Suspected Developmental Delay Research Articles

A 9-year retrospective cohort study of the monitoring and screening of childhood developmental delay in Thailand.

Developmental delay in early childhood can have negative long-term cognitive and psychiatric sequelae, along with poor academic achievement, so early screening and surveillance are paramount. The aim of this study is to evaluate the impact of screening and surveillance on child developmental delay using the Developmental Surveillance and Promotion Manual (DSPM) and the Thai Early Developmental Assessment for Intervention (TEDA4I) for Thai children aged 0-5years old. Data were obtained from the routine developmental screening for specific disorders at ages 9, 18, 30, 42 and 60 months conducted using DSPM and TEDA4I from 2013 to 2021. Descriptive statistics were used to analyse the data, and the results are visualised graphically herein. Only 56% of the children were screened for child developmental delay using DSPM. The proportion of children screened increased from <1% in 2013 to 90% in 2021. Suspected developmental delay prevalence increased significantly from 3.91% in 2013-2015 to 10.00% in 2016-2018 and 26.48% in 2019-2021. Moreover, of the children with suspected developmental delay who received developmental stimulation within a month, only 87.9% returned for follow-up visits when they were evaluated again using TEDA4I to ascertain any abnormalities and specific areas of deficit. The overall proportion of children diagnosed with developmental delay was 1.29%. During the pandemic, the proportion of screening tests for child developmental delay at routine vaccination visits and follow-ups decreased but was still at least 80% in each region. Since 1%-3% of children have suspected developmental delay, early detection is key to treating it as soon as possible. We anticipate that our findings will raise awareness in parents and caregivers about childhood developmental delay and lead to the implementation of early intervention and follow-up at the rural level in Thailand.

Family responsive care mediating the home visiting effects on left-behind children's early development in rural China.

The early development of left-behind children requires great concern and improvement. Yet, current interventions for left-behind children are mainly focussed on children older than 3. This study aims to assess the effectiveness of a home visiting programme on family responsive care and early development of rural left-behind children and examine whether family responsive care mediates the effects of intervention on child development. A quasi-experimental study design was utilized in this study. A stratified clustered sampling was employed to choose villages in programme towns into intervention group. A control village was matched with every intervention village. All of the left-behind children and their caregivers meeting the inclusion criteria in the chosen villages were enrolled in the survey. The outcomes included child development, caregiver's early stimulation, parent-child communication, and learning materials. Baseline assessments were conducted in 2018, and endline assessments were conducted in 2020. In the endline survey, we enrolled 608 children with 258 in the intervention group and 350 in the control group. Left-behind children in the intervention group were less likely to have development delay compared with the control group (odds ratio [OR] = 0.59, 95% confidence interval [CI]: 0.36, 0.96). Migrant parents of children in the intervention group showed higher proportion of expressing emotional support to their children when communicating (OR = 1.69, 95% CI: 1.05, 2.72). Children who received home visits more than once per 2months had lower level of suspected development delay than children in the control group (OR = 0.34, 95% CI: 0.18, 0.68). Caregiver's early stimulation and migrant parents' emotional support to left-behind children mediated the intervention dose and left-behind children's development. Caregiver's early stimulation mediates the intervention and child's development. The findings suggest a promising future for scaling similar early childhood development interventions for left-behind children in rural settings.

Effects of SARS-CoV-2 gestational exposure and risk factors on neurodevelopment until 12 months: A prospective cohort study in Brazil

BackgroundThe effects of SARS-CoV-2 gestational exposure on child development remain inconclusive. AimsTo analyze the effects of SARS-CoV-2 gestational exposure on neurodevelopment until 12 months. Study designProspective cohort study conducted in five municipalities in Southeast Brazil from August 2021 to September 2022. SubjectsInfants were recruited from a serological survey performed during neonatal screening and followed up to 12 months old. We included 224 infants exposed to SARS-CoV-2 during pregnancy and 225 non-exposed, according to the serology results of the newborn as well as their mothers and the maternal antenatal RT-PCR results. Outcome measuresDevelopmental assessments were performed at 6 and 12 months using the Survey of Wellbeing of Young Children-Brazilian Version (SWYC-BR). Children with suspected developmental delay (SDD) at 6 and 12 months were considered at high risk for developmental delay (HRDD). Additionally, risk factors associated with SDD were examined. ResultsThere were 111 children identified with SDD and 52 with HRDD. SARS-CoV-2 gestational exposure was not associated with SDD. Exposure in the first gestational trimester increased SDD risk by 2.15 times compared to the third. Cesarean delivery predicted SDD (OR 1.56; 95%CI 1.01–2.42) and HRDD (OR 1.91; 95%CI 1.04–3.48). Additionally, suspected maternal depression predicted SDD (OR 1.76; 95%CI 1.01–3.10). ConclusionSARS-CoV-2 gestational exposure did not increase the developmental delay risk. However, our findings suggest that the earlier the gestational exposure, the greater the developmental delay risk at 12 months. Cesarean delivery and suspected maternal depression increased the developmental delay risk, independent of virus exposure.

Factors Associated with Suspected Developmental Delay in Thai Children Born with Low Birth Weight or Asphyxia

ObjectivesThe aim of the study was to identify factors associated with a risk of suspected developmental delay (SDD) in high-risk children in Thailand.MethodsWe used data on children enrolled for developmental delay (DD) screening across Thailand collected by the Rajanagarindra Institute of Child Development, Department of Mental Health, Ministry of Public Health, Thailand. Children who were under 5 years of age with a birth weight of fewer than 2500 g and/or birth asphyxia in Thailand with high risk of DD were assessed using the Developmental Assessment for Intervention Manual (DAIM) between August 2013 and November 2019 (N = 14,314).ResultsThe high-risk children who had a gestational age at birth of < 37 weeks (adjusted odds ratio = 1.54; 95% confidence interval = 1.39–1.70) and/or had a birth weight < 2500 g (1.22; 1.02–1.45), or had mothers who were not government officers (1.46; 1.11–1.93), had a low education level (1.36; 1.19–1.55), had a poor nutritional status (1.34; 1.09–1.65), and/or who were living in a high-altitude area (1.59; 1.32–1.91) were at a higher risk of SDD.Conclusions for PracticeChildren with a low birth weight and/or asphyxia during birth had a high risk of DD. SDD monitoring of children by community health workers and/or by developing outreach strategies, especially in underserved regions, should be considered. In addition, developing policies and guidelines, and intervention for high-risk children ought to be conducted to reduce the subsequent problems caused by the late detection of DD.

Early stimulation and responsive care: A mediator of caregivers' depression on the suspected developmental delay of left-behind children in China

BackgroundDue to multiple factors, left-behind children in rural areas suffer from neurodevelopment delay and their caregivers suffer from depressive symptoms. This study aimed to analyze the effect of caregivers' depressive symptoms on left-behind children's neurodevelopment, with early stimulation and responsive care mediating. MethodsWe conducted a cross-sectional survey in five counties in China. A total of 904 left-behind children aged 0–3 and their primary caregivers were enrolled. The Zung Self-rating Depression Scale (ZSDS) was used to measure caregivers' depressive symptoms. The Ages and Stages questionnaires-third edition (ASQ-3), which contains five domains: communication (CM), gross motor (GM), fine motor (FM), problem-solving (CG), and personal social (PS), was used to screen children for suspected developmental delay (SDD). Results31.4 % of left-behind children suffered from SDD, while 39.7 % of left-behind children's caregivers experienced depressive symptoms. Caregivers' ZSDS scores were positively correlated with the SDD on four domains (FM, GM, CG, and PS), while Early stimulation and responsive care was negatively correlated with the SDD on four domains (CM, FM, CG, and PS). LimitationsThe cross-sectional design limited the ability to ascertain causal relations. Besides, the findings may not be generalized to all regions of China due to the heterogeneity of the study population. ConclusionsLeft-behind children under three years old in rural China were at high risk of SDD, while a substantial proportion of their caregivers had depressive symptoms. Caregivers' depressive symptoms may negatively affect the SDD of left-behind children through caregivers providing less early stimulation and responsive care.

Variability in infant crawling with typical development and risk of developmental delay

ABSTRACT This study reports on crawling variability and differences in variability between infants with typical development (TD) and those with developmental delays. This longitudinal study included 0-year-old infants with no apparent dysfunction. The crawling movement in the video was coded objectively with reference to previous research. The infants were screened after 2 years of age, and the TD and suspected developmental delay (SDD) crawling codes were analysed and compared. Among TD infants, variation in hands-and-knees crawling decreased more in the group with belly-crawling experience than in the group without. However, this tendency was not observed in infants with SDD. Furthermore, TD infants showed more variable patterns of limb movement timing during belly-crawling than those with SDD. This study suggests variability during the entire crawling period. Moreover, exploration of an efficient diagonal gait was critical for crawling variability and subsequent development, which tends to be deficient in infants at risk of developmental delay.

The relationship between home environment and early childhood development of left-behind children under 3 years in rural China

BackgroundHome environment provides stimulation and learning opportunities required for children’s early development. However, few studies have focused on the effects of home environment on left-behind children’s development in rural China. The study aimed to investigate the relationship between home environment and early childhood development of left-behind children under 3 years old in rural China. MethodsInformation about sociodemographic characteristics, caregivers’ mental health, home environment and children’s development was collected. Infant/Toddler Home Observation for Measurement of the Environment Inventory (IT-HOME) was used to assess home environment. Child’s development was evaluated with the Chinese version of the Ages & Stages Questionnaire - third edition. ResultsElevated caregivers’ depressive symptoms were associated with a higher risk of total suspected development delay. An increase of one score in the IT-HOME resulted in a 7% decrease in total suspected development delay. Higher scores in the dimensions of involvement and variety were associated with a lower risk of suspected development delay adjusting for covariates. ConclusionsOur results have implications for home-based intervention aiming at promoting nurturing care as well as caregivers’ mental health, which is required for early development of young left-behind children in rural areas of China.

Prospective associations between various prenatal exposures to maternal psychological stress and neurodevelopment in children within 24 months after birth

BackgroundThere is increasing evidence that prenatal exposure to maternal psychological distress may be a factor influencing offspring neurodevelopment, but stress type-dependent effects of maternal psychological distress on offspring neurodevelopment in early childhood have yet to be fully elucidated. Additionally, although positive maternal mental health exerts potential effects in protecting against adverse health outcomes, few investigators have considered the effects of positive maternal mental health on offspring neurodevelopment in early childhood. AimsTo determine the associations between various prenatal exposures to maternal psychological distress and positive life-event experiences and offspring neurodevelopment within 24 months of age. MethodsA total of 4412 mother-child dyads were recruited from the Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC). Maternal perceived stress, negative life-event stress, positive life-event experiences around the time of conception (i.e., three months prior to and after conception) were assessed at 12–16 gestational weeks, and maternal anxiety and depressive symptoms were assessed at 32–36 gestational weeks. We measured children's neurodevelopment using the Ages and Stages Questionnaire, Third Edition (ASQ-3) at two, six, 12, and 24 months postnatally. We then exploited generalized linear models to estimate the associations between prenatal maternal psychological distress and positive life-event experiences and children's neurodevelopment at the above periods, and generalized linear mixed models were applied to assess the associations between maternal psychological distress and positive life-event experiences and suspected developmental delay (SDD) in children within 24 months after birth based on a longitudinal design. ResultsMaternal perceived stress and negative life-event stress around the time of conception, and anxiety and depressive symptoms during late pregnancy were negatively associated with scores of children's neurodevelopment at two, six, 12, and 24 months of age; while maternal life-event experiences were positively associated with scores of children's neurodevelopment. Longitudinal analysis revealed that higher levels of maternal negative life-event stress and depressive symptoms augmented the risk of SDD in personal-social (OR = 1.435, 1.681). Mothers who experienced higher levels of positive life-event experiences exhibited a reduced risk of SDD in gross motor and personal-social domains (OR = 0.373, 0.350). ConclusionsPrenatal exposure to maternal psychological distress is negatively associated with children's neurodevelopment in early childhood depending upon the type of distress. Maternal positive life-event experiences around the time of conception appeared to present potential benefits for child neurodevelopment.

Impact of Stunting on Development of Children between 1-3 Years of Age.

Stunting occurs due to chronic malnutrition and is a major problem for children in developing countries. It is important to evaluate the impact of stunting on the development of children. This study aimed to investigate the impact of stunting on the development of children between 1-3 years of age. This cross-sectional study was conducted from July 2020 to March 2021 in Surabaya, Indonesia. A questionnaire and growth assessment were done, following the development measurement to stunted and non-stunted children who met the inclusion and exclusion criteria. Development was measured by the Denver Developmental Screening Test II (DDST-II), and Cognitive Adaptive Test/Clinical Linguistic & Auditory Milestone (CAT/CLAMS) scales. Three hundred children are included in this study, consisting of 150 stunted and 150 non-stunted children. Stunted children had a higher risk to be suspected of delayed development compared to non-stunted children. The Crude Odd Ratio was 2.98, 4.24, 4.75 with the p-value 0.006, 0.001. and 0.001 respectively. The Adjusted Odd Ratio was 0.34, 0.24, 0.21 with p-value of 0.008, 0.001, and 0.001 respectively. Stunting is associated with suspected development delay among children 1-3 years of age. Initiatives related to prevention need to be established and nutrition advice needs to be provided.

Child Development and Nutritional Status of Children Under Five: A Cross-Sectional Study of a Fishermen Community in Terengganu, Malaysia

This study aims to determine child development, nutritional status and the association between child development and nutritional status. This cross-sectional study was conducted among 60 fishermen’s children under five years old in selected districts in Terengganu. All respondents were assisted by their mothers during the assessment. Child development was evaluated through the Denver II Development Screening Test. Nutritional status was determined via the anthropometry assessment (BMI-for-age and height-for-age). Preponderantly, the prevalence of suspected development delay of children under-five in Terengganu was 31.7%. The prevalence of suspected delay for language, fine motor-adaptive, and personal-social skills were 15.0%, 1.7%, and 16.7%, respectively. BMI-for-age z-score and height for age z-score of these children were -1.62±1.23 and -0.27±1.41, respectively, indicating a normal range; nonetheless, there were still children that were wasted (23.3%), severely wasted (13.3%), stunted (5.0%), severely stunted (1.7%), and at risk of being overweight (1.7%). However, the chi square test showed there was no association found between child development and nutritional status, BMI-for-age and height-for-age (p>0.001), among fishermen’s children under-five in this study. The nutritional status had no effect on the development of these fishermen's children, but may have been influenced by other factors such as stimulating surroundings, parenting abilities, and culture.

Prenatal exposure to ambient fine particulate matter and early childhood neurodevelopment: A population-based birth cohort study

Although previous studies have reported the adverse effect of air pollution exposure during pregnancy on neurodevelopment in children, epidemiological evidence is limited, and the results are inconsistent. This study aimed to explore the association between prenatal ambient fine particulate matter (PM2.5) exposure and early childhood neurodevelopment in a large birth cohort study of 4009 maternal-child pairs. Prenatal daily PM2.5 exposure concentrations at 1 km spatial revolution were estimated using high-performance machine-learning models. Neurodevelopmental outcomes of children at ages 2, 6, 12, and 24 months were assessed using the Ages and Stages Questionnaire (ASQ). Distributed lag nonlinear models were used to identify critical windows of prenatal PM2.5 exposure. General linear mixed models with binomially distributed errors were used to estimate the effect of prenatal PM2.5 exposure on suspected developmental delay (SDD) in five developmental domains based on the longitudinal design. Prenatal PM2.5 exposure was significantly associated with decreased scores for all neurodevelopmental domains of children at ages 2, 6, and 24 months. Each 10-μg/m3 increase in PM2.5 exposure was significantly associated with increased risk of SDD for all subjects (RR: 1.52 95% CI: 1.19, 2.03), specifically, in problem-solving domain for girls (RR: 2.23, 95% CI: 1.22, 4.35). Prenatal PM2.5 exposure in weeks 18 to 34 was significantly associated with both ASQ scores and SDDs. Our study proposed that prenatal PM2.5 exposure affected early childhood neurodevelopment evaluated with the ASQ scale. PM2.5 exposure might increase the risk of SDD for boys and girls, specifically in the problem-solving domain for girls.

The Effect of Parenting Quality on Child Development at 36–48 Months in China’s Urban Area: Evidence from a Birth Cohort Study

Environmental exposures, especially parenting quality, are critical for later child development. This study aimed to determine the status of parenting quality and suspected development delay of preschool children in China’s urban area and explore the associations between these two factors. The research was based on a birth cohort study conducted in Changsha, Hunan province, China. We used the Parenting Assessment Tool and Ages and Stages Questionnaires, Third Edition (ASQ-3), to measure parenting quality and child development status, respectively. Other data were collected from maternal health manuals and self-administered questionnaires during the follow-up period. The generalized estimating equation was used to examine whether parenting quality was significantly associated with child development outcomes. In the study, good parenting quality was 33.6% measured at 18 months, and suspected development delay was below 10% at 36–48 months among urban China; we observed negative associations between parenting quality scores and child development scores; poor parenting quality had a negative association with suspected development delay [OR and 95% CI: 2.74 (1.17, 6.40)], girls [OR and 95% CI: 0.33 (0.16, 0.69)] and maternal education years (>12 years) [OR and 95% CI: 0.27 (0.12, 0.64)] were protective factors for suspected development delay. Our findings highlighted the importance of good parenting quality among children in urban areas of China through a birth cohort study and may be used to reduce the children at high risk of developmental delay as a future intervention program.

Poor maternal nutritional status before and during pregnancy is associated with suspected child developmental delay in 2-year old Brazilian children

Inadequate pre-pregnancy BMI and gestational weight gain (GWG) have been associated with sub-optimal child development. We used data from the 2015 Pelotas (Brazil) Birth Cohort Study. Maternal anthropometry was extracted from antenatal/hospital records. BMI (kg/m2) and GWG (kg) adequacy were classified according to WHO and IOM, respectively. Development was evaluated using the INTER-NDA assessment tool for 3,776 children aged 24 months. Suspected developmental delay (SDD) was defined as <10th percentile. Associations between maternal exposures and child development were tested using linear and logistic regressions. Mediation for the association between BMI and child development through GWG was tested using G-formula. Sex differences were observed for all child development domains, except motor. Maternal pre-pregnancy underweight increased the odds of SDD in language (OR: 2.75; 95%CI: 1.30–5.80), motor (OR: 2.28; 95%CI: 1.20–4.33), and global (OR: 2.14; 95% CI: 1.05–4.33) domains for girls; among boys, excessive GWG was associated with SDD in language (OR: 1.59; 95%CI: 1.13–2.24) and cognition (OR: 1.59; 95%CI: 1.15–2.22). Total GWG suppressed the association of pre-pregnancy BMI with percentiles of global development in the entire sample. Maternal underweight and excessive GWG were negatively associated with development of girls and boys, respectively. The association of pre-pregnancy BMI with global child development was not mediated by GWG, irrespective of child’s sex.

Domain- and sex-specific effects of prenatal exposure to low levels of arsenic on children’s development at 6 months of age: Findings from the Ma’anshan birth cohort study in China

The relationship between prenatal arsenic exposure at low levels and poor development in children, especially in regard to neurodevelopment, has aroused several concerns, but the conclusions have been inconsistent. It still remains unclear whether such adverse effect is associated with a specific profile of the developing brain in early life. To investigate the association between arsenic exposure in utero and children’s development and behaviour, we performed a large prospective birth cohort study including 2315 mother-infant pairs in Anhui Province, China. The Ages and Stages Questionnaire of China (ASQ-C) was used to assess the status of children’s development and behaviour at 6 months postpartum, and the levels of arsenic were determined in umbilical cord serum samples. Odds ratios for suspected developmental delay (SDD) in each domain of the ASQ-C clusters were estimated using logistic regression models. Compared with low arsenic levels group, medium and high arsenic levels were significantly associated with the increased risks of SDD in the personal-social domain among infants aged 6 months after adjustment for all potential confounders (OR = 1.33, 95% CI (1.01, 1.75) and OR = 1.47, 95% CI (1.08, 2.00), respectively). Sex stratification analysis demonstrated that this association was stronger in females. The sensitivity analyses also showed that high cord serum arsenic levels were associated with a 1.80-fold (95% CIs (1.12, 2.90)) higher risk of a more severe developmental delay in the personal-social domain among six-month-old females. Our results suggest that low-level arsenic exposure in utero could have an adverse domain-specific effect on children’s development at 6 months of age, particularly among females. Further studies are warranted to support the findings and explore the mechanism of these domain-and sex-specific associations.

Desenvolvimento neuropsicomotor e o brincar de crianças em uma unidade de educação infantil

Este estudo teve como objetivo verificar a relação entre as características do brincar e o desenvolvimento neuropsicomotor de crianças de uma Unidade de Educação Infantil (UEI). Trata-se de uma pesquisa com delineamento longitudinal, de caráter descritivoexploratório, observacional e com abordagem quantitativa dos dados. Participaram 23 crianças, de ambos os sexos, com idade entre 3 e 4 anos, matriculadas em uma UEI do município de Belém-PA, em 2017. Para registro das características do brincar das crianças na escola foi utilizado o Protocolo de Observação do Brincar (POB) e para avaliação do desenvolvimento neuropsicomotor usou-se o Teste de Denver II. O estudo revelou que 56,5% das crianças apresentaram o resultado suspeita de atraso no desenvolvimento. As variáveis do brincar que tiveram associação estatisticamente significativa com a suspeita de atraso no DNPM, a partir do Teste U de Mann-Whitney foram: interação em grupo (p=0,04), brincadeira proposta pelo objeto (p=0,03) e não brincadeira-exploração (p=0,02). Considera-se que esta pesquisa possa contribuir para a identificação precoce de desvios no desenvolvimento de crianças no contexto escolar.

Effect of books and toys on early childhood development in poor rural areas of China

Objective: To explore the effect of books and toys on early childhood development in poor rural areas of China. Methods: The baseline survey data of the Integrated Early Childhood Development (IECD) conducted in 2013, which was supported by the United Nations International Children's Emergency Fund (UNICEF) China Office, were analyzed retrospectively in this study. The survey was conducted in 6 counties in 2 provinces of China (Shanxi and Guizhou), and all 6 neighboring counties were located in extremely poor areas. The socio-demographic characteristics and caring behaviors of the caregivers (the lack of children's books and toys) were assessed by UNICEF's Multiple Indicator Cluster Surveys-5 and caregivers' depression was assessed by the Zung Self-rating Depression Scale. A total of 2 701 children were enrolled, of these, 1 151(42.62%) were girls, the age (18±10) months and 1 263 (46.76%) children were from Shanxi Province, the remaining 1 438 (53.24%) children were from Guizhou Province. The early childhood developmental status was evaluated by Ages and Stages Questionnaires (ASQ). Log-binomial model was used to analyze the association between early childhood development and the lack of children's books and toys. Furthermore, sensitivity analyses (data stratification) were made to explore the effect of books and toys on early childhood development under different caregiving conditions with different caregivers who were depressive or non-depressive. Results: Among the 2 701 participants, 1 537 (56.90%) children lacked of books, 1 148 (42.50%) children lacked of toys, the suspected development delay (SDD) prevalences of overall ASQ, communication (CM), gross motor (GM), fine motor (FM), cognitivity (CG) and personal-social (PS) domains were 33.02% (892/2 701), 15.51% (419/2 701), 13.25% (358/2 701), 15.66% (423/2 701), 14.96% (404/2 701) and 11.81% (319/2 701). Under adjustment of the potential confounders, the Log-binomial regression showed that children who lacked books had significantly higher risk of SDD in overall ASQ (prevalence ratio (PR)=1.27, 95%CI: 1.11-1.45) and CM (PR=1.64, 95%CI: 1.31-2.07) than those who had sufficient books. Compared with children who had sufficient toys, those who lacked the toys also had the increased risk of SDD in overall ASQ (PR=1.34, 95%CI: 1.19-1.50), CM (PR=1.44, 95%CI: 1.18-1.76), GM (PR=1.54, 95%CI: 1.24-1.91), FM (PR=1.86, 95%CI: 1.52-2.27), CG (PR=1.80, 95%CI: 1.47-2.20) and PS (PR=1.88, 95%CI: 1.49-2.39). Sensitivity analysis revealed that the lack of books increased the risk of SDD in overall ASQ of the caregivers' non-depression group (PR=1.35, 95%CI: 1.08-1.71) and depression group (PR=1.17, 95%CI: 1.01-1.38), and the lack of toys increased the risk of SDD in overall ASQ of the caregivers' depression group (PR=1.54, 95%CI: 1.32-1.79). Conclusion: Lack of childrens' books and shortage of toys were independent risk factors for early childhood development in poor rural areas of China and both of them increased the risk of SDD significantly.

Quality of care and suspected developmental delay among children aged 1\u201359\u2009months: a cross-sectional study in 8 counties of rural China

BackgroundThe data about quality of care of more than 70 countries were available from UNICEF but little was known about China. We examined the status about quality of care and explored its associations with developmental outcomes in Chinese children.MethodsA cross-sectional study with probability proportional to size sampling method was conducted in 8 counties of rural China. A total 1927 children were assessed on development status using Ages and Stages Questionnaires-Chinese (ASQ-C) based on Chinese normative data. Nutritional status was derived from the anthropometric method following WHO guidelines. Caregivers were interviewed through household questionnaires from UNICEF’s 5th Multiple Indicator Cluster Survey to understand the quality of care, including the status of availability of children’s books, availability of playthings, support for learning, fathers’ support for learning and inadequate care. Moreover, quality of care was explored to be categorized into three levels (poor, medium and good) for overall assessment. Multivariable logistic regression model was applied to estimate the odds ratios and 95% confidence intervals between quality of care and suspected developmental delay (SDD) after adjustment for potential confounding variables.ResultsThe proportions of availability of children’s books, playthings, support for learning, fathers’ support for learning and inadequate care were 36.8, 91.3, 83.1, 16.4 and 4.9%, respectively. When compared to available data of more than 70 countries and areas, the quality of care in rural China was in the middle to upper level. After adjustment for potential confounding variables, multivariable analysis showed that SDD in overall ASQ remained negatively associated with availability of children’s books (odds ratio [OR] and 95% confidence interval [CI]: 1.64 [1.27–2.12]), playthings (OR and 95% CI: 2.23 [1.52–3.27]) and support for learning (OR and 95% CI: 1.81 [1.06–3.10]). When compared with children under good quality of care, children under medium and poor quality of care had higher prevalence of SDD in overall ASQ (OR and 95% CI: 1.59 [1.21–2.07]; 3.05 [1.96–4.74]).ConclusionsQuality of care in rural China still had scope for improvement. Better quality of care had negative associations with SDD.

The effect of a community-based, integrated and nurturing care intervention on early childhood development in rural China.

This study investigated whether an integrated, community-based and nurturing care intervention led to a reduction in the prevalence of suspected neurodevelopmental delay in children. The study also considered how the programme could be sustained to promote early development in children aged under 3 years in the poorest areas of rural China. A quasi-experimental design was applied, with data collection before and after a 2-year programme implementation, in both intervention and comparison (control) areas. From July 2014, the Integrated Early Childhood Development (IECD) programme was implemented in poverty-stricken areas in four counties of China. Nurturing care intervention focusing on five components (child health, nutrition, responsive care, protection and early learning support) was delivered mainly by the village early childhood development centre and township/village clinic. Another two counties of similar per capita gross domestic product, geographical characteristics, under-five mortality rate, under-five underweight prevalence and ethnicity to the four programme counties were selected as the comparison and received no IECD programme intervention. The Ages & Stages Questionnaire was used to evaluate the neurodevelopmental outcome of children; the overall suspected developmental delay (SDD) referred to any developmental delay in the communication, gross-motor, fine-motor or problem-solving or personal-social domains of the questionnaire. Children underwent anthropometric measurements and haemoglobin concentration testing through peripheral blood. Face-to-face interviews of caregivers were conducted to collect intervention use, cognitive stimulation and child-protection behaviours. A difference-in-differences regression approach, adjusting for confounding factors, was applied to estimate intervention impact on the neurodevelopmental outcomes in the children. Path analysis was employed to examine the mediating effects of growth, nutrition status, cognitive stimulation and child-protection behaviours through which the IECD intervention predicted children's developmental health. In total, 2953 children aged under 3 years and their caregivers were enrolled at baseline, and 2745 child-caregiver pairs completed the postintervention assessment. Prevalence of overall SDD was reduced by 18% (from 37% at baseline to 19% at postintervention) in intervention counties, which is a significant difference compared with the 10% reduction in control counties (from 30% to 20%), with an adjusted odds ratio of 0.69 (95% confidence interval: 0.54-0.89). Consistent findings were found across domains. Path analysis indicated that the effect of the intervention on promoting developmental health was mediated by multiple nurturing care-associated factors, including cognitive stimulation frequency, positive discipline, length-for-age growth and haemoglobin concentration. The community-based integrated intervention could significantly prevent developmental delay in children aged under 3 years in rural China.

The social–emotional development among children left behind by migrant mothers in rural China: a cross-sectional study

BackgroundEconomic development and rapid urbanisation in China has caused parents to migrate to urban cities for jobs and to leave their children behind. The population of left-behind children has grown and requires attention, as early child development might be negatively affected by the lack of parental interaction. We therefore aimed to assess the specific influence of migrant mothers on early child development, especially on social–emotional problems. MethodsWe did a cross-sectional study obtaining data from eight counties of central and western rural China. We included children of either sex who were aged 59 months or less, and assessed their development status using the Chinese edition of the Ages and Stages Questionnaires: Social-Emotional. The primary measures were the association between being left behind by migrant mothers and developmental problems in various domains (communication, gross motor, fine motor, problem solving, and personal–social competence). We evaluated this association using multivariate logistic regressions while adjusting for sociodemographic (age, sex, education level of caregivers, and birth order), socioeconomic (household income), and perinatal (gestational age, birthweight, and delivery method) covariates. This study was approved by the Ethics Committee of Peking University Health Science Center. All caregivers gave their written permission or fingerprint (for illiterate caregivers) for their children's involvement in the survey. FindingsBetween Oct 5, 2016, and Jan 31, 2017, we assessed 1927 children. No significant associations were observed after adjusting for potential confounders between being left behind by migrant mothers and the following developmental measures: overall suspected development delay and development delay in domains of communication, gross motor, fine motor, problem solving, and personal–social competence. Children left behind by migrant mothers were more likely to have social–emotional problems than those living with their own mothers (odds ratio [OR] 1·45, 95% CI 1·03–2·06). Additionally, children aged 24–59 months (OR 1·88, 95% CI 1·20–2·95), girls (2·74, 1·56–4·82), and the second and later child in the family (1·85, 1·18–2·91) are all factors that could increase the odds of social–emotional problems in those who were left behind by migrant mothers. InterpretationThis study suggested that although children left behind by migrant mothers presented similarly with their peers living with their mothers on development, they were more likely to have social–emotional problems. Interventions should pay more attention to children who are girls, aged 24–59 months, and the second and later child of the family. FundingUNICEF China.

Screening for developmental delay in preschool-aged children using parent-completed Ages and Stages Questionnaires: additional insights into child development

BackgroundDevelopmental delay is a delay in areas of speech, language, motor, social and cognitive development. Because of the negative impact of intellectual and learning disabilities, early identification of children with...