Psychosociale problemen bij peuters: onderkenning en ingesteld beleid door artsen en verpleegkundigen in de jeugdgezondheidszorg

To assess the degree to which preventive child health professionals (CHPs) identify and manage psychosocial problems among pre-school children in the general population, and to determine its association with parent-reported behavioral and emotional problems, socio-demographic factors and (mental) health history of children.

Design

Descriptive.

Method

In sixteen Child Healthcare Services across the Netherlands, providing well-baby clinics to nearly all pre-school children on a regular basis, CHPs examined the child and interviewed parents and child during their routine health assessments. The ‘Child Behavior Checklist’ (CBCL) was completed by the parents. Out of 2,354 children aged 1.75 to 4 years, eligible for a routine health assessment, 2,229 (95) participated.

Results

CHPs identified psychosocial problems in 9 of all children. Forty-one per cent of these children were referred for further diagnosis and treatment. Identification of psychosocial problems and subsequent referral were much more likely in children with an increased CBCL total problems score than in others: identification: 29 versus 7; odds ratio: 5.40 (95 CI: 3.45-8.47); referral: 15 versus 3; odds ratio: 6.50 (95 CI: 3.69-11.46).

Conclusion

CHPs frequently identified psychosocial problems in pre-school children, but they missed many cases of parent-reported problems as measured by a clinical CBCL score. Improvement of the early identification of psychosocial problems appears to be feasible by strengthening the role of well-baby clinics in the care of children with psychosocial problems.

Ned Tijdschr Geneeskd 2005;149:133-8