Young US Children Research Articles

Documentation Status and Parental Concerns About Development in Young US Children of Mexican Origin

To examine parent concerns about development, learning, and behavior for young children of Mexican origin, and to identify whether these reports differ by families' citizenship/documentation status. Data come from the 2005 California Health Interview Survey, a population-based random-digit dial telephone survey of California's noninstitutionalized population. California Health Inerview Survey (CHIS) investigators completed interviews of 43 020 households with a total of 5856 children under age 6 years, of whom 1786 were reported being of Mexican origin. Developmental risk was measured by parent concerns elicited by the Parents' Evaluation of Developmental Status. We used bivariate and multivariate analyses to examine associations between developmental risk and family citizenship/documentation status (parents are undocumented, at least one documented noncitizen parent, or both parents are US citizens) among children of Mexican origin and US-born non-Latino white children, after adjusting for age, income, parental education, and predominant household language. In multivariate analyses, children of Mexican origin did not differ significantly from US-born white children in developmental risk (odds ratio 1.12, 95% confidence interval 0.88-1.42). In subgroup analyses, children of Mexican origin with undocumented parents had higher odds of developmental risk (odds ratio 1.53, 95% confidence interval 1.00-2.33) than non-Latino white children whose parents were citizens, after adjusting for confounders. Mexican children with undocumented parents have greater parent-reported developmental risk than Mexican and white children whose parents are US citizens or otherwise legally documented. More research is needed to understand the roles of immigration stress and home environments on the developmental risks of children in households with undocumented parents.

Does Having a Regular Primary Care Clinician Improve Quality of Preventive Care for Young Children?

This study examines whether having a regular clinician for preventive care is associated with quality of care for young children, as measured by interpersonal quality ratings and content of anticipatory guidance. The National Survey of Early Childhood Health (NSECH), a nationally representative parent survey of health care quality for 2068 young US children fielded by the National Center for Health Statistics (NCHS). Bivariate and multivariate analyses evaluate associations between having a regular clinician for well child care and interpersonal quality, the content of anticipatory guidance, and timely access to care. In bivariate analysis, parents of children with a regular clinician for preventive care reported slightly higher interpersonal quality (69 vs. 65 on a 0-100 scale, P = 0.01). Content of anticipatory guidance received was slightly greater for children with a regular clinician (82 vs. 80 on a 0-100 scale, P = 0.03). In bivariate analysis, a regular clinician was associated with interpersonal quality only among African American and Hispanic children. In multivariate analyses, controlling for factors that could independently influence self-reports of experiences with care, interpersonal quality but not anticipatory guidance content was higher for children with a regular clinician. Having a regular primary care clinician is embraced in pediatrics, although team care among physicians is also widely practiced. For young children, having a regular clinician is associated with modest gains in interpersonal quality and no differences in content of anticipatory guidance. The benefit of having a regular clinician may primarily occur in interpersonal quality for subgroups of young children.

Characteristics of Persistent Diarrhea in a Community‐Based Cohort of Young US Children

The objective of the study was to define the characteristics and microbiology of persistent diarrhea (PD) in US children. Six-month prospective cohort study of a convenience sample of 604 healthy 6- to 36-month-old children recruited by the Slone Center Office-based Research Network. Of 611 diarrhea episodes, 50 (8.2%) lasted < or = 14 days. The incidence of PD was 0.18 episodes per person-year, and the median duration of episodes was 22.0 days (range, 14-64 days). PD episodes were more likely than acute episodes to result in a medical visit (28.0% vs 8.2%; P = 0.0001). The most commonly used treatments were oral rehydration solution (12.0% of episodes) and antibiotics (6.0%). No bacterial or parasitic pathogens were associated with PD; but norovirus, rotavirus and sapovirus were each significantly more prevalent in PD stools compared with baseline stools, with relative risks of 12.4, 6.9 and 6.2, respectively. Fifty-nine per cent of the PD specimens tested were negative for all studied pathogens. PD occurs with a frequency of approximately 1 case per 5 person-years in US infants and young children. It seems to be a generally benign illness, with only 28% of cases presenting to medical care. Although viral pathogens seem to cause a minority of PD episodes in this population, most are not due to currently known infectious agents.

Stature, weight, and body mass among young US children born at term with appropriate birth weights

Objective: To describe weight, stature, and body mass index (BMI) changes occurring before the age of 7 years, which may influence the prevalence of overweight in adolescence and adulthood. Methods: Regression models predicting height and weight at ages 2 months to 6.75 years were based on the third National Health and Nutrition Examination Survey. Birth certificate data were used to adjust ethnic-specific models for birth weight for gestational age. Results: Attained height is higher for non-Hispanic black children than for either non-Hispanic white or Mexican American children (P ≤ .001). Weights at 2 months, 2 years, and 6.75 years are similar among racial/ethnic groups after adjustments. Mexican American children at ages 2 to 6.75 years had higher prevalences of BMI >85th percentile than either non-Hispanic white or black children (boys = 25.6%, SE = 2.7 compared with 14.1%, SE = 1.7 and 16.5%, SE = 1.7, respectively; girls = 21.9%, SE = 3.6 compared with 13.0%, SE = 1.7 and 13.7%, SE = 2.2, respectively). For non-Hispanic whites and Mexican Americans and for non-Hispanic black boys, BMI decreased slightly between ages 2 and 6.75 years; BMI for non-Hispanic black girls did not. Conclusion: Size differences before the age of 7 years may influence later ethnic-specific overweight prevalence, independent of prenatal influences. (J Pediatr 2000;137:205-13)

Immunization Referral Practices of Pediatricians in the United States

Concerned about alarmingly low rates of immunization among some young US children as well as disturbing trends in vaccine availability and delivery, the American Academy of Pediatrics sought to examine national trends in referral for immunization among US pediatricians. A self-administered eight-page questionnaire on issues in childhood immunization was mailed to a random sample of the AAP's 36,000 US resident members. Four rounds of the survey yielded a sample size of 1246, for a response rate of 77%. A majority of respondents reported referral of some patients for immunization; reported reasons for referral focused on issues of cost to the patient. Personal characteristics of pediatricians (age and gender) were not related to referral practices. Pediatricians practicing in solo or group settings were 2.8 times as likely as those in clinics or other settings to refer patients for immunization. Those in nonmetropolitan areas were nearly twice as likely as those in large metropolitan areas to refer for immunization. When setting and location were controlled, pediatricians who reported that their states had programs to provide all vaccines free or at reduced cost were much less likely to indicate that they referred patients for immunization. A majority of US pediatricians refer some of their patients to other providers for immunizations because of financial reasons. Children outside of metropolitan areas may be at particular risk for problems of availability of and access to immunizations. This study raises, once again, the issue of differential health care access for children based on payment mechanisms.

Age, Sex, and Season of Onset of Juvenile Diabetes in Different Geographic Areas

Age, sex, and estimated time of onset of insulin-dependent diabetes were determined for children in Pittsburgh (N = 673), Gainesville (N = 976), Galveston (n = 741), and Melbourne (N = 851). The US cities had a decrease in new cases during the summer and peak incidence in January through April. In Melbourne, monthly trends were reversed: there were more cases during May through August. In US cities, but not in Melbourne, children less than 6 years old showed a greater variation by season than children 6 years old and older. Observations of the same fall and winter onset (in different calendar months) of insulin-dependent diabetes in Australia and the United States, and exaggeration of seasonal differences in young US children, suggest that onset of insulin-dependent diabetes is associated with seasonally varying viral diseases. Mumps and rubella infections do not seem to be responsible for much of the seasonal variation. Seasonal peaks of mumps and rubella are later than those observed for insulin-dependent diabetes, and immunization with live mumps and rubella viruses has not been associated with changes in incidence of insulin-dependent diabetes. An increase in disease incidence in boys over girls below age 6 years and in girls over boys at ages 6 through 11 years was consistently observed but not explained.