Danish Preschool Children Research Articles

Growing pains in Danish preschool children: a descriptive study

This study provides a detailed description of growing pains in young Danish children as standardized diagnostic criteria are needed to avoid misclassifications of other musculoskeletal diagnoses. The study is nested in a cohort study of Danish preschool children. At baseline, parents completed a questionnaire with sociodemographic information. During the study, the parents received a text message every two weeks inquiring about musculoskeletal pain in the child. If pain was reported, a telephone interview about pain characteristics was conducted. The present study includes data from 2016 to 2019 with 777 children, aged 3–6 years of age at baseline. The prevalence of growing pains was 24–43%, depending on the definition. The pain occurred most frequently 1–3 times per week and most commonly in the lower legs, could be unilateral or bilateral and was usually without consequences. The prevalence increased with age, and there were no consistent associations with socio-economic factors. We suggest using Evan’s criteria with the addition of unilateral pain as standard diagnostic criteria in the future. We found no relation to periods of rapid growth and suggest that the term is a misnomer. Etiology and long-term courses of pain need to be explored in future studies.

The effects of a large-scale school readiness intervention on Danish preschool children’s emergent mathematics skills

ABSTRACT Children’s emergent mathematics skills are important predictors of their later achievements. We analyze and present the effects of a large-scale school readiness intervention in preschools in Denmark. We thereby provide evidence on the effects of a broadly based professional development program (with supporting materials) implemented in a universal childcare system. Estimates of the effects were obtained from a cluster-randomized controlled trial on a large sample of more than 5000 children. The children’s emergent mathematics skills were assessed using a formal validated test (Tools for Early Assessment in Math) before and after the intervention. The results showed that the intervention on average had significantly positive effects for the participating children. Only children of non-Western origin benefitted more than other children from the intervention. In addition, the effects were moderated by exposure and by child-staff-ratio; stronger effects were associated with higher exposure and with lower child-staff-ratio.

The Effect of a Structured Intervention to Improve Motor Skills in Preschool Children: Results of a Randomized Controlled Trial Nested in a Cohort Study of Danish Preschool Children, the MiPS Study.

The preschool age seems to be decisive for the development of motor skills and probably the most promising time-window in relation to improvement of motor skills. This trial investigates the effect of an intensive structured intervention to improve motor skills in 3–6-year-old preschool children. A total of 471 Danish preschool children participated in a cluster randomized controlled trial. The intervention was to enhance motor skills, including predefined minimum criteria. Motor skills were measured using the Motor Assessment Battery for Children-2 (MABC-2) (total and three domains) at baseline and 6-, 18-, and 30-months post-intervention. The effect was estimated by multilevel linear regression with preschool and child included as random effects and adjusted for baseline values. Effect estimates were mainly positive at 6 months, but negative at 30 months with very few statistically significant estimates. In preschools with baseline motor skills scores below average, there was a tendency towards a larger improvement in the intervention group. Future interventions and research should focus on clusters with poor motor skills, as there is larger room for improvement. It remains to be seen whether the intervention can influence general well-being, physical activity, and self-perceived competence, both short- and long-term.

Ammonia, ammonium, and the risk of asthma: A register-based case–control study in Danish children

Background: Evidence concerning the health effects of exposure to fine particulate matter less than 2.5 μm in diameter (PM2.5) and particulate components such as ammonium (NH4 +) is limited. We aimed to investigate gaseous ammonia (NH3), particulate ammonium (NH4 +), the total concentration of these pollutants (NHx), and PM2.5 and their association with asthma in Danish preschool children. Methods: Estimates of incidence rate ratios associated with exposure to air pollution were calculated for children followed for the development of childhood asthma (n = 335,629) from their first to their sixth birthday during the time period 2006–2012 using a time-matched case–control design by combining register information. Modeled average concentrations of NH3, NH4 +, NHx, and PM2.5 (5.56 km × 5.56 km grid resolution) during the past 3 months prior to the date of first diagnosis of asthma for cases. Results: We identified 12,935 incident cases of asthma. The base adjusted hazard ratio of incident asthma was 1.74 for children exposed to the highest decile of NH3 exposure (95% confidence interval = 1.60, 1.89) compared to children exposed to the lowest decile of NH3 exposure during the past 3 months prior to first diagnosis. Similar hazard ratios were found for the highest levels of NH4 + (2.33; 2.04, 2.65) and NHx (1.82; 1.68, 1.96). The positive associations were slightly attenuated, when adjusting for socioeconomic status, but disappeared when additionally adjusting for region, except in a two-pollutant model including NH4 + and PM2.5. No association was found with PM2.5. The findings were robust when using different exposure time windows. Conclusions: Increased NH4 + exposure may be a risk factor for the onset of asthma in preschool children.

Effects of the Healthy Start randomized intervention on dietary intake among obesity-prone normal-weight children.

The study aimed to evaluate the impact of a 15-month intervention on dietary intake conducted among obesity-prone normal-weight pre-school children. Information on dietary intake was obtained using a 4 d diet record. A diet quality index was adapted to assess how well children's diet complied with the Danish national guidelines. Linear regression per protocol and intention-to-treat analyses of differences in intakes of energy, macronutrients, fruit, vegetables, fish, sugar-sweetened beverages and diet quality index between the two groups were conducted. The Healthy Start study was conducted during 2009-2011, focusing on changing diet, physical activity, sleep and stress management to prevent excessive weight gain among Danish children. From a population of 635 Danish pre-school children, who had a high birth weight (≥4000 g), high maternal pre-pregnancy BMI (≥28·0 kg/m2) or low maternal educational level (<10 years of schooling), 285 children completed the intervention and had complete information on dietary intake. Children in the intervention group had a lower energy intake after the 15-month intervention (group means: 5·29 v. 5·59 MJ, P=0·02) compared with the control group. We observed lower intakes of carbohydrates and added sugar in the intervention group compared with the control group after the intervention (P=0·002, P=0·01). The intervention resulted in a lower energy intake, particularly from carbohydrates and added sugar after 15 months of intervention, suggesting that dietary intake can be changed in a healthier direction in children predisposed to obesity.

The Galker test of speech reception in noise; associations with background variables, middle ear status, hearing, and language in Danish preschool children

PurposeWe tested “the Galker test”, a speech reception in noise test developed for primary care for Danish preschool children, to explore if the children's ability to hear and understand speech was associated with gender, age, middle ear status, and the level of background noise. MethodsThe Galker test is a 35-item audio-visual, computerized word discrimination test in background noise. Included were 370 normally developed children attending day care center. The children were examined with the Galker test, tympanometry, audiometry, and the Reynell test of verbal comprehension. Parents and daycare teachers completed questionnaires on the children's ability to hear and understand speech. As most of the variables were not assessed using interval scales, non-parametric statistics (Goodman–Kruskal's gamma) were used for analyzing associations with the Galker test score. For comparisons, analysis of variance (ANOVA) was used. Interrelations were adjusted for using a non-parametric graphic model. ResultsIn unadjusted analyses, the Galker test was associated with gender, age group, language development (Reynell revised scale), audiometry, and tympanometry. The Galker score was also associated with the parents’ and day care teachers’ reports on the children's vocabulary, sentence construction, and pronunciation. Type B tympanograms were associated with a mean hearing 5–6dB below that of than type A, C1, or C2. In the graphic analysis, Galker scores were closely and significantly related to Reynell test scores (Gamma (G)=0.35), the children's age group (G=0.33), and the day care teachers’ assessment of the children's vocabulary (G=0.26). ConclusionsThe Galker test of speech reception in noise appears promising as an easy and quick tool for evaluating preschool children's understanding of spoken words in noise, and it correlated well with the day care teachers’ reports and less with the parents’ reports.

A speech reception in noise test for preschool children (the Galker-test): Validity, reliability and acceptance

PurposeThis study evaluates initial validity and reliability of the “Galker test of speech reception in noise” developed for Danish preschool children suspected to have problems with hearing or understanding speech against strict psychometric standards and assesses acceptance by the children. MethodsThe Galker test is an audio-visual, computerised, word discrimination test in background noise, originally comprised of 50 word pairs. Three hundred and eighty eight children attending ordinary day care centres and aged 3–5 years were included. With multiple regression and the Rasch item response model it was examined whether the total score of the Galker test validly reflected item responses across subgroups defined by sex, age, bilingualism, tympanometry, audiometry and verbal comprehension. ResultsA total of 370 children (95%) accepted testing and 339 (87%) completed all 50 items. The analysis showed that 35 items fitted the Rasch model. Reliability was 0.75 before and after exclusion of the 15 non-fitting items. In the stepwise linear regression model age group of children could explain 20% of the variation in Galker-35-score, sex 1%, second language at home 4%, tympanometry in best ear 2%, and parental education another 2%. Other variable did not reach significance. ConclusionThe Galker-35 was well accepted by children down to the age of 3 years and results indicate that the scale represents construct valid and reliable measurement.

A multicenter, randomized, controlled study of Training Executive, Attention, and Motor Skills (TEAMS) in Danish preschool children with attention-deficit/hyperactivity disorder: Rationale and description of the intervention and study protocol

Abstract Background: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder that is often detected during the preschool years. Neuroimaging data indicate that children with ADHD have brains that are characterized by growth and functional anomalies. Data suggest that the diminution of ADHD symptoms is correlated with improved neural functioning and growth. On the basis of these findings, interventions that target neural growth, which indicates neural development, can possibly lead to a more enduring treatment for ADHD. Training Executive, Attention, and Motor Skills (TEAMS) is a non-pharmacological neurocognitive intervention program that targets preschool children with ADHD. The program is designed to stimulate neurocognitive growth through physical activity and play in combination with psychoeducation and guidance for the parents. Population: Children between the ages of three and six years from Region Zealand in Denmark who have been diagnosed with ADHD are offered participation in the trial. According to a calculation of the strength needed to result in a statistically significant outcome, the estimated group size should be, at minimum, 87 children. On the basis of Region Zealand’s visitation history records, the cohort is expected to include approximately 100 to 120 children. Method: The intervention groups participate in eight weekly group sessions that consist of separate parent and children’s groups. The control groups receive the standard treatment program as outlined by the clinical guidelines of Region Zealand. The ADHD Rating Scale-IV and the Danish version of the Strengths and Difficulties Questionnaire are used to assess ADHD symptom severity before and after the intervention and to monitor the duration of the outcome. A comparative analysis of data from the intervention and control groups will illustrate the study’s results. Study aim: This is a multicenter, randomized, controlled, single-blind, parallel-group study with the primary aims of testing the TEAMS concept and investigating whether the intervention significantly lowers ADHD symptoms and increases the functionality level after the intervention as compared with the control group. A secondary aim is to monitor the duration and endurance of the outcome for six months after the intervention. This study is currently in progress. Full results and conclusions will be reported after the study’s completion in 2015.

A Pneumococcal Carriage Study in Danish Pre-school Children before the Introduction of Pneumococcal Conjugate Vaccination

We present data on pneumococcal carriage before the introduction of the heptavalent-pneumococcal conjugated vaccine (PCV7) in Denmark. In the pre-PCV7 period, the incidence of invasive pneumococcal disease (IPD) among children younger than 5 years was approximately 25 per 100.000 population, with the highest incidence rates observed in children younger than 2 years of age. The study included 437 children aged 12-72 months attending day care centres (DCC) and was conducted during 48 months. In total, 56% (n=247) of children were pneumococcal carriers with the highest prevalence in children aged 12–23 months (69%), the proportion significantly declining with increasing age. PCV7 serotypes accounted for 33%, PCV10 for 34%, and PCV13 for 57% of all carried isolates. The proportion of serotypes included in the three conjugate vaccines was higher among IPD isolates compared to carrier isolates (range 35– 90%). We found that the frequency of carriage was high among Danish pre-school children attending DCC and serotypes were not frequently covered by PCV7 in the pre-PCV7 period.

Prevalence of overweight and obesity in Danish preschool children over a 10‐year period: a study of two birth cohorts in general practice

To determine change in the prevalence of overweight and obesity in preschool children, over a 10-year period and to identify possible predictors of overweight in 5-year-old children. Anthropometric data from birth and routine child health examinations at 3 and 5 years of age performed in general practice were collected in 5580 children from two Funen birth cohorts (1992 and 2001, respectively) representing 48% of the total population at similar age. The prevalence of overweight and obesity was classified using the International Obesity Task Force definitions. In a Danish representative survey of preschool children, the average body mass index (BMI) and prevalence of overweight and obesity did not vary significantly during the 10-year period. No significant changes in mean birth weight were registered and mean BMI in the group of obese children did not increase. Overweight or obesity at 5 years was strongly associated with overweight and obesity at 3 years and with birth weight and gender. The prevalence of overweight and obesity was observed to be stable over a decade in Danish preschool children without changes in mean BMI in the group of obese children. A strong association between overweight and obesity at 3 and at 5 years of age was detected.

Associations between pedagogues attitudes, praxis and policy in relation to physical activity of children in kindergarten – results from a cross sectional study of health behaviour amongst Danish pre-school children.

This paper reports on associations between physical activity, pedagogue's attitudes towards promoting physical activity and the physical activity policies (PAP) in kindergarten. The paper deals with data on physical activity of 3-6 year olds in kindergarten which originates from a cross-sectional study conducted in 2006 among all Danish kindergartens. A questionnaire of 48 questions based on pedagogues assessment regarding the health related polcies and praxis in kindergarten and the attitudes of pedagogues was mailed (n = 4200) to all institutions in the country. In total, 1149 kindergartens and 693 integrated institutions returned the survey. The results show a relation between pedagogue's attitudes towards promoting children's physical activity and the number of children having moderately intense physical activity for at least one hour a day. The study also shows a positive association between policies and pedagogue's attitudes towards promoting children's physical activity and the number of days that pedagogues initiated games that made the children physically active. The study suggests that the social and organizational environment in the kindergarten is an important determinant for the level of physical activity among children. This means that the individual norms and attitudes of pedagogues along with the collective intentions and values expressed in written and adopted organizational policies (a Physical Activity Policy--PAP) are important aspects to be worked upon if kindergarten should play an active role in the promotion of healthy lifestyle among kindergarten aged children. Strong municipal and institutional leadership as well as educational interventions in the curricula of pedagogues could be important ways to bring about such change.

Caries prevalence in Danish pre-school children delivered vaginally and by caesarean section

Objective. The mode of delivery may significantly influence the diversity and composition of the oral microflora and facilitate early acquisition of mutans streptococci. The aim was to compare caries prevalence and experience in 3-year-old children delivered vaginally and by caesarean section (C-section). Materials and methods. The study had an observational cohort protocol based on extracted information from governmental databases and nationwide registers concerning birth, social and educational levels and dental status. Children born at the Copenhagen University Hospital in 2005 were eligible and the final study group with complete information consisted of 594 children, 443 delivered vaginally and 151 by C-section. Results. The total caries prevalence was 8% and no significant difference was displayed between the groups. When only the children with caries (dmfs > 0) were compared, those delivered by C-section had a higher mean value in comparison with those delivered vaginally (dmfs 6.8 vs 3.2), but the difference was not statistically significant. There was a significant relationship between caries prevalence and low family income in the total study group (OR = 5.8, p < 0.05). Conclusions. Within the limitations of this observational cohort study, caries prevalence in 3-year-old children was not related to the mode of delivery. However, the tendency of more severe caries in the C-section group justifies further studies, preferably with a prospective design.

The Child Behavior Checklist for Ages 1.5–5 (CBCL/1½–5): Assessment and analysis of parent- and caregiver-reported problems in a population-based sample of Danish preschool children

Background: Psychometric instruments are used increasingly within research and clinical settings, and therefore standardization has become an important prerequisite, even for investigating very young children. Currently, there are no standardized psychometric instruments available for assessment of preschool children in Denmark. Aims: The aim was to achieve Danish national norm scores for the Child Behavior Checklist for Ages 1½–5 (CBCL/1½–5) and the Caregiver Report Form (C-TRF). Methods: The study was based on an age- and gender-stratified cohort sample of 1750 children aged 1½–5 years born at Aarhus University Hospital, Denmark. The CBCL/1½–5 and C-TRF were mailed to parents, who were asked to pass on the C-TRF to the preschool caregiver. The national standard register data gave access to information on socio-economic status, family type, ethnicity and parental educational level for analysis of participation and representation. Results: A total number of 850 (49%) families replied, and 624 caregivers replied. The mean Total Problem Score (TPS) with 95% confidence interval was 17.3 (16.3–18.3) for parents' reports. Age-and gender-specific scale score findings for Danish preschoolers and schoolchildren were comparable. No differences were found in the mean TPS within subgroups related to parental socio-demographic features. Conclusion: On the basis of a large sample, Danish national norm scores and profiles of the ASEBA Preschool Forms were established; the scores of descendents must, however, be assessed with some caution. With this reservation, the CBCL/1½–5 and C-TRF forms are now available in Danish and can be recommended for use in clinical and research settings.

Mental state talk by Danish preschool children

Sixteen 4 to 6-year-old Danish children were video-recorded, while interacting spontaneously with their family in their homes. The mental state talk of the children was identified and analysed with respect to three mental domains: desire, feeling and cognition, and was compared to data from a similar study carried out with Canadian families (Jenkins et al., 2003). Our results suggest some cross-cultural differences in children’s mental state talk. First, Danish children produce a larger variation of mental state talk words than Canadian children do, and second, the distribution of mental state talk across the three domains differed for the two language groups. Semantic variation between Danish and English was identified in the study, which may partly explain the findings. Furthermore we present a usage-based approach to the investigation of children’s development of psychological categories in language as well as cross-linguistically.