Children In Low-income Communities Research Articles

Factors Associated With Caregiver Reporting of Developmental Concerns Among Children in Low-Income Communities

Early detection and access to interventions for developmental delays in young children have been shown to improve health, social, and academic outcomes later in life. The purpose of this study is to examine the factors associated with caregivers' perception of child developmental concerns in low-income communities. A countywide survey was conducted in Los Angeles County (LAC), California, among 4,863 participating Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) families with children ages 1–4 years. Proportional odds ordinal logistic regression was used to evaluate the association between the severity of reported developmental concerns and respondent characteristics. Results indicate that demographic characteristics, support systems, health care visits during COVID-19, and maternal symptoms of depression are associated with higher odds of reporting more severe developmental concerns among the WIC population. Advancing policies, programs, and research that aim to improve early detection and access to childhood professionals for all families will be essential to allow all children in low-income households to optimize their development.

Fish Consumption Improved Head Circumference and Mid-Upper Arm Circumference among Infants in Zambia: A Randomised Controlled Trial

Fish is a good source of Animal Source Proteins (ASP). Families from low-income countries with limited access to other animal source proteins can utilize it to improve the nutrition status of infants and young children. The objective of the study was to assess if fish fed during the early complementary feeding period had an effect on improved head circumference (HC) and mid-upper arm circumference (MUAC) among infants aged 6–7 months. A randomised controlled trial was conducted from April 2019 to January 2020 in the Samfya district, Luapula Province, Zambia. The infants (238) were randomised to either the fish group (intervention) or the sorghum group (control). Every week for a period of 6 months, infants received seven sachets of fish powder and sorghum powder, respectively. Compliance was also monitored during the fish powder distribution. The head circumference measurements were conducted at baseline and once each follow-up month for a period of six months while the MUAC measurements were conducted twice (at baseline and endline). Using statistical software for data science (STATA) (version 16), a linear mixed effect model was used to analyse the data. The results showed that fish improved head circumference for age z score (HCZ) by 0.53 (95% CI: 0.23–0.82), p-value < 0.001, and MUAC by 0.36 (95% CI: 0.13–0.59) p-value < 0.002. Therefore, fish can be used as the main source of protein in complementary foods for infants and young children in low-income communities with limited access to meat.

Combined screening of early childhood development, hearing and vision by community health workers using mHealth tools in a low-income community

ABSTRACT Children in low-income communities are at risk for developmental delays and sensory losses. mHealth screening tools enable community health workers to detect developmental delays and sensory losses. This study aims to describe a combined (developmental and sensory – hearing and vision) mHealth-supported screening programme conducted by community healthcare workers with children aged four-six years (n = 63) at early childhood development centres in a low-income community. Early childhood development practitioners (n = 5) assisted with developmental screening. Referral rates were 30% (n = 19) for development, 6% (n = 4) for hearing and 5% (n = 3) for vision. The average screening time for combined screenings was 11.72 min (SD 3.45 min). Post screening questionnaires probing participants' perspectives and experiences of the combined screening were positive. A combined mHealth-supported screening programme conducted by community health workers and early childhood development practitioners appears viable, supporting early detection of developmental delays and sensory losses in children from low-income communities.

Self-Regulation and Academic Achievement from Early to Middle Childhood Among Children in Low-Income Neighborhoods

ABSTRACT Research Findings: Greater self-regulation has been identified as a protective factor for low-income children’s academic achievement. However, we know less about the long-term protective nature of specific aspects of self-regulation. Data were drawn from predominantly African American and Latino children in low-income communities in Boston, Chicago, and San Antonio during early childhood (mean age = 4.84 years) and middle childhood (mean age = 9.30 years; n = 348). The current investigation found that preschoolers’ overall self-regulation predicted their academic skills in middle childhood, net of child and family characteristics as well as academic competence during preschool. Furthermore, when executive function (EF) and effortful control (EC) in early childhood were examined as simultaneous predictors of quantitative and literacy scores during middle childhood, there were moderate linkages from EF to both academic domains. Practice or Policy: Our findings suggest that the long-term gains of interventions that focus on fostering globalself-regulation in preschool may yield more benefits for math than for reading, especially if such programs target young children’s executive function in particular.

A Parent Coach-Led Model of Well-Child Care for Young Children in Low-Income Communities: Protocol for a Cluster Randomized Controlled Trial.

BackgroundThe Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT) intervention was created as a team-based approach to well-child care (WCC) that relies on a health educator (Parent Coach) to provide the bulk of WCC services, address specific needs faced by families in low-income communities, and decrease reliance on the clinician as the primary provider of WCC services.ObjectiveThis study aims to evaluate the impact of PARENT using a cluster randomized controlled trial.MethodsThis study tested the effectiveness of PARENT at 10 clinical sites in 2 federally qualified health centers in Tacoma, Washington, and Los Angeles, California. We conducted a cluster randomized controlled trial that included 916 families with children aged ≤12 months at the time of the baseline survey. Parents will be followed up at 6 and 12 months after enrollment. The Parent Coach, the main element of PARENT, provides anticipatory guidance, psychosocial screening and referral, developmental and behavioral surveillance, screening, and guidance at each WCC visit. The coach is supported by parent-focused previsit screening and visit prioritization, a brief, problem-focused clinician encounter for a physical examination and any concerns that require a clinician’s attention, and an automated text message parent reminder and education service for periodic, age-specific messages to reinforce key health-related information recommended by Bright Futures national guidelines. We will examine parent-reported quality of care (receipt of nationally recommended WCC services, family-centeredness of care, and parental experiences of care), and health care use (WCC, urgent care, emergency department, and hospitalizations), conduct a cost analysis, and conduct a separate time-motion study of clinician time allocation to assess efficiency. We will also collect data on exploratory measures of parent-and parenting-focused outcomes. Our primary outcomes were receipt of anticipatory guidance and emergency department use.ResultsParticipant recruitment began in March 2019. After recruitment, 6- and 12-month follow-up surveys will be completed. As of August 30, 2021, we enrolled a total of 916 participants.ConclusionsThis large pragmatic trial of PARENT in partnership with federally qualified health centers will assess its utility as an evidence-based and financially sustainable model for the delivery of preventive care services to children in low-income communities.Trial RegistrationClinicalTrials.gov: NCT03797898; https://clinicaltrials.gov/ct2/show/NCT03797898International Registered Report Identifier (IRRID)DERR1-10.2196/27054

Ending Child Poverty by Investing in Children and Families.

Ending Child Poverty by Investing in Children and Families.

Social connectedness among parents raising children in low-income communities: An integrative review.

Social isolation has been linked to numerous health risks, including depression and mortality. Parents raising children in low‐income and under‐resourced communities are at an increased risk for experiencing social isolation and its negative effects. Social connectedness (SC), one's sense of belongingness and connection to other people, or a community, has been linked to reduced social isolation and improved health outcomes in the general population, yet little is known about the impact SC has on parents with low incomes. This integrative review aims to describe the current state of the science surrounding SC in parents with low incomes, summarize how SC is being defined and measured, evaluate the quality of the science, and identify gaps in the literature to guide future research. Five electronic databases were searched, yielding 15 articles for inclusion. Empirical studies meeting the following criteria were included: population focused on parents who have low incomes or live in low‐income communities and have dependent children, outcomes were parent‐centered, SC was a study variable or a qualitative finding, and publication date was before March 2021. Findings emphasize SC as a promising construct that may be protective in the health and well‐being of parents and children living in low‐income communities. However, a lack of consensus on definitions and measures of SC makes it difficult to build a strong science base for understanding these potential benefits. Future research should focus on understanding the mechanisms by which SC works to benefit parents and their children.

A community-based, cross-sectional study to assess interactions between income, nutritional status and enteric parasitism in two Brazilian cities: are we moving positively towards 2030?

BackgroundThis study assessed the interactions between income, nutritional status and intestinal parasitism in children in Brazil.MethodsA cross-sectional study (n = 421 children aged 1 to 14 years living in the states of Piauí (rural communities in the city of Teresina) and Rio de Janeiro (rural and periurban communities in the city of Cachoeiras de Macacu) was performed in order to obtain income and anthropometric data, as well as fecal samples for parasitological analyses through the Ritchie technique.ResultsChildren infected with Ascaris lumbricoides had significantly lower means of height-for-age z scores (− 1.36 ± 0.75 vs. − 0.11 ± 1.02; p < 0.001), weight-for-age z scores (− 1.23 ± 0.74 vs. 0.09 ± 1.15; p = 0.001), and weight-for-height z scores (− 0.68 ± 0.44 vs. 0.23 ± 1.25; p = 0.006) when compared with uninfected children. Infection with hookworm was also associated with lower means of height-for-age z scores (− 1.08 ± 1.17 vs. − 0.12 ± 1.02; p = 0.015) and weight-for-age z scores (− 1.03 ± 1.13 vs. 0.08 ± 1.15; p = 0.012). Children infected with Entamoeba coli presented significantly lower means of height-for-age z scores (− 0.54 ± 1.02 vs. − 0.09 ± 1.02; p = 0.005) and weight-for-age z scores (− 0.44 ± 1.15 vs. 0.12 ± 1.15; p = 0.002). The multivariate multiple linear regression analysis showed that height-for-age z scores are independently influenced by monthly per capita family income (β = 0.145; p = 0.003), female gender (β = 0.117; p = 0.015), and infections with A. lumbricoides (β = − 0.141; p = 0.006) and Entamoeba coli (β = − 0.100; p = 0.043). Weight-for-age z scores are influenced by monthly per capita family income (β = 0.175; p < 0.001), female gender (β = 0.123; p = 0.010), and infections with A. lumbricoides (β = − 0.127; p = 0.012), and Entamoeba coli (β = − 0.101; p = 0.039). Monthly per capita family income (β = 0.102; p = 0.039) and female gender (β = 0.134; p = 0.007) positively influences mid upper arm circumpherence.ConclusionsIntestinal parasitism and low family income negatively influence the physical development of children in low-income communities in different Brazilian regions.

Reaching Thousands of Children in Low Income Communities With High-Quality ECED Services: A Journey of Perseverance and Creativity.

This paper describes a creative and bold way in which a local NGO addressed increasing access and quality of ECED services in Colombia. This case study on Fundacion Carulla's aeioTU early childhood innovation in Colombia contributes to understanding the possibilities for the private sector to spark innovation, and the importance of an open and collaborative strategy in contributing to the ECED sector at large. The critical role of monitoring and evaluation in the provision of services is highlighted. This guided key decisions on different growth phases. After a decade of work, Fundacion Carulla-aeioTU has shown capacity to effectively support children's development in low-income settings through their participation in quality programming. Furthermore, this case study also describes how the organization, having proven its capacity to provide high-quality services directly to children, decided to innovate and bring about different solutions to reach and support other stakeholders in the early childhood development ecosystem.

MHealth developmental screening for preschool children in low-income communities.

Children are often only identified with a developmental delay when they enter primary school due to developmental delays hindering academic progress. Detection of at-risk children in low-income communities is typically unavailable due to several challenges. This study validated an mHealth-based developmental screening tool as a potential time- and cost-effective way of delivering services for preschool children. This cross-sectional within-subject study screened 276 preschool children from low-income communities using the mHealth Parents' Evaluation of Developmental Status (PEDS) tools. The mHealth PEDS tools' performance was then evaluated by comparing caregiver concerns according to the PEDS tools with results obtained using a reference standard assessment tool, the Vineland-3. The mHealth PEDS tools identified 237 (85.9%) of children at risk of developmental delay compared to 80.1% (n = 221) of children identified with a developmental delay using the Vineland-3. Sensitivity of the PEDS tools was high (92.6%) with low specificity (22.5%) using US standardised criteria. Literacy skills were found to be most delayed, according to the PEDS: DM (89.3%; n = 142) and Vineland-3 (87.1%; n = 134). Low specificity of the prescribed criteria may require the implementation of adapted referral criteria within low socio-economic status (SES) settings. The mHealth PEDS tools may still be valuable for preschool developmental surveillance of children within low SES settings. It is recommended, however, that children who are identified with a developmental concern undergo a second screen to reduce false positives.

Impact of a Language and Literacy Training and Coaching Intervention on Early Childhood Outcomes in Low-Income Communities

We implemented an Extension-led language and literacy training and coaching intervention targeting preschool teachers and children in low-income communities in Nevada. Participation in the intervention had a positive influence on the language and literacy instruction skills of preschool teachers and language and literacy skills of children. Analysis of 40 preschool classrooms and 199 preschoolers over 3 years of data collection identified improvements in general classroom environments and teachers' language and literacy practices. Preschoolers demonstrated improvements in alphabet knowledge, comprehension, phonological awareness, vocabulary, and oral language. Extension professionals elsewhere may use a similar approach to positively affect the achievement gap of at-risk children.

Prevalence and risk factors of gross motor delay in pre-schoolers.

Gross motor skills are important for children's health and development. Delays in these skills are a concern for healthy developmental trajectories and therefore early identification of delay is important. This study screened for gross motor delay in children from low-income communities and investigated potential risk factors associated with gross motor delay. This cross-sectional study involved 701 pre-schoolers (Mage = 54.1 ± 8.6 months, 52.8% boys) from childcare services in low-income and remote communities in Australia. Gross motor delay was assessed using the Ages and Stages Questionnaire - third edition. Potential risk factors included: sex, age, birthweight, prematurity status, weight status, childcare service, postcode, parent's education, parent's marital status, parent's employment and family income. Results showed 4.4% of the children were delayed in gross motor skills and 8.8% were at risk of delay. Logistic regression showed being a boy (odds ratio (OR) 1.78, 95% confidence interval (CI) 1.12-2.84), underweight (OR 2.72, 95% CI 1.18-6.30) or overweight (OR 1.83, 95% CI 1.00-3.33), and parental unemployment (OR 1.79, 95% CI 1.01-3.16) were factors associated with a higher odds of children being delayed or at risk of gross motor delay. A higher family income (OR 0.35, 95% CI 0.13-0.93) was associated with lower odds of delay. This unique study demonstrated children in low-income communities, especially boys, underweight and overweight children, have higher odds of being at risk of gross motor delay. Therefore, early screening is vital in this population in order to identify delays and potentially intervene with appropriate motor skill interventions.

The Effect of Community-Based Nutritional Interventions on Children of Women Living With Human Immunodeficiency Virus in Rural India: A 2 × 2 Factorial Intervention Trial.

Malnutrition is a common clinical concern among children in low-income communities affected by human immunodeficiency virus (HIV). We examined the effect of a community-based nutritional intervention on anthropometric and clinical outcomes of children of women living with HIV in rural India. We assigned women living with HIV and their child (oldest 3-8 years) to 1 of 4 programs: (1) community-based HIV care program, (2) program 1 + nutrition education, (3) program 1 + food supplement, and (4) all elements of programs 1-3. Study data were collected at baseline and months 6, 12, and 18. We applied mixed-effects modeling with restricted maximum likelihood estimation to examine changes in weight (all children) and CD4+ T-cell counts (children with HIV only). Overall, 600 mother-child pairs were enrolled (150/group) with 100% retention at follow-up visits. Approximately 20% of children were living with HIV. Children in program 4 had higher weight gain than those in programs 1, 2, and 3 at all time points (adjusted P < .001). We found a higher increase in CD4+ T cells across all time points among participants in programs 3 and 4 compared with program 1 (adjusted P < .001). Factorial analysis suggested a synergistic effect of combining nutrition education and food supplements for weight gain but not for increase in CD4+ T cells. A combination of nutrition education and food supplements provided to women living with HIV significantly increased weight and CD4+ T cells, and such interventions can be integrated into HIV-care programs in low-income settings.

Energy consumption behaviours of children in low-income communities: A case study of Khayelitsha, South Africa

This paper investigates the energy consumption behaviour of primary school children in a low-income community in South Africa, an area of enquiry that has received little attention to date. The study uses a mixed-methods approach comprising a survey, energy diaries and a focus group. The paper provides insights into how children’s energy behaviours are shaped by geographical and contextual factors such as the socio-economic situation of the family and social practices, as well as accessibility of fuel sources and appliances in specific areas. The main behaviours performed by children are lighting, cooking, heating, charging of electronic devices, and the use of applications inside the home for entertainment and communication purposes. Although some of these behaviours are documented, we identified important differences with existing studies relating to cooking and heating behaviours: the children in this study used a range of modern and more traditional/transitional fuels shaped by household energy access and affordability. Furthermore, the children in this study demonstrated increased autonomy in using appliances and fuels and engaged in household tasks such as independent cooking and family care in comparison with existing studies. The paper concludes by identifying areas for future studies to ensure children’s energy needs and practices are better integrated into energy interventions, planning and decision-making, all factors key to shaping long-term sustainable energy futures.

Factors Associated With Leisure Time Physical Activity Among Schoolchildren in a Predominantly Latino Community.

School initiatives aimed at increasing physical activity (PA) may improve the health of children in low-income communities. Assessors completed 5909 observations of students' PA during leisure periods using a validated instrument in 19 schools in low-income Latino communities. We examined relationships between school environment factors (eg, presence of playground equipment) and levels of moderate-to-vigorous physical activity (MVPA). Overall, 16.4% of students were engaged in vigorous activity, lower than reported in prior analyses. Consistent with earlier reports, boys were more engaged in vigorous PA than girls (18.6% vs 13.2%). Playground equipment, such as balls and jump ropes, were present in 27.5% of activity areas. Supervision was present in 83.1% of observations; however, staff members were only observed leading organized activity in 1.7%. Playground equipment was associated with higher rates of MVPA, particularly among elementary boys (p < .0001). Staff supervision was not associated with MVPA, possibly because staff members rarely led organized activity. We found low rates of leisure time PA among students in this low-income Latino community. The presence of playground equipment was favorably associated with activity levels. Increasing the availability of playground equipment might promote activity among children in similar populations.

Effect of a Breakfast in the Classroom Initiative on Obesity in Urban School-aged Children

Serving breakfast in the classroom is promoted to increase participation in the federal School Breakfast Program. However, little is known about the effect of breakfast in the classroom on children's weight status. To evaluate the effect of a breakfast in the classroom initiative, which combined breakfast in the classroom with breakfast-specific nutrition education, on overweight and obesity among urban children in low-income communities. A cluster-randomized clinical trial among 1362 fourth- through sixth-grade students from low-income urban communities across 2.5 years. Sixteen kindergarten through eighth grade Philadelphia public schools with universal breakfast participated. Participants were recruited in September 2013, and the intervention began in January 2014. Data analysis took place from April 1, 2018, to August 30, 2018. Intervention schools received a program that included breakfast in the classroom and breakfast-specific nutrition education. Control schools continued breakfast before school in the cafeteria and standard nutrition education. The primary outcome was the combined incidence of overweight and obesity. Secondary outcomes included the combined prevalence of overweight and obesity, incidence and prevalence of obesity, changes in body mass index (BMI) z score, and School Breakfast Program participation. Among the 1362 students, mean (SD) age was 10.8 (0.96) years and 700 (51.4%) were female; 907 (66.6%) were black, 233 (17.1%) were Hispanic, 100 (7.3%) were white, 83 (6.1%) were Asian, and 39 were of multiple or other race/ethnicity. After 2.5 years, students in intervention schools had participated in the School Breakfast Program 53.8% of days, compared with 24.9% of days among students in control schools (β = 0.33; 95% CI, 0.22-0.42). There was no difference between intervention and control schools in the combined incidence of overweight and obesity after 2.5 years (11.7% vs 9.3%; odds ratio [OR] 1.31; 95% CI, 0.85-2.02; P = .22). However, the incidence (11.6% vs 4.4%; OR, 2.43; 95% CI, 1.47-4.00) and prevalence (28.0% vs 21.2%; OR, 1.46; 95% CI, 1.11-1.92) of obesity were higher in intervention schools than in control schools after 2.5 years. A breakfast in the classroom initiative increased participation in the School Breakfast Program and did not affect the combined incidence of overweight and obesity. However, the initiative had an unintended consequence of increasing incident and prevalent obesity. Further research is needed to identify approaches to increase participation in the School Breakfast Program that do not increase obesity among students. ClinicalTrials.gov identifier: NCT01924130.

Blood Lead Surveillance and Exposure Sources Among Alaska Children.

Nationally, the child lead poisoning prevention strategy focuses on children in low-income communities living in old housing with lead paint. In Alaska, however, only about 3% of existing homes were built before 1950 and 38% were built during 1950-1979. As such, lead paint in old housing is a less frequent source of exposure for Alaska children with elevated blood lead levels (EBLLs). The Alaska Department of Health and Social Services collects and maintains data for all blood lead level (BLL) tests in the state and is responsible for following up on EBLLs. The Alaska Department of Health and Social Services conducts telephone interviews with parents of children with an EBLL to identify and remove possible sources of lead from the child's environment and prevent subsequent exposure. This review summarizes the surveillance data on BLLs in Alaska children for 2011-2015 and describes the most commonly identified possible sources of childhood lead exposure statewide since 2011. While the proportion of children in Alaska who received a BLL test during these years is low compared with other states and EBLL prevalence is low among children tested, several possible sources of exposure were identified among children with EBLLs, including nonpaint sources. This report summarizes the challenges of combatting childhood lead exposure in a rural state where housing is a less common exposure source and describes ongoing work to prevent childhood lead exposure in Alaska.

Instrumentalising the digital: adolescents’ engagement with ICTs in low- and middle-income countries

ABSTRACTIn development agendas regarding children in low-income communities, both older and emerging media are typically ignored or assumed to have beneficial powers that will redress social and gender inequality. This article builds on a recent rapid evidence review on adolescents’ digital media use and development interventions in low- and middle-income countries to examine the contexts of children and adolescents’ access to, and uses of, information and communication technology(ICT). Noting that only a handful of studies heed the significance of social class and gender as major axes of inequality for adolescents, the article scrutinises the gap between the rhetoric of ICT-based empowerment and the realities of ICT-based practice. It calls for a radical rethinking of childhood and development in light of the actual experiences, struggles, and contexts.

Qualitative Evaluation of Individual and Group Well-Child Care

ObjectiveIndividual well care (IWC) is the standard delivery model for well-child care in the United States. Alternative models, such as group well care (GWC), may create opportunities to enhance care for babies. The purpose of this study was to evaluate parents' perceptions of social/wellness benefits and system challenges of IWC and GWC. MethodsSince 2014, we have provided both IWC and GWC at an urban academic practice serving a low-income minority community. We conducted a mixed method study involving surveys and 18 focus groups (11 IWC groups, n = 32 parents; 7 GWC groups, n = 33 parents). Parents completed surveys before convening focus group discussions. Survey results were analyzed using independent t tests; focus groups were digitally recorded, transcribed, and analyzed to identify themes. ResultsBoth groups had similar demographics: parents were mostly female (91%) and black (>80%); about half had incomes < $20,000. Parents' mean age was 27 years; children's mean age was 11 months. There were no significant differences in overall scores measuring trust in physicians, parent empowerment, or stress. IWC parents' themes highlighted ways to improve care delivery, while GWC parents highlighted both satisfaction with care delivery and social/wellness benefits. GWC parents strongly endorsed this model and reported unique benefits, such as garnering social support and learning from other parents. ConclusionsParents receiving both models of care identified ways to improve primary care delivery. Given some of the benefits reported by GWC parents, this model may provide the means to enhance resilience in parents and children in low-income communities.

Non-nutritional determinants of satisfactory growth among infants and pre-school children in low income communities in Ja-Ela Medical Officer of Health area, Sri Lanka

Background: In Sri Lanka, poor growth of infants and pre-school children is a persistent concern with 14% of them having low weight for height. It has been observed that some infants grow well and develop successfully even in low income set-ups despite many unfavourable circumstances, a phenomenon that has not been studied adequately. Objective: To describe the non-nutritional determinants of positive growth among infants and pre-school children in low income communities in Sri Lanka. Methods: An unmatched case control study including a qualitative arm was carried out. Cases were ‘well grown’ and controls were ‘poorly grown’ infants and pre-school children in Ja-Ela Medical Officer of Health area, who were recruited from the child welfare clinic and at home. Growth was determined by weight for age using standard procedure. An interviewer-administered questionnaire obtained data from their mothers/caretakers on the potential determinants of growth. Ten of the cases were randomly selected for the qualitative study and their mothers underwent in-depth interviews. Results: A total of 51 cases and 67 controls were recruited for the study. Their average family income was Rs. 17,700 (SD=4200). Cases and controls did not differ significantly by the mode of delivery, type of pregnancy, order of pregnancy and whether pregnancy was planned or not. The only non-nutritional determinants of positive growth were: whether the child is easy to be fed (OR=3.58; 95% CI: 1.66, 7.72) and corporative with the mother (OR=3.77; 95% CI: 1.05, 13.54). The qualitative study further identified readiness to eat and preference for a wide variety of food as non-nutritional determinants of positive growth, which seemed to be intrinsic characteristics of a child rather than shared features among the siblings in a family. Conclusions: Intrinsic characteristics of a child such as readiness to eat, cooperating with the mother and preferring a variety of food partly determine good growth. Dynamics of these characteristics need further study.