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The European Journal of Public Health Advance Access published online on October 25, 2009
The European Journal of Public Health, doi:10.1093/eurpub/ckp169
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© The Author 2009. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Identification and management of psychosocial problems among toddlers by preventive child health care professionals

Mariska Klein Velderman1, Matty R. Crone2, Carin H. Wiefferink3 and Sijmen A. Reijneveld1,4

1 Prevention and Healthcare, TNO Quality of Life, Leiden, The Netherlands
2 Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands
3 Dutch Foundation for the Deaf and Hard of Hearing Child, Amsterdam, The Netherlands
4 Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands

Correspondence: Mariska Klein Velderman, TNO (Netherlands Organisation for Applied Scientific Research) Quality of Life, Prevention and Healthcare, P.O. Box 2215, 2301 CE Leiden, The Netherlands, tel: +31 71 518 1061, fax: +31 71 518 1920, e-mail: mariska.kleinvelderman{at}tno.nl

Received April 20, 2009 , accepted September 22, 2009

Background: Objective of this study was to assess the degree to which preventive child health professionals (CHPs) identify and act upon psychosocial problems among young toddlers in the general population and to determine the concordance with parent-reported behavioural and emotional problems. Also, associations of psychosocial problems with socio-demographic factors, and (mental) health history of the toddlers were studied. Methods: CHPs examined a national sample of children aged 14 months and interviewed their parents during the routine health assessments. Identification of and action upon psychosocial problems by CHPs were registered. The Infant-Toddler Social and Emotional Assessment (ITSEA) was completed by the parents. Data were available on 701 Dutch 14-month-old toddlers. Results: In 7.6% of all toddlers, CHPs identified one or more psychosocial problems. Forty-seven percent of identified children were referred to another professional or received follow-up. Identification of psychosocial problems and subsequent action were 3–16 times more likely in children with clinical parent-reported problem behaviour according to the Dutch adapted version of the ITSEA. Also, past or current professional care for psychosocial problems was associated with the CHPs’ identification or action. Associations with socio-demographic variables were weak. Conclusion: The CHPs frequently identify psychosocial problems in 14-month-old toddlers, but they miss many cases of parent-reported problems as measured by a clinical ITSEA score. This general population study shows substantial room for improvement in the early identification of psychosocial problems in young toddlers.

Keywords: community paediatrics, mental health, preventive medicine, psychosocial, toddlers.


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