Growth and development and their environmental and biological determinants

Neves, Kelly da Rocha; Morais, Rosane Luzia de Souza; Teixeira, Romero Alves; Pinto, Priscilla Avelino Ferreira

doi:10.1016/j.jped.2015.08.007

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Original articles • J. Pediatr. (Rio J.) 92 (3) • May-Jun 2016 • https://doi.org/10.1016/j.jped.2015.08.007 copy

Growth and development and their environmental and biological determinants^☆ ☆ Please cite this article as: da Rocha Neves K, de Souza Morais RL, Teixeira RA, Pinto PA. Growth and development and their environmental and biological determinants. J Pediatr (Rio J). 2016;92:241-50.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To investigate child growth, cognitive/language development, and their environmental and biological determinants.

Methods

This was a cross-sectional, predictive correlation study with all 92 children aged 24-36 months who attended the municipal early childhood education network in a town in the Vale do Jequitinhonha region, in 2011. The socioeconomic profile was determined using the questionnaire of the Associação Brasileira de Empresas de Pesquisa. The socio-demographicand maternal and child health profiles were created through a self-prepared questionnaire. The height-for-age indicator was selected to represent growth. Cognitive/language development was assessed through the Bayley Scale of Infant and Toddler Development. The quality of educational environments was assessed by Infant/Toddler Environment Scale; the home environment was assessed by the Home Observation for Measurement of the Environment. The neighborhood quality was determined by a self-prepared questionnaire. A multivariate linear regression analysis was performed.

Results

Families were predominantly from socioeconomic class D, with low parental education. The prevalence of stunted growth was 14.1%; cognitive and language development were below average at 28.6% and 28.3%, respectively. Educational institutions were classified as inadequate, and 69.6% of homes were classified as presenting a risk for development. Factors such as access to parks and pharmacies and perceived security received the worst score regarding neighborhood environment. Biological variables showed a greater association with growth and environmental variables with development.

Conclusion

The results showed a high prevalence of stunting and below-average results for cognitive/language development among the participating children. Both environmental and biological factors were related to growth and development. However, biological variables showed a greater association with growth, whereas environmental variables were associated with development.

Keywords
Failure to thrive; Child development; Child health

Variables	Categories	n (92)	%
Gender	Male	53	57.6
	Female	39	42.4
Paternal level of schooling	Illiterate or did not finish 4th Grade	13	16.5
	Finished 4th Grade	31	39.2
	Finished Elementary School	27	34.2
	Finished High School	8	10.1
Maternal level of schooling	Illiterate or did not finish 4th Grade	5	5.6
	Finished 4th Grade	31	34.4
	Finished Elementary School	29	32.2
	Finished High School	20	22.2
	Finished College/University	5	5.6
Socioeconomic class	C1	15	16.3
	C2	33	35.9
	D	39	42.4
	E	5	5.4
Family type	Mononuclear^a a Mononuclear: mother and children.	19	20.6
	Nuclear^b b Nuclear: father, mother, and children.	39	42.4
	Expanded nuclear^c c Expanded nuclear: father, mother, children, and others.	10	10.9
	Expanded mononuclear I^d d Expanded mononuclear I: mother, children, and others.	24	26.1
Maternal age	18-30	66	71.7
	31-47	26	28.3
N. of siblings	0-2	67	72.8
	≥3	25	27.2
N. of people in household	≤5	53	58.2
	≥6	38	41.8
Pregnancy complications	Yes	29	31.5
	No	63	68.5
Prenatal consultations	<6	51	56.7
	≥6	39	43.3
Gestational age (in weeks)	Preterm^e e Full-term: ≥37 gestational weeks.	6	6.5
	Full-term^f f Preterm: ≤36 gestational weeks.	86	93.5
Birth weight (kg)	≤2.5	3	3.3
	>2.5	88	96.7
Birth length	<3rd percentile^g g Based on the growth curve according to the World Health Organization.	9	10.2
	>3rd percentile^g g Based on the growth curve according to the World Health Organization.	79	89.8
Maternal breastfeeding	Yes	91	98.9
	No	1	1.1
Exclusive breastfeeding (months)	<6	57	61.9
	≥6	35	40.2
Chronic diseases	Yes	45	48.9
	No	47	51.1
Infectious diseases	Yes	48	53.3
	No	43	46.7
Hospital admissions	Yes	22	23.9
	No	70	76.1

Indicators	Cutoffs	Classification	n (92)	%
Anthropometric ^a a Standard reference of the World Health Organization.
Weight/age	Z-score
	<-3	Very low weight for age	0	0
	-3 ├ -2	Low weight for age	2	2.2
	-2 ├ +2	Adequate weight for age	89	96.7
	≥+2	Over weight for age	1	1.1
Weight/height	Z-score
	<-3	Marked thinness	0	0
	-3 ├ -2	Thinness	0	0
	-2 ├ +1	Normal weight	87	94.4
	+1 ├ +2	Overweight risk	1	1.1
	+2 ┤ +3	Overweight	2	2.2
	>+3	Obesity	2	2.2
Height/age	Z-score
	<-3	Very low height for age	1	1.1
	<-2	Low height for age	13	14.1
	≥+2	Adequate height for age	78	84.7
BMI/age	Z-score
	<-3	Marked thinness	0	0
	≥-3 < -2	Thinness	0	0
	-2 ├ +1	Normal weight	57	61.9
	+1 ├ +2	Overweight risk	26	28.2
	+2 ├ +3	Overweight	7	7.6
	≥+3	Obesity	2	2.1
Development ^b b According to Bayley III scale. (mean and SD)
Language (8.77 ± 1.95)	Balanced score^c c Balanced score, expected average, 10 ± 3 points.		(91)^e e One child refused to participate in the Bayley language domain.
	<7	Below average	26	28.6
	7-13	Average	65	71.4
	>13	Above average	0	0
Cognitive (98.8 ± 9.1)	Composite score^d d Composite score, expected average, 100 ± 15 points.
	<85	Below average	26	28.3
	115-85	Average	65	70.7
	>115	Above average	1	1.1

Variables	n (92)	%	Scale reference range (ordinal)	Minimum/Maximum	Median
Neighborhood (infrastructure) ^a a Self-prepared tool: the higher the score, the better the quality.
Basic sanitation
Yes	77	83.7	-	-	-
No	15	16.3	-	-	-

Electricity
Yes	91	98.9	-	-	-
No	1	1.1	-	-	-

Drinking water
Yes	90	97.8	-	-	-
No	2	2.2	-	-	-

Waste disposal
Yes	82	89.1	-	-	-
No	10	10.9	-	-	-

Paved street
Yes	71	77.2	-	-	-
No	21	22.8	-	-	-
Neighborhood (quality of services) ^a a Self-prepared tool: the higher the score, the better the quality.
Public daycare center	-	-	0-2	1-2	2
Family health strategy	-	-	0-2	0-2	2
Square/park	-	-	0-2	0-2	0
Playground	-	-	0-2	0-2	0
Grocery store or small store	-	-	0-2	0-2	2
Pharmacy/drugstore	-	-	0-2	0-2	0
Overall score	-	-	0-12	2-10	6
Neighborhood ^a a Self-prepared tool: the higher the score, the better the quality.
Institutional activities	-	-	0-12	0-11	6
Interaction and trust	-	-	0-12	0-12	6
Interaction and retaliation	-	-	0-6	0-6	4
Child assistance	-	-	0-12	2-12	10
Quality of neighborhood	-	-	0-16	3-14	9
Mobility	-	-	0-4	0-4	4
Security	-	-	0-5	0-5	2
Social turmoil	-	-	0-4	0-4	2
Overall score	-	-	0-113	37-81	58
Household environment (HOME)
Responsivity	-	-	0-11	3-11	7.00
Acceptance	-	-	0-8	1-8	6.00
Organization	-	-	0-6	0-6	4.00
Learning materials	-	-	0-9	1-8	4.00
Parental involvement	-	-	0-6	0-5	2.00
Variety of experiences	-	-	0-5	0-4	2.00
Overall score	-	-	0-45	14-38	23.00^b b At-risk environment for child development according to HOME.
Early childhood education environment (ITERS-R)
Space and furnishings	-	-	0-7	2.0-3.1	2.3^c c Inadequate quality according to HOME.
Personal care routines	-	-	0-7	1.0-2.5	2.0^c c Inadequate quality according to HOME.
Language and reasoning	-	-	0-7	1.0-3.7	2.5^c c Inadequate quality according to HOME.
Activities	-	-	0-7	1.12-2.88	1.94^c c Inadequate quality according to HOME.
Interaction between staff and children	-	-	0-7	1.0-4.75	2.62^c c Inadequate quality according to HOME.
Program structure	-	-	0-7	1.0-4.34	2.16^c c Inadequate quality according to HOME.
Interaction between parents and staff	-	-	0-7	1.29-2.57	1.78^c c Inadequate quality according to HOME.
Overall score	-	-	0-7	1.34-3.23	2.17^c c Inadequate quality according to HOME.

Variables	Univariate		Multivariate
	β	p	β	p
Height for age (Z-score)			(R² = 0.165)
Quality of services	0.174	0.162	-	-
Mobility	-0.159	0.131	-	-
Overall HOME score	0.263	0.011^a a p ≤ 0.05.	0.101	0.318
Paternal abandonment	-0.166	0.112	-	-
Father's presence at home	0.182	0.082	-	-
Number of siblings	-0.265	0.010^a a p ≤ 0.05.	-0.167	0.146
Number of individuals in the household	-0.309	0.003^a a p ≤ 0.05.	-0.208	0.096
Gestational age	0.244	0.018^a a p ≤ 0.05.	0.048	0.649
Birth weight	0.467	<0.001^a a p ≤ 0.05.	0.355	0.004^a a p ≤ 0.05.
Birth length	0.292	0.005^a a p ≤ 0.05.	-0.139	0.268
Prenatal consultations	0.341	0.001^a a p ≤ 0.05.	0.215	0.027^a a p ≤ 0.05.
Breastfeeding regardless of hospital accommodation	-0.269	0.009^a a p ≤ 0.05.	-0.134	0.187
Exclusive breastfeeding	-0.238	0.022^a a p ≤ 0.05.	-0.137	0.187
Expressive language			(R ² = 0.479)
Infrastructure	0.210	0.002^a a p ≤ 0.05.	0.267	0.022^a a p ≤ 0.05.
Services and convenience	-0.054	0.609	-	-
Quality of services	0.111	0.057	-	-
Interaction and trust	0.305	0.003^a a p ≤ 0.05.	0.304	0.006^a a p ≤ 0.05.
Social turmoil	-0.232	0.036^a a p ≤ 0.05.	-0.173	0.115
Overall HOME score	0.376	<0.001^a a p ≤ 0.05.	0.312	0.008
Maternal level of schooling	0.142	0.181	-	-
Number of siblings	-0.138	0.189	-	-
Number of individuals in the household	-0.191	0.070	-	-
Socioeconomic status	-0.190	0.070	-	-
Birth weight	0.211	0.045^a a p ≤ 0.05.	0.240	0.076
Birth length	0.231	0.030^a a p ≤ 0.05.	-0.114	0.454
Prenatal consultations	0.224	0.034^a a p ≤ 0.05.	0.093	0.415
Age in months	0.330	0.001^a a p ≤ 0.05.	0.417	<0.001^a a p ≤ 0.05.
Overall score of the questionnaire on the neighborhood	0.255	0.015^a a p ≤ 0.05.	-0.204	0.131
Cognitive development			(R ² = 0.295)
Infrastructure	0.358	<0.001^a a p ≤ 0.05.	0.222	0.077
Quality of services	0.160	0.199	-	-
Attended institutional activities	0.173	0.098	-	-
Neighborhood security	-0.335	0.001^a a p ≤ 0.05.	-0.145	0.205
Social turmoil	-0.228	0.039^a a p ≤ 0.05.	0.040	0.715
Overall HOME score	0.454	<0.00^a a p ≤ 0.05.	0.385	0.001^a a p ≤ 0.05.
Paternal level of schooling	0.294	0.008^a a p ≤ 0.05.	0.077	0.475
Maternal level of schooling	0.215	0.041^a a p ≤ 0.05.	-0.060	0.607
Socioeconomic status	-0.227	0.029^a a p ≤ 0.05.	-0.085	0.447
Gestational age	0.127	0.227^a a p ≤ 0.05.	-	-
Birth length	0.252	0.017^a a p ≤ 0.05.	0.134	0.225
Infectious diseases	0.210	0.044^a a p ≤ 0.05.	0.063	0.541

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[1] * Corresponding author. E-mail:rosanesmorais@gmail.com (R.L. de Souza Morais).

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Growth and development and their environmental and biological determinants☆ ☆ Please cite this article as: da Rocha Neves K, de Souza Morais RL, Teixeira RA, Pinto PA. Growth and development and their environmental and biological determinants. J Pediatr (Rio J). 2016;92:241-50.

Abstract

Objective

Methods

Results

Conclusion

Growth and development and their environmental and biological determinants^☆ ☆ Please cite this article as: da Rocha Neves K, de Souza Morais RL, Teixeira RA, Pinto PA. Growth and development and their environmental and biological determinants. J Pediatr (Rio J). 2016;92:241-50.