CP-QOL questionnaire is being used for this purpose.Objectives:The aim is to determine the QOL in Indian children with CP using CP-QOL questionnaire and to correlate QOL scores with demographic details of the patient.Materials and Methods:Subjects were parents of 50 children (4–12 years) attending child development center of Guru Teg Bahadur Hospital were enrolled. The parent–proxy version of the CP-QOL questionnaire translated into Hindi was administered by one author. Scoring and analysis were performed as per specified method. Cronbach's alpha was calculated for each domain for validation. Effect of clinical and demographic profile on QOL was analyzed.Results:CP-QOL questionnaire was administered to 50 parents of CP children (32 males, 18 females). The overall QOL score of the children studied was computed to be 38.29 ± 5.2. Age and maternal education had a significant bearing on the QOL of the children (P < 0.05). Type of CP, gender, and epilepsy did not affect the QOL significantly (P > 0.05). Good internal consistency and reliability were found in the domains of social well-being and acceptance, functioning, participation, and physical health (Cronbach's alpha >0.7). Access to services, pain, and impact of disability and family health showed a weak correlation with Cronbach's alpha <0.7.Conclusion:QOL in children with CP was compromised. The CP-QOL questionnaire can be used to measure QOL in Indian children with CP.

How is perceived community cohesion and membership in community groups associated with children's dietary adequacy in disadvantaged communities? A case of the Indian Sundarbans.

BackgroundMembership in community groups and a sense of community cohesion may facilitate collective action in mobilizing resources towards better health outcomes. This paper explores the relationship of these factors, along with individual level socio-economic variables, to dietary adequacy among children below 6 years of age, a proximate determinant of child malnutrition.MethodsWe conducted a cross-sectional survey in Patharpratima block of the Sundarbans in West Bengal, India, using a two-stage, 30 cluster random sampling design. In 1200 sampled households, we used a structured questionnaire to interview mothers of children below 6 years of age on their child’s nutritional intake. We also interviewed household heads to assess perceived community cohesion using a nine item scale, membership in any community self-help organization, and other socio-economic determinants. We used a logistic regression model to assess their association with a minimum acceptable diet among children between 6 months to 6 years.ResultsOnly 9.33 % children between 6 and 71 months of age received a minimum acceptable diet. With each increase in the perceived community cohesion score (scale 0-9), a child is 1.31 times more likely to have minimum acceptable diet (95 % CI 1.14, 1.50). The odds of minimum acceptable diet were also higher among children whose mothers had primary education (2.09, 95 % CI 1.03, 2.94) as compared to illiterate mothers and in households with surplus food resources (2.72, 95 % CI 1.32, 5.58) as compared to those without surplus or deficit. In contrast, registering at an Anganwadi (government early child development) centre (odds ratio 1.34 95 % CI 0.69, 2.60) and community membership (odds ratio 0.93, 95 % CI 0.59, 1.46) were not associated with minimum acceptable diet.ConclusionThe results are consistent with what is known about the importance of maternal education and access to food resources in ensuring that children have a minimum acceptable diet. Perceived community cohesion seems to play a positive role in children’s diets. Further research needs to clarify which community characteristics and services are the most relevant, how they can better support children’s diets, and how interventions can strengthen these community characteristics and services.

Fragile X Premutation Carrier Epidemiology and Symptomatology in Israel-Results from a Tertiary Child Developmental Center.

Fragile X syndrome (FXS) is the most prevalent known genetically inherited cause for autism and intellectual disability. Premutation state can cause several clinical disorders as well. We aimed to perform a nesting approach to acquire data with regard to first degree relatives of index fragile X cases at the largest child development center in Israel in order to map characteristics of Israeli FXS permutation women carriers. Seventy-nine women were referred due to a related fragile X syndrome patient, mainly an offspring or sibling. General information regarding demographics, ethnicity, and associated medical conditions were collected using interviews and structured questionnaires. Thirteen (17%) of the women who were referred as "carrier" were proven to be actually full mutation. The mean years of education were 14 (±1.51, range 12-17). Twenty-one women (27%) originated from Tunisia (mainly from the island of Djerba). Ten women (13%) reported delivery of their affected offspring beyond 41 gestational weeks. Twenty-two percent of women with premutation reported symptoms consistent with learning difficulties, mainly dyscalculia, and 14% reported ADHD symptoms. Awareness about clinical disorders of the carriers was existent only in 25% of the patients. Increased awareness and knowledge dissemination concerning premutation symptomatology and associated medical conditions are warranted. We suggest a national registry to be installed in different countries in order to identify fragile X premutation carriers at increased risk for various medical complications.

Correlation between Calorie Intake and Nutritional Status of Autism Spectrum Disorder in Children

Background: Autism Spectrum Disorder (ASD) is a severe pervasive developmental disorder with prevalence as high as one in sixty-eight children. Children diagnosed with ASD may have food intake problem and might affect their nutritional status in the future. The objective of this study was to analyze the correlation between total calorie intake and nutritional status of ASD children. Methods: This cross-sectional study was conducted in Indigrow Child Development and Autism Center involving 16 patients from October to November 2015. Total calorie intake was assessed by 24-hour food recall and nutritional status was measured by Z-score. Correlation was analyzed using Spearman’s Rho. Results: Overweight and obesity were found in 10 out of 16 ASD children assessed. Total calorie intake was not significantly correlated with nutritional status of ASD children (r=0.021, p=0.940). Conclusions: There is no significant relevance between total calorie intake and nutritional status in ASD children at Indigrow Child Development and Autism Center. [ AMJ .2016;3(2):320–3] DOI: 10.15850/amj.v3n2.790

Strategies for Effective Eating Development—SEEDS: Design of an Obesity Prevention Program to Promote Healthy Food Preferences and Eating Self-Regulation in Children From Low-Income Families

ObjectiveTo develop a scientifically based childhood obesity prevention program supporting child eating self-regulation and taste preferences. This article describes the research methods for the Strategies for Effective Eating Development program. A logic model is provided that depicts a visual presentation of the activities that will be used to guide the development of the prevention program. DesignRandomized, controlled prevention program, pretest, posttest, 6 months, and 12 months. SettingTwo sites: Houston, TX and Pasco, WA. Each trial will last 7 weeks with 8–10 mother–child dyads in each arm (prevention and control). ParticipantsRecruitment at Head Start districts (Texas; n = 160) and Inspire Child Development Center including Early Childhood Education and Head Start (Washington; n = 160). Sixteen trials with 16–20 parent–child dyads per trial will provide adequate power to detect moderate effects. InterventionMulticomponent family-based prevention program incorporating a dialogue approach to adult learning and self-determination theory. Main Outcome MeasuresChild assessments will include observed taste preferences, caloric compensation, and eating in the absence of hunger. Parent assessments will include parent-reported feeding, feeding emotions, acculturation, child eating behaviors, child food preferences, and child dietary intake. Heights and weights will be measured for parent and child. AnalysisA multilevel growth modeling analysis will be employed to consider the nested nature of the data: time points (level 1) within families (level 2) within trials (level 3).

Synthesis Paper – Speech Development

This paper examines the speech development of a case study child, H.D. (initials for confidentiality reasons), a three-year old in the Child Development Center of Learning and Research at Virginia Tech. The observations used throughout this paper are based on twenty hours of service learning hours over a ten-week period. H.D.’s speech development was based on the notions that speech is connected to thought in children, teacher-student dialogue enhances a child’s ability to communicate, and clinical judgments are used to determine a child’s potential communication barriers. Based off research, it was determined that H.D. is right on track with his speech development.

Naptime data meetings to increase the math talk of early care and education providers

ABSTRACTClassroom conversations about mathematics—math talk—between early care and education providers and young children have been associated with growth in mathematical thinking. However, professional development opportunities to learn about math teaching and learning are limited in many community-based child development centers. New approaches that are less costly and time consuming are needed to support providers in planning and implementing rich math experiences for young children. Professional development activities that are offered within the work site and during work hours may be most feasible for a large percentage of community-based programs. The purpose of this study was to design and test the impact of brief, data-based staff meetings during naptime in child care classrooms on providers’ math interactions with their students. Findings indicate that such meetings increase participants’ math talk in specific domains and predict growth in children’s math abilities 6 months later. The potential of naptime data meetings to enhance math interactions and other areas of professional practice are discussed. Future directions for additional research are recommended.

CDC Kerala--The Untold Story.

This article is our life time experience in conceptualizing and systematically developing Child Development Centre (CDC) Kerala in the last 25 years, from a research project to a national training centre in child and adolescent development and premarital counseling. CDC Kerala's major contribution was in creating a 'conceptual framework' of a valid link between childhood disability, low birth weight, adolescent girls' nutrition and fetal onset adult lifestyle diseases. It all started with a randomized controlled trial (RCT) proving beyond doubt that early stimulation is effective in improving the neurodevelopmental status of high risk babies at one and two years and the same cohort was followed-up in detail at 5, 13, 16, 19 and 24 completed years. The process of establishing CDC Kerala is being presented under (i) clinical child development, (ii) adolescent care counseling, (iii) young adults and premarital counseling and (iv) institution building.

Hearing in school-aged children with trisomy 21 - results of a longitudinal cohort study in children identified at birth.

To report the prevalence of hearing problems and the hearing sequelae in school-aged children with trisomy 21 in a longitudinal study. All children with trisomy 21 were identified via schools, community-based child development centres, general practitioners, or the universal newborn hearing screen. Audiological data and otorhinolaryngological problems were prospectively entered in to the Audiological Surveillance Programme database from each visit. Retrospective review of the Audiological Surveillance Programme database in the Glasgow area (United Kingdom) of all children reviewed between 2004 and 2012. All pre-teenaged children with trisomy 21 of school age (aged 5-12 years old). Hearing thresholds, aetiology of hearing loss and management of hearing loss was determined for the cohort of children. A total of 102 children were included. Fifty-four had normal hearing. Twenty-six had fluctuating otitis media with effusion; five had hearing in normal limits, six were managed with hearing aids, fourteen were managed conservatively, and one had ventilation tube insertion. Fifteen had persistent otitis media with effusion; four had ventilation tube insertion; and nine were managed with hearing aids. Seven had mixed hearing loss with four required hearing aids. Otitis media with effusion was the commonest cause of hearing impairment; effusions may fluctuate through the pre-teenaged years, and thus, hearing aids are beneficial. Ventilation tube insertion and bone-conducting hearing aids were useful when ear-level hearing aids were not tolerated. Mixed hearing loss occurred in later years as sensorineural hearing loss developed on a background of otitis media with effusion.

Saccadic vector optokinetic perimetry in children with neurodisability or isolated visual pathway lesions: observational cohort study.

Children and adults with neurological impairments are often not able to access conventional perimetry; however, information about the visual field is valuable. A new technology, saccadic vector optokinetic perimetry (SVOP), may have improved accessibility, but its accuracy has not been evaluated. We aimed to explore accessibility, testability and accuracy of SVOP in children with neurodisability or isolated visual pathway deficits. Cohort study; recruitment October 2013-May 2014, at children's eye clinics at a tertiary referral centre and a regional Child Development Centre; full orthoptic assessment, SVOP (central 30° of the visual field) and confrontation visual fields (CVF). Group 1: age 1-16 years, neurodisability (n=16), group 2: age 10-16 years, confirmed or suspected visual field defect (n=21); group 2 also completed Goldmann visual field testing (GVFT). Group 1: testability with a full 40-point test protocol is 12.5%; with reduced test protocols, testability is 100%, but plots may be clinically meaningless. Children (44%) and parents/carers (62.5%) find the test easy. SVOP and CVF agree in 50%. Group 2: testability is 62% for the 40-point protocol, and 90.5% for reduced protocols. Corneal changes in childhood glaucoma interfere with SVOP testing. All children and parents/carers find SVOP easy. Overall agreement with GVFT is 64.7%. While SVOP is highly accessible to children, many cannot complete a full 40-point test. Agreement with current standard tests is moderate to poor. Abnormal saccades cause an apparent non-specific visual field defect. In children with glaucoma or nystagmus SVOP calibration often fails.

Prevalence and assessment of biochemical parameters of attention-deficit hyperactivity disorder children in Bangladesh

Background and Objectives:This study aimed to evaluate some new biochemical parameters that help ensuring the early and precise diagnosis of attention-deficit hyperactivity disorder (ADHD) in blood plasma.Design and Settings:A prospective study conducted with patients scheduled for some new biochemical parameters that help ensuring the early and precise diagnosis of ADHD in blood plasma in a Child Development Center of the Chittagong, Bangladesh.Materials and Methods:The study was carried out at two levels. The first level was questionnaire on personal data and disease history while the second was on biochemical examination of the plasma ammonia and lactate status. A total of 100 children (age range 2 years 4 months to 12 years 6 months, mean age 7 years 5 months) were investigated in this study among 75 were male and 25 were female. This study was conducted in Chittagong Maa-O-Shishu General Hospital, Bangladesh.Results:We observed that the level of plasma ammonia and lactate were higher in ADHD children (36-60 μmol/L; P < 0.05 and 22-30 μmol/L; P < 0.05, respectively) compare to a reference value. The prevalence of ADHD is higher in male (75%) than in female (25%) with a ratio of 3:1. Consanguinity increases the risk of having ADHD in the next generation.Conclusion:This study concludes that there might be a correlation between ADHD and increased level of plasma ammonia and lactate level, and those might be an important parameter in the diagnosis of ADHD patients.

Screening for Amblyogenic Factors in a Rural State: Implementing a Statewide Childhood Vision Project

Wyoming is the least populated state in the United States, with approximately 582,000 people living in a geographic area of 97,093 square miles. Wyoming's sparsely populated cities and towns struggle to support an optimal level of primary and specialist health care (Gantenbein, Robinson, Wolverton, & Earls, 2011). Limited availability of primary care for children presents a barrier to the provision of screening services for potentially correctable conditions such as amblyopia (Kemper & Clark, 2006). Amblyopia is the most common form of unilateral blindness in children, with an estimated prevalence of 1-5% (Holmes & Clarke, 2006). To address the need for vision screening services in areas where primary care is limited, the Lions Clubs of Tennessee established a network of lay screeners who were trained to follow a standardized screening protocol (Donahue, Johnson, & Leonard-Martin, 2000). The success of the Tennessee program led the Lions Clubs International Foundation (LCIF) to incorporate vision screening into its Core Four sight preservation initiatives and provide matching funds for Lions Clubs in various states, including Wyoming, to initiate vision screening programs (see Donahue et al., 2006, for a review). THE PROGRAM The Wyoming Lions Early Childhood Vision Program (WLECVP) provides children aged 6 months to 6 years with free annual vision screening, administered by trained lay persons from the community. In a state where vision screening is not mandated and where public schools do not begin vision screening until a child registers for kindergarten, WLECVP affords Wyoming children access to modern vision screening services well before they enter school. Similar to the Tennessee Lions Vision Screening Project, WLECVP utilizes trained Lions volunteers to set up and conduct screenings throughout the state, but WLECVP utilizes the services of Lions volunteers to a much lesser extent. What makes WLECVP unique is its use of 14 regional Child Development Centers and their staff members to conduct vision screenings in 46 sites. The Child Development Centers are state-supported entities that provide education and related services to children with developmental delays and disabilities from birth through 5 years of age. To meet children's needs, the centers work in conjunction with other early child care and education sites such as Head Start programs, developmental preschools, and private childcare settings. Child Development Centers were chosen by WLECVP as primary screening sites for several reasons. First, they serve children with developmental delays--a population with higher rates of vision problems than the general population (Sandfeld-Nielsen, Skov, & Jensen, 2007). Second, their staff members have regular contact with the children being screened, which provides more consistent and secure lines of communication with the parents or guardians of a child who has failed a screening activity. Third, their staff members are specially trained to work with children and families and may be more adept in attaining the cooperation of children who are difficult to screen, such as those with developmental delays. Finally, given their location in population centers throughout the state, they provide readily accessible developmental screening services for the entire population of children from birth to five years of age. At the outset of the program in 2001, the WLECVP project coordinators assembled an advisory team made up of optometrists, ophthalmologists, teachers of visually impaired students, early childhood special education teachers, and specialists in early childhood education to develop a vision-screening protocol for that could be administered by lay screeners. At the time, no single tool had been developed that was capable of reliably identifying amblyopia risk factors. Therefore, the team decided on a battery of five different vision screening tools that took into consideration the particular strengths of each tool in detecting specific amblyopia risk factors. …

Variable implementation of good practice recommendations for the assessment and management of UK children with neurodisability.

The aims of this study were to determine whether UK child development teams (CDTs) have implemented good practice recommendations for the co-ordinated assessment and support of children with neurodisability and to explore some of the factors associated with variations in good practice implementation. Surveys were sent to every UK CDT in 2009/2010. Responses about CDT provision and ways of working were compared with good practice recommendations from national policy documents and professional organizations. The extent to which CDTs in England and Wales met 11 selected good practice recommendations was scored; teams in Scotland and Northern Ireland were given a score out of 9 to reflect the optional use of the common assessment framework and early support materials in these countries. Responses were received from 225/240 (94%) UK CDTs. Thirty-seven per cent of CDTs in England and Wales had implemented nine or more of the 11 recommendations. Fifty-nine per cent of teams in Scotland and 78% of teams in Northern Ireland met between six and nine recommendations of good working practice. Higher levels of implementation of recommendations were found when the CDT had a Child Development Centre base and for teams who had received increased funding in the 5 years preceding the survey. There was considerable variability in the degree to which CDTs implemented good practice recommendations for the diagnosis and management of children with neurodisability. Evidence about child and parent satisfaction, and the effectiveness of CDT practices and provision, is required, so policymakers, healthcare commissioners and clinicians can provide the most appropriate services to children with neurodisability and their families.

Developmental Outcome of Children with Cerebral Palsy after Feeding and Seating Intervention

Background: Cerebral Palsy (CP) is a diagnostic term used to describe a group of permanent disorders of movement &amp; posture causing activity limitation that are attributed to non progressive disturbances in the developing fetal or infant brain. The motor disorders are often accompanied by disturbances of sensation, perception, cognition, communication and behavior as well as by epilepsy, secondary musculoskeletal problem and feeding difficulties. Aims: To see the development of a child with cerebral palsy after comprehensive feeding &amp; seating intervention. To recommend measure for reducing neurodevelopmental problems. To improve mother- child interaction. Methods: This hospital based prospective cross sectional observational study was done in Child Development Center (CDC) of the Department of Pediatrics, Chattagram Maa Shishu-O-Genaeral Hospital (CMSOGH), Chittagong from July 2013 to December 2013. Children with Cerebral palsy aged 1-15 years included in this study. Results: Most of the patients (60%) before intervention were having only liquid food. After intervention most of the patients were having either a combination of semi-solid and solid food (48%) or only semi-solid food (42%). After intervention 80% of patients were sitting during feeds which was only 12% before intervention. After intervention feeding time is reduced to 15 to 30 minutes which was 30 min to one hour. Most of the patients (90%) never ate by themselves before intervention, only 4% were selffed. After intervention 56% were self feeding for some part of the meal &amp; 24% were self feeding at every meal. Conclusion: Feeding problems in children with cerebral palsy are common. Simple home based measure, like feeding and seating intervention, should be carried out under the guidance of Child Development Center run by developmental therapist with assistance from pediatricians &amp; child psychologists in order to improve the development of the child with cerebral palsy as well as the quality of life.DOI: http://dx.doi.org/10.3329/cmoshmcj.v14i1.22872 Chatt Maa Shi Hosp Med Coll J; Vol.14 (1); Jan 2015; Page 11-14

Focus Groups Support the Use of the Environment and Policy Assessment Observation (EPAO) for Obesity Prevention in Childcare

Preschool age is a critical period for obesity prevention. Increasingly more children are being cared for outside the home; however, no national nutrition and physical activity guidelines exist for child care centers. The Environment and Policy Assessment Observation (EPAO) instrument was administered at two child development centers (CDC) located in Fairfax, VA. Sites were selected based on partial vs. non‐subsidized status. Focus groups were conducted with parents at each center to identify the factors which promote a healthy child care environment. CDC 1, serving a population of lower mean income level, scored significantly higher (69%) on the EPAO compared to CDC 2 (53%). Higher scores related to serving more meals family style, teachers eating with children, and encouraging new foods. The emergent themes of the focus groups reinforced these findings as CDC 1 parents, as compared to CDC 2 parents, felt better informed about nutritional policies and practices. Parents appreciated that the menu included wide variety, cultural exposure, and allergen/gluten free options. CDC 1 parents commented on the relationship that staff had with children stating that staff nurtured a calm and encouraging environment. CDC 1 parents felt family style meals promoted table manners, self‐sufficiency, and civility. The policies pertaining to birthdays and celebrations were also clearly articulated and favorable. This study suggests that parents support many of the policies and practices identified by the EPAO. National child care policies for nutrition and physical activity should integrate the use of assessment tools such as the EPAO in the prevention of childhood obesity.

G539(P) Trainee-led quality improvement in enhancing service in community paediatrics

Context We planned to address two key areas of service provision in our secondary level hospital. Firstly, in keeping with many Community Paediatric Departments, our hospital has experienced an increase in the number and complexity of referrals. As a result many families had long waits for consultations. Secondly in our trust safeguarding work had historically represented a large proportion of the acute workload. Problem and Assessment 1. Child Development Centre (CDC) appointments Long waiting lists for medical appointments were negatively affecting patient care. The department was not compliant with the NICE guidance on the timeframe for assessment of children with possible social communication disorders. Patient satisfaction surveys had also identified this as an area of concern for families. 2. Child Protection Assessments Vulnerable children competed with acute admissions for assessments and were often seen out of hours, when Consultant medical staff were not on site. Social Care had highlighted concerns about long and unpredictable waits for assessments. Intervention Firstly, trainees in consultation with their consultant supervisors developed a flexible clinical arrangement to target service provision and meet community competencies in the CDC setting. Trainees were expected to complete six CDC clinics during their six month rotation, which were tailored to the trainee’s acute rota. Secondly, a daily child protection medical clinic was implemented and delivered by trainees under consultant supervision. Monthly safeguarding peer review meetings were initiated in line with Royal College of Paediatrics and Child Health guidance to provide support and facilitate training in this area. Strategy for change To instigate and review the response to change, the Plan-Do-Study-Act (PDSA) cycle was used. An initial multi-disciplinary team (MDT) meeting was used to formalise plans and disseminate information, with three monthly MDT feedback meetings planned. Measurement of improvement During the initial six month period, review of waiting lists has shown that trainee delivered CDC clinics have resulted in a reduction of waiting lists by 56 patients (the equivalent of 0.4 PA Consultant time). Urgent new patient appointments have fallen from 12 to 0, although routine new patient appointments have increased from 45 to 68. Feedback from the MDT is largely positive. Review of child protection referrals has shown that following the instigation of child protection medical clinics the number of assessments occurring out of hours has fallen to 19% compared to 44% previously. 81% of children are now seen at a prearranged time, without delay, compared to approximately 23% previously. Trainees report feeling more supported in carrying out safeguarding work. A repeat CDC patient satisfaction survey and a planned audit of the child protection clinics will provide further feedback on the success of these interventions, which will lead to further action (PDSA). Effects of changes Developing a flexible approach to encompass trainees’ acute commitments, has required meticulous planning. Room availability was an unexpected factor needing close consideration in the plans. Involvement of trainees has required support and supervision both from Consultants, and the wider MDT, thus requiring some changes to their previous practice. Lessons learnt Managing a change in service provision requires consideration of many different priorities. When trainees take a key role, it ensures the changes work at their level. Message for others Working within the European Working Time Directive and today’s financial constraints, a flexible approach to service provision is necessary. This initiative has highlighted that direct trainee involvement in the design of service delivery can result in significant changes that benefit patients, trusts and trainees alike. Moreover this venture has enhanced community training, as well as providing trainees with valuable experience in management of change.

G436(P) A Retrospective Audit of Melatonin Prescribing Amongst the Community Paediatricians in a Hertfordshire Child Development Centre and Cost Implications

Aims In 2012–2013 melatonin prescriptions cost our Paediatric department over £45,000 per year. An audit was carried out to explore the practice of prescribing melatonin among clinicians, compare it with current evidence for melatonin prescribing and find cost effective ways of reducing the annual melatonin spend. Methods Families of children with neurodevelopmental disorders issued with melatonin from hospital or community pharmacies from January to June 2013 were included in the audit. Cases were randomly selected and case-notes and doctor’s reports audited retrospectively. Children on melatonin for less than 6 months were excluded from the study. Results A total of 17 case-notes were audited. A detailed sleep history was documented in merely 1 case. Only 12% of cases were given verbal advice on sleep hygiene, prior to starting melatonin, and received sleep support whilst on melatonin. Paediatricians requested sleep hygiene support from Primary care in 6% of children. A sleep-diary was never used to monitor sleep at any stage of management. Children taking melatonin ranged from 1 to 8 years, with one child on melatonin for 12 years. Paediatricians did not suggest breaks from therapy in all cases. Given dosages of melatonin were ranged from 2 mg to 12 mg. Conclusion This audit highlighted the need for the development and implementation of evidence-based melatonin guidelines for Paediatricians, a sleep tool-kit for health professionals to help conduct a more effective sleep interview and sleep information to help support families establish good sleep hygiene in their children. So far, a melatonin guideline and sleep support tool-kit has been developed and circulated to relevant stakeholders. This has resulted in better prescribing practice, sleep support for families and a reduction in melatonin prescribing. Following the introduction of the guidelines, the preliminary results on the melatonin expenditure concluded a cost saving amount of £5651 over a period of 5 months, April to August 2014, compared to the same time period in 2013. These initial results are quite promising in predicting a larger saving in the future.

Methods for surveillance of fetal alcohol syndrome: The Fetal Alcohol Syndrome Surveillance Network II (FASSNetII) - Arizona, Colorado, New York, 2009 - 2014.

Surveillance of fetal alcohol syndrome (FAS) is important for monitoring the effects of prenatal alcohol exposure and describing the public health burden of this preventable disorder. Building on the infrastructure of the Fetal Alcohol Syndrome Surveillance Network (FASSNet, 1997-2002), in 2009 the Centers for Disease Control and Prevention awarded 5-year cooperative agreements to three states, Arizona, Colorado, and New York, to conduct population-based surveillance of FAS. The Fetal Alcohol Syndrome Surveillance Network II (FASSNetII, 2009-2014) developed a surveillance case definition based on three clinical criteria: characteristic facial features, central nervous system abnormalities, and growth deficiency. FASSNetII modified the FASSNet methods in three important ways: (1) estimation of a period prevalence rather than birth prevalence; (2) surveillance of FAS among school-age children (ages 7-9 years) to better document the central nervous system abnormalities that are not apparent at birth or during infancy; and (3) implementation of an expert clinical review of abstracted data for probable and confirmed cases classified through a computerized algorithm. FASSNetII abstracted data from multiple sources including birth records, medical records from child development centers or other specialty clinics, and administrative databases such as hospital discharge and Medicaid. One challenge of FASSNetII was its limited access to non-medical records. The FAS prevalence that could be estimated was that of the population identified through an encounter with the healthcare system. Clinical and public health programs that identify children affected by FAS provide critical information for targeting preventive, medical and educational services in this vulnerable population.

Clinical characteristics of autism spectrum disorder in Israel: impact of ethnic and social diversities.

Despite the increased global prevalence and recognition of autistic spectrum disorder (ASD), it is still scarcely reported in the Arab world. Though Israel has a higher prevalence of ASD, a previous national survey of patients diagnosed between 1972 and 2004, demonstrated that 98% of them were of Jewish ancestry. The disproportional low number of Arab children with ASD in Israel is unclear but may reflect lower awareness and cultural bias. In the present study we collected clinical and demographic characteristics of 200 children with ASD from Arab and Jewish sectors in Israel that were evaluated in two child development centers. We compared the incidence and the medical comorbidity of autism between these two ethnics groups. The medical and psychiatric comorbidity profile in these children was similar to the worldwide published studies. In the present study the prevalence of autism in the Arab sector in Israel was similar to that of the Jewish sector. The Arab patients presented with more severe autistic manifestations and higher incidence of mental retardation, familial members with autism, and consanguinity (P < 0.05), while in the Jewish sector milder forms (such as Asperger syndrome and PDD-NOS) were more frequent. This discrepancy might be explained by both genetic and cultural factors.