Swedish Child Health Services Research Articles

Children in family foster care have greater health risks and less involvement in Child Health Services.

This study investigated the impact of being in family foster care on selected health determinants and participation in Child Health Services (CHS). Two groups of 100 children, born between 1992 and 2008, were studied using data from Swedish Child Health Services for the preschool period up to the age of six. The first group had been in family foster care, and the controls, matched for age, sex and geographic location, had not. Descriptive statistics were used to describe differences in health determinants and participation in Child Health Services between the two groups. The foster care group had higher health risks, with lower rates of breastfeeding and higher levels of parental smoking. They were less likely to have received immunisations and attended key nurse or physician visits and speech and vision screening. Missing data for the phenylketonuria test were more common in children in family foster care. Children in family foster care were exposed to more health risks than the control children and had lower participation in the universal child health programme during the preschool period. These results call for secure access to high-quality preventive health care for this particularly vulnerable group of children.

Infrequent attention to dietary and physical activity behaviours in conversations in Swedish child health services

To investigate conversations between nurses and parents in Swedish child health services and to assess to what extent attention is directed towards dietary and physical activity behaviours in children. Twenty-three nurses audio-recorded one session each. Recordings were assessed and topics were classified according to predetermined categories. The three most frequent topics of conversation concerned physical examinations of the child (30% of session time), talking to the child to establish or maintain contact and interest (15%), and development of language skills (12%). Dietary habits came on fourth place (10%), and physical activity ranked 14 (4%). Attention to dietary and physical activity behaviours in children is infrequent in Swedish child health services. Concern is raised about the efficacy of prevention efforts against childhood obesity.

An Evaluation of Training in Motivational Interviewing for Nurses in Child Health Services

Acquiring proficiency in motivational interviewing (MI) may be more difficult than generally believed, and training research suggests that the standard one-time workshop format may be insufficient. Although nurses represent one of the professions that have received most training in MI, training in this group has rarely been systematically evaluated using objective behavioral measures. To evaluate an enhanced MI training program, comprising a 3.5-day workshop, systematic feedback on MI performance, and four sessions of supervision on practice samples. Nurses (n = 36) in Swedish child health services were trained in MI. Skillfulness in MI was assessed using the Motivational Interviewing Treatment Integrity (MITI) Code. Effects of training were compared to beginning proficiency thresholds. Participants did not reach beginning proficiency thresholds on any of the indicators of proficiency and effect sizes were small. The present study adds to a growing body of literature suggesting that the current standard MI training format may not provide practitioners with enough skillfulness. Moreover, the results indicate that even enhanced training, including systematic feedback and supervision, may not be sufficient. Suggestions for improved MI training are made.

Child health care uptake among low‐income and immigrant families in a Swedish county

To study the uptake of child health care among low-income and immigrant families in the county of Uppsala, Sweden, to investigate whether these families received extra attention as proposed in the Swedish Child Health Services (CHS) state-of-the-art consensus document from the year 2000. Data were collected for 25,024 infants born 1998-2006 from the database of statistics of the Child Health Care Unit in Uppsala and socio-demographic indicators from Swedish national registers. Disposable income was divided into quartiles. Country of birth of the mother was categorized into four regions with two subgroups each, mothers with or without a Swedish-born partner. Analysis was conducted by Cox regression and linear regression models. Small differences between Swedish vs. immigrant and high vs. low-income families were detected. Low-income mothers (RR 0.78) as well as mothers born in all country of birth regions with an immigrant partner (RR 0.28-0.95) had lower rates of participation in parental groups. The CHS provided basic child health care to almost all infants including children in immigrant and low-income Swedish families. However, the results did not indicate that disadvantaged families received the extra attention proposed in the consensus document.

Contents of Swedish school health questionnaires

Aim: This study aims to analyse and link the content of the health information requested in questionnaires used locally in Swedish child and school health services. Background: In industrialized countries, children’s health needs are changing from physical to psychosocial needs and the questionnaires used for health screening and guiding health promotion must therefore adapt to these changes. Methods: Questionnaires were analysed, together with health items linked to the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY). The inter-rater agreement for linking was 80%. Standard age groups were used to improve the comparability across different questionnaires. Results: The information requested for the youngest children focused on communication and acquiring language. For the children aged 6 years and above, health questionnaires related to mental functions, the school situation, psychosomatic symptoms and issues associated with taking care of one’s health. Conclusions: The information relating to health in questionnaires revealed that interest focused on health items strongly related to the different age groups and to psychosocial health. The focus was the child as a person rather than the child within a family and school environment.

Expressive vocabulary in 18‐month‐old children in relation to demographic factors, mother and child characteristics, communication style and shared reading

Previous research has elucidated the associations between children's language development and reading habits, and maternal education, communication style, gender and birth order. Research including maternal age and child temperament is more scarce. We studied the associations of all these factors with children's expressive vocabulary and reading habits. We also analysed the relationships of reading with expressive vocabulary, and effect sizes associated with frequent reading. Questionnaires were completed by mothers of 1091 children aged 17-19 months visiting the Swedish Child Health Services. Expressive vocabulary was assessed by the Swedish Communication Screening at 18 months, a screening version of McArthur-Bates Communicative Development Inventories. Mother's perception of ability to communicate was measured by a scale constructed ad hoc from the International Child Development Programmes, a parent education curriculum. Bates' 'difficultness' scale was used to assess temperament. Good communication, low maternal age, female gender and frequent reading were significantly associated with expressive vocabulary. High maternal education, good communication, higher maternal age, female gender and being a first-born child were significantly associated with frequent reading. Reading at least 6 times/week added more than 0.3 SD in vocabulary regardless of gender and communication. The findings support the importance of reading and communication quality to early language development. Knowledge of the relationship between children's vocabulary and book reading in a context of joint attention is both theoretically and practically valuable to speech and language pathologists, pre-school teachers, child health workers and other professionals.

Consulting on feeding and sleeping problems in child health care: what is at the bottom of advice to parents?

The aim of this study was to investigate and interpret ideas inherent in sleep and diet consultations concerning infants in Swedish child health services. Data were obtained through semi-structured interviews of professionals employed in these services. A qualitative method with a phenomenological approach was applied to analyse the data. The results indicate that professionals have underlying conceptions. They considered that when parents force food on their child, this is a violation of the child's integrity. This view is based on the idea that such actions restrict the child's right to self-determination. In the participants' opinions, when the child is forced to sleep well, this is not regarded as a violation of the child's integrity, but is perceived as support of the child's autonomy. An underlying theoretical view may be that parents' time can be saved if the child becomes independent of the parents at as early an age as possible.

The role of the Swedish Child Health Services in breastfeeding promotion

The role of the Swedish Child Health Services in breastfeeding promotion

The role of the Child Health Services in promoting mental health: an introduction

This paper gives an introduction to the psychosocial work in the Swedish Child Health Services (CHS). There are substantial problems in defining and evaluating the preventive mental health work of the CHS. The issues raised include: why early preventive intervention is important; the promotion of parental mental health as an aim of the CHS; how the CHS can increase parenting knowledge and skills; what evidence there is about intervention among target groups; and finally, how recent research knowledge can be applied in the CHS.

The role of the Swedish Child Health Services in breastfeeding promotion.

Sweden has one of the highest breastfeeding incidence and duration rates among industrialized countries. Although the Child Health Services offer breastfeeding support to all mothers, there are geographical differences in breastfeeding frequency at different ages. The aims of this study were to describe the present activities in the Child Health Services regarding breastfeeding promotion and to find research evidence regarding interventions. Thirty-three out of 42 healthcare districts replied to a questionnaire. Differences were found in the transfer of responsibility for newborn infants from hospital to Child Health Centres, criteria for and timing of home visits and recommendations regarding introduction of supplementary food and breastfeeding education for parents and professionals. There were also regional differences in breastfeeding statistics and follow-up periods. The following recommendations were made on the basis of the survey and relevant literature: transfer of responsibility for newborn infants must guarantee follow-up of all mother-infant pairs; uniform breastfeeding assessment and documentation must be established; all mother-infant pairs must be offered early home visits, continued on a regular basis by health visitors; drop-in consultations must be established; a telephone hotline must be set up; for preventive purposes, growth charts must be used based on breastfed infants; evidence-based guidelines for the introduction of other foods must be followed; information must be provided in parent groups; breastfeeding statistics must use WHO definitions; polyclinics must be available for service to mothers/infants after early discharge and as resources for Child Health Centres; Child and Maternal Health Centres must collaborate; quality assurance programs must be established; breastfeeding courses must be offered in the under- and postgraduate training of professionals; compulsory in-service education must be offered; lactation consultant training must be offered at the university level; and lactation consultant positions must be established.