National Survey Of Children Research Articles

Anxiety, Depression, and Behavioral and/or Conduct Disorder in Adolescence Among Former Preterm and Term Infants of Different Race and Ethnicities.

To compare parental reports of recent diagnoses of anxiety, depression, and/or behavioral/conduct disorder among former preterm (PT) and term adolescents by race/ethnicity and evaluate receipt of mental healthcare within the past year among those adolescents with any of these conditions. A total of 20,871 Non-Hispanic white (NHW), Non-Hispanic black (NHB), and Hispanic adolescents were evaluated using data from the 2017/2018 National Survey of Children's Health. PT birth and race/ethnicity disparity in the diagnosis of these emotional/behavioral problems and receipt of mental healthcare among adolescents with any of these diagnoses were analyzed using logistic regression. The unadjusted prevalence (95% CI) of these diagnoses was significantly higher among former PT (0.19 [0.17-0.22]) compared to term (0.15 [0.14-0.16]) adolescents. Despite having higher rates of adverse socioeconomic measures, former PT and term NHBs and Hispanics had lower unadjusted prevalence of these diagnoses in comparison to NHWs. After adjusting for differences in demographic, clinical, and socioeconomic characteristics,NHBs (0.47 [0.36-0.64]) and Hispanics (0.40 [0.30-0.54]) remain at lower odds of the composite measure of the emotional and/or behavioral problemscompared to NHWs, while PT birth did not have a significant impact on this outcome measure. Only 53% of adolescents with these diagnoses received recent mental healthcare. No significant differences in the adjusted odds of receipt of mental healthcare were noted across the groups based on PT birth or race/ethnicity. In contrast to PT birth, race/ethnicity had a significant impact on the adjusted odds of emotional/behavioral disorders during adolescence. Among adolescents with these diagnoses, PT birth and race/ethnicity did not significantly influence the adjusted odds of receipt of mental healthcare.

National Survey Data to Evaluate Case Management Services: A Systematic Review on Care Coordination Using the National Survey of Children With Special Health Care Needs.

Purpose of Study: The National Survey of Children with Special Health Care Needs (NS-CSHCN) is a publicly available resource that can be utilized to evaluate case management services such as care coordination. The authors sought to identify how researchers operationalize care coordination when utilizing this resource. Primary Practice Setting: National outpatient survey. Methodology and Sample: MEDLINE, PsycINFO, and CINAHL Complete were searched for studies that utilized the NS-CSHCN and report on outcomes of pediatric care coordination. Data from studies were extracted and results are descriptively reported. Results: The authors screened 4,577 citations and included 19 studies reporting on the impact of pediatric care coordination. Care coordination was defined differently and was sometimes captured as part of the medical home definition, or assessed using study-specific questions on coordinated services and satisfaction with communication from the medical team. Implications for Case Management Practice:

Prevalence of Chronic Pain among School-aged Children in the United States During the First Year of the COVID-19 Pandemic: A Nationally Representative Study

The COVID-19 pandemic and its associated disruptions have been shown to increase rates of childhood depression, anxiety, obesity, and insomnia. Thus far, the epidemiological impact of the pandemic on the national prevalence of pediatric chronic in the United States has not been systematically addressed. We aimed to compare the national prevalence of pediatric chronic pain between 2019 (pre-pandemic) and 2020 (first year of the pandemic) and determine whether changes varied across sociodemographic groups. Cross-sectional analysis of children (6-17 years) participating in the National Survey of Children's Health (NSCH) 2019 and 2020 (n=48,319). Chronic pain was defined as the caregiver reporting their children had “frequent or chronic difficulty with repeated or chronic physical pain during the past 12 months”. We computed adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) comparing the prevalence of chronic pain between survey years using survey-weighted Poisson regression adjusted for age, sex, race/ethnicity, parental education, and Census region. In separate Poisson models with interactions between sociodemographic variables and survey year, we tested for multiplicative effect measure modification using joint Wald tests for all interaction terms. The estimated national prevalence (95% CI) of chronic pain in children 6-17 years was 10.6% (9.7, 11.6%) in 2019, decreasing to 7.3% (6.7, 8.0%) in 2020. The adjusted prevalence of chronic pain was estimated to be 31% lower in 2020 than in 2019 (aPR=0.69, 95% CI: 0.61, 0.79; p<0.001). We found no differences in the change in chronic pain prevalence by age (p=0.68), sex (p=0.65), race/ethnicity (p=0.55), parental education (p=0.76), and Census region (p=0.28). Contrary to our expectations, the national prevalence of pediatric chronic pain decreased during the first year of the COVID-19 pandemic relative to the same period one year earlier. Additional studies are needed to investigate longitudinal patterns and mechanisms explaining reduced pain burden.

National Survey Data to Evaluate Case Management Services: A Systematic Review on Care Coordination Using the National Survey of Children With Special Health Care Needs.

National Survey Data to Evaluate Case Management Services: A Systematic Review on Care Coordination Using the National Survey of Children With Special Health Care Needs.

Impact of Developmental Disability on Frequent School Absenteeism in US Children Aged 6 to 17 Years: National Survey of Children's Health, 2016 to 2017.

ABSTRACTBACKGROUNDIn the United States, approximately seven million students are chronically absent from school each year. Students with disabilities are more likely to be chronically absent than students without a disability. Using the bioecological systems theory, this study examined the impact of individual developmental disabilities and disability severity on frequent school absenteeism.METHODSThis study conducted a secondary analysis using combined data from the National Survey of Children's Health, 2016 to 2017. Bivariate relationships were examined using x2 tests, and odds ratios adjusting for individual, microsystem, and macrosystem factors were calculated using multivariable logistic regressions.RESULTSChildren with selected developmental disabilities had significantly higher odds of absenteeism compared to children without developmental disabilities. The odds of absenteeism differed between age ranges and developmental disability conditions. A dose‐response relationship was also present for certain developmental disabilities in that children with a moderate to severe condition had higher odds of absenteeism.CONCLUSIONSChildren with one or more developmental disabilities had higher odds of absenteeism compared to children with typical development. However, odds were not consistent across age, condition, or condition severity. This population may benefit from tailored school interventions to promote regular attendance and mitigate the impact of frequent school absenteeism on education.

Social Determinants of Emergency Department Visits in Mild Compared to Moderate and Severe Asthma.

Social determinants of health (SDH) influence emergency department (ED) use among children with asthma. We aimed to examine if SDH were more strongly associated with ED use among children with moderate/severe compared to mild asthma. This study utilized the 2016-2019 data from the National Survey of Children's Health. Children with asthma ages 0-17years (N = 9937) were included in the analysis. Asthma severity and all-cause ED use in the past year were reported by caregivers. The association between patient factors and ED visits was evaluated using ordinal logistic regression. Based on the study sample, 29% of children with asthma had moderate/severe asthma. In the mild group, 30% visited the ED at least once in the past 12months, compared to 49% in the moderate/severe group. SDH associated with ED visits included race/ethnicity, insurance coverage, and parental educational attainment, but the strength of these associations did not vary according to asthma severity. In a nationally representative data set, SDH were equally predictive of ED use regardless of children's asthma severity. Interventions to reduce ED use among children with asthma should be considered for children with any severity of asthma, especially children in socially disadvantaged groups at higher risk of ED utilization.

Analysis of Timely Access to Healthcare and Difficulty Procuring Specialist Care Among Children with and without Anxiety or Depression Disorders

Background: To examine disparities to access preventive care and specialist care in children with anxiety or depression disorders.&#x0D; Methods: The population of interest was extracted from the National Survey of Children’s Health 2011/2012 (NSCH 2011/12) data set. The sample included children (0-17 years old) and their caregivers who completed the survey. Data were analyzed from February 2011 to June 2012. Outcome variables included reports for missed or delayed care, and problems procuring specialist care based on parental response to interview questions. Covariates included child/caregiver demographics, insurance status, household employment, and poverty levels.&#x0D; Findings: A total of 85 536 records were extracted from the NSCH 2011/12 data set. The covariate-adjusted odds (also adjusted as necessary using the correct sampling methods suggested by the NSCH) of having delayed or missed care for a child with anxiety or depression were 2.26 (95% confidence interval [CI], 1.83-2.79, p&lt;0.001) times higher than a child without anxiety or depression. The covariate-adjusted odds of the caregiver reporting problems procuring specialist care for a child with anxiety or depression were 1.66 (95% CI, 1.45-1.88, p&lt;0.001) times higher than a child without these diagnoses.&#x0D; Conclusions: Children with anxiety or depression are less likely to obtain timely preventive care and have problems procuring specialist care. These findings highlight a disparity that requires the attention of healthcare providers and outreach programs.

Psychiatric Diagnoses in Children With CKD Compared to the General Population

Rationale & ObjectiveChildren with chronic kidney disease (CKD) are subject to physical and psychosocial challenges, which may confer greater risk of developing psychiatric disorders. We sought to examine key psychiatric diagnoses in children with CKD compared with those in the general pediatric population and assess the correlation between parent-reported diagnosis and self-reported symptoms of depression.Study DesignCross-sectional.Setting & ParticipantsChildren ages 2-17 years receiving current medical care who participated in the Chronic Kidney Disease in Children Study (CKiD) or the National Survey of Children’s Health.ExposureCKD.OutcomesParent-reported diagnoses of depression, anxiety, or attention-deficit and hyperactivity disorder (ADHD).Analytical ApproachUsing Poisson regression, we determined the age, sex, and race-adjusted prevalence ratio comparing diagnoses between children with CKD and those in the general population overall and within subgroups of sex, race, maternal education status, and CKD stage. Secondarily, we examined the correlation between depression status using standardized self-reported screening instrument scores and parent-reported diagnosis.ResultsEight hundred seventy-five children with CKD and 72,699 children in the general population were included. Those with CKD had an adjusted prevalence ratio of 1.32 (95% CI, 1.01-1.73) for depression, 0.72 (95% CI, 0.52-0.99) for anxiety, and 1.03 (95% CI, 0.86-1.25) for ADHD. The results were similar across subgroups of CKD stage, sex, race, or maternal education. The correlation between parent-reported diagnosis and instrument-detected depression was weak, r = 0.13 (95% CI, 0.03-0.23).LimitationsRetrospective parent- or self-reported data were used.ConclusionsChildren with CKD had a higher prevalence of parent-reported depression, equivalent prevalence of attention-deficit and hyperactivity disorder, and lower prevalence of anxiety diagnoses compared to other children. These findings are inconsistent with results of prior studies and suggest that baseline assessments used in CKiD may have limited utility in describing psychiatric disorders among children with CKD. Improved mental health assessment approaches in pediatric nephrology are needed.

Five-Year Trends in US Children’s Health and Well-being, 2016-2020

Ensuring the well-being of the 73 million children in the United States is critical for improving the nation's health and influencing children's long-term outcomes as they grow into adults. To examine recent trends in children's health-related measures, including significant changes between 2019 and 2020 that might be attributed to the COVID-19 pandemic. Annual data were examined from the National Survey of Children's Health (2016-2020), a population-based, nationally representative survey of randomly selected children. Participants were children from birth to age 17 years living in noninstitution settings in all 50 states and the District of Columbia whose parent or caregiver responded to an address-based survey by mail or web. Weighted prevalence estimates account for probability of selection and nonresponse. Adjusted logistic regression models tested for significant trends over time. Diverse measures pertaining to children's current health conditions, positive health behaviors, health care access and utilization, and family well-being and stressors. A total of 174 551 children were included (annual range = 21 599 to 50 212). Between 2016 and 2020, there were increases in anxiety (7.1% [95% CI, 6.6-7.6] to 9.2% [95% CI, 8.6-9.8]; +29%; trend P < .001) and depression (3.1% [95% CI, 2.9-3.5] to 4.0% [95% CI, 3.6-4.5]; +27%; trend P < .001). There were also decreases in daily physical activity (24.2% [95% CI, 23.1-25.3] to 19.8% [95% CI, 18.9-20.8]; -18%; trend P < .001), parent or caregiver mental health (69.8% [95% CI, 68.9-70.8] to 66.3% [95% CI, 65.3-67.3]; -5%; trend P < .001), and coping with parenting demands (67.2% [95% CI, 66.3-68.1] to 59.9% [95% CI, 58.8-60.9]; -11%; trend P < .001). In addition, from 2019 to 2020, there were increases in behavior or conduct problems (6.7% [95% CI, 6.1-7.4] to 8.1% [95% CI, 7.5-8.8]; +21%; P = .001) and child care disruptions affecting parental employment (9.4% [95% CI, 8.0-10.9] to 12.6% [95% CI, 11.2-14.1]; +34%; trend P = .001) as well as decreases in preventive medical visits (81.0% [95% CI, 79.7-82.3] to 74.1% [95% CI, 72.9-75.3]; -9%; trend P < .001). Recent trends point to several areas of concern that can inform future research, clinical care, policy decision making, and programmatic investments to improve the health and well-being of children and their families. More analyses are needed to elucidate varying patterns within subpopulations of interest.

Adequacy of Medical Home Care and Sociodemographic Factors Associated With Educational Services Use Among Children With Autism Spectrum Disorder

<h3>Research Objectives</h3> To examine whether adequacy of medical home care was significantly associated with the likelihood of children with an autism spectrum disorder (ASD) currently using educational services To identify sociodemographic factors associated with current use of educational services among children with ASD. <h3>Design</h3> Retrospective analysis of cross-sectional data from the 2016/2017 National Survey of Children's Health (NSCH). Binary logistic regression was conducted with current educational services utilization as the outcome. <h3>Setting</h3> The 2016/2017 NSCH was administered to households in the U.S. and District of Columbia. <h3>Participants</h3> Participants were 1,248 children ages 1-17 years old with ASD currently receiving educational services under individualized family service or education plans. <h3>Interventions</h3> Not Applicable. <h3>Main Outcome Measures</h3> Educational services utilization was defined as current receipt of an individualized family or educational service plan. <h3>Results</h3> Inadequate medical home care was significantly associated with higher likelihood of current educational services use (aOR = 1.95, 95% CI [1.10, 3.44], p = .028) in children with ASD. Sociodemographic factors significantly associated with lower odds of using educational services included older children (aOR = 0.91, 95% CI [0.84, 0.99], p = .028), lower overall maternal health status (aOR = 0.52, 95% CI [0.29, 0.94], p = .031), and children who did not qualify as having special health care needs (aOR =0.38, 95% CI [0.17-0.85], p = .018). <h3>Conclusions</h3> Results suggest inadequate medical home care is associated with higher odds of educational services utilization in children with ASD. Use of educational services varies by children's age, maternal health status, and presence of other special health care needs. The inverse relationship between adequacy of medical home care and educational services utilization among children living with ASD suggests further research to explore the complex relationship between medical home care and educational services use. Future research is needed to examine differences more closely in medical home care, defined within the NSCH survey structure, in relationship to the odds of educational services utilization. <h3>Author(s) Disclosures</h3> The presenter declares no conflict of interest.

Abstract P097: The Missing Link In Current Prevention Strategies Focused On Reducing CVD Risk Among Youth: Youth's Mental Health

Background: Physical activity (PA), sedentary behavior such as screen time (SB), and sleep are well-known health behaviors associated with cardiovascular disease (CVD) risk factors (i.e., obesity) among youth. CVD risk factors are also prevalent among youth with a mental health diagnoses, in particular, depression. PA, SB, and sleep have also been independently associated with an increased risk of depression among youth. How these behaviors interact together and influence CVD risk among youth remains unclear. Such information is vital to the prevention of CVD among youth and further examination is urgently needed to guide the development of future intervention strategies. Objective: To examine the interplay of health behaviors, mental health indicators, and other sociodemographic predictors of obesity risk using a national representative sample of youth in the U.S. Methods: Adolescents (aged 13-18 years) from the 2018-2019 National Survey of Children’s Health data was utilized. Obesity risk was defined as a BMI% 85. Demographics (age, sex, race, ethnicity), PA, screen time, hours of sleep per night on weeknights, and diagnosis of depression and anxiety from a health care provider were extracted. Meeting Recommendations was defined as: PA (60 minutes/day, 4-7 days/week); screen time ( 2 hours/day); and sleep ( 8 hours/night). Multivariable logistic regression analyses examined the predictors of obesity risk. Results: The analytic cohort included 17,053 youth with a mean age of 15.59 1.11 years. Youth with obesity risk were more often (p&lt;0.001) male (55% vs 51%), non-White (22% vs 19%), and Hispanic (13% vs 10%). In the multivariable model, the most significant predictors of obesity risk included not meeting physical activity recommendations (OR = 1.52, 95% CI 1.42, 1.64) and a diagnosis of depression (OR = 1.45, 95% CI 1.28, 1.64). Conclusions: Both physical activity and depression are independently contributing to obesity risk among youth in a large, national cohort. The interplay of health behaviors, mental health, and CVD risk factors among youth need to be examined further to elucidate possible mechanisms of causation.

Effects of the COVID-19 pandemic on children’s oral health and oral health care use

BackgroundThe COVID-19 pandemic led to early restrictions on access to oral health care and social distancing requirements. The authors examined the early effects of the COVID-19 pandemic on children’s oral health and access to oral health care in the United States. MethodsUsing nationally representative data from the National Survey of Children’s Health, the authors compared several measures of children’s oral health and oral health care use early during the pandemic in 2020 with 1 year earlier. Logistic (multinomial or binary) regression models were estimated, adjusting for several child and household covariates and state fixed effects. Similar comparisons were estimated for 2019 relative to 2018 to evaluate prepandemic trends. ResultsChildren in 2020 were 16% (relative risk ratio, 0.84; 95% CI, 0.75 to 0.93) less likely to have excellent dental health as perceived by parents and 75% (relative risk ratio, 1.75; 95% CI, 1.14 to 2.67) more likely to have poor dental health than in 2019. In addition, children in 2020 had higher risk of bleeding gingivae (odds ratio, 1.46; 95% CI, 1.16 to 1.85). The likelihood of having a dental visit in the past 12 months was 27% (odds ratio, 0.73; 95% CI, 0.65 to 0.82) lower in 2020, including lower likelihood for preventive visits. The differences between 2020 and 2019 were observed across demographic and socioeconomic subgroups. There were no such differences between 2019 and 2018. ConclusionsThere was a widespread decline in children’s oral health status and access to oral health care early during the COVID-19 pandemic. Practical ImplicationsPrompt policies and oral health campaigns are needed to counter the pandemic effects and increase timely access to dental services.

Mapping mental health inequalities: The intersecting effects of gender, race, class, and ethnicity on ADHD diagnosis.

While the effects of social stratification by gender, race, class, and ethnicity on health inequalities are well-documented, our understanding of the intersecting consequences of these social dimensions on diagnosis remains limited. This is particularly the case in studies of mental health, where "paradoxical" patterns of stratification have been identified. Using a Bayesian multi-level random-effects Poisson model and a nationally representative random sample of 138,009 households from the National Survey of Children's Health, this study updates and extends the literature on mental health inequalities through an intersectional investigation of one of the most commonly diagnosed psychiatric conditions of childhood/adolescence: attention-deficit hyperactivity disorder (ADHD). Findings indicate that gender, race, class, and ethnicity combine in mutually constitutive ways to explain between-group variation in ADHD diagnosis. Observed effects underscore the importance and feasibility of an intersectional, multi-level modelling approach and data mapping technique to advance our understanding of social subgroups more/less likely to be diagnosed with mental health conditions.

Sociodemographic and socioeconomic correlates of learning disability in preterm children in the United States

BackgroundIn 2019, 1 in every 10 infants born in the United States was preterm. Prematurity has life-threatening consequences and causes a range of developmental disabilities, of which learning disability is a prevalent complication. Despite the availability of special services for children living with learning disability, gaps still exist in terms of access due to socioeconomic factors. The aim of this study is to evaluate socioeconomic and sociodemographic correlates of learning disability in preterm children.MethodsThis cross-sectional study used data from the 2016–2018 National Survey of Children’s Health. Weighted multivariable analyses were conducted to ascertain the association of sociodemographic and socioeconomic factors on learning disability among preterm children. The main outcome variable was the presence of learning disability.ResultsAmong 9555 preterm children in our study population, 1167 (12%) had learning disability. Learning disability was significantly associated with health insurance, food situation, and poverty level after adjustment for other variables. Children currently insured had lower odds of having learning disability compared to those without health insurance (OR = 0.79, 95% C.I. = 0.70–0.91). Also, children living in households that cannot afford nutritious meals are more likely to have learning disability compared to those that can afford nutritious meals at home (OR = 1.55, 95% C.I. = 1.22–1.97).ConclusionThese findings highlight the need for intervention efforts to target these children living with a learning disability to achieve the 2004 Individuals with Disabilities Education Act of promoting educational equality and empowerment of children living with a learning disability.

Parent-Reported Problems Accessing Mental Health Services Among a National Sample of Youth with Autism Spectrum Disorder and Anxiety.

The objective of this study was to identify factors associated with parent-reported problems accessing needed mental health services (MHS) in youth with autism spectrum disorder and anxiety. This study is a secondary analysis using the National Survey of Children's Health 2016 to 2017 data sets with multivariable logistic regression. Subjects are 6 to 17 year olds with parent-reported autism spectrum disorder (ASD) and anxiety. Outcome is parent-reported challenge accessing needed mental health treatment, dichotomized to not a problem versus problem. Covariates included race/ethnicity, intellectual disability, insurance, medical home, poverty level, and parent education level. The sample included 568 youth with ASD and anxiety-78% male subjects, mean age 12.5 years, and 63% White, non-Hispanic. Fifty-three percent of youth with ASD and anxiety had parent-reported problems accessing needed MHS. Lack of medical home (adjusted odds ratio [aOR] 5.97, 95% confidence interval [CI] [2.72-13.09]) and coexisting intellectual disability (aOR 2.23, 95% CI [1.08-4.60]) were significantly associated with problems accessing MHS. Reported family incomes at 0% to 99% and 100% to 199% of the federal poverty level as compared with family income at 400% federal poverty level or above (aOR 0.32, 95% CI [0.11-0.94] and aOR 0.35, 95% CI [0.13-0.95], respectively) was associated with decreased problems accessing MHS. In this nationally representative study, more than half of youth with ASD and anxiety had parent-reported problems accessing needed MHS. Lack of a medical home, co-occurring intellectual disability, and higher socioeconomic status (SES) are associated with problems accessing MHS. Therefore, policies to support the medical home; increase mental health supports available for those with ASD, anxiety, and coexisting intellectual disability; and support access for all SES levels may increase mental health access.

Barriers to Mental Health Services for Parents and Siblings of Children with Special Health Care Needs.

Caregivers of children with special health care needs (CSHCNs), especially those whose children have emotional, behavioral, or developmental problems (EBDPs), experience considerable strain and stress related to caring for their child’s special needs. The enormous burden of caregiving can decrease a parent’s ability to provide care, impacting the health of the child, the parents, and overall family functioning. To manage these challenges, these parents report the need for mental health care for themselves or their children, but many families with need go without care. Comprehensive knowledge about barriers to family mental health care for families of CSHCN is lacking. This study examines data from the National Survey of Children with Special Health Care Needs (2005/2006 and 2009/2010) to estimate time-specific, population-based prevalence of fourteen specific barriers to family mental health services and identifies risk factors for experiencing barriers to care for families of CSHCN. Among all CSHCN, cost barriers (33.5%) and lack of insurance (15.9%) were the most commonly reported obstacles to service access in 2005 and 2009, followed by inconvenient service times (12.3%), and locations (8.7%). Reports of these barriers increased significantly from 2005 to 2009. All types of barriers to family mental health services were reported significantly more frequently by CSHCN with EBDPs than by those without. CSHCN’s race, insurance, and parent education and income levels were factors associated with cost barriers to family mental health care. Understanding barriers to mental health care for families of CSHCN is critical to creating policy and practice solutions that increase access to mental health care for these families.

Child developmental and special education service receipt: The intersection of health and poverty

BackgroundChildren born of low birth weight (LBW) and/or premature may have developmental delays and difficulties. The vulnerability, without early intervention, would have detrimental lifelong effects. ObjectivesThis study examined 1) the relationship between LBW and prematurity and the occurrence and timing of children's receipt of developmental and special education services; and 2) whether poverty intersects with LBW and prematurity affecting service receipt. MethodsThis population-based study used cross-sectional data from the National Survey of Children's Health which consisted of approximately 52,000 participants aged 1–17 between 2017 and 2018 in the United States. We conducted logistic regression to analyze the predictive relationship of LBW/prematurity and the occurrence of receiving developmental and special education services. We then conducted ordered logistic regression to examine whether LBW and prematurity predicted the timing of receiving developmental and special education services. Further, we conducted moderating analyses to examine whether the predictive relationships above varied with poverty. The analyses listed above were weighted to reflect the population drawn. ResultsChildren born with LBW and prematurity were more likely to receive developmental and special education services and they tended to receive services earlier than those born at normal weight and term. Educational disparities were evident among children in low-income families. Children of LBW in low-income families were less likely to receive earlier services than those in affluent families. ConclusionsThis study indicates developmental and special education needs of children born LBW and/or premature. With restrained assets, low-income families may need more assistance to promote optimal development for their children.

Implementation and Challenges of Online Education during the COVID-19 Outbreak: A National Survey of Children and Parents in China

This study aims to explore the implementation and challenges of China's national online education strategy – “Suspending Classes Without Stopping Learning” (SCWSL) – during the COVID-19 pandemic from the perspective of children and their parents. Altogether 28,334 children (aged 6-8 years) and their parents were randomly sampled from nine cities in five provinces of China, and a mixed-method design involving a questionnaire and interviews was used. The results indicated that: (1) most children had participated in online education characterized by wide-ranging content, teacher-led interaction, and rich learning platforms; (2) online education had an effect on children's physical and mental health; (3) parent pressure was at a medium to high level due to online education; and (4) parents perceived that offline education was more effective than online education, and this perception varied significantly between geographical regions, living areas, and school types. These findings reveal that the sudden implementation of nationwide online education created many challenges, and also provided practical implications for countries carrying out online education in the post-pandemic era.

Infant feeding practices and asthma in children aged 6 months to 5 years using a propensity score approach

We examined the association between exclusive breastfeeding, early introduction of feeding formula, early weaning, and asthma in children aged six months to five years in a sample of non-institutionalized US children using a propensity score approach. Our study used data from the National Survey of Children's Health (2012-2018) of 3,820 children with physician-diagnosed asthma aged 6 months to 5 years. Propensity score matching (PSM) was applied to control selection bias with age, sex, race, birth weight, Federal Poverty Level, parent's education, and parent smoking history used as covariates in PSM. The total number in the matched sample was 6,904 (3,452 non-asthmatics; 3,452 asthmatics). Matched and unmatched samples were analysed using the χ2 test and multiple logistic regression. Exclusive breastfeeding was protective against asthma in the pre-matching (AOR 0.72; 95% CI: 0.54-0.97; p = 0.03) and post-matching (AOR 0.66; 95% CI: 0.55-0.81; p < 0.001) samples. Formula feeding before 6 months was associated with asthma in unmatched (AOR 1.38; 95% CI: 1.15-1.66; p < 0.001) and matched (AOR 1.31; 95% CI: 1.16-1.47; p < 0.001) sample. Early weaning before 6 months was associated with asthma in unmatched (AOR 1.62; 95% CI: 1.35-1.54; p < 0.001) and matched sample (AOR 1.37; 95% CI: 1.23-1.54; p < 0.001). Public health systems should continue to recommend the implementation of the World Health Organization exclusive breastfeeding guideline in developed countries. Asthma interventions in children under two years should continue to emphasize exclusive breastfeeding to reduce the incidence of infant asthma.

A National Survey of Children’s Experiences of Parental Separation and Support Needs in Australia

We used a mixed-methods online survey to recruit 616 young Australians whose parents had separated, to understand their experiences and how to better support them throughout the separation process. Persistent themes included conflict, lack of communication and agency, mental health concerns, and feelings of confusion, frustration, loss, and grief. Some suggested it would have been useful to talk about reasons for the separation, their rights, opinions and feelings, with some indicating the separation process affected their ongoing mental health and relationships. There was a general preference for face-to-face counseling, closely followed by online counseling and online peer-to-peer support, indicating that a “one size fits all” approach is not suitable for young people. Young people should be offered services early in the separation process that can be extended in content to other issues such as new partners, school life and mental health, and continued beyond the timeframe of the separation process.