Swedish Child Research Articles

Screening accuracy and developmental language disorder remain stable between 2.5 and 3 years.

This study re-evaluated the classification accuracy of language screening. This is because the new Swedish child health programme moved this screening from 3 to 2.5 years of age. Another aim was to investigate the stability of diagnoses between these two time points. Children were recruited consecutively during 2016-2017 from three Child Health Services in Gävle, Sweden. Forty-eight monolingual children (31 boys) and 93 bilingual children (38 boys) underwent language screening and a clinical examination by a speech and language pathologist at 2.5 years of age. They were re-examined after 6 months (at 36-38 months) for clinical diagnosis. Of the 48 monolingual children, 45 retained their status at both 2.5 and 3 years of age, while three no longer met the criteria for development language disorder. Among the 93 bilingual children, 87 retained their 2.5-year status at age 3, two no longer met the criteria, and four new cases were diagnosed. These differences were not statistically significant. All changes in screening parameters between 2.5 and 3 years were within the 95% Confidence Interval, indicating stable classification. Screening accuracy and language status were robust between 2.5 and 3 years, providing no support for a wait-and-see approach.

“It’s an Extra Twist That’s a Bit Tricky to Solve”: Staff Balancing Parental Involvement When Supporting the Participation of Adolescents in a Family-Oriented Practice

This study explores staff balancing parental involvement when performing recovery-oriented work via Patient-Initiated Brief Admission (PIBA) for adolescents. Data from focus group interviews with employees in Swedish Child and Adolescent Psychiatry (CAP) is discussed and analyzed using ecological systems theory. Findings suggest dualistic views on participation and parental involvement, where safety and security have to be considered supporting adolescents’ participation in psychiatric inpatient care. Staff has the potential to involve parents during PIBA without automatically diminishing adolescents’ participation, and this has to be legitimized if PIBA is to become an integrated tool to promote recovery-oriented care in CAP.

How could you help me? Children's voices on violence in child welfare files: A thematic analysis

BackgroundA significant number of children experience violence, frequently from parents or other caregivers. Yet, many of these children lack access to community support, largely due to the challenges they face in disclosing abuse. Even when children do disclose abuse, it does not necessarily lead to their receiving the help needed. Recognizing children as epistemic subjects is essential both for ensuring their access to adequate support and for advancing knowledge about child abuse. ObjectiveThis study aimed to explore children's voices on violence in child welfare files to enhance our understanding of their experiences of violence. Participants and settingThe sample consisted of 120 children who provided abuse information in Swedish child welfare investigations into physical and sexual abuse. MethodData were collected from child welfare files and analyzed qualitatively using thematic analysis. ResultsSix themes were identified—acts of violence, emotions, context, disclosure, agency, and abuse dynamics—all of which informed the overarching theme: Children's voices highlight violence as a specific problem characterized by power and control dynamics that significantly impact their lives. ConclusionsThe collective findings indicate that mechanisms of violence extend beyond physical acts, emphasizing the need for Child Welfare Services (CWS) to recognize child abuse as a distinct issue characterized by dynamics of power and control. These dynamics significantly affect children's health and their capacity to assert their own interests. Failure to address these aspects risks underestimating the severity of the violence and impeding the provision of adequate support.

Adoption from care, the reunification principle and consensual placements: the political promotion of a controversial child protection measure in Sweden

ABSTRACT Swedish child welfare policies have traditionally been family-centred, and great importance has been placed on consensual measures and the reunification of children in care with their birth families. Adoptions of children from care are rare. Thus, when the government commissioned the Swedish Board of Health and Welfare (NBHW) to improve social services’ knowledge about adoption, it seemed to indicate an ideological shift in Swedish child protection policies. For over a year, we documented the activities of the working group at the NBHW as they tried to mediate between what they interpreted as a political attempt to promote adoption on the one hand and social services’ reluctant stance towards adoption on the other. We identified three main challenges in this task: (i) the handling of the commission’s ideological premises, (ii) the question of what kind of knowledge about adoption should be disseminated to social services, and (iii) the question of what knowledge is relevant for social services. The article uses theories of metagovernance to show how the NBHW dealt with these challenges by reframing the commision’s premises, adapting the message and by balancing the objectives of addressing the issues social services identified as relevant and of fulfilling its remit.

The Safe Environment for Every Kid Model in the Swedish Child Health Services: Adoption and Introduction in a Healthcare Region.

Early support for children and families in need can improve children's health and development. In a Swedish region, a new working model called Safe Environment for Every Kid (SEEK) was introduced in the Child Health Services to facilitate the early identification of psychosocial risk factors. The aim of this study was to describe the adoption and introduction of the SEEK model in the Child Health Services of Region Jönköping County. Quantitative data were analysed using descriptive statistics, whereas qualitative data were analysed separately by a thematic approach. The results were then interpreted together with documents (including CHS management meeting notes and documents describing planning and training sessions) using an exploratory mixed-methods approach to give a comprehensive description of the adoption and introduction of the SEEK model. The results show that the SEEK model improved coordination and collaboration, which led to better integrated care for children and families. The structure was regarded as supportive when introducing the SEEK model in Child Health Services. The questionnaire, as part of the SEEK model, was used in 88% of possible health visits. The most reported reason for not using it was a lack of time. The desire to make a difference and thereby promote better health and development for children was a crucial factor for the nurses in adopting the SEEK model in their clinical practice. The design using coaches was also appreciated and supported the adoption and introduction of the SEEK model. Parents and healthcare professionals did not contribute to the research process. The results are based on dialogues between CHS nurses and parents after the parents filled in the SEEK questionnaire, providing an understanding of professional relationships when dealing with challenging issues.

MINISTOP 3.0: Implementation of a mHealth obesity prevention program within Swedish child healthcare – study protocol for a cluster randomized controlled trial

BackgroundPreviously, we have reported on the efficacy and real-world effectiveness of a parent-oriented mobile health intervention (MINISTOP 1.0 and 2.0), which have shown improvements in pre-school children’s lifestyle behaviours. However, there is a need for implementation evidence. The overall aims of this study are to: (i) compare two different implementation strategies for MINISTOP 3.0 (Basic vs. Enhanced) on: acceptability, appropriateness, feasibility, organizational readiness to implement MINISTOP 3.0 within Swedish child healthcare (primary outcomes) as well as reach, costs, and adoption of MINISTOP 3.0 (secondary outcomes); (ii) evaluate cost-effectiveness of MINISTOP 3.0; (iii) explore the sustainability of MINISTOP 3.0; (iv) evaluate the determinants of effectiveness of MINISTOP 3.0 on children’s key lifestyle behaviours; and (v) investigate the long-term effects of MINISTOP 3.0 on children’s body mass index.MethodsA hybrid type III implementation-effectiveness design will be used. A cluster randomized controlled trial will be conducted to compare the effects of basic versus enhanced implementation strategies on the outcomes at the child healthcare level. A minimum of 50 child healthcare centers across Sweden will participate and we aim to recruit 120 nurses. Child healthcare nurses in both groups will offer the MINISTOP 3.0 app to the families at the 2.5/3-year routine visit. Basic implementation strategies include educational meeting with nurses, formal implementation blueprint, develop/distribute educational materials and enhanced implementation includes all aforementioned strategies plus auditing/providing feedback and ongoing training for nurses. All outcomes will be assessed at baseline and 12 months post-implementation. Implementation outcomes will be assessed quantitatively using questionnaires and sustainability will be assessed qualitatively at 12 months. Children’s key lifestyle behaviours will be collected through a parental questionnaire within the MINISTOP app at baseline and 6 months after they have received the app. Children’s weight/height will be measured at routine visits at 2.5/3 (baseline), 4 and 5 years of age.DiscussionThis study will provide important implementation evidence with regards to implementing mHealth interventions within Swedish child healthcare at scale and these results have the potential to be generalized to other digital interventions being implemented in child healthcare.Trial registrationClinicalTrials.gov, NCT05667753. Registered December 29, 2022.

Identifying children at risk in Swedish Child Health Services.

Child Health Services plays an important role in identifying at-risk children and intervening early to break negative trends in child health. Sociodemographic risk factors can impact the workload of Child Health Services and affect the possibilities of providing the national child healthcare programme. This study aims to present the sociodemographic characteristics of families who are registered within the Child Health Services, as defined by the Child adjusted Care Need Index. By collecting personal identification numbers from children six years or younger registered at a child healthcare centre, and combining this with their caregiver's sociodemographic background, this study was able to create a sociodemographic index for each child healthcare centre in Sweden. The study included 687,543 children and 1,335,540 caregivers from 981 child healthcare centres in Sweden. Approximately 21% of all children in the study population had a caregiver born in Southern or Eastern Europe outside the European Union, or in Africa, Asia, or South America, 7% had single parents, 17% had at least one unemployed caregiver, and 9% had at least one caregiver who had not completed high school. The average input values and the average index values varied widely both between and within the regions. This study displays a large variation in sociodemographics for child healthcare centres both within and between regions. Since several regions and national agencies in Sweden use the Child adjusted Care Need Index, it is necessary to keep the dispersion in mind.

Parents’ perceptions of the safe environment for every kid (SEEK) model in the Swedish child health services

BackgroundThe Safe Environment for Every Kid (SEEK) model was developed to address psychosocial risk factors (financial worries, depressive symptoms, major parental stress, alcohol misuse and intimate partner violence) in the pediatric primary care setting but has not been evaluated from the parents’ perspective. To further investigate the usefulness of SEEK, it is important to explore how parents perceive the model.ObjectiveThe aim of the present study was to explore parents’ perceptions of the SEEK model as a part of regular health visits in the Child Health Services in Sweden.Participants and settingEighteen parents (13 women and five men) in two Swedish counties participated in the study.MethodsSemi-structured telephone interviews were conducted, and the resulting data were analyzed using reflective thematic analysis.ResultsThree themes were identified: Acceptance and understanding of the SEEK model in the child health services, The questionnaire as a bridge to a dialogue, and Feeling trust in the system and the child health nurse’s professional competence. Further, an overarching theme was created that encompassed a core meaning of all three themes; SEEK provides a process-oriented framework to receive support in parenting with a focus on child health.ConclusionsThe study showed that parents express both acceptance and understanding of the SEEK model and they perceive that the model provides an avenue for repeated dialogues about the family’s situation during the child’s upbringing and an opportunity to access support if needed.

Gender-specific play behavior in relation to autistic traits and behavioral difficulties at the age of seven in the SELMA study.

Childhood gender nonconformity is related to psychological distress and behavioral difficulties. Similarly, there is evidence for a link between gender nonconformity, or gender dysphoria in some studies, and autism spectrum disorder and related traits. Our knowledge on those associations mostly originates from clinical populations, which might lead to overestimation. Thus, this study aimed to assess associations between gender nonconformity and behavioral difficulties in a population-based study. In the Swedish Environmental Longitudinal, Mother and Child, Asthma and Allergy (SELMA) study, cross-sectional associations between gender-specific play behavior and behavioral outcomes and autistic traits were investigated among 718 children at 7-years of age. Play behavior was measured using the Preschool Activities Inventory; behavioral outcomes and autistic traits were measured with the Strengths and Difficulties Questionnaire and the Social Responsiveness Scale, respectively. Linear and logistic regression analyses were performed. Higher composite play behavior scores (indicating either increased masculine or decreased feminine play behavior) were associated with increased autistic trait scores in girls (β = 0.13; 95% confidence interval [CI] = 0.00, 0.26). Furthermore, higher composite scores were shown to be associated with behavioral difficulties in both girls (β = 0.11; 95% CI = 0.04, 0.18) and boys (β = 0.10; 95% CI = 0.02, 0.19). Additionally, higher feminine scores were related with increased problems in peer relationships in boys (β = 0.04; 95% CI = 0.00, 0.07). This study suggests a link between gender nonconforming play behavior and autistic traits as well as behavioral difficulties among children in a non-clinical population, which calls attention to the necessity of supporting children with gender nonconformity from early ages.

Child welfare workers’ understanding of young people’s sexual health when conducting assessments due to substance use problems

Young people with substance use problems often have an early sexual debut, an increased risk of sexually transmitted infections and unplanned pregnancies, and a high risk of experiencing sexual violence. At the same time, according to the national action plan on sexual and reproductive health and rights (SRHR), the social services in Sweden have an important role in addressing sexual health in various contexts, such as in child welfare investigations. Therefore, this study has investigated how Swedish child welfare workers understand and relate to sexual health issues in child welfare investigations regarding young people with substance use problems. Following a strategic sampling, 15 child welfare workers were interviewed. The interviews were examined with a thematic content analysis with results showing that sexual health issues represented an area where knowledge was lacking. This was largely connected to that the child welfare workers had not been taught about SRHR in their bachelor’s degree nor in their continued education within the child welfare system. As a result of this, they often developed their own individual, professional approach for assessing sexual health matters, guided by the principle of “not investigating more than necessary”. When addressing sexual health in their assessment work, the child welfare workers primarily focused on risk, vulnerability and exposure. Not assessing young peoples’ sexual health was seen as protecting the right to confidentiality and privacy. In summary, this meant that young people with a problematic substance use were seldom given opportunities to talk about their sexual health, and especially not about positive sexual experiences related to their substance use.

Children's right to participation in Swedish child welfare – The extent, nature and determinants of child interviews during investigations

BackgroundChildren's right to participation in child welfare decision-making is highlighted in law and research. However, there is a lack of comprehensive empirical research on how such participation is actually fulfilled. ObjectiveThis article aims to describe and analyse the extent, nature and determinants of children's participation in child welfare investigations in Sweden as well as to discuss barriers to participation. Participants and settingThe dataset comprises a cohort of 2123 children investigated during 2022 across eight municipalities in Stockholm County, Sweden. MethodsThe study is based on cross-sectional data where the responsible child welfare workers served as informant in a survey focusing child and case factors concerning 2123 children subject to child welfare investigations. The data is analysed by using descriptive and binary logistic regression analyses. ResultsIn approximately 75 % of the child welfare investigations, child welfare workers held interviews with the child (with or without parental presence) while individual child interviews were carried out in about 50 % of the cases. Multiple interviews (≥3) occurred in 14 % of the cases. Reasons for not interviewing children included finding interviews to be unnecessary, perceiving the child as too young, and reluctance by the child as to participation. Investigations involving older children and referrals related to abuse increased the odds for participation. ConclusionsThe study suggests that more children are interviewed by child welfare authorities than found in previous studies, but that there still is a gap between the legislative intention to facilitate child participation and the actual state of child welfare practice.

Associations between Motor Competence, Physical Activity and Sedentary Behaviour among Early School-Aged Children in the SELMA Cohort Study.

Low motor competence (MC) has been associated with lower physical activity (PA) and long-term health risks in children. Less is known about sex-specific patterns and associations during early school age. The aim of this study was to explore how motor difficulties are associated with PA levels, screen time, and organised sports participation (OSP). Data from 479 children, seven years of age, participating in the Swedish Environmental, Longitudinal, Mother and child, Asthma, and allergy (SELMA) pregnancy cohort study were used. MC and activity-related outcomes were assessed with questionnaires answered by parents. Associations between MC and outcomes were evaluated using logistic regression models adjusted for sex, overweight, and parental education level. Sex differences were investigated with interaction analyses and in stratified models. Children with motor difficulties had the same level of PA as their peers, but more screen time and lower OSP. Compared with children with normal MC, boys with motor difficulties had lower rates of OSP, but girls did not. This indicates that the identification and compensatory support for motor difficulties for boys at an early age, as well as the development of inclusive leisure time activities, are of importance to facilitate health-promoting activities on equal terms.

Kompletterande, kompenserande och komplicerande

Complementing, compensating and complicating – informal organisation in Swedish child fare work The child welfare work within the Swedish personal social services (PSS) is clearly marked by formalisation and specialisation. It is guided by a diversity of national and local guidelines, while different units assume responsibility for specific tasks (e.g., intake, investigation and decision, or care and treatment). A risk of service fragmentation has been identified as a substantial downside to these organisational settings. However, prior research has mainly focused on formal organisational structures and how work is ‘supposed to’ be carried out. Less attention is paid to informal organisation, namely how work is ‘actually performed’ on day-to-day basis, which has been identified as an important but often overlooked aspect for understanding organisational performance. Therefore, the aim was to describe and analyse the influence of informal organisation in child welfare cases. Non-participating observations and group interviews were conducted in 11 Swedish municipalities. The findings show that informal organisation can ‘grease the wheels’ in child welfare cases: firstly, by complementing formal structures and offering alternative channels for collaboration and information exchange; and secondly, by compensating for gaps in areas of responsibility within the formal organisation, such as when staff offer informal care and support, even though their work is supposed to specifically focus on investigation and decision making, or individual social workers assume an informal case management role. Nevertheless, informal organisation was also found to complicate work, as unregulated and informal areas of work also allow the conflicting interests and work logics among different units and their staff to unfold. The findings are finally discussed in relation to the future organisation of social services.

Juggling conflicting demands when using a new intervention to combat child physical abuse in the Swedish child welfare services

ABSTRACT This article focuses on the complexities of using a new intervention when parents are suspected of child physical abuse. Children leaving a child forensic interview due to suspected child physical abuse are often handed over to their parents, who sometimes are the suspected perpetrators. The Efter barnförhöret (EB) [After the child forensic interview] intervention was developed to aid children in this stressful situation by providing professional support from child welfare services to the child and parents. The article is based on interviews with 11 respondents working with EB. Narratives reveal how respondents use their discretionary space to navigate different institutional logics. In the themes Focusing on the child, Getting parents motivated, The challenges with organizational boundaries and Demand trumps resources, respondents argue that EB, despite organizational challenges, is considered an important intervention that meets the needs of children and families after the disclosure of child physical abuse.

Oral health with focus on dental fear and dental caries in Swedish preschool child populations attending public dental health care: Trends over 30 years.

To study changes in oral health with focus on reported dental fear prevalence and interrelationships between dental fear and prevalence of dental caries and performed restorative dental treatment in preschool child populations attending regular public dental health care between 1983 and 2013. Every 10 years, random samples of about 100 children aged 3 and 5 years, respectively, took part in cross-sectional studies based on oral examination and a questionnaire. One question, put to the child and answered by the parent, mirrored dental fear: "What do you feel at the prospect of an appointment with a dentist?". Agreement to at least one of three alternatives, ill at ease, frightened and sick, indicated dental fear. Frightened and/or sick mirrored severe dental fear. 79%-94% of the samples answered the question and constituted the study group. Prevalence of caries and number of filled tooth surfaces were recorded. Dental parameters were presented in mean values. During the 30 years, dental fear prevalence was fairly constant. 21% of 3-year-olds and 15% of 5-year-olds reported dental fear in 2013. Positive relationships between dental fear prevalence and caries prevalence and number of filled tooth surfaces were found. Dental caries was reduced during the study time, but to a lesser degree in children with dental fear compared to children without dental fear. Although children were offered public dental health care, the prevalence of dental fear remained high. Children with dental fear are caries risk individuals.

A collaborative process: child participation in interventions provided by Swedish child and family welfare services

ABSTRACT The right of children to express their views on matters concerning them is a core principle of the Convention on the Rights of the Child, as defined in Article 12. However, research shows that interventions provided by Swedish child and family welfare services are planned and based on parents’ perspectives even though research suggests that child participation results in welfare service provision that is better matched to the children’s needs. The aim of this study is to explore how child participation is constructed in interventions provided by Swedish child and family welfare services and to study which elements are of importance to this process. The article is based on a qualitative interview study with 14 family social workers and 11 children aged 7–16 with experience of family interventions provided by the child and family welfare services. The results suggest that child participation is a collaborative process in which both the child and the FSW have an active role to play. Participation is constructed through a series of seemingly small, everyday actions in the meeting between the child and the FSW. By actively asking questions and allowing the child to practice participation and influence the process, the FSW can, together with the child, work towards increased child participation in interventions.

Implementation of the Infant-Toddler Checklist in Swedish child health services at 18 months: an observational study

BackgroundCommunication and language disorders are common conditions that emerge early and negatively impact quality of life across the life course. Early identification may be facilitated using a validated screening tool...

National survey of physicians in Swedish child health centres finds insecurity and unawareness regarding management of undescended testicles.

To investigate underlying factors for previously reported shortcomings in child health centres' (CHC) referral process of boys with undescended testicles. A total of 386 physicians working at Swedish CHCs were surveyed regarding their knowledge about undescended testicles and their clinical management. Multivariate regression analyses were performed to identify risk factors of non-adherence to guidelines and self-reported lack of clinical skills. The overall knowledge of the health benefits of undescended testicle surgery was high (89%), while two-thirds were unaware of surgery being recommended <1 year of age. One-fifth of respondents had never received guidance on examination techniques. Male gender (adjusted odds ratio [aOR] 0.51, 95% confidence interval [95% CI] 0.31-0.86), education in paediatrics (aOR 0.37, 95% CI 0.18-0.76) and more experience (aOR 0.02, 95% CI 0.01-0.09) significantly decreased the risk of unfamiliarity with examinations. More experience decreased the risk of stating the incorrect indications for undescended testicle surgery (aOR 0.17, 95% CI 0.03-0.95) and finding examinations difficult (aOR 0.22, 95% CI 0.07-0.72). Medical education outside Nordic countries was a risk factor for unawareness of guidelines (aOR 2.06, 95% CI 1.21-3.51). The knowledge and confidence level of the study population varied widely. The results indicate a need for further theoretical and practical education among Swedish CHC physicians.

Swedish child homicide investigations: A population-based study 1998 to 2017

BackgroundChild homicide investigations are intricate, and the forensic examinations are of paramount importance in such cases. Despite this, the forensic profile of child homicides remains unexplored. ObjectiveOur objective was to provide an overview of the forensic aspects and investigational challenges in Swedish child homicide cases spanning from 1998 to 2017, with a specific focus on enhancing investigative methods. Participants and setting70 cases with 82 victims (41 girls, 41 boys) aged between 0 and 14 were included. MethodPolice, crime scene and autopsy reports of solved Swedish child homicides were retrospectively reviewed. ResultsOn average, 3.5 cases (4.1 victims) occurred annually, primarily within families (79 %). Notably, the number of cases increased by 10 % during the latter half of the study period (2008–2017) compared to the initial decade (1998–2007). In nearly 29 % of instances, the perpetrators followed the homicides with their own suicides. A majority of child deaths (89 %) resulted from concentrated acts of violence, most frequently involving blunt or sharp force. Furthermore, 66 % of the homicides took place within the parental home. Adequate crime scene processing, including documentation and evidence collection, occurred in 74 % of cases. The investigation unveiled several complicating factors: 22 % of victims and 47 % of crime scenes displayed no obvious signs of violence. Moreover, offenders often made physical (27 %) and verbal (26 %) attempts to mislead investigators. ConclusionsIn conclusion, most child homicides are familial in nature and associated with investigational complexities that can lead to misdirection. This research may inform procedural recommendations for child homicide investigations, but further exploration is needed to better understand the forensic characteristics of suspicious child deaths.

EDC mixtures during pregnancy and body fat at 7 years of age in a Swedish cohort, the SELMA study

BackgroundSome endocrine disrupting chemicals (EDC), are “obesogens” and have been associated with overweight and obesity in children. Daily exposure to different classes of EDCs demands for research with mixtures approach. ObjectivesThis study evaluates the association, considering sex-specific effects, between prenatal exposure to EDC mixture and children's body fat at seven years of age. MethodsA total of 26 EDCs were assessed in prenatal urine and serum samples from first trimester in pregnancy from 737 mother-child pairs participating in the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy (SELMA) study. An indicator for children's “overall body fat” was calculated, using principal component analysis (PCA), based on BMI, percent body fat, waist, and skinfolds measured at seven years of age. Weighted quantile sum (WQS) regression was used to assess associations between EDC mixture and children's body fat. ResultsPrincipal component (PC1) represented 83.6 % of the variance, suitable as indicator for children's “overall body fat”, with positive loadings of 0.40–0.42 for each body fat measure. A significant interaction term, WQS*sex, confirmed associations in the opposite direction for boys and girls. Higher prenatal exposure to EDC mixture was borderline significant with more “overall body fat” for boys (Mean β = 0.20; 95 % CI: −0.13, 0.53) and less for girls (Mean β = −0.23; 95 % CI: −0.58, 0.13). Also, higher prenatal exposure to EDC mixture was borderline significant with more percent body fat (standardized score) for boys (Mean β = 0.09; 95 % CI: −0.04, 0.21) and less for girls (Mean β = −0.10 (−0.26, 0.05). The chemicals of concern included bisphenols, phthalates, PFAS, PAH, and pesticides with different patterns for boys and girls. DiscussionBorderline significant associations were found between prenatal exposure to a mixture of EDCs and children's body fat. The associations in opposite directions suggests that prenatal exposure to EDCs may present sex-specific effects on children's body fat.