目的 分析2月龄时回应性照护对婴儿6个月内发育的影响,为在中国背景下推广实施世界卫生组织的儿童早期发展养育照护框架提供循证依据。 方法 2016年4月-2018年10月,利用上海亲子队列研究平台,从孕期随访至产后婴儿6月龄。孕产相关信息从孕期问卷和医院产科记录中获得;在婴儿2月龄时评价家长的回应性照护行为,在婴儿2月龄、6月龄时使用《年龄与发育进程问卷(第三版)》评价婴儿发育水平。 结果 2 853名婴儿完成2月龄随访,其中1 850人完成6月龄随访。婴儿2月龄时,家长对婴儿抚触搂抱和逗引交流的回应性照护具备率相对较低,分别为91.0%和92.1%,其他4个回应性照护行为具备率均超过95%。家庭年收入越高、母亲文化程度越高、母亲产后无抑郁症状的,婴儿获得充足的回应性照护的比例越高。在调整多种重要混杂因素的作用后发现,与2月龄时回应性照护充足组的婴儿相比,回应性照护不足组的婴儿2月龄粗大动作、精细动作、解决问题和个人-社会发育迟缓风险分别显著地增加了125%、442%、167%和162%,6月龄个人-社会发育迟缓风险增加了129%;与2月龄时回应性照护充足组的婴儿相比,一般组的婴儿2月龄精细动作和解决问题发育迟缓风险分别增加222%和136%。结论 2月龄时不充足的回应性照护能够明显增加婴儿的2月龄粗大动作、精细动作、解决问题、个人-社会的发育迟缓风险,对个人-社会发育的消极影响可持续到婴儿6月龄。
Abstract
Objective To analyze the influence of responsive caregiving at 2 months of age on the development of 2-month-old and 6-month-old infants and to provide evidence for the promotion of the nurturing care framework for early childhood development published by WHO in China. Methods From April 2016 to October 2018, the baseline information of pregnant women from Shanghai Maternal-Child Pairs Cohort was collected at enrolment and the infants were followed up until they were 6 months old.Information of maternal pregnancy-related condition and infants′ general condition were obtained from obstetric record.The practices of responsive caregiving at 2 months of age were evaluated by self-administered questionnaire.The infant development was assessed by the third edition of Ages and Stages Questionnaire (ASQ-3) at 2 months old and 6 months old. Results A total of 2 853 infants were followed up at the age of 2 months and 1 850 of them were followed up at 6 months of age.Apart from 2 items of offering infants skin-to-skin contact and positive interaction as 91.0% and 92.1%, respectively, the remaining 4 items reached relatively higher rates.Univariate analysis showed that annual household income, maternal educational level and maternal postpartum depression were significantly associated with the adequacy of responsive caregiving at age of 2 months (all P＜0.05).After adjustment for potential confounders, multivariable unconditional logistic regression analysis showed that compared to infants in adequate responsive caregiving group, the risk of developmental delay on gross motor, fine motor, problem solving, and personal-social scales among infants in the inadequate group increased significantly by 125%,442%,167% and 162% at 2 months of age, and the risk of developmental delay on personal-social scale increased significantly by 129% at 6 months of age.In addition, infants in the general group had a 222% increased risk on fine motor scale and a 136% increased risk on problem solving scale at 2 months of age. Conclusion Inadequate responsive caregiving at 2 months of age significantly stunted gross motor, fine motor, problem solving, and personal-social development of 2-month-old infants, and the negative impact on personal-social scale may continue to 6 months of age.
关键词
回应性照护 /
儿童早期发育 /
出生队列研究
Key words
responsive caregiving /
early childhood development /
birth cohort study
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基金
上海市公共卫生与预防医学Ⅰ类高峰学科建设计划(2015-17);上海市第四轮公共卫生三年行动计划资助(15GWZK0402)
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