Children In Health Care Settings Research Articles

Screening for adverse social conditions in child healthcare settings: protocol for a systematic review

IntroductionAdverse social conditions affect children’s development and health outcomes from preconception throughout their life course. Early identification of adverse conditions is essential for early support of children and their families....

Diagnosis of sleep disorders in child healthcare settings

ObjectivesSleep disorders impact at least 10 % of children, pose risks to overall wellbeing, and are key targets of preventive interventions. The objectives of this study were to describe the prevalence of pediatric sleep disorder diagnoses across sociodemographic characteristics and co-occurring conditions, and to explore potential sociodemographic disparities. MethodsCross-sectional analysis of 12,394,902 children (0–17 years; 50.9 % Medicaid-insured) in the 2017 MarketScan database. Prevalence was assessed utilizing ICD-10 codes, with multivariate logistic regressions examining disparities (insurance coverage; race and ethnicity in Medicaid-insured) for diagnoses in ≥0.10 % of children. ResultsThe prevalence of sleep disorder diagnoses was 2.36 %. The most common diagnoses were obstructive sleep disordered breathing (oSDB, 1.17 %), unspecified sleep disorders (0.64 %), insomnia (0.52 %), and other SDB (0.10 %), with <0.10 % for all other diagnoses. Insomnia and parasomnias diagnoses were much lower than diagnostic estimates. Sleep diagnoses were more prevalent in Medicaid versus commercially insured youth, 2-5-year-olds, and in children with co-occurring medical, neurodevelopmental, or behavioral health conditions. Girls and boys were generally equally likely to be diagnosed with any sleep disorder. In Medicaid-insured children, white children were more likely to have any sleep diagnosis compared to all other racial and ethnic groups. Black/African American children were more likely than white children to have oSDB. ConclusionsCompared to diagnostic estimates, claims data suggest sleep disorders are under-diagnosed, with notable sociodemographic disparities. Findings suggest a need for clinical resources to identify and address sleep disorders and to understand biases potentially driving disparities, given that sleep is a modifiable determinant of child wellbeing.

Adherence to Clinical Guidelines for Dose Finding and Monitoring Methylphenidate Use: A Medical Record Audit in Child and Adolescent Mental Health Care and Pediatric Settings.

Background: Guideline adherence is important to ensure optimal and safe use of methylphenidate for children and adolescents with attention-deficit/hyperactivity disorder (ADHD). We investigated adherence to Dutch guidelines regarding dosing and monitoring of methylphenidate in child and adolescent mental health care and pediatric treatment settings. Methods: Five hundred six medical records of children and adolescents were investigated in 2015 and 2016. We assessed adherence to the following guideline recommendations: (1) at least four visits during the dose-finding phase; (2) monitoring thereafter at least every 6 months; (3) measuring height and weight at least annually; and (4) the use of validated questionnaires to assess treatment response. Pearson's chi-squared test statistics were used to examine differences between settings. Results: Only a small portion of patients had at least four visits during the dose-finding phase (5.1% in the first 4 weeks to 12.4% in the first 6 weeks). Also, less than half of the patients (48.4%) were seen at least every 6 months. Height was recorded at least annually in 42.0% of patients, weight in 44.9%, and both recorded in a growth chart in 19.5%. Questionnaires to assess treatment response were only used in 2.3% of all visits. When comparing both settings, more patients in the pediatric settings were seen every 6 months, although height and weight were recorded more often in the mental health care setting. Conclusion: Overall, guideline adherence was low. Training of clinicians and adding guideline recommendations to electronic medical records templates may improve adherence. Additionally, we should aim to close the gap between guidelines and clinical practice by looking critically at the feasibility of guidelines.

A feasibility Randomised Controlled Trial as a first step towards evaluating the effectiveness of a digital health dashboard in preventive child health care: a mixed methods approach

BackgroundWithin preventive Child Health Care (CHC), the 360°CHILD-profile has been developed. This digital tool visualises and theoretically orders holistic health data in line with the International Classification of Functioning, Disability and Health. It is anticipated that evaluating the effectiveness of the multifunctional 360°CHILD-profile within the preventive CHC-context is complex. Therefore, this study aimed at investigating the feasibility of RCT procedures and the applicability of potential outcome measures for assessing the accessibility and transfer of health information.MethodsDuring the first introduction of the 360°CHILD-profile in CHC practice, a feasibility RCT with an explanatory-sequential mixed methods design was executed. CHC professionals (n=38) recruited parents (n=30) who visited the CHC for their child (age 0–16). Parents were randomised to “care as usual” (n=15) or “care as usual with, in addition, the availability of a personalised 360°CHILD-profile during 6 months” (n=15). Quantitative data on RCT feasibility were collected on recruitment, retention, response, compliance rates and outcome data on accessibility and transfer of health information (n=26).Subsequently, thirteen semi-structured interviews (5 parents, 8 CHC professionals) and a member check focus group (6 CHC professionals) were performed to further explore and gain a deeper understanding of quantitative findings.ResultsIntegration of qualitative and quantitative data revealed that the recruitment of parents by CHC professionals was problematic and influenced by organisational factors. The used randomisation strategy, interventions and measurements were executable within the setting of this specific study. The outcome measures showed skewed outcome data in both groups and a low applicability to measure accessibility and transfer of health information. The study revealed points to reconsider regarding the randomisation and recruitment strategy and measures in the next steps.ConclusionsThis mixed methods feasibility study enabled us to gain a broad insight into the feasibility of executing an RCT within the CHC context. Trained research staff should recruit parents instead of CHC professionals. Measures, potentially for evaluating 360°CHILD-profile’s effectiveness, need further exploration and thorough piloting before proceeding with the evaluation process. Overall findings revealed that executing an RCT within the context of evaluating 360°CHILD-profile’s effectiveness in the CHC setting will be much more complex, time-consuming and costly than expected. Thereby, the CHC context requires a more complex randomisation strategy than executed during this feasibility study. Alternative designs including mixed methods research must be considered for the next phases of the downstream validation process.Trial registrationNTR6909; https://trialsearch.who.int/.

LGBTQ+ Persons’ Experiences of Parenthood in the Context of Maternal and Child Health Care: A Meta-ethnography

This study aims to integrate and synthesize knowledge of lesbian, gay, bisexual, transgender and queer (LGBTQ+) persons’ experiences of parenthood in the context of maternal and child health care. For nurses to provide optimal care for LGBTQ+ parents, we need to derive knowledge from their perspectives. An interpretive meta-synthesis approach, meta-ethnography, was chosen for this study. A lines-of-argument synthesis based on four themes was developed: (1) Entering the world of LGBTQ+ parenthood; (2) The emotional journey in LGBTQ+ parenthood; (3) Struggling with the system as a LGBTQ+ parent and (4) A need to expand the knowledge horizon of LGBTQ+ parenthood. The overarching metaphor, “To be recognised as parents, unique and good enough, like everybody else,” reflects how recognition and inclusion may support LGBTQ+ persons in their parenthood and broaden the understanding of parenthood. Knowledge of the LGBTQ+ family needs to be given greater attention in maternity and child health care settings, and in education and health policies.

Same-sex mothers' experiences of equal treatment, parenting stress and disclosure to offspring: a population-based study of parenthood following identity-release sperm donation.

What are the experiences of same-sex mothers following identity-release sperm donation regarding equal treatment in society, parenting stress and disclosure to child? Mothers predominantly reported equal treatment in society, low levels of parenting stress and early disclosure of the donor conception to the child, and half of the couples had also informed the child of his/her right to obtain the donor's identity. The number of two-mother families is increasing, and previous studies have reported about challenges related to heteronormativity, discrimination and the status of the non-birth mother. Same-sex mothers have been found to disclose the child's donor conception earlier than different-sex parents, but little is known regarding disclosure of the child's right to obtain identifying information about the donor. The present study concerns the fourth wave of data collection of a nation-wide longitudinal study. A total of 143 same-sex mothers (73% response rate) following identity-release sperm donation completed individual surveys when their donor-conceived child had reached age 7. These women represent a total of 82 couples who had undergone sperm donation treatment. The study is part of the longitudinal Swedish Study on Gamete Donation (SSGD). Couples accepted for gamete donation treatment at seven Swedish University hospitals were recruited between 2005 and 2008 and were requested to complete postal surveys during four waves of data collection. The present study sample includes same-sex mothers who completed a survey when their donor-conceived child had reached 7 years of age. Data were collected with the Swedish Parenting Stress Questionnaire (SPSQ), and study-specific items on experiences of treatment in society and disclosure behavior. Group comparisons (birth mothers vs non-birth mothers) were conducted using Chi2-tests, independent t-tests and Mann-Whitney U-tests, and written comments provided for open-response items were analyzed by qualitative content analysis. The mothers were generally open about the child's donor conception and the large majority (>80%) reported being treated positively and in the same way as other parents. However, satisfaction with treatment in health care settings was significantly lower than that reported in contacts with the child's school and recreational activities (P < 0.001) and open-response comments indicate that this may be related predominantly to heteronormative language and assumptions. Birth mothers and non-birth mothers reported similar treatment in society and similar levels of parenting stress. All but one couple had already talked with their 7-year-old child about his/her conception with donor sperm. Half of the couples had also informed the child about his/her opportunity to obtain identifying information about the donor, and remaining couples planned later disclosure. Children's reactions were generally described as neutral, positive or characterized by interest and curiosity. The present study was performed within the context of the Swedish legislation on identity-release donation, which limits the generalizability to same-sex couples using anonymous or known sperm donors. Although no evidence of attrition bias was found, it is possible that those couples who initially declined participation in the SSGD (23%) or dropped out at the fourth wave of data collection (27%) differ from the study sample in terms of variables that we were unable to control for. The present finding that most same-sex mothers in a population-based sample experience equal treatment in society is encouraging and validates previous results from predominantly qualitative studies. Nevertheless, the fact that a subgroup experiences discrimination and less favorable treatment indicates that further action is needed, particularly in child health care settings. The present study is the first to report on the timing of parents' disclosure of the child's right to identifying donor information and suggests that disclosure during preschool ages is feasible and does not appear to be related to negative consequences. In view of the increased availability and use of identity-release donation, there is a pressing need to investigate parents' intentions, behaviors and needs with regard to talking with their child about his/her opportunity to obtain the donor's identity. Financial support from the Swedish Research Council (2013-2712) and the Swedish Research Council for Health, Working Life and Welfare (2014-00876). There are no conflicts of interest to declare. N/A.

Protecting Children From Sexual Abuse by Health Care Professionals and in the Health Care Setting.

Sexual abuse or exploitation of children is never acceptable. Such behavior by pediatricians and health care professionals is particularly concerning because of the trust that children and their families place on adults in the health care profession. The American Academy of Pediatrics stands strongly behind the social and moral prohibition against sexual abuse or exploitation of children by health care professionals. Pediatricians and health care professionals should be trained to recognize and abide by appropriate provider-patient boundaries. Medical institutions should screen staff members for a history of child abuse issues, train them to respect and maintain appropriate boundaries, and establish policies and procedures to receive and investigate concerns about patient abuse. Everyone has a responsibility to ensure the safety of children in health care settings and to scrupulously follow appropriate legal and ethical reporting and investigation procedures.

Bowel and bladder function in infant toilet training (BABITT) – protocol for a randomized, two-armed intervention study

BackgroundIn the last decades, the average age for toilet training has increased in the western world. It is suggested that the postponed initiation of toilet training is a contributing factor to problems related to bowel and bladder control. Functional gastrointestinal and urinary tract disorders are prevalent in childhood, causing suffering in affected children and for their families, and consuming healthcare resources. To evaluate whether assisted infant toilet training can prevent functional gastrointestinal and urinary tract disorders in young children, we are conducting a randomized intervention study with a 4-year follow-up.MethodsThis randomized two-armed intervention study will include 268 Swedish infants recruited at six child healthcare centers in Region Dalarna located in the central part of Sweden. The intervention entails parents being instructed and practicing assisted infant toilet training with their child. Children are randomized to start assisted infant toilet training at 0–2 months or at 9–11 months of age.The primary objective is to determine the efficacy of assisted infant toilet training initiated at 0–2 months on the prevalence of functional gastrointestinal disorders (defined as infant colic, infant dyschezia and/or functional constipation) up to the age of 9 months. Secondary objectives are to evaluate whether assisted toilet training initiated during the first year of life reduce the prevalence of functional gastrointestinal disorders (defined as functional constipation, gastrointestinal symptoms and/or stool toileting refusal) and urinary tract disorders (defined as bladder dysfunction and/or urinary tract infections) up to the age of 4 years. Furthermore, infant-to-mother attachment, parental stress, the toilet training process and overall parental experiences will be evaluated/explored.DiscussionThis protocol article presents the rationale and design of a randomized two-armed intervention study that will determine the efficacy of assisted infant toilet training on functional gastrointestinal disorders up to the age of 9 months. Furthermore, the study will evaluate whether assisted infant toilet training during the first year of life can prevent functional gastrointestinal and urinary tract disorders in children up to 4 years of age. If effective, assisted infant toilet training could be recommended in child healthcare settings and new evidence-based guidelines on infant toilet training could be implemented.Trial registrationThe study protocol was retrospectively registered at ClinicalTrials. gov (NCT04082689), initial release June 12th, 2019)

Implementation of a proactive referral tool for child healthcare professionals to encourage and facilitate parental smoking cessation in the Netherlands: a mixed-methods study

BackgroundRecently, the parent-tailored telephone based smoking cessation counseling program ‘Smoke-free Parents’ was shown to be effective in helping parents to quit smoking. To implement this program in child healthcare settings in the Netherlands, the research team developed a proactive referral tool to refer parents to Smoke-free Parents. The aim of the present implementation study was to explore the facilitators, barriers, and suggestions for improvement in the implementation of this referral tool.MethodsChild healthcare professionals (N = 68) were recruited via multiple strategies (e.g., social media, mailings, and word of mouth among healthcare professionals) and invited to complete two online (quantitative and qualitative) questionnaires and to participate in a telephone semi-structured qualitative interview between April 2017 and February 2019. In total, 65 child healthcare professionals were included in the analyses. After inductive coding, thematic analyses were performed on the qualitative data. Descriptive analyses were performed on the quantitative data.ResultsThe data from both questionnaires and the telephone interview revealed that the majority of the child healthcare professionals (92.3 % female; average years of working as a healthcare professional: 23.0) found the Smoke-free Parents referral tool accessible and convenient to use. Yet there were several barriers that limited their use of the tool. The data revealed that one of the main barriers that healthcare professionals experienced was parental resistance to smoking cessation assistance. In addition, healthcare professionals noted that they experienced tension when motivating parents to quit smoking, as they were not the parent’s, but the child’s healthcare provider. Additionally, healthcare professionals reported being concerned about the lack of information about the costs of Smoke-free Parents, which limited professionals referring parents to the service.ConclusionsAlthough healthcare professionals reported rather positive experiences with the Smoke-free Parents referral tool, the use of the tool was limited due to barriers. To increase the impact of the Smoke-free Parents telephone-based smoking cessation counseling program via child healthcare settings, it is important to overcome these barriers. Suggestions for improvement in the implementation of the referral tool in child healthcare settings are discussed.

"Pain talk": A triadic collaboration in which nurses promote opportunities for engaging children and their parents about managing children's pain.

Effective communication with children about pain is important and has the potential to mediate the short‐ and longer‐term effects of pain on children. Most communication studies relating to children's pain have focused on language children use to describe everyday pain experiences. However, little is known regarding how health professionals, particularly nurses, communicate with children in healthcare settings about pain. This study aimed to explore how nurses talk to children and their parents about pain and what factors influence nurses’ use of language and non‐verbal communication. A cross‐sectional mixed‐methods (predominantly qualitative) survey (“pain talk”) was conducted, comprising qualitative items about pain communication and four vignettes portraying hypothetical cases of children representing typical child pain scenarios. Participants were recruited via email, social media, newsletters, established networks, and personal contacts. A total of 141 registered (68.1%) or in‐training nurses across 11 countries with experience of managing children's pain completed the survey. Textual survey responses were analyzed using conventional qualitative content analysis. Qualitative content analysis generated a meta‐theme “Being confident and knowing how to do ‘pain talk’” and four main themes that described the functions, purpose, and delivery of “pain talk”: (a) “contextualizing and assessing,” (b) “empowering, explaining, and educating,” (c) “supporting, affirming, and confirming,” and (d) “protecting, distracting, and restoring.” “Pain talk” was a triadic collaborative communication process that required nurses to feel confident about their role and skills. This process involved nurses talking to children and parents about pain and creating engagement opportunities for children and parents. “Pain talk” aimed to promote the agency of the child and parent and their engagement in discussions and decision‐making, using information, support, and comfort. Nurses shaped their “pain talk” to the specific context of the child's pain, previous experiences, and current concerns to minimize potential distress and adverse effects and to promote optimal pain management.

Ethical concerns in maternal and child healthcare in Malawi

BackgroundCaring is a core function of nurses and it confers upon them ethical obligations as ethical agents. Failure to carry out such ethical obligations raises ethical concerns. This study was not intended to explore ethical concerns, but the reported findings reveal problems which have ethical implications. This paper aims to elucidate the ethical issues inherent in the findings and propose strategies to mitigate them.Research design and methodsAn exploratory-descriptive qualitative design was used within a larger Action Research Study. Data were collected through focus group discussions with nurse/midwives, and through exit interviews which were conducted with the women who participated in the study on their day of discharge. Six focus group discussions and thirty exit interviews were conducted, and data were analysed through thematic analysis.Participants and research contextThe study took place at selected maternal and child healthcare settings in Lilongwe, Malawi. The participants were nurse/midwives and women who were admitted in maternal and child healthcare settings and were purposively sampled.Ethical considerationsEthical approval was obtained from the relevant ethics committee and all ethical guidelines were followed in the conduct of the study.FindingsThe findings are presented under three themes which emerged from the data. The findings reveal effects of staff shortages on patient outcomes, problems experienced in low resource clinical settings and disrespectful nurse/patient communication.ConclusionThe findings reveal that institutional factors constrain moral agency and patient safety is severely compromised in some of the clinical settings in Malawi which raises serious ethical concerns.

Sleep and its relation to health-related quality of life in 3\u201310-year-old children

BackgroundConsidering the reports of increasing sleep problems in children, affecting health and well-being in young children and their families, we found it important to gain more knowledge about sleep and its correlation to health-related quality of life (HRQoL) in young, healthy children. The aims with this study were to describe sleep quality, sleep duration, and HRQoL in healthy 3–10-year-old children and to test associations between children’s sleep and HRQoL.MethodsParents of 160 children (average age: 6.9 years, SD ±2.2) participated in the study. Sleep onset problems (SOP), sleep maintenance problems (SMP), and sleep duration were measured by the Pediatric Insomnia Severity Index (PISI). KIDSCREEN-27 was used to measure HRQoL in five dimensions: physical well-being, psychological well-being, autonomy and parent relation, social support and peers, and school environment.ResultsThe average score was 2.2 for SOP (SD +/− 2.2) and 1.3 for SMP (SD +/− 1.6). Few children (2%) were reported to sleep less than 8 h per night. Younger children had statistically significant higher SOP and SMP than older children. Correlations were found between SOP and poor psychological well-being (p < 0.05, ρ = − 0.16), and between SMP and poor physical wellbeing (p < 0.05, ρ = − 0.16), psychological well-being (p < 0.05, ρ = − 0.21), poor school environment (p < 0.01, ρ = − 0.29), autonomy and parent relation (p < 0.05, ρ = − 0.16), and poor social support and peers (p < 0.05, ρ = − 0.19).ConclusionChildren’s sleep associates with health-related quality of life and needs to be acknowledged in child health care settings and schools.

Infant-Toddler Checklist identifies 18-month-old children with communication difficulties in the Swedish child healthcare setting.

AimAt present, there is no reliable method to screen for communication difficulties at age 18‐months in the Swedish child health care. This study examined the psychometric properties of the Communication and Symbolic Behavior Scales Developmental Profile Infant‐Toddler Checklist (ITC) when used at the 18‐month visit in the child healthcare setting.MethodsChildren aged 16–20 months (n = 679) were screened. Children were referred for an assessment if they screened positive screen or if the parent or nurse was concerned about the child's communicative development. Two groups of positive screens were used in the analysis (n = 78 children), one based on the ITC result, and one combining the ITC with contradicting information from the nurses' informal clinical assessment.ResultsThe AUC ranged from 0.68 to 0.84. The sensitivity was 0.85, and the specificity was 0.59. When the ITC result was combined with the nurses' information, sensitivity increased to 0.88 and specificity to 0.63. The internal consistency was moderate to high, and fit indices were satisfactory.ConclusionThe results suggest that the ITC can be used to identify children in need of interventions to enhance communication at 18 months of age, especially in combination with the nurse's assessment.

Face Protection for Children in Healthcare Settings

Face Protection for Children in Healthcare Settings

Facilitating implementation of an evidence-based method to assess the mental health of 3-5-year-old children at Child Health Clinics: A mixed-methods process evaluation.

A number of instruments for identifying mental health problems in children are available, but there is limited knowledge about how to successfully implement their use in routine practice. The Strengths and Difficulties Questionnaire (SDQ) is an instrument with sound psychometric properties. Because using multi-informant SDQs when assessing young children has been emphasized, parent- and preschool teacher reports on the SDQ were introduced at Child Health Clinics in a Swedish municipality. This paper aimed to describe a facilitation programme developed to support the introduction of SDQ in clinical practice and evaluate how nurses perceived the facilitation strategies used. Moreover, the dose (delivery) and reach (response rate and population coverage) of the questionnaires were assessed. The mixed-methods process evaluation was guided by Moore et al.'s framework. Process data were excerpted from monitoring data, the trial database, research group documents, study materials, group interviews with nurses, and a survey on nurses' opinions and experiences of the screening method and the implementation process. Data were analysed using descriptive statistics and qualitative content analysis. Facilitation strategies used included: educational meetings, educational outreach visits, newsletters, facilitative administrative support, and adaptations made in procedures and materials when required. Although nurses described a variety of barriers at the organisational and individual level, they were in favour of using the SDQ in clinical practice and emphasised the importance of the facilitation strategies used for its implementation. While dose levels (77-91%) indicated that nurses essentially delivered the intervention as intended, parental response rates remained between 54 and 63% and population coverage at around 50%, throughout the intervention period. The facilitation program was perceived to support the implementation of the SDQ at the yearly check-ups in the child healthcare setting, but further efforts are required to reach all families.

Mixed perceptions of women on care in maternal and child healthcare settings in Lilongwe, Malawi

BackgroundThis paper reports findings of a study which was conducted in response to a plethora of negative patient/client experiences which occur in various clinical settings in Malawi and are commonly reported in the media. The study was aimed at embedding compassionate care in selected maternal and child healthcare settings where the study was conducted. Research methodologyThe study employed a qualitative methodology which utilized an exploratory-descriptive qualitative design. However, this was part of a larger Participatory Action Research Study (PAR). In-depth exit interviews were conducted with women who were discharged from postnatal ward and women whose babies or children were discharged from nursery and paediatric ward respectively. The study had a sample of 30 participants who were purposively selected. Thematic analysis was conducted. FindingsThe findings revealed the perceptions of women of the care rendered in the maternal and child health care settings where the study was conducted. The study revealed mixed perceptions of the women on the care. More commonly, the women perceived that the care was good. However, some women perceived that the care was poor. Three main themes emerged from the data and these include: women’s perception of good care in maternal and child healthcare settings; women’s perception of poor care in maternal and child healthcare settings and Perceptions of women on personnel and healthcare facility factors essential for improved care. ConclusionThe study revealed positive caring encounters and this implies that nurses and midwives in Malawi can still care. It is therefore argued that caring is not completely a lost virtue. Mentorship through a compassionate leadership strategy is proposed to enhance the delivery of compassionate care.

The Adolescent Patient Experiences of Diabetes Care Questionnaire (APEQ-DC): Reliability and Validity in a Study Based on Data from the Norwegian Childhood Diabetes Registry.

PurposePatient-reported experiences are a key source of information on quality in health care. Most patient experience surveys only include adults’ assessments including parent or proxy surveys in child health care settings. The aim of this study was to determine the psychometric properties of the Adolescent Patient Experiences of Diabetes Care Questionnaire, a new instrument developed to measure adolescent experiences of paediatric diabetes care at hospital outpatient departments in Norway.Patients and MethodsThe questionnaire was developed based on a literature review, qualitative interviews with adolescents, expert-group consultations, pretesting of the questionnaire and a pilot study. The pilot study involved adolescents aged 12–17 years with type 1 diabetes, sampled from the four largest paediatric outpatient departments in Norway. We assessed the levels of missing data, ceiling effects, factor structure, internal consistency, item discriminant validity and construct validity.ResultsThe pilot study included responses from 335 (54%) patients. Low proportions of missing or “not applicable” responses were found for 17 of the 19 items, and 14 of these 19 items were below the ceiling-effect criterion. Five indicators were identified: consultation, information on food and physical activity/exercise, nurse contact, doctor contact and outcome. All except one indicator met the criterion of 0.7 for Cronbach’s alpha. Each of the single items had a stronger correlation with its hypothesized indicator than with any of the other indicators. The construct validity of the instrument was supported by 38 out of 45 significant associations.ConclusionThe content validity of the instrument was secured by a rigorous development process. Psychometric testing produced good evidence for data quality, internal consistency and construct validity. Further research is needed to assess the usefulness of the Adolescent Patient Experiences of Diabetes Care Questionnaire as a basis for quality indicators.

Empowering LGBTQ parents: How to improve maternity services and child healthcare settings for this community – ‘She told us that we are good as a family’

Parental empowerment plays an essential role in maternity and child healthcare. Professionals delivering these services are ideally placed to improve parents' empowerment and well-being. This study aims to describe the supporting factors of parental empowerment from the perspective of self-identified lesbian, gay, bisexual, trans, or queer (LGBTQ) parents in Finland. The study was conducted using a qualitative inductive design, and 22 parents participated. Interviews were conducted between July and September of 2016 and analysed using inductive content analysis. Four categories emerged: 1) Parents' willingness to create socially recognized families, 2) Parenthood support, 3) Respectful partnership with all parents, and 4) Accessible services. Services were more empowering when parents were treated with dignity. This focus requires gender-neutral communication and a clear sense of security for parents. The findings indicate more education on LGBTQ-related issues is still needed.

Innovations in parental smoking cessation assistance delivered in the child healthcare setting.

Addressing parental smoking in the child healthcare setting improves the health of all family members. Innovative approaches, such as mobilizing technology-based platforms, may streamline screening and motivate acceptance of behavioral health services to treat tobacco use and dependence. The obective of this study was to describe innovations added to the CEASE intervention and to track 2 year post-intervention implementation data on families who were screened for tobacco use. Child healthcare practices in five states (IN, NC, OH, TN, and VA) used an electronic tablet screener to identify tobacco use within families and deliver tobacco cessation assistance to smokers. Motivational/educational videos on cessation were displayed via the screener to enhance its utility. Five CEASE intervention practices screened 50,111 family members for tobacco use and identified 6,885 families with children exposed to tobacco smoke. The mean number of screeners per practice per month was 417; the mean number of households with smokers identified per month was 57. Of 2,764 smokers who were at visits and consented, 57% indicated that they wanted a prescription to reduce or quit smoking; 94% of these were given preprinted prescriptions. Of 41% who requested connection to the quitline, 93% were given enrollment forms. Electronic screening was used to routinely identify tobacco users, leading to increased potential for offering cessation assistance to all household members who smoke. Improved delivery of smoking cessation services to families may be achieved by integrating technological innovations into routine pediatric practice. CLINICAL TRIALS REGISTRATION: Trial Number NCT01882348.

Child sleep behaviors and sleep problems from infancy to school-age

ObjectiveFew studies have examined the sleep behaviors associated with a caregiver-reported sleep problem beyond early childhood and across different age groups. This study examined sleep behaviors associated with a caregiver-reported sleep problem from birth to middle childhood. MethodsParticipants were 5107 children from the Longitudinal Study of Australian Children—Birth Cohort. Caregiver-reported child sleep problems and sleep behaviors were assessed biennially from ages 0–1 to 10–11 years. Logistic regressions were used to examine associations between three child sleep behaviors (waking overnight, difficulty falling asleep, and difficulty sleeping alone) and the odds of having a caregiver-reported sleep problem at each age. ResultsCaregiver-reported child sleep problems were most prevalent in infancy (17.1%) and decreased through middle childhood (7.7%). All three sleep behaviors were associated with a sleep problem at each age. Whereas waking overnight was the most common sleep behavior and was associated with the highest odds of having a sleep problem from infancy to age 6–7 years (ORs = 5.78–8.29), difficulty falling asleep was the most common sleep behavior and was associated with the highest odds of having a sleep problem at ages 8–9 and 10–11 years (ORs = 10.65 and 17.78, respectively). ConclusionCaregivers’ endorsement of a child sleep problem was associated with developmentally-relevant sleep behaviors, with night awakenings most relevant during infancy and difficulty falling asleep most relevant in middle childhood. Study findings have implications for targeted and developmentally-focused sleep problem screening questions in child healthcare settings. Future research examining additional indicators of caregiver-defined sleep problems is required.