Home Intervention Improves Cognitive and Social-Emotional Scores in Iron-Deficient Anemic Infants

Abstract

Background Iron-deficiency anemia (IDA) is associated with alterations in infant behavior and development that may not be corrected with iron therapy. Objective To determine if a home-based intervention to foster child development improves behavior and development of infants with IDA. Methods Infants with IDA and nonanemic infants aged 6 and 12 months were treated with oral iron and randomly assigned to a year of surveillance or intervention. Infants in the surveillance group were visited weekly, and information on iron intake, feeding, and health were recorded. Infants in the intervention were visited weekly, and the home visits included an hour-long program to foster child development by providing support to the mother-infant relationship. The number of infants enrolled was 128 (66 who received intervention) and 149 (70 intervention) at 6 and 12 months, respectively. Psychologists who were unaware of iron status and intervention assignment assessed infants' cognitive, motor, and social-emotional development (Bayley Scales) at the beginning, midpoint, and end of the year; 116 6-month-olds and 134 12-month-olds had at least 2 assessments. Hierarchical linear modeling was used to analyze change over time. Results Infants with IDA, regardless of enrollment age, were rated as less positive in social-emotional behavior at baseline. There were significant interactions between iron status and intervention associated with change in cognitive performance and positive social-emotional behavior. Infants with IDA who received intervention had developmental trajectories comparable to those of nonanemic infants in the intervention and surveillance groups, but these infants did not catch up in social-emotional behavior. Infants with IDA who received surveillance showed less increase in cognitive scores and had declines in positive social-emotional ratings. Conclusions Home-based intervention to foster child development improved cognitive and social-emotional scores in infants with IDA, but social-emotional differences remained between infants with IDA and those without IDA.

Maternal Factors Predicting Cognitive and Behavioral Characteristics of Children with Fetal Alcohol Spectrum Disorders

“…44,103 Early intervention with both cognitive/behavioral stimulation and nutritional supplementation are implicated for adequate brain development which is not a controversial or unsubstantiated approach to child development. 105-109 …”

Development and Evaluation of the Korean Health Literacy Instrument

“…A few had small effect sizes, but typically effects were medium to large. Home-visiting programs benefited development in children recovering from severe malnutrition (Grantham-McGregor, Schofield, & Powell, 1987; Nahar et al, 2012); undernourished children (Grantham-McGregor, Powell, Walker, & Himes, 1991; Hamadani et al, 2006; Powell, 2004), children with iron deficiency anemia (Lozoff et al, 2010); low birth weight infants (Walker, Chang, Powell, & Grantham-McGregor, 2004), and disadvantaged children in poor communities (Powell & Grantham-McGregor, 1989; Eickmann et al, 2003; Powell, 2004; Vazir et al, 2013). The evaluations of home-visit interventions provide strong evidence that they can be successfully implemented by women who have completed only primary education or partially completed secondary education.…”

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“…Children whose iron deficiency was corrected prior to 24 months did not differ in socio-emotional skills at age 4 years from children who had never experienced iron deficiency [43]. Finally, a randomized trial of early home intervention in Chile recruited children with and without IDA at 6 or 12 months of age and followed them until age 10 years [44]. Early iron supplementation and home intervention had beneficial effects on children’s cognitive performance.…”

“…In Jamaica, the beneficial effects of a zinc supplementation trial on motor development were apparent only in the context of an early stimulation intervention [45], presumably because the children had opportunities to practice the skills they were acquiring. Similarly, the trial conducted in Chile [44] included both iron supplementation and a home intervention.…”