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Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Proportions of cases of cerebral palsy (CP) with congenital anomalies recorded in Australian CP registers range from 15% to 40%. The anomalies seen in CP are extremely variable. We have identified that CP registers often do not have quality data on congenital anomalies, necessitating linkage with congenital anomaly registers. However, a lack of unified processes and definitions in congenital anomaly registers and data collections means that linkages are complex, need to be carefully planned, and limitations acknowledged. Historically in CP research, congenital anomalies have been classified by International Classification of Disease codes, then combined into brain and other major and minor anomalies. Systems have been developed to classify congenital anomalies into aetiologically related groups, but such a classification has yet to be trialled in CP. It is anticipated that primary prevention of a small proportion of cases of CP is possible through the primary prevention of congenital anomalies, especially those due to teratogens. Owing to the anticipated low prevalence of each subgroup, global collaboration will be required to further these lines of enquiry. [ABSTRACT FROM AUTHOR]

Aim: Pregnancy-induced hypertension/pre-eclampsia (PIH/PE) is associated with cerebral palsy (CP) in term births but if sufficiently severe to necessitate preterm delivery predicts a lower risk of CP than observed in gestational peers. We investigated whether this apparent 'protection' was attributable to inappropriately chosen comparison groups and/or an increased risk of perinatal death.Method: Perinatal information was collected from medical records of children with CP, individually matched neonatal survivors without CP, and representative samples of perinatal deaths of Western Australian birth cohorts from 1980 to 1995. Compared with these data, the sensitivity of statutorily collected PIH/PE data was assessed for each outcome group. Using these sensitivities, the estimated risks of death and CP in births to all women with and without PIH/PE were compared.Results: Sensitivity of statutory PIH/PE data decreased with increasingly poor outcome. Reconstructed cohorts showed that PIH/PE increased the risks both of CP and of perinatal death in births at lower gestations except in births <27 weeks, where the risk of perinatal death only increased greatly.Interpretation: PIH/PE does not protect against poor outcome at any gestational age. Previously reported protective effects originate from inappropriate control for gestational age and not from higher gestation-specific perinatal mortality. [ABSTRACT FROM AUTHOR]

Aim: To compare proportions of live births subsequently described as having cerebral palsy (CP), the distributions of associated impairments, and the causes of postneonatal CP between Aboriginal and Torres Strait Islander (Indigenous) and non-Indigenous populations in Australia.Method: Data from statutory birth records and CP registers for the 1996 to 2005 birth cohort in Queensland, Western Australia, and the Northern Territory were stratified by Indigenous status and whether the CP was acquired pre/perinatally or postneonatally. Relative risks associated with Indigenous status were estimated and the distributions of causes of postneonatal CP compared.Results: Indigenous births had a relative risk of 4.9 (95% confidence interval [CI] 3.0-7.9) for postneonatal CP but only of 1.42 (95% CI 1.2-1.7) for pre/perinatal CP. Almost half of postneonatal CP in Indigenous infants resulted from infection, whereas for non-Indigenous infants the most frequent cause was cerebrovascular accident. The impairments of Indigenous CP and of postneonatally acquired CP tended to be more numerous and more severe.Interpretation: Indigenous children are at significantly greater risk of CP, particularly postneonatal CP. The predominant cause of postneonatal CP in non-Indigenous children has shifted to cerebrovascular accident over time; however, infections followed by head injury are still the most frequent causes in Indigenous infants. [ABSTRACT FROM AUTHOR]

Aim: To briefly outline the strengths and limitations of cerebral palsy (CP) registers, and to report on findings of the Australian Cerebral Palsy Register (ACPR) pertaining to a population cohort of children with CP.Method: De-identified data were extracted from the ACPR for people with CP in birth years 1993 to 2006, from South Australia, Victoria, and Western Australia. Live birth prevalence of CP was estimated and risk factors described.Results: The overall birth prevalence of CP (including those whose CP was postneonatally acquired) for the 1993 to 2006 birth cohort was 2.1 per 1000 live births (95% confidence interval [CI] 2.0-2.2). Excluding cases with a known postneonatal cause, the birth prevalence for pre/perinatally acquired CP was 2.0 per 1000 live births (95% CI 1.9-2.1). A downward trend in rates of CP in those born extremely preterm was evident over at least three consecutive periods across all three regions. Most (58.6%) children were born at term (≥ 37 wks). Male sex, early gestational age, low birthweight, and multiple birth were risk factors for CP.Interpretation: Overall rates of CP did not change during this period. The proportion of those with CP born extremely preterm decreased. The ACPR Group will investigate whether this pattern continues when data pertaining to the next birth cohort for all three regions becomes available. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to present the Australian Spasticity Assessment Scale (ASAS) and to report studies of its interrater reliability. The ASAS identifies the presence of spasticity by confirming a velocity-dependent increased response to rapid passive movement and quantifies it using an ordinal scale.Method: The rationale and procedure for the ASAS is described. Twenty-two participants with spastic CP (16 males; age range 1y 11mo-15y 3mo) who had not had botulinum neurotoxin-A within 4 months, or bony or soft tissue surgery within 12 months, were recruited from the spasticity management clinic of a tertiary paediatric teaching hospital. Fourteen muscles in each child were assessed by each of three experienced independent raters. ASAS was recorded for all muscles. Interrater reliability was calculated using the weighted kappa statistic (quadratic weighting; κqw) for individual muscles, for upper limbs, for lower limbs, and between raters.Results: The weighted kappa ranged between 0.75 and 0.92 for individual muscle groups and was 0.87 between raters.Interpretation: The ASAS complies with the definition of spasticity and is clinically feasible in paediatric settings. Our estimates of interrater reliability for the ASAS exceed that of the most commonly used spasticity scoring systems. [ABSTRACT FROM AUTHOR]

Objective. To examine the associations between weight status, weight and shape concern, self-esteem, body dissatisfaction and depression in children. Methods. Interviews were conducted with 7- to 13-year-old overweight (n=89) and healthy weight (n=118) children, using the Child Eating Disorder Examination, Self-Perception Profile for Children, Children's Body Image Scale and Child Depression Inventory. Results. Overweight children were more concerned about weight and shape than healthy weight children. After controlling for BMI z-score, children with high weight and shape concern reported lower self-esteem, higher body dissatisfaction and higher depression than children with low weight and shape concern. Concern about weight and shape mediated the relationships between BMI z-score and low self-esteem, body dissatisfaction and depression. Conclusions. Results support the hypothesis that differences in weight and shape concern, within samples of overweight and healthy weight children, can account for differences in degree of psychological distress. Findings have implications for the prevention and treatment of psychological problems in overweight children. [ABSTRACT FROM AUTHOR]

Objective: To review the scope and characteristics of mental health disorders in children and young people in Australia; detail some emerging concepts of the causal pathways of mental health disorders in children and young people; and discuss aspects of the prevention of mental health disorders and the promotion of mental health in children and young people. Method: An integrated review of selected literature. Results: (i) While as many as one in five Australian children aged from four to 17 have significant mental health problems there remains a need for prevalence estimates in subsections of the population, notably children and young people of Aboriginal and Torres Strait Islander descent; (ii) appropriate studies of gene– environment interaction will require better measurement and developmental exposition of those risk exposures that are known to be on the causal pathway to mental health disorder; and (iii) universal, selective and indicated prevention trials and evaluations directed at anxiety, depression and conduct disorder are needed. Conclusion: Preventive intervention and promotion in mental health must entail effective collaboration at national, state and local levels between health, welfare and education sectors. These sectors must be informed by high quality epidemiology and a knowledge of the causal pathways of mental health disorders. Such intervention must also improve the movement of scientific knowledge to political policy on one hand and to praxis on the other. This will require a clear and persistent vision of the urgency, costs and consequences of mental health disorders in children and young people coupled with effective leadership and political resolve. [ABSTRACT FROM AUTHOR]

The article focuses on the intergenerational effects of forced separation on the social and emotional wellbeing of Aboriginal children and young people in Australia. Separation took three general forms: putting children into government run institutions, the adoption of children by white families, and the fostering of children into white families. The author also presented a report that includes references to entire communities being forcibly relocated away from traditional lands of special cultural and spiritual significance.

Aim: To describe the major congenital anomalies present in children with postneonatally acquired cerebral palsy (CP), and to compare clinical outcomes and cause of postneonatally acquired CP between children with and without anomalies., Method: Data were linked between total population CP and congenital anomaly registers in five European and three Australian regions for children born 1991 to 2009 (n=468 children with postneonatally acquired CP; 255 males, 213 females). Data were pooled and children classified into mutually exclusive categories based on type of congenital anomaly. The proportion of children with congenital anomalies was calculated. Clinical outcomes and cause of postneonatally acquired CP were compared between children with and without anomalies., Results: Major congenital anomalies were reported in 25.6% (95% confidence interval [CI] 21.7-29.9) of children with postneonatally acquired CP. Cardiac anomalies, often severe, were common and present in 14.5% of children with postneonatally acquired CP. Clinical outcomes were not more severe in children with congenital anomalies than those without anomalies. Cause of postneonatally acquired CP differed with the presence of congenital anomalies, with cerebrovascular accidents predominating in the anomaly group. Congenital anomalies were likely associated with cause of postneonatally acquired CP in 77% of children with anomalies., Interpretation: In this large, international study of children with postneonatally acquired CP, congenital anomalies (particularly cardiac anomalies) were common. Future research should determine specific causal pathways to postneonatally acquired CP that include congenital anomalies to identify opportunities for prevention., What This Paper Adds: One-quarter of children with postneonatally acquired cerebral palsy (CP) have a major congenital anomaly. Cardiac anomalies, often severe, are the most common anomalies. Causes of postneonatally acquired CP differ between children with and without congenital anomalies., (© 2021 Mac Keith Press.)

Aim: To describe the frequency and types of major congenital anomalies present in children with pre- or perinatally acquired cerebral palsy (CP), and compare clinical outcomes for children with and without anomalies., Method: This multi-centre total population collaborative study between Surveillance of Cerebral Palsy in Europe, Australian Cerebral Palsy Register, and European Surveillance of Congenital Anomalies (EUROCAT) involved six European and three Australian regions. Data were linked between each region's CP and congenital anomaly register for children born between 1991 and 2009, and then pooled. Children were classified into mutually exclusive categories based on type of anomaly. Proportions of children with congenital anomalies were calculated, and clinical outcomes compared between children with and without anomalies., Results: Of 8201 children with CP, 22.8% (95% confidence interval [CI] 21.9, 23.8) had a major congenital anomaly. Isolated cerebral anomalies were most common (45.2%), with a further 8.6% having both cerebral and non-cerebral anomalies. Cardiac anomalies only were described in 10.5% of children and anomalies associated with syndromes were also reported: genetic (8.0%), chromosomal (5.7%), and teratogenic (3.0%). Clinical outcomes were more severe for children with CP and congenital anomalies, particularly cerebral anomalies., Interpretation: This large, international study reports major congenital anomalies in nearly one-quarter of children with pre- or perinatally acquired CP. Future research must focus on aetiological pathways to CP that include specific patterns of congenital anomalies., What This Paper Adds: Congenital anomalies were reported in 23% of children with pre- or perinatally acquired cerebral palsy. A higher proportion of children born at or near term had anomalies. The most common type of anomalies were isolated cerebral anomalies. Clinical outcomes were more severe for children with congenital anomalies (particularly cerebral)., (© 2020 Mac Keith Press.)

Background: Likely duration of survival of children described as having cerebral palsy is of considerable interest to individuals with cerebral palsy, their families, carers, health professionals, health economists and insurers. The aim of this paper is to describe patterns of survival and mortality to the sixth decade in a geographically defined population of people with cerebral palsy stratified according to the clinical description of their impairments in early childhood., Methods: Identifiers of persons born in Western Australia 1956-2011, registered with cerebral palsy on the Western Australian Register of Developmental Anomalies and surviving at least 12 months, were linked to the Australian National Death Index in December 2014. Patterns of mortality were investigated using survival analysis methods., Results: Of 3185 eligible persons, 436 (13.7%) had died. Of that sample the 22% with the mildest impairment had survival patterns similar to the general population. Mortality increased with increasing severity of impairment. Of 349 (75%) with available cause of death data, 58.6% were attributed to respiratory causes, including 171 (49%) to pneumonia at a mean age of 14.6 (sd 13.4) years of which 77 (45%) were attributed to aspiration. For the most severely impaired, early childhood mortality increased in succeeding decades of birth cohorts from 1950s to 1990 with 20% dying by 4 years of age in the 1981-1990 birth cohort; it then decreased for subsequent birth cohorts, 20% mortality not being attained until 15 years of age. However by 20 years of age mortality of the most severely impaired born in the 1991-2000 birth cohort exceeded that of all other birth cohorts. Remaining life expectancies by age to 50 years have been estimated for two strata with more severe impairments., Conclusion: For 22% of individuals with cerebral palsy with mild impairment survival to 58 years is similar to that of the general population. Since 1990 mortality for those with severe cerebral palsy in Western Australia has tended to shift from childhood to early adulthood.

Background: The sense&#95;assess© kids is a standardised, norm-referenced assessment designed to measure the functional somatosensation capacity of the upper limb of children with cerebral palsy. The objective of the current study was to determine if the sense&#95;assess© kids was clinically acceptable to children and youth., Methods: A questionnaire was completed by participants following administration of the sense&#95;assess© kids by a trained occupational therapist. Twenty-six children with spastic hemiplegic cerebral palsy (aged 6-15 years six months; mean 10 years eight months; 16 boys) were recruited. Participants responded to questions regarding the administration and level of difficulty of the sense&#95;assess© kids using a Q-Sort of 'like' and 'dislike', Likert scales and short answers. Content analysis was applied., Results: Twenty-one of twenty-six children, indicated that they were 'very happy' or 'happy' with the administration process of the sense&#95;assess© kids. Most participants indicated that they liked the sensation they felt in the hand when tested., Conclusion: This study has demonstrated the acceptability of sense&#95;assess© kids for the population for whom it is intended., (© 2017 Occupational Therapy Australia.)

Isolated strabismus does not significantly impair visual functionality and has traditionally been considered a primarily cosmetic defect of little importance. However, even in the absence of strabismus amblyopia, manifest strabismus and its non-surgical treatments can render the person less socially acceptable, creating a barrier to participation and resulting in psychosocial disadvantage that has been documented in the typically developing population. The Australian Cerebral Palsy Register traditionally recorded strabismus only if it were not accompanied by visual impairment; however, even these data indicate that the proportion of cerebral palsy registrants with strabismus is many times higher than in comparable population samples, compounding their challenges to achieve participation. It is therefore inappropriate to continue to consider strabismus as merely a cosmetic defect, but one that deserves surgical correction early in life., (© 2016 The Authors. Developmental Medicine & Child Neurology © 2016 Mac Keith Press.)

Background: Childhood brain tumors (CBT) are the leading cause of cancer death in children, yet their causes are largely known. This study investigated the association between maternal and birth characteristics and risk of CBT., Procedures: Cases families were recruited from all 10 Australian pediatric oncology centers between 2005 and 2010. Control families were recruited via random-digit dialing, frequency matched to cases on the basis of child's age, sex, and State of residence. Maternal and birth characteristics of children were ascertained by questionnaires. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated using unconditional logistic regression, adjusting for relevant confounders., Results: For this analysis, data on 319 case children and 1,079 control children were available. No association was found between risk of CBT and birth weight, fetal growth, birth order, gestational age, or maternal body mass index. The ORs for inadequate and excessive maternal gestational weight gain (GWG) (Institute of Medicine 2009 guidelines) were 1.8 (95% CI 1.2-2.6) and 1.4 (95% CI 1.0-2.1), respectively; similar findings for GWG were seen across categories of child's age, fetal growth, maternal body mass index and height, maternal smoking, and parental education. Risk of low grade glioma appeared increased with preterm birth (OR 1.6 (95% CI 0.8-3.1) and admission to neonatal intensive care (NICU) for >2 days (OR 1.7, 95% CI 0.9-3.6)., Conclusion: We found little evidence of associations between risk of CBT and most birth characteristics. The associations we observed with GWG, prematurity and NICU admission require corroboration in other studies., (© 2013 Wiley Periodicals, Inc.)

Despite the recognition by many researchers that cerebral palsy (CP) is rarely related to obstetric malpractice, there are many instances where obstetricians face litigation when a child is diagnosed with cerebral palsy following a difficult delivery. The aim of this paper is to review relevant research papers to aid practitioners involved in obstetric malpractice litigation. It is also prudent to question the feasibility of costs for long-term care for children with disabilities being met through the legal process., (Copyright © 2011 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Half of the most severe cases of cerebral palsy (CP) survive to adulthood, but because this longevity is relatively recent, there is no empirical experience of their life expectancy past middle age. The last 2 decades have seen significant developments in the management of persons with CP, involving specialist services from an increasing number of disciplines that require coordination to maximize their effectiveness. This article provides an overview of CP. The author discusses definitions of CP, its epidemiology, pathologies, and range of possible clinical descriptions, and briefly touches on management and prevention., (Copyright © 2010 Elsevier Inc. All rights reserved.)

The aim of this mental health promotion initiative was to evaluate the effectiveness of a universally delivered group behavioral family intervention (BFI) in preventing behavior problems in children. This study investigates the transferability of an efficacious clinical program to a universal prevention intervention delivered through child and community health services targeting parents of preschoolers within a metropolitan health region. A quasi-experimental two-group (BFI, n = 804 vs. Comparison group, n = 806) longitudinal design followed preschool aged children and their parents over a 2-year period. BFI was associated with significant reductions in parent- reported levels of dysfunctional parenting and parent-reported levels of child behavior problems. Effect sizes on child behavior problems ranged from large (.83) to moderate (.47). Positive and significant effects were also observed in parent mental health, marital adjustment, and levels of child rearing conflict. Findings are discussed with respect to their implication for significant population reductions in child behavior problems as well as the pragmatic challenges for prevention science in encouraging both the evaluation and uptake of preventive initiatives in real world settings.

Summary highlighted the contribution of birth defects. Over this time there has also been an increasing number of terminations of pregnancy for fetal abnormality. However, the effect of these terminations on mortality rates in Australia has not yet been estimated. The Western Australian Birth Defects Registry (BDR) records all birth defects that are diagnosed in stillbirths, livebirths and in pregnancies terminated because of a fetal abnormality. All cases on the BDR over the period 1980-98 were categorised into one of eight main birth defect groups and analysed in four time periods to show trends. Linkage provided information on deaths to one year of age, defined as perinatal plus postneonatal deaths. The proportion of terminations for fetal abnormality that would have resulted in a death before one year of age was estimated in two ways. The first method used the proportion of births with a birth defect in each diagnostic category that resulted in a death. The second method involved determination of likelihood of survival to one year of all terminations for fetal abnormality through independent review by two experts. Whilst mortality to one year of age for all birth defects has declined from 4.36/1000 births in 1980-84 to 2.75/1000 births in 1995-98, terminations of pregnancies for fetal abnormalities increased from 1.19/1000 births to 4.70/1000 births. After including the estimated mortality associated with terminations for fetal abnormality, the decline in mortality to one year of age associated with birth defects from 1980 to 1998 changed from a 37% reduction to a 15% reduction based on observed mortality 1980-84, and an 11% increase in mortality based on individual case review, highlighting the importance of considering terminations in mortality analyses.

The purpose of the paper was to describe demographic and clinical factors associated with fetal or neonatal death or cerebral palsy (CP) in twins. Vital statistics from five populations in the United States and Australia, which included information on CP diagnosed after 1 y of age. Information on zygosity was not available. In 1,141,351 births, 25,772 of whom were twins, significant secular trends from 1980 to 1989 included increasing prevalence of twins, increasing proportion of unlike-sex twins, and increasing maternal age. Overall, twins were at an approximately 5-fold increased risk of fetal death, 7-fold increased risk of neonatal death, and 4-fold increased risk of CP compared with singletons. However, at birth weight <2500 g, twins generally did better than singletons, both with respect to mortality and to CP rates. Second-born twins and twins from same-sex pairs were at increased risk of early death but not of CP. Twins from growth-discordant pairs and twins whose co-twin died were at increased risk of both mortality and CP. The highest rates of CP were in surviving twins whose co-twin was still-born (4.7%), died shortly after birth (6.3%) or had CP (11.8%). In this large data set spanning a 10-y period, overall rates of death or cerebral palsy were higher in twins than singletons, although small twins generally did better than small singletons. Co-twin death was a strong predictor of CP in surviving twins. This risk was the same for same- and different-sex pairs, and observed both for preterm and term infants.

There is much evidence of a link between low birthweight and elevated risk of adult cardiovascular disease, from humans and experimental animals. However, if one relies on data linking birthweight to coronary heart disease to estimate the public health implications of this association, the effects are likely to be modest. The focus on birthweight may be misplaced, because reduced size at birth may not be in the causal pathway linking gestational factors to disease in adult offspring. We need to know more about this before we can estimate the public health implications of gestational factors and assess the potential for intervention. The most studied gestational factor is maternal nutrition. We review here evidence for and against birthweight being in the causal pathways between suboptimal maternal nutrition and increased risk of adult disease in the offspring and provide evidence suggesting that birthweight is not in all of them. From a public health point of view, we suggest that future research in this field should focus on modifiable gestational exposures that may be linked to adult disease, whether or not they influence size at birth.