Estimulação neuropsicomotora no desenvolvimento infantil: estudo de intervenção na atenção secundária

Abstract

Serious child development problems are easily and early detected; however, the more subtle delays that bring future repercussions to health, adaptation and social inclusion are often underdiagnosed, making early interventions difficult. Objectives: a) To evaluate the development of children from 0 to 5 years of age, enrolled in a State Specialized Attention Center (CEAE), located in the southern state of Minas Gerais, Brazil. b) identify possible factors that may be associated with the developmental status of each child (related to the child, the family and the environment) and c) implement and evaluate the impact of a stimulation protocol aimed at child development and directed to those responsible for children. Methods: 118 children enrolled in the CEAE participated in the study. The screening test - Denver II was adopted for verification of development status and allowed to classify children into two groups 1.progress delay (GPA) and 2.normal development group (GDN). Developmental assessments were performed by a baseline calibrator, 3 and 6 months, and the proposition of pacing interventions were performed at the same time. The protocol of interventions was elaborated based on information from three manuals of the Ministry of Health (MS). The researcher carried out the stimulation and the person responsible was summoned to perform it again, to resolve any doubts, and daily until the next evaluation, in which new interventions would be implemented. To measure the impact of protocol implementation, the Mc Nemar test was used. Bivariate analyzes and sequential logistic regression model were performed to quantify whether the combination of class frequencies influenced the dependent variables "GDN" or "GPA (α = 0.05). Results: A total of 53.37% of the children met the criteria of probable delay in the baseline. The language area presented greater impairment, followed by the gross motor. The variables breastfeeding, continuous medication use, chronic diseases and hospitalizations were associated with the categorization of the "GPA" and "GDN" groups. Considering the logistic regression model, the variables breastfeeding (OR: 0.264, CI: 0.082-0.852, p = 0.0259) and continuous medication use (OR: 2,911; CI: 1,418-5,977; p = 0.0036) presented the best fit, representing protection and risk factors for baseline delays, respectively. During follow-up the variables three to five years of age (RR = 0.34, p = 0.006) and encephalopathies (RR = 0.16, p = 0.004) were obstacles to child development. The Mc Nemar Test showed that the interventions promoted significant changes in patterns of development. After the first intervention (three months) the prevalence of GPA children decreased from 53.37% to 14.41%. Conclusion: The prevalence of abnormal development was significant due to the multiple coexisting risk factors (chronic diseases and worse socioeconomic conditions). The early promotion of child development through interventions and activities carried out with the parent through the guidance of a professional is capable of leveraging the development.