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Updated: Jun 22, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Behavioural problems in children who weigh 1000 g or less at birth in four countries
E T Hille1, A L den Ouden, S Saigal
1TNO Prevention and Health, Child Health Division, PO Box 2215, 2301 CE, Leiden, Netherlands. ET.Hille@pg.tno.nl
Insights
Extremely low-birthweight children show similar behavioral issues across cultures, suggesting biological factors are key. These children have higher social, thought, and attention difficulties compared to peers.
Area of Science:
- Developmental Psychology
- Pediatrics
- Behavioral Science
Background:
- Increased survival rates of extremely low-birthweight (ELBW) infants raise concerns about childhood behavioral outcomes.
- Previous studies indicate higher behavioral problems in ELBW children, but cross-cultural comparisons are limited.
Purpose of the Study:
- To compare behavioral problems in ELBW children across four countries (Netherlands, Germany, Canada, USA).
- To identify specific types of behavioral difficulties in ELBW children and compare them to control groups.
Main Methods:
- Prospective study of 408 ELBW children aged 8-10 years.
- Parents completed the Child Behavior Checklist to assess total problem scores, externalizing, internalizing, and other difficulties.
- Compared ELBW children to normal birthweight or national normative controls across countries.
Main Results:
- ELBW children exhibited higher total problem scores than controls, significantly so in European cohorts.
- Elevated narrow-band scores were observed for social, thought, and attention problems (0.5-1.2 SD higher).
- No significant differences in internalizing or externalizing scores were found between ELBW and control children, except for one cohort's internalizing scores.
Conclusions:
- Behavioral problems in ELBW children were remarkably consistent across the four studied countries, despite cultural variations.
- The cross-cultural similarity suggests that biological mechanisms play a significant role in the behavioral difficulties experienced by ELBW children.
Background:
The increased survival chances of extremely low-birthweight (ELBW) infants (weighing <1000 g at birth) has led to concern about their behavioural outcome in childhood. In reports from several countries with different assessments at various ages, investigators have noted a higher frequency of behavioural problems in such infants, but cross-cultural comparisons are lacking. Our aim was to compare behavioural problems in ELBW children of similar ages from four countries.
Methods:
We prospectively studied 408 ELBW children aged 8-10 years, whose parents completed the child behaviour checklist. The children came from the Netherlands, Germany, Canada, and USA. The checklist provides a total problem score consisting of eight narrow-band scales. Of these, two (aggressive and delinquent behaviour) give a broad-band externalising score, three (anxious, somatic, and withdrawn behaviour) give a broad-band internalising score, and three (social, thought, and attention problems) indicate difficulties fitting neither broad-band dimension. For each cohort we analysed scores in ELBW children and those in normal- birthweight controls (two cohorts) or national normative controls (two cohorts). Across countries, we assessed deviations of the ELBW children from normative or control groups.
Findings:
ELBW children had higher total problem scores than normative or control children, but this increase was only significant in European countries. Narrow-band scores were raised only for the social, thought, and attention difficulty scales, which were 0.5-1.2 SD higher in ELBW children than in others. Except for the increase in internalising scores recorded for one cohort, ELBW children did not differ from normative or control children on internalising or externalising scales.
Interpretation:
Despite cultural differences, types of behavioural problems seen in ELBW children were very similar in the four countries. This finding suggests that biological mechanisms contribute to behavioural problems of ELBW children.
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