Challenges In Care Of Children Research Articles

Disparities in Unmet Health Care Needs Among US Children During the COVID-19 Pandemic.

The COVID-19 pandemic disrupted pediatric health care in the United States, and this disruption layered on existing barriers to health care. We sought to characterize disparities in unmet pediatric health care needs during this period. We analyzed data from Wave 1 (October through November 2020) and Wave 2 (March through May 2021) of the COVID Experiences Survey, a national longitudinal survey delivered online or via telephone to parents of children aged 5 through 12 years using a probability-based sample representative of the US household population. We examined 3 indicators of unmet pediatric health care needs as outcomes: forgone care and forgone well-child visits during fall 2020 through spring 2021, and no well-child visit in the past year as of spring 2021. Multivariate models examined relationships of child-, parent-, household-, and county-level characteristics with these indicators, adjusting for child's age, sex, and race/ethnicity. On the basis of parent report, 16.3% of children aged 5 through 12 years had forgone care, 10.9% had forgone well-child visits, and 30.1% had no well-child visit in the past year. Adjusted analyses identified disparities in indicators of pediatric health care access by characteristics at the level of the child (eg, race/ethnicity, existing health conditions, mode of school instruction), parent (eg, childcare challenges), household (eg, income), and county (eg, urban-rural classification, availability of primary care physicians). Both child and parent experiences of racism were also associated with specific indicators of unmet health care needs. Our findings highlight the need for continued research examining unmet health care needs and for continued efforts to optimize the clinical experience to be culturally inclusive.

Perceptions of Mental Health in the LGBTQ+ Student Community: Needs, Barriers, and Access

In 2020, the COVID-19 pandemic devasted health outcomes and economies globally. As a result, many suffered financial hardships, childcare challenges, and poor mental health due to the pandemic’s negative effects. Young people were particularly affected by the pandemic as it pertained to education, social isolation, and access to essential resources and services. Additionally, the U.S. experienced a rise in anti-LGBTQ+ proposals and laws were introduced or passed in various states across the country, particularly in the South. LGBTQ+ youth and young adults are more likely to experience and report poor mental health compared to their straight counterparts. As a result, my two research collaborators (Dr. Gayle Beck and Phillis Lewis) and I proposed to examine the perceptions of mental health services, access, and availability among the LGBTQ+ student community and LGBTQ+ identifying faculty and staff on the University of Memphis campus. As a result of the pending or enacted anti-LGBTQ+ legislation and the effects of the pandemic, a needs assessment was conducted. Three methodological approaches were used to capture student, faculty, and staff insights; an online survey, focus groups, and interviews. The results of the needs assessment suggest that efforts could be used to improve access and reduce barriers for LGBTQ+ students on campus to improve overall mental health by facilitating the provision of counseling services, improving the campus atmosphere for students via training, and supporting LGBTQ mental health on campus.

Problem behaviours and caregiver burden among children with Autism Spectrum Disorder in Kuching, Sarawak.

Caregivers of children with Autism Spectrum Disorder (ASD) often experience emotional and psychological distress, as well as disruptions to family life and employment due to the challenges of caring for children with ASD. This study examines the relationship between problem behaviours and caregiver burden among children with ASD. A cross-sectional study using convenience sampling recruited 230 caregivers of children with ASD aged 4 to 18 years from selected autism centres in Kuching, Sarawak. The caregivers completed the Aberrant Behaviour Checklist-2 and the Zarit Burden Interview. Univariate analysis revealed a significant difference in caregiver burden for children with ASD receiving medications (p = 0.013), registered with the Social Welfare Department (p = 0.036), and having siblings with ASD (p = 0.046). About 40% of the children exhibited at least one domain of problem behaviour. More than half of the caregivers (53.9%) experienced burden, with the majority experiencing mild burden. Positive associations were seen between irritability (r = 0.458, p < 0.01), social withdrawal (r = 0.439, p < 0.01), stereotypic behaviour (r = 0.392, p < 0.01), hyperactivity/non-compliance (r = 0.467, p < 0.01), and caregiver burden. Child factors, including the duration of problem behaviour (r = 0.182, p = 0.007), medication use (eta = 0.187, p = 0.005), Social Welfare Department registration (eta = 0.138, p = 0.036), and the presence of siblings with ASD (eta = 0.130, p = 0.046) were associated with caregiver burden. Multiple linear regression showed that hyperactivity/noncompliance significantly predicted caregiver burden. Specific problem behaviours in children with ASD were associated with caregiver burden. These results highlight the need for interventions for the child with ASD and their caregivers.

Veteran Caretaker Perspectives of the Need for Childcare Assistance During Health Care Appointments

PurposeIn 2020, Congress passed legislation to establish the national Veterans Child Care Assistance Program (VCAP) targeting eligible veterans receiving care through the Veterans Health Administration (VA). This needs assessment describes the childcare needs of veteran caretakers of young children and explores the implications of inadequate childcare on health care engagement. MethodsSurvey data were collected from 2,000 VA users with dependent children; data were analyzed using standard descriptive statistics. Qualitative data were collected from 19 veterans through focus groups and analyzed using rapid thematic analysis. FindingsMore than 75% of veterans surveyed indicated that they required childcare assistance during health care appointments and 73% reported barriers to finding childcare. Prominent barriers included the high cost of childcare and not having a trusted source of childcare. Nearly 58% of survey respondents reported missed or canceled VA health care appointments due to childcare challenges. Furthermore, 35% of surveyed veterans reported that their children had accompanied them to an appointment in the past year. Among these veterans, 59% brought their children into the exam room. Focus group participants discussed how having children present during their health care appointments hampered communication with health care providers. ConclusionsVeterans report that lack of childcare keeps them from attending and remaining focused on the provider during their health care visits, which could compromise quality of care. As one of the only health systems in the United States that will offer childcare assistance, VCAP presents an opportunity to improve health care access and quality by reducing missed appointments and suboptimal care.

Exploring spiritual/religious coping strategies among mothers of children with severe or profound intellectual disability during genetic counseling in Brazil.

Parents use several coping strategies to deal with the challenges of caring for children with disabilities. This qualitative study explored the spiritual/religious coping strategies adopted by Brazilian mothers of children with severe or profound intellectual disabilities who were attending the medical genetics clinic for genetic counseling. Individual semi-structured interviews were conducted with 15 participants, selected by convenience. Thematic content analysis was used to investigate the data. Five major themes were recognized: (1) spirituality/religion as a source of resilience; (2) surrender to God's plan; (3) a feeling of predestination; (4) children with a disability perceived/conceived as a blessing; and (5) pleading for divine intervention. Participants highlighted the ability to recover and adapt to bad circumstances and stressful events with God's support using spiritual/religious resources and practices. They attributed the cause and control of events in their lives to an external and transcendental source, showing themselves to be resigned to the condition of their child with a disability and his/her demands. The feeling of predestination appeared as a form of divine intervention as well as a way of attributing meaning to the situation. Their child with a disability was compared constantly to an "angel," a celestial being created by God to be a messenger and fulfill divine purposes. From the participants' perspective, these coping mechanisms appeared to have helped them adjust to the situation. Spirituality and religiousness have become crucial in cultures such as Brazil, where religious practices, often highly syncretic, are common. A more detailed and comprehensive understanding of how spiritual/religious coping strategies are mobilized during the genetic counseling process can improve the cultural competence of genetic counselors and help guide proposals for more effective clinical interventions.

Extended family collaboration in childcare during the coronavirus disease-19 pandemic

The coronavirus disease-19 pandemic and the accompanying public health restrictions have posed significant challenges to parents with dependent children. A rich body of literature has examined the problems encountered by parents and their gendered division of labour in childcare during the pandemic. However, little attention has been paid to their interactions and collaborations with extended family for childcare. Drawing on qualitative interviews with 43 urban parents in Shenzhen, China, I examine how parents mobilised childcare support from extended family during the pandemic, focusing on their collaboration with grandparents. Viewing parenting as a series of interactive and relational practices, I analyse how parents made new childcare arrangements and sought support from extended family to cope with work–childcare conflict and their ambivalence towards family collaboration in childcare during the pandemic. My findings highlight the significance of extended family collaboration for parents to overcome childcare challenges and reveal the embeddedness and relationality of parenting during the coronavirus disease-19 pandemic within extended family.

Exploring the Lived Experiences of Compassion Fatigue in Parents who Adopt Children with Trauma Histories

Abstract The challenges of caring for children with early life adversity have been identified as contributing to feelings of compassion fatigue (CF)—an emotional disconnection resulting from repeated exposure to another’s trauma. Although extensive studies have focused on contributors to trauma-inducing workplace stress and well-being, research on trauma-related stress in the home, especially in adoptive parent populations, is relatively underexplored. This study aimed to understand how adoptive parents make sense of their experiences of parenting adopted children, identify core components of CF, understand parents’ perceptions of contributing factors and explore wider relational impacts. Parents were recruited from Adoption UK via email invite. Semi-structured interviews were conducted with twelve parents to form a holistic picture of adoptive parents’ experiences. Data were analysed using Reflexive Thematic Analysis. Findings yielded three overarching and interrelated themes: (i) a parent not a therapist; (ii) strained connections; and (iii) support is a mirage. Findings support recent literature highlighting the reality of CF in adoptive parents and the need to develop more preventative structures and responsive systems of support adapted to the needs of adopted children but also the unique needs of their families to help prevent mental health crises across the family and adoption breakdowns.

Longitudinal Outcomes of Chronically Transfused Adults with Sickle Cell Anemia and a History of Childhood Stroke

Background: Rigorous studies define the use of chronic transfusion therapy (CTT) for secondary stroke prevention in children with sickle cell anemia (SCA). Limited evidence informs the use of indefinite CTT for children with SCA and a history of stroke when they enter adult care. Often, adults with a history of childhood stroke are treated by extrapolation of pediatric practice and continue CTT. However, the risk of recurrent stroke in these adults is unknown. In this retrospective study, we describe outcomes of adults with a history of SCA and childhood stroke and compare them to adults without a history of childhood stroke. Methods: The Johns Hopkins University Institutional Review Board approved this study. The inclusion criteria were: SCA diagnosis, ≥ 18 years old, received adult care at Johns Hopkins Hospital (JHH), and documentation of a stroke via diagnosis code or mention in hematology clinic notes prior to the age of 18 or no stroke in childhood. Subjects without a history of stroke in childhood were matched based on age, gender, and genotype. For each subject, we performed a systematic chart review extending from their initial encounter with hematology care at JHH (pediatric or adult, whichever was available) to the final visit in the electronic medical record. Data collection spanned from January 1990 to February 2022. Variables collected include demographic data, SCA morbidities, and CTT treatments. We reported descriptive statistics for the subjects with a history of childhood stroke. Then we compared subjects with and without childhood stroke using the Mann Whitney U test for continuous outcomes and Fischer's exact test for categorical outcomes. We performed data analysis with Stata/SE Version 16.1. Results: There were 42 subjects with SCA and a history of childhood stroke (Table 1). In this group, the median age at the time of the study was 30 years (IQR 24 to 35 years). The median age at the time of childhood stroke was 7 years (IQR 5 to 11 years), and all subjects received CTT for secondary stroke prevention. Subjects received a median of 17.7 years of CTT (IQR 12.2 to 23.3 years). The median annual pretransfusion hemoglobin S for this group was 31% (IQR 24 to 39%), which suggests adherence to CTT. The median ferritin was 3842 ng/dL (SD 3842); 45% were alloimmunized. Five subjects with a history of childhood stroke had a stroke in adulthood: one subject (age 24) had discontinued CTT, two subjects (age 21, 23) were intermittently adherent to CTT and stroke occurred at a hemoglobin S of 49% in one subject (other unrecorded), and two subjects (ages 21, 22) received regular CTT and presented with a hemoglobin S of 14% and 24% respectively. Comparison of subjects with and without a history of childhood stroke are shown (Table 2). More subjects with a history of childhood stroke received CTT than those without (33 (100%) vs 21 (63%), p = 0.0001). We observed 0.7 strokes per 100 person·years in subjects with a history of childhood stroke and 1.1 strokes per 100 person·years in subjects without a history of childhood stroke. These were not different (p = 0.63). A comparison of SCD complications between those with and without a history of childhood stroke identified that adults on CTT because of childhood stroke had less avascular necrosis (AVN) (4 (12%) vs 12 (42%), p = 0.01) and leg ulcers (0 vs. 6 (18%), p = 0.02) than those without a history of childhood stroke. Conclusions: Among 42 adults with a history of childhood stroke, recurrent strokes occurred in 12% and in a comparable number of adults without a history of childhood stroke. This finding suggests that continuing CTT in adult care may reduce the risk of recurrent stroke to that of a population without a history of childhood stroke. Here, we find that adults with a history of childhood stroke on CTT have lower rates of AVN and leg ulcers, which suggests that CTT may reduce the risk of developing these complications. Larger, prospective studies are needed to define the extent to which CTT reduces recurrent stroke in adults with a history of childhood stroke. This evidence is necessary to inform decisions to continue CTT in adulthood because iron overload associated with CTT can be morbid and the burden of CTT visits may lead to missed work, lost wages, and childcare challenges. Further studies may also enhance decisions during pediatric care to direct children with history of stroke towards curative therapy. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Kōrero Mai: A Kaupapa Māori study exploring the experiences of whānau Māori caring for tamariki with atopic dermatitis

Racism and colonisation have caused the systemic exclusion of Indigenous Māori populations in Aotearoa (New Zealand) and the perpetuation of health inequities. Atopic dermatitis, a chronic skin condition, is one such example where Māori tamariki (children) are disproportionately affected. International research highlights the challenges of caring for children with atopic dermatitis; however, there has been no such research in Aotearoa. This small qualitative study, using Kaupapa Māori (Indigenous Māori) methodology, aimed to explore the experiences of Māori parents caring for their tamariki with atopic dermatitis. Cultural engagement was paramount to the research using kaupapa kōrero (cultural narrative) through kanohi-ki-te-kanohi (face-to-face) interviews to explore the lived experiences of six whānau Māori (Māori families). Data were analysed thematically using a kaupapa Māori lens with five overarching themes: 1) the constant hard work of maintaining good skin health for tamariki; 2) the embarrassment is punishing for whānau; 3) courage is required to maintain vigilance; 4) constantly seeking solutions; and 5) whānau/people-focused solutions. Kōrero (conversations) illustrated that whānau Māori experience systemic racism across health, education, and social systems; implicit bias; and differential treatment within health services that impact caring for their tamariki. These findings reiterate the failure of mainstream primary healthcare institutions to enact Te Tiriti o Waitangi obligations and ensure health equity for whānau Māori. To survive and thrive within their contexts, Māori whānau drew on mātauranga Māori (Māori knowledge systems) in their everyday practices. Therefore, strategies to support whānau to reclaim and maintain Indigenous practices, alongside the responsibility of healthcare providers to improve health outcomes, are imperative to achieve health equity for Māori.

When the Challenges of Widowhood Extend to Childcare: Essential Considerations for Social Work Practice

Unless widows recount their painful experiences of caring for their children, their day-to day lived challenges of childcare may be misunderstood if not totally missed by social workers in practice. This article discusses the widow’s painful experiences of caring for their children in Binga District in Zimbabwe and the critical aspects needed for consideration by social workers in practice. A qualitative research approach using a phenomenological research design was adopted to capture the lived struggles of the widows in caring for their children. Using purposive sampling, twenty-four widows participated in the in-depth interviews, with ten widows participating in individual interviews whilst fourteen widows participated in two separate focus group interviews with seven widows in each group. Data were analysed thematically with predetermined and emerging themes critically discussed and compared with existing literature. The findings showed that due to dwindling resource bases, widows are bound to fail to meet the physiological, psychosocial, economic and educational needs of their children. The article recommends deliberate and systematic social work considerations in efforts to intervene and avert the circumstances of the widows that have a negative impact on childcare.

Adolescent marriage and motherhood in Turkey: A qualitative study exploring determinants, impacts and opinions about preventive strategies.

This study aimed to understand the determinants of child marriages, becoming a child mother, their impacts and opinions about preventive strategies. The phenomenological research approach was adopted with one-to-one semi-structured interviews between December 2017 and May 2018. The population of the study consisted of 36 adolescent married mothers registered in the Family Health Centres. Interviews were recorded, transcribed and evaluated based on a thematic analysis was conducted. In the study, four main themes and 12 subthemes were determined. Adolescent marriages determinants occurred as patriarchal cultural norms, the perception that girls would be safe under the protection of another man, and poverty. Adolescent brides experienced partner violence and were subjected to physical, psychological and sexual violence in their marriage. Adolescent mothers had low maternal self-confidence, childcare challenges and were late to take on childcare responsibilities, and their children were neglected. As a result of early marriage, the participants experienced psychological problems and burnout later in their lives. Improving family-child communication, and eliminating financial inadequacies were among the opinions on prevention strategies of child marriages. The findings of this study identified the determinants and impact of adolescent marriages and revealed the problems experienced by adolescent brides and mothers. The most important contribution of this study is that it deals with the motherhood experiences. In addition, it is one of the important findings of this study that it draws attention to their neglected children's due to lack of knowledge and experience of their mothers about childcare.

Operational Constraints and Gender Biases: A Qualitative Analysis of Physician Parenting Experiences.

Objective:Although parenting responsibilities are correlated with gender disparities in professional development and salary, the nature of parental challenges is not well characterized. The aims of this study were to (1) illuminate faculty physicians' experiences with parenting and (2) identify system challenges and opportunities for improvement.Materials and Methods:In October 2019, a survey about parenting was sent to all physician faculty at a large Midwest academic medical center. Qualitative analysis of free-text response to the survey item “is there anything you wish to share about your experience of pregnancy or parenting as a physician” was performed. Themes were inductively identified and developed from the responses in a team-based iterative approach.Results:Of 2069 total physician faculty, 1085 (52.4%) responded to the survey and 253 (23%) of the respondents provided free-text comments. From these comments, the authors identified three themes as sources of challenges for physician parents: operational constraints, gender biases, and nontraditional or nonheteronormative family structures. Operational factors pertained to lack of scheduling flexibility, childcare challenges, lactation, colleague coverage, and transparency of policies. Responses indicated that gender biases are encountered by all genders, and expectations built on assumptions of “traditional” gender roles and family structure are problematic for many physician parents.Conclusion:Addressing the challenges and opportunities identified in the study is critical to building a more supportive institutional culture around parenting and to increase gender parity in academic medicine.

Tips for Coping with a New Baby During COVID-19

All babies cry. Most babies cry a lot from two weeks to two months of age. Some cry more than others, and some cry longer than others. For many new parents, crying is one of the most stressful parts of coping with a newborn.In some cases, extreme stress and a temporary lapse of emotional control in a caregiver can lead to actions that result in abusive head trauma. In fact, the most common trigger for abusive head trauma is simply a crying baby. As an American Academy of Pediatrics policy statement points out, actions that lead to abusive head trauma often happen when caretakers experience stress and get to the end of their rope.However, there is a bright side: The key to preventing abusive head trauma is to understand how common feelings of frustration, isolation, and exhaustion are during the first few months of an infant’s life.Usually, new parents can seek out social supports and external help—but what when we are all restricted in our movements and our contacts? What happens when families face child care challenges and more ongoing fallout from the COVID-19 pandemic? Here are a few suggestions:American Academy of Pediatricswww.aap.org and www.HealthyChildren.orgAdapted from the HealthyChildren.org article Tips for Coping with a New Baby During COVID-19 by Robert Sege, MD, PhD, FAAP (1/13/2022).The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Child care institutions in India: Caregivers' solutions to challenges in childcare

AbstractFor effective childcare, identifying challenges and exploring the solutions to those challenges is critical. This study explores the different challenges of childcare in child care institutions and its solutions from caregivers' perspectives. The researcher uses a basic interpretive design approach and selects 39 respondents by purposive sampling, and uses semi‐structured interviews. The findings indicate need for separate institutions for different categories of children and trained and professional caregivers, balancing gender engagement, the necessity for establishing separate institutional care for differently able children, need for effective implementation of foster care and sponsorship and need to work with families for effective children's restoration.

How Knowledge Mapping Can Bridge the Communication Gap Between Caregivers and Health Professionals Supporting Individuals With Complex Medical Needs: A Study in Fragile X Syndrome.

The challenges of caring for children with complex health needs, such as intellectual disability (ID) and autism spectrum disorder (ASD), are multiple and experienced by both caregivers and health professionals. Fragile X syndrome (FXS) is the most common single gene cause of ID and ASD, and provides a pertinent model to understand these complexities of care, as well as the communication challenges experienced between caregivers and healthcare professionals. In recent years both caregivers and healthcare professionals have recognized the need for enhancing communication both in clinical and research settings. Knowledge mapping has emerged as a tool to support quality communication between team participants. Here we review how differences in mental models, as well as challenges related to health literacy and knowledge transfer can have an impact on communication. Next, we present different knowledge mapping approaches used in complex situations, with a focus on concept maps and care maps. Finally, we highlight the potential benefits and limitations of mapping to improve communication issues related to caring for individuals with FXS and potentially other neurodevelopmental disorders (NDDs).

Meeting Challenges in the Long-Term Care of Children, Adolescents, and Young Adults with Acute Lymphoblastic Leukemia.

To discuss the long-term view of treating and following pediatric, adolescent, and young adult patients with acute lymphoblastic leukemia (ALL) - with review of what can be done to prevent, monitor for, and treat complications of therapy. Pediatric, adolescent, and young adult oncology patients, including those with ALL, are living longer with higher overall survival rates as treatments and supportive care for these patients continue to improve. These patients are burdened by the risk of significant health and quality of life consequences as a result of their treatment.. For these patients, the late effects of treatment can be life-threatening, such as secondary cancers or cardiotoxicity, or life-altering with respect to quality of life. The goal of this paper is to review the current literature, research, and surveillance guidelines regarding the late effects of ALL therapy, to outline what can be done to mitigate the toxic effects of oncology treatment, and to extend life expectancy and improve quality of life for our patients. We review risk factors and interventions available to prevent and treat cardiovascular disease, secondary malignancies, endocrine complications (obesity, osteoporosis, infertility, and premature menopause), cognitive effects, and effects on functioning and mortality.

536Patterns of change in lifestyle behaviours following childbirth

Abstract Background Lifestyle behaviours may worsen following childbirth due to barriers such as time constraints and reduced prioritization of personal health. We therefore aimed to assess the patterns of change in weight and lifestyle behaviours following childbirth in a longitudinal community-based cohort. Methods Data from surveys 3 and 5 (ages 25-30 and 31-36 years) of the 1973-8 birth cohort of the Australian Longitudinal Study on Women’s Health were used. We assessed changes in weight, energy intake, diet (diet quality, macronutrients and micronutrients), physical activity and sitting time in parous women compared to those who remained nulliparous by survey 5 using one-way analysis of covariance. Results Of 4927 nulliparous women at survey 3, 2503 became parous by survey 5. Over 6 years, parous women had an increase in weight (1 kg; 95%CI 0.50, 1.54), higher energy intake (833.3 kJ/day; 95%CI 706.07, 960.52), better diet quality (1.4 units; 95%CI 0.81, 2.08), lower physical activity (-370.5 METmin/day; 95%CI -427.07, -313.87) and less sitting time (-1.8 hours/day; 95%CI -1.93, -1.60) than nulliparous women on adjusted analyses. On stratification of parity, the improvement in diet quality was only present in primiparous women and sitting time decreased with higher parity. Conclusion There is a worsening in weight and some lifestyle behaviours following childbirth in Australian women. While higher parity was associated with further decreases in sitting time, improvements in diet quality were not maintained. Key message Women need support to maintain healthy lifestyle behaviours amidst the challenges of caring for children, particularly with increasing family size.

Pediatric Trainees as Parents: Perspectives From a Pandemic.

Resident parents are at the intersection of converging challenges during the coronavirus disease 2019 (COVID-19) pandemic, and their perspective has yet to be explored. This qualitative study aimed to identify themes related to the experience of pediatric resident parents during the COVID-19 pandemic. We performed semistructured interviews with pediatric residents who were also parents. Using thematic analysis, transcripts were analyzed iteratively until theoretical sufficiency was achieved. Twelve residents were interviewed from 9 pediatric residency programs. Five major themes, representing conflicts or tensions experienced by participants, were defined by the data: 1) Duty as a doctor versus duty as a parent; 2) Balance of work obligations versus childcare challenges; 3) Appreciation of added support versus worry about peers' perceptions of accommodations; 4) Gratitude for the recognition of challenges faced by resident parents versus fear of reversion to the norm; and 5) Protective impact of parenthood versus challenges to mental health. Both parents and healthcare workers faced innumerable challenges during the COVID-19 pandemic, and this exploration of the experiences of pediatric resident parents provides a unique lens for examining the tensions that this group faced. Our results may allow residency programs to better support their pediatric resident parents during this crisis.

Challenges in Care of Children with Acute Leukemia in a Government Hospital in India: A Retrospective Analysis

Abstract Introduction Acute leukemia (AL) is among the most common treatable cancers in childhood but many children are forced to abandon therapy. Objective We have explored reasons for treatment abandonment through this study. Materials and Methods Retrospective analysis from an ongoing registry data of childhood AL patients, where all newly diagnosed AL patients of ≤18 years of age (June 2014–November 2017) were included. Patients &gt;18 years of age, having any history of treatment of AL outside our institute, and/or patients with relapsed AL were excluded. The primary outcome of the study was treatment abandonment rate. Results A total of 710 AL patients were included in the study, average distance traversed to reach the hospital being 161.66 km. Most children were aged 1 to 10 years (49.4%, n = 351), followed by &gt;10 to 18 years (46.6%, n = 331), and ≤1 year age (3.9%, n = 28). The commonest symptoms were fever (67.4%), pallor (38.6%), bleeding (11.5%), bone pain (13.8%), neck swellings (14.9%), and, rarely, testicular swellings or Superior vena cava (SVC) syndrome (1.1%). A high abandonment rate was noted prior to leukemia subtyping (35.2%, n = 250) mostly among males 62% (n = 155) and the 1- to 10-year group 55.6% (n = 139). A total of 460 (64.8%) patients were subsequently subcategorized by immunophenotyping. Precursor B-cell (Pre-B) Acute Lymphoblastic Leukemia (ALL) in 307 (43.2%) patients was the commonest subtype, followed by early Pre-B ALL (Pro-B ALL) in 10 (1.4%), T-cell ALL (T-ALL) in 51 (7.1%), Acute Myeloid Leukemia (AML) in 45 (6.3%), Acute Promyelocytic Leukemia (APML) in 28 (3.9%), and Mixed Phenotypic Acute Leukemia (MPAL) in 19 (2.6%). Conclusion The most common group of patients was aged 1 to 10 years (median age: 5 years). An abandonment rate of 35.2% was seen prior to complete diagnostic workup. The reason for this high abandonment, despite good disease prognosis, is a relevant social and health issue, and needs further evaluation. The problems discussed in this study are relevant to lower-income families and areas where health care is not easily accessible. The government agencies, nongovernment organizations and society would need to work together to overcome these issues.

The COMET study: Examining the effects of COVID-19-related perceived stress on Los Angeles Mothers’ dysregulated eating behaviors, child feeding practices, and body mass index

The COVID-19 pandemic and associated restrictions and mandates have had pronounced implications on the well-being of individuals. This study conducted exploratory analyses of the relationship between COVID-19-related life changes and COVID-19-related perceived stress and associations between COVID-19-related perceived stress and dysregulated maternal eating behaviors, child feeding practices, and body mass index (BMI) in Los Angeles mothers. Mothers (Mage = 37.6 ± 6.9) of children aged 5–11 (N = 197, response rate 92.5%) completed an online questionnaire assessing COVID-19-related life changes, COVID-19-related perceived stress, mechanisms used to cope with COVID-19, child feeding practices, their own eating behavior, demographics, and height and weight. The highest proportion of participants reported changes to work, disruptions due to childcare challenges, and increased home responsibilities. Higher COVID-19-related perceived stress was experienced by those who reported loss of work hours (29%), loss of job (15.2%), reduced ability to afford childcare (18.8%), and reduced ability to afford rent/mortgage (19.8%) (ps < 0.05) than those who did not. The most common strategy that mothers indicated using to cope with COVID-19 related stress was eating comfort foods (e.g., candy and chips) (58.7%). COVID-19-related perceived stress was positively associated with mother's BMI and emotional eating (ps < 0.05). Rewarding their child's eating and behavior with food were both positively associated with the number of COVID-19 related life changes (ps < 0.05). This study yields new knowledge of the effects of the COVID-19 pandemic on mothers' dysregulated eating behaviors and child feeding practices. The results highlight the importance of conducting further research to confirm these findings and understand the nature of associations between COVID-19-related perceived stress and health. This is crucial in order to explore ways in which lasting impacts of the pandemic on mental and physical health can be prevented.