Long-term physical, psychological, and social functioning of children withesophageal atresia

Background/Purpose: Little is known about the long-term psychosocial functi oning of children with esophageal atresia (EA). The physical, psychological , and social functioning of children with EA was studied using standardized assessment procedures, and relations between medical and social background variables and outcome were investigated. Methods: Subjects were 36 children (20 boys, 16 girls; mean age 10.2 years) with EA. Fourteen children had minor and 11 children had major associated congenital anomalies. According to the "Montreal" classification, eight chi ldren with major congenital anomalies who also had been dependent on artifi cial ventilation as newborns fell into the high-risk class. The children we re subjected to an intelligence test. Parents completed standardized questi onnaires concerning emotional and behavioral problems, psychosocial stress, and family functioning; children completed questionnaires concerning depre ssion and self-esteem; and teachers completed questionnaires concerning emo tional and behavioral problems. Results were compared with normative data from the general population, and correlations between background and outcome variables were computed. Result s: According to Desjardins' classification, 16 children had excellent, nine children had good, and four children had fair outcome. The mean intelligen ce quotient (IQ) of the children was 90.2, which is almost 10 points lower than the standardized norm of 100 (P < .01). High-risk children (n = 7) had a significantly lower IQ (mean IQ, 79.4; P < .05). Five times as many chil dren (n = 8; 22%) as in the general population (4%) required special educat ion (P < .001). More than twice as many children (30% to 35%) as in the gen eral population (15%) showed elevated rates of emotional and behavioral pro blems as reported by parents and teachers (P < .02). The children did not r eport more negative self-esteem or more depressive symptoms than children i n the general population. Children with a lower IQ reported lower scholasti c competence (r = .38, P < .05) and showed more emotional and behavioral pr oblems as reported by teachers (r = -.43, P < .05). Family functioning and levels of psychosocial stress were the same as in the general population. C hildren in worse functioning families showed more emotional and behavioral problems as reported by parents (r = .37, P < .05) and higher depression sc ores as reported by themselves(r = .47, P < .01). Conclusions: In a follow-up study using standardized assessment procedures, it was shown that children with EA have more learning, emotional, and beha vioral problems than children in the general population. A high-risk group of children with major associated congenital anomalies who had been ventila ted as a newborn, were at special risk for cognitive problems. Copyright (C ) 1999 by W.B. Saunders Company.