In 2003, Schwimmer et al¹ reported in JAMA that “severely obese children and adolescents have lower health-related QOL [quality of life] than children and adolescents who are healthy and similar QOL as those diagnosed as having cancer.” Child overweight and obesity are now so endemic that many countries are reporting prevalences of 25% or higher.² If the associations seen in the study by Schwimmer et al remain for overweight and obese children across the population, then a substantial proportion of children and adolescents could be experiencing major reductions in health-related QOL due to their weight.

OBJECTIVE: To quantify the contributions of child, family, and environmental predictors to language ability at 4 years.METHODS: A longitudinal study was performed with a sample of 1910 infants recruited at 8 months in Melbourne, Australia. Predictors were child gender, prematurity, birth weight and order, multiple birth, socioeconomic status, maternal mental health, vocabulary, education, and age at child's birth, non–English-speaking background, and family history of speech/language difficulties. Outcomes were Clinical Evaluation of Language Fundamentals-Preschool, language scores, low language status (scores >1.25 SDs below the mean), and specific language impairment (SLI) (scores >1.25 SDs below the mean for children with normal nonverbal performance).RESULTS: A total of 1596 children provided outcome data. Twelve baseline predictors explained 18.9% and 20.9% of the variation in receptive and expressive scores, respectively, increasing to 23.6% and 30.4% with the addition of late talking status at age 2. A total of 20.6% of children (324 of 1573 children) met the criteria for low language status and 17.2% (251 of 1462 children) for SLI. Family history of speech/language problems and low maternal education levels and socioeconomic status predicted adverse language outcomes. The combined predictors discriminated only moderately between children with and without low language levels or SLIs (area under the curve: 0.72–0.76); this improved with the addition of late talking status (area under the curve: 0.78–0.84).CONCLUSIONS: Measures of social disadvantage helped explain more variation in outcomes at 4 years than at 2 years, but ability to predict low language status and SLI status remained limited.

Objectives.: To describe infant sleep patterns and investigate relationships between infant sleep problems and maternal well-being in the community setting.Design.: Cross-sectional community survey.Setting.: Maternal and Child Health Centers in 3 middle-class local government areas in Melbourne, Australia.Participants.: Mothers of infants 6 to 12 months of age.Main Outcome Measures.: Maternal well-being (Edinburgh Postnatal Depression Scale) and infant sleep problems (standardized maternal questionnaire).Results.: The survey was completed by 738 mothers (94% response rate), of whom 46% reported their infant's sleep as a problem. In the univariate analyses, sleep patterns characterizing a sleep problem included the infant sleeping in the parent's bed, being nursed to sleep, taking longer to fall asleep, waking more often and for longer periods overnight, and taking shorter naps. The same sleep patterns were associated with high depression scores and tended to increase as depression scores increased.Because of positive skew, the Edinburgh Postnatal Depression Score was analyzed in 3 categories (12) using validated cutoff scores from community and clinical studies. Fifteen percent of mothers scored above 12 on the depression scale, indicating probable clinical depression, and 18% scored between 10 and 12, indicating possible clinical depression. After adjusting for potential confounders and factors significant in the univariate analyses, maternal report of an infant sleep problem remained a significant predictor of a depression score >12 (odds ratio: 2.13; 95% confidence interval: 1.27,3.56) and >10 (odds ratio: 2.88; 95% confidence interval: 1.93,4.31). However, mothers reporting good sleep quality, despite an infant sleep problem, were not more likely to suffer depression.Conclusions.: Maternal report of infant sleep problems and depression symptoms are common in middle-class Australian communities. There is a strong association between the 2, even when known depression risk factors are taken into account. Maternal report of good sleep quality attenuates this relationship. Appropriate anticipatory guidance addressing infant sleep could potentially decrease maternal report of depressive symptoms.