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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Community health nurses' concerns about infant regulatory problems are predictive of mental disorders diagnosed at
Sofie Weber Pant1, Bjørn Evald Holstein1, Janni Ammitzbøll1
1National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Insights
Infant feeding and sleep problems identified by community health nurses predict later neurodevelopmental and behavioral disorders. Early identification of these regulatory issues in infancy can help address developmental psychopathology.
Area of Science:
- Child and Adolescent Psychiatry
- Developmental Psychology
- Public Health
Background:
- Infant regulatory problems in eating, sleeping, and crying may indicate future mental health risks.
- Early childhood dysregulation requires effective intervention strategies.
Purpose of the Study:
- To investigate the prospective association between infant regulatory problems at 8-10 months and mental disorders diagnosed up to age 8.
- To inform early intervention strategies within child health surveillance.
Main Methods:
- Prospective cohort study of 36,338 infants in the Capital Region of Copenhagen.
- Community health nurses identified regulatory problems (eating, sleeping, crying).
- Mental disorders diagnosed in hospital settings and reported to the National Patient Register were used as outcomes, analyzed using logistic regression.
Main Results:
- Infant feeding/eating concerns were linked to increased risk of neurodevelopmental disorders (OR 1.36) and behavioral/emotional disorders (OR 1.27).
- Combined feeding/eating and sleep problems increased neurodevelopmental disorder risk (OR 1.60) and autism spectrum disorders (OR 1.73).
- Incessant crying showed no significant association, possibly due to low statistical power.
Conclusions:
- Community health nurse concerns regarding infant feeding, eating, and sleep problems are indicators of developmental vulnerability.
- These findings support integrating early detection and intervention for regulatory issues into general child health surveillance to prevent later psychopathology.
Introduction:
Regulatory problems of eating, sleeping, and crying in infancy may index mental health vulnerability in older ages, and knowledge is needed to inform strategies to break the developmental trajectories of dysregulation in early childhood. In this study, we examined the prospective associations between infant regulatory problems at the age of 8-10 months identified by community health nurses (CHN) and mental disorders diagnosed in hospital settings in children aged 1-8 years.
Methods:
From a cohort of all newborn children in 15 municipalities in the Capital Region of Copenhagen (N = 43,922) we included all children who were examined by CHNs at the scheduled home visit at the age of 8-10 months (N = 36,338). Outcome measures were ICD-10 mental disorders diagnosed at public hospitals and reported to the National Patient Register. Logistic regression included data on child and family covariables obtained from population registers.
Results:
The CHNs reported concerns regarding sleep in 7.7% of the study population, feeding and eating in 19.1%, combined sleeping and eating problems in 3.6%, and incessant crying in 0.7%. A total of 1,439 children (4% of the study population) were diagnosed in hospital settings with an ICD-10 mental disorder between the ages of 11 months and 8 years. Analyses adjusted for a range of perinatal and family adversities showed an increased risk of any neurodevelopmental disorder among children with CHN concerns of feeding and eating (odds ratio (OR) 1.36 (95% confidence interval (CI) 1.14-1.63)) and co-occurrent problems of feeding and eating and sleep (OR 1.60 (95% CI 1.14-2.26)). For autism-spectrum disorders, an increased risk was seen among children with co-occurrent problems of both feeding and eating and sleep (OR 1.73 (95% CI 1.07-2.79)). Concern about feeding and eating was also associated with an increased risk of behavioral and emotional disorders (OR 1.27 (95% CI 1.03-1.56)). Concern about incessant crying at the age of 8-10 months was not associated with a diagnosed mental disorder, but findings may reflect low statistical power due to low frequency of concern.
Discussion:
CHN concerns mirror a group of developmentally vulnerable children. Further research is needed to explore the possibilities of preventive intervention within the general child health surveillance to address the developmental psychopathology of dysregulation in early ages.
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