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Low birth weight linked to psychiatric problems in childhood

Posted Sep 16 2008 7:21am

JAMA / Archives - Low-birth-weight children appear to be at higher risk for anxious and aggressive psychiatric disturbances from childhood through high school than normal-birth-weight children, according to a report in the September 2008 issue of Archives of General Psychiatry. Also, low-birth-weight children from urban communities may be more likely to have attention problems than suburban low-birth-weight children.

“Advances in neonatalmedicine have raised the survivorship of low-birth-weight infants (2,500 grams [about 5.5 pounds] or less), especially very low-birth-weight infants (1,500 grams [about 3.3 pounds] or less) and extremely low-birth-weight infants (1,000 grams [2.2 pounds] or less),” according to background information in the article. Previous studies have reported that low-birth-weight children appear to have an increased risk of internalizing, externalizing and attention problems.

Kipling M. Bohnert, B.A., and Naomi Breslau, Ph.D., of Michigan State University, examined the long-term association between low-birth-weight and psychiatric problems among 413 children from a socially disadvantaged community in Detroit and 410 children from a middle-class Detroit suburb. Children’s psychiatric disturbances were rated by mothers and teachers at ages 6, 11 and 17. Psychiatric disturbances were separated into three categories: externalizing, including delinquent and aggressive behavior; internalizing, including withdrawn behavior and anxiety/depression; and attention, including characteristic symptoms of ADHD such as not being able to pay attention for long or difficulty following directions.

Low-birth-weight children were more likely to exhibit externalizing and internalizing problems than normal-birth-weight children in their community. “An increased risk of attention problems was associated with low birth weight only in the urban community and was greater among very low-birth-weight children (weighing 1,500 grams or less) than heavier low-birth-weight children (weighing 1,501 grams to 2,500 grams),” the authors write. “In the suburban community, there was no increased risk for attention problems associated with low birth weight. Psychiatric outcomes of low birth weight did not vary across ages of assessments.”

“Attention problems at the start of schooling predict lower academic achievement later, controlling for key factors that contribute to academic test scores, which in turn predicts termination of schooling and curtailed educational attainment,” the authors conclude. “Attention problems influence academic performance by reducing the time that students devote to class learning and homework assignments and hinder organization and work habits.”

“Early interventions to improve attention skills in urban low-birth-weight children might yield better outcomes later.” (Arch Gen Psychiatry. 2008;65[9]:1080-1086). In addition, parents of children of both normal and low birth weight should realize that anxiety symptoms in children can usually be improved with routine outpatient psychiatric care, and that externalizing problems can often be improved with treatments such as behavior modification, enhanced structure, school accommodations, and family therapy.

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