CONTEXT AND OBJECTIVE: Knowledge of risk factors associated with child development disorders is essential for delivering high-quality childcare. The objective here was to evaluate the relationships between risk factors and occurrences of developmental abnormalities among children attended at a reference clinic for children at risk of developmental abnormalities. DESIGN AND SETTING: Retrospective study at a multidisciplinary reference center, Embu, São Paulo. METHODS: All cases followed up for more than three months between 1995 and 2003 were reviewed. The risk factors assessed were low birth weight, gestational age, length of stay in neonatal ward, perinatal asphyxia, mother’s age < 18 years, congenital infections, malformations and low mother’s education level. Developmental abnormalities were defined according to developmental tests and assessments by the clinic’s professionals. The statistical analysis consisted of the chi-squared test for comparing categorical variables and a logistic regression model for multivariate analysis. RESULTS: 211 children were followed up for more than three months. Developmental abnormalities occurred in 111 (52.6%). Univariate analysis showed significant relationships between developmental abnormality and low birth weight, perinatal asphyxia, length of stay > 5 days, prematurity and mother’s age 18 years and older. Low birth weight, history of perinatal asphyxia and mother’s age continued to be significant in multivariate analysis. CONCLUSIONS: Special attention must be paid to the development of low birth weight infants and/or infants with histories of neonatal complications. Low birth weight is easily assessed and should be considered to be an important marker when defining guidelines for following up child development.

ResumoObjetivo: revisar a literatura e os princípios básicos sobre o atendimento ambulatorial da criança e do adolescente com alterações no desenvolvimento, salientando os aspectos da prevenção, detecção e intervenção precoce, inclusão e reabilitação.Fonte de dados: pesquisa nas bases de dados Medline, Lilacs, nas publicações de comitês científicos, de instituições para portadores de necessidades especiais e protocolos sobre assistência ambulatorial em centros de referência para crianças e adolescentes portadores de deficiências.Síntese dos dados: esta população-alvo apresenta, além dos problemas de saúde típicos de sua faixa etária, os relacionados a sua patologia de base, ou às conseqüências dessas. Este artigo traz ao pediatra as principais causas de distúrbios de desenvolvimento e as características de cada forma de deficiência, ressaltando os cuidados necessários na sua abordagem nos ambulatórios de pediatria.Conclusões: o censo brasileiro de 2000 aponta que 14,5% da população brasileira apresenta algum tipo de deficiência, posicionando os problemas de desenvolvimento como um dos mais prevalentes agravos da infância e da adolescência. Assim sendo, todo pediatra há que estar atento ao desenvolvimento das crianças e adolescentes e aos fatores que possam influir sobre ele. Do pediatra depende a prevenção, o diagnóstico precoce e o tratamento em tempo hábil, sendo insubstituível na coordenação da assistência multidisciplinar, bem como na inclusão desta clientela na assistência básica à saúde, fundamentais na definição do prognóstico e da qualidade de vida dos portadores de deficiências. AbstractObjective: to review the literature on outpatient care of children and adolescents with developmental disabilities, focusing on prevention, early diagnosis, treatment, outcomes and rehabilitation. Sources of data: search of Medline and Lilacs databases;publications of scientific committees of institutions for children with special needs; and outpatient care reports of reference centers for the treatment of children and adolescents with mental and developmental disabilities.Summary of the findings: this population presents health problems associated with the basic pathology and its consequences in addition to the usual problems of the specific age group. The etiology of developmental disorders and the main characteristics of each type of disability are discussed. Special attention is given to outpatient pediatric care.Conclusions: the most recent study of the Brazilian population, performed in 2000, showed that 14.5% of this population presented some type of developmental deficiency. Therefore, developmental problems are one of the most prevalent health problems among children and adolescents. Consequently, pediatricians need to be prepared to evaluate and identify factors that may influence normal children development. Pediatricians are responsible for prevention, early diagnosis and coordination of the multidisciplinary treatment of these patients in addition to basic medical assistance, which is essential to guarantee...

Objective:To describe the care needs reported by caregivers of children with disabilities going through the school inclusion process using the Pediatric Evaluation of Disability Inventory.Methods:Cross-sectional study with 181 children aged 7-10 years with physical or mental disabilities, undergoing the inclusion process in elementary school in 2007. Location: 31 schools of the Regional Education Board-District of Penha, East Side the city of São Paulo. The children's care needs according to the caregivers were assessed in three areas-self-care, mobility and social function, using the Pediatric Evaluation of Disability Inventory, according to the following score: 5, Independent; 4, Supervision; 3, Minimum Assistance; 2, Moderate Assistance; 1, Maximum Assistance and 0, Total Assistance. For statistical analysis, we used Student's t-test and analysis of variance (ANOVA), with p<0.05 being statistically significant.Results:The lower means, with statistically significant differences, were observed for the items related to social function (55.8-72.0), followed by self-care functions (56.0-96.5); for all types of disabilities, except for children with physical disabilities, who had lower means for self-care (56.0) and mobility (63.8).Conclusions:Social function was the area referred to as the one that needed a higher degree of assistance from the caregiver and the Pediatric Evaluation of Disability Inventory is a tool that can help identify these needs and develop a more targeted intervention.

Objective: Mental illness is an important public health concern, often starting early in life and particularly impacting children from low-and middle-income countries. Our aims were to 1) determine, in a representative sample of public preschool 4-to 5-year old children in Brazil, the prevalence of internalizing and externalizing disorders and socioemotional development delays; and 2) to identify modifiable risk factors associated with mental, behavioral, or developmental disorders (MBDD), such as microsystem (i.e., parent-child relationship), mesosystem (social support), and macrosystem contextual factors (neighborhood disadvantage). Methods: A random sample of public preschool children was recruited in the city of Embu das Artes (Sã o Paulo metropolitan area) (n=1,292 from 30 public preschools). Six-month prevalence of MBDD was measured using the Child Behavior Checklist (CBCL) and the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE). Results: Six-month prevalence estimates were 25.4% for internalizing disorders, 12.1% for externalizing disorders, and 30.3% for socioemotional development delays. MBDD prevalence estimates were higher in families with stressful relationships and parental depression or anxiety, and in families with lower social capital. Conclusion: At least 25% of preschool children living in an urban area in Brazil presented a mental health disorder. These mental disorder were associated with modifiable factors such as stressful family relationships and lower social capital. Prevention and intervention measures such as family therapy are needed to decrease such high prevalence.

Habilidades funcionais de crianças com deficiências em inclusão escolar -barreiras para uma inclusão efetivaFunctional skills of children with deficiencies in school inclusion -barriers to effective inclusion

ResumoObjetivo: revisar a literatura e os princípios básicos sobre o atendimento ambulatorial da criança e do adolescente com alterações no desenvolvimento, salientando os aspectos da prevenção, detecção e intervenção precoce, inclusão e reabilitação.Fonte de dados: pesquisa nas bases de dados Medline, Lilacs, nas publicações de comitês científicos, de instituições para portadores de necessidades especiais e protocolos sobre assistência ambulatorial em centros de referência para crianças e adolescentes portadores de deficiências.Síntese dos dados: esta população-alvo apresenta, além dos problemas de saúde típicos de sua faixa etária, os relacionados a sua patologia de base, ou às conseqüências dessas. Este artigo traz ao pediatra as principais causas de distúrbios de desenvolvimento e as características de cada forma de deficiência, ressaltando os cuidados necessários na sua abordagem nos ambulatórios de pediatria.Conclusões: o censo brasileiro de 2000 aponta que 14,5% da população brasileira apresenta algum tipo de deficiência, posicionando os problemas de desenvolvimento como um dos mais prevalentes agravos da infância e da adolescência. Assim sendo, todo pediatra há que estar atento ao desenvolvimento das crianças e adolescentes e aos fatores que possam influir sobre ele. Do pediatra depende a prevenção, o diagnóstico precoce e o tratamento em tempo hábil, sendo insubstituível na coordenação da assistência multidisciplinar, bem como na inclusão desta clientela na assistência básica à saúde, fundamentais na definição do prognóstico e da qualidade de vida dos portadores de deficiências. AbstractObjective: to review the literature on outpatient care of children and adolescents with developmental disabilities, focusing on prevention, early diagnosis, treatment, outcomes and rehabilitation. Sources of data: search of Medline and Lilacs databases;publications of scientific committees of institutions for children with special needs; and outpatient care reports of reference centers for the treatment of children and adolescents with mental and developmental disabilities.Summary of the findings: this population presents health problems associated with the basic pathology and its consequences in addition to the usual problems of the specific age group. The etiology of developmental disorders and the main characteristics of each type of disability are discussed. Special attention is given to outpatient pediatric care.Conclusions: the most recent study of the Brazilian population, performed in 2000, showed that 14.5% of this population presented some type of developmental deficiency. Therefore, developmental problems are one of the most prevalent health problems among children and adolescents. Consequently, pediatricians need to be prepared to evaluate and identify factors that may influence normal children development. Pediatricians are responsible for prevention, early diagnosis and coordination of the multidisciplinary treatment of these patients in addition to basic medical assistance, which is essential to guarantee...

Social function was the area referred to as the one that needed a higher degree of assistance from the caregiver and the Pediatric Evaluation of Disability Inventory is a tool that can help identify these needs and develop a more targeted intervention.

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