Child Development Outcomes Research Articles

High yield of congenital hypothyroidism among infants attending Children Hospital, Nairobi, Kenya. Facility based study in the absence of newborn screening.

Congenital hypothyroidism (CHT) is a treatable cause of intellectual disability. Late diagnosis and delayed initiation of treatment leads to irreversible neurodevelopmental and intellectual disability. Thus, newborn screening is crucial. However, 71 % of babies are born in an area with no established newborn screening program and Kenya is not an exception. We aimed to determine the incidence of CHT, developmental outcomes of patients in the absence of newborn screening. A retrospective data of subjects who met the inclusion criteria, newborn and infants from 3days to 2 years whose thyroid function test (TFT) was undertaken during well baby visit or clinical suspicion of CHT were collected. Laboratory reference range for age was used to interpret the result and TSH>10 Uiu/mL after 6weeks of life is considered abnormal according to ESPE guideline. Developmental outcome of children was collected from patient file documented by primary physician and parental concern. Of 1,426 children met inclusion criteria, 90 had elevated TSH. Out of which 70 repeat TFT showed normal TSHand free T4. The incidence of abnormal TSH across the different age groups was 2.4 , 7.2 and 10.5 % for ages 0-29days, 1-11months, and 1-2 years, respectively with p value of =0.0002. While 20 cases with CHT identified with incidence of 14 per 1,000 children (1.4 %; 95 % CI: 0.9-2.1 %). Out this 12 (60 %) had poor developmental outcomes. Down's syndrome was the common associated condition 9/20 (45 %). All cases were Primary CHT. This study shows high incidence of CHT in a small cohort of patients over 5-year period with poor development outcome.

In vitro fertilization and long-term child health and development: nationwide birth cohort study in Japan

The aim of this study is to compare long-term health outcomes between IVF-conceived children and non-IVF-conceived children in Japan, in the context of strong recommendation for single embryo transfer. Using data from a nationwide birth cohort linked with perinatal database, this study analyzed 2140 children born in Japan in May 2010. It compared child health and development outcomes up to 9 years of age between IVF-conceived and non-IVF-conceived children (binary exposure). A Poisson regression with robust variance to estimate the risk ratios for the association between IVF and various long-term child health and developmental outcomes. After adjusting for confounding factors, no significant differences were observed between IVF-conceived and naturally conceived children for most outcomes, including hospitalization, obesity, and developmental milestones. IVF-conceived children showed a slightly lower risk of attention problems at 8 years (adjusted Risk Ratio [aRR]: 0.73, 95% CI: 0.53–1.00). In subgroup analyses, IVF-conceived term children and singletons demonstrated reduced risk of cognitive delays at 5.5 years (aRR: 0.31, 95% CI: 0.10–0.96 and aRR: 0.37, 95% CI: 0.14–0.98, respectively).Conclusion: In this Japanese cohort, IVF conception was not associated with adverse long-term health or developmental outcomes. These findings provide reassurance about the safety of IVF, particularly in the context of single embryo transfer policies. Further research is needed to explore specific IVF protocols and subgroups.What is known:• Long-term health and developmental outcomes of IVF-conceived children remain inconsistent across studies and populations, despite the widespread use of this technology.What is new:• A nationwide population-based cohort study in Japan did not show adverse effects of IVF on long-term child health and development through age 9.• These findings provide reassurance about the safety of IVF, while indicating the need for careful monitoring in specific subgroups such as preterm and multiple births.

Air Pollution, Child Health, and Cognitive Development

ABSTRACT This study investigates the impact of indoor air pollution exposure, assessed through blood carbon monoxide (CO) levels, on both the development and health outcomes of preschool-age children in Nigeria. Prior research often relies on ambient air pollution data, which presents limitations in resource-constrained settings. To address this, we employ a direct approach, measuring CO levels in participants’ blood using the Rad-57 CO-oximeter. Our analysis demonstrates a robust association between elevated CO levels and significantly reduced acquisition of gross motor, fine motor and problem-solving skills. CO also exerts a statistically significant negative impact on children’s health outcomes. In light of these findings, we discuss potential policy implications to mitigate these detrimental effects.

Constantly changing, constantly adapting: Lives and life-course data of children and childhood social care

ObjectivesChildhood social care can lead to lifelong problems affecting health, educational attainment and other areas of a person’s life. Improving outcomes for children are therefore key policy objectives in many nations. The aim of this workshop was to inspire and drive forward life-course research on childhood social care internationally. ApproachThe workshop included presentations on the themes of the data jigsaw across the family life-course and data sovereignty and engagement. Presentations under each theme were followed by group activities and discussions. ResultsAdministrative data collections that include longitudinal details on childhood social care, developmental, health and other outcomes are becoming increasingly available for researcher purposes. Examples include the BEBOLD platform and the New South Wales Child E-Cohort in Australia, ECHILD in England and the Welsh SAIL Databank. First nations data sovereignty and engagement of childhood social care recipients has become a norm in many nations and led to improvements in research, including in methodology and interpretation of results. Together, improved access to data and meaningful stakeholder engagement can inform policy and practice to improve outcomes for children and young people. ConclusionsBarriers exist to understanding the family and home environments, such as very limited or no information about the fathers and other household members. Capturing populations who move between jurisdictions, e.g. migrants, is limited as administrative data is difficult to share across devolved nations/federated states. In some cases, a mismatch exists between expectations of meaningful engagement and institutional/research culture, resource and skill availability.

Attachment relationship quality with mothers and fathers and child temperament: An individual participant data meta-analysis.

A growing body of research suggests that, compared with single parent-child attachment relationships, child developmental outcomes may be better understood by examining the configurations of child-mother and child-father attachment relationships (i.e., attachment networks). Moreover, some studies have demonstrated an above-chance level chance of concordance between the quality of child-mother and child-father attachment relationships, and child temperament has been offered as a plausible explanation for such concordance. To assess whether temperament plays a role in the development of different attachment network configurations, in this preregistered individual participant data meta-analysis we tested the degree to which the temperament dimension of negative emotionality predicts the number of secure, insecure-avoidant, insecure-resistant, and disorganized attachment relationships a child has with mother and father. Data included in the linear mixed effects analyses were collected from seven studies sampling 872 children (49% female; 83% White). Negative emotionality significantly predicted the number of secure (d = -0.12) and insecure-resistant (d = 0.11), but not insecure-avoidant (d = 0.04) or disorganized (d = 0.08) attachment relationships. Nonpreregistered exploratory analyses indicated higher negative emotionality in children with insecure-resistant attachment relationships with both parents compared to those with one or none (d = 0.19), suggesting that temperament plays a small yet significant role in child-mother/child-father insecure-resistant attachment relationships concordance. Taken together, results from this study prompt a more in-depth examination of the mechanism underlying the small yet significantly higher chance that children with increased negative emotionality have for developing multiple insecure-resistant attachment relationships. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Associations Between Childcare Physical Activity and Sedentary Time and Early Childhood Developmental Outcomes: A Compositional and Isotemporal Substitution Analysis.

Physical activity and sedentary time are independently associated with health and developmental outcomes in preschool children. However, the integrated nature of these behaviours on early life outcomes, particularly during childcare hours, is currently understudied. As such, the aim of this study was to examine the association between preschool children's physical activity and sedentary time during childcare and various developmental outcomes (psychosocial, cognitive and fundamental movement skills). A total of 107 preschool children (Mage: 41 ± 6 months) recruited from London, Canada, wore ActiGraph wGT3X-BT accelerometers during childcare hours to measure their sedentary time, light intensity physical activity (LPA) and moderate-to-vigorous intensity physical activity (MVPA). Developmental outcomes, including psychosocial health (internalising, externalising, prosocial behaviour), indicators of cognitive development (memory, inhibitory control) and fundamental movement skills (locomotor control, object control, total fundamental movement), were assessed using validated tools. Compositional regression and isotemporal substitution models were estimated to examine how movement compositions in childcare were associated with developmental outcomes. Engaging in more MVPA relative to LPA and sedentary time was associated with fewer internalising symptoms and better total fundamental movement skills and object control skills, whilst spending more time in LPA relative to MVPA and sedentary time was associated with more internalising symptoms and worse object control skills. Isotemporal substitution models suggested that theoretically increasing sedentary time or engaging in MVPA at the expense of time engaging in LPA during childcare is associated with lower internalising symptoms. The findings of this study provide preliminary evidence that engaging in MVPA during childcare, at the expense of time in LPA or sedentary time, is associated with children's fundamental movement skills and psychosocial development. Further longitudinal research is required, with larger samples of young children, to assess the mechanisms through which childcare movement behaviour compositions may interact with developmental outcomes, including contextualising both sedentary time and LPA. ClinicalTrials.gov identifier: NCT05359536.

A systematic review and meta-analysis of the effectiveness of interventions targeting the parent-child relationship in families of children with an intellectual disability.

The review aimed to investigate the effectiveness of parent-child relationship interventions for families of children with intellectual disability up to 12 years old. Quasi-experimental or randomised controlled trials (RCTs) of interventions targeting the parent-child relationship where ≥50% of children had an intellectual disability were included. Meta-analyses of parent-child relationship outcomes and child outcomes used standardised mean difference as the effect size. Twenty-seven papers were included (N = 1325). Parent-child relationship outcomes improved significantly (n = 1325; g = 1.08, 95% CI: 0.64, 1.52) with a large effect size that was robust to sensitivity analyses. Child developmental outcomes improved significantly (n = 1082; g = 0.65, 95% CI: 0.23, 1.07), and indicated a large effect size for child socialisation and communication. Findings suggest that interventions targeting parent-child relationship quality are associated with substantial improvements in parent-child relationship and may improve child outcomes related to socialisation and communication.

The Effectiveness of Trauma-Informed Parenting Programs for Traumatized Parents and Their Components: A Meta-Analytic Study.

Parents who have been exposed to trauma face distinct challenges in parenting that can lead to negative child developmental outcomes and intergenerational transmission of trauma. Parenting programs for traumatized parents seem promising, but the existing evidence on their effectiveness has not yet been synthesized. This study aimed to examine the overall effect of trauma-informed parenting programs on (a) parenting and (b) parental mental health outcomes by conducting two three-level meta-analyses. Moderator analyses were performed to identify whether program components, delivery techniques, and other study and program characteristics were associated with effectiveness. A literature search conducted up to August 2024 yielded 15 studies reporting on 110 effect sizes. Significant overall effects were found of trauma-informed parenting programs on both parenting outcomes (d = 0.75, 95% CIs = [0.09, 1.15], p = .027) and parental mental health outcomes (d = 0.21, 95% CIs = [0.09, 0.32], p < .001). The first meta-analysis on parenting found no significant moderators, while the second meta-analysis on parental mental health indicated that programs emphasizing child disciplining skills yielded smaller effects (d = 0.04) compared to programs without this component (d = 0.31). Programs using modeling techniques yielded larger effects (d = 0.32) compared to programs without (d = 0.14). Larger program effects on parental mental health were also found for programs with longer durations and when individual sessions were used. Thus, evidence supports the effectiveness of trauma-informed parenting programs in improving parenting and reducing parental mental health problems.

Identifying Key Factors for Predicting the Age at Peak Height Velocity in Preadolescent Team Sports Athletes Using Explainable Machine Learning.

Maturation is a key factor in sports participation and often determines the young athletes' characterization as a talent. However, there is no evidence of practical models for understanding the factors that discriminate children according to maturity. Hence, this study aims to deepen the understanding of the factors that affect maturity in 11-year-old Team Sports Athletes by utilizing explainable artificial intelligence (XAI) models. We utilized three established machine learning (ML) classifiers and applied the Sequential Forward Feature Selection (SFFS) algorithm to each. In this binary classification task, the logistic regression (LR) classifier achieved a top accuracy of 96.67% using the seven most informative factors (Sitting Height, Father's Height, Body Fat, Weight, Height, Left and Right-Hand Grip Strength). The SHapley Additive exPlanations (SHAP) model was instrumental in identifying the contribution of each factor, offering key insights into variable importance. Independent sample t-tests on these selected factors confirmed their significance in distinguishing between the two classes. By providing detailed and personalized insights into child development, this integration has the potential to enhance the effectiveness of maturation prediction significantly. These advancements could lead to a transformative approach in young athletes' pediatric growth analysis, fostering better sports performance and developmental outcomes for children.

The relationships between resilience and child health behaviors in a national dataset.

Resilience mechanisms at the individual, family, and environmental levels may improve health outcomes despite potentially harmful stress exposure partly through the practice of positive health behaviors. We performed a secondary analysis of 2016-2021 National Survey of Children's Health data to assess the relationships between three resilience domains - child, family, neighborhood - and six health behaviors using multiple regression models adjusted for the other resilience domain(s) and potential confounders. Analysis revealed significant associations between each resilience domain and multiple health behaviors in a total weighted analytic sample of 70,156,540 children. For each outcome, the odds of better health behaviors were highest with high resilience in all possible domains. For example, among children ages 0-5 years, the adjusted odds of having "good quality" vs. "poor quality" sleep for those with "high" resilience in all domains were 2.21 times higher (95% CI 1.78, 2.63) than for those with "low" resilience in all domains. This line of research may help to inform the design of resilience and health behavior promotion interventions by targeting multiple socio-ecological domains of influence to improve health and development outcomes in children exposed to experiences or sources of potential stress. This study assessed the associations between three socio-ecological resilience domains (child, family, and neighborhood) and six child and family health behaviors in a national dataset. Resilience exists within multiple socio-ecological levels and supports healthy functioning despite experiencing stress. Studies in adults and limited pediatric sub-populations show associations between resilience and health behaviors, which in turn influence numerous health outcomes. Resilience at three levels of socio-ecological levels was found to be associated with the performance of multiple child and family health behaviors in a nationally representative general pediatric population. These findings have important implications for child and family health promotion efforts.

Intergenerational coparenting and child development outcomes: A systematic review

AbstractGrandparents often serve important childrearing roles. The present study is a systematic review of research that examined the association between intergenerational coparenting and children's development. Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, 220 records were identified, and 16 studies were included in the final review. The review provided a detailed analysis of the methodological characteristics of research in this area. Findings indicated that better intergenerational coparenting was associated with higher levels of children's social competence, executive functioning, and attachment security. Evidence also suggests parenting mediates the relation between intergenerational coparenting and child development. Several directions for future research emerged from the review including the need (a) for measurement strategies that reflect the multidimensional nature of intergenerational coparenting, (b) to consider the various parent‐grandparent dyads, and (c) to incorporate other family factors and processes (e.g., quality of parent‐grandparent relationships) into studies that focus on intergenerational coparenting.

Early Maternal Prenatal Cannabis Use and Child Developmental Delays

Maternal prenatal cannabis use is associated with adverse neonatal health effects, yet little is known about its association with child developmental outcomes. To evaluate associations between maternal prenatal cannabis use in early pregnancy and child early developmental delays. This cohort study included 119 976 children born to 106 240 unique individuals between January 2015 and December 2019 and followed up to aged 5.5 years or younger (through December 31, 2021) at Kaiser Permanente Northern California. Individuals were screened for prenatal cannabis use via self-report and urine toxicology at entrance into prenatal care (approximately 8- to 10-weeks' gestation). Data were analyzed from February 2023 to March 2024. Maternal prenatal cannabis use defined as any use (self-reported or by urine toxicology testing) and use frequency. Early developmental delays (speech and language disorders, motor delays, global delays) in children up to age 5.5 years defined by International Statistical Classification of Diseases and Related Health Problems, Ninth Revision and Tenth Revision diagnoses codes ascertained from electronic health records. In this cohort of 119 976 pregnancies among 106 240 unique pregnant individuals, there were 29 543 Hispanic pregnancies (24.6%), 6567 non-Hispanic Black pregnancies (5.5%), 46 823 non-Hispanic White pregnancies (39.0%), 12 837 pregnancies (10.7%) to individuals aged 24 years or younger, and 10 365 pregnancies (8.6%) to individuals insured by Medicaid. Maternal prenatal cannabis use was documented for 6778 pregnancies (5.6%). Daily maternal prenatal cannabis use was reported for 618 pregnancies (0.5%), weekly for 722 pregnancies (0.6%), and monthly or less for 1617 pregnancies (1.3%). No association was observed between maternal prenatal cannabis use and child speech and language disorders (HR, 0.93; 95% CI, 0.84-1.03), global developmental delays (HR, 1.04; 95% CI, 0.68-1.59), or motor delays (HR, 0.86; 95% CI, 0.69-1.06). No association was detected between the frequency of maternal prenatal cannabis use and child early developmental delays. In this cohort study, maternal prenatal cannabis use was not associated with an increased risk of child early developmental delays. Future research is needed to assess different patterns of cannabis use throughout pregnancy. Given the association between maternal prenatal cannabis use and other adverse outcomes, pregnant individuals should be educated on those risks.

Perceptions of roles of community healthcare workers in early childhood in Limpopo, South Africa.

As part of the Reengineering Primary Health Care initiative, the South African National Department of Health (NDoH) has committed to expanding access to home-based care provided by community health workers. The NDOH also prioritised Community Health Workers (CHWs) in their agenda to improve child development outcomes in South Africa. However, there is limited research on CHWs' experiences and knowledge of early childhood development. To explore CHWs' motivation for work, their background, training and scope of work around Early Child Development (ECD). The study was conducted in Mopani District, Limpopo province, South Africa, in 2017. Five focus group discussions (FGDs) were conducted with 41 CHWs participating within a large cluster-randomised study. Data were analysed thematically using an inductive approach. Community health workers' motivation to work was influenced by personal experiences, community needs and community service. In terms of knowledge, CHWs indicated that a nutritious diet with extended breastfeeding, immunisations and preschool education is imperative for a child to thrive. The Road to Health Booklet, weighing scales and the mid-upper arm circumference tape were used as screening tools for ECD. Community health workers perceived their knowledge around ECD to be insufficient. Community health workers play a crucial role in healthcare; therefore, capacity development on ECD and the provision of ECD screening tools to optimise their under-five child visits are necessary.Contribution:This study will potentially contribute to the improvement of the CHW programme in ensuring that children under 5 years of age are holistically cared for to ensure that they thrive.

Participation of fathers and siblings in home rehabilitation programmes for children with neuro-developmental delay: a scoping review

BackgroundThe role of, and impact on, mothers caring for children with neuro-developmental delay (NDD) is well documented. However, the role of fathers and siblings in families of children with NDD remains significantly understudied, particularly in low- and middle-income countries (LMICs). There has been an increased call for holistic rehabilitation of children with NDD at the family level. This study aimed to explore the involvement of fathers and siblings in the home rehabilitation programmes of children with NDD.MethodsA scoping review was conducted using the Joanna Briggs Institute (JBI) Peters et al.'s methodology and reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Articles were retrieved from PUBMED, ScienceDirect, PsycINFO, SCOPUS, PEDro, and Google Scholar. Reference lists of relevant studies were also manually searched.ResultsThirty research articles were identified. Father and sibling participation in home-based rehabilitation and caregiving is low in LMICs compared to high-income countries due to economic factors and cultural beliefs. Reduced participation stresses mothers and reduces developmental outcomes in children with NDD.ConclusionsThis review highlights the need for rehabilitation professionals to encourage father and sibling participation in caregiving for children with NDD in home rehabilitation programmes.

Trends and predictors of severe and moderate anaemia among children aged 6–59 months in India: an analysis of three rounds of National Family Health Survey (NFHS) data

BackgroundChildhood anaemia remains a significant public health problem in India, as it adversely affects child development and overall health outcomes. This study aimed to analyse the prevalence of severe and moderate anaemia among children aged 6–59 months and identify consistent predictors of this condition over the past 15 years.MethodsData from the three most recent rounds of the NFHS were used for this analysis. The final weighted sample included 40,331 children from the NFHS-3 (2005–2006), 200,093 from the NFHS-4 (2015–2016), and 178,909 from the NFHS-5 (2019–2021). Descriptive and bivariate analyses were conducted, followed by binary logistic regression to identify factors associated with severe and moderate anaemia in children aged 6–59 months. All statistical analyses were performed using Stata version 14.ResultsOver the past 15 years, the prevalence of severe and moderate anaemia among children in India has shown a slight decline. However, the influence of various predictors has changed over time. Young children (aged 6–23 months), those from Scheduled Caste (SC) and Scheduled Tribe (ST) communities, and children born to mothers with high parity and low educational attainment remain particularly vulnerable to anaemia. Additionally, short-term illness significantly increases the risk of anaemia. Furthermore, women’s autonomy, indicated by higher education and lower fertility rates, along with maternal nutrition education, have emerged as key factors in reducing anaemia burden in the future. Notably, children whose mothers had no education were 1.4 times more likely to suffer from severe or moderate anaemia. Similarly, children born to mothers with four to five children (OR 1.1, p < 0.05) and those with six or more children (OR 1.2, p < 0.05) had an elevated risk of anaemia.ConclusionThe findings highlight three key areas for programmatic focus to accelerate anaemia reduction in India: [1] targeting young children (aged 6–23 months); [2] ensuring the inclusion of SC and ST communities in all relevant interventions; and [3] promoting women’s autonomy. These strategies are essential for reducing the burden of anaemia across the country.

A method and approach for evaluating coparenting events during couples group interventions.

When interventionists stimulate productive father-mother dialogues around coparenting, there are numerous potential benefits for families. Families stand to benefit from more positive involvement of fathers with both coparents and children, key contributors to healthy child developmental outcomes. In this report, we introduce a new strategy and rating system for helping practitioners and supervisors assess the nature and quality of coparenting-related dialogues and conversations in the context of couples group interventions. The system derives from analysis of 24 relationship-enhancement groups, 13 enrolling English-speaking couples and 11 enrolling Spanish-speaking couples, all parents of young children. All groups were co-led by a male-female team explicitly trained to focus on marital and parenting themes and supervised to address couples issues - not coparenting issues explicitly. All co-leaders spoke the native language of group participants. We documented how frequently coparenting events occurred, and how the nature and quality of events varied within and across groups. Overall, in both English- and Spanish-speaking groups expressly assembled to focus on marital and parenting issues, coparenting events occurred relatively infrequently. At the same time, both mothers and fathers appeared motivated to raise and discuss issues associated with their coparenting, and extended discussions about coparenting issues broached by the parents blossomed in approximately 37% of all instances. Process-oriented (rather than didactic) co-leader responses appeared especially helpful in scaffolding prolonged coparenting discussions. We propose that use of the system as a training, supervision and self-assessment tool can help clinicians become more consciously aware of how well their interventions succeed in promoting and scaffolding coparenting conversations during group interactions.

The Feasibility and Acceptability of Using a Digital Conversational Agent (Chatbot) for Delivering Parenting Interventions: Systematic Review.

Parenting interventions are crucial for promoting family well-being, reducing violence against children, and improving child development outcomes; however, scaling these programs remains a challenge. Prior reviews have characterized the feasibility, acceptability, and effectiveness of other more robust forms of digital parenting interventions (eg, via the web, mobile apps, and videoconferencing). Recently, chatbot technology has emerged as a possible mode for adapting and delivering parenting programs to larger populations (eg, Parenting for Lifelong Health, Incredible Years, and Triple P Parenting). This study aims to review the evidence of using chatbots to deliver parenting interventions and assess the feasibility of implementation, acceptability of these interventions, and preliminary outcomes. This review conducted a comprehensive search of databases, including Web of Science, MEDLINE, Scopus, ProQuest, and Cochrane Central Register of Controlled Trials. Cochrane Handbook for Systematic Review of Interventions and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to conduct the search. Eligible studies targeted parents of children aged 0 to 18 years; used chatbots via digital platforms, such as the internet, mobile apps, or SMS text messaging; and targeted improving family well-being through parenting. Implementation measures, acceptability, and any reported preliminary measures of effectiveness were included. Of the 1766 initial results, 10 studies met the inclusion criteria. The included studies, primarily conducted in high-income countries (8/10, 80%), demonstrated a high mean retention rate (72.8%) and reported high acceptability (10/10, 100%). However, significant heterogeneity in interventions, measurement methods, and study quality necessitate cautious interpretation. Reporting bias, lack of clarity in the operationalization of engagement measures, and platform limitations were identified as limiting factors in interpreting findings. This is the first study to review the implementation feasibility and acceptability of chatbots for delivering parenting programs. While preliminary evidence suggests that chatbots can be used to deliver parenting programs, further research, standardization of reporting, and scaling up of effectiveness testing are critical to harness the full benefits of chatbots for promoting family well-being.

The impact of children's access to public health insurance on their cognitive development and behavior

While a large literature examines the immediate and long-run effects of public health insurance, much less is known about the impacts of total program exposure on child developmental outcomes. This paper uses an instrumental variable strategy to estimate the effect of cumulative eligibility gain on cognitive and behavioral outcomes measured at three points during childhood. Our analysis leverages substantial variation in cumulative eligibility due to the dramatic public insurance expansions between the 1980s and 2000s. We find that increased eligibility improves child cognitive skills and present suggestive evidence on better behavioral outcomes. There are notable heterogeneous effects across the subgroups of interest. Both prenatal eligibility and childhood eligibility are important for driving gains in the test scores at older ages. Improved child health is found to be a mediator of the impact of increased eligibility.

Routine third-trimester ultrasonography and child neurodevelopmental outcomes: a follow-up of a pragmatic cluster-randomised controlled trial

ABSTRACT Aims/Background Routine third-trimester ultrasonography is increasingly conducted to screen for foetal growth restriction (FGR) and reduce adverse perinatal and child neurodevelopmental outcomes using timely obstetric management. While it did not reduce adverse perinatal outcomes in previous trials, evidence regarding its association with child neurodevelopmental outcome is absent. We examined whether routine third-trimester ultrasonography is positively associated with child developmental and behavioural/emotional outcomes compared to usual care. Design/Methods Dutch mothers with a low-risk pregnancy participating in a subsample (n = 1070) of a nationwide cluster-randomised trial reported infant (age 6 months) and toddler (age 28 months) developmental milestones (Ages and Stages Questionnaire) and toddlers’ internalising and externalising problems (Child Behavior Checklist). Usual care (n = 380) comprised selective ultrasonography. The intervention strategy (n = 690) included two routine third-trimester ultrasounds next to usual care. Both strategies applied the same interdisciplinary protocol for FGR detection and management. Results Adjusted linear mixed-level regressions revealed that routine third-trimester ultrasonography was positively but modestly related to z-standardised infant developmental milestones at 6-month follow-up, B = 0.20, 95%CI [0.07; 0.32], p = 0.003, compared to usual care. At 28-month follow-up, these strategies did not differ in child developmental outcome and internalising and externalising problems. Conclusion Routine third-trimester ultrasonography was positively but modestly associated with infant development. In toddlerhood, routine ultrasonography was not related to child developmental and behavioural/emotional outcomes. Overall, these findings do not support the implementation of routine third-trimester ultrasonography for low-risk pregnant women for reasons concerning children’s early neurodevelopmental outcomes.

Acceptability and feasibility of a group-based intervention to improve outcomes for children at risk for developmental delays in Kenya: A piloted randomized trial.

The Care for Child Development (CCD) program may improve child development outcomes in resource-limited settings, but has not yet been adapted to group-based settings to facilitate sustainable dissemination. In this study, we determined the acceptability and feasibility of a group-based CCD program, with evaluation of program outcomes for child development, home environment, and symptoms of maternal depression as secondary outcomes. We evaluated this adapted program using a 2 × 2 crossover-designed pilot study administered over 10 bi-weekly sessions. Acceptability and feasibility were assessed through focus group discussions using qualitative methods. Child development, home observations, and symptoms of maternal depression were evaluated at baseline, 6months, and 12months and assessed quantitatively. Twenty-six mother-child dyads participated. Overall, they perceived CCD as acceptable and feasible, and especially beneficial within its group-based format. Although there were no measured improvements in child development, improvements in stimulating home environments (mean difference 2.5, 95% C.I. [0.37, 4.72]) were found. Further scale-up of this intervention is needed to determine effectiveness.