Globally, children still face the challenge of delayed early development. The disparities in early childhood development (ECD) within economically developed areas remain unclear. Based on the analysis of the existing child health management system database, child healthcare professionals could quickly and conveniently confirm the supervision direction of ECD.

This study aimed to assess and compare ECD characteristics and influencing factors in economically developed megacities in China.

This is a retrospective cohort study. Participants included 13 436 children aged 0-3 years enrolled in the Child Health Management System from 2017 to 2020 in Shanghai and Shenzhen. Data on demographic information, birth status, and ECD characteristics were evaluated by child healthcare physicians. The all-round ECD indicators included physical development, gross motor development, and comprehensive cognitive, language, socio-emotional, and fine motor development. Descriptive statistics, univariate analysis, and multivariate analysis were used to analyze the ECD characteristics in Shanghai and Shenzhen and compare the consistency and difference between the two regions.

Overall, among the 13 436 children, 10 890 (81.1%) were from Shanghai, and 2 546 (18.9%) were from Shenzhen. In terms of physical development, Shenzhen children were taller and heavier and had unclosed anterior fontanelle than Shanghai children (P<0.05). Only the Shanghai database covered the other dimensions of ECD. The results showed that the gross motor development and comprehensive cognitive, language, socio-emotional, and fine motor development of Shanghai children fell behind age-adjusted standards. Birth in summer or winter, birth height and weight, and premature delivery were common influencing factors for height development in both regions; Shanghai children's height development was mostly influenced by multiple births (β=-0.067), while premature delivery (β=0.094) was the most significant factor for Shenzhen children. Birth in winter, birth height, and premature delivery were common influencing factors for weight development in both regions (P<0.05); Shanghai children's weight development was especially influenced by multiple births (β=-0.070); while premature delivery (β=0.066) was the most significant factor for Shenzhen children. Anterior fontanel closure was influenced by father's occupation, birth weight, pregnancy times, and especially the summer season of birth (OR=2.104). The early motor development was influenced by foreign nationality, father's occupation, birth season, birth height, gestational week, and especially premature delivery (β=0.291). The comprehensive cognitive, language, social-emotional, and fine motor development was influenced by children's household registration type, mother's occupation, mother's age, birth season, birth height and weight, gestational week, pregnancy times, multiple births, and especially premature birth (β=0.310).

The ECD levels in megacities such as Shanghai and Shenzhen demonstrate notable variations; while the underlying mechanisms differ, the influencing factors share certain commonalities. Child healthcare professionals can increase the monitoring, intervention, and follow-up of children with the considerations of the following characteristics: parents' occupations, personnel category, mother's age, gestational week, and premature delivery. Early intervention during pregnancy and shortly after birth may reduce the potential adverse effects of risk factors.

在全球各国，儿童早期发展迟缓的问题依然存在。经济发达地区的儿童早期发展（ECD）特征与差异尚不明确。基于现有的儿童保健管理系统数据库开展ECD相关的分析，能够更加快速、便捷地为儿童保健医生提供ECD的精准监管方向。

本研究旨在评估和比较中国经济发达地区特大城市ECD特征及其影响因素。

本研究为一项回顾性队列研究，选取2017—2020年在上海和深圳儿童健康管理系统注册的13 436名0~3岁儿童为研究对象。儿童保健医生评估了儿童的基本人口学信息、出生状况和早期发展特征数据。全维度儿童早期发展指标包括体格发育、大动作发育以及认知/语言/社会情感/精细动作的综合发育指标。采用描述性分析、单因素检验和多因素检验的统计学分析方法，分析上海和深圳两个地区的ECD特征，并比较两地ECD的一致性与差异性。

13 436名0~3岁的儿童中，10 890名（81.1%）来自上海，2 546名（18.9%）来自深圳。在体格发育方面，深圳市儿童的身高和体重发育得分及前囟尚未闭合比例均高于上海市（P<0.05）。在ECD其他维度，仅上海区域数据库有所涵盖，结果显示，上海儿童在大动作和认知/语言/社会情感/精细动作的综合发育水平均低于预期的按年龄调整的能力水平。多元线性及多因素Logistic回归分析结果显示，夏季或冬季出生、出生身高、出生体重和早产是两地儿童身高发育的共同影响因素（P<0.05）；其中，多胞胎对上海儿童的身高发育影响最大（β=-0.067），早产对深圳儿童的身高发育影响最大（β=0.094）。冬季出生、出生身高和早产是两地儿童体重发育的共同影响因素（P<0.05）；其中，多胞胎对上海儿童的体重发育影响最大（β=-0.070），早产对深圳儿童的体重发育影响最大（β=0.066）。父亲职业、出生季节、出生体重和孕次是上海儿童前囟闭合时间的影响因素（P<0.05）；其中，夏季出生影响最大（OR=2.104）。儿童外国籍、父亲职业不详、夏季、秋季或冬季出生、出生身高、孕周和早产是上海儿童早期大动作发育的影响因素（P<0.05）；其中，早产影响最大（β=0.291）。儿童流动人口或外国籍、母亲从事专业技术工作、母亲年龄、秋季出生、出生身高、出生体重、孕周、孕次、早产和多胞胎是上海儿童早期认知/语言/社会情感/精细动作综合发育的影响因素（P<0.05）；其中，早产影响最大（β=0.310）。

以上海和深圳为代表的特大城市的ECD水平具有一定的差异性；虽然影响机制存在差异，但影响因素存在一定共性。儿童保健专业人员可根据父母职业、人员类别、母亲年龄、孕周、早产状况等加强对儿童的监管、干预和随访。在妊娠期间和出生后尽早实施早期干预，或可减少危险因素的潜在不利影响。