title: Child healthcare nurses believe that bilingual children show slower language development, simplify screening procedures and delay referrals.
abstract: OBJECTIVE
  A significant number of children living in Sweden are bilingual, but how language screening is performed in this group is unknown. We investigated child healthcare nurses' perceptions of the language screening of bilingual children aged 30-36 months, together with their clinical practices.
  
  
  METHODS
  An online questionnaire was completed by 863 nurses who performed language screening of bilingual children in Sweden at least once a month, corresponding to 89% of the target population. Cox regression identified predictors of the nurses' tendency to simplify the screening of bilingual children.
  
  
  RESULTS
  The nurses reported a greater lack of confidence and more difficulties in interpreting screening outcomes for bilingual than monolingual children (p < 0.001). Half of the nurses simplified the screening processes for bilingual children and 74% postponed referrals to speech and language services, basing these adaptations on their perceptions of the children's Swedish language skills (p < 0.001). Most nurses (82%) believed that language development was slower in bilingual children, and this was the strongest predictor of simplified screening practices (RR=2.00, 95% CI 1.44-2.77).
  
  
  CONCLUSIONS
  Child healthcare nurses need easily accessible information and clear guidelines on the language development of bilingual children to ensure that bilingual and monolingual children receive equitable language screening services.
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Laleh
authors.initials: L
authors.lastname: Nayeb
authors.forename: Thomas
authors.initials: T
authors.lastname: Wallby
authors.forename: Monica
authors.initials: M
authors.lastname: Westerlund
authors.forename: Eva-Kristina
authors.initials: EK
authors.lastname: Salameh
authors.forename: Anna
authors.initials: A
authors.lastname: Sarkadi
mesh_terms: D002675:Child, Preschool; D006801:Humans; D007804:Language Development; D007805:Language Development Disorders / Q000175:diagnosis; D008403:Mass Screening / Q000706:statistics & numerical data*; D019303:Multilingualism; D064689:Nurses, Public Health / Q000523:psychology / Q000706:statistics & numerical data*
keywords: Bilingual; Child health nurses; Child healthcare; Language development; Screening