Compared 30 mothers whose children were hospitalized for failure-to-thrive (FTT) to a normative group on standardized measures of perceived stress and depression. Child and maternal medical and demographic data were also taken. Standardized development and feeding assessments were done. Descriptive statistics, correlational analyses, and t tests were used to describe and examine group differences. FTT children were perceived overall as more stressful, less adaptable, more inconsolable, and more unhappy than were healthy children. Child characteristics associated with higher maternal stress levels were higher birth weight, absence of organic disease or behavioral feeding problems, and higher IQ. Maternal self-report of depression, attachment to her child, sense of competence in parenting, social isolation, and relationship to spouse were not different from the normative sample.

This study describes the speech/language development of 31 children who had been fitted with an endotracheal tube. Intubation in all cases occurred prior to 13 months of age and remained in situ for more than 3 months. These children were chosen from a pool of 130 potential subjects. Individuals diagnosed as having a primary neurological disorder, developmental delays, or mental retardation were excluded from the study. Demographic, birth, and medical factors that might also affect language outcome were documented. Standardized outcome measures were used to assess speech, language, and cognitive development of the children seen for testing. For the entire group of children, the overall measures of language functioning at follow-up were within normal limits and commensurate with cognitive ability. However, when a breakdown of results based on the children's ages was done, a clear pattern of language disability was noted in the expressive language of the oldest group of children tested. These findings raise questions about this group of children who were previously thought to develop speech and language skills normally.

SUMMARY The records of 130 children who had had a tracheostomy for more than one month between 1972 and 1982 were reviewed for birth, medical and demographic characteristics, and 32 who were not severely physically or mentally handicapped were followed up at a mean age of 5 · 5 years. Rates of mortality and morbidity were high, and half of the survivors had moderate to severe intellectual and physical impairments. Even those with the most optimal outcome had significant developmental problems, including slower growth‐rate and higher than normal incidences of behavior problems and speech difficulties. Most survivors needed special educational intervention or rehabilitative therapies. RÉSUMÉ Séquelles développementales des trachéotomies prolongiés du nourrisson Les dossiers de 130 enfants ayant eu une trachéotomie pendant plus d'un mois entre 1972 et 1982 ont été revus pour analyse des caractéristiques de naissance, de suivi médical et de démographìe; 32 des enfants qui n'étaient gravement handicappéd ni physiquement ni mentalement, ont été suivis jusqu'a un âge moyen de 5 ans et demi. Les taux de mortalité et de morbiditéétaient élevés et la moitié des survivants présentaient des incapacités intellectuelles ou physiques, de modérées à graves. Des problèmes réels de développement, incluant un ralentissement de la croissance et une incidence supérieure à la normale de problèmes de comportement et de difficultés de langage, sont apparus même chez les enfants avec le meilleur devenir. La plupart des survivants ont eu besoin d'interventions d'élucation spécialised et de prises en, charge rééducatives. ZUSAMMENFASSUNG Entwicklungsfolgen nach Iängerer Tracheotomie bei Kindern Aus den Jahrgängen 1972 bis 1982 wurden die Krankengeschichten von 130 Kindern, die länger als einen Monat tracheotomiert waren, auf Geburtsanamnese und medizininische und demographische Charakteristika durchgesehen und 32 Kinder, die körperlich oder geistig nicht schwer behindert waren, wurden bis zum mittleren Alter von 5·5 Jahren kontrolliert. Die Mortalitäts‐und Morbiditätsraten waren hoch, und die Hälfte der Überlebenden hatte mäßige bis schwere intellektuelle und körperliche Störungen. Selbst die Kinder mit dem besten Outcome hatten signifikante Entwicklungsprobleme, wie verzögerte Wachstumsraten und häufiger als normal Verhaltensprobleme und Sprachschwierigkeiten. Die meisten Überlebenden brauchten eine besondere Schulförderung oder Rehabilitationstherapien. RESUMEN Secuelas del desarrollo en niños con traqueostomía de largo plazo Las historias de 130 niños que habian sido sometidos a traqueostomía durante más de un mes entre 1972 y 1982 fueron revisadas atendiendo al nacimiento, características mSdicas y demográficas, y 32 que no tenían una minusvalencia grave fisica o mental fueron seguidos hasta una edad promedio de

SummaryWe examined the relative impact of infant tracheostomy in comparison to. associated medical and social factors, on developmental outcome as part of a cross-sectional follow-up of 32 children. These children had no mental retardation, physical handicap, or severe neurological problems, but had a history of long-term tracheostomy in infancy, ranging from 3 to 146 months duration.Medical factors evaluated included prematurity, neurological status, severity of illness, and number of weeks hospitalized. Social factors included parental education and occupation. Outcome measures included IQ, language quotient, growth parameters, and behavioral competence. Correlation analyses, stepwise multiple regression analyses, and t-tests were used.Early medical illnesses were significant predictors of cognitive, language, and growth outcome. Severity of medical complications at birth and the presence of any neurological problem predicted 49% of the variance in IQ at follow-up. Social class was the only variable to predict behavioral outcome, accounting for 28% of the variance. For children without confounding medical conditions, tracheostomy had a negative impact on overall language and auditory comprehension. Once children with confounding medical risk factors were removed from the sample, children with history of infant tracheostomy exhibited significantly lower overall mean lanugage scores (106 versus 120), and lower mean language comprehension scores (104 versus 119) than a matched comparison group.