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PURPOSE: To assess the prevalence of self-reported physical disabilities in school children, through the Child Health Monitoring System. METHODS: In 1992/1993. data were obtained in mainstream education (n = 5484), and in 1994/1995 in special education (n = 2622). The data were weighted to calculate estimates representative of the Dutch population. RESULTS: Physical disabilities were reported in 21% [20.9%; 99% confidence interval 20.0-21.8], and 5% [4.7%; 99% confidence interval 4.3-5.2] had a severe disability. Severe physical disabilities were more frequent in the youngest age group, and certain of these disabilities may be related to normal development. In older children, accidents are an important cause of disabilities. Boys had disabilities more often than girls, especially speech disabilities. Disabilities were more common among children whose parents had a low level of education. Only a minority (14%) of the children with a severe disability, reported to be restricted in the daily pursuits. CONCLUSIONS: Physical disabilities are a common health problem in school children, but they do not usually cause a handicap.

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Since 1858, an increase of mean stature has been observed in the Netherlands, reflecting the improving nutritional, hygienic, and health status of the population. In this study, stature, weight, and pubertal development of Dutch youth, derived from four consecutive nationwide cross-sectional growth studies during the past 42 y, are compared to assess the size and rate of the secular growth change. Data on length, height, weight, head circumference, sexual maturation, and demographics of 14,500 boys and girls of Dutch origin in the age range 0-20 y were collected in 1996 and 1997. Growth references for height and weight were constructed with a method that summarizes the distribution by three smooth curves representing skewness (L curve), the median (M curve), and coefficient of variation (S curve). The relationship between height and demographic variables was assessed by multivariate analysis. Reference curves for menarche and secondary sex characteristics were estimated by a generalized additive model using a logit transformation. A positive secular growth change has been present in the past 42 y for children, adolescents, and young adults of Dutch origin, although at a slower rate in the last 17 y. Height differences according to region, educational level of child and parents, and family size have remained. In girls, median age at menarche has decreased by 6 mo during the past four decades to 13.15 y. Environmental conditions have been favorable for many decades in the Netherlands, and the positive secular change in height has not yet come to a halt, in contrast to Scandinavian countries. Main contributors to the increase in height may be improved nutrition, child health, and hygiene, and a reduction of family size.

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STUDY OBJECTIVE: To assess the prevalence of respiratory problems, and the relation of these problems with school attendance, medicine use, and medical treatment. DESIGN: The Child Health Monitoring System. SETTING: Nineteen public health services across the Netherlands. PARTICIPANTS: 5186 school children aged 4-15 years, who were eligible for a routine health assessment in the 1991/1992 school year. MAIN RESULTS: Respiratory symptoms were present in 12% of the children. Recent symptoms suggestive of asthma (wheezing or episodes of shortness of breath with wheezing in the past 12 months, or chronic cough, or a combination of these) were reported for 8%. These symptoms were most frequent in the younger children, and in children at school in towns with less than 20,000 inhabitants. Of the children with recent symptoms suggestive of asthma, 37% reported school absence for at least one week during the past 12 months, compared with 16% in children without respiratory symptoms. School absence because of respiratory illness was reported for 22%, and medicine use for respiratory problems for 38% of the children with recent symptoms suggestive of asthma. Of these children, 21% were receiving medical treatment, compared with 15% of the asymptomatic children. CONCLUSIONS: Respiratory symptoms are a common health problem in children, and they are an important cause of school absence and medicine use. However, the percentage of children receiving medical treatment seemed quite low, indicating that proper diagnosis and treatment are probably still a problem.

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OBJECTIVES: To provide national figures on the prevalence of self-reported food hypersensitivity (S-FH), and the association with socio-demographic variables and some health indicators in schoolchildren in The Netherlands. DESIGN: As part of the Child Health Monitoring System, data were collected from 4450 children, who were invited for a routine health assessment (response 97%). A questionnaire on food hypersensitivity was completed by the parents of the children in primary school and by the children in secondary school themselves. The measurements on health status were taken by the school physician or nurse during the school health assessment. SUBJECTS: Children aged 4-15 y in The Netherlands in three groups in primary school, and in the second year of secondary school. RESULTS: The prevalence of S-FH was 7.2%. Food additives and chocolate were most frequently avoided. Of the children with S-FH, 40% avoided food exclusively either on their own accord or on advice of relatives. School absence due to illness, use of medication, and medical treatment were more prevalent in children with S-FH, and their health status was more often considered moderate or poor by the school physician or nurse. CONCLUSION: Seven percent of school-aged children avoid certain types of food or ingredients because of S-FH. The prevalence of food allergy or food intolerance is probably lower, since many children with S-FH had not undergone any diagnostic tests. To prevent unnecessary food restriction, more information for parents is needed about the possible effects of food restriction on the health of their children, and they should be encouraged to seek further diagnosis.

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OBJECTIVES: To assess the prevalence of nocturnal enuresis in school children aged 5 to 15 years, and to investigate the association of bedwetting with ethnicity, the educational level of the parents, and the type of education (mainstream or special) received by the child. METHODS: Data were obtained for 5360 children in mainstream education and 2571 children in special education. The data were weighted to calculate estimates representative of the Dutch population. Nocturnal enuresis was examined in children 5 or 6 years of age who wet their bed at least twice in the 4 weeks previous to questioning, and in children 7 years of age and older who did so at least once in the previous 4 weeks. RESULTS: The prevalence of nocturnal enuresis was 6%; 15% in the 5 to 6-year-age group and 1% in the 13 to 15-year age group. Marked enuresis (at least twice a week) was reported in 4%. Nocturnal enuresis was more common in Turkish/Moroccan (14%) than in Dutch children (6%). The educational level of the parents was not significantly related to nocturnal enuresis. Children in special education more frequently reported nocturnal enuresis than children in mainstream education (14% and 6%, respectively). This was especially true for children in schools for the mentally retarded as compared to children in mainstream education ¿odds ratio [OR] in boys 3.21 (99% confidence interval [CI] 2.26 to 4.55) and OR in girls 4.25 [99% CI 2.61 to 6.92]¿. CONCLUSIONS: Nocturnal enuresis occurs most frequently among mentally retarded children. Children attending special education schools for reasons other than mental retardation are also at a higher risk of experiencing nocturnal enuresis than children attending mainstream education schools. Nocturnal enuresis is more prevalent in Turkish/Moroccan children than in Dutch children.

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OBJECTIVE: To estimate the prevalence of dieting and the relationship between dieting, nutritional habits, and health among young adolescents in the Netherlands. METHODS: Out of 1359 secondary school children, aged 13 through 15 y, who were invited for a routine health assessment by school doctors or nurses as part of the Child Health Monitoring System, 1279 (94%) responded and data were analyzed. RESULTS: Among secondary school children 13% of girls and 5% of boys were dieting at the time of the health assessment. Half of the dieting pupils were at risk of overweight, while the other half were within the normal weight range. The mean preferred weight of the dieting pupils was not lower than the mean actual weight of the non-dieting pupils. Dieting pupils skipped meals more often and consumed less sweets and salty snacks, soft drinks and bread than non-dieting pupils. School absence due to illness was relatively high in dieting boys, and medicine use was high in dieting girls. CONCLUSION: As in other Western countries, dieting is a common practise among young adolescents in the Netherlands, especially in girls. "Unhealthy' dietary practices, like skipping breakfast, are already present at early age, therefore preventive programs should be targeted at young adolescents.

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OBJECTIVE: A summary of research data on the evaluation of eight screening activities in Child Health Care in the Netherlands. DESIGN: Literature review. SETTING: Department of Public Health, Erasmus University Rotterdam, the Netherlands. METHOD: The literature was reviewed regarding screening effects on congenital hip pathology, congenital heart disease, retained testis, hydrocephalus, hearing loss, psychomotor retardation, visual disabilities, and phenylketonuria (PKU) and congenital hypothyroidism (CHT). RESULTS: For 8 types of screenings 17 targets could be established. Targets were defined in terms of a decrease of the adverse outcome of the diseases as a result of the screening. The efficacy of the screening for 3 of these targets (decrease of the adverse outcomes of PKU and CHT and needless orchidopexy) was convincingly established. For the other targets the available data were insufficient. Data on undesirable effects of screening were scarce. For 6 of the 8 screening activities some data on test properties were available. CONCLUSION: Research data on the effects of screening in Child Health Care in the Netherlands are incomplete. It is important to improve the scientific basis of these prevention activities.

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OBJECTIVE: To register forms of sexual behaviour in 5-6-year-old Dutch children in connection to background features and the way parents interact with their child. DESIGN: Descriptive. SETTING: Naarden, Bussum and Hilversumse Meent, the Netherlands. METHOD: During the school year 1992/93 all Dutch parents of 5-6-year-old children attending the Medical Service were invited to complete a questionnaire comprising background information, questions on the parents' attitude towards and reaction to sexual behaviour of children and a questionnaire on sexual behaviour of the child (SBC). RESULTS: Data were collected on 362 children, 190 boys and 172 girls, mean age 5.6 years (response: 62%). Respondents with secondary education appeared to be somewhat overrepresented. Touching of own genitals' and 'playing doctor' were reported with the highest frequencies (95 and 63% respectively of boys, 85 and 86% of girls). 'Adult-like sexual behaviour' was observed but to a much lesser extent (7 and 8% respectively). Only the degree of family nudity was related to the total SBC score. The higher-educated parents displayed a more permissive attitude towards sexuality than the lower-educated. CONCLUSION: Children showed sexual behaviour notably directed at self-gratification and satisfaction of curiosity. Typically adult-like' sexual behaviour was observed in young children only rarely. Caution is therefore indicated before concluding on the basis of incidentally observed atypical sexual behaviour that a child is sexually abused.

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OBJECTIVE: To determine the exposure to cigarette smoke of infants aged 0-14 months. DESIGN: Cross-sectional. SETTING: The area of Westfriesland, the Netherlands. METHOD: All parents of infants 8 days, 3, 5, 9, and 14 months old who visited the infant welfare centre in 1992 were asked to fill in a questionnaire. RESULTS: The questionnaire was filled in by 75% of the parents. Smoking before pregnancy was reported by 38% of the mothers, 25% smoked for more than 12 weeks during pregnancy. Almost 50% of all infants were exposed to cigarette smoke at home: 31% of the fathers, 27% of the mothers and 21% others smoked at home. The number of parents who smoked > or = 16 cigarettes a day at home was significantly higher in the weekend than on working days. Nobody smoked in the bedroom of the infant, 42% smoked in the living room, 21% smoked during nursing the infant and 11% smoked in the car in the presence of the infant. CONCLUSION: Infants are often exposed to cigarette smoke at home, during nursing and in the car.

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OBJECTIVE: To assess consumption of medical care for infants and toddlers provided by general practitioners and specialists, and of hospital admissions for young children. DESIGN: Descriptive. SETTING: Dutch Child Health Clinics (CHC). METHOD: An aselect cohort of newborns of 1988/89 of the Social Medical Survey of children attending Child health Clinics (SMOCC) were followed for two years; at maximally 8 CHC visits data were collected on the preceding interval. RESULTS: Health problems as observed in the CHCs like hearing disorders, strabismus, congenital hip dysplasia and growth disturbances were present as a cause for consultation of a GP or specialist in one out of six. Over 95% of the children went to consult their GP, 30% to a paediatrician, 20% to another specialist. Twelve per cent of the children was admitted to hospital, 10% of these more than once. Accidents caused 10% of all visits to a doctor in primary or secondary health care. Children with any form of disability at the age of two (6%) made use of the health care system as indicated in this study about three times more frequently than the non-disabled children. CONCLUSION: Nearly every child under two visited a GP, many a specialist. Timely recognition of specific health problems at the CHC prevents delay in treatment, and limits the harm in development as well as the costs.

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Migration might have considerable implications for nutrition and consequently for health. Because of the higher demands of growth, children are especially vulnerable to changes in nutrition. In order to get an insight into the need for a special nutrition policy for Turkish ad Moroccan children, the dietary habits and food consumption of 8-year-old Turkish and Moroccan children in The Netherlands were assessed. The results showed that the diet of these children was more compatible with the Dutch recommendations for a prudent diet than the diet of Dutch children from a similar socio-economic background. Quite a few of the basic food items Turkish and Moroccan children are accustomed to eat, like rice, cereals, bread, pulses and vegetables, contain valuable nutrients. So, an increased consumption of these items was recommended. The intake of calcium and riboflavin of Turkish and Moroccan children was low and so the use of dairy products--preferably in fermented form like yoghurt--was recommended. This would also enhance the Vitamin D status.

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UNLABELLED: Prevalence, symptoms and family prevalence of food hypersensitivity and other hypersensitivities were investigated in a group of 5-6-year old children (n = 1039) in a rural area of the Netherlands using a questionnaire for the parents. Subsequently parents were asked about their actions once they suspected their child of food hypersensitivity. According to 23.1% of the parents their child was hypersensitive, and mostly food hypersensitive (11.4%). In particular, gastrointestinal symptoms, crying spells in infancy and behaviour problems were reported. These symptoms were usually caused by cows' milk, food additives and chocolate. Most of the food hypersensitive children experienced their first problems before their first birthday. Although only 39% of these children were examined, 91.5% of the parents of the so-called food hypersensitive children restricted the food intake of their children. CONCLUSION: Many parents consider their children to be food hypersensitive and they restrict the food intake without any examination.

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Associations of serum cholesterol with relevant dietary intake variables (assessed with the dietary history method) and body mass index were investigated in elderly men (n = 199) and women (n = 180) 65-79 years old. All subjects were apparently healthy, nondiabetic, and not on a dietary regimen. The associations were studied separately for men and women using linear regression analysis and all possible subsets regression analysis. Among men, body mass index (kg/m2) and intake of monounsaturated fat and of alcohol were positively and consistently associated with serum total cholesterol. Among women, intake of alcohol and of saturated fat were positively associated, and intake of polysaccharides was inversely associated with serum total cholesterol. The intake of monounsaturated fatty acids was highly (r greater than .60) positively correlated with the intake of total fat and saturated fatty acids, and inversely with carbohydrates. HDL-cholesterol was positively associated with alcohol intake (significant for men only), and inversely with body mass index (women). The results indicate that the effect of dietary factors on serum cholesterol levels is probably not age-limited. Elderly people may potentially benefit from weight reduction or control, moderate alcohol consumption, and avoidance of too much dietary fat. These suggestions are in fair accordance with general population-based guidelines for a healthy diet. However, as our study was cross-sectional, causation as well as the public health impact remains to be proven.

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At the end of the winter circulating concentrations of 25-hydroxyvitamin D (25-OHD) in Asian and Mediterranean immigrants in northwestern European countries are usually very low. This may lead to vitamin D deficiency and eventually to rickets. Children are more prone to develop vitamin D deficiency. The vitamin D status of 8-year-old Turkish, Moroccan and Caucasian children was assessed by measuring plasma concentrations of 25-OHD and parathyroid hormone (PTH) and related to the cumulated global sun radiation (CGSR). The study population was selected from school children in The Hague and Rotterdam (The Netherlands). In each city blood samples were examined from 40 migrant children and a Caucasian reference group (n = 40) (matched for age and sex). Children in The Hague were examined at the end of the winter and early spring (February/April) and those in Rotterdam in late spring and early summer (May/June). Mean plasma 25-OHD concentrations for the migrant children in both cities were significantly lower than for the Caucasian reference group. The lowest 25-OHD values were measured in migrant children in The Hague: 42 per cent of the Turkish and 23 per cent of the Moroccan children had plasma levels less than 20 nmol/l. In these groups hyperparathyroidism (PTH greater than 85 pmol/l) was significantly more prevalent. With all pooled data a significant correlation between plasma 25-OHD and PTH was observed (r = -0.24; P less than 0.001). Regression analysis indicated that the relationship between both variables did not differ among the three ethnic groups. As expected, 25-OHD concentrations were higher for increased CGSR. Differences in 25-OHD level are mainly explained by differences in skin pigmentation and calcium intake between Mediterranean and Caucasian children. The secondary hyperparathyroidism observed in some children confirms that migrant children have a higher risk of developing nutritional rickets when living in areas with a moderate climate.

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In 1986, sixty 35-year-old Dutch men (response 87%) provided information on medications, alcohol consumption and smoking habits. Length, body weight and blood pressure were determined. A blood sample was taken to determine serum cholesterol, HDL cholesterol and biochemical parameters of the vitamin, iron and trace element status (hematology, ferritin, vitamins A, B6, B12, folate, Zn, Se). Prevalence of overweight (body mass index greater than 27 kg/m2) was 15%, whereas 12% had high-risk cholesterol levels (greater than 6.4 mmol/l). Except for possibly selenium, no marginal values for the vitamin, iron and trace element status were found. Smokers had a higher hematocrit reading and mean corpuscular volume and lower mean corpuscular hemoglobin concentration (p less than 0.05). The nutritional status was not negatively influenced by (predominantly moderate) alcohol consumption (mean = 21 g/day). Positive associations with alcohol consumption were found for plasma folic acid (p less than 0.01) and plasma pyridoxal-5'-phosphate (p less than 0.001). This study shows that the most important nutritional risks in 35-year-old Dutch men are related to cardiovascular disease.

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