Identification of children with psychosocial problems differed between preventive child health care professionals.

OBJECTIVE: To assess whether differences between individual Preventive Child Health Care (PCH) professionals in the percentage of children they identify as having psychosocial problems are larger than expected based on chance and whether such differences can be explained by differences in parent-reported problems or risk indicators. STUDY DESIGN: We used data from three community-based studies among 3,170 Dutch children aged 8 till 12 years, invited for a routine health examination. Parents filled in the Child Behavior Checklist (CBCL) and questions on demographic characteristics. After the examination, PCH professionals registered whether they had identified any psychosocial problem in the child. We examined differences between professionals in the rate of identified children. We used multilevel logistic regression analysis to assess whether such differences could be explained by parent-reported problems or risk indicators. RESULTS: Significant differences between PCH professionals were found (P<0.001). These differences could not be explained by parent-reported problems or risk indicators. The differences were largest for children with a score above the CBCL clinical cut-off point. CONCLUSION: Some PCH professionals are more likely to identify psychosocial problems than others, independently from parent-reported problems or other risk indicators.

Continuous admission to primary school and mental health problems.

BACKGROUND: Younger children in a school class have higher rates of mental health problems if admission to primary school occurs once a year. This study examines whether this relative age effect also occurs if children are admitted to school continuously throughout the year. METHODS: We assessed mental health problems based on parent-reports (using the Child Behavior Checklist, CBCL) and on professional assessments, among two Dutch national samples of in total 12,221 children aged 5-15 years (response rate: 86.9%). RESULTS: At ages 5-6, we found a higher occurrence of mental health problems in relatively young children, both for mean CBCL scores (p = 0.017) and for problems assessed by child health professionals (p < 0.0001). At ages 7-15, differences by relative age did not reach statistical significance. CONCLUSION: Continuous admission to primary school does not prevent mental health problems among young children, but may do so at older ages. Its potential for the prevention of mental problems deserves further study.

Area deprivation and child psychosocial problems--a national cross-sectional study among school-aged children.

BACKGROUND: We examined the association of area deprivation with the occurrence of psychosocial problems among children aged 4-16 in a representative national sample of children based on standardised measures of parent-reported problems and diagnoses made by doctors and nurses working in child healthcare (child health professionals, CHPs). METHODS: The study comprised 4480 children aged 4-16 years, eligible for a routine health assessment (response: 90.1 %), in 19 Child Healthcare Services across the Netherlands that routinely provided preventive child healthcare to nearly all school-aged children. Parents completed the Child Behaviour Checklist (CBCL). CHPs examined the child and interviewed parents and child during their routine health assessments. Main outcome measures concerned psychosocial problems as reported by parents (i. e. a clinical score on the CBCL) and as identified by CHPs. RESULTS: Prevalence rates of psychosocial problems were 8.6% for parent-reported problems and 10.1 % for CHP-identified problems. They were much higher in the most deprived third of the areas. Odds ratios (95 % confidence intervals) compared with the least deprived third were 1.93 (1.41-2.64) regarding parent-reported problems and 1.76 (1.30-2.38) regarding CHP-identified problems. Regarding parent reports, associations were slightly stronger for behavioural problems than for emotional problems. Less than a quarter of the area differences could be explained by individual and family characteristics. CONCLUSIONS: Child psychosocial problems occur more frequently in deprived areas. Both preventive and curative health services should be better equipped for this concentration of child and adolescent morbidity in deprived areas.

Infant crying and abuse.

Child abuse and neglect are important causes of child morbidity and death. We assessed potentially detrimental parental actions induced by infant crying in 3259 infants aged 1-6 months, in the Netherlands. In infants aged 6 months, 5.6% (95% CI 4.2-7.0) of parents reported having smothered, slapped, or shaken their baby at least once because of its crying. The risks of detrimental actions were highest for parents from non-industrialised countries, those with either no job or a job with short working hours, and those who judged their infant's crying to be excessive. Clinicians should be aware of the risks of abuse in children known to cry a lot and should target interventions at parents to help them cope with this crying.

Identification and management of psychosocial problems among toddlers in Dutch preventive child health care.

OBJECTIVES: To assess the degree to which preventive child health professionals (CHPs) identify and manage psychosocial problems among preschool children in the general population and to determine the association with parent-reported behavioral and emotional problems, sociodemographic factors, and mental health history of children. DESIGN: The CHPs examined the child and interviewed the parents and child during their routine health assessments. The Child Behavior Checklist (CBCL) was completed by the parents. SETTING: Sixteen child health care services across the Netherlands that routinely provided well-child care to nearly all preschool children. PATIENTS: Of 2354 children aged 21 months to 4 years who were eligible for a routine health assessment, 2229 (94.7%) participated. MAIN OUTCOME MEASURES: Identification and management of psychosocial problems by CHPs. RESULTS: In 9.4% of all children, CHPs identified psychosocial problems. Two in 5 of the CHP-identified children were referred for additional diagnosis and treatment. Identification of psychosocial problems and subsequent referral were much more likely in children with a clinical CBCL total problems score than in others (identification: 29% vs 7%; odds ratio [95% confidence interval], 5.40 [3.45-8.47]; referral: 15% vs 3%; odds ratio [95% confidence interval], 6.50 [3.69-11.46]). CONCLUSIONS: The CHPs frequently identify psychosocial problems in preschool children, although less than among school-aged children, but they miss many cases of parent-reported problems as measured by a clinical CBCL score. This general population study shows substantial room for improvement in the early identification of psychosocial problems.