Children In Flanders Research Articles

Primary school children's conflicted emotions about using their heritage languages in multilingual classroom tasks

AbstractFor many children in Flanders, Belgium, the language of instruction is not their first language. Allowing children to use their heritage languages in the classroom has been argued to have functional and socioemotional benefits. In two exploratory studies, we introduced a multilingual task in four classrooms across three linguistically and socially diverse primary schools, where Dutch was the language of instruction, to determine how students experience the opportunity to use their linguistic repertoire in class. The multilingual task was preceded by an assessment of students’ emotional reactions to the languages they speak through the Self‐Assessment Manikin gauging students’ emotional responses (pleasure, arousal, and dominance), and followed by a semistructured interview on students’ language choices. Both studies yielded similar results. Students generally indicated that they felt happy, calm, and in control when speaking their heritage language. Despite these positive assessments, many students refrained from using their heritage language in the multilingual tasks. A qualitative analysis revealed a variety of language‐related reasons leading to linguistic insecurity, language anxiety, and not using the heritage language: perceived language proficiency, language norms, language status, and appropriate contexts for language use. Conversely, we also identified several students who felt proud to showcase their heritage language. While multilingual tasks have the potential to induce positive emotions in students, teachers need to be aware of potential backlash and prepared to navigate the negative emotions surrounding contested language choices.

Epidemiology and clinicopathological characteristics of native kidney disease in children in Flanders, Belgium.

The Flemish Collaborative Glomerulonephritis Group (FCGG) registry is a population-based kidney biopsy registry that has been including all native kidney biopsies performed in children in Flanders (Belgium), since 2017. From 2017 to 2020, 148 pediatric (< 18years) native kidney biopsies were included. Each biopsy received a histopathological and final nephrological diagnosis, and concordance between both was assessed. Disease chronicity, summarized by the Mayo Clinic Chronicity Score, was determined on 122 biopsies with > 5 glomeruli. Kidney biopsy rate was high (29.0 biopsies per million children per year), median age was 10.0years (IQR 5.8-14.7), and boys predominated (56.1% males). A total of 140 biopsies (94.6%) showed a representative pathology result. Glomerular disease was most prevalent, with IgA nephropathy/IgA vasculitis (43 biopsies, 29.1%) and minimal change disease (MCD) (29 biopsies, 19.6%) being the overall most frequent diagnoses. In general, diagnostic concordance was high (80.7%). In Alport syndrome and focal segmental glomerulosclerosis (FSGS), concordance was lower, as the nephrological diagnosis was often determined by results of genetic analysis. Nephrotic syndrome was the most frequent indication for kidney biopsy (31.8%) and was mainly caused by MCD and FSGS. The degree of disease chronicity on kidney biopsies was generally low, although 27.3% of biopsies with a diagnosis of FSGS showed moderate-to-severe chronic damage. The presented epidemiological findings validate data from previous European registry studies and may inspire kidney biopsy registries worldwide to implement novel features such as clinicopathological concordance and chronicity grading. A higher resolution version of the Graphical abstract is available as Supplementary information.

Mental health problems in refugee and immigrant primary school children in Flanders, Belgium.

European countries face the challenge of promoting refugee and immigrant children's well-being within their host communities, invoking the necessity of adequate mental health assessment. This study aims to contribute to document the psychosocial well-being of primary school refugee and non-refugee immigrant children in Flanders, Belgium. A total of 120 children (8-12years old) with migration backgrounds participated in the study. Through self-report, parent and teacher questionnaires we scrutinized externalizing and internalizing behavioral problems, post-traumatic stress problems, and classroom relationships. Thirty percent of the participants reported high levels of post-traumatic stress; around 25% reported a high or very high prevalence of internalizing and externalizing behavioral problems. Self-reported mental health problems are elevated in comparison to the general population. Refugee children did not report more difficulties than their immigrant peers. In the perception of parents and teachers, respectively 20% and 5% of children showed high or very high amounts of internalizing and externalizing behavioral difficulties. Almost 70% of the participants perceived the class climate as unsafe. Refugee and immigrant children are at risk for mental health difficulties, and experience classroom dynamics as markedly distressful. School-based intervention might be particularly suited to support these children's psychosocial well-being in resettlement.

Exploring English in TV product advertising for Dutch‐speaking children

AbstractIn the context of global English, children are an interesting target group both from a marketing and a linguistic perspective, yet the use of English in advertising for children has so far received little research attention. Investigating English in a corpus of 3566 free morphemes (smallest independent linguistic elements) in 98 TV product advertisements aimed at Dutch‐speaking children in Flanders, Belgium, this study addresses the methodological question of what counts as ‘English’ before inquiring into: (1) the overall amount of English; (2) which parts of the adverts are susceptible to English; and (3) the types of English used. Results show 80% of the adverts contain English, but English accounts for only 13% of the total free morphemes in the adverts. 70% of adverts contain English in the product or company name, which suggests that even in advertising language, the use of English is limited to specific functions in the Dutch‐speaking Belgian context.

Dutch speech intelligibility in bilingual Turkish-Dutch children in Flanders

AbstractThis study examines the Dutch intelligibility of a group of monolingual Dutch and bilingual Turkish-Dutch preschool children in Flanders, as rated by native Dutch listeners and measured by a Dutch intelligibility test. The intelligibility of the bilingual children is compared to that of the monolingual Dutch children, in order to examine whether age and/or task effects are similar or different in the two groups. The results revealed that intelligibility was affected by age, but showed no significant interaction between age and group. However, we found a significant interaction between age and task: children’s intelligibility increased with age for a word production as well as a sentence production task, but much more so for the latter than for the former. We discuss the results in relation to the children’s developing phonological systems, the age of exposure to Dutch and the nature of the test.

Excessive gaming behaviour in primary school children in Belgium

Abstract Background The use of electronic devices (smartphones, laptops,...) has gradually become a common activity among primary school children. Especially children's excessive use of elec-tronic games has been increasingly considered an important Public Health issue. This study explored the effects of personal and social factors on gaming behaviour in primary school children. Methods A survey was conducted in primary school children in Flanders (Belgium), 2016. Overall 8,444 children, mainly 9 to 11 years old, were included. First, descriptive and bivariate analyses were conducted. Subsequently, a multinominal logistic regression was performed to analyse gaming behaviour. Results Overall, 27% (n = 2,277), 25% (n = 2,108), 29% (n = 2,453) and 19% (n = 1,606) of the participating children showed a low, moderate, frequent and very frequent level of gaming behaviour, respectively. Gender differences were statistically significant, with boys showing more moderate, frequent and very frequent gaming behaviour. Further, chances for gaming were higher among children with a more frequent consumption of high sugar content soda, chips and candies. Conclusions More frequent gaming in boys can already be observed in primary school. How-ever, further research is needed to explore the development of this behaviour over longer time periods. Further results might provide useful information for developing effective prevention strategies concerning excessive gaming behaviour among primary school children. Key messages Excessive gaming behaviour is already present in 9 to 11 years old children. It might be useful to develop effective prevention strategies regarding excessive gaming in primary school children.

Interactive acculturation of Turkish-Belgian parents and children in Flanders: A case study of Beringen

This article tackles the relationship between Turkish-Belgian families with the Flemish society, within the specific context of their experiences with early childhood education and care (ECEC) system in Flanders. Our findings are based on a focus group with mothers in the town of Beringen. The intercultural dimension of the relationships between these families and ECEC services is discussed using the Interactive Acculturation Model (IAM). The acculturation patterns are discussed under three main headlines: language acquisition, social interaction and maternal employment. Within the context of IAM, our findings point to some degree of separationism of Turkish-Belgian families, while they perceive the Flemish majority to have an assimilationist attitude. This combination suggests a conflictual type of interaction. However, both parties also display some traits of integrationism, which points to the domain-specificity of interactive acculturation.

Vestibular Infant Screening – Flanders: The implementation of a standard vestibular screening protocol for hearing-impaired children in Flanders

ObjectivesThe Vestibular Infant Screening – Flanders (VIS-Flanders) project aims to implement and refine a vestibular screening protocol for all children with neonatal hearing loss in Flanders (Belgium) to limit the impact of a vestibular dysfunction on the motor, cognitive and psychosocial development of hearing-impaired children. MethodsEach child with a confirmed neonatal hearing loss in Flanders will undergo a vestibular screening at the age of 6 months in the reference centers involved in the neonatal hearing screening program. The cervical Vestibular Evoked Myogenic Potential (cVEMP) test will be used as a screening tool. The test is short, child-friendly, feasible at a young age and highly correlated with motor and balance performance. The results of an extensive follow-up protocol at the Ghent University Hospital will enable further refinement of the screening protocol. ResultsData collection in all reference centers has started since June 2018. This paper outlines the rationale for the screening and the set-up of this four-year project. ConclusionsCurrent available literature strongly favors vestibular assessment in congenitally hearing-impaired children. A standard vestibular screening for these children should lead to early identification of vestibular deficits and subsequent prompt referral for further motor assessment and rehabilitation, in order to limit the impact of a vestibular dysfunction in developing children and improve their quality of life.

Susceptibility to measles, mumps, and rubella in 5-year-old children in Flanders, Belgium

The second dose of an MMR vaccine is a catch up for persons who did not receive the first dose or for primary vaccine failures. Catch up doses can be scheduled according to convenience into the program of the country. The second MMR dose is often administered at the age of 5 years, before school entry. Some countries chose to implement the second dose at the age of 10-13 years, as is the case for Belgium. The here presented long-term follow-up of a cohort of children, set up originally to analyze maternal antibodies against vaccine preventable diseases, offers a unique opportunity to evaluate ad interim the current long-interval MMR vaccination schedule in Belgium. After 1 MMR dose at 12 months of age, rubella immunity is almost intact at 5 years of age (94.5 % is seropositive), measles seropositivity scores 86.8 %, and mumps 32 %, measured with ELISA. A seroneutralization (SN) test for mumps antibodies reveals much higher seropositivity rates (88 %). Using a regression model on the log (IgG) titer for all antigens, no influence was found from any of the studied variables, except for girls who had a significantly higher rubella IgG titer (p=0.002) compared to boys. The data show considerable susceptibility to mumps and measles in 5-year-old children, confirming a previously conducted seroprevalence study (2006). Both advantages and disadvantages of shortening or enlarging the vaccine schedule are discussed.

A survey on happiness in primary school children in Flanders

Background Although a complex concept, happiness seems to be associated with factors such as physical and mental health and wellbeing. Nevertheless, studies directly assessing happiness in young people are scarce and children from primary schools are seldom the subject of study. Methods In Spring 2013, a questionnaire was distributed among all primary schools of the city of Lier (34,000 inhabitants, 20 km southward from Antwerp). To assess happiness, a ten point scale was used, asking: ‘If I would give myself a score on ten …

HEAPS Study Design: Health Effects of Air Pollution in Antwerp Schools

The HEAPS study (Health Effects of Air Pollution in Antwerp Schools) was set up to evaluate the health impact of traffic related air pollution on school children in Flanders, Belgium. The study comprises the biomonitoring of 130 children (aged 6-12) from 2 schools and simultaneous air quality monitoring. All air quality and health measurements were performed in both spring and autumn 2011. One of the schools was located next to a busy road of 20,000 vehicles/day, the other school was located at an urban background location. Air quality measurements were performed at the schools (UFP, PM, BC, NOx, and O3), at a selection of 40-50 home locations (BC, NO2) and while in transport (UFP, BC). The measurements were translated into exposure estimates in different time frames: respectively evaluating acute health effects, subacute effects (1 to 10 days before sampling), and long term health effects. The land use regression technique was applied to estimate BC and NO2 concentrations at unmeasured locations. In the exposure assessment, the time-activity pattern of the children and concentrations in different micro-environments were taken into account. Next to this, personal NO2 samplers were carried by the children during one week. Health assessment consisted of measurements of fractional exhaled nitric oxide (FeNO), exhaled breath condensate (EBC) markers (pH, 8-isoprostane, cytokines), and urinary 8-oxo-2'-deoxyguanosine (8-oxodG). Additionally, allergic inflammation in the nose was assessed in spring with a Rhinostick, while in autumn the Rhinostick was used to analyze nasal concentrations of IL-8, eosinophilic cation protein (ECP), and tryptase. ISAAC-type questionnaires on asthma, rhinitis and eczema symptoms were distributed amongst all children attending one of the schools. Acknowledgement: the study was financed by the Flemish Environment Agency (VMM), the Flemish Administration of Environment, Nature and Energy (LNE), and the Flemish Agency for Care and Health (VAZG).

Analysing care-related decisions in parents of congenitally deaf children: introduction of an explanatory model

Research into issues of deafness is characterised by the dominance of the medical model of disability. Although social and cultural-linguistic models have received increasing attention from scholars, they have been used mainly in theoretical debate. Empirical application has been limited. Based on our comprehensive research project into the care-related decisions of parents of congenitally deaf children in Flanders, Belgium, an explanatory model for care-related parental decisions was constructed, which transcends the specific findings generated by our studies. This model is presented and discussed in this paper. Illustrations are provided based on our empirical findings.

Evaluating the Implementation Fidelity of a Multicomponent Intervention for Oral Health Promotion in Preschool Children

This study evaluates the process of implementation of a longitudinal intervention program to promote oral health in preschool children in Flanders, Belgium. As the program was implemented in an existing preventive health care organization, the study also evaluates this setting as the context for implementation. Qualitative and quantitative methods were used to evaluate implementation fidelity, based on Carroll's theoretical framework of implementation fidelity (Carroll et al., Implementation Science 2:40, 2007). Questionnaire data from participants and health workers were analyzed, and document analyses were performed to compare registrations of the actions with the planning manual. Results were mixed. Whereas more than 88 % of all parents attended all home visits, only 57 % received at least 9 of the 11 planned consultations. Fifty-two percent of the families received all supporting materials, and on average, 73 % of all attending families received all information at a contact as described in the manual. Moderating factors such as the adequate use of facilitators and high participant responsiveness had a positive impact on implementation fidelity, whereas the quality of delivery differed to a great extent between the nurses who were involved during the entire intervention period and those who gave only a few sessions. Implementing an intervention in an existing well-baby program has many advantages, although lack of time presents a challenge to implementation fidelity. The results of this process evaluation allow a better understanding of the contribution of implementation fidelity to the effectiveness of health promotion programs.

Accessibility to cochlear implants in Belgium: State of the art on selection, reimbursement, habilitation, and outcomes in children and adults

Belgium, and especially the northern region called Flanders, has been a center of expertise in cochlear implants and early hearing screening for many years. Some of their surgeons and engineers were pioneers in the development of cochlear implants and in 1998 Flanders was the first region in Europe to implement a universal hearing screening program for all neonates. The Belgian National Institute for Health and Disability Insurance has reimbursed cochlear implants in children and adults since 1994 and bilateral implantation in children under the age of 12 years since February 2010. These deaf children, screened and implanted early, achieve higher auditory, speech and language outcomes and increasing numbers are going to regular schools using fewer interpreters. In 2010, 93% of severe-to-profound deaf preschool children in Flanders had received cochlear implants and 25% had bilateral implants. Although on average twice as many adults as children are implanted a year in Belgium, we have less research data available from this adult population. Also very little is published about the growth curves and minimal rehabilitation requirements (intensity, duration etc.) after implantation for both children and adults. So, there still remain many challenges for the future.

The KörperkoordinationsTest für Kinder: reference values and suitability for 6–12‐year‐old children in Flanders

An adequate coordination level in children is important for their general development, but also for health, psychosocial, academic and well-being-related reasons. In this study, the suitability of the KörperkoordinationsTest für Kinder (KTK) as an assessment instrument for the gross motor coordination was evaluated in 2470 children from 26 elementary schools for general education spread over the Flemish and Brussels-capital region. All children performed four subtests: walking backwards (WB), moving sideways (MS), hopping for height (HH) and jumping sideways (JS). Age and gender-specific values were established for the Flemish children anno 2008. Overall, the current sample scored significantly worse than their 1974 German counterparts (P<0.001). Score distribution showed 21% of the children being placed in the problematic range of gross motor coordination level. A decline in coordination was observed especially in those tasks relying primarily on coordinative capacities (WB and MS), while improvements or status quo in those tasks relying on strength and speed (JS and HH) were explained by secular trends. We suggest that the KTK is a valuable instrument for the assessment of the gross motor coordination of Flemish children and efforts should be made in order to face the decline in coordination.

E058 The influence of 12 years of universal hearing screening and early implantation on the educational setting and support of deaf children in Flanders (Belgium)

E058 The influence of 12 years of universal hearing screening and early implantation on the educational setting and support of deaf children in Flanders (Belgium)

Continuous Deep Sedation at the End of Life of Children in Flanders, Belgium

Context Few guidelines have yet been put forth for continuous deep sedation in pediatrics, and empirical data on the use of this practice in minors are rare. Objectives To estimate the incidence of continuous deep sedation in minor patients (aged 1–17) and describe the characteristics of, and the decision-making process before, continuous deep sedation. Methods An anonymous population-based postmortem survey was mailed to all physicians signing the death certificates of all patients aged 1–17 years who died between June 2007 and November 2008 in Flanders, Belgium. The questionnaire concerned whether or not continuous deep sedation was used at the end of life and measured characteristics of sedation and the decision-making process preceding it. Results Response rate was 70.5% ( n = 165). Of all children, 21.8% had been continuously and deeply sedated at the end of life. Duration of sedation was one week or less in 72.4% of cases, and artificial nutrition and hydration were administered until death in 54.3% of cases. Benzodiazepines were used as the sole drug for sedation in 19.4% of cases, benzodiazepines combined with morphine in 50%, and morphine as the sole drug in 25%. In 23.5% of cases, physicians had the explicit intention, or the concurrent intention, to hasten death. Only 3.0% of patients requested sedation and 6.1% consented. Parents consented in 77.8% of cases and requested sedation in 16.7%. Conclusion Minor patients were commonly kept in continuous deep sedation or coma until death in Flanders, Belgium. Given the high incidence of the practice and indications that it is often used without involving the patient—and sometimes with a life-shortening intention—the development of specific guidelines for sedation in children might contribute to due care practice.

The long-term outcome after severe trauma of children in Flanders (Belgium): a population-based cohort study using the International Classification of Functioning—related outcome score

Important long-term health problems have been described after severe paediatric trauma. The International Classification of Functioning (ICF) was developed as a universal framework to describe that health. We evaluated outcome in children after ‘severe’ trauma (defined as: hospitalised >48 h) by means of a questionnaire based on this ICF construct (IROS). Questionnaires were sent to children; one year after this trauma and to ‘control’ children without any previous ‘severe’ trauma. We created propensity score-matched pairs (n = 133) and evaluated differences in health perception. IROS characteristics were investigated by means of Item Response Theory models. We then estimated the health state of each individual based on his/her response pattern (factor score z01) and investigated the effect of selected covariates with simple linear regression. Significant odds ratios for differences between matched groups (p < 0.05) were observed for among others emotional problems, mobility, societal life and family burden, but not for chronic pain. Children in the trauma group showed, e.g. significant more physician (estimated relative risk R′ 1.7) and psychologist (R′ 3.5) visits. IROS primarily provides information from medium to high health burden levels and factor scores ranged from 0.41 (lowest) to 0.967 (highest burden). A significant impact on health burden could only be proven for the ‘state at discharge’ (p = 0.015), although there was a tendency towards worse factor scores for children that were older, had a higher Injury Severity Score or after traffic injury. In conclusion, we showed that the burden of health problems for children and families after severe trauma is still high and physical, as well as psychosocial in nature. The health state at discharge seems to predict long-term outcome, which might be of importance in view of, e.g. trajectory assistance. IROS may provide an improved scoring system to evaluate outcome after (paediatric) injury or critical illness.Electronic supplementary materialThe online version of this article (doi:10.1007/s00431-010-1271-y) contains supplementary material, which is available to authorized users.

Medical End-of-Life Decisions in Children in Flanders, Belgium

To estimate the prevalence of end-of-life decisions and to describe their characteristics and the preceding decision-making process in minors in Belgium. Population-based postmortem anonymous physician survey. Flanders, Belgium. All physicians signing the death certificates of all patients (N = 250) aged 1 to 17 years who died between June 2007 and November 2008 in Flanders, Belgium. Prevalence and characteristics of end-of-life decisions and the preceding decision-making process. For 165 of the 250 deaths, a physician questionnaire was returned (70.5%). In 36.4%, death was preceded by an end-of-life decision. Drugs were administered to alleviate pain and symptoms with a possible life-shortening effect in 18.2% of all deaths, nontreatment decisions were made in 10.3%, and lethal drugs without the patient's explicit request were used in 7.9%. No cases of euthanasia, ie, the use of drugs with the explicit intention to hasten death at the patient's explicit request, were reported. Poor clinical prospects (84.6%) and low quality of life expectations (61.5%) were important reasons for the physicians to engage in end-of-life decisions. Parents were involved in decision making in 85.2% of these decisions, patients in 15.4%. Medical end-of-life decisions are frequent in minors in Flanders, Belgium. Whereas parents were involved in most end-of-life decisions, the patients themselves were involved much less frequently, even when the ending of their lives was intended. At the time of decision making, patients were often comatose or the physicians deemed them incompetent or too young to be involved.

Reproducibility and validity of a diet quality index for children assessed using a FFQ

The diet quality index (DQI) for preschool children is a new index developed to reflect compliance with four main food-based dietary guidelines for preschool children in Flanders. The present study investigates: (1) the validity of this index by comparing DQI scores for preschool children with nutrient intakes, both of which were derived from 3 d estimated diet records; (2) the reproducibility of the DQI for preschoolers based on a parentally reported forty-seven-item FFQ DQI, which was repeated after 5 weeks; (3) the relative validity of the FFQ DQI with 3 d record DQI scores as reference. The study sample included 510 and 58 preschoolers (2.5-6.5 years) for validity and reproducibility analyses, respectively. Increasing 3 d record DQI scores were associated with decreasing consumption of added sugars, and increasing intakes of fibre, water, Ca and many micronutrients. Mean FFQ DQI test-retest scores were not significantly different: 72 (sd 11) v. 71 (sd 10) (P = 0.218) out of a maximum of 100. Mean 3 d record DQI score (66 (sd 10)) was significantly lower than mean FFQ DQI (71 (sd 10); P < 0.001). The reproducibility correlation was 0.88. Pearsons correlation (adjusted for within-person variability) between FFQ and 3 d record DQI scores was 0.82. Cross-classification analysis of the FFQ and 3 d record DQI classified 60 % of the subjects in the same category and 3 % in extreme tertiles. Cross-classification of repeated administrations classified 62 % of the subjects in the same category and 3 % in extreme categories. The FFQ-based DQI approach compared well with the 3 d record approach, and it can be used to determine diet quality among preschoolers.