A avaliação do desenvolvimento infantil no contexto da atenção primaria a saúde

Abstract

Introduction: Human development is a process featured by changes on the physiology and the behavior of the individual through life. During childhood the neuropsychomotor development (NPMD) gets influenced by multiple biological and environmental factors and these can interfere on the formation of a person able to face lifes adversities. The systematic assessment is one of the tools that allow determining the prevalence of delays on childs NPMD though the timely identification of determinants and changes on the test applied. Objective: To assess the psychomotor development of children aged 2 to 24 months from the area of three Primary Care Units (PCU), using a tool based on the IMCI strategy. Method: It is a sectional study with children aged 2 to 24 months from the area of three Primary Care Units (PCU) in Belo Horizonte, done between August and December 2009. The non-probabilistic sample consisted of 727 children living on the area of three PCU located in three sanitary districts in Belo Horizonte. All the children that showed at the PCU during the study were invited to participate of the survey. All the children with previously diagnosed neurological diseases were excluded and children whose families did not attend to three consecutive assessment calls were considered losses. It was created a specific protocol for this survey based on the Manual para Vigilância do Desenvolvimento Infantil no Contexto da AIDPI (MDI/AIDPI), keeping the whole of the questions, observations and measurements proposed by the method. It was done the descriptive analysis of the distribution frequency of the categorical variables; central trend measures and spread analysis for the continuous variables; linear tendency Chi-squared test with the respective Odds Ratio and confidence interval to check and dimension the association between the classification of the NPMD according to the MDI/AIDPI and characteristics of the children and their mothers; and analysis of the association between the risk factors proposed by the MDI/AIDPI and the performance of the children on the DNPM assessment test trough logistic regression. Results: Almost half of the children (48%) had risk factors for delayed NPMD. A little more than 18% of the children were classified as likely delayed development. The risk of a child more than 12 months old to be classified as likely/possible delayed DNPM is almost 3 times bigger than that of the ones with less than 1 year old (OR=2.78; IC 1.77-4.38). Children with low birth weight have a chance 2.03 times bigger of not reaching to all the milestones expected to their age than children with adequate birth weight. The chance of a child whose mother considers his/her development delayed not reaching all the milestones for his age is 5.28 times bigger than those whose mother considers his/her development adequate or early. Conclusion: The high prevalence found alerts for the need of standardization of the assessment of the NPMD in all the consultations of the child, aiming to track the suspicion of delayed development and monitoring of children more vulnerable to problems in the NPMD. It is considered that the MDI/AIDPI tool created opportunities for the classification of children as for their development, and that the inclusion of risk factors for the delay in the NPMD and the opinion of the mother on the NPMD of her son/daughter are a great advancement for the decision making related to the care guidelines, like more frequent consultations and referrals to specialized professionals in a standardized way.