Many children receive attention-deficit hyperactivity disorder (ADHD) medication, but factors that determine medication prescription are largely unknown. This study aimed to determine the relative impact of factors on the child, family and general practitioner (GP) practice level on ADHD medication prescription. We included 1259 Dutch children aged 6–18 years with a diagnostic code of ADHD or related behavioural problems (ICPC codes P20-P22) in NIVEL primary care database. Using multilevel analyses, we examined predictors of ADHD medication prescription. Children diagnosed as ‘hyperactive’ were 16 times more likely to be prescribed ADHD medication than those with ‘behavioural concerns’. Children with a parent or sibling receiving ADHD medication were three to four times more likely to be prescribed ADHD medication themselves. Children from GP practices with a high percentage of children with ADHD were twice as likely to be prescribed ADHD medication. Concluding, factors on the individual, family and GP practice level determine ADHD medication prescription. Future research into the decision-making process for ADHD medication is warranted.
The aims of our pilot study were to test (1) the effectiveness of tactile stimulation by fathers on their infants’ physiological responses such as oxygen saturation levels, heart rates (HRs), and respiration rates (RRs) and (2) fathers’ perceived levels of attachment to infants in the neonatal intensive care unit (NICU). This was a quasi-experimental design using a control group, which assessed pre- and post-intervention differences via t tests. Twenty neonate–father dyads participated in the intervention and 20 neonate–father dyads populated a control group from one general hospital located in South Korea. Infants in the experimental group received tactile stimulation for one 10-minute period per day, for five consecutive days. Overall, we found that tactile stimulation by fathers significantly stabilized infants’ physiological status, including oxygen saturation levels, HRs, and RRs (t = 2.138, p = .039; t = –2.348, p = .024; t = –3.461, p = .001, respectively) with effect size ranged 0.67–1.10 and increased paternal attachment levels (t = 3.982, p = .001) with large effect size (1.29). This pilot study suggests that tactile stimulation by the father may be regarded as an important and potentially useful intervention for the care of infants in the NICU.
Restraint is often perceived as necessary to ensure that medical procedures are carried out safely. The limited research into nurses’ perceptions of restraint practices with hospitalized children hinders understanding the extent of the problem. A survey design was used to investigate nurses’ perceptions of restraint use from five units in one children’s hospital in Ireland. Findings revealed that restraint is a common practice, with physical and psycho- logical restraints most commonly used and newborn to 4-year-old children most likely to be restrained. Restraint was most often used for cannulation and latterly for administering medication and preventing interference to intravenous lines. To promote the use of thera- peutic holding for the safe delivery of procedures, nurses require education and skills training. Restraint should only be used as a last resort and in all situations, nurses should assess the need to use restraint and explore any alternatives in order to gain the child’s cooperation. More research is needed into the situational variables that can lead to restraint usage in order to identify learning needs and promote the use of alternative interventions.
Evidence has shown the implementation of medical home model improves care quality and outcomes. However, it is not clear whether receiving care from a medical home has any impact on racial/ethnic disparities in emergency department (ED) use by children with asthma. This study using the US National Survey of Children with Special Health Care Needs, 2009–2010, estimated racial/ethnic disparities in ED use. Generalized liner models were used to examine factors associated with ED use. Racial/ethnic differences in ED use were attenuated after adjusting for socio-economic variables. Ratios of prevalence ratios were calculated to examine the effect modification of medical home on ED use associated with race/ethnicity. The adjusted prevalence ratio of ED use of the Black to non-Hispanic White was 1.51 (95% confidence interval (CI): 1.36–1.67) with medical home and 1.35 (95% CI: 1.24–1.47) without medical home. Among those with care from a medical home Latino children had higher ED use compared with White children. There is no evidence that the self-reported care from a medical home narrows the gaps in ED use between non-Hispanic White and Black or Latino children with asthma.
Home visiting is an evidence-based strategy used to enhance child and family health outcomes. Such primary healthcare endeavours demand the full participation of individual and families. We conducted a review to identify approaches to planning, executing and assessing home-visiting health promotion interventions to determine how parents and children can be best engaged. A structured search (2000–2015) was undertaken using a defined search protocol. The quality of the papers was assessed using standard appraisal tools. Sixteen studies were retrieved. A content analysis of the findings sections of the papers was undertaken and guided by the eight phases of the PRECEDE-PROCEED health promotion planning framework. The analysis found that while all the PRECEDE assessment areas were represented no studies included all phases. Parents and children did not appear to be actively involved in undertaking the assessments and evaluation of the home-visiting health promotion programmes. The findings suggest that there is a need to develop a consistent home-visiting approach that includes comprehensive assessments in the planning phases and parent and child involvement at each step of programme development, implementation and evaluation. This approach enables the development of tailored and sustainable health promotion intervention in order to achieve optimal child health outcomes.
Last-minute cancelation of planned surgery can have substantial psychological, social, and economic effects for patients/families and also leads to wastage of expensive health-care resources. In order to have a deeper understanding of the contextual, psychological, practical, and behavioral factors that potentially impact pediatric surgery cancelation, we conducted a qualitative study to create ‘personas’ or fictional portraits of parents who are likely to cancel surgery. We conducted in-depth qualitative interviews with 21 parents of children who were considered ‘at risk’ for surgical cancelation and whose scheduled surgery was canceled at late notice. From the themes, patterns, and associated descriptive phrases in the data, we developed and validated five different personas of typical scenarios reflecting parent experiences with surgery and surgery cancelations. The personas are being employed to guide contextualized development of interventions tailored to prototypical families as they prepare and attend for surgery.
Five years ago, we published a commentary in the Canadian Medical Association Journal arguing that inadequately managed pain in children should be considered an adverse event, a harmful patient outcome. We argued that inadequately managed pain meets the definition of an adverse event and further hypothesized that treating pain as an adverse event may improve care by raising health care administrators and quality improvement experts’ awareness of this issue. In this article, we reflect on the progress made in both moving this proposition forward and testing out the concept. We then move on to look at what still needs to be done to ensure that children’s pain is managed effectively.
This article reviews the literature on the effects of living in a disenfranchised community for low-income African American children who have asthma. The review focuses on social integration, social network, interactions with parents, and limited cultural resources, which lead to negative health outcomes among these children.
In this article, we argue for a conceptual move from family-centred care (FCC) to a child-centred care approach and the implications for clinical nursing practice. Firstly, we argue that the parents and professional dominance constructs an asymmetric relationship towards the child, which may take away the focus from the child; Secondly, we need to renew efforts to promote the fundamental principles of protection, promotion and participation rights for children and young people according to the United Nations Convention on the Rights of the Child declaration and thirdly, we need to strengthen the child’s perspective and to view the child as an agent representing own experiences and wishes to be respected and negotiated.
The study focuses on the parents of children who were affected by narcolepsy after a pandemic influenza and vaccination campaign in Finland. The main aim of the study was to clarify parents’ expectations and perceived support from the intervention and to assess their need for additional support. The data were gathered using questionnaires. Fifty-eight parents answered the baseline questionnaire and 40 parents the final questionnaire. Parents’ expectations of and perceived support from the intervention mainly related to peer support. The intervention offered an arena for sharing information and experiences and provided encouragement for coping in everyday life. Many expectations were not met, especially those concerning information about needed services, financial benefits and availability of local support. The results highlight that for persons with rare disorders and their families, an inpatient psychosocial intervention can offer an important arena to receive both informal and professionally led peer support. Comprehensive psychosocial and other support services are also needed in the community. Listening to parents’ perspectives on the intervention and perceived support can help to establish multiform family-centred support for families with children affected by a rare chronic disabling condition.
Misuse of antibiotics is largely responsible for the emergence of bacterial resistance. Children represent a subset of the population who frequently receive antibiotics. The objectives were to calculate the frequency of antibiotic prescriptions that do not comply with best practice recommendations in paediatrics primary care and to examine the thoughts and feelings of physicians and parents about antibiotic prescription and recommendations from the national health authorities. We included children admitted at the paediatric emergency room (PER) of the NANTES university hospital between June 2011 and October 2012 and who were under antibiotic drugs. Two independent experts evaluated the compliance with the national recommendations. Parents and general practitioner (GP) who prescribed the antibiotic before admission to PER were called to collect their thoughts and feeling about antibiotic prescription. The median age of the 88 included children was 2.8 years. The upper respiratory tract infection motivated the prescription of antibiotic in 59%. Seventy-six per cent of the prescriptions analysed were inappropriate, 72% of the antibiotics had a too broad spectrum, and one-third was not indicated. Ninety-one per cent of the interviewed parents thought that the antibiotic prescribed to their child was adequate. Among the 77 prescribing GP who were called, 33% agreed that they lacked time during consultation to explain to parents that no antibiotics were required. Antibiotic prescriptions were too often inadequate in this sample of children admitted in a French PER. Efforts have to be made with physicians and general public to optimize the antibiotic drug use.
Child health literacy is a ‘hot topic’ of late, as researchers and practitioners work to attain an equitable and healthy future. Health literacy emphasizes the wide range of skills that people need to access, understand, evaluate and use health information to promote good health. In light of the recognition that health literacy is an important determinant of health for adults, addressing child health literacy early on is essential to maximize future health outcomes. Meeting children’s specific needs arguably includes the delivery of information that can be easily accessed and understood by younger age groups. While much academic discourse pertains to the importance of building parental health literacy, there is less literature that explicitly focuses on child-centred health literacy. On the premise that health literacy is an asset, this paper provides an argument for investing in children’s health literacy by working with children to encourage meaningful contributions in research and practice.
Our primary objective was to gather perspectives of children diagnosed with juvenile idiopathic arthritis (JIA) and their parents as they relate to physical activity (PA) participation. To do so, we conducted a study on 23 children diagnosed with JIA and their parents (N = 29). We used convenience sampling to recruit participants and qualitative method- logies (one-on-one semi-structured interviews). We adopted a five-step framework analysis to categorize data into themes. Children and their parents described factors that act to facilitate or hinder PA participation. Pain was the most commonly highlighted PA barrier described by children and their parents. However, children who were newly diagnosed with JIA and their parents were more likely to highlight pain as a barrier than were child/parent dyads where children had been previously diagnosed.
This article presents a qualitative study realized in the Children’s University Hospital of Parma, Italy, aimed at observing the effects of the fictional narrative in the emotions of the young patients. The results showed that, especially by means of projection, identification and symbolization, the imagination helps the children to elaborate in a positive way the bad emotions elicited by the experience of the disease and of the stay in hospital. Furthermore, the study was useful to the healthcare professionals in order to understand the emotive, cognitive and relational needs of the patients. We suggest the introduction of creative expression in the narrative medicine in addition to the autobiographical accounts, the questionnaires and the interviews in some particular care contexts.
Osteosarcoma (OS) typically occurs during puberty. The one-year treatment for OS can be very challenging. However, little empirical research has explored the experiences of adolescents with OS. This research explored the experiences of Taiwanese adolescents with OS, utilizing a qualitative inductive content analysis with in-depth interviews and field notes that captured interviewer observations. In total, 20 participants—aged between 10 and 19 years and being treated for OS—were recruited. Ten categories were extracted: disbelief, hope for recovery and maintaining body integrity, experience with physical symptoms, inappropriate sleep hygiene, experience of psychosocial distress, use of spirituality to recover from misfortune, information acquisition, preparation to return to school, interdependence, and dedication to hope of recovery. This is the first empirical qualitative study to explore the experiences of Taiwanese adolescents with OS during treatment since being diagnosed. Close surveillance of the compliance in rehabilitation and physical function is needed. Providing age-appropriate and culture-oriented support systems would be helpful for addressing their psychosocial difficulties. Social networking sites closely moderated by health professionals may be a feasible way enhancing psychosocial well-being. Conducting a descriptive exploratory qualitative study for further development of psychosocial supportive care interventions is recommended.
The capacity of children to act as agents is being increasingly recognized and has important implications for health research and practice. However, there are various discrepancies in how children’s agency is defined in the literature. The aim of this analysis was to examine the concept of children’s agency within the health-related literature, using Rodgers evolutionary method. The following questions were addressed: How did the concept of agency become associated with children in the health-related literature? What are the sociocultural and legal contexts that surround the concept of children’s agency? What is the meaning of children’s agency? Forty-five articles were included in the analysis. An inductive approach was used to identify the attributes of children’s agency as well as the temporal, disciplinary, and paradigmatic trends in its conceptualization. The concept of children’s agency first appeared in the health literature in the 1980s and was defined as an ability children could gradually develop. Later on, children’s agency was used to refer to the capacity of all children to influence their own and others’ health-care needs and is now increasingly used to refer to children as active agents who reflect on and construct their social worlds.
The United Nations Convention on the Rights of the Child has inspired numerous initiatives to recognize children’s health-related rights. Whereas children’s rights have served as the dominant moral framework for child health concerns in Europe, pediatric bioethics has emerged as the principal framework used in North America. Despite their similarities, these two frameworks differ significantly. Children’s rights initiatives tend to be universalists, highlighting substantive standards for all children, while pediatric bioethics has developed norms, models, and procedures for the ethical analysis and management of individual cases. The aim of this article is to critically examine the respective contributions and intersections of children’s rights and pediatric bioethics moral frameworks in child health. We describe our collaboration bridging our work with these two frameworks to address pediatric health-care concerns in the Republic of Georgia. We conclude with recommendations for how the complementarity of these two frameworks can be further bridged and promoted internationally.
This article reports findings from a process and impact study of a residential early parenting centre programme in Australia. The programme supports parents with young children under the age of three, referred from health and child protection services. Multiple sources of data were used from interviews, focus groups, direct observations, observer notes and a parenting sense of competence questionnaire. Qualitative data were analysed using thematic analyses, and paired t-tests were used to test data from the questionnaire. Three themes emerged from thematic analysis of the qualitative data: engaging families, building parenting capacity and transitioning back to the community. Parents’ perceptions of parent competence improved significantly between admission and discharge for participating families. Detailed accounts of the way in which nurses work to achieve positive outcomes in relation to parenting confidence and satisfaction in the short term have provided useful insights into often taken-for-granted support processes in working with referred parents. The complexity of the nurses’ role and implications for nursing practice in residential parenting centres are discussed. Future research is warranted to determine longer-term benefits of this programme being delivered in a residential early parenting centre.
The aim of this study was to explore the reactions of children aged 10–11 years towards being weighed and measured and subsequently told their correct weight as part of the National Child Measurement Programme (NCMP). The study was undertaken in primary schools in a Primary Care Trust (PCT) in the North East of England, UK. One-to-one semi-structured interviews were conducted post-NCMP measurement (and the feedback) with a sample of 21 children, aged 10–11 years, conveniently sampled from the primary schools in the PCT. Findings from the study indicate that the NCMP, especially the weight feedback letter caused annoyance, panic and worry among children who were indicated to have weight problems and oversensitised all children about weight issues, regardless of their weight category. The NCMP is a potentially useful ‘wake-up call’ to the fact that something needs to be done for children identified to be overweight or obese but needs to be delivered with a sensitivity to the impact of the news on the child.
The purpose of this study was to investigate the association between body mass index (BMI) status and physical performance in Brazilian children. The analyzed sample was composed of 978 children of both sexes (518 boys and 460 girls), aged 7 to 11 years. BMI and skinfolds were measured, and three motor tests were applied (flexibility, cardiorespiratory fitness, and muscular strength/endurance). In both sexes, overweight/obese children presented poor performance in all motor tests, except flexibility. In general, overweight/obese children have an increased odds ratio (OR) to present poor physical performance (boys: OR = 3.64 for cardiorespiratory fitness, OR = 1.94 for muscular strength/endurance, OR = 1.52 for flexibility; girls: OR = 5.03 for cardiorespiratory fitness and OR = 2.62 for muscular strength/endurance). In conclusion, for both sexes, a poor physical performance in the tests measuring cardiorespiratory fitness and muscular strength/ endurance was associated with the presence of overweight/obesity.
The aims of this study are to: (1) examine the preliminary utility of the Self-Management and Research Technology (SMART) pilot project, (2) identify which adolescents were most likely to benefit from participation, and (3) examine interview feedback to inform future program iterations. Twenty-three adolescents (M age = 15.13 years) were enrolled in the six-week text message pilot program consisting of daily interactive blood glucose (BG) prompts and type 1 diabetes-related educational text messages. Medical charts were reviewed for hemoglobin A1c and to corroborate medical record and demographic data. Glucometer data were downloaded to calculate an average monthly BG level and daily BG monitoring frequency. No statistically significant improvements were observed pre-intervention to post-intervention in glycemic outcomes. Participants with a high text message response rate were more likely to demonstrate improvement in average monthly BG levels and daily BG monitoring frequency than those with a low text message response rate. Participants reported satisfaction with the text message program. The text message-based SMART pilot project demonstrated preliminary efficacy for a targeted subset of adolescents who were engaged with the program. Continued research with a larger sample and longer trial duration is warranted to evaluate the potential utility of text message-based interventions.
Venepuncture and other needle-related procedures can distress children and have a lasting negative impact. Adults’ behaviour during these procedures may affect children’s reactions. However, the literature is contradictory and rarely considers verbal and non-verbal behaviour together. This study therefore examined the effect of adults’ verbal and non-verbal behaviour on children’s distress during venepuncture. Participants comprised 51 child and carer dyads and 10 staff members. Child anxiety was measured before the procedure. The procedure was recorded. The resulting audio-visual data were coded using the Child–Adult Medical Procedure Interaction Scale–Revised. Correlation analysis identified variables that were significantly associated with child distress: child anxiety, carer distress-promoting behaviour, staff distress-promoting behaviour and intimate distance. These were included in a path diagram of child distress. Exploration of the diagram identified that children’s anxiety was mostly strongly associated with children’s distress during venepuncture. Staff and carer behaviour did not increase children’s distress. The results suggest interventions to reduce children’s distress during venepuncture may be more effective if they focus on reducing children’s anxiety beforehand.
Autism spectrum disorder (ASD) is being more recognized and diagnosed in developing as well as developed countries. We aimed to investigate the frequency of anxiety, depression, and quality of life in mothers of children with ASD in Iranian families. We conducted a descriptive cross-sectional study on demographic data and mental health characteristics of 127 mothers of children with ASD. Mothers of children with ASD had high levels of anxiety (72.4%), depression (49.6%), and low scores of health-related quality of life (HRQOL). There was strong association between the child’s age and the severity of mother’s depression and QOL. Duration since diagnosis of ASD positively correlated with maternal depression. Anxiety, depression, and low HRQOL are more common in Iranian mothers with autistic children in our study. Our findings have implications for further investigation in mental health status of mothers of children with ASD, and providing educational support and interventional strategies may improve the mental health status of the entire family.
The aim of this study was to analyze the association between risk behaviors and adiposity indicators in adolescents and to discuss some methodological aspects related to this relationship. We evaluated 1,321 adolescents (55.2% female) aged 10–16 years. Relative body fat (%fat) by measurement of triceps and subscapular skinfold thickness and waist circumference (WC) were used as total and central adiposity indicators, respectively. Physical inactivity, time spent in front of the TV, the consumption of soda and/or chocolate, alcohol, and tobacco smoking were analyzed as risk behaviors. Information about the socioeconomic status (categorized into three levels) and nutritional status of the mother (overweight or normal weight) were used as adjustment factors in the analyses of prevalence ratio (PR) of the outcomes and their associated 95% confidence intervals (95% CI). The chi-square test and Poisson regression were used for statistical analyses. Low associations were found between risk behaviors and adiposity indicators. Tobacco smoking was the most positively correlated behavior with adiposity in girls (%fat: PR = 1.61; 95% CI = 1.04–2.47; WC: PR = 1.90; 95% CI = 1.17–3.08) and in adolescents whose mothers were normal weight (%fat: PR = 2.31; 95% CI = 1.33–4.03; WC: PR: 2.31; CI: 1.19–4.46). Additionally, as an important methodological issue, we highlighted the assessment of risk behaviors in adolescents as crucial to producing more robust evidence on the subject. Of the investigated behaviors, we concluded that tobacco smoking is the behavior most associated with adiposity indicators.
To promote the growth and development of premature infants, effective and tender care is required in neonatal intensive care units (NICUs). The purpose of this study was to test the potential effects of massage therapy on increasing physical growth and promoting gastrointestinal function in premature infants. Twenty subjects were divided into two groups in the NICU of one general hospital located in South Korea. The experimental group (n = 10) were given massage therapy and the control group (n = 10) received routine care. Massage therapy was performed twice daily for 14 days, for 15 minutes per session. In the physical growth, height and chest circumference were significantly increased in the experimental group. In assessing gastrointestinal function, frequency of pre-feed gastric residual was significantly decreased and numbers of bowel movements were significantly increased in the experimental group. This study showed massage therapy has the potential effects on increasing physical growth and gastrointestinal function in premature infants. The massage in the NICU might be utilized as a part of developmental care, but more research needs to be done. NICU nurses need to be trained in massage therapy techniques to provide more effective clinical care for premature infants.
Studies on parents’ participation in care of a hospitalized child are rare and have not sufficiently addressed the factors prompting parents’ participation in their child’s care. This study investigated the relative contributions and predictive value of parents’ and children’s demographics on parents’ participation in care. A convenience sample of 294 parents participated from four major hospitals in a metropolitan area in Amman. Parents completed two sets of measures, a socio-demographic form and the Arabic version of the Index of Parent Participation/Hospitalized Child. A series of bivariate analyses were completed to investigate associations between socio-demographic variables and parents’ participation in care. The multiple regression analysis identified four variables as the optimal set of predictors for parent participation in the care of a hospitalized child: hospital experience, type of illness, child’s age and type of hospital. The importance of interpreting these findings in a cultural context is discussed.
The identification of clinical indicators with good predictive ability allows the nurse to minimize the existing variability in clinical situations presented by the patient and to accurately identify the nursing diagnosis, which represents the true clinical condition. The purpose of this study was to analyze the accuracy of NANDA-I clinical indicators of the nursing diagnosis ineffective airway clearance (IAC) in children with acute respiratory infection. This was a prospective cohort study conducted with a group of 136 children and followed for a period of time ranging from 6 to 10 consecutive days. For data analysis, the measures of accuracy were calculated for clinical indicators, which presented statistical significance in a generalized estimated equation model. IAC was present in 91.9% of children in the first assessment. Adventitious breath sounds presented the best measure of accuracy. Ineffective cough presented a high value of sensitivity. Changes in respiratory rate, wide-eyed, diminished breath sounds, and difficulty vocalizing presented high positive predictive values. In conclusion, adventitious breath sounds showed the best predictive ability to diagnose IAC in children with respiratory acute infection.
Sleep problems in children and adolescents are a significant public health concern and may be linked to a variety of psychoemotional difficulties. This study aimed to evaluate sleep quality and associated factors in conflict-affected Georgian adolescents after 9 months of forced displacement. Thirty-three internally displaced adolescents (mean age 11.4 years) and 33 adolescents (mean age 10.8 years) from the general population completed the Epworth Sleepiness Scale and the Children’s Depression Inventory (CDI). Parents completed the Children’s Sleep–Wake Scale and provided information on their socioeconomic status (SES) and the adolescents’ sleep behavior, academic performance, and peer social relationships. The groups differed significantly in sleep quality, peer relationships, SES, and CDI scores. In the internally displaced group, the only significant predictor of sleep quality was SES, which increased the predictive capacity of the model (demographic and psychosocial variables) by 20% in the hierarchical analyses. The most significant predictor in the non-internally displaced group was CDI. This research indicates that displacement may affect sleep quality and psychosocial functioning. The importance of family SES as a contributing factor to displaced adolescents’ poor sleep quality is highlighted. An integrated approach designed to improve the psychosocial environment of internally displaced adolescents is needed for their protection.
Expectations prior to needle-related procedures can influence individuals’ decision making and compliance with immunization programmes. To protect from human papilloma virus (HPV) and cervical cancer, the immunization needs to be given before sexual debut raising interest for this study’s aim to investigate how 11 to 12-year-old girls narrate about their expectations prior to HPV vaccination. A total of 27 girls aged 11 to 12 years participated in this qualitative narrative study by writing short narratives describing their expectations. The requirement for inclusion was to have accepted HPV vaccination. Data were subjected to qualitative content analysis. Findings showed the following expectations: going to hurt, going to be scared and going to turn out fine. The expectations were based on the girls’ previous experiences, knowledge and self-image. The latent content revealed that the girls tried to transform uneasiness to confidence. The conclusion drawn from this study is that most girls of this age seem confident about their ability to cope with possible unpleasantness related to vaccinations. However, nurses need to find strategies to help those children who feel uneasy about needle-related procedures.
Utilization of community health centres for child health care instead of hospital outpatient clinics is being promoted in China. To evaluate breastfeeding rates and health outcomes of infants who received health care from hospital outpatient clinic or community health centre, a prospective cohort study with six months follow-up was undertaken in Chengdu, China. Participants were 845 mothers and their infants, 417 receiving care from one hospital and 428 from five community health centres. The ‘any breastfeeding’ rates at one and three months post-partum were significantly lower (p < 0.01) in the hospital outpatient clinic (84% and 68%) than community health centres (92% and 78%). The presence of common illness problems was similar, though the prevalence of lower respiratory tract infection was significantly higher in the hospital group (14.6% vs. 6%, p < .01). No difference in infant growth was observed between the two groups. The results support continuing expansion of child health-care services through community health centres in China.
School entry provides an opportune moment for health professionals to intervene with children who are overweight, yet identification and management of childhood obesity presents challenges in practice. This multi-method qualitative study explored the experiences of 26 school health professionals in addressing childhood obesity at school entry. Methods included semi-structured interviews with service managers (n = 3); focus groups with school nurses (n = 12) and child health practitioners (n = 6); and open-ended questionnaires with school nurses (n = 4) and child health practitioners (n = 1) who were unable to attend the focus groups. A thematic analysis revealed agreement between service managers, school nurses and child health practitioners. Whilst it was felt school health professionals have an important role to play in managing childhood obesity, efforts to address child weight were limited by a lack of capacity, lack of clear protocols, challenges of engaging parents and insufficient training in childhood obesity and related lifestyle issues. School health policymakers need to recognize childhood obesity as a serious public health issue, allocate appropriate resources to nurse training and development and ensure clear pathways are established to ensure consistency of care.
Since the surgery for congenital heart disease (CHD) is considered highly risky, appropriate postoperative care is crucial. After the surgery, children are often discharged with unhealed wounds, incomplete recovery, and continuing pain. Health education programs based on empowerment education model can assist clients to develop skills in self-management. This study aimed to evaluate the effectiveness of an empowerment health education program for improving caregiving knowledge, caring behaviors, and self-efficacy of parents caring for children after corrective surgery for CHD. This prospective clinical trial enrolled pediatric patients undergoing surgical correction for CHD. Patients were divided into two groups: the control group (n = 42), which received the standard education program, and the intervention group (n = 44), which participated in the empowerment theory-based education program. We collected data on left ventricular ejection fraction (LVEF); peripheral oxygen saturation (SpO2); New York Heart Association classification of the patients; and the parents’ caregiving knowledge, caring behaviors, and self-efficacy before surgery and one month and three months after surgery. At one month and three months after surgery, the intervention group scored higher than the control group in caregiving knowledge, caring behavior, and self-efficacy. By the third month after surgery, the intervention group had significantly higher values of LVEF and SpO2 than the control group.
Delays in child growth or development are significant problems for children, their families and population health. Eliciting parental concerns as early as possible to promote child growth and development requires close collaborative working with parents. There is evidence that parents delay expressing concern and that health-care professionals are not always effective at eliciting and attending to parental concerns. The aim of this study was to understand the experiences of parents of preschool children who had expressed a child growth or development concern. An Interpretative Phenomenological Analysis (IPA) study design was used with a purposive sample of parents of 15 preschool children in Ireland. Data were collected by semi-structured interviews and analysed using IPA. One key superordinate theme – Uncertainty – ‘a little bit not sure’ captured how parents made sense of their concerns about their child’s growth and development. In addition to watching, comparing and wondering, parents assessed whether their child could ‘do other things’ or if something in particular could have caused the growth or development problem. Parents, particularly mothers, grapple with uncertainty associated with unfamiliar cues in the complex and multifaceted nature of child growth and development in their efforts to make sense of what is happening with their child.
Children participating in research, like other children, may be being maltreated. There is also potential for exposure to abuse during research. Research training, practices and protocols to respond to disclosure and discovery of abuse to protect both researchers and children may not be sufficiently robust. Our aim was to compare and contrast research practices reported in the literature related to protecting children and to recommend safer ways to conduct research. The simultaneous increase in research with children, along with an increased willingness to listen to child victims of abuse, means that researchers must consider the protection of children in the research setting. Twenty-three papers were identified in a literature review. These studies reported a wide variation of ethical considerations, methods, methodology and came from different disciplines. From the 23 papers, two overarching themes were identified: social justice and research and safer research. To make research safer teams should consider training, safety protocols and support for child protection, which includes support to report safeguarding concerns to social care. Further work is required to ensure that training, protocols and support are effective in facilitating researchers to identify and make appropriate child abuse referrals. Ethics practices in abuse research need further debate.
This study aims to investigate of three different distraction methods (distraction cards, listening to the music of cartoon and balloon inflation) on pain and anxiety relief of children during phlebotomy. This study is a prospective, randomized, and controlled trial. The sample consisted of 6 to 12 years old children who require blood tests. Children were randomized into four groups as the distraction cards, the music, the balloon inflation, and the control. Data were obtained by conducting interviews with the children, their parents, and the observer before and after the procedure. The pain levels of the children were assessed by the parent and observer reports as well as self-report using the Wong-Baker FACES. The anxiety levels of children were assessed by parent and observer reports using Children Fear Scale. One hundred and twenty children (mean age: 9.1 ± 1.6 years) were included. The self-reported procedural pain levels showed significant differences among the study groups (p = .040). The distraction card group (2.33 ± 3.24) had significantly lower pain levels (p = .057) than the control group (4.53 ± 3.23). The procedural child anxiety levels reported by the observer showed a significant difference among the study groups (p = .032). All the forms of distraction significantly reduced pain and anxiety perception.
The study aimed to assess the prevalence of parental perceptions of a child’s vulnerability (PPCV) in a Dutch community-based sample and its relationship with children’s health and health-related quality of life (HRQoL). Parents completed the Child Vulnerability Scale and a socio-demographic questionnaire. The Pediatric Quality of Life Inventory 4.0 was administered to measure HRQoL. The prevalence of PPCV was assessed in relation to socio-demographic and health-related characteristics. In a three-step multiple hierarchical regression model, the mediational role of PPCV in the association between chronic illness and HRQoL was investigated. Participants were 520 Dutch children aged 5–18 years from nine Dutch schools. In all, 69 (13.3%) had a chronic illness; 1.9% was perceived vulnerable, 3.0% in groups 5–7 and 1.7% in groups 8–12 and 13–18. Younger age of the child, presence of a chronic illness and low HRQoL were associated with PPCV. PPCV partially mediated the negative association between chronic illness and HRQoL. In conclusion, PPCV is associated with adjustment to chronic illness. More research is needed regarding the mechanisms through which PPCV affects HRQoL and to examine whether PPCV can be targeted in parenting interventions.
Childhood immunizations are invaluable in preventing contagious diseases. Nonetheless, vaccines have become increasingly controversial with growing numbers of caregivers refusing to vaccinate their children. The percentage of fully vaccinated children in Vermont is one of the lowest nationally. This study set out to determine Vermont caregivers’ attitudes toward immunizations to better explain why the percentage of fully vaccinated children has fallen in Vermont. A survey regarding caregivers’ health care knowledge about children, their vaccination concerns, and their children’s vaccination status was sent to participants in the Vermont Women, Infants and Children’s Program from two districts. In total, 83% (n = 379) of respondents reported their children received all recommended vaccinations for their age. Respondents who considered themselves highly knowledgeable regarding their children’s health care and confident about the safety of vaccinations were significantly associated with reporting their children as being current on vaccinations and with their intent to continue vaccinations. Respondents indicated highest concern regarding the safety and number of vaccinations administered during one visit. Primary care providers were indicated as important resources for addressing concerns about vaccinations and health care knowledge of children. The results help to understand low vaccination rates in Vermont and can be used for targeting health campaigns to improve vaccination rates.
Improved life-sustaining technology in the neonatal intensive care has resulted in an increased probability of survival for extremely premature babies. In the neonatal intensive care, the condition of a baby can deteriorate rapidly. Nurses and parents are together for long periods at the bedside and so form close and trusting relationships. Neonatal nurses as the constant caregivers may be presented with contradictory demands in attempting to meet the baby’s needs and being a patient and family advocate. This article aims to explore the issues arising for neonatal nurses when holding information about changes to a condition of a baby that they are unable to share with parents. Data were collected via interviews with 24 neonatal nurses in New South Wales, Australia. A qualitative approach was used to analyse the data. The theme ‘keeping secrets’ was identified and comprised of three sub-themes ‘coping with potentially catastrophic news’, ‘fear of inadvertent disclosure’ and ‘a burden that could damage trust’. Keeping secrets and withholding information creates internal conflict in the nurses as they balance the principle of confidentiality with the parent’s right to know information. The neonatal nurses experienced guilt and shame when they were felt forced by circumstances to keep secrets or withhold information from the parents of extremely premature babies.
This article aims to share critical debate on undertaking interviews with children in the home setting and draws on the authors’ extensive research fieldwork. The article focuses on three key processes: planning entry to the child’s home, conducting the interviews and exiting the field. In planning entry, we include children’s engagement and issues of researcher gender. In conducting the interviews, we consider issues such as the balance of power, the importance of building a rapport, the voluntary nature of consent and the need for a flexible interview structure. Finally, we address exiting from the child’s home with sensitivity at the end of the interview and/or research study. Undertaking research in the child’s home provides a known and familiar territory for the child, but it means that the researcher faces a number of challenges that require solutions whilst they are a guest in a child’s home.
Evidence-based practice (EBP) is challenging for most nurses due to the time constraints of caring for patients and the emerging pressures of a changing health service. To explore these challenges, and thus to establish possible means of overcoming them, three focus groups (n = 17) with children’s nurses were conducted. Participants were asked how they would define EBP, what the barriers to EBP were, what skills they needed to help access evidence and how they could integrate evidence into everyday practice. Data were analysed thematically and the anticipated themes of definitions of EBP, barriers, education and nursing culture were determined. Important subthemes were personal and employer disengagement, passivity and lack of resource utilisation. Passive use of evidence readily available in patient folders and on the wards was common. It seemed that little consideration was given to how often this evidence was updated. Nurses define their access to evidence as primarily passive in nature. This is reinforced by a lack of ready access to ongoing education and a perceived lack of investment at institutional level in their continued engagement with evidence. Promoting EBP needs to engage more with those ritual and traditional aspects of nursing culture to challenge these perceptions.
The purpose of this study was to investigate the effects of prenatal Qi exercise on mother–infant interaction and the behavioral state of the infant. A prospective, quasi-experimental design was used in 70 healthy pregnant women of more than 18 weeks of gestation. Pregnant women in the intervention group received 90 minutes of prenatal Qi exercise twice a week for 12 weeks. Prenatal Qi exercise group’s Nursing Child Assessment of Feeding Scale scores was higher in mother’s sensitivity to cues, responses to distress, socioemotional growth fostering, and cognitive fostering and for children in responsiveness. There was no significant difference in Anderson Behavioral State Scoring System scores between groups. The results suggested that prenatal Qi exercise is a valuable approach to positively influence mother–infant interaction postdelivery.
Children experience moderate to severe pain post-operatively. Nurses have been found to have a variety of aims in this context. Surgeons’ aims when managing post-operative pain have not been explored. This qualitative study set out to explore paediatric surgeons’ aims when managing post-operative pain in one paediatric hospital in Canada. Consultant surgeons (n = 8) across various specialities took part in semi-structured interviews. Surgeons’ overarching aim was to keep the child comfortable. Various definitions of comfortable were given, relating to the child’s experience of pain itself and their ability to undertake activities of daily living. Children’s behavioural pain cues seem to be a primary consideration when making treatment decisions. Parents’ views regarding their child’s pain were also seen as important, suggesting children may not be seen as competent to make decisions on their own behalf. The need to maintain a realistic approach was emphasised and pain management described as a balancing act. Surgeons may draw on both tacit and explicit knowledge when assessing children’s pain. There appears to be an expectation among surgeons that some pain is to be expected post-operatively and that the diagnostic value of pain may, in some cases, supersede concerns for the child’s pain experience.
The purpose of this research was to describe the biopsychosocial characteristics of adolescents with chronic pain and functional disability. Data were obtained from a registry of 100 adolescents (mean age = 15.84, SD = 2.72; 21 males) admitted to an interdisciplinary pain rehabilitation program. Clinician ratings were used to categorize coping and personality styles. The most common chief complaint at admission was limb pain (n = 44), followed by headache (n = 21) and abdominal pain (n = 17). Eighteen patients presented with other types of pain. The most frequent triggers to pain were physical trauma, medical condition or disability, and surgery or another medical procedure. Sleep problems, mental health difficulties, and high academic performance were common. Seven previously identified pain-associated disability factors, including passive or dependent coping style, chronic illness in a parent, personality consistent with alexithymia, unresolved family problems, early pain experiences, learning/developmental difficulties, and perfectionistic personality, were common. Ninety-eight adolescents presented with two or more of these contributing factors. Fifty-six adolescents had four or more of the factors. Adolescents with chronic pain and associated disability presented with numerous biopsychosocial factors that relate to their impairment. The understanding and attention to these factors will be important for successful rehabilitation.
The objective of this study was twofold: First, to conduct a confirmatory factor analysis of the Portuguese versions of Disabkids-10; and second, to examine potential differences in factor structures between age-groups, genders, and informants. The sample included 293 school-aged children and adolescents with chronic health conditions and 197 parents. Both family members (whenever possible) completed the self- and proxy-report versions of Disabkids-10. The factorial model of Disabkids-10 had good fit for self-reported data and minimally acceptable fit for proxy-reported data. The multigroup analyses confirmed the model invariance across age-groups (children vs. adolescents), genders (boys vs. girls), and informants (children vs. parents). The generic developmental applicability of these questionnaires makes them recommended for health care routine assessments on pediatric intervention needs and outcomes.
To support children with chronic diseases, reference values to measure developmental changes in self-perception and self-esteem are considered a useful yardstick. To develop reference values to measure self-perceived competence and self-esteem in Japanese children, the Children’s Perceived Competence Scale (CPCS) was administered to 768 children of elementary school grade 1 (6 years) to grade 6 (11 years) at four public schools in Japan, from November to December 2012. After excluding 74 with chronic diseases and/or incomplete responses, 694 children were included. CPCS measures children’s self-perceived competence in cognitive, social, physical domains, and general self-worth, namely self-esteem. There was a tendency for scores of cognitive and general self-worth to decrease with increasing grade. Scores among grade 5 respondents were significantly lower than those among grade 4 respondents for both social and physical domains. Scores among boys and girls differed significantly, with boys scoring higher for physical domain in grades 3 and 6 and for general self-worth domain in grade 6. The CPCS reference values to measure self-perceived competence and self-esteem in Japanese children were developed in this study. These reference values are useful to inform practitioners supporting children with psychological or psychiatric problems or those with chronic diseases.
Every day, thousands of children suffer the effects of chronic health conditions and families struggle with illness management and children’s behavioural and emotional adjustment. Many parents experience difficulties with their caregiving role and lack confidence in their ability to manage their child’s illness and ensure the child’s well-being. While there is consistent evidence as to the extent and impact of childhood chronic illness, there is a paucity of evidence-based parenting approaches to help children with chronic health conditions and their families. This paper provides a narrative review of the current literature to examine relationships between chronic childhood illness, emotional and behavioural disorders and parenting. Key guidelines and recommendations for the development of evidence-based parenting programs for parents of children affected by chronic health conditions are provided.
As a magnetic resonance imaging (MRI) examination lasts about 45 minutes and as the technique is sensitive to motion, children are often given sedation or anesthesia. The aim of this study was to examine whether children aged three to nine years could undergo MRI while awake and achieve adequate image quality if age-adjusted routines were used. A two-group controlled experimental design was used. Thirty-six children were assigned to a control group and underwent MRI with the prevalent routines. Thirty-three children were assigned to an intervention group and underwent the MRI while awake. The age-adjusted routine included a booklet and a story book, a model of the MRI scanner with the MRI sound, and a DVD film during the examination. In the control group, 30 children underwent the examination under anesthesia and 6 underwent the examination while they were awake. All had acceptable examinations. In the intervention group, 33 children had their examination while awake and 30 of them had acceptable examinations. The parents’ satisfaction with the care was assessed to be equal or higher in the intervention group and the costs were calculated to be lower. Thus, many children receiving age-appropriate preparation and distraction can undergo MRI examinations while awake.
There are several concerns in relation to children living with a parent suffering from a mental illness. In such circumstances, the health-care professionals need to involve the whole family, offering help to the parents on parenting as well as support for their children. These children are often helped by participating in meetings that provide them with contact with others with similar experiences. The aim of this study was to investigate young adults’ childhood experiences of support groups when living with a mentally ill parent. Seven young women were chosen to participate in this study. A qualitative descriptive method was chosen. The main category emerged as ‘the influence of life outside the home because of a parent’s mental illness’ from the two generic categories: ‘a different world’ and ‘an emotion-filled life’. The participants’ friends did not know that their parent was ill and they ‘always had to...take responsibility for what happened at home’. These young adults appreciated the support group activities they participated in during their childhood, stating that the meetings had influenced their everyday life as young adults. Despite this, they associated their everyday life with feelings of being different. This study highlights the need for support groups for children whose parents suffer from mental illness.
Physical activity contributes to children’s physical and mental well-being. Research suggests that active free play helps to maintain and increase physical activity in children and also contributes to social and emotional well-being. To date, these studies have focused on Western countries. Thus, this study was conducted to gain insights into the factors of perceptions of fun, barriers, and facilitators affecting active free play from the perspective of Japanese children using focus group interviews. In Japan, 12 focus groups were conducted with 60 children aged 9–11 years. Children’s perceptions of fun in active free play were categorized into socializing, achievement, emotions, and freedom. Additionally, active boys' groups were interested in free play and adventure play; girls' groups were interested in free play with less physical movement and challenges; inactive boys' groups were interested in relaxing and competitive play with bodily contact. However, children mentioned that busy schedules, weather, and health-related factors acted as main barriers. Lastly, children noted facilitators include setting schedules, having access to equipment and playgrounds, and holding special events. The findings provide insights into active free play-related factors for active and inactive Japanese children and also clarify the differences between Japanese and Western children. Such findings will contribute to designing interventions to increase active free play.
A narrative case study approach was used to collect a storied account from Joseph about his recollections and experience of the completed suicide of a family member with whom he lived with at 13 years of age. Data are presented longitudinally to capture Joseph’s perceptions and recollections of events leading up to, surrounding and following the suicide. Findings reveal that, as a child Joseph felt strong responsibility to keep his uncle safe and maintain his uncle’s life; and perceived a lack of support for himself and his family throughout the events. Today as a young man, Joseph remains profoundly affected by this suicide and the events surrounding it, and experiences flashbacks and intrusive thoughts, though his distress remains largely invisible to others. It is important that the acute and longer term needs of children affected by suicidality and suicide are recognised. We argue that increased awareness on the part of health professionals about the ongoing grief and distress surrounding suicide survivorship can create opportunities for opportunistic assessment and review of child survivor welfare.
Children with life-limiting and disabling conditions are surviving longer than previously, and many require palliative and supportive care, usually at home. Home-based care can put family life under considerable strain, as parents care for their child’s complex, often unpredictable, continuing care needs. Rainbow Trust Children’s Charity aims to bridge gaps in services for children with life-threatening or terminal conditions by providing family support workers (FSWs). The study used a range of methods (surveys, interviews and ethnographic observation) approach to explore key aspects of the work of the FSWs. The target population for the surveys was families with a child having complex, life-threatening or terminal conditions receiving care from FSWs. The participants included 55 families (12 bereaved) and 39 children aged 2–18 years. Thematic analysis revealed how the FSWs became a presence in families’ lives in three main ways: (1) encompassing and embracing families through supporting needs and promoting resilience; (2) befriending and bonding through developing knowledge, trusting relationships and a sense of closeness; and (3) accompanying and enduring by ‘being with’ families in different settings, situations and crises and by enduring alongside the families. The study demonstrated the fundamental importance of workers who are able to provide aspects of support that is usually not provided by other services.
Many children experience treatable moderate to severe pain following surgery. Increasingly, children undergo surgery as day cases, and, as such, parents are more likely to be responsible for managing pain post-operatively. Research in the United States and Finland has found parents fear the side effects of analgesics; think they are addictive; and that children should receive as little analgesia as possible. Little is known about parental attitudes in this context in the United Kingdom. This study set out to explore parental attitudes towards children’s pain and analgesic drugs to contribute to existing knowledge about parental attitudes elsewhere so that the information provided to parents can be tailored effectively. A convenience sample of parents (n = 108) at one hospital in South West London completed the Parental Pain Expression Perceptions and the Medication Attitudes Questionnaires. Although many parents have a good understanding of the ways in which children express pain, a substantial proportion of parents hold misconceptions regarding how children express pain and concerns in relation to analgesic drugs. This may impact on the quality of the pain management provided to children post-operatively and needs taking into account when preparing parents in this context.
Children with life limiting conditions and their families have complex needs. Evaluations must consider their views and perspectives to ensure care is relevant, appropriate and acceptable. We consulted with children, young people, their parents and local professionals to gain a more informed picture of issues affecting them prior to preparing a bid to evaluate services in the area. Multiple methods included focus groups, face-to-face and telephone interviews and participatory activities. Recordings and products from activities were analysed for content to identify areas of relevance and concern. An overarching theme from parents was ‘Why does it happen like this?’ Services did not seem designed to meet their needs. Whilst children and young people expressed ideas related to quality of environment, services and social life, professionals focused on ways of meeting the families’ needs. The theme that linked families’ concerns with those of professionals was ‘assessing individual needs’. Two questions to be addressed by the evaluation are (1) to what extent are services designed to meet the needs of children and families and (2) to what extent are children, young people and their families consulted about what they need? Consultations with families and service providers encouraged us to continue their involvement as partners in the evaluation.
The purpose of this study was to describe child health centre (CHC) nurses’ views of managing parental groups during early childhood. All 311 CHC nurses working within the Swedish CHC system in one county were asked to complete a web-based questionnaire. Findings showed that although the CHC nurses were experienced, several found group leadership challenging and difficult. The need for specialized groups for young parents, single parents and parents whose first language was not Swedish was identified by 57% of the nurses. The CHC nurses found the participation of fathers in their parental groups to be low (an estimate of 10–20%), and 30% of the nurses made special efforts to make the fathers participate. Education in group dynamics and group leadership can strengthen CHC nurses in managing parental groups. It is recommended that specialized parental groups are organized by a few family centres so CHC nurses can develop their skill in managing such groups.
This article reviews the literature on modifiable factors associated with mental health in siblings of children with chronic illness. Three clinical databases were searched. A total of 17 studies met the inclusion criteria. Several key themes emerged from the review. Better sibling mental health was associated with camp attendance, perceived parent/peer support, illness education and enhancing control through cognitive coping strategies and routine. Parental and sibling psychoeducation interventions and social support may enhance children’s mental health when their sibling has a chronic illness.
Family-centred care (FCC) has been well recognised, accepted and reported in the literature as an optimised way of caring for hospitalised children. While neonatal units strive to adopt this philosophy, published research suggests there are difficulties implementing FCC principles in daily practice. Appreciative inquiry (AI) is a philosophy and methodology that offers a unique, strength-based approach to promoting organisational learning and positive organisational change. As a participatory approach, AI facilitates change from the ground up and lends itself to building effective partnerships or collaborations. This article reports the findings of a one-day workshop using an AI methodology to bring neonatal nurses and parents together to enhance the FCC within a neonatal intensive care unit in Sydney, Australia. Participants (n = 15) developed collaborative insights of optimal FCC that can be built upon to support neonates and their families in the future. Shared visions were formed, strategies identified and a development plan made for ongoing collaborations and partnerships. AI provides a flexible framework that enables the mandatory collaboration needed to develop action plans that can form the catalyst for organizational change in health-care research and practice.
Background: In recent years, the age at which parents start and finish toilet training (TT) their children has increased. To cope with the problems caused by this later completion, it is essential to identify the beliefs and attitudes of the parents.
Methods: Two thousand questionnaires were distributed to parents of children aged 30 to 36 months, attending 50 randomly selected schools in Antwerp, Belgium.
Results: Too many children are toilet trained after the minimum school age of 30 months. Most parents are not aware of the possible negative consequences this can entail. Mothers with a paid occupation think more often that children should be toilet trained before the age of 30 months, and the higher the mother’s educational level, the more likely she will send her child to school toilet trained. More of single parents think that children who are not yet toilet trained should be allowed to go to school and more often send their not fully toilet-trained children to school.
Conclusion: Parents should be better informed about the possible negative consequences of a later completion of TT. Single parents, more than other parents, should be assisted in the TT process and offered more support.
In this ethically approved hermeneutic phenomenological study conducted in Ireland, mothers’ experiences in caring for children with complex needs were explored. The sample comprised mothers (n = 17) at home caring for children with complex needs. Data were analysed from multiple interviews (n = 48) and diary records (n = 11). Care is provided in a going between world of travel. Providing care when travelling is challenging, and all journeys require careful preparation and pre-emptive care. Few unnecessary journeys are undertaken. Unnecessary travelling could be avoided by careful and coordinated service planning.
In Kenya, as in other developing countries, diarrhea is among the leading causes of child mortality. Despite being easy to prevent and treat, care seeking for major child illnesses including diarrhea remains poor in the country. Mortality due to diarrhea is even worse in informal settlements that are characterized by poor sanitary conditions and largely unregulated health care system among other issues. The study aims to examine the health care seeking practices of caregivers of children under 5 with diarrhea in two informal settlements in Nairobi, Kenya. The article used data from a maternal and child health (MCH) prospective study conducted between 2006 and 2010. Results show that more than half (55%) of the caregivers sought inappropriate health care in the treatment of diarrhea of their child. Of the 55%, about 35% sought no care at all. Use of oral rehydration solution and zinc supplements, which are widely recommended for management of diarrhea, was very low. The critical predictors of health care seeking identified in the study are duration of illness, informal settlement of residence, and the child’s age. The study showed that appropriate health care seeking practices for childhood diarrhea remain a great challenge among the urban poor in Kenya.
Academics from a variety of disciplines claim that gender has an influence on men’s and women’s food choices and portion sizes at mealtime and snack time. While these socially constructed norms present health-related implications for both men and women, it is arguable that men have a greater risk of problems associated with overweight as a consequence of gendered food choices and dietary practices. This article reports on qualitative research data attained from Australian boys in early childhood and middle primary school years. The data were thematically analysed using inductive analysis. The voices of boys provide the opportunity to understand how gendered food choices, among males, emerge in contemporary Western culture. Such research can also potentially play a role in developing strategies to assist boys in making healthy food selection, which will ultimately assist their food-related health literacy as they move towards adolescence and adulthood.
South Asian (SA) children are less active but have enhanced metabolic risk factors. Physical activity (PA) is a modifiable risk factor for metabolic disease. Evidence suggests that environmental factors and socio-economic status influence PA behaviour. The purpose of this study was to understand PA environments, barriers and facilitators of PA in deprived environments for children from SA backgrounds. Focus groups were conducted with 5 groups of children aged 7–9 years (n = 33; male = 16, female = 17; SA = 17, White = 8 and Black = 8) from two schools in deprived wards of Coventry, England. Thematic analysis was used to identify key themes and subthemes across all transcripts. From the results, emergent themes included school and home environment, outdoor activity, equipment, weather, parental constraints and safety. Ethnic differences were apparent for sources of beliefs and knowledge and religious practice as constraints for PA. The findings suggest that school provides a good foundation for PA attitude, knowledge and behaviour, especially for SA children. To increase PA, multi-component interventions are needed, which focus on changing the home environment (i.e. junk food and media time), encouraging outdoors activity, changing perceptions of safety and weather conditions, which provide parental constraints for children. Interventions also need to be considerate to religious practices that might constrain time.
This exploratory, qualitative study was designed to be the first stage of an action research project to investigate whether graduates from BSc children’s nursing programmes are sufficiently prepared to assess children’s emotional health. Early identification of children’s and young people’s emotional problems is important for timely interventions to be initiated. Data were gathered from a focus group and a series of semi-structured interviews and interpreted using thematic analysis approaches. The findings indicated those interviewed can recognise when a child was emotionally unwell, reporting that assessments were brief, subjective and completed without the use of age-appropriate assessment tools. It is concluded that assessment of a child’s emotional health appears to take low priority in comparison to its physical counterpart.
Health-care systems seek to advance their care to adolescents through the online provision of information and support. An online, moderated, asynchronous discussion board called Let’s Chat Pain was created to recruit adolescent users of online content for pain to a discussion about pain coping and associated Internet use. Participants were asked about everyday pain coping and the role they judge online information to play in this coping. They were asked about determinations of website reliability and validity for health but especially for help with pain problems. Themes around adolescent trust in online websites for pain and research are explored, in addition to inhibiting and disinhibiting factors associated with the Internet use for health. We found users to mistrust online content even when they know it to be valid. Further study is needed to assess if there are ways of instilling confidence in pain information presented online for this group.
Previous research suggests that parental report of children’s feeding corresponds with their child’s nutritional intake (Cooke et al., 2006; Ekstein et al., 2010). The current study aimed to determine whether there is a relationship between parental report of children’s feeding problems and their child’s nutritional intake in a non-clinical population and, in addition, to establish whether parental anxiety (Cooke et al., 2003) can predict whether parental report of feeding problems correspond with the child’s intake. Sixty-one parents of children aged two to seven years completed the parent report measure; the Behavioural Paediatric Feeding Assessment Scale as well as a food diary detailing their child’s intake, which was analysed using CompEAT nutritional software. They also completed the anxiety subscale of the Hospital Anxiety and Depression Scale. Previous findings of an association between parent report of feeding problems and child’s intake (Cooke et al., 2006) were not replicated. However, an association was found between parents’ anxiety and their reports of feeding problems. Parental anxiety was also found to independently predict whether parent report of feeding problems matched the child’s intake. Findings highlight the importance of a multifactorial approach to understanding childhood feeding difficulties. This requires replication with a clinical sample.
To assess Belgian siblings’ self-reported quality of life (QoL) and the impact of illness on four different paediatric illnesses. Healthy siblings (n = 131) of children with type 1 diabetes, cancer, congenital heart disease (CHD) and cystic fibrosis (CF) completed the Child Health Questionnaire and the Sibling Perception Questionnaire. Results were compared to those of a matched group of siblings of healthy children. Siblings reported a good QoL, similar to controls, with the exception that siblings reported better on the QoL domain pain (p < .01). QoL was not related to time since diagnosis but the impact of illness was higher nearer to the time of diagnosis (r = -.39, p < .001). QoL of siblings of children with CHD or cancer was lower than QoL in the CF or type 1 diabetes group whilst impact of illness was highest for the CHD group. QoL of siblings of a child with a chronic illness is similar to the QoL of peers. Studies investigating siblings’ QoL or the impact of illness on siblings should include the day-to-day demands of the illness as well as less obvious illness-related issues like ‘hidden stress’ and ‘sense of control’.
This qualitative study explored the experiences and breastfeeding outcomes of a group of mothers who expressed colostrum in the antenatal period. In-depth interviews were conducted over the telephone with 12 women who had attended a unique antenatal lactation clinic appointment at 37 weeks’ gestation. Seven main response themes were identified. Most women reflected positively upon their attendance and reported that the experience of expressing colostrum allowed them to become familiar with their breasts and gave them a sense of security by having a supply of colostrum stored for possible use after birth. The main negative emotions reported were a sense of embarrassment at expressing the colostrum, particularly in front of another person, the difficulties with expressing colostrum and in one instance, the physical pain associated with the process. Antenatal expression of colostrum may improve maternal breastfeeding confidence. Further research using long-term records will determine whether this practice improves breastfeeding outcomes.
The aim of this study is to evaluate the psychometric properties of the translated Malay language version of TZO-AZL Preschool Children Quality of Life (TAPQOL) questionnaire in preschool children. Preterm children and term children aged between two and five years were enrolled into the study. The Malay language version of TAPQOL and a set of questions regarding the child’s health status were answered by the caregivers. The internal consistency, Spearman’s correlation coefficients and principal component analysis (PCA) with Varimax rotation and Mann–Whitney U test for group comparison were employed to evaluate the psychometric properties of this instrument. A total of 258 children (120 preterm children and 138 term children) were recruited to this study with a response rate of 94%. All (sub)domains except one had Cronbach’s α coefficients of more than .7. The Spearman’s correlation coefficients between 12 subdomains were generally low. PCA supported the structural unidimensionality of the items in the instrument. Preterm children had lower quality of life scores than that of term children. Malay version of TAPQOL has multidimensional construct. It is a reliable and valid instrument for preschool children, with almost similar psychometric properties to the original version.
Bronchiolitis is a major cause of children’s admission to hospital. The study aim was to describe the experiences of parents who had, or nurses who cared for, a child admitted to hospital for severe bronchiolitis requiring oxygen therapy. A descriptive phenomenological approach was used to interview 12 mothers and 12 nurses. The findings were clustered into three domains: fear, parent–child interaction and technical caring. The mothers found the experience to be extremely frightening, based on their fear that their child could die. This was compounded by their lack of knowledge and understanding about what was happening and their inability to fulfil their mothering role. Although nurses recognised that parents were anxious, they did not seem to appreciate fully the depth of fear and emotion that mothers were experiencing and tended to describe procedural aspects of their role. The mothers’ relationship with their child was focused upon physical contact and the desire to comfort their child. Their ability to do so was significantly impacted upon by the method of oxygen delivery to their child. For nurses, although they recognised the psychosocial dimension, their emphasis was on health and safety aspects of oxygen therapy, both for the child and themselves.
Adolescence is the potential period for growth and optimal functioning, but developmental issues like time of transition from childhood to adulthood will create stress and affect the adolescent’s quality of life (QOL). However, there is a lack of research tool for measuring adolescent’s QOL in Malaysia. The aim of the study was to determine the validity and reliability of the self-report Malay version of the pediatric QOL (PedsQL™) 4.0 Generic Core Scales in assessing the QOL of Malaysian adolescents. A cross-sectional study design using the 23-item self-report Malay version of the PedsQL 4.0 Generic Core Scales was administered on a convenient cluster sampling (n = 297 adolescent) from a secondary school. The internal consistency reliability had Cronbach’s α values ranging from .70 to .89. Factor analysis reported a six-factor structure via principal axis factor analysis. In conclusion, the self-report Malay version of the pediatric QOL 4.0 Generic Core Scales is a reliable and valid tool to measure the QOL of multiethnic Malaysian adolescents.
Approximately 20% of children in the United States meet the criteria for a psychosocial disorder; however, less than 25% of these children receive psychosocial services. A questionnaire assessed primary care pediatricians’ (PCPs) perceptions of effectiveness, availability, and burden of treatment options for children’s psychosocial difficulties and parents’ acceptance and adherence with these treatments. Repeated measures analysis of variance found that PCPs are more likely to refer children with psychosocial problems to a mental health professional than to prescribe medication. PCPs prescribe medications more than counseling parents themselves or watchful waiting. PCPs reported children’s behavior is more likely to improve with mental health services than with medication, though medication is the most available treatment. PCPs believe parent training programs are very effective for treating children’s behavior problems, but believe parents are more accepting and compliant with other treatments. Findings indicate PCPs’ perceptions of availability and acceptability of treatment options drive their treatment recommendations of psychosocial problems.
Previous studies separately examined the effects of positioning or environmental stressors on preterm infants’ sleep and stress. Since positioning and environmental stressors occur simultaneously during infant hospitalization exploring these variables in the same study may offer new insights. A quasi-experimental study by one-group interrupted time-series design. In the current study, a total of 22 preterm infants were enrolled. Each infant was moved to either the supine or prone position for an hour at a time. Infants were videotaped and the sleep–wake states, stress behaviours and environmental conditions (light, noise and stimulation/handling) were recorded during the observation period. A total of 80 observations from 22 infants were accrued. In the supine position, preterm infants demonstrated more frequent waking states after adjusting for various environmental stressors (p < .01). These infants demonstrated more frequent stress behaviours in the supine position after adjusting for various environmental stressors (p < .01). These results suggest that the prone position is a more favourable position for facilitating sleep and reducing stress for preterm infants exposed to varying environmental stressors. Preterm infants present different stress behaviours in response to varying types of environmental stimuli.
The study systematically reviewed all types of unintentional injury and injury prevention research studies occurring within child care centers in the United States. A total of 2 reviewers searched 11 electronic databases to identify 53 articles meeting inclusion criteria. No studies used trauma registries or randomized control trials. Data were not pooled for further analysis because studies lacked standardized definitions for injury, rates, severity, exposure, and demographics. The following child care center injury rates were reported: (0.25–5.31 injuries per 100,000 child-hours); (11.3–18 injuries per 100 children per year); (6–49 injuries per 1000 child-years); (2.5–8.29 injuries per child-year); (2.6–3.3 injuries per child); (3.3–6.3 injuries per 100 observations); (635–835 medically attended injuries per year per 100,000 children and 271–364 child care center playground injuries per year per 100,000 children); and (3.8 injuries per child per 2000 exposure hours). Child care center injury rates were comparable to injury rates published for schools, playground, and summer camp. Most injuries were minor, while most severe injuries (fractures and concussions) were falls from playground structures. Future studies need to use standardized injury definitions and injury severity scales, focus efforts on preventing severe playground injuries in child care centers, and report child care parameters for inclusion in national injury databases.
This randomized clinical study explored the effects of two cord care methods on hydration, temperature, pH, and floras at the cord area in high-risk newborns. One group used the water method; and the other group used the alcohol method. Seventy-two newborns, including premature newborns, in the neonatal intensive care unit (NICU) of a university-affiliated hospital in South Korea were enrolled from August 2011 to May 2012. Hydration, temperature, pH, and floras were measured daily until the cords fell off. The results showed no difference between the groups in hydration, temperature, pH, and the colonization of floras, but cord detachment in the alcohol group took 2 days longer (12.8 [5.7] days) than in the water group (10.9 [4.1] days). Our findings suggest that the clean-and-dry method of cord care, which uses water, could be sufficient, possibly even better than alcohol in maintaining the physiologic surface milieu of the cord area with less chance of infection and manipulation in NICUs with optimal infection control.
Medical rehabilitation arranged by the Social Insurance Institution of Finland is provided for children with severe disabilities. The study aimed to find out which service characteristics were associated with perceived outcomes of rehabilitation. Parents whose children had participated in rehabilitation (n = 496) responded to a mail questionnaire that included questions on service characteristics and possible outcomes. Based on factor analysis, four outcome variables were formed. Logistic regression analysis was used to identify the particular service characteristics that were associated with the perceived outcomes. The family’s participation in rehabilitation planning and the child’s willingness to participate in rehabilitation activities were associated with good outcomes. Having a contact person for the rehabilitation process predicted child and family empowerment outcomes. The results emphasize the significance of establishing a good partnership between the professionals and the family; of developing the contents of the rehabilitation program, so that they motivate the child, and of organizing service coordinators for each family.
Bullying is a serious public health problem, and many studies have examined the effect of school-based anti-bullying programs. However, these programs and those outcomes are complex, broad, and diverse. Research is needed into the optimal strategies for these comprehensive programs, which consider both the effectiveness and cost of programs. We performed a meta-analysis of 13 studies using the Comprehensive Meta-Analysis software package to calculate effect size (ES) and the Q statistic. We conducted subgroup analyses to examine the differences based on student grade level, program duration, and program strategy. The pooled ES calculation indicated that school-based anti-bullying programs have a small to moderate effect on victimization. The results of the Q test indicated significant heterogeneity across studies of victimization (Q = 39.625; I2 = 69.7%; p < .001). Studies involving training in emotional control (p < .01), peer counseling (p < .05), or the establishment of a school policy on bullying (p < .05) showed significantly larger ESs on victimization than did studies that did not involve these strategies. Effective school-based anti-bullying programs should include training in emotional control, peer counseling, and the establishment of a school policy on bullying.
In the current study, we investigated the occurrence of posttraumatic growth (PTG) among parents whose children had had stem cell transplantation (SCT) and survived. Although SCT is well established, it remains stressful and dangerous, and SCT is only performed if there is no other choice of treatment to be considered. A questionnaire batteries including the Post-Traumatic Stress Disorder (PTSD) Check List—Civilian version and the Post-Traumatic Growth Inventory were sent out to a cross-sectional national sample of parents of children who had had SCT six months or more before the study. The response rate was 66% (n = 281). The data were analyzed in relation to parents’ appraisal of the event, gender, and perceived social support. The results confirm that SCT in childhood is an event of extreme adversity for the parents. Indications of PTSD were found among an important minority of the parents. Nevertheless, a large proportion of the parents had experienced growth as a consequence of the child’s illness. Appreciation of life and personal strength were the domains with the highest scores. Moreover, a higher level of PTG was correlated with a higher level of posttraumatic stress and with an experience of the trauma as more severe. In summary, the study indicates that PTG is a relevant concept for this group of parents.
Chronically ill children require several hours of additional care per day compared to healthy children. As parents provide most of this care, they have to incorporate it into their daily schedule, which implies a reduction in time for other activities. The study aimed to assess the effect of having a chronically ill child on parental employment and parental leisure activity time, and to explore the role of demographic, social, and disease-related variables in relation to employment and leisure activities. Outcomes of 576 parents of chronically ill children and 441 parents of healthy school children were analyzed with multivariate regression. Having a chronically ill child was negatively related with family employment, maternal labor force participation, and leisure activity time. Use of child care was positively related to family and maternal employment of the total group of parents. Within parents of chronically ill children, most important finding was the negative relation of dependency of the child on daily care and low parental educational level with family and maternal employment. In conclusion, parents of chronically ill children, mothers in particular, are disadvantaged in society probably due to the challenge of combining child care with work and leisure time.
The management of diabetes is complicated, as treatment affects the everyday life of both children and their families. To enable optimal care for children with type 1 diabetes, it is important to highlight health-related quality of life (HrQoL) as well as medical outcomes to detect psychological problems that otherwise could be missed. The aim was to study HrQoL in children and adolescents with type 1 diabetes dependent on gender, age and co-morbidity and to study the consistency between children’s self-reporting and parents’ proxy reporting. The cross-sectional data were collected using the questionnaire DISABKIDS Chronic Generic Measure and the DISABKIDS diabetes module. Parents in the proxy report perceived their children’s HrQoL to be lower than children themselves. Boys reported their HrQoL to be better than girls. Results show that living with an additional disease has an impact on the HrQoL, which is an important factor to consider in the quality registry. Assessing HrQoL on a routine basis may facilitate detection and discussion of HrQoL-related questions in the national quality registry.
Minor illnesses in children are often cured at home with over the counter medicines. Even though there is a wide use of medicines among children, they rarely receive medical advice about their medications from doctors or pharmacists. The aim of this study is to evaluate children’s beliefs about medicines as well as to explain what children know about medicines. A cross-sectional survey was used to collect data from four primary schools in Penang Island, Malaysia. The target population of this research was schoolchildren of 11 and 12 years old regardless of their gender and social status. A self-administration questionnaire was used to obtain the data from schoolchildren and their parents. After including all schoolchildren in grades five and six, the total sample size was 1000 children in addition to 1000 parents. This study found that most children have inadequate knowledge and false beliefs about the efficacy of medicines. Children’s beliefs about the efficacy of medicines were affected by their age group, gender and race (p < .05). Females, older children and Chinese were more knowledgeable about the efficacy of medicines. Furthermore, the socio-economic status, parents’ education level and parents’ occupation influenced children’s beliefs about medicines (p < .001). This study showed that children have misconception about medicines. The need for medicine education should be implemented to get more knowledgeable users of medicines in future. However, the role of health-care professional should be increased in terms of medicine education.
The aim of this study was to examine the psychometric properties of the Psychosocial Risk Assessment in Pediatrics (PRAP). PRAP is a screening tool designed to assess pediatric patients who are at risk of experiencing elevated distress during health-care encounters. A cross-sectional observational study was conducted with 200 pediatric patients. Patient’s distress levels were observed during their health-care encounter using the Children’s Emotional Manifestation Scale (CEMS). Health-care staff and parents were asked to rate the patient’s level of cooperation and stress. Exploratory factor analysis supported a single latent factor structure of the PRAP tool. Cronbach’s α for internal reliability was .83. PRAP score was strongly correlated with CEMS score with r = .82 (p < .0001). The PRAP is a standardized, reliable, and valid method for health-care providers to assess a patient’s risk of experiencing significant distress during treatment or testing.
When children are critically ill, parents still strive to be present and participate in the care of their child. Pediatric intensive care differs from other realms of pediatric care as the nature of care is technically advanced and rather obstructing than encouraging parental involvement or closeness, either physically or emotionally, with the critically ill child. The aim of this study was to elucidate the meaning of caring in the pediatric intensive care unit from the perspective of parents. The design of this study followed Benner’s interpretive phenomenological method. Eleven parents of seven children participated in observations and interviews. The following aspects of caring were illustrated in the themes arising from the findings: being a bridge to the child on the edge, building a sheltered atmosphere, meeting the child’s needs, and adapting the environment for family life. The overall impression is that the phenomenon of caring is experienced exclusively when it is directed toward the exposed child. The conclusion drawn is that caring is present when providing expert physical care combined with fulfilling emotional needs and supporting continuing daily parental care for the child in an inviting environment.
This qualitative study examines what contributes to the development of personal identity among refugee adolescents of African origin who have immigrated to Québec. For this purpose, 12 adolescents participated in individual interviews and in self-recorded interviews. The research findings show that the development of young people’s personal identity is directly and indirectly influenced by personal characteristics, the environmental, and the interpersonal relationships. We identify both elements that facilitate the development of personal identity and obstacles to such development so as to provide better support for health education among refugee adolescents.
Children in many areas of New Zealand have poor health indices; statistics indicate health inequalities. Existing international indicators of child health currently take little account of local context. There are few composite indicators of how child health services are integrated at a community level. This study aimed to explore what local people consider would be useful indicators of better child health. Data for this qualitative study were collected via 24 individual interviews and two focus groups in a rural area of New Zealand. A total of 13 in-depth interviews were conducted with parents/families of small children. Participants were asked about wide-ranging aspects of child health. Also, 11 interviews and two focus groups were conducted with front line health professionals/stakeholders. Key themes from the content thematic analysis: include child health should be measured in multidimensional ways; essential interdependence of family––child health; universal access to culturally appropriate care, free primary care services and parenting education and support is needed; and there is a lack of integration and communication between health, education and social services. There is an important need to measure and monitor communication/integration across existing health, education and social services, provide better parenting support and health education and improve access to culturally appropriate primary care.
The purpose of this study is to examine prevalence rates of pain reports in youth with type 1 diabetes mellitus (T1DM) and potential predictors of pain. Pain is a common and debilitating symptom of diabetic polyneuropathies. There is currently little research regarding pain in youth with T1DM. It was predicted that self-care and general health factors would predict pain as suggested by the general pain literature. Participants (N = 269) ranged in age from 13 to 17 years; youth had a mean time since diagnosis of 5.8 years. Data collected included diabetes self-management variables, ratings of the patient’s current functioning and pain intensity (‘current’), and information collected about experiences that occurred in the time preceding each appointment (‘interim’). About half of the youth (n = 121, 49.0%) reported any interim pain across both appointments. Female adolescents and those individuals who were physically active and/or utilized health-care system more acutely were more likely to report interim central nervous system pain. Improved diabetes self-management and increased level of physical activity may reduce experiences of pain and increase the quality of life of youth with T1DM. Regular monitoring of both current and interim pain experiences of youth with T1DM is recommended.
Indirect and direct health-related quality of life (HRQoL) measures are intended to assess the same underlying constructs. There is evidence that the two types of assessments can show important differences. We assessed the agreement between the utilities of direct and indirect HRQoL measurements in children following pediatric intensive care unit (PICU) admission. We collected Health Utilities Index 3 (HUI-3) and Visual Analog Scale (VAS) ratings of children who were urgently admitted to the PICU of a university-affiliated pediatric hospital at ICU admission (baseline) and one month post-ICU admission. The mean (SD) VAS converted standard gamble and HUI-3 utilities were 0.82 (±0.19) and 0.70 (±0.39), respectively, at baseline (n = 51), and 0.81 (±0.15) and 0.58 (±0.39) at one month (n = 36). The VAS utilities were significantly greater than the HUI-3 utilities (p = 0.009). At baseline, the intraclass coefficient (95% confidence interval) was 0.49 (0.25–0.68), representing moderate agreement, and at one month, was 0.18 (-0.87 to 0.45), representing negligible agreement. There were significant differences between indirect and direct measures, and inconsistent agreement between utilities derived from the two measures. These data illustrate the potential impact of HRQoL assessment techniques on economic analyses used to inform health policy decision-making for pediatric critical care.
Studies demonstrate a link between parental distress, youth illness appraisals, and depression symptoms in youth with juvenile rheumatic diseases. However, the exclusive use of broadband (i.e. general) measures of parental distress in these studies has resulted in conceptual and clinical imprecision regarding the parent–child adjustment process. Our aim was to reanalyze previously published data (i.e. Wagner et al., 2003) using a depression-specific scale derived from the general adult distress measure in the original study. Parents completed the Brief Symptom Inventory (BSI), youth completed the Child Depression Inventory (CDI), and the Illness Intrusiveness Scale (IIS-C). Thirteen Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) depression-specific items from the BSI comprised the parent measure of Depressive Symptoms Scale (DS). Consistent with Wagner et al. (2003), adult DS scores were associated with youth CDI scores. However, youth illness appraisals had unique effects on the parent–child depression relation. Elevated youth perceptions of illness intrusiveness amplified the negative effect of parent depressive symptoms on youth depressive symptoms; decreased illness intrusiveness buffered the negative effect of parent depression. The empirical and clinical implications of assessing parent and youth adjustment in a domain-specific manner are discussed.
Studies have demonstrated the negative impact of environmental tobacco smoke (ETS) or parental cigarette smoking on pediatric asthma. Little is known, however, regarding whether there is a gender difference in the effect of household ETS on pediatric asthma. Using a nationwide survey in Taiwan, we examined the relationship between asthma prevalence in the past year and household ETS among children below 12 years of age (N = 3761). We used multivariate regression models to assess odds ratios (ORs) and 95% confidence intervals (CIs) for the association of household ETS and asthma attacks by gender. In about 3% of the sample, parents reported that their children had an asthma attack in the past year, confirmed by physicians. Multivariate logistic regression revealed that household ETS predicted asthma attacks for girls (OR = 3.11, 95%CI = 1.24–7.76) but not for boys. Father’s education was significantly associated with asthma attack for both girls (OR = 1.24, 95%CI = 1.04–1.47) and boys (OR = 1.15, 95%CI = 1.05–1.26). Girls with lower family income were more likely to have had an asthma attack in the last year (OR = .48, 95%CI = .27–.87). The impact of household ETS and family socioeconomic status on asthma attacks differs by gender among children below 12 years.
Functional health literacy is founded on general and numerical literacy and practical skills and is required for the appropriate and effective management of health symptoms in children. This study aimed to assess the health literacy skills of parents and caregivers of preschool-aged children, using a progressive scenario describing a child with fever and presenting tasks relating to selection of a medicine and hypothetical dosing of their child. Participants (n = 417) from 33 childcare- and health-related sites in Sydney, Brisbane, Melbourne and Auckland completed the study. Participants’ responses were largely appropriate regarding actions in response to worsening symptoms, selection of an appropriate product (from a limited range), whereby 84.5% of responses were for a single-ingredient paracetamol product and use of the package directions to state the frequency of dosing (93.1% of frequencies appropriate for paracetamol and 66.7% for ibuprofen). However, in only 50.8% of cases was an appropriate weight-based dose calculated, and doses were not measured to within 10% of the stated dose in 16.7% of cases. Future studies should focus on skill development via educational campaigns for parents and caregivers.
The aim of this study was to determine how malnutrition rates change in young Chinese children when 2006 World Health Organization (WHO) growth standards are used instead of 1978 WHO/National Center for Health Statistics reference. Cross-sectional survey data were used from rural western China and the Tibet region. The heights and weights of children of <36 months of age were measured. The nutritional status of the children was assessed by two references. Using 2006 reference instead of 1978 reference, the prevalence of stunting increased significantly (17.9% vs. 12.3% in rural western China and 37.5% vs. 28.1% in rural Tibet). The prevalence of underweight was lower in rural western China (7.7% vs. 11.7%) than rural Tibet (13.1% vs. 15.3%). For all ages, the prevalence of stunting increased and the greatest relative increase appeared in the first six months (102.9% in rural western China vs. 134.9% in rural Tibet). With respect to underweight, the relative increase occurred only during the first six months (314.3% in rural western China vs. 48.1% in rural Tibet); however, the reduction was observed in other age groups. For young Chinese Han and Tibetan children, the difference in estimation of malnutrition between two references differed in magnitude. The scale of change in the prevalence rates of stunting and underweight is much greater when 2006 reference was introduced.
This paper presents a qualitative study aimed at exploring the role of health-care professionals in hospitalized children’s emotional experiences. A total of 27 children and adolescents from ages 6 to 15 years admitted to the Pediatric Hematology and Oncology ward of an Italian hospital participated in the study. Each participant was asked to talk about an emotional experience of happiness, anger, sadness and fear, felt in the presence of a doctor or nurse on the ward. The emotional tales were coded and analyzed qualitatively. The results showed that all the emotions considered were experienced when the staff was present, nurses in particular. Doctors and nurses played a role of active participants, encouraging children’s emotions, especially for happy events. More research is needed to clarify the role of the staff in supporting children to cope with negative emotions.
Irrigation as a bowel management approach has been reportedly used with children for more than 20 years. Parents managing their child’s chronic bowel problem have previously been shown to have increased emotional stress. The aim of this study was to explore professionals’ (n = 24) understanding and parents’ (n = 18) experiences of using transanal irrigation with children at home as a mid to longer term bowel management approach. This study was underpinned by action research methodology and used mixed methods determined by an action research group of parents, professionals, researchers, a voluntary sector worker, commercial representative and independent observer. Data informed the study outcome which was the development and evaluation of a shared health resource to support professionals in their holistic approach when prescribing transanal irrigation and guide parents in the areas of education, management, problem solving, support and goal setting. The resource includes constructed case studies from parents of their experiences to inform choice and decision-making between parents and professionals. The shared health resource provides an approach to initiating and evaluating transanal irrigation and is available in a paper format from key Internet sites across hospital, community and voluntary services.
Currently there appears to be few opportunities and little evidence of physically disabled children and young people (C&YP) participating in mainstream social activities. A qualitative review was undertaken to examine the factors affecting physically disabled C&YP (8–15 years) in the United Kingdom participating in out-of-school activities. Views and experiences were explored from the perspective of the service users and providers to assess current provision and to determine the need for future research into factors that may affect participation. Searches were conducted across eight databases, the references of the included studies were checked and the websites were searched. Studies that used a qualitative design that examined the views relating to out-of-school activities were included. Nine papers were identified, which included three peer-reviewed papers and six pieces of grey literature and pertinent government documents to include views and experiences of out-of-school activity provision. The main themes emerging from the review were the need for social inclusion, out-of-school activities run by volunteers and accessibility, with threads throughout, which require further research including parental influence, provision, training and attitudes. This review highlights the absence of the service user’s voice and sheds light on the limited provision and barriers affecting participation in out-of-school activities.
Admission to hospital is recognised as a difficult time for children and families. This study explored clown doctor activities in an acute paediatric setting and the impact their activities have on children, their families, other health professionals and clown doctors themselves. We used observation, semi-structured interviews and focus groups with children and parents and staff and clown doctors and results provide a rich description of the work of clown doctors. The major themes were ‘the encounter – in the moment’ of the interaction of the child and the clown doctor and ‘beyond the encounter’. The findings show that the impact of clown doctor visits is experienced beyond the immediate interaction, and this has not been clearly articulated in previous studies. This study highlights the multifaceted and complex nature of the work of the clown doctors and the high level of skill required as they modify and interpret play, activities and environment based on individual need and response.
The aim of this study was to review and evaluate the psychometric properties of two general musculoskeletal outcome measures focusing on pediatric physical disability, namely, the Pediatric Outcomes Data Collection Instrument (PODCI) and the Activities Scales for Kids (ASK). Although this review reveals the psychometric superiority of ASK to PODCI, further research should confirm the psychometric properties of both the instruments. A number of psychometric issues need to be further addressed. Specifically, future studies should examine additional types of reliability and validity, for example, content, construct, criterion, and discriminant with more sophisticated statistical analyses, for example, Aiken’s item content validity coefficient and confirmatory factor analysis. Until these issues are addressed, researchers should be cautious utilizing these instruments in children with musculoskeletal problems in a clinical setting.
This study compared parental cognitions and relationship characteristics of mothers of children with atopic disease with those of mothers of children without atopic disease. These factors include child-rearing attitudes, parental locus of control, parental sense of competence, attachment security, and maternal sensitivity. Preplanned subanalyses were carried out according to specific disease, mothers’ perception of disease severity, and presence of concurrent atopic diseases. The descriptive comparative study of 233 Korean mothers included 102 mothers of children aged six years or younger with atopic dermatitis, asthma, and/or allergic rhinitis. Data were collected from 2007 to 2008 from local clinics and day care centers. Parental cognitions and relationship characteristics did not differ significantly between groups of mothers, except that mothers of children with atopic dermatitis showed less affection. However, subanalyses showed that mothers who perceived their child’s disease to be severe were less likely to encourage autonomy and had a lower sense of competence, more rejecting attitudes, and an external locus of control. Although we should be cautious in generalizing these results, special care plans are strongly recommended for mothers of children with severe atopic disease to provide support and education, help mothers develop an internal locus of control, and increase parental sense of competence.
Needle-related procedures are reported to be problematic for children. In a school-based celiac disease screening, 12-year-olds’ experiences with relaxation and guided imagery (R-GI) during venipuncture were investigated. One group tried nurse-led R-GI (n = 60) and another group received standard care (SC; n = 49). A mixed method design was applied using short written narratives, facial affective scale (FAS), and visual analog scale (VAS) for pain intensity. Qualitative content analysis highlighted that diversity and contradictions when facing blood tests. FAS scores were significantly lower in the SC group before (p = 0.01), during (p = 0.01), and after (p = 0.01) venipuncture. VAS scores did not differ between the groups. The blood test was mostly experienced as unproblematic, and GI during venipuncture did not decrease pain or affect. However, the fact that a number of children scored high FAS indicates a need for effective methods to help children cope with needle-related school-based procedures.
Our objectives were to examine whether providers engage children with asthma in treatment-related discussions at the level children prefer (engagement concordance) and to determine whether engagement concordance is related to child, caregiver, and provider characteristics. Children with asthma (n = 296) aged 8–16 years were recruited at five pediatric practices in North Carolina. Using audiotaped medical visit transcripts, we documented the number of treatment-related questions the providers asked the children. Children reported their preferred level of provider engagement. A logistic generalized estimating equation was used to determine which variables predicted engagement concordance. Most children (96.6%) wanted to be involved in treatment-related discussions. One-third of the providers did not ask children any treatment-related questions. Only 36.1% of provider–child dyads were concordant. Most discordant dyads were under-engaged (83.1%). Better engagement concordance was observed among older children (odds ratio (OR) = 1.19, 95% confidence interval (CI) (1.07, 1.33)), male children (OR = 1.67, 95% CI (1.03, 2.70)), and among providers with fewer years in practice (OR = .97, 95% CI (.94, .99)). Providers engaged in treatment-related discussions with younger children and females less frequently than these children preferred. Providers should ask children how much they want to be involved in treatment-related discussions and then attempt to engage children at the level they prefer.
Mucopolysaccharidoses (MPS) and Batten disease are rare life-limiting conditions (LLCs) characterised by progressive and permanent physical and cognitive decline. The impact of such conditions on families, and notably on siblings, has not yet been described or documented. This paper presents data from a UK-wide study that sought to understand the family experience of supporting a child with the rare degenerative LLCs of MPS and Batten disease. The aim of this paper is to report sibling experiences related to these rare degenerative and progressive conditions, in order to inform the future development of supportive interventions. Eight siblings of children with MPS (n = 7) and Batten Disease (n = 1) participated in semi-structured qualitative interviews. A card sort technique was utilised to support and engage the children. Siblings are clearly impacted emotionally, pragmatically and relationally by the ill health of another child in the family. The data indicate four key themes which demonstrate impacts on siblings: perceptions of the condition and its symptoms, impact on daily life, emotional consequences and ways of coping. Siblings often had considerable knowledge of the condition and took on important roles in symptom management. However, these experiences were in the context of managing relationships within the family (often protecting parents from an awareness of how much they knew) and relationships at school (including distraction from learning and being bullied by peers). The data highlight how sibling experiences are generated through a combination of negative disability discourses and support through peers and family members. The data indicate how these features shift as a consequence of witnessing the advancement of their brother’s or sister’s condition and the emotional sequelae of disease progression. Exploration of siblings’ experiences of living with such rare progressive and degenerative LLCs suggest the focus of interventions to support this group should address their emotional health and ways to overcome isolation and build connections with other siblings who share their unique experiences. Critically, the data suggest that sibling support should be cognisant of the trajectory of the illness as well as the family, school and peer relational contexts that siblings inhabit.
This study explored the relationships between hospitalized children’s anxiety level, mothers’ use of coping strategies, and mothers’ satisfaction with the hospital experience. Twenty-four hospitalized children and their mothers participated in this study. Children were asked to draw a person in the hospital, which was then coded as a projective measure of anxiety; mothers were asked to complete questionnaires on their coping behaviors and their satisfaction with their child’s hospital experience. The use of more coping strategies by the mothers was related to less anxiety in the children. In addition, the more coping strategies the mothers used, the higher they reported their satisfaction. The findings suggest the importance of providing resources aimed at increasing maternal coping and satisfaction with the quality of care of a child’s hospitalization in order to minimize the negative effects of the hospitalization on the children.
Ethnic minority children in the United Kingdom often experience health disadvantage. Parenting influences children’s current and future health, but little is known about whether parenting behaviours and mother’s perception of her infant vary by ethnicity. Using the Born in Bradford (BiB) birth cohort, which is located in an ethnically diverse and economically deprived UK city, we conducted a cross-sectional analysis of mother’s self-reported parenting confidence, self-efficacy, hostility and warmth, and infant temperament at six months of age. We examined responses from women of Pakistani (N = 554) and White British (N = 439) origin. Pakistani mothers reported feeling more confident about their abilities as a parent. Significantly fewer Pakistani women adopted a hostile approach to parenting, an effect that was attenuated after adjustment for socioeconomic status and mental health. Overall, women with more self-efficacious, warm and less hostile parenting styles reported significantly fewer problems with their infant’s temperaments. Of women with higher self-efficacy parenting styles, Pakistani mothers were significantly more likely than White British mothers to report more problematic infant temperaments, although absolute differences were small. It is unlikely that the ethnic variation seen in children’s cognitive and behavioural outcomes in childhood is attributable to differences in parenting or infant characteristics reported at six months.
This study aimed to investigate the association of the anthropometric, clinical variables and maximal oxygen uptake (V<sc>o</sc>2max) with diabetes-specific health-related quality of life (HRQoL) in youths with type 1 diabetes mellitus (T1DM) and to find the predictors of HRQoL and blood glucose control. A total of 239 youths with diabetes (124 boys and 115 girls) were recruited from diabetes-based summer camps. HRQoL assessment was carried out with the Pediatric Quality of Life Inventory 3.0 Diabetes Module (Information Resources Centre, Mapi Research Trust, France); V<sc>o</sc>2max was evaluated by conducting the 20-m shuttle run test. Higher V<sc>o</sc>2max and the insulin pump therapy were significant predictors of the HRQoL in the multiple regression analysis; other clinical and anthropometric variables had no effect. The better blood glucose control was explained only by the higher V<sc>o</sc>2max. The good cardiorespiratory fitness (expressed by V<sc>o</sc>2max) has clinical and QoL benefits for paediatric patients with T1DM.
This study aims to analyze the epidemiological characteristics and predictors of mortality from burn injuries in childhood patients admitted to our hospital during an eight-year period. The medical records of acute childhood burn patients were reviewed retrospectively. All variables thought to be associated with mortality were entered in a multiple binary logistic regression model (method = stepwise). The magnitude of risk was measured by the odds ratio, and the 95% confidence interval was estimated. A total of 2269 acute childhood burn patients were admitted during the study period. A total of 86 (3.8%) children died due to burn injuries. Deaths were seen 1.849 times more in males than in females. According to the 1%–10% total body surface area (TBSA) burned group, mortality occurred 121.116 times more in the >41% TBSA burned group. Most burn injuries can be avoided by keeping children away from hazardous and dangerous environments. Also, requiring a multidisciplinary management in these patients, quality of care services given by physicians and nurses certainly will create a positive impact on patients’ outcomes.
The present study examined psychological adjustment in parents of infants with congenital anomalies (CAs), focusing on the interval from the disclosure of the diagnosis to six months after the infant’s birth and considering the effects of the parent’s gender and the timing of diagnosis (pre- vs postnatal). Within-group diversity was also examined by identifying distinct patterns of individual adjustment over time. Parents of 43 infants (43 mothers and 36 fathers) with a pre- or postnatal diagnosis of a CA answered questionnaires assessing psychological distress and quality of life one month after the disclosure of the diagnosis and six months after the infant’s birth. Results showed a significant reduction in psychological distress and a significant increase in physical quality of life over time, for both parents, regardless of the timing of diagnosis. In all, 57% of parents presented a pattern of recovery from diagnosis to six months post birth and 26.6% presented a pattern of resilience. However, 15.2% of parents showed chronic adjustment difficulties. Findings suggest that most parents tend to adjust to their infant’s CA, although some experienced difficulties and should be targeted for specialised counselling. Both members of the couple should be acknowledged, as both experience similar patterns of adjustment.
The rise in childhood obesity in recent years has been accompanied by a number of initiatives to treat the condition. However, such interventions have often been characterised by poor levels of adherence to treatment and corresponding high attrition rates. This article presents data drawn from qualitative interviews to examine families’ reasons for engaging or not engaging with child obesity services. Interviews took place with 15 families whose children attended a UK-based childhood obesity service and 17 families whose children withdrew from treatment. Our data suggested that involvement of children in the decision to attend a clinic was important in building engagement. Specialist diet and exercise advice tailored to individual family circumstance encouraged clinic engagement, but failed to engage some families who felt their personal circumstances had not been considered sufficiently. The clinic environment was viewed as not age appropriate for some children and did not match the expectations of some families. Our findings highlight the value of involving children in the decision to attend an obesity service and practitioners should, as much as possible, tailor advice to the circumstances of each family. Providing clinics for particular age groups in terms of environment and timing may enhance engagement with services.
This study was aimed at identifying behavioural, normative and control belief influencing intention to practise exclusive breastfeeding among pregnant women in Malaysia. An interviewer-guided questionnaire assessing behavioural, normative and control belief was developed based on the findings elicited from focus group discussions. Intention referred to the respondent’s intended duration of exclusive breastfeeding, which was measured in weeks. Bivariate correlational analysis, linear regression analysis and independent t test comparing intenders and non-intenders were conducted to identify the composite belief measures and individual beliefs significantly influencing intention. Composite measures of all the beliefs were significantly correlated with intention, but injunctive normative belief and behavioural belief were the only significant factors identified from linear regression analysis. The respondents agreed to comply with four referents of their mother, husband, nurses and mother-in-law. Non-intenders believed that those referents would oppose them practising exclusive breastfeeding for six months. The behavioural belief concerning difficulty to leave the infant significantly differentiated intenders from non-intenders. Exclusive breastfeeding promotion should include the woman’s mother, husband and mother-in-law. Nurses should provide accurate and complete information related to breastfeeding practise. Providing support for women to continue the practise even though separated from their infants may improve their intention and practise of exclusive breastfeeding.
The international physical inactivity epidemic among children has contributed to child obesity. Schools can be an effective source of physical activity opportunity. A cross-sectional sample of 1306 American children was drawn from the Panel Study of Income Dynamics – Child Development Supplement, 2007. The aim of this study was to determine the role of in-school physical activity on body mass index (BMI) percentile among middle and high school-aged children. Multinomial logistic regression was used to assess the associations between the independent variable, physical activity, and the dependent variable, BMI percentile. After adjusting for covariates, children who had no physical activity during physical education (PE) were much more likely to be obese than normal weight in comparison with those who met the US national requirements (odds ratio = 1.58, confidence interval = 1.14, 2.20). This study suggests that meeting US national guidelines for PE-related physical activity may be effective in preventing obesity.
This study investigates parental experiences and perceptions of the care received during their child’s prolonged hospitalization. It relates this care to the Beanstalk Program (BP), a develop-mentally focused care program provided to these families within an acute care hospital setting. A total of 20 parents (of children hospitalized between 1-15 months) completed the Measures of Processes of Care (MPOC-20) with additional questions regarding the BP. Scores rate the extent of the health-care provider’s behaviour as perceived by the family, ranging from ‘to a great extent’ (7) to ‘never’ (1). Parents rated Respectful and Supportive Care (6.33) as highest, while Providing General Information (5.65) was rated lowest. Eleven parents participated in a follow-up, qualitative, semi-structured interview. Interview data generated key themes: (a) parents strive for positive and normal experiences for their child within the hospital environment; (b) parents value the focus on child development in the midst of their child’s complex medical care; and (c) appropriate developmentally focused education helps parents shift from feeling overwhelmed with a medically ill child to instilling feelings of confidence and empowerment to care for their child and transition home. These results emphasize the importance of enhancing child development for hospitalized infants and young children through programs such as the BP.
Little is known about the nonmedical out of pocket expenses (NOOPEs) incurred by families of hospitalized children. The purpose of this study is to help nurses, other healthcare providers, hospital administrators, and policymakers better understand the NOOPEs incurred by families during their child’s hospitalization. Parents of children (n = 50) who underwent orthopedic surgery at a major tertiary-care children’s hospital reported all NOOPEs incurred during their child’s hospitalization. Descriptive statistics and univariate and multiple logistic regression analyses were used to analyze the data. The total NOOPEs ranged from $17.00 to $4745.00 (M = $736.21) per hospitalization, with 2096 missed hours from work. Length of stay, gross family income, distance from the hospital, and Hollingshead score are significant predictors of expenses (F-ratio = 732.88, p < 0.001). Hospitalization is associated with numerous NOOPEs. Future research needs to investigate the total array of expenses to families.
Research has shown mixed findings about the relationship between parenting style and child lifestyle outcomes. This paper describes a cross-sectional study that aimed to clarify the relationship between ineffective parenting and childhood obesity by using multiple measures of child and family functioning. Sixty-two families with an obese child (aged four to 11 years) were matched with 62 families with a healthy weight child on key sociodemographic variables. Significant differences were found on several measures, including general parenting style, domain-specific parenting practices, and parenting self-efficacy (d = .53 to 1.96). Parents of obese children were more likely to use permissive and coercive discipline techniques, and to lack confidence in managing children’s lifestyle behaviour. In contrast, parents of healthy weight children were more likely to implement specific strategies for promoting a healthy lifestyle.
The objective of this study is to determine the factors influencing breastfeeding duration in Greece. A total of 145 women were interviewed, on the third day post-partum. Women were followed up by telephone interviews at three and six months post-partum. Chi-square test and binomial sequential logistic regression analysis were used for statistical analysis. Results from this study show that baby-friendly hospital, antenatal courses, mother’s perception of her capability to successfully breastfeed her infant, mother’s intention to breastfeed for a duration of six months or more, mother’s and father’s education level, introduction of complementary foods or fluids, caesarean delivery, smoking and ethnicity were significantly associated with the duration of breastfeeding. In conclusion, additional antenatal and postnatal framework is necessary. Mothers’ prediction of the duration of breastfeeding is an additional tool for identification of women with a high probability for early weaning.
Referrals to children’s palliative care services typically occur late in the illness trajectory, with many children who would benefit not referred at all. Previous studies report health care professionals’ (HCPs) assessment of various parent-related factors as barriers to referral. We conducted a cross-sectional survey of HCPs working in a paediatric tertiary care hospital in the United Kingdom, with an established paediatric palliative care team, to explore staff perceptions of barriers, knowledge and attitudes, with the aim of developing interventions to increase patient access to palliative care services. Survey respondents evidenced good knowledge of the principles of palliative care in closed questions, but their attitudes expressed in open-text questions and reported reasons to refer to a palliative care service demonstrated an association of palliative care with death and dying. We suggest that the association of palliative care with end of life may be a modifiable factor relevant to late and non-referral and deserving of further investigation and attention in education and training.
The objective of this article was to determine the impact of different bottles and teats for feeding babies with a cleft palate (with and without a cleft lip) on weight velocity, feeding behaviour, and maternal self-esteem. A mixed methods study incorporating the use of diaries to record feeding patterns of babies and levels of professional support received was used. Growth was assessed by converting weights into standard deviation scores and using the differences to express weight velocity over a six-week period. Visual analogue scales were used to assess mothers’ perceptions of their children and themselves. The Edinburgh Postnatal Depression Score (EPDS) was used to identify maternal depression. The study demonstrated that the most significant effect on weight was determined by cleft type. Babies with isolated clefts of the hard and soft palate experienced greater feeding problems and suffered the biggest weight losses. This remained significant independently of the type of bottle/teat used. Poor weight gain was also associated with a mother’s low perception of herself and her child, and her tendency towards depression. The study highlights the importance of the early assessment of babies’ feeding skills and regular follow-up and support from trained and experienced nurse specialists.
This study aims to describe nurses’ knowledge of and attitudes towards the management of fever in one children’s hospital in Ireland. A descriptive, quantitative research design was employed. One hundred and nineteen nurses working in one children’s hospital completed a self-report questionnaire. Nurses’ mean knowledge score about the physiology of fever, fever management and antipyretics was 51 per cent (n = 119), which was lower than expected. Nurses had both appropriate and inappropriate attitudes towards fever and fever management. Inconsistent attitudes between nurses were identified. Nurses who participated in this study are not expert managers of fever. Their lack of knowledge and inconsistent attitudes are affecting the care of febrile children, and may be fuelling parents’ fever phobia. Further education is required to improve nurses’ knowledge of fever and fever management. Inappropriate attitudes need to be challenged and addressed in an effort to promote evidence-based care for febrile children.
Children entering school need to build healthy peer relationships; school, however, is the central place for bullying. School nurses have a growing focus on providing care for students with social, emotional and behavioural problems. We examined the relational development of children at school entry in regard to aggression and empathy, showing that teacher-reported aggression decreased between Pre-primary and Year One, while empathy increased between Year One and Year Two classes. No gender difference was found in teacher-reported total, or covert aggression. Understanding how development of empathy can be supported in children at school entry is important, thereby supporting development of pro-social behaviour and decreasing bullying. School nurses must understand the importance of surrounding children with safety in relationships as they begin school.
Benefits of family meals include diet quality, social interaction and wellbeing, yet previous research indicates only one in four adolescents eats a meal with their family every day. This study identified factors relating to the frequency and importance of family meals. A focus group conducted with seven adolescents was analysed thematically. The themes and findings of past research were used to develop a Family Meals Questionnaire (FMQ), completed by 76 adolescents. Regular engagement in healthy family meals eaten around the table was reported, with the majority of participants reporting that their meals included a variety of foods and portions of vegetables. Frequency of family meals was associated with increased family togetherness for both males and females. The nutritional value of meals was found to be most important to females, whereas the impact of family meals on mood was more salient for males. Findings suggest that the views and behaviour of other family members may influence adolescents’ enjoyment and perceptions of the importance of family meals, and therefore impact on their frequency. These findings may inform the development of future interventions aimed at increasing adolescent engagement in family meals by adopting a family systems approach to improve the frequency and experience of family meals.
This prospective longitudinal study explored the growth patterns of preterm infants and the implications of rearing them in an advancing culture. The study measured the weight, length, and head circumference of 343 Korean preterm infants over 12 months corrected age. Data were analyzed using a generalized estimation equation for growth patterns of preterm infants by the degree of prematurity (mild, moderate, or severe). Results showed that the early ‘catch-up phenomenon’, accelerated growth rate, occurred around 11 months corrected age, although the mild preterm group weighed less, was shorter, and had a smaller head circumference than the moderate and severe preterm groups. This may reflect the Asian culture’s preference for big babies and draws special attention to the influence of cultural values and childrearing practices in the growth of preterm infants. Pediatric nurses should be alert to accelerated growth in preterm infants in societies in cultural transition.
We examined how prenatal exposure to breastfeeding information from various media sources, maternal knowledge of benefits, family and clinician support, and peer practices influence breastfeeding outcomes in early infancy. Initiation of breastfeeding, any breastfeeding at two months, and exclusivity of breastfeeding at two months were examined in a cohort of US women using data from the Infant Feeding Practices Study II. Descriptive statistics, chi-square analyses and logistic regression were conducted. Approximately 85 percent of the women initiated breastfeeding. At two months, 63.8 percent continued breastfeeding, while only 38.1 percent breastfed exclusively. Mothers with greater knowledge about breastfeeding benefits were 11.2 (95% CI: 6.87–18.45) times more likely to initiate breastfeeding and 5.62 (95% CI: 4.19–7.54) times more likely to breastfeed at two months than those with lower levels of knowledge. Women whose families prenatally supported exclusive breastfeeding were 8.21(5.12–13.2) times more likely to initiate and continue breastfeeding (OR 3.21, 95% CI: 2.51–4.11). Clinicians who supported breastfeeding only also increased the odds of a woman initiating breastfeeding (OR 1.95, 95% CI: 1.31–2.88). Interventions to increase maternal knowledge of breastfeeding benefits and family and clinician support of breastfeeding in the prenatal period may help increase breastfeeding rates. The encouragement of breastfeeding needs to be a priority among health care providers to improve the health of mothers and infants.
The objective of this study was to advance our understanding and appreciation of the health status of young children in the state of Nevada in addition to their discrepancies in accessing health care. This study used the 2008–2009 Nevada Kindergarten Health Survey data of 11,073 children to assess both independent and combined effects of annual household income, race/ethnicity, primary language spoken in the family, rural/urban residence, and existing medical condition on access to health care. Annual household income was a significant predictor of access to health care, with middle and high income respondents having regular access to care compared to low income counterparts. Further, English proficiency was associated with access to health care, with English-speaking Hispanics over 2.5 times more likely to have regular access to care than Spanish-speaking Hispanics. Rural residents had decreased odds of access to preventive care and having a primary care provider, but unexpectedly, had increased odds of having access to dental care compared to urban residents. Finally, parents of children with no medical conditions were more likely to have access to care than those with a medical condition. The consequences for not addressing health care access issues include deteriorating health and well-being for vulnerable socio-demographic groups in the state. Altogether these findings suggest that programs and policies within the state must be sensitive to the specific needs of at risk groups, including minorities, those with low income, and regionally and linguistically isolated residents.
The burden of social inequality falls disproportionately on child health and survival. This inequality raises the question of how wide this gap is, or what its relation is with the level of child mortality. Whether these disparities are increasing or declining with the development and how they differ from region to region or from state to state within the country needs to be looked into. As a measure of inequality and to compare the disparities between different states of India, concentration curves and indices are constructed from infant and under five mortality data classified under different quintiles of wealth index from the National Family Health Survey (NFHS-3) data of India. Inequality measures indicate that inequality in child mortality is more concentrated in the comparatively developed states than the poorer states in India.
This study investigates the relationships between resilience and behavioral problems in school-aged children with atopic dermatitis (AD) and identifies factors associated with these behavioral problems. A total of 102 school-aged children suffering from chronic AD were administered a self-report questionnaire on resilience, and the Korean version of the Child Behavior Checklist, to measure their internalizing/externalizing behavioral problems. The means of the internalizing and externalizing behavioral problems of children with AD were 6.58 and 7.26, respectively. Both resilience and economic status were negatively correlated with the internalizing, r -0.262, p < 0.05, and externalizing, r -0.248, p < 0.05, behaviors in children. The higher the children’s school achievements, the less externalizing behavioral problems were reported, r -0.327, p < 0.05. Resilience was identified as the single potent variable affecting children’s behavioral problems. The higher the children’s resilience scores, the lower was the chance of both internalizing, β -1.648, p 0.034, and externalizing behavioral problems, β -1.382, p 0.041. To prevent possible behavioral problems in children with chronic AD, a care plan enhancing their resilience (i.e. promoting parenting skills and social supports for children) should be developed.
The aim of this study was to investigate asthma management self-efficacy in parents of primary school-age children with asthma and to explore possible associations between parent asthma management self-efficacy, parent and child characteristics, asthma task difficulty and asthma management responsibility. A cross-sectional descriptive survey of 113 parents was conducted to assess the level of parent asthma management self-efficacy, asthma task difficulty and confidence, asthma responsibility and socio-demographic characteristics. The findings indicate that parents had higher self-efficacy for attack prevention than attack management. Parents had higher self-efficacy for asthma management tasks that are simple, skills based and performed frequently such as medication administration and less confidence and greater difficulty with tasks associated with judgement and decision-making. Multivariate linear regression analysis identified English language, child asthma responsibility and parent education as predictors of higher asthma management self-efficacy, while an older child was associated with lower parent asthma management self-efficacy. The implications of these results for planning and targeting health education and self-management interventions for parents and children are discussed.
The aim of this study was to revise and organize according to recall time based criteria, questionnaires created and validated to assess the level of physical activity in children and adolescents, with the intention of enabling their proper understanding and subsequent use by nurses and health care professionals. In order to determine the questionnaires’ quality, their degree of reliability and validity was the main feature to be taken into account. Thirty-eight papers were retrieved and analyzed, 31 of which were aimed at designing and validating a questionnaire intended for physical activity (PA) level assessment in youth populations (four to 19 year olds). The most widely used questionnaires were those whose recall time spans from one to seven days. In general, all questionnaires were characterized by the use of pen-and-paper format and scarce utilization of new technologies.
Based upon validity and reliability criteria, in order to assess PA level in children and adolescents, nurses should use the "Children’s Leisure Activities Study Survey" and the "Flemish Physical Activity Computer Questionnaire", respectively. There is a need for the validation of these tools in other languages and cultures.
Recently, increased recognition has been attributed to the requirement to include the views of child patients in the planning of new health care services so that contemporary buildings can be designed to enhance future experience. This is important, especially since the voices of young children are so often under-represented or represented through adult proxies. The purpose of this article is to share young children’s perspectives of what constitutes ideal physical design features for hospital-built environments. Using a participatory art-based approach, data were collected from 55 children (aged five–eight years) across three children’s hospitals in Ireland. Emergent findings revealed three broad themes: personal space, physical environment and access. This study is important for nurses, clinicians and environmental designers because it outlines what a supportive child health care environment should constitute. Hospital environments need to be constructed not just to be child friendly, but to also respect children’s right to dignity, privacy, family support and self-control.
Obesity continues to affect African Americans in epidemic proportions, particularly among women and adolescent females. Perceptions, beliefs, behaviors, and body sizes of adolescents are associated with those of their mothers, yet little is known about the transgenerational meanings and experiences of obese African American adolescent girls and their mothers. An interpretive phenomenological study was conducted with seven African American adolescents between the ages of 11 and 17, and their adult female caregivers. Audio-taped interviews were transcribed and analyzed by a multicultural interpretive team. Two constitutive patterns and associated themes were identified. One pattern, ‘Framing: sizing it up; sizing it down’, with its three associated themes is presented. Mothers and daughters are engaged in multiple common practices in which they self-define body size, while protecting their self-esteem and self-image. This pattern illustrates how the women and girls created an image of their bodies as they confronted and acknowledged their self-perceptions, compared themselves to others in their environment, and evaluated themselves against specific parameters of acceptable size.
The provision of information is an individual entitlement and a prerequisite to enabling children to understand their illness, make choices about their health care and be involved in decision-making processes around these choices. However, limited evidence exists on children’s perspectives of information provision while an inpatient in hospital. The aim of this paper is to describe the process of information exchange between health professionals and children in hospital. Informed by an ethnographic design, data were collected using multiple methods, including semi-participant observations, interviews and participatory activities. Forty-nine children aged six to 16 years, with a variety of medical and surgical conditions, admitted to one children's ward at one children's hospital participated in the research. Findings revealed that children encountered a variety of information management experiences. The key message for health professionals is that there is a need to develop child- and family-focussed strategies for assessing children’s information needs in order to determine their preferences for information (amount, format, from whom, etc.), to develop a method for gaining an appreciation of parents’ and health professionals’ beliefs about the optimal amount and type of information to relay to children, and to achieve consensus about who is best placed to transmit this information to children.
This population-based study evaluates the prevalence of factitious disorders, Münchausen syndrome, and Münchausen syndrome by proxy in a clinical setting. All children referred to the Pediatric Unit of the Department of Pediatrics of the Catholic University Medical School (Agostino Gemelli Hospital) in Rome were recruited between November 2007 and March 2010. An experienced interdisciplinary team of medical professionals analyzed all suspected cases. A total of 751 patients were hospitalized. Factitious disorders were diagnosed in 14/751 patients, resulting in a prevalence of 1.8%. Three of 14 (21.4%) patients fulfilled the criteria for Münchausen syndrome. Münchausen syndrome by proxy was identified in four of 751 patients, resulting in a prevalence of 0.53%. The perpetrator was the mother in three of four of these cases. The epidemiological data obtained in this population-based study indicate that the prevalence of factitious disorders, Münchausen syndrome, and Münchausen syndrome by proxy is higher than previously observed. Moreover, early detection was possible thanks to the awareness of an expert interdisciplinary team. We suggest that physicians must consider the possibility of these diagnoses whenever there are discrepancies in a child’s illness presentation.
This article reports an explorative study which aims to investigate hospitalized children’s views of their relationships with nurses and doctors. Twenty-seven school-aged children and adolescents from 6 to 15 years old in the paediatric haematology and oncology ward of an Italian hospital participated in the study. Each participant was asked to draw him or herself with a doctor or nurse from the ward while they were doing something. The drawings were analysed using Pictorial Assessment of Interpersonal Relationships (PAIR) and a qualitative analysis. The results showed that the participants viewed their relationships with health professionals positively, in particular with the nurses. This relationship was perceived as close, intimate, cohesive and without conflict. In some cases it became an emotional bond. Finally, this relationship helped the patients to cope with painful and uncomfortable medical procedures, which gradually became familiar and accepted. The clinical implications of this study are discussed.
In Lacey J. Benson, Robert Cohn and David C. Kaelber’s article ‘The association of continuity of care on the diagnosis of hypertension in children and adolescents’, 13(4): 361–369, 2009, DOI: 1 0.1177/1367493509344680, the following errors have been identified: Dr. Robert Cohn’s affiliations should have read: Case Western Reserve University School of Medicine, and Department of Pediatrics, MetroHealth Medical Center, Cleveland, OH, USA Dr. David Kaelber’s affiliation should have read: Case Western Reserve University School of Medicine, and Department of Pediatrics, Internal Medicine and Information Services, The MetroHealth Medical Center, Cleveland, OH, USA The editors and publishers apologise to the authors and regret any inconvenience caused.