Preventive Child Health Care Research Articles

Preventive oral healthcare for children: towards appropriate care

In recent decades, oral healthcare has shifted from curation to prevention. Preventive oral healthcare for children consists mainly of oral health education to improve health behaviors and clinical prevention such as fissure sealants, application of fluoride varnish, removal of supragingival plaque and dental polishing. In addition, the periodic clinical examination is an important preventive instrument. These 5 preventive interventions for children up to 12 years of age can be discussed using the principles of 'appropriate care'. Appropriate care is an approach of the Dutch government to ensure the accessibility, quality and affordability of care in the Netherlands. Central to the approach are the effectiveness, efficiency and patient-centeredness of care. This article describes to what extent preventive oral healthcare meets these principles based on literature, care consumption data and recommendations from the clinical guidelines 'Oral care for children: prevention and treatment of dental caries' and the 'Advice on Caries Prevention' by the Ivory Cross, a Dutch scientific association for oral health. Appropriate oral healthcare is best served by care that is tailored to both the individual oral disease burden of the patient and their risk of disease as well as to the wishes of the patient.

Maternal Disability and Early Child Preventive Care.

Preventive health care for children comprises routine well-child visits and immunizations. Women with physical, sensory, or intellectual or developmental disabilities tend to experience more barriers to preventive health care; yet it is unknown whether such barriers are observed among their young children. This population-based study in Ontario, Canada included children born between 2012 and 2019 whose mothers had a physical (n = 74 084), sensory (n = 26 532), or intellectual or developmental (n = 1391) disability, multiple disabilities (n = 5774), or no disability (n = 723 442). Primary outcomes were receipt of the recommended number of well-child visits and routine immunizations in the first 2 years. Secondary outcomes included receipt of the enhanced 18-month developmental assessment and any developmental screen. Relative risks (aRR) were generated using modified Poisson regression and adjusted for maternal sociodemographics and mental health and child sex. Compared with children of mothers without disabilities, those whose mothers had intellectual or developmental disabilities were less likely to receive the recommended number of well-child visits (56.3% vs 63.2%; aRR 0.92, 95% confidence interval [CI] 0.88-0.97), routine immunizations (43.8% vs 53.7%; aRR 0.88, 95% CI 0.83-0.94), enhanced 18-month developmental assessment (52.3% vs 60.8%; aRR 0.92, 95% CI 0.88-0.97), or any developmental screen (54.9% vs 62.5%; aRR 0.94, 95% CI 0.90-0.99). Other disability groups did not experience such disparities. There is a need to develop resources to improve access to preventive health care for young children of women with intellectual or developmental disabilities.

When Infant Mortality Was Born: Dutch Preventive Child Health Care without the State, 1890–1930

Abstract This article investigates the emergence of Dutch preventive child health care in the first decades of the twentieth century. It shows that the rise of collective action on this terrain followed from the recognition of “infant mortality” as a public problem – a late–nineteenth century configuration that went hand in hand with the professionalisation of paediatrics. It also shows that the organisational forms that this collective action took depended on whose health was perceived to be at stake in specific articulations of the public problem of infant mortality. Finally, this article explores the motives of the Dutch state in the organisation of public health in the interbellum and queries the relationship between the state and public health more broadly. Drawing on pragmatist philosophy, we argue that states are best understood as the result of historically contingent processes that take on different forms in different times and places. Such histories enable a better view of the elements at play in the organisation of collective action and of the pivotal role played therein by the perception of public problems.

Collaboration between general practitioners and health visitors about children of concern in Denmark: a qualitative study

ABSTRACT Primary health care services are responsible for preventive measures to optimize child development in the first years of life. In Denmark, these services are shared between general practitioners and municipality health visitors. National guidelines mandate collaboration between these professionals but in reality, they work in parallel. We aimed to explore how professionals experience collaboration and communication regarding children with professional concern about their wellbeing. Seventeen semi-structured interviews were conducted with general practitioners, and health visitors. Both professions considered closer collaboration to be important in meeting children’s needs. Barriers to collaboration and communication included differing legal obligations, Information Technology-systems (IT), lack of financial incentives, lack of mutual professional acknowledgment and respect, and absence of routines for sharing knowledge. The traditional division of responsibilities between physicians and nurses in which all professionals involved in preventive child health care are acculturated seems to impede collaboration based on unequal professional status. IT infrastructure needs to support information sharing and structures to support informal meetings between professionals are warranted to support more collaborative practice.

The Effect of Using a Client-Accessible Health Record on Perceived Quality of Care: Interview Study Among Parents and Adolescents.

Patient-accessible electronic health records (PAEHRs) are assumed to enhance the quality of care, expressed in terms of safety, effectiveness, timeliness, person centeredness, efficiency, and equity. However, research on the impact of PAEHRs on the perceived quality of care among parents, children, and adolescents is largely lacking. In the Netherlands, a PAEHR (Iuvenelis) was developed for preventive child health care and youth care. Parents and adolescents had access to its full content, could manage appointments, ask questions, and comment on written reports. This study aims to assess whether and how using this PAEHR contributes to perceived quality of care from a client's perspective. We chose a qualitative design with a phenomenological approach to explore how parents and adolescents perceived the impact of using a PAEHR on quality of care. In-depth interviews that simultaneously included 1 to 3 people were conducted in 2021. In total, 20 participants were included in the study, representing parents and adolescents, both sexes, different educational levels, different native countries, and all participating municipalities. Within this group, 7 of 13 (54%) parents had not previously been informed about the existence of a client portal. Their expectations of using the client portal, in relation to quality of care, were discussed after a demonstration of the portal. Parents and adolescents perceived that using Iuvenelis contributed to the quality of care because they felt better informed and more involved in the care process than before the introduction of Iuvenelis. Moreover, they experienced more control over their health data, faster and simpler access to their health information, and found it easier to manage appointments or ask questions at their convenience. Parents from a migratory background, among whom 6 of 7 (86%) had not previously been informed about the portal, expected that portal access would enhance their understanding of and control over their care processes. The parents expressed concerns about equity because parents from a migratory background might have less access to the service. Nevertheless, portal usability was regarded as high. Furthermore, both parents and adolescents saw room for improvement in the broader interdisciplinary use of Iuvenelis and the quality of reporting. Using Iuvenelis can contribute to the client-experienced quality of care, more specifically to perceived person centeredness, timeliness, safety, efficiency, and integration of care. However, some quality aspects, such as equity, still need addressing. In general, client information about the portal needs to be improved, specifically focusing on people in vulnerable circumstances, such as those from migratory backgrounds. In addition, to maximize the potential benefit of using Iuvenelis, stimulating a person-centered attitude among professionals is important. Considering the small number of adolescent participants (n=7), adding quantitative data from a structured survey could strengthen the available evidence.

Pre-Pandemic and Recent Oral and Medical Health Care Utilization among Young American Indian Children and Their Caregivers

Children from diverse ethnic groups are at significantly increased risk for dental caries. In particular, American Indian (AI) children have the highest incidence of detal caries of any ethnic group. The COVID-19 pandemic dramatically restricted health care access, including preventive oral health care. Given this context, it is unclear whether or not preventive oral health care for AI children has resumed since lockdown. To address this question, we surveyed adult AI caregivers (N = 152) of children aged 0–5 years, assessing recent (12-month) and pre-COVID (for caregivers of children aged 3–5 years) preventive oral and medical health services. We also examined medical health care access and utilization among caregivers. Among children aged 3–5 years old, both pre-pandemic and past year medical care utilization were generally high (80 and 90%, respectively) as was any oral health care utilization (64 & 78%, respectively). Oral health check-ups were more common over the last year (62%) compared to pre-COVID (44%). Recent health care utilization among children 1–5 years old in this sample were generally comparable to national estimates, except for higher reported preventive medical care (99% vs. 87.6%, respectively) and higher preventive oral care (96% vs. 59.6%, respectively). More caregivers reported delaying or foregoing needed health care due to COVID (28–38%) versus due to cost (8–17%). In this survey of AI caregivers, recent child preventive health care utilization was high, and changes in utilization following the lockdown phases of the pandemic were comparable for oral and medical health care.

Computerized adaptive testing to screen pre-school children for emotional and behavioral problems.

Questionnaires to detect emotional and behavioral (EB) problems in preventive child healthcare (PCH) should be short; this potentially affects their validity and reliability. Computerized adaptive testing (CAT) could overcome this weakness. The aim of this study was to (1) develop a CAT to measure EB problems among pre-school children and (2) assess the efficiency and validity of this CAT. We used a Dutch national dataset obtained from parents of pre-school children undergoing a well-child care assessment by PCH (n = 2192, response 70%). Data regarded 197 items on EB problems, based on four questionnaires, the Strengths and Difficulties Questionnaire (SDQ), the Child Behavior Checklist (CBCL), the Ages and Stages Questionnaire: Social Emotional (ASQ:SE), and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). Using 80% of the sample, we calculated item parameters necessary for a CAT and defined a cutoff for EB problems. With the remaining part of the sample, we used simulation techniques to determine the validity and efficiency of this CAT, using as criterion a total clinical score on the CBCL. Item criteria were met by 193 items. This CAT needed, on average, 16 items to identify children with EB problems. Sensitivity and specificity compared to a clinical score on the CBCL were 0.89 and 0.91, respectively, for total problems; 0.80 and 0.93 for emotional problems; and 0.94 and 0.91 for behavioral problems. Conclusion: A CAT is very promising for the identification of EB problems in pre-school children, as it seems to yield an efficient, yet high-quality identification. This conclusion should be confirmed by real-life administration of this CAT. What is Known: • Studies indicate the validity of using computerized adaptive test (CAT) applications to identify emotional and behavioral problems in school-aged children. • Evidence is as yet limited on whether CAT applications can also be used with pre-school children. What is New: • The results of this study show that a computerized adaptive test is very promising for the identification of emotional and behavior problems in pre-school children, as it appears to yield an efficient and high-quality identification.

Capitated, Multisector, Universal Preventive Health Care for Children and Youth

This Viewpoint discusses the need to reorganize the provision of well-child care whereby responsibility for services is formally divided and coordinated and funding is free from traditional, risk-based health insurance.

Is household shock a boon or bane to the utilisation of preventive healthcare for children? Evidence from Uganda

This paper investigates how poor households in low-income countries trade off time investment in their children’s preventive healthcare vis-à-vis labour force participation during household-level health shocks. By using the reported illness or death of any household member as the indicator for an adverse health shock, I examine its effect on the intake of Vitamin A Supplementation (VAS) by children. Using four waves of the Uganda National Panel Survey, I find that children between 12–24 months are significantly more likely to get VAS when the household is under a health shock. I argue that this effect works through an economies of scale mechanism, by which the household adult(s) utilise the released time from the labour force during the shock to access remedial care from the healthcare facility and simultaneously obtain VAS for their children during the same visit. This arguably results from the high opportunity cost of time-constrained households, which is exacerbated by a mediocre service delivery side. To distinguish the unique mechanism of the health shock in this context, the effect and channels of an income shock are also explored. By proxying a negative income shock with the household-reported incidence of flood or drought, the study cautiously hints that VAS adoption may increase among the relatively wealthy who experience a dominating substitution effect of the income shock.

Key developmental milestones helped to identify children with special educational needs and disabilities at an early stage.

Responding to developmental delay promptly is important, as it helps children to reach their full potential. This study investigated how developmental milestones predicted primary school children with special educational needs and disabilities (SEND) at an early stage. We obtained data about 36 milestones between 12 and 45 months using the Dutch Development Instrument. Development, primary school classification and background characteristics were collected from the Dutch Preventive Child Healthcare system in Utrecht from 2008 to 2016. We investigated SEND classifications and the primary schools that the children attended at 4-12 years of age. The findings include area under the curve (AUC) data. Data on 30 579 children in mainstream schools and 1055 children with SEND were available. Different milestones predicted SEND classifications. Fourteen milestones and parental education predicted attendance at special needs schools with smaller classes (AUC 0.913). Nine milestones, sex, migration background and parental education predicted attendance at schools for severe communication problems (AUC 0.963). Ten milestones and parental education predicted attendance at schools for severe learning difficulties (AUC 0.995). Milestones did not accurately predict attendance at schools for severe behavioural or psychiatric problems. Milestones at 12-45 months predicted most SEND classifications at primary school age, except severe behavioural or psychiatric problems.

The effects and process of the intervention “Individual Shantala Infant Massage” in preventive child healthcare to improve parent–child interaction: study protocol for a quasi-experimental study

BackgroundIndividual Shantala Infant Massage is an intervention that is offered by several Dutch Preventive Child Healthcare (PCH) organizations as optional preventive support, in addition to basic care as offered to all children. It targets vulnerable families and aims to enhance sensitive parenting and to reduce (effects of) parental stress. The intervention is carried out by a certified nurse. It consists of three structured home visits. Parents learn to massage their infant and receive parenting support. This study aims to investigate the effectiveness and the process of the intervention. The main hypothesis is that Individual Shantala Infant Massage leads to increased parental sensitive responsiveness, lower perceived and physiological parental stress, and improved child growth and development in the intervention group, compared to a control group where this intervention is not offered by PCH. Secondary research questions address effects on parenting confidence and parental concerns regarding the infant, the influence of background characteristics and the intervention process.MethodsThe study is a quasi-experimental non-randomized trial. The aim is to include 150 infant-parent dyads in both the intervention and the control group. This takes into account possible attrition and missing data as 105 dyads with complete data per group are sufficient for analysis. All participants complete questionnaires at T0 (pre-test, child age between six-sixteen weeks), T1 (post-intervention, or ± four weeks after T0), and T2 (follow-up at five months). At T2, a hair tuft is cut from the parents’ head to measure hair cortisol levels. Data on infant growth and development is obtained from PCH files. In the intervention group, additional data is collected to evaluate the intervention process: parents complete an evaluation questionnaire at T1, nurses keep semi-structured logbooks of intervention sessions and interviews are conducted with parents and professionals.DiscussionStudy results can contribute to the evidence base of infant massage as applied in Dutch PCH, and can inform parents, PCH practitioners, policy makers and researchers both inside and outside the Netherlands on feasibility and effectiveness of the infant massage intervention as applied in this format and setting.Trial registrationISRCTN registry: ISRCTN16929184. Date (retrospectively) registered: 29/03/2022.

Early detection of risk for maltreatment within Dutch preventive child health care: A proxy-based evaluation of the long-term predictive validity of the SPARK method

BackgroundFor effective prevention of child maltreatment, it is crucial that risk factors for child maltreatment are identified as early as possible. In the Dutch preventive child healthcare, the SPARK-method is used for this purpose. ObjectiveThe current study investigated the predictive validity of the SPARK-method for predicting child protection activities, as a proxy for child maltreatment, and whether the estimation can be improved with an actuarial module. Participants and settingParticipants included a community sample of 1582 children of approximately 18-months-old for whom the SPARK was administered during well-child visits at home (51 %) or at the well-baby clinic (49 %). MethodsSPARK measurements were linked to data on child protection orders and residential youth care over a 10-year follow-up period. The predictive validity was evaluated using Area Under the receiver operating characteristic Curve (AUC) values. ResultsResults showed good predictive validity for the SPARK clinical risk assessment (AUC = 0.723; large effect). The actuarial module led to a significant improvement in predictive validity (AUC = 0.802; large effect), z = 2.05, p = .04. ConclusionThese results show that the SPARK is suitable for estimating the risk of child protection activities and that the actuarial module is a valuable addition. The SPARK can be used to support professionals in preventive child healthcare with their decision on appropriate follow-up actions.

Birth weight and hypertension: nature or nurture?

Birth weight and hypertension: nature or nurture?

Effect of using client-accessible youth health records on experienced autonomy among parents and adolescents in preventive child healthcare and youth care: A mixed methods intervention study.

Client autonomy is important in Dutch youth care. It correlates positively with mental and physical health and can be strengthened by professional autonomy-supportive behaviour. Aiming for client autonomy, three youth care organisations co-developed a client-accessible youth health record (EPR-Youth). Currently, limited research is available on how client-accessible records contribute to adolescent autonomy. We investigated whether EPR-Youth strengthened client autonomy and whether professional autonomy-supportive behaviour reinforced this effect. A mixed methods design combined baseline and follow-up questionnaires with focus group interviews. Different client groups completed questionnaires about autonomy at baseline (n = 1404) and after 12months (n = 1003). Professionals completed questionnaires about autonomy-supportive behaviour at baseline (n = 100, 82%), after 5months (n = 57, 57%) and after 24months (n = 110, 89%). After 14 months, focus group interviews were conducted with clients (n = 12) and professionals (n = 12). Findings show that clients using EPR-Youth experienced more autonomy than non-users. this effect was stronger among adolescents aged 16 and older than among younger adolescents. Professional autonomy-supporting behaviour did not change over time. However, clients reported that professional autonomy-supporting behaviour contributed to client autonomy, emphasising that professional attitude needs addressing during implementation of client-accessible records. Follow-up research with paired data needs to strengthen the association between using client-accessible records and autonomy.

Mixed methods evaluation of an oral health education program for pediatric dental, medical and nursing providers.

To evaluate the application of knowledge, attitudes, and skills learned in an oral health education program among pediatric dental and medical residents, and pediatric and family nurse practitioners (PNPs and FNPs). A mixed methods study design included a year-end online survey and focus groups. Eighty participants completed the survey (94%) and seven focus groups were conducted (n = 69) representing each of the four cohorts in 2020-2022. Analysis of variance was used to assess differences in survey responses by dental/medical specialty. Focus group audio recordings were analyzed using Atlas.ti.22 to identify common themes. The program increased knowledge and skills in oral health core competencies and positive attitudes regarding oral health education. All PNPs (100%) and most pediatric medical residents (94%) and FNPs (91%) strongly agreed/agreed that the oral health program led to an increase in screening for early childhood caries, more confidence in applying fluoride varnish and providing oral health anticipatory guidance during patient visits. Most pediatric medical residents, PNPs and FNPS (98%) strongly agreed/agreed that primary care providers should incorporate oral health into their practice and provide referrals to dental professionals as part of well-child visits. The program improved oral health-related knowledge, attitudes and skills among dental and medical primary care providers. Future oral health education programs for health care professionals can use this model to help bridge the gap between dental and primary care and ultimately improve access to preventive oral health care for children and families.

Learning from health system actor and caregiver experiences in Ghana and Nepal to strengthen growth monitoring and promotion.

Globally, growth monitoring and promotion (GMP) of infants and young children is a fundamental component of routine preventive child health care; however, programs have experienced varying degrees of quality and success with enduring challenges. The objective of this study was to describe implementation of GMP (growth monitoring, growth promotion, data use, and implementation challenges) in two countries, Ghana and Nepal, to identify key actions to strengthen GMP programs. We conducted semi-structured key informant interviews with national and sub-national government officials (n = 24), health workers and volunteers (n = 40), and caregivers (n = 34). We conducted direct structured observations at health facilities (n = 10) and outreach clinics (n = 10) to complement information from interviews. We coded and analyzed interview notes for themes related to GMP implementation. Health workers in Ghana (e.g., community health nurses) and Nepal (e.g., auxiliary nurse midwives) had the knowledge and skills to assess and analyze growth based on weight measurement. However, health workers in Ghana centered growth promotion on the growth trend (weight-for-age over time), whereas health workers in Nepal based growth promotion on measurement from one point in time to determine whether a child was underweight. Overlapping challenges included health worker time and workload. Both countries tracked growth-monitoring data systematically; however, there was variation in growth monitoring data use. This study shows that GMP programs may not always focus on the growth trend for early detection of growth faltering and preventive actions. Several factors contribute to this deviation from the intended goal of GMP. To overcome them, countries need to invest in both service delivery (e.g., decision-making algorithm) and demand generation efforts (e.g., integrate with responsive care and early learning).

A feasibility Randomised Controlled Trial as a first step towards evaluating the effectiveness of a digital health dashboard in preventive child health care: a mixed methods approach

BackgroundWithin preventive Child Health Care (CHC), the 360°CHILD-profile has been developed. This digital tool visualises and theoretically orders holistic health data in line with the International Classification of Functioning, Disability and Health. It is anticipated that evaluating the effectiveness of the multifunctional 360°CHILD-profile within the preventive CHC-context is complex. Therefore, this study aimed at investigating the feasibility of RCT procedures and the applicability of potential outcome measures for assessing the accessibility and transfer of health information.MethodsDuring the first introduction of the 360°CHILD-profile in CHC practice, a feasibility RCT with an explanatory-sequential mixed methods design was executed. CHC professionals (n=38) recruited parents (n=30) who visited the CHC for their child (age 0–16). Parents were randomised to “care as usual” (n=15) or “care as usual with, in addition, the availability of a personalised 360°CHILD-profile during 6 months” (n=15). Quantitative data on RCT feasibility were collected on recruitment, retention, response, compliance rates and outcome data on accessibility and transfer of health information (n=26).Subsequently, thirteen semi-structured interviews (5 parents, 8 CHC professionals) and a member check focus group (6 CHC professionals) were performed to further explore and gain a deeper understanding of quantitative findings.ResultsIntegration of qualitative and quantitative data revealed that the recruitment of parents by CHC professionals was problematic and influenced by organisational factors. The used randomisation strategy, interventions and measurements were executable within the setting of this specific study. The outcome measures showed skewed outcome data in both groups and a low applicability to measure accessibility and transfer of health information. The study revealed points to reconsider regarding the randomisation and recruitment strategy and measures in the next steps.ConclusionsThis mixed methods feasibility study enabled us to gain a broad insight into the feasibility of executing an RCT within the CHC context. Trained research staff should recruit parents instead of CHC professionals. Measures, potentially for evaluating 360°CHILD-profile’s effectiveness, need further exploration and thorough piloting before proceeding with the evaluation process. Overall findings revealed that executing an RCT within the context of evaluating 360°CHILD-profile’s effectiveness in the CHC setting will be much more complex, time-consuming and costly than expected. Thereby, the CHC context requires a more complex randomisation strategy than executed during this feasibility study. Alternative designs including mixed methods research must be considered for the next phases of the downstream validation process.Trial registrationNTR6909; https://trialsearch.who.int/.

Sustainable preventive integrated child health care: reflections on the importance of multidisciplinary and multisectoral stakeholder engagement

ABSTRACT Worldwide, 85% of all children who die are under the age of five. A recent scoping review examining the literature from 2000 to 2021 shows the importance of sustainable integrated preventive child health care for improving child health, enhancing the uptake of preventive child health services, and decreasing health-care costs. In 2022, we organised a stakeholder workshop in Uganda to discuss and contextualise the findings of the scoping review. The workshop took place under the umbrella of the Centre of Excellence for Sustainable Health, a virtual collaborative centre co-hosted by Makerere University in Uganda and Karolinska Institutet in Sweden. The workshop convened multidisciplinary and multisectoral stakeholders, including parents, nurses, paediatricians, nutritionists, village health team members, religious leaders, social workers, teachers, lawyers, health and climate researchers, and representatives from the police, the agricultural sector, the Ministry of Health, the World Health Organization, and other international and national non-governmental organisations, among others. We reflect on the importance of multidisciplinary and multisectoral stakeholder engagement, not only in building bridges between research and practice but also in linking sectors and connecting people for sustainable preventive integrated child health care. Though an important step, this workshop was only a first step; over time, relationships must be nurtured, multisectoral systems built and research and policy closely connected. We hope this workshop will not remain a one-off event but becomes an institutionalised effort that sparks action for sustainable preventive integrated child health care in Kampala and beyond, and sustainable health for all.

A Digital Dashboard for Visual Representation of Child Health Information: Results of A Mixed Methods Study on Usability and Feasibility of A New CHILD-Profile

Background: A digital 360°CHILD-profile, developed within Dutch preventive Child Health Care, visualizes and theoretically orders relevant health information in line with the International Classification of Functioning, Disability and Health. This comprehensible dashboard is designed make electronic health data accessible and facilitate transformation towards Personalized Health Care.

Developmental monitoring: benefits of a preventive health care system

A developmental monitoring system with only preventive tasks may help to identify children with EB, cognitive developmental, and/or family problems. This can lead to early support for most of these children, with low referral rates to (more specialized) mental health and social care services. Our findings deserve validation in comparable settings and in other countries. •Well-child care requires monitoring of the health and development of children for timely identification of problems and subsequent intervention. • The Dutch Preventive Child Healthcare system is an example of a developmental monitoring system with only preventive tasks. •A developmental monitoring system with only preventive tasks may help to identify children with problems, resulting in early support for the majority. • This may reduce referral rates to (more specialized) mental/social health services.