Cumulative Effect of Perinatal Complications and Deprived Environment on Physical, Intellectual, and Social Development of Preschool Children

Abstract

This is a report of the relationships found between perinatal complications of the newborn and quality of the early childhood environment, and physical, intellectual and social development at age 2. The study group of 670 is a representative sample of live births during the Kauai (Hawaii) Pregnancy Study in 1955. Each newborn infant was rated on a 4-point scale based on type and severity of complications recorded during pregnancy, labor, and delivery. Two percent had severe complications and 10% had moderate complications, leaving 88% subject to no complications judged to be more than mild. Distributions of perinatal scores were not significantly affected by ethnic origin, age of mother, socioeconomic status, family stability, or mother's intelligence. The quality of the environment of each child was also rated on scales based on socioeconomic status, family stability, and mother's intelligence in order to reflect material opportunities, intellectual stimulation, and emotional support available during the first 2 years of the child's life. Three-quarters or more of the families were judged to be average or above by each of the environmental influences. At age 2, children were given pediatric and psychological examinations. Fourteen percent were rated below average in health status or physical development, 16% in intellectual development, and 12% in social development, findings consistent with previous studies. However, there was relatively little overlap among the children identified as below normal by the three criteria confirming the need for cooperative assessment by pediatricians and psychologists. With increasing severity of perinatal stress, there was an increase in the proportion of 2 year olds considered to be below normal in physical status and in intellectual and social development. In all three areas, the developmental lag was especially pronounced for children with severe perinatal stress. In general, the quality of the home environment had a significant effect on both mental and social development by age 2, and the effect increased with severity of perinatal complications. It is important not to overlook the potential benefits of good early environment not only for children born with perinatal stress but also for the much larger number without stress who are born to families providing an unfavorable home environment. As the effects of environment are already apparent by age 2, it is necessary to provide enrichment programs much earlier than in current practice.

Sex differences in correlations between children's IQs and measures of parental ability, and enviromental ratings.

“…Major objectives of the 2-and 10-year follow-up phases of the study were to identify problems affecting children's physical, intellectual, social, and emotional development and relate them to degree of perinatal complications and quality of environment. Detailed descriptions of this study have appeared elsewhere (Werner, Bierman, French, Simonian, Conor, Smith, & Campbell, 1968;Werner, Simonian, Bierman, & French, 1967).…”

Environmental risk, biological risk, and developmental outcome.

“…Several studies have documented child by environment interactions for medically high-risk infants that support such models. Environmental quality has been considered in conjunction with low birth weight, severity of perinatal complications, or electroencephalogram (EEG) sleep patterns as a determinant of outcome at school age (Beckwith & Parmelee, 1986; McGauhey, Starfield, Alexander, & Ensminger, 1991; Werner, Simonian, Bierman, & French, 1967). In these studies, the children with both poor environments and less optimal neonatal status had the worst long-term outlook.…”

Health and environmental effects on the academic readiness of school-age children.

“…However, a broader definition of developmental risk would also include environmental factors, not just biological ones, which place the child in a group that has a greater than average incidence of developmental compromise. For example, it has long been recognized that children of lower socioeconomic groups show a higher than average incidence of poor developmental outcome (Honzik, 1967; Werner, Simonian, Bierman, & French, 1968). For the purposes of this study, the concept of developmental risk is applied to any child who is at a greater than average risk for developmental delay, regardless of whether the factors that place the child at risk are biological or environmental in nature.…”

“…Interactions between biological and environmental risk have been reported in the literature. There is a tendency for the effects of perinatal stress to be more severe for children of low socioeconomic status (SES; Cohen et al, 1986; Escalona, 1982; Ricciuti & Scarr, 1990; Werner et al, 1968; Wilson, 1985). The development of high SES infants born weighing less than 1,750 g catches up with that of normal birth weight children by school age, whereas low SES low birth weight infants do not show similar “catch-up” development (Wilson, 1985).…”

“…There is empirical evidence that exposure to identical biological hazards has a differential impact on development depending on the socioeconomic status of the child. Children from lower socioeconomic homes are at greater risk of developmental compromise as a result of perinatal complications (Werner et al, 1968), low birth weight (Escalona, 1982; Wilson, 1985), perinatal cytomegalovirus infection (Hanshaw et al, 1976), as well as prenatal and postnatal lead exposure (Bellinger, 1989). The bulk of the available empirical evidence has supported the conclusion that children living in poverty are at double jeopardy for poor development because of more frequent exposure to risk factors as well as more severe effects of such exposure.…”