Impairment In Preschool Children Research Articles

Estimation of urinary cadmium benchmark dose thresholds for preschool children in a cadmium-polluted area based on Bayesian model averaging.

Urinary cadmium (U-Cd) values are indicators for determining chronic cadmium toxicity, and previous studies have calculated U-Cd indicators using renal injury biomarkers. However, most of these studies have been conducted in adult populations, and there is a lack of research on U-Cd thresholds in preschool children. We aimed to apply benchmark dose (BMD) analysis to estimate the U-Cd threshold level associated with renal impairment in preschool children in the cadmium-polluted area. 518 preschool children aged 3-5years were selected by systematic sampling (275 boys, 243 girls). Urinary cadmium and three biomarkers of early renal injury (urinary N-acetyl-β-D-glucosaminidase, UNAG; urinary β2-microglobulin, Uβ2-MG; urinary retinol-binding protein, URBP) were determined. Bayesian model averaging estimated the BMD and lower confidence interval limit (BMDL) of U-Cd. The medians U-Cd levels in both boys and girls exceeded the recommended national standard threshold (5μg/gcr) and U-Cd levels were higher in girls than in boys. Urinary N-acetyl-β-D-glucosaminidase (UNAG) was the most sensitive biomarker of renal effects in preschool children. The overall BMDL5 (BMDL at a benchmark response value of 5) was 2.76μg/gcr. In the gender analysis, the BMDL5 values were 1.92μg/gcr for boys and 4.12μg/gcr for girls. This study shows that the U-Cd threshold (BMDL5) is lower than the national standard (5μg/gcr) and boys' BMDL5 was lower than the limit set by the European Parliament and Council in 2019 (2μg/gcr), which provides a reference point for making U-Cd thresholds for preschool children.

Prenatal Exposure to Bisphenols and Visual Impairment in Preschool Children: A Prospective Birth Cohort Study in China

Prenatal Exposure to Bisphenols and Visual Impairment in Preschool Children: A Prospective Birth Cohort Study in China

Nonverbal Executive Functioning in Relation to Vocabulary and Morphosyntax in Preschool Children With and Without Developmental Language Disorder.

Developmental language disorder (DLD) is characterized by persistent and unexplained difficulties in language development. Accumulating evidence shows that children with DLD also present with deficits in other cognitive domains, such as executive functioning (EF). There is an ongoing debate on whether exclusively verbal EF abilities are impaired in children with DLD or whether nonverbal EF is also impaired, and whether these EF impairments are related to their language difficulties. The aims of this study were to (a) compare nonverbal performance of preschoolers with DLD and typically developing (TD) peers, (b) examine how nonverbal EF and language abilities are related, and (c) investigate whether a diagnosis of DLD moderates the relationship between EF and language abilities. A total of 143 children (nDLD = 65, nTD = 78) participated. All children were between 3 and 6.5 years old and were monolingual Dutch. We assessed nonverbal EF with a visual selective attention task, a visuospatial short-term and working memory task, and a task gauging broad EF abilities. Vocabulary and morphosyntax were each measured with two standardized language tests. We created latent variables for EF, vocabulary, and morphosyntax. Analyses showed that children with DLD were outperformed by their TD peers on all nonverbal EF tasks. Nonverbal EF abilities were related to morphosyntactic abilities in both groups, whereas a relationship between vocabulary and EF skills was found in the TD group only. These relationships were not significantly moderated by a diagnosis of DLD. We found evidence for nonverbal EF impairments in preschool children with DLD. Moreover, nonverbal EF and morphosyntactic abilities were significantly related in these children. These findings may have implications for intervention and support the improvement of prognostic accuracy. https://doi.org/10.23641/asha.24121287.

Quality of life of preschool children with psychomotor development disorders and their families. Availability of medical care and quality of its provision for this category of patients

Background. Improving the quality of life of neurologicaly impaired child and his family is an issue of particular importance. The purpose of the study was to assess the quality of life of children with psychomotor development disorders and their families, the impact on the family of existing psychomotor disorders in children, as well as the availability of medical care and satisfaction with the quality of its provision to this category of patients; to identify the relationship between the calculated indicators of quality of life of children and their families and existing disorders of psychomotor development in children. Materials and methods. The study analyzed the results of the survey of 45 neurologically impaired preschool children’s parents. Results. A direct significant correlation of different strength was observed between the scores of the boys, their families and children’s neurological pathology. The correlation between the performance of the girls, their families and neurological disorders was mostly unreliable. This study also tested that the averages of the boys and their families were significantly higher than those of the girls in some sections of all questionnaires used. The rates of the children with mental retardation and their families mostly significantly exceeded the values of the children with other nosologies. The inverse correlation of different strength was verified between the indicators in the section The Parent HRQL Summary Score of the PedsQLTM 2.0 Family impact module questionnaire, the Total scores of the PedsQLTM Healthcare Satisfaction Generic Module questionnaire, the values in Psychosocial Health Summary section and the Total scores rates of the PedsQLTM 4.0 Generic Score Scales questionnaire in boys with mental retardation and in all examined boys, as well as in their families and neurological disorders. No correlation was found between the rates of the boys with ADHD and their neurological problems. Conclusions. The presence of direct and inverse reliable correlation of different strength between the average values of the examined boys with psychomotor development disorders, boys with mental retardation, as well as their families and the neurological pathology present in children was established. The correlation between the performance of the girls and their families and the neurological disorders of children in most sections is unreliable. It is necessary to conduct research with a larger number of participants.

Prevalence of Visual Impairment in Preschool Children in Southern China.

PurposeThe goal of this study is to assess the prevalence and distribution of visual impairment in preschool children in southern China.MethodsPreschool children aged 36–83 months were enrolled in a vision screening program in Shantou City. Visual acuity test and non-cycloplegic refraction were conducted. According to the American Academy of Ophthalmology (AAO) guidelines, visual impairment was defined as uncorrected visual acuity (UCVA) in either eye <20/50, 20/40, and 20/32 in children aged 36–47, 48–59, and 60–83 months, respectively, as well as an interocular difference (IOD) of ≥ two lines of UCVA.ResultsThe UCVA test was successfully performed on 7,880 children (94.6% of the enrolled population). A total of 938 (11.9%; 95% CI 11.2–12.6) children were found to have reduced UCVA in the worse eye, and 393 (5%; 95% CI 4.5–5.5) of the children had an IOD of two or more lines. Combining the reduced UCVA with the IOD criteria identified 1,032 (13.1%; 95% CI 12.4–13.8) children with visual impairment. UCVA in preschool children improves with age naturally and boys have slightly better age-adjusted UCVA than girls. Causes of reduced visual acuity included uncorrected refractive error, amblyopia, congenital cataract, and others. The cylindrical diopter in the right eye of children with reduced vison was higher than that of children with normal vision (1.19 ± 1.05 vs. 0.52 ± 0.49, P < 0.001). A total of 146 (1.9%, 95% CI 1.6–2.2) of the preschool children wore spectacles. The proportion of wearing spectacles increased with age (χ2 = 35.714, P < 0.001), but with IOD increasing by.1 logMAR, the odds of wearing spectacles decreased by 44.8%.ConclusionThis study provided data on the prevalence of visual impairment in preschool children in China by large-scale school-based vision screening. Further studies should be conducted to verify the benefit from vision screening.

СПОСОБНОСТЬ К ПРЕДВОСХИЩЕНИЮ СИТУАЦИЙ БУДУЩЕГО У СЛАБОВИДЯЩИХ ДОШКОЛЬНИКОВ

Abstract. Th e article deals with the issue of ability to anticipate future events in preschool children with visual impairments. Th e relevance of the study is due to the fact that the development of the prognostic ability in older preschool age makes it an important condition for the process of socio-psychological adaptation of children with disabilities, including preschoolers with impaired vision. Th e aim of the study was to revial the specifi cs of future events anticipation in visually impaired preschool children. Th e study involved 60 preschoolers aged 5 to 7 years, including 30 children with visual impairments and 30 children with unimpaired vision. As a result of the analysis of structural and functional components, it was found that visually impaired preschoolers predict actions more oft en, and they also have a lower level of the speech-communicative function as compared to the one in their normo-typical peers. In children with visual impairments, the ability to anticipate manifests itself more successfully in organized activities, as well as in their relationships with parents, rather than with surrounding adults or children. Th e study revealed the specifi cs of the ability to anticipate future situations in visually impaired preschoolers with speech impairments. It was found that children of this nosology experience real diffi culties in forming a prognosis, since visually impaired preschoolers have a lower level of development in regulatory, cognitive and speech-communicative functions compared to the one of their peers without visual impairments. Preschoolers with visual impairments can set and hold goals, as well as cope with the mental replay of various options for actions and are aware of the consequences of their implementation in relation to themselves and people around them. However, they have diffi culties in understanding and defi ning both their own emotions and the emotions of people around them in predictable situations.

Polyunsaturated fatty acids supplementation can improve specific language impairment in preschool children: a pilot study

BackgroundSpeech and language are one of the higher cognitive brain functions. Language delay is one of the major concerns of child health in Egypt. Speech therapy is the standard management in language delay.ObjectiveWe aimed to investigate the potential role of dietary supplementation with polyunsaturated fatty acids (PUFAs) in improving specific language impairment.Subjects and methodsA total of 220 children (ages 3–4) were included in this study at the Phonetics Department, Helwan School of Medicine, Egypt, during the period from 2015 to 2018. Children received comprehensive neurological examination and intelligence quotient (IQ) test to exclude the other causes of language delay. Language evaluation was performed using the Arabic language test. They either received family counseling, speech therapy (45 min; 3 times a week for 16 weeks), and PUFA supplementation 500 mg twice daily (group A) or only counseling and speech therapy (group B). Language quotient (LQ) was calculated before and after treatment.ResultsOur results show that LQ significantly improved in group A compared with group B (p < 0.004).ConclusionDietary supplementation with PUFA has a beneficial role in the management of specific language impairment along with speech therapy.

A novel objective visual acuity screener for preschool children

We report initial evaluation of a novel OKN-based preschool visual acuity (VA) screener, including comparison with E-ETDRS VA measurement in adults and sensitivity and specificity for detecting monocular visual impairment in preschool children.

Atypical longitudinal development of speech-evoked auditory brainstem response in preschool children with autism spectrum disorders.

Language impairment is common in children with autism spectrum disorders (ASDs). Previous research has shown that this disability may be, in part, due to atypical auditory processing of speech stimuli. However, how speech sounds are processed in children with ASD remains largely unknown. The present study assessed the developmental pattern of auditory information processing at the level of the brainstem in preschool children with ASD using speech-evoked auditory brainstem response (speech-ABR). Children with ASD (N = 15) and of typical developing (TD) (N = 20), both of preschool age, were enrolled. The speech-ABRs recorded at two different time points (T1 and T2; 9.68 months apart on average) were virtually identical in the TD group. However, in the ASD group, the wave V latency of speech-ABR was significantly shortened and the amplitudes of wave A and C were significantly larger at T2, compared to those recorded at T1 (10.78 months apart on average). Compared to the TD group, the wave V and A latencies were prolonged at T1, whereas the wave E amplitude decreased and wave F latency prolonged at T2. There was a positive partial correlation between the language performance and the wave A amplitude in the ASD group. These results indicate that auditory processing at the subcortical level is well-developed in the TD preschool children, but is immature and abnormal in the children with ASD at the same ages. Thus, aberrant speech processing at the brainstem level may contribute significantly to the language impairment in children with ASD at preschool ages. Autism Res 2019, 12: 1022-1031. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Language impairment is common in children with autism spectrum disorders (ASDs). We investigated the developmental pattern of subcortical auditory processing by monitoring changes in the speech-evoked auditory brainstem response (speech-ABR) over a period of 10 months in preschool children. Our results show that subcortical auditory processing is impaired and immature in children with ASD compared with age-matched, typically developing children. The results suggest that speech-ABR may be used as an objective measure in evaluating the language performance of children with ASD. The results also suggest that aberrant speech processing at the level of the brainstem may contribute significantly to the language impairment in preschool children with ASD.

Comparative analysis of results of the pedagogical experiment on creative imagination development in speech impaired preschool children

The relevance of the research is due to the fact that one of the most important mental processes in preschool children is creative imagination. Thanks to creative imagination, the child can find new ways to solve arising problems. The article reflects results of the ascertaining and control experiments and presents statistical data.

Analysis of EEG networks and their correlation with cognitive impairment in preschool children with epilepsy

ObjectiveCognitive impairment (CI) is common in children with epilepsy and can have devastating effects on their quality of life. Early identification of CI is a priority to improve outcomes, but the current gold standard of detection with psychometric assessment is resource intensive and not always available. This paper proposes exploiting network analysis techniques to characterize routine clinical electroencephalography (EEG) to help identify CI in children with early-onset epilepsy (CWEOE) (0–5 years old). MethodsFunctional networks from routinely acquired EEGs of 51 newly diagnosed CWEOE were analyzed. Combinations of connectivity metrics with subnetwork analysis identified significant correlations between network properties and cognition scores via rank correlation analysis (Kendall's τ). Predictive properties were investigated using a cross-validated classification model with healthy cognition, mild/moderate CI, and severe CI classes. ResultsNetwork analysis revealed phase-dependent connectivity having higher sensitivity to CI and significant functional network changes across EEG frequencies. Nearly 70.5% of CWEOE were aptly classified as having healthy cognition, mild/moderate CI, or severe CI using network features. These features predicted CI classes 55% better than chance and halved misclassification penalties. ConclusionsCognitive impairment in CWEOE can be detected with sensitivity at 85% (in identifying mild/moderate or severe CI) and specificity of 84%, by network analysis. SignificanceThis study outlines a data-driven methodology for identifying candidate biomarkers of CI in CWEOE from network features. Following additional replication, the proposed method and its use of routinely acquired EEG forms an attractive proposition for supporting clinical assessment of CI.

A systematic review and classification of interventions for speech-sound disorder in preschool children.

Multiple interventions have been developed to address speech sound disorder (SSD) in children. Many of these have been evaluated but the evidence for these has not been considered within a model which categorizes types of intervention. The opportunity to carry out a systematic review of interventions for SSD arose as part of a larger scale study of interventions for primary speech and language impairment in preschool children. To review systematically the evidence for interventions for SSD in preschool children and to categorize them within a classification of interventions for SSD. Relevant search terms were used to identify intervention studies published up to 2012, with the following inclusion criteria: participants were aged between 2 years and 5 years, 11 months; they exhibited speech, language and communication needs; and a primary outcome measure of speech was used. Studies that met inclusion criteria were quality appraised using the single case experimental design (SCED) or PEDro-P, depending on their methodology. Those judged to be high quality were classified according to the primary focus of intervention. The final review included 26 studies. Case series was the most common research design. Categorization to the classification system for interventions showed that cognitive-linguistic and production approaches to intervention were the most frequently reported. The highest graded evidence was for three studies within the auditory-perceptual and integrated categories. The evidence for intervention for preschool children with SSD is focused on seven out of 11 subcategories of interventions. Although all the studies included in the review were good quality as defined by quality appraisal checklists, they mostly represented lower-graded evidence. Higher-graded studies are needed to understand clearly the strength of evidence for different interventions.

Sensitivity of an oral health-related quality-of-life questionnaire in detecting oral health impairment in preschool children.

This two-year cohort study evaluated whether the Early Childhood Oral Health Impact Scale (ECOHIS) is responsive to detect changes related to dental caries. Preschool children were examined in 2010 regarding dental caries, and their parents responded to the ECOHIS. After 2 years, 352 children (response rate = 73.6%) were re-examined and a new ECOHIS was responded. Children were categorized according to caries increment (no new caries, 1-3 surfaces with new lesions, and four or more decayed surfaces). The outcome variables were related to the decline of quality of life as determined via ECOHIS: decline, severe decline, and differences between baseline and follow-up scores. Effect sizes (ES) were calculated, and the associations were evaluated through Poisson regression. ES was small for children with 1-3 new lesions (ES = 0.19) and moderate for children with four or more new carious lesions (ES = 0.61). Children who developed 1-3 new lesions were significantly associated with all outcome variables compared to children with no new lesions, but the associations were stronger for children with four or more new carious lesions. The ECOHIS is sensitive to the deterioration of quality of life due to caries increments in preschool children.

Visual Impairment in Preschool Children in the United States

Visual impairment (VI) in early childhood can significantly impair development. To determine demographic and geographic variations in VI in children aged 3 to 5 years in the United States in 2015 and to estimate projected prevalence through 2060. Descriptive study reporting statistics estimated based on prevalence data from 2 major population-based studies conducted in the United States between 2003 and 2011. Using US census projections, prevalence of VI and cause-specific VI in the better eye were reported by race/ethnicity, state and region, and per capita prevalence of VI by state. The study included preschool children in the United States. Analyses for this study were conducted between February 2016 and March 2017. Prevalence of VI among children aged 3 to 5 years in the United States. In 2015, more than 174 000 children aged 3 to 5 years in the United States were visually impaired. Almost 121 000 of these cases (69%) arose from simple uncorrected refractive error, and 43 000 (25%) from bilateral amblyopia. By 2060, the number of children aged 3 to 5 years with VI is projected to increase by 26%. In 2015, Hispanic white children accounted for the highest number of VI cases (66 000); this group will remain the most affected through 2060, with an increasingly large proportion of cases (37.7% in 2015 and 43.6% in 2060). The racial/ethnic group with the second most VI is projected to shift from non-Hispanic white children (26.3% in 2015 decreasing to 16.5% in 2060) to African American children (24.5% in 2015 and 22.0% in 2060). From 2015 to 2060, the states projected to have the most children with VI are California (26 600 in 2015 and 38 000 in 2060), Texas (21 500 in 2015 and 29 100 in 2060), and Florida (10 900 in 2015 and 13 900 in 2060). These data suggest that the number of preschool children with VI is projected to increase disproportionally, especially among minority populations. Vision screening for refractive error and related eye diseases may prevent a high proportion of preschool children from experiencing unnecessary VI and associated developmental delays.

Screening for Specific Language Impairment in Preschool Children: Evaluating a Screening Procedure Including the Token Test

Specific language impairment (SLI) comprises impairments in receptive and/or expressive language. Aim of this study was to evaluate a screening for SLI. 61 children with SLI (SLI-children, age-range 4–6 years) and 61 matched typically developing controls were tested for receptive language ability (Token Test—TT) and for intelligence (Wechsler Preschool-and-Primary-Scale-of-Intelligence—WPPSI). Group differences were analyzed using t tests, as well as direct and stepwise discriminant analyses. The predictive value of the WPPSI with respect to TT performance was analyzed using regression analyses. SLI-children performed significantly worse on both TT and WPPSI (p le .0001). The TT alone yielded an overall classification rate of 79%, the TT and the WPPSI together yielded an overall classification rate of 80%. TT performance was significantly predicted by verbal intelligence in SLI-children and nonverbal intelligence in controls whilst WPPSI subtest arithmetic was predictive in both groups. Without further research, the Token Test cannot be seen as a valid and sufficient tool for the screening of SLI in preschool children but rather as a tool for the assessment of more general intellectual capacities. SLI-children at this age already show impairments typically associated with SLI which indicates the necessity of early developmental support or training. Token Test performance is possibly an indicator for a more general developmental factor rather than an exclusive indicator for language difficulties.

The impact of epilepsy on preschool children and their families.

This study investigated the possible presence of sensory-motor developmental impairments in preschool children with epilepsy and explored epilepsy impact on their activities and quality of life and on the stress load of their family. Study participants were children aged 2-6years diagnosed with epilepsy without any other comorbidities (epi-only children). The instruments used for assessment included the Neurological, Sensory, Motor, Developmental Assessment (NSMDA) scale for sensory-motor development, the Impact of Childhood Neurologic Disability Scale (ICNDS), and the Impact of Pediatric Epilepsy Scale (IPES) for disease impact on disability and Quality of Life (QoL), as well as the Pediatric Outcomes Data Collection Instrument (PODCI) for functional health status, and the Parental Stress Scale (PSS) for the family stress load. Required data were obtained from direct testing or observation of children's activities and mother-supplied answers to questions. Eighty-two children were investigated. The NSMDA scores were in the normal development range 6-8. Significant moderate impact of the disease on disability and QoL was estimated with the ICNDS and IPES instruments. The PODCI scores were similar to healthy population levels except for the happiness dimension which was better for children with epilepsy. PSS were significantly above normal. The functional health and QoL of the children as well as their family stress were found to be positively correlated with increasing age. It is found that epilepsy does not degrade neuromotor development and functional health status of preschool epi-only children, though it has a significant impact on their neurological disability and QoL and the stress level of their families; this impact seems to decrease with age.

Status and Determinants of Motor Impairment in Preschool Children from Migrant Families in China.

BackgroundAlthough poor health conditions and decreased developmental levels have been investigated in migrant children, no study in China has focused on these children’s individual motor development.ObjectivesThis study aims to explore the prevalence of motor impairment in Chinese migrant children and to determine the contributory factors.Patients and MethodsIn this cross-sectional study, a structured questionnaire was administered to primary caregivers of preschool children aged 3 - 6 (n = 2,976) in ten kindergartens from two districts of Suzhou, China, to assess the children’s home socioeconomic status and motor environment, that is, the presence of affordances for motor development. Motor ability was assessed using the Movement Assessment battery for children-second edition (MABC-2). Multiple logistic regression analysis was used to determine the risk factors for motor impairment in migrant children.ResultsMigrant children showed correlations with impairment in manual dexterity, aiming and catching, and motor development (odds ratios [ORs] = 1.320, 1.255, 1.260, respectively; P < 0.05). Outdoor movement affordances and toys for fine motor development were significantly associated with motor impairment in migrant children (ORs = 0.834 [movement affordances, 0.843 [toys], P < 0.05).ConclusionsChinese migrant children are at a high risk of motor impairment, which is associated with a lack of outdoor movement affordances and toys for fine motor development. Future prevention and intervention should focus on the motor environment of the home.

Prevalence and Factors associated with Hearing Impairment in Preschool Children in Albania

Background: Hearing impairment (HI), a condition that affects disproportionally children in developing countries, could negatively impact the development of communications skills of involved children when not timely detected and treated. Aims: We aimed to assess the prevalence of HI and the factors and health conditions associated with it, among preschool children in Albania. Study design: Cross-sectional survey. Methods: During November 2009-May 2011 a simple random sample of 400 preschool children aged 4-6 years old and attending public kindergartens in urban and rural areas of Tirana, the capital of Albania were examined about hearing ability via tonal audiometry and tympanometry. HI was defined by a threshold of ≥ 20 dB in the better ear. In addition, objective examination of ear, nose and pharynx was carried out in order to detect potential structures and/or diseases contributing to HI. Binary logistic regression was used to assess the factors associated with HI in this sample of preschool children. Results: In this sample of children (51% females, 73.5% urban residence) the total prevalence of HI was 16%. Otitis Media with effusion, suppurative otitis media and past otitis media was present in 14.6%, 1% and 13.1% of cases, respectively. Upon adjustment for several confounding effects, the only factors significantly associated with HI were current otitis media in objective examination (OR=5.62; 95% CI: 2.18-14.4) and recurrent otitis media in anamnesis (OR=1.82; 95% CI: 1.33-2.51). Conclusions: HI is a common and serious condition that might negatively affects the future development of preschool children. Routine screening of newborn and/or preschool children is an effective way to address this problem in Albania.

Maternal Work Absence: A Longitudinal Study of Language Impairment and Behavior Problems in Preschool Children.

Combining work and family responsibilities is challenging when children have special needs, and mothers commonly make employment-related adjustments. In this study, the authors examined associations between maternal work absence and child language impairment and behavior problems in preschool children. Questionnaire data at child age 3 years from 33,778 mothers participating in the prospective population-based Norwegian Mother and Child Cohort Study were linked to national register data on employment and long-term physician-certified sick leave at child age 3-5 years. Mothers who reported having a child with language impairment had a consistently higher risk of not being employed and were at increased risk of taking long-term sick leave at child age 5 years. Co-occurring problems were associated with excess risk. Language impairments in preschool children, in particular when they are co-occurring with behavior problems, are likely to have a range of negative short- and long-term consequences for the financial and overall health and well-being of mothers and their families.

How do primary health-care practitioners identify and manage communication impairments in preschool children?

Communication impairments (CIs) in preschool children are common and can have long-term adverse consequences if not detected and treated early. This study investigated the knowledge, training and practice of primary health-care practitioners in the identification and management of CIs in preschool-aged children. A cross-sectional survey of 277 primary health-care practitioners in the Inner West and South West Sydney was undertaken. The majority of practitioners surveyed understood the importance of early identification of CIs. Eight per cent ofpractitioners correctly identified all of the 'red flags' for verbal and non-verbal communication. The majority (80%) correctly described the management of a typical case presentation. Two-thirds of practitioners reported using a tool in their practice for developmental surveillance, but the quality of surveillance tools was variable. One-third felt their training in this area was poor and 90% indicated they would like further training. Barriers to referral included waiting times, availability and cost of services. We concluded that primary health-care practitioners are aware that CIs are significant and they need to be identified early. There are opportunities for further training and promoting high-quality developmental surveillance in primary care. In addition, there are broader health system issues that include promotion of an integrated response to the detection and management of CIs.