[Impact of postpartum depression on care use and work]. / Impact van postpartumdepressie op zorggebruik en arbeidsparticipatie.

OBJECTIVE: To describe the care which women with postpartum depression (PPD) in the Netherlands use for their complaints, and the impact of PPD on their general use of care for themselves and for their child, and on their participation in work. DESIGN: The data came from the control group of a prospective comparative study on the effectiveness of screening for PPD within the setting of Youth Health Care. METHOD: We obtained data by means of two online questionnaires. Three weeks postpartum, we examined the background characteristics of the mother. Twelve months postpartum, we inquired about depression since birth, care use for depressive symptoms, general care use since birth for both mother and child, and participation in work up to 12 months postpartum. To test differences, we used chi-square and student t-tests. RESULTS: Of the 1049 participating women, 99 (9.4%) indicated that they had experienced depression in the year since giving birth. Of the 99 'women with PPD', 71.0% made at least some use of care aimed at their PPD complaints. Of these women with PPD, 31.3% were diagnosed with depression, and 37.7% were actually treated. Mothers with PPD used considerably more care for themselves and their child than mothers without PPD. Absenteeism from work was significantly higher among women with PPD. CONCLUSION: The limited number of women with PPDreceiving care by and the social costs entailed by PPD justify investment in routine screening and customized care pathways for these women.

Parental perception of weight and weight-related behaviour in 2- to 4-year-old children in the eastern part of the Netherlands.

Parental perception of weight status and weight-related behaviour of their toddler was determined through a questionnaire survey in child health care centres (CHCs). Complete data on weight, length, sex and age were available for 635 of 682 children (93.1%). The median age of the children was 37.0 months (range 24-56 months). Of all 635 children, 76.5% were normal weight, 16.2% underweight and 7.2% overweight. Parents' perception of the weight of their child compared with their peers was moderately related to the actual weight status. Of the parents of overweight and underweight children, 87.0% and 89.3%, respectively, were not concerned. Only the parents' perception of the amount of food eaten by their child was significantly related to the weight status. The primary goal of CHC workers should be to create parental awareness in case of their child being overweight or underweight and to support them in accomplishing a healthy lifestyle.

[Overweight and obesity in preschool children (0-4 years): behaviour and views of parents]. / Overgewicht en obesitas bij jonge kinderen (0-4 jaar): gedrag en opvattingen van ouders.

OBJECTIVE: Description of unhealthy behaviour and views regarding nutrition, physical exercise and education in families with young children, in relation to specific groups with a high risk of overweight. DESIGN: Cross-sectional study. METHOD: In wellbaby clinics for infants and toddlers in various sites in The Netherlands 534 parents were requested to fill in questionnaires on nutrition, physical exercise and education. Enquiry into background characteristics took place and several hypotheses were tested. Using a bivariate and multivariate analysis each hypothesis was examined with regard to linkage of the answers to specific high-risk groups. RESULTS: 73% (390 parents) responded. Overweight was found in 15% of the 2-4-year-olds, this included 3.7% with obesity. Relatively often, parents held views and showed behaviour characteristic of an unhealthy lifestyle for young children. For example, approximately 1 out of 7 families was not used to having breakfast. 43% of the respondents considered sweetened milk products approprite substitutes for milk and 39% of the children always had soft drinks at their disposal. One fifth of the parents indicated that they did not have enough time to go out with their child. Approximately 1 out of 10 toddlers aged 2-4 years had a TV in their own room; 22% were allowed to determine whether they wanted to watch TV or not and 9% were allowed to decide how long they watched. Such specific high-risk behaviour was seen in particular in families with non-western mothers, mothers with a low level of education or mothers living on social security. Regular use of child care or a nursery seemed to have some protective effect. CONCLUSION: In families with children aged 0-4 years, behaviour patterns related to overweight at a later age were frequently observed. In view of the increased incidence of overweight and obesity in young children, initiation of research aimed at optimisation of education is warranted, which should include special attention for the behaviour of parents with regard to 5 spearheads: breast-feeding, more outside play and more physical exercise, a regular wholesome breakfast, less consumption of sweetened drinks and less TV and computer use. Implementation of interventions in young age groups is able to prevent the development of unhealthy lifestyle and childrearing styles.

Effectiveness of ultrasound screening for developmental dysplasia of the hip.

OBJECTIVE: To determine the effectiveness of ultrasound screening for developmental dysplasia of the hip (DDH) after the neonatal period. DESIGN: Prospective cohort study. SETTING: Child health care centres. PARTICIPANTS: Infants attending the child health care centres. INTERVENTIONS: The intervention group (n = 5170) was screened by ultrasound at 1, 2, and 3 months of age. The control group (n = 2066) was screened by routine physical examination as part of the programme for child health surveillance at the child health care centres (CHC screening). For evaluation of the screening, the children in both the intervention and control group received an ultrasound examination after 6 months of age to detect any abnormality that might have been missed by the screening. RESULTS: The sensitivity of the ultrasound screening was 88.5%, and the referral rate 7.6%. As a result of the ultrasound screening, 4.6% of the children were treated. The sensitivity of the CHC screening was 76.4%, with a referral rate of 19.2%. The treatment rate was 2.7%. Of the treated children in the ultrasound screening group, 67% were referred before the age of 13 weeks, whereas in the CHC screening group only 29% were referred before this age. CONCLUSIONS: This study shows that ultrasound screening detects more children with DDH than CHC screening and that more of them are detected at an earlier age. To accomplish this, even fewer children have to be referred. However, even general ultrasound screening seems not to eradicate late cases of DDH. The higher treatment rate in the population screened by ultrasound may be a result of overtreatment.

Ultrasonographic screening for developmental dysplasia of the hip in infants. Reproducibility of assessments made by radiographers.

We studied the reproducibility of ultrasonographic screening examination of the hip when read by diagnostic radiographers. In order to determine interobserver variability, 200 ultrasonograms were classified according to Graf's method by five observers (four radiographers and one radiologist). The kappa values for interobserver variability indicated moderate agreement (kappa 0.47) for the exact Graf classification and substantial agreement (kappa 0.65) for the classification of normal (type I) versus abnormal (type IIa-IV). Agreement was significantly different for normal, immature and abnormal hips. Comparison of the findings in our interobserver study with existing information based on other examinations and treatment revealed that only a small number of infants with mildly dysplastic hips would have been typed as normal by some observers as a result of observer variability. In conclusion, the interobserver agreement on the ultrasound assessment of the hip was good enough for screening purposes. Observer variability did not result in any severe cases being missed.

Positional preference: prevalence in infants and follow-up after two years.

OBJECTIVES: 1) To determine the prevalence of positional preference in the general population of infants up to the age of 6 months; 2) to gather information on possible risk factors; 3) to determine the percentage of children with positional preference undergoing diagnostic evaluation and/or treatment; and 4) to assess the overall outcome of positional preference in infants and toddlers, with currently used diagnostic and treatment practices. SETTING: Infant health care centers in The Netherlands. METHODS: Seven thousand six hundred nine infants below the age of 6 months were screened for positional preference (cases: n = 623). Anamnestic data and physical signs of asymmetry of the range of motion and the shape of the head were recorded. These data were also registered of an immediate next child visiting the infant health care center with the same sex and about the same age but without positional preference (controls: n = 554). In a first follow-up study, 6 to 8 months after the original study, 468 of the 623 children with positional preference were reexamined for asymmetry of the range of motion and the shape of the head. In a second follow-up study, 24 to 32 months after the original study, 129 of 259 children who still had shown signs of asymmetry in the first follow-up study were again reexamined. RESULTS: The prevalence of positional preference was 8.2% and was highest in children below 16 weeks of age. The boy:girl ratio was 3:2. Firstborns, premature children, and children with breech position at the time of delivery proved to have a higher risk for positional preference. The supine sleeping position of the child and a strong preference in offering the feeding always from the right or the left side were positively correlated with positional preference. In the first follow-up study, 12% still showed restricted active range of motion, 8% restricted passive range of motion, 47% asymmetric flattening of the occiput, and 23% of the forehead. Thirty-two percent of the children with positional preference had been referred for diagnostical/therapeutical intervention. In the second follow-up study, active range of motion was restricted in 6%, passive rotation in 2%, 45% had an asymmetric flattening of the occiput, and 21% of the forehead. CONCLUSION: Positional preference is frequently observed (8.2%) in The Netherlands. It leads to referral, additional diagnostics and, if necessary, treatment of almost 1 of every 3 affected children. Extrapolated to the original population in 1995, 2.4% of all children would still have a restricted range of motion and/or flattening of the skull at the age of 2 to 3 years. The high prevalence of positional preference in infancy, the persistency of accompanying signs, the large number of children referred for further diagnostic and/or treatment, and the resulting high medical expenses strongly call for a primary preventive approach.positional preference, deformational plagiocephaly, asymmetry, infants, population-based study.

[Recommendations of vitamin D supplements for toddlers frequently disregarded]. / Aanbevolen vitamine-D-suppletie bij peuters veelal niet toegepast.

OBJECTIVE: To inventory the use of colecalciferol in children aged 1-4 years. DESIGN: Cross-sectional. METHOD: Fifteen health centre physicians throughout the Netherlands in April 1998 collected data on the use of colecalciferol among children aged 1 to 4 years. At the periodical medical examination, parents were asked if their child was given colecalciferol and if so, the name of the preparation and the dosage. The child's age and the mother's country of origin were also recorded. RESULTS: 660 Children were evaluated: 190 aged 1 year, 200 aged 2 years, 220 aged 3 years and 50 aged 4 years. There existed a 'top five' of preparations used by 72% of the parents. Fifty-seven per cent of the children (almost) daily received the dose of colecalciferol recommended by the Dutch Health Council (10-15 micrograms). Fifteen per cent received no suppletion at all. The percentage of nonusers increased with age from 9% of those aged 1 year to 26% of those aged 4 years. Of the children given some form of suppletion (almost) every day, 81% received the recommended dose, 16% too little and 3% too much. Suppletion according to the recommendations was found more often for children of European mothers than for children of non-European mothers. Enquiries among all university hospitals left the impression that rickets is infrequent among otherwise healthy children.

[No asymmetry of head rotation and shape found in three quarters of 2-3 year olds exhibiting postural preference in infancy]. / Geen asymmetrie van de hoofdrotatie en -vorm bij driekwart van de 2-3-jarigen die als zuigeling een voorkeurshouding hadden.

OBJECTIVE: Assessment of the course of signs of asymmetry in toddlers who had a preferential posture as infants. DESIGN: Descriptive. METHOD: Children who at the age of 1-6 months showed a preferential posture (n = 623) and at the age of 7-14 months displayed asymmetry of the shape and/or the rotation of the head (n = 259 of 468 children examined; 55%), were invited in 1997/'98 at the age of 2-3 years by 71 physicians of Infant Health Care Centres in the Netherlands. These physicians examined 129 children for asymmetry of the rotation and shape of the head. The parents of children with asymmetry were questioned about their reaction to the condition. RESULTS: Of the 129 children examined, 53% still had signs of asymmetry: active rotation was restricted in 6%, passive rotation in 2%, 45% had an asymmetric flattening of the occiput and 21% of the forehead. Of the 68 parents, 4 (6%) regarded the asymmetry of their child's head as a problem. CONCLUSION: Asymmetry in infants runs a favourable course with respect to rotation and shape of the head; the condition had disappeared in three-quarters of the toddlers who had shown a preferential posture as infants. Flattening of the occiput is the most persistent sign. Parents infrequently experience the asymmetry at the age of 2 to 3 years as a problem.

Early detection of developmental dysplasia of the hip in The Netherlands: the validity of a standardized assessment protocol in infants.

OBJECTIVES: This study evaluated the validity of the traditionally recommended screening protocol for developmental dysplasia of the hip in infants. METHODS: Study children (n = 1968) underwent a standardized screening examination. RESULTS: The incidence of developmental dysplasia of the hip was 3.7%. The sensitivity of the test protocol was 86%, the specificity was 82%, and the predictive values of positive and negative tests were 16% and 99%, respectively. CONCLUSIONS: The validity of the screening protocol for developmental dysplasia of the hip is disappointingly low. The yield of adding an ultrasonographic examination to current screening activities needs further study.

[Preferential posture in infants; serious demands on health care]. / Voorkeurshouding bij zuigelingen; groot beroep op de gezondheidszorg.

OBJECTIVE: To determine the prevalence of preferential posture in infants up to the age of six months; to determine the percentage of referrals for diagnostics and (or) treatment; to gather information about risk factors. SETTING: Infant Health Care (IHC) centres in the Netherlands. DESIGN: Descriptive controlled investigation. METHOD: During September 1995 a total of 7609 infants were examined by 167 IHC doctors for the presence of preferential posture. Data on the physical examination and on the occurrence of risk factors were registered for every child with preferential posture (n = 623) and for a next child of the same age and the same sex without preferential posture. Six months later 468 children with preferential posture were re-examined. RESULTS: The prevalence of preferential posture was 8.2% and was highest in children below 16 weeks of age. The ratio boy:girl was 3:2. Firstborns, premature children and children in breech position at the time of delivery, had a higher risk for preferential posture. The position of the child after the first week of life and the way of feeding proved to be significant risk factors. After six months 32% of the children with preferential posture had been referred for additional diagnostics and, if necessary, treatment. CONCLUSION: Preferential posture is frequently observed and leads to referral, additional diagnostics and (or) treatment in 2.5% of all children up to 6 months of age.