BACKGROUND Difficult children are ones whose behavior deviates from the norm, which manifests as restlessness, violence, and difficulty in separating from the mother. Such problematic behaviors usually exhaust their parents during child rearing. This study aimed to identify individual and environmental factors that influence children's problematic behavior, which could be helpful in supporting parents' child rearing. METHODS Records of children's problematic behaviors and their individual or environmental information were collected from 8691 children at their 5-year-old health checks. Problematic behaviors were divided into three categories; anxious behaviors, developmental behaviors, and personal habits. Individual factors included sex, parental age, birth order, birth weight, and birth abnormalities. The environmental factors were mother's smoking during pregnancy or currently, partner's cooperation in child rearing, having someone to consult about child rearing, and television viewing time. Using logistic regression, we identified the association between such behaviors and aggravating factors. RESULTS Problematic behavior was identified in 2.2%, 11.5%, and 16.1% of cases, respectively, with regard to anxious behaviors, developmental behaviors, and personal habits. The individual factors (including birth order and birth abnormality), and the environmental factors (including mothers currently smoking, lack of someone to consult about child rearing, and long television-watching time) were associated with the odd ratio of increased risk for some problematic behaviors. CONCLUSION Behaviors in difficult children are not influenced by individual factors but by several environmental factors. To reduce the parental child rearing burden, health providers should be aware of these aggravating factors.

中文翻译：

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困难儿童问题行为与个体/环境因素的关联

背景困难儿童是指行为偏离常态的儿童，表现为烦躁、暴力、难以与母亲分离。这种有问题的行为通常会让他们的父母在抚养孩子的过程中筋疲力尽。本研究旨在确定影响儿童问题行为的个人和环境因素，这可能有助于支持父母抚养孩子。方法从8691名5岁儿童健康检查中收集儿童问题行为记录及其个人或环境信息。问题行为分为三类；焦虑行为、发展行为和个人习惯。个体因素包括性别、父母年龄、出生顺序、出生体重和出生异常。环境因素为母亲孕期或当前吸烟、伴侣育儿配合、育儿咨询、看电视时间等。使用逻辑回归，我们确定了此类行为与加重因素之间的关联。结果 在焦虑行为、发展行为和个人习惯方面，分别有 2.2%、11.5% 和 16.1% 的病例出现问题行为。个体因素（包括出生顺序和出生异常）和环境因素（包括母亲目前吸烟、没有人咨询育儿问题、看电视时间长）与某些问题风险增加的奇数比有关。行为。结论 困难儿童的行为不受个体因素的影响，而是受多种环境因素的影响。为了减轻父母抚养孩子的负担，卫生服务提供者应该意识到这些加重因素。