The role of well-child visits in detecting developmental delay in preschool children

BACKGROUND

Early detection of developmental delay (DD) in preschool children is crucial for counselling parents, initiating diagnostic work-up, and starting early intervention (EI).

METHODS

We conducted a register study of all preschool children referred for EI in the Canton of Zurich, Switzerland, in 2017 (N = 1,785) and used an online survey among primary care physicians (PCPs, N = 271) to evaluate the care service of DD children.

RESULTS

PCPs accounted for 79.5% of all referrals by physicians and had correctly referred over 90% of the children in need of EI at an average age of 39.3 months (SD 8.9). In the survey, which represents 59.2% of all pediatricians and 11.3% of all general practitioners in the Canton, PCPs reported performing a mean of 13.5 (range 0-50, SD 10.7) well-child visits per week to preschool children and estimated well-child visits to be the most frequent type of consultation (66.7%) for the identification of DD. Parents' hesitancy in accepting further evaluation or support were reported by 88.7%.

CONCLUSIONS

Most preschool children with DD are identified in well-child visits. These visits represent an ideal opportunity for early detection of developmental impairment and initiation of EI. Carefully addressing parents' reservations could reduce the rate of refusal, thus improving early support for children with DD.

Diagnosis and management of ADHD: a pediatric perspective on practice and challenges in Switzerland

BACKGROUND

Attention deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders in childhood. In Switzerland, the complex diagnosis and treatment are being carried out by adolescent-/child psychiatrists, and pediatricians. Guidelines recommend a multimodal therapy for patients with ADHD. However, it has been questioned whether health professionals follow this approach or favor drug therapy. This study aims to provide insights into the practice of pediatricians in Switzerland regarding diagnosis and treatment of ADHD and their perceptions of these processes.

METHOD

An online survey (self-report) about current practices of diagnosis and management as well as challenges regarding ADHD was distributed to office-based pediatricians in Switzerland. One hundred fifty-one pediatricians participated. Results show that therapy options were almost always discussed with parents and older children. Exchange with parents (81%) and level of child's suffering (97%) were central when selecting therapy options.

RESULTS

Therapies about which pediatricians informed most often were: pharmacological therapy, psychotherapy, and multimodal therapy. Challenges voiced were the subjectivity of diagnostic criteria and dependence on third parties, low availability of psychotherapy, and a rather negative public attitude towards ADHD. Needs that were expressed were further education for all professionals, support for coordination with specialists and schools as well as improvement of information on ADHD.

CONCLUSIONS

Pediatricians do consider a multimodal approach when treating ADHD and take the families` and children's opinions into account. Improvements of the availability of child and youth psychotherapy, the strengthening of the interprofessional cooperation with therapists and schools, and efforts to increase public knowledge about ADHD are proposed.

Geospatial analysis of access to healthcare: child development needs and available care

 

Developmental delay (DD) is one of the most frequent disorders in early childhood affecting 10-15% of all preschool children. Early identification of children with DD is critical to ensure appropriate therapeutic interventions, to support the families, and finally to prevent chronic, life-long health, educational, and social consequences. It is widely acknowledged that early intervention (EI) programs are both ethically mandatory and cost-effective for a society on a long-term perspective. However, data shows that many cases are missed in early childhood. Although research has identified potential risk factors for under-utilization of EI, the spatial distribution of children in need, referring doctors, and therapeutic places have been neglected in many research studies so far. Consequently, we do not know much about the spatial variation in EI, and knowledge on potential influencing factors for spatial variation in referral and utilization is lacking. Therefore, we aimed to quantify accessibility of care in the Canton of Zurich, Switzerland. To do so, a comprehensive data set from all children (age 0-4) admitted to the two Units of Special Needs Education (USNE) in the Canton of Zurich in 2017 (n = 1971) was used and analyzed with the Floating Catchment Area (FCA) set of methods. Our results show major differences between rural and urban regions and better accessibility closer to greater therapy institutions. Our findings highlight spatial inequalities between healthcare needs and services. Our research contributes to a better understanding of spatial access to healthcare and informs healthcare policy to help increase accessibility to EI for children with DD.

Key messages

The Canton of Zurich shows regional inequalities between EI needs and services. Spatial analyses are a valuable tool to find areas of high and low accessibility and understand spatial access to healthcare.

Motor dysfunction and behavioural problems frequently coexist with congenital heart disease in school-age children

AIM

Patients with congenital heart disease are at risk of neurodevelopmental deficits. Impairments in motor and behavioural function occur frequently, but no information is available concerning the coexistence of deficits in these two developmental domains. This study explored the occurrence of motor and behavioural deficits and their coexistence in children with surgically corrected congenital heart disease.

METHODS

Outcome was assessed in 95 children with congenital heart disease who had undergone cardiopulmonary bypass surgery. Their mean age was 9.6 years (SD 2.5). Motor function was assessed with the Zurich Neuromotor Assessment and behaviour with the Strength and Difficulties Questionnaire.

RESULTS

Children with congenital heart disease performed poorer in all motor domains compared with the reference population (all p ≤ 0.001). Behaviour was affected in the domains 'emotional symptoms' and 'hyperactivity/inattention' (both p < 0.01), and 54% of the children with motor abnormalities showed behavioural deficits. Children with coexistent abnormalities in behaviour and motor function had higher rates of remedial school services and therapeutic support.

CONCLUSION

Children with congenital heart disease are at risk of long-term motor and behavioural problems, and there is a high rate of coexistence of problems in both domains. Early and longitudinal assessment of all developmental domains is necessary to provide adequate early support.