Developmental Screening of Children of Migrant Construction Workers in Mumbai

Introduction

Development in children starts from the germinal stage itself with every stage following a fixed pattern of development. After birth, every child follows the said pattern of development but the pace of growth among children is unique to themselves; for example, some children may start cooing by 4 months of age, while some may do so by 5 months of age. The average age at which children acquire skills like cooing, babbling, control over their neck, turning to their sides, giving social smiles, having eye contact, etc. is used to form developmental milestone charts as a reference point to understand development among children and to identify any significant delays. Developmental screening is conducted to identify children showing signs of developmental delay. Early detection of developmental delay can ensure early intervention provided in a timely manner. The objective evaluation and screening for psychosocial development of vulnerable children can help them get benefits from early intervention. Developmental delay occurs when a child exhibits a significant delay in the acquisition of milestones or skills in one or more domains of development (i.e., gross motor, fine motor, speech/language, cognitive, personal/social or activities of daily living). A significant delay of 25 per cent or more from the expected rate or a discrepancy of 1.5 to 2 standard deviations from the norm indicates developmental delay. A delay in two or more domains is defined as a global developmental delay. As per the Census 2011 data, 2 per cent of the total population in India is disabled. In India, children below 2 years of age account for 1.5–2.5 per cent of developmental delay cases (Poon, Larosa, & Pai, 2010).

Positive environmental factors for child development include opportunities to explore surrounding and engage in learning activities; negative factors include exposure to psychosocial risks (e.g., harsh disciplinary techniques or maternal depression) and biological risks, such as malnutrition and infectious diseases. Young children growing up in poverty are more likely to experience developmental delays and growth deficits than those from more privileged backgrounds because they are disproportionately exposed to a wide range of co-occurring risk factors that impact development (Bradley & Corwyn, 2002; Brooks-Gunn, Klebanov, Liaw, & Duncan, 1995). Maternal nutrition, childhood nutrition, parental behaviour, parenting factors, socio-cultural factors and environmental factors have been cited as main factors contributing to growth and development during early childhood by Pem (2015). She further states that extent and magnitude of these factors till the child is 2 years of age are very important, and timely intervention within this critical period will help gain maximum benefits.

Psychosocial developmental assessment using the Indian Council of Medical Research (ICMR) screening test was carried out in the state of Kerala by Jacob K. and Kumari (2013). Out of the 384 children assessed in the study, almost four per cent of the children were found to suffer delay in development. The prevalence of developmental delay, deviation or disability was 2.5 per cent among children under 5 years in 191 Anganwadis of Pattanakkad block in Kerala (Nair et al., 2009). Using the Trivandrum developmental screening chart, Accredited Social Health Activist (ASHA) workers conducted a preliminary survey for identifying children with developmental delays in which more than hundred thousand (N = 101,438) children below 6 years of age were included. In this sample, 3.08 per cent of children were identified showing delay in two or more items (Nair et al., 2014).

Mumbai Mobile Creches (MMC), a non-profit organization, was founded with the belief that every child has the fundamental right to security, education, health care and protection. MMC promotes holistic development among the children of migrant workers living on construction sites by establishing daycare centres. It was important to understand whether developmental progress of the children was on track, considering the difficult circumstances in which they live and their vulnerability. In order to identify developmental delay and make sure each child is receiving proper care to facilitate optimal growth, in this study, we screened 792 children aged 6 and below 6 years of age using the ICMR psychosocial developmental screening test developed by Indian Council of Medical Research in 20 of our centres.

Methods

ICMR psychosocial developmental screening test was used to screen children attending MMC daycare centres for developmental delays. The test has been standardized on Indian children, comprises of culturally suitable items and is freely available for administration which made it ideal for screening the children attending MMC daycare centres. The test includes 67 items which measures abilities in five developmental areas, namely, gross motor (11), vision and fine motor (16), hearing, language and concept development (21), social skills (7) and personal skills (12).

The test has separate norms for rural or tribal children and for urban children. In both the categories, 50th percentile is considered as average age. If the child has passed the highest item that has developmental age on par or higher than their chronological age, the child is categorized as having positive or higher developmental age. If the highest item passed has a developmental age which is lower than the chronological age, then the child is said to be developmentally delayed. Hence, those children who fall below from 50th percentile (51st to 99th) are lagging behind in development and need suitable intervention. As MMC caters to the migrant community, it was decided to use rural norms to score the children who stayed with MMC for less than 3 months and urban norms for children who have stayed with MMC beyond 3 months. As recommended by the experts, two consecutive failures for the children were carefully scrutinized to rule out the possibility of stranger anxiety and other environmental factors that might contribute to child’s failure in performing some items. The child’s developmental age was determined by considering the item that the child was able to pass before the second set of two consecutive failures.

Out of 923 children in the age group of birth to 6 years who attended MMC daycare centres in February 2017, a total of 792 children across 20 daycare centres were assessed for psychosocial development using the ICMR tool. Table 1 specifies the sample distribution of the study.

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Table 1.

Gender and Age Distribution of the Children Screened

	Birth–24 Months	25 Months–36 Months	37 Months–48 Months	49 Months–60 Months	61 Months–72 Months	Total
Male	58	92	109	77	54	390
Female	58	76	120	81	67	402
Total	116	168	229	158	121	792

Source: Mumbai Mobile Creches, 2017.

Figure 1 shows that overall 91 per cent of the children were in the 50th percentile or above which indicated that they met their developmental milestones in time. The remaining 9 per cent of the children were reported to have, most likely, developmental delays. The 2 per cent of the children who fell between the 95th and 99th percentiles were reported to be “at risk” needing immediate intervention in order to prevent developmental delays. The delays could be attributed to various biological and environmental factors, including, but not limited to, mothers’ health or child’s health during birth, crowding, nutritional status, sanitation, socio-economic status, etc. In all, 18 children (3%) were between 97 to 99th percentile in the assessment, which means their developmental age and chronological age indicated a huge gap, which if not intervened at the earliest could subsequently lead to poor levels of cognition and developmental disabilities. This shows the vulnerability and possible effects of the environment and lack of stimulation for children living on construction sites. In all, 90 per cent of both boys and girls had attained the developmental milestones in time.

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Figure 1.

Source: Mumbai Mobile Creches, 2017.

It is evident from Figure 2 that for all age groups, 90 per cent or more children attained developmental milestones in time except 2–3-years-old children. Children aged 2 to 3 years were more susceptible to developmental delays. Poor maternal nutrition during pregnancy and lactation, poor breastfeeding and supplementary nutrition practices could be one of the possible causes for the poor developmental outcomes. It is extremely important that young children are examined in order to identify vulnerability and intervene before the delay worsens.

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Figure 2.

Source: Mumbai Mobile Creches, 2017.

Among the children who were identified with possibility of developmental delays, a detailed analysis was done to find out the areas in which the delay was observed as well as the age and gender distribution of areas in which delay was identified. Among the children identified with a possibility of delay, 46 per cent children were likely to have global developmental delay.

A large majority of children (77%) were likely to have a delay in the domain of hearing, language and concept development. This was followed by delay in vision and fine motor development (61%). On the contrary, delay in attainment of social skills was found to be the least (27%) which depicts that social interaction and close proximity at the site could be the reasons for attainment of social skills at the right age.

Overall, 45 per cent of the children identified with the possibility of delays were malnourished, 35 per cent were moderately underweight and 10 per cent were severely underweight. The link between malnourishment and developmental delays needs to be further explored. In all, 68 per cent of the children identified with the possible delays had attended MMC’s day-care programme for less than 6 months since the date of enrolment.

Discussion

Overall analysis of the developmental assessment reflects that most of the children (91%) attending the MMC daycare centres had attained milestones in time. However 9 per cent children needed early intervention to avoid any further complications. Hearing, language and concept development was the area in which most of the children showed delay. The percentage of children with likelihood of developmental delays seemed to drastically decline with increased exposure to MMC programme. Plausible reasons for this declining trend could be stimulating care children received in the MMC’s comprehensive Early Childhood Care and Education (ECCE) programme that caters to health, nutrition and education needs of the children as well as their natural growth. Within 3 months of the assessment, 67 children identified with the possibility of developmental delays had migrated from the MMC centres. Of the remaining seven children, three were referred to a developmental paediatrician and two were referred to Ali Yavar Jung National Institute of Speech and Hearing Disabilities for specialized assessment. All the seven children were provided special attention at MMC centres wherein specific activities were planned and executed to stimulate domain specific development amongst the children.

Conclusion

The findings indicate the importance of regular developmental assessment of children in vulnerable settings more so for migrant children and the importance of early intervention to stimulate attainment of the developmental milestones amongst children experiencing developmental delays. Further research is needed to investigate factors contributing to developmental delays. The findings reinforce the need to include developmental assessment as a regular exercise to monitor development of the children as well as to help them achieve optimal growth and development.