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Long-term physical, psychological, and social functioning of children with esophageal atresia
N H Bouman1, H M Koot, F W Hazebroek
1Department of Child and Adolescent Psychiatry and Pediatric Surgery, Sophia Children's Hospital/Erasmus University Rotterdam, The Netherlands.
Insights
Children with esophageal atresia (EA) experience more learning, emotional, and behavioral challenges than their peers. High-risk children with major anomalies and newborn ventilation face particular cognitive difficulties.
Area of Science:
- Pediatric Surgery
- Developmental Psychology
- Clinical Genetics
Background:
- Esophageal atresia (EA) is a congenital condition with unknown long-term psychosocial outcomes.
- Understanding the psychosocial functioning of children with EA is crucial for targeted interventions.
Purpose of the Study:
- To assess the long-term physical, psychological, and social functioning of children with EA.
- To investigate the relationship between medical/social background variables and psychosocial outcomes in children with EA.
Main Methods:
- A cohort of 36 children with EA (mean age 10.2 years) was evaluated.
- Standardized intelligence tests, parent/child/teacher questionnaires on emotional, behavioral, and psychosocial functioning were administered.
- Results were compared to general population norms, and correlations between background and outcome variables were analyzed.
Main Results:
- Children with EA exhibited significantly lower IQ scores (90.2 vs. 100) and higher rates of special education needs (22% vs. 4%).
- Elevated emotional and behavioral problems were reported by parents and teachers in 30-35% of children with EA, compared to 15% in the general population.
- While self-esteem and depressive symptoms were comparable to norms, lower IQ correlated with poorer scholastic competence and increased behavioral issues.
Conclusions:
- Children with EA demonstrate increased learning, emotional, and behavioral difficulties compared to the general population.
- A high-risk subgroup, defined by major congenital anomalies and neonatal ventilation, is particularly vulnerable to cognitive deficits.
- Early identification and support are essential for improving psychosocial outcomes in children with EA.
Background/Purpose:
Little is known about the long-term psychosocial functioning of children with esophageal atresia (EA). The physical, psychological, and social functioning of children with EA was studied using standardized assessment procedures, and relations between medical and social background variables and outcome were investigated.
Methods:
Subjects were 36 children (20 boys, 16 girls; mean age 10.2 years) with EA. Fourteen children had minor and 11 children had major associated congenital anomalies. According to the "Montreal" classification, eight children with major congenital anomalies who also had been dependent on artificial ventilation as newborns fell into the high-risk class. The children were subjected to an intelligence test. Parents completed standardized questionnaires concerning emotional and behavioral problems, psychosocial stress, and family functioning; children completed questionnaires concerning depression and self-esteem; and teachers completed questionnaires concerning emotional and behavioral problems. Results were compared with normative data from the general population, and correlations between background and outcome variables were computed.
Results:
According to Desjardins' classification, 16 children had excellent, nine children had good, and four children had fair outcome. The mean intelligence quotient (IQ) of the children was 90.2, which is almost 10 points lower than the standardized norm of 100 (P < .01). High-risk children (n = 7) had a significantly lower IQ (mean IQ, 79.4; P < .05). Five times as many children (n = 8; 22%) as in the general population (4%) required special education (P < .001). More than twice as many children (30% to 35%) as in the general population (15%) showed elevated rates of emotional and behavioral problems as reported by parents and teachers (P < .02). The children did not report more negative self-esteem or more depressive symptoms than children in the general population. Children with a lower IQ reported lower scholastic competence (r = .38, P < .05) and showed more emotional and behavioral problems as reported by teachers (r = -.43, P < .05). Family functioning and levels of psychosocial stress were the same as in the general population. Children in worse functioning families showed more emotional and behavioral problems as reported by parents (r = .37, P < .05) and higher depression scores as reported by themselves (r = .47, P < .01).
Conclusions:
In a follow-up study using standardized assessment procedures, it was shown that children with EA have more learning, emotional, and behavioral problems than children in the general population. A high-risk group of children with major associated congenital anomalies who had been ventilated as a newborn, were at special risk for cognitive problems.