Caregivers Of Young Children Research Articles

Effectiveness of caregiver educational materials for paediatric community-acquired pneumonia in the emergency department: a qualitative study.

The objective of this study was to better understand caregiver perspectives on educational materials relating to paediatric community-acquired pneumonia and antibiotic stewardship in the emergency department setting. This was a phenomenologically informed qualitative study. Caregivers of young children in Hamilton, Ontario were presented with four educational materials (animated video, physician led lecture-style video, caregiver led testimony-style video, and a printed brochure) providing information relating to treatment strategies for community-acquired pneumonia. Caregivers were then asked open-ended questions about how they felt about the effectiveness of the media used. The principles of conventional content analysis guided the coding and synthesis of the transcribed interviews. Eleven caregivers were interviewed. Most caregivers preferred the animated video and brochure to the lecture-style physician video and caregiver testimonial video. Common themes for effective educational materials included visually attention-grabbing graphics, accessible language, and formats they could reference following their visit (e.g. brochure). The busy nature of the emergency department setting can impede effective communication between clinicians and parents. Employing educational materials may allow for more informed parent-provider communication on care decision making. Caregivers in our study prioritized the simplest information formats for education around community-acquired pneumonia and antimicrobial stewardship which could be referenced following discharge. This was best accomplished by short, animated videos and brochures. Results from this study can inform development of future educational materials used in paediatric emergency department settings to optimize caregiver education and corresponding care plan adherence.

The role of food reward in the associations between weight-based discrimination and feeding practices among caregivers of young children

Certain caregiver feeding practices, including restrictive feeding for weight control, restrictive feeding for health, emotion regulation feeding, and reward feeding, are known to negatively influence short- and long-term child eating and health outcomes. Beyond body size, the precise psychosocial characteristics of caregivers more likely to engage in such feeding practices are unknown. In particular, caregivers who have experienced discrimination based on their weight, who have internalized those biased beliefs, or who find food to be very rewarding may be more likely to use restrictive or controlling feeding practices. The present study investigated the associations among experiences of weight-based discrimination, internalized weight bias, and food reward (i.e., reward-based eating drive) with use of restriction for weight control, restriction for health, emotion regulation feeding, and reward feeding in an online US sample of caregivers (M = 35.27 ± 9.08 y/o) of 2–5 year-old children (N = 305). About half (50.8%) of respondents self-identified as women and most as non-Hispanic (88.5%) and White (75.1%). There were significant positive correlations among caregivers' experience of weight-based discrimination, internalized weight bias, and use of all four feeding practices. Regression results showed that caregivers’ food reward moderated the main effect of weight-based discrimination on restrictive feeding for weight control and emotion regulation feeding, such that caregivers who were high in food reward and who experienced discrimination were most likely to engage in these feeding practices. These results can inform interventions aimed at improving child food environments and health.

The Use of Pictorial Recall Aids Modifies Dietary Assessment Results: Experiences from Quantitative 24-hour Dietary Recalls of Young Children in Nepal and Senegal

BackgroundRecall bias or memory error is a known limitation of recall-based dietary assessment methods and can lead to substantial misrepresentation of diets. Pictorial recall aids have been used by various studies to mitigate recall bias, but their effect on quantitative, 4-pass 24-h dietary recall (24HR) results has not yet been measured. ObjectivesThis article examines uptake of pictorial recall aids among caregivers of young children in Kathmandu Valley, Nepal, and Guédiawaye Department, Senegal; describes what foods/beverages are subject to recall bias in these contexts; and assesses the effect of these recall aids on estimated dietary outcomes. MethodsWe used cross-sectional data from 24HR surveys that provided a recall aid to reduce caregiver recall bias. Young children’s dietary outcomes were calculated from the 24HR data. Logistic regressions were used to compare characteristics and estimated dietary outcomes of children by recall aid uptake. McNemar’s test and paired t-tests were used to compare estimated dietary outcomes in initial 24HR data with revised 24HR data that incorporated omitted items identified by the recall aid. ResultsPictorial recall aids had relatively high uptake by caregivers in both contexts. Beverages, unhealthy snacks, and fruit were most subject to recall bias. Adding omitted items identified by recall aids resulted in statistically significant changes in most dietary outcomes assessed. Children of caregivers who chose to use the recall aid had significantly different estimated dietary outcomes than children of caregivers who did not use the recall aid. ConclusionsThe use of pictorial recall aids modifies 24HR results in these 2 contexts. Rigorous research is needed to fully understand the impact of recall aids on 24HR methodology and results, with an aim to improve the accuracy of dietary assessment and ultimately inform evidence-based nutrition programming, policy, and recommendations.

An Online Survey of Picture Book Reading Practices with Children Between the Ages of 0 and 30 Months

ABSTRACT There is a great deal of variability in how families read and interact with picture books. To understand why reading practices may (or may not) relate to language outcomes, a necessary step to understand what occurs in the home. The goal of this work is to better understand the frequency and nature of picture book reading at home with children between the ages of 0 and 30 months in the United States. In an online survey, 282 caregivers answered questions about their picture book reading habits. Book reading was overall very common. Over 90% of families reported reading at least weekly to their child and nearly 70% reported reading daily, with caregivers of older children reporting reading slightly more frequently than caregivers of younger children. Caregivers also reported reading picture book text as well as a range of extra-textual activities. These textual and extra-textual behaviors varied across families and varied with child age and language skills. This study provides insight into how much, and what kind of linguistic input children encounter during picture book reading, and how this input may vary with age.

Exit interviews from two randomised placebo-controlled phase 3 studies with caregivers of young children with autism spectrum disorder

IntroductionAutism spectrum disorder (ASD) is characterised by difficulty with social communication and restricted, repetitive patterns of behaviour. This study aimed to improve understanding of the ASD patient experience with the treatment (bumetanide) regarding the changes in core symptoms and to assess changes considered as meaningful. To achieve this, qualitative interviews were conducted with caregivers of patients in two phase 3 clinical trials (NCT03715153; NCT03715166) of a novel ASD treatment.MethodsCaregivers were invited to participate in one interview after completion of the pivotal phase 3 study; for those of them who continued treatment after study completion, a second interview was held 3 months after trial completion. The interviews were conducted by qualitative researchers and followed a semi-structured interview guide. The interviews focused on patients’ ASD symptoms and their impact on their daily life before enrolment, and on any symptom changes patients experienced during the trial.ResultsOut of the 13 eligible patients’ caregivers, 11 were interviewed up to two times at clinical sites in the UK, Spain, and Italy. The caregivers reported impairments in a wide range of skills: deficits in communication and social interaction; restricted, repetitive patterns of behaviour, interests, or activities; and cognitive, emotional, and motor impairments. Compared to before the trial initiation, caregivers also reported improvements in the following domains: communication, interaction with others, cognition, aggression, emotions, repetitive movements, eating, and sleeping.ConclusionThe exit interviews provided a rich source of qualitative data, allowing a deeper understanding of caregivers’ and patients’ experience of the disease and allowing us to understand what constitutes a meaningful change. These data also helped identify important experiences that may inform the patient-reported outcome measurement strategy for future trials in ASD.

Exploring Oral Health Knowledge and Practices among Early Childhood Caregivers A Cross-Sectional Survey

Early childhood is a crucial developmental phase of a child's well-being, which lays the foundation for their future growth. Lack of good oral practices may cause dental issues during this fundamental phase of development and have a long-lasting impact on a child's overall well-being. This cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan, to explore oral health knowledge and practices among the caregivers of young children. A sample of 94 participants, including parents, caregivers, early childhood educators, and healthcare professionals (HCPS), was included through a convenient sampling technique. An online survey questionnaire was administered, which covered various aspects of oral hygiene practices to prevent common oral diseases among children. All statistical analyses were performed using SPSS 22.0. Statistical significance was accepted as p ≤0.05. Results of the study revealed no significant differences in oral health knowledge and practices based on age and gender. However, comparisons based on profession and roles showed a significant difference. Most participants agreed on the importance of regular oral hygiene practices. However, their opinions differed on certain oral hygiene practices, including the frequency of brushing and the timing of the first dental visit. This study underscores the importance of targeted education and interventions to improve oral health outcomes during the critical developmental phase of childhood.

Complementary food exposure and children's early understanding of food words: the approaching eating through language (APPEAL) study.

Language skills, such as the ability to understand words (receptive language), develop during infancy and are built through interactions with the environment, including eating. Exposure to complementary foods also begins in infancy and may play a significant role in language development, especially in understanding of food-related words. However, the relationship between the complementary foods to which a child is exposed and early language acquisition has not been previously studied. We hypothesized that young children's food-related receptive language (FRL) would reflect the complementary foods to which they were frequently offered by caregivers. Caregivers of young children (4-26 months; n = 408) in the Approaching Eating through Language (APPEAL) Study in the US were surveyed via Qualtrics. FRL was assessed by caregiver-report via a modified MacArthur-Bates Communicative Development Inventory. Complementary foods offered (CFO) by caregivers were assessed using a modified Food Frequency Questionnaire. Latent Class Analysis (LCA) was implemented to identify, 1) groupings of foods frequently offered (>1x/week) and 2) groupings of food-related words understood by the young children. A 5-class best fit LCA model was identified for CFO (-log likelihood [-llik]=-8727) and for FRL (-llik=-5476). Cross-classification of the CFO and FRL derived classes revealed that children with higher exposure to complementary foods were perceived by caregivers to be most likely to also understand a greater number of food-related words (Probability=0.48). As expected, children having been offered a greater number of complementary foods and who understood a greater number of food-related words were older, compared to those with less complementary food exposure and food-related language acquisition (p < 0.001). These findings support the potential role of introduction to complementary foods in development of food-related language.

Caregiver knowledge and attitudes relating to paediatric pneumonia and antimicrobial stewardship: a qualitative study

ObjectiveThe objective of this study was to understand caregiver perspectives and experiences relating to the treatment of paediatric community-acquired pneumonia (CAP).Design, setting and patientsThis was a phenomenological qualitative study involving...

Effects of a front-of-package disclosure on accuracy in assessing children's drink ingredients: two randomised controlled experiments with US caregivers of young children.

Test effects of a standardised front-of-package (FOP) disclosure statement (indicating added sugar, non-nutritive sweetener (NNS) and juice content) on accuracy in assessing ingredients and perceived healthfulness of children's drinks. In two randomised controlled experiments, the same participants viewed drink packages and indicated if products contained added sugar or NNS and percent juice and rated drink healthfulness. Experiment 1 (E1) included novel (non-US) children's drinks with a) product claims only (control), b) claims and disclosure, or c) disclosure only. Experiment 2 (E2) included existing children's drinks (with claims) with a) no disclosure (control) or b) disclosure. Both experiments evaluated sweetened (fruit drink and flavoured water) and unsweetened (100 % juice and juice/water blend) drinks. Potential individual differences (education level and race/ethnicity) in effects were explored. Online survey. Six hundred and forty-eight US caregivers of young children (1-5 years). FOP disclosures significantly increased accuracy for most ingredients and drink types, including identifying presence or absence of NNS in sweetened drinks, no added sugar in juice/water blends, and actual percent juice in fruit drinks and juice/water blends in both experiments. Disclosures also increased recognition that the novel 100 % juice and juice/water blend did not contain NNS or added sugar (E1) and existing sweetened drinks contained added sugar (E2). Disclosures reduced perceived healthfulness of sweetened drinks but did not increase unsweetened drink healthfulness ratings. Some differences by participant socio-demographic characteristics require additional research. FOP disclosures on children's drink packages can increase caregivers' understanding of product ingredients and aid in selecting healthier children's drinks.

Development and psychometric validation of the Pandemic-Related Traumatic Stress Scale for children and adults.

To assess the public health impact of the COVID-19 pandemic on mental health, investigators from the National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) research program developed the Pandemic-Related Traumatic Stress Scale (PTSS). Based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) acute stress disorder symptom criteria, the PTSS is designed for adolescent (13-21 years) and adult self-report and caregiver-report on 3-12-year-olds. To evaluate psychometric properties, we used PTSS data collected between April 2020 and August 2021 from non-pregnant adult caregivers (n = 11,483), pregnant/postpartum individuals (n = 1,656), adolescents (n = 1,795), and caregivers reporting on 3-12-year-olds (n = 2,896). We used Mokken scale analysis to examine unidimensionality and reliability, Pearson correlations to evaluate relationships with other relevant variables, and analyses of variance to identify regional, age, and sex differences. Mokken analysis resulted in a moderately strong, unidimensional scale that retained nine of the original 10 items. We detected small to moderate positive associations with depression, anxiety, and general stress, and negative associations with life satisfaction. Adult caregivers had the highest PTSS scores, followed by adolescents, pregnant/postpartum individuals, and children. Caregivers of younger children, females, and older youth had higher PTSS scores compared to caregivers of older children, males, and younger youth, respectively. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Burden of care and a sense of loneliness in caregivers of children with type 1 diabetes. a cross-sectional study

BackgroundTreatment of type 1 diabetes is a process involving not only sick children, but also their caregivers.AimTo assess the burden of care and sense of loneliness in caregivers of children with type 1 diabetes. Also, an analysis was conducted of the connection between sociodemographic factors characterizing caregivers and the clinical factors characterizing sick children and between the burden of care and the sense of loneliness.Materials and methodsThe study included 125 caregivers of children with type 1 diabetes. In order to collect the research data, the Caregiver Burden Scale and the Revised UCLA Loneliness Scale were used.ResultsIn the research group, the total result in the caregiving burden scale was 2.14, which remains within the average burden level. Caregivers showed the highest burden level in the General Strain Subscale. The analysis showed that mothers experience a greater burden of care than fathers in the General Strain Subscale and that caregivers of younger children are more burdened with care within the Isolation and Disappointment Subscales. Moderate high degree of loneliness was shown in 4.8% of caregivers. A higher burden of care for caregivers of children with type 1 diabetes is accompanied by a higher sense of loneliness.ConclusionsThe results of this study may help healthcare professionals plan a holistic, family-centered care program that will take into account factors that increase the burden of care: younger age of the affected child, motherhood, caregiver unemployment, feelings of loneliness, lower education, caregiver unemployment, blood glucose meter measurements, and frequent night-time blood glucose measurements.

Sustainable home gardens in Western Kenya: A qualitative study for co-designing nutrition-sensitive interventions

Populations living in rural sub-Saharan Africa (SSA) increasingly face negative climate change impacts on their nutrition and health status. For smallholder farming families, home gardens can serve as an adaptation strategy, by offsetting climate change-related harvest losses and diversifying households' diets. The present study aimed to identify perceptions and experiences among rural caregivers of children under five years and local stakeholders working in the fields of agriculture or nutrition with regard to home gardening in Siaya County, Kenya. Thirty in-depth interviews with caregivers of young children and 26 interviews with local stakeholders were conducted, using a semi-structured interview guide. The data were analysed employing inductive content analysis. Caregivers and local stakeholders perceived home gardens as beneficial for the households’ nutrition, finances, and women empowerment. However, they also pointed to five major challenges in the process of establishing and maintaining home gardens: 1) water scarcity, 2) limited financial capital, 3) demanding physical labour, 4) limited land availability/control, and 5) lack of knowledge and technical support. For the design of sustainable home gardens, we identified four components as essential at the implementation stage: 1) locally available material and resources, 2) strong community collaboration and co-design, 3) comprehensive capacity building, 4) and lasting local partnerships. In conclusion, the establishment and sustained management of home gardens in Siaya County require a holistic, participatory and multi-actor approach. This will facilitate the provision of essential inputs and activities to ensure a sense of ownership and responsibility.

Measuring dengue illness intensity: Development and content validity of the dengue virus daily diary (DENV-DD)

BackgroundDengue is the most prevalent arboviral infection causing an estimated 50–60 million cases of febrile illness globally per year, exacting considerable disease burden. Few instruments exist to assess the patient illness experience, with most based on healthcare provider assessment, lacking standardization in timepoints and symptom assessment. This study aimed to evaluate the content validity of the novel ‘Dengue Virus Daily Diary (DENV-DD)’, designed to measure symptom intensity and disease burden within outpatient infant to adult populations.MethodsThe Dengue Illness Index Report Card was used as a foundation to create the DENV-DD, consisting of patient- and observer-reported outcome (PRO/ObsRO) instruments. In two South American dengue-endemic communities, qualitative combined concept elicitation and cognitive debriefing interviews were conducted among individuals and caregivers of children with symptomatic laboratory-confirmed dengue. Interviews were conducted across two rounds allowing DENV-DD modifications. A small-scale quantitative assessment of the DENV-DD was also conducted with data from an independent Dengue Human Infection Model (DHIM) to generate early evidence of feasibility of DENV-DD completion, instrument performance and insight into the sign/symptom trajectory over the course of illness.ResultsForty-eight participants were interviewed (20 adults, 20 older children/adolescents with their caregivers, 8 caregivers of younger children). A wide spectrum of signs/symptoms lasting 3–15 days were reported with fever, headache, body ache/pain, loss of appetite, and body weakness each reported by > 70% participants. DENV-DD instructions, items and response scales were understood, and items were considered relevant across ages. DHIM data supported feasibility of DENV-DD completion.ConclusionsFindings demonstrate content validity of the DENV-DD (PRO/ObsRO instruments) in dengue-endemic populations. Psychometric and cultural validity studies are ongoing to support use of the DENV-DD in clinical studies.

Perceived control, loneliness, early-life stress, and parents’ perceptions of stress

The COVID-19 pandemic has highlighted the importance of understanding what contributes to individual variability in experiences of stress. Increases in stress related to the pandemic have been especially pronounced in parents, indicating a need for research examining what factors contribute to parents’ perceptions of stress. Here, we assessed the relationship between parents’ perceptions of stress, control, loneliness, and experiences of childhood trauma in two populations of caregivers. In Study 1, we examined the relationship between perceptions of stress, control, loneliness, and history of early stress, along with indices of socioeconomic risk and resting parasympathetic nervous systema activity, which has been linked to variability in perceptions of stress, in caregivers of young children. Perceived control, loneliness, childhood stress, and resting parasympathetic nervous system activity predicted caregivers’ stress. In Study 2, we replicated these initial findings in a second sample of caregivers. Additionally, we examined how these processes change over time. Caregivers demonstrated significant changes in perceptions of control, loneliness, and stress, and changes in control and childhood trauma history were associated with changes in perceptions of stress. Together these results indicate the importance of assessing how caregivers perceive their environment when examining what contributes to increased risk for stress. Additionally, they suggest that caregivers’ stress-related processes are malleable and provide insight into potential targets for interventions aimed at reducing parents’ stress.

Caregiver-based perception of disease burden in Schaaf-Yang syndrome.

Schaaf-Yang syndrome (SYS) is a neurodevelopmental disorder caused by truncating variants in the paternally expressed MAGEL2 gene in the Prader-Willi syndrome-region on chromosome 15q. In addition to hypotonia and intellectual disability, individuals with SYS are frequently affected by neonatal contractures and autism spectrum disorder. In this study, we focus on the burden of disease on patients and their families for the first time. Based on the online SYS Patient Voices Survey the perspective of 81 primary caregivers on SYS was assessed. The perceived severity of muscular and developmental manifestations dominated the evaluation of the phenotype in early childhood, while behavioral issues were considered more impactful later in life. Importantly, an apprehension toward symptoms with a later onset was observed in caregivers of younger children. Available therapeutic options, while mostly effective, did not sufficiently alleviate the total burden of disease. Overall, parents stated that caring for an individual with SYS was very challenging, affecting their daily lives and long-term planning. Our study demonstrates the necessity for treatments that, adapted to age and in accordance with the caregivers' prioritization, improve the patients' medical condition and thus facilitate their and their families' social participation.

Impact of COVID-19 pandemic on insomnia and sleep efficiency in parents and caregivers of young children

IntroductionDuring the COVID-19 pandemic, sleep problems were highly prevalent. However, few studies assess sleep quality among parents and caregivers with young children. This study aimed to describe the impacts of the COVID-19 pandemic on sleep patterns among parents and caregivers with young children (&amp;lt;6 years) and identify the factors associated with insomnia and sleep efficiency.MethodsAn internet sample of 136 caregivers (age: 35 ± 9.7 y, 70.6% female) were recruited internationally from May 21, 2020 to July 1, 2020. Participants completed the Center for Epidemiological Studies–Depression Scale-10 (CES-D-10), Sleep Hygiene and Practices Scale (SHPS), Coronavirus Impact Scale (CIS), Insomnia Severity Index (ISI), and sleep patterns prior to and during the pandemic. Hierarchical regressions were conducted to examine the factors associated with insomnia and sleep efficiency.ResultsNearly 40% of the caregivers reported household incomes &amp;lt;$10,000. More than half reported clinical levels of depressive symptoms (59.2%) and low sleep efficiency (65.8%). Approximately 90% reported that their sleep-wake routine was altered with delayed bedtime and midpoint, and more naps and nightmares. Almost half (51.5%) were experiencing clinically meaningful insomnia symptoms. Greater insomnia symptom severity was independently associated with lower income, greater depressive symptoms, poor sleep hygiene behaviors, altered sleep-wake routine, and greater COVID-related disruptions in daily life. The predictors associated with poor sleep efficiency during the pandemic were lower income and poor sleep efficiency before the pandemic.DiscussionThe study highlighted the factors associated with insomnia and poor sleep efficiency during the COVID-19 pandemic. Interventions are needed to support caregivers' sleep during global crises.

PTFS09-01-23 Effects of a Front-of-Package Disclosure on Accuracy in Assessing Children's Drink Ingredients. Two Randomized Controlled Experiments With Caregivers of Young Children

PTFS09-01-23 Effects of a Front-of-Package Disclosure on Accuracy in Assessing Children's Drink Ingredients. Two Randomized Controlled Experiments With Caregivers of Young Children

Optimization of a method for collecting infant and toddler urine for non-target analysis using cotton pads and commercially available disposable diapers.

Urine is an abundant and useful medium for measuring biomarkers related to chemical exposures in infants and children. Identification of novel biomarkers is greatly enhanced with non-targeted analysis (NTA), a powerful methodology for broad chemical analysis of environmental and biological specimens. However, collecting urine in non-toilet trained children presents many challenges, and contamination from specimen collection can impact NTA results. We optimized a caregiver-driven method for collecting urine from infants and children using cotton pads and commercially available disposable diapers for NTA and demonstrate its applicability to various children biomonitoring studies. Experiments were first performed to evaluate the effects of processing method (i.e., centrifuge vs. syringe), storage temperature, and diaper brand on recovery of urine absorbed to cotton pads. Caregivers of 11 children (<2 years) used and retained diapers (with cotton pads) to collect their child's urine for 24 h. Specimens were analyzed via a NTA method implementing an exclusion list of ions related to contamination from collection materials. Centrifuging cotton pads through a small-pore membrane, compared to a manual syringe method, and storing diapers at 4 °C, compared to room temperature, resulted in larger volumes of recovered sample. This method was successfully implemented to recover urine from cotton pads collected in the field; between 5-9 diapers were collected per child in 24 h, and the total mean volume of urine recovered was 44.7 (range 26.7-71.1) mL. NTA yielded a list of compounds present in urine and/or stool that may hold promise as biomarkers of chemical exposures from a variety of sources. Infant and children urine is a valuable matrix for studies of the early life exposome, in that numerous biological markers of exposure and outcome can be derived from a single analysis. Depending on the nature of the exposure study, it may be the case that a simple collection method that can be facilitated by caregivers of young children is desirable, especially when time-integrated samples or large volumes of urine are needed. We describe the process for development and results of an optimized method for urine collection and analysis using commercially available diapers and non-target analysis.

Child DNA methylation in a randomised controlled trial of a video-feedback intervention to promote positive parenting and sensitive discipline (VIPP-SD)

IntroductionA major modifiable risk factor for behavioural difficulties is harsh and insensitive parenting, and it has been hypothesised that the biological mechanism by which parenting influences child behaviour is via changes in the child's DNA methylation. We attempted to, in part, address the hypothesis that parenting is associated with child DNA methylation and, in turn, behaviour.MethodsPrimary caregivers of young children with behavioural difficulties (children aged 12–36 months) were randomised to receive a video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) (n = 151), or usual care (n = 149). Child buccal samples were collected at a 2-year post-randomisation follow up (children aged 3–5 years, VIPP-SD group n = 106, usual care group n = 117) and were assessed for DNA methylation at the NR3C1, FKBP5 and OXYR genes. Child behaviour was assessed at baseline, post-intervention and 2-years post-randomisation using the Preschool Parental Account of Children's Symptoms (PPACS). We examined group differences in DNA methylation, associations of DNA methylation with behaviour, and sex differences.ResultsFor the NR3C1 and OXYR genes, there were no group differences, sex differences, or associations of DNA methylation with child behaviour, though all non-significant findings were in the hypothesised direction. For FKBP5 DNA methylation, there was a significant interaction between group and sex, such that males in the usual care group had higher DNA methylation than females, but in the intervention group females had higher DNA methylation than males. However, FKBP5 DNA methylation was not associated with behaviour in males or females.DiscussionWe provide the first evidence from a randomised controlled trial focused on improving parenting for sex-specific changes in child DNA methylation at a key gene involved in stress reactivity and psychopathology. This study adds to our understanding of causal mechanisms linking parenting with child behaviour, which is important for developing targeted interventions. A key limitation is that child DNA methylation was only assessed at one time point, so we were unable to assess change in DNA methylation over time. However, we demonstrate that is possible to collect and analyse DNA samples from families with young children receiving parenting interventions in the community, providing impetus for further research on this topic.

Building inclusive early learning environments for children with a disability in low-resource settings: Insights into challenges and opportunities from rural Zimbabwe

The majority of young children with a disability live in low- and middle-income countries, where access to inclusive early learning programs supported by governments or non-government organizations is usually unavailable for the majority of the population, who live in rural areas. This study explored the feasibility of leveraging materials and personnel available within local communities to provide inclusive early learning programs in rural Zimbabwe. Caregivers of young children with some disability were given the opportunity to describe their experienced challenges; ways in which they informally support their children’s early learning; and the types of skills and resources they were able and willing to offer to support the establishment and operation of a more formal group-based inclusive early learning program. Qualitative data were generated from a purposive sample of caregivers of children with diverse impairments (n = 12) in two remote rural districts in Zimbabwe. Themes were identified in the rich qualitative data caregivers provided during individual interviews. The challenges caregivers experienced included the failure of interventions to improve their children’s level of functioning, the lack of access to assistive devices, the perception that the local school would be unable to accommodate their children, and worry about the future. Despite these stressors, caregivers actively supported their children’s self-care, social, moral and cognitive development and sought ways to save the funds that would be needed if their children could attend school. Caregivers were also willing and able to provide diverse forms of support for the establishment and operation of an inclusive early education program: food, funding, teaching and learning materials, and free labor. The insights obtained from these data informed the design of local community-controlled inclusive early education programs and the types of support caregivers and children may need to participate fully in these.