Child's Doctor Research Articles

Characteristics of parents receiving counseling from child's doctor to limit child's sugar drink consumption

Due to limited information on sugar drink counseling, characteristics of parents who reported ever receiving counseling from a child's doctor to limit a child's sugar drink intake were examined. This cross-sectional analysis was conducted on a convenient sample of 1570 US parents (aged ≥ 18 years) using the 2009 HealthStyles Survey. The outcome measure was parents with children aged ≤ 18 years who reported being told by a child's doctor to limit a child's sugar drink intake. Data were weighted to provide national estimates. Multivariable logistic regression was used to examine factors associated with ever receiving sugar-drink counseling from a child's doctor. Only 23% of parents reported receiving counseling from a child's doctor to limit a child's sugar drink intake. Parental factors significantly associated with receiving this counseling were: being male (adjusted odds ratio (OR) = 1.38; 95% confidence interval (CI) = 1.02, 1.86), having an annual household income of <$25 000 (versus ≥$60 000, OR = 2.12; 95% CI = 1.33, 3.38) and parents who agreed with 'enjoying learning about health issues' (versus disagree, OR = 2.43; 95% CI = 1.36, 4.36). Age, race/ethnicity, education and marital status were not significantly associated with receiving counseling. Few parents reported ever receiving counseling from a child's doctor, and we found a few differences among those reporting sugar drink counseling.

Sources and Perceived Credibility of Vaccine-Safety Information for Parents

The source of health information can have an impact on the manner and frequency of its use. In the arena of vaccine safety, a variety of sources promulgate information from very different perspectives. The spectrum runs from traditional sources such as public health officials and physicians to nontraditional sources, such as celebrities. To assess what proportion of parents trust vaccine information from different sources and whether different groups of parents vary in their trust of such information. In January 2009, as part of a larger study of parents and nonparents, 2521 online surveys were fielded to a nationally representative sample of parents of children aged ≤ 17 years. The main outcome measure was the source credibility of vaccine-safety information used by parents. The response rate was 62%. Parents reported trusting their children's doctor for vaccine-safety information most often (76% endorsed a lot of trust), followed by other health care providers (26%), government vaccine experts/officials (23%), and family and friends (15%). In contrast, celebrities were trusted a lot by 2% of the respondents and not at all by 76% of the respondents. Levels of trust in specific sources of vaccine-safety information varied significantly by gender (women > men) and race/ethnicity (Hispanics > other groups). Although most parents place a lot of trust in their child(ren)'s physician, parents' trust in non-health professional sources for such information should not be discounted. Those who design public health efforts to provide evidence-based information must recognize that different strategies may be required to reach some groups of parents who use other information sources.

Vaccine Attitudes, Concerns, and Information Sources Reported by Parents of Young Children: Results From the 2009 HealthStyles Survey

To describe the vaccine-related attitudes, concerns, and information sources of US parents of young children. We calculated weighted proportions and 95% confidence intervals for vaccine-related attitudes, concerns, and information sources of parents with at least 1 child aged 6 years or younger who participated in the 2009 HealthStyles survey. The overall response rate for the survey was 65% (4556 of 7004); 475 respondents were parents or guardians ("parents") of at least 1 child aged 6 years or younger. Among those respondents, nearly all (93.4%) reported that their youngest child had or would receive all recommended vaccines. The majority of parents reported believing that vaccines were important to children's health (79.8%) and that they were either confident or very confident in vaccine safety (79.0%). The vaccine-related concern listed most often by parents was a child's pain from the shots given in 1 visit (44.2%), followed by a child getting too many vaccines at 1 doctor's visit (34.2%). When asked to list their most important sources of information on vaccines, the most common response was a child's doctor or nurse (81.7%). To maintain and improve on the success of childhood vaccines in preventing disease, a holistic approach is needed to address parents' concerns in an ongoing manner. Listening and responding in ways and with resources that address specific questions and concerns could help parents make more informed vaccination decisions.

Acceptability of Testing Children for Tobacco-Smoke Exposure: A National Parent Survey

Tests are available to measure children's exposure to tobacco smoke. One potential barrier to testing children for tobacco-smoke exposure is the belief that parents who smoke would not want their child tested. No previous surveys have assessed whether testing children for exposure to tobacco smoke in the context of their child's primary care visit is acceptable to parents. To assess whether testing children for tobacco-smoke exposure is acceptable to parents. We conducted a national random-digit-dial telephone survey of households from September to November 2006. The sample was weighted by race and gender, based on the 2005 US Census, to be representative of the US population. Of 2070 eligible respondents contacted, 1803 (87.1%) completed the surveys. Among 477 parents in the sample, 60.1% thought that children should be tested for tobacco-smoke exposure at their child's doctor visit. Among the parental smokers sampled, 62.0% thought that children should be tested for tobacco-smoke exposure at the child's doctor visit. In bivariate analysis, lower parental education level, allowing smoking in the home, nonwhite race, and female gender were each associated (P < .05) with wanting the child tested for tobacco-smoke exposure. The majority of nonsmoking and smoking parents want their children tested for tobacco-smoke exposure during the child's health care visit.

Fathers' depression related to positive and negative parenting behaviors with 1-year-old children.

To examine the associations between depression in fathers of 1-year-old children and specific positive and negative parenting behaviors discussed by pediatric providers at well-child visits. We performed a cross-sectional secondary analysis by using interview data from 1746 fathers of 1-year-old children in the Fragile Families and Child Wellbeing Study. Positive parenting behaviors included fathers' reports of playing games, singing songs, and reading stories to their children ≥ 3 days in a typical week. Negative parenting behavior included fathers' reports of spanking their 1-year-old children in the previous month. Depression was assessed by using the World Health Organization Composite International Diagnostic Interview Short Form. Weighted bivariate and multivariate analyses of parenting behaviors were performed while controlling for demographics and paternal substance abuse. Overall, 7% of fathers had depression. In bivariate analyses, depressed fathers were more likely than nondepressed fathers to report spanking their 1-year-old children in the previous month (41% compared with 13%; P < .01). In multivariate analyses, depressed fathers were less likely to report reading to their children ≥ 3 days in a typical week (adjusted odds ratio: 0.38 [95% confidence interval: 0.15-0.98]) and much more likely to report spanking (adjusted odds ratio: 3.92 [95% confidence interval: 1.23-12.5]). Seventy-seven percent of depressed fathers reported talking to their children's doctor in the previous year. Paternal depression is associated with parenting behaviors relevant to well-child visits. Pediatric providers should consider screening fathers for depression, discussing specific parenting behaviors (eg, reading to children and appropriate discipline), and referring for treatment if appropriate.

Clinique de la dyslexie

Dyslexia is characterized by a severe, persistent reading disorder occurring in an intelligent child. In the large field of learning disabilities, dyslexia is related to a cerebral dysfunction well described with Imagery and genetic studies. Nevertheless the diagnosis of dyslexia cannot be done by another way than clinical symptoms. Optimizing the management of children with dyslexia is a critical issue and is now possible, thanks to the improvement of neurosciences data and the mobilization of the key stakeholders. The knowledge of the precise symptoms is essential in order to lead the child's doctor able to improve coordination and harmonization of teaching and care and guidance of parents.

Prévention du risque allergique en milieu scolaire

The prevention of allergy risk in schools requires a collective management that combines teachers, extra-curricular personnel, children's doctors and school doctors. There should be individual avoidance measures concerning food allergies and contact allergies for each child, while collective protective measures are needed for respiratory allergies.

Use of Supplemental Vitamin D Among Infants Breastfed for Prolonged Periods

To determine the rate of vitamin D supplementation in predominantly breastfed children. To identify patient characteristics, parental beliefs, and practitioner policies associated with supplementation. A prospective observational study was conducted in a practice-based research network. Network pediatricians completed a survey regarding their policy on vitamin D supplementation for breastfed infants. Parents of children 6 to 24 months old completed a survey on the initial type of feeding given to the child, length of breastfeeding, formula supplementation, and use of multivitamins. Parents indicated their level of agreement with statements regarding vitamin D supplementation. Among 44 responding pediatricians, 36.4% indicated that they recommended vitamin D supplementation for all breastfed infants. A total of 2364 surveys were completed on age-eligible children; 1140 infants were breastfed for at least 6 months with little or no formula supplementation. The rate of vitamin D use for these infants was 15.9%. Use of vitamin D was significantly associated with parental agreement that their child's pediatrician recommended supplementation (odds ratio [OR]: 7.8), and that vitamins are unnecessary because breast milk has all needed nutrition (OR: 0.12). Among parents of predominantly breastfed infants who indicated that their child's doctor recommended vitamin D, 44.6% gave the supplementation to their child. Conversely, 67% of parents agreed that breast milk has all needed nutrition, and only 3% of these parents gave vitamin D to their children. A minority of breastfed infants received vitamin D supplementation. Educational efforts directed at both physicians and parents are needed to increase compliance with vitamin D supplementation guidelines.

Comments on the article “Changing attitudes towards the care of children in hospital: a new assessment of the influence of the work of Bowlby and Robertson in the UK, 1940–1970” by Frank C.P. van der Horst and Rene van der Veer (Attachment and Human Development Vol 11, No 2, March 2009, 119–142)

The authors give an impressive list of references, but these do not reflect the situation in the UK; most of those looking after children in hospital did not write about what they did or read about what others did. Children in hospital saw little or nothing of their parents, and once they had ‘settled’ the doctors and nurses were unaware of their distress. John Bowlby's interest in maternal deprivation led him to appoint James Robertson as his research assistant, to observe responses of young children to loss of maternal care on admission to hospital. They formulated the theoretical framework of the three stages through which the children went; protest, despair, and detachment constituting a developmental interference. Robertson was so concerned when nobody would listen that in 1952 he made the film ‘A Two Year Old Goes to Hospital’, which upset children's doctors and nurses. It also probably contributed to the government setting up in 1957 a Committee chaired by Sir Harry Platt to consider the Welfare of Children in Hospital. ‘Going to Hospital with Mother’ was made by Robertson in 1958. With Dermod MacCarthy he showed the films to the Committee, who accepted the suggestions in Robertson's Memorandum which included unrestricted visiting and mothers being admitted with their young children. The Report, known as the Platt Report, was published in 1959. Robertson could then show his films publicy, campaign in the media and encourage the pressure group NAWCH (the National Association for the Welfare of Children in Hospital) who were successful in getting many of the Committee's recommendations implemented, to the benefit of all children in hospital.

A narrative of resistance: Presentation of self when parenting children with asthma

Using a social constructivist perspective and narrative analysis, the purpose of this paper is to illustrate how an understanding of self-presentation in interactions may inform health care interventions. We examine how a single African American mother, living in poverty, presents her sense of self in the context of obtaining and providing asthma care for her children. By analyzing four separate encounters--two interviews with the children's mother, the clinical encounter between the mother and her children's doctor, and an interview with the doctor, we gain an understanding of the mother's self-presentation and identity and the doctor's view of the mother. The analyses reveal the mother's consistent desire to protect her children in an unpredictable social world. By examining self-presentation, behavior that is typically construed as non-adherence is reframed as resilience, one mother's attempt to assert control. We argue that an understanding of identity production may enable practitioners and patients to create collaborative interventions. The analysis presented in this paper points to the need for a co-constructed intervention that allows for choice and control and honors the mother's sense of self.

You and your child's doctor

You and your child's doctor

Parent Reactions to a School‐Based Body Mass Index Screening Program

This study assessed parent reactions to school-based body mass index (BMI) screening. After a K-8 BMI screening program, parents were sent a letter detailing their child's BMI results. Approximately 50 parents were randomly selected for interview from each of 4 child weight-classification groups (overweight, at risk of overweight, normal weight, underweight) to assess parent recall of the letter, reactions to BMI screening, and actions taken in response to the child's BMI results. Most parents found the BMI screening letter easy to read and had poor recall of numerical information (eg, the child's BMI percentile) but good recall of the child's weight classification (eg, normal weight or overweight). Most parents, and ethnic-minority parents in particular, supported school-based BMI screening. Parents of children whose weight was outside of the normal range were more likely to recall receiving the letter and talking to the child and the child's doctor about it. Parents who recalled their child as being overweight were more likely to report changing the child's diet and activity level. Most parents, and ethnic-minority parents in particular, wanted their child to participate in an after-school exercise program. An overweight condition in parents, but not children, was associated with an interest in family-based cooking and exercise classes. Most parents, and ethnic-minority parents in particular, viewed school-based BMI screening and after-school exercise programs favorably. Parents reported taking action in response to a BMI result outside of the normal range. Parents who were overweight themselves were particularly interested in family cooking and exercise classes.

BECOMING A BABY?

The image of the foetus has become, in the twenty-first century, a particularly potent force. This is the foetus at a particular historical moment: a thumb-sucking, wriggling, engrossing little bod...

Influences on parents’ decisions for home and automobile smoking bans in households with smokers

Objective To understand clinician influence on use of home and automobile smoking bans in homes of children living with a smoker. Methods Parents were surveyed on tobacco use, smoking bans, demographics and opinions about tobacco, including harm from environmental tobacco smoke (ETS). Responses from 463 diverse households with smokers were analyzed. Results 42% of respondents smoked; 50% had a home smoking ban and 58% an automobile smoking ban. Nonsmokers living with a smoker, those who strongly agreed in ETS harm, and those having a child ≤5 years more often had a home smoking ban. Those recalling their child's doctor ever asking the respondent about their smoking status and African American respondents less frequently had a home ban. Automobile smoking bans were more often held by those with strong agreement in ETS harm and less often found in families having a child receiving Medicaid/uninsured. Conclusions Having a strong perception of harm from ETS exposure was associated with having smoking bans. Aspects of health encounters not measured by this study may be negatively influencing adoption of home smoking bans or lead to recall bias. Practice implications Clinicians should examine the strength, focus, and response to their messages to parents about tobacco.

Preferences for EMS Transport andPediatric Emergency Department Care

Objectives. To characterize the reasons pediatric emergency department (PED), patients access emergency medical services (EMS) for transport to the pediatric ED. To describe the acceptability of other modes of transport andalternative sites of care. Methods. We included a convenience sample of the responsible adults accompanying pediatric patients who arrived via EMS to the PED of an academic medical center. We administered a survey to evaluate why they chose EMS andtheir feelings about alternative modes of transport (e.g., medical van, taxi) or alternative sites of care (e.g., urgent care center, primary care physician's office, or getting an appointment within 24 hours). Results. One hundred thirthy-eight surveys were completed. Pediatric patients averaged eight years of age. Trauma (44%) andseizures (17%) were the chief complaints. The primary reasons for EMS use were perceived medical necessity (54%) andsecurity of transport by EMS (17%). Only transport by EMS was found to be acceptable. The responsible adults expressed acceptance of the PED (median = 7, 1 = not acceptable, 7 = very acceptable) as a destination, more than their child's primary care doctor's (median = 4), urgent care centers (median = 3), or no transport anda physician appointment within 24 hours (median = 1). Conclusions. Adults access the EMS system for children because of concerns regarding the acuity of illness andfor the security of EMS transport. They were generally uninterested in transport by any mode other than EMS. However, they would accept transport to alternative sites for immediate care.

Patient-Physician E-mail: An Opportunity to Transform Pediatric Health Care Delivery

The objectives of this study were to assess the patterns of patients who use a patient-physician e-mail service, measure physician time required to answer a patient question via e-mail compared with that via telephone, and determine the satisfaction of families who are provided e-mail access to their child's rheumatologist. A consecutive series of patients' families were offered e-mail access during a 2-year period. Data regarding patient e-mail use were collected, including urgency of message, subject matter, message volume, and time of day of messaging. The duration of the pediatric rheumatologist's e-mail interactions and telephone interactions with patients was measured using a stopwatch. After 1 year of enrollment in the patient-physician e-mail service, families were mailed a 12-item satisfaction survey regarding their e-mail experience. A total of 306 of 328 families who were offered patient-physician e-mail access enrolled, and 121 used the service. The patients sent 40% of their e-mails outside business hours. Messages that were urgent (notification of disease flare, notification of new symptoms, or parent expectation of same-day response) made up 5.7% of the e-mails sent to the physician. Messages that required emergent attention made up 0.002% of the e-mails to the physician. Answering patient questions by e-mail was 57% faster than using the telephone for the physician. The physician received 1.2 e-mails per day from patients. The families who responded to the survey agreed that patient-physician e-mail increased access to the physician and improved the quality of care. The families did not find that patient-physician e-mail distanced them from their child's doctor. Patient-physician e-mail is a service that patients will use given the opportunity. The e-mail service enables physicians to answer medical questions with less time spent compared with telephone messaging. In our experience in an academic pediatric subspecialty practice, patients reported enhanced communication and access with the e-mail service.

Informing Parents About CT Radiation Exposure in Children: It's OK to Tell Them

The purpose of our study was to determine how parents' understanding of and willingness to allow their children to undergo CT change after receiving information regarding radiation dose and risk. One hundred parents of children undergoing nonemergent CT studies at a tertiary-care children's hospital were surveyed before and after reading an informational handout describing radiation risk. Parental knowledge of whether CT uses radiation or increases lifetime risk of cancer was assessed, as was willingness to permit their child to undergo both a CT examination that their child's doctor recommended and one for which their doctor thought observation might be equally effective. Of the 100 parents who were surveyed, 66% believed CT uses radiation before reading the handout, versus 99% afterward (p < 0.01). Before reading the handout, 13% believed CT increases the lifetime risk of cancer, versus 86% afterward (p < 0.01). After reading the handout, parents became less willing to have their child undergo CT given a hypothetic situation in which their doctor believed that either CT or observation would be equally effective (p < 0.01), but their willingness to have their child undergo CT recommended by their doctor did not significantly change. After reading the handout, 62% of parents reported no change in level of concern. No parent refused or requested to defer CT after reading the handout. A brief informational handout can improve parental understanding of the potential increased risk of cancer related to pediatric CT without causing parents to refuse studies recommended by the referring physician.

Parental Factors Impacting the Enrollment of Children in Cardiac Critical Care Clinical Trials

Clinical trials are abundant in adult cardiovascular medicine; however, they are rare in pediatric cardiology. Pediatric cardiac trial design may be impacted by the heterogeneous nature of the underlying cardiac defects, as well as by a strong emotional response from parents whose child will undergo a surgical intervention. The purpose of this study was to assess factors that may have an impact on parents considering enrollment of their child in a clinical trial at the time of surgical intervention. A voluntary, self-administered questionnaire (14 questions) was provided to parents of children 16 years of age or younger during the preadmission testing period. Demographic and procedure-related variables were collected for each patient. A total of 119 surveys were analyzed over a 1.5-year period. Only 8% of the parents had their child participate in a clinical trial in the past. Fifty-six percent of the parents preferred that their child's cardiologist or surgeon explain clinical trial details, with 23% preferring the principal investigator and 3% preferring the research coordinator. Fifty percent of the parents were favorably disposed to participate in a clinical trial if the drug or device was currently used by their child's doctor, and 19% were encouraged to participate if the drug or device was approved for use in adults. The majority of parents (64%) preferred to be asked about participating in a trial within 1 month prior to the planned procedure, and 40% preferred to discuss trial details at a remote time in an outpatient location. Sixty-three percent of parents believed that most of the medications currently used in children were already approved by the Food and Drug Administration. Most parents (91%) believed that clinical trials conducted in children will help improve pediatric health care; 74% believed that their child may receive potential benefit from enrolling in a trial. Finally, 43% believed that funding for trials should come from government and health care agencies, as opposed to pharmaceutical companies (24%). This survey reveals the importance of the attending physician and timing in educating parents regarding a cardiac critical care clinical trial. These data may impact the design and successful conduct of future trials.

Parent Use of Touchscreen Computer Kiosks for Child Health Promotion in Community Settings

The goals were to evaluate the use of touchscreen computer kiosks, containing only child health-promoting information, in urban, low-income, community settings and to characterize the users of these kiosks. Three user-driven touchscreen computer kiosks were placed in low-income urban locations in Seattle, Washington, from March 2005 to October 2005. The locations included a public library, a Department of Motor Vehicles office, and a McDonald's restaurant. Users selected age-appropriate modules with prevention information and screening tools. Users entered the age of the child and were presented with age-appropriate modules. On exiting, users were asked to rate their experience and to provide basic demographic data. In total, there were 1846 kiosk sessions. Almost one half occurred at McDonald's. Seventy-eight percent of users identified themselves as first-time users. Users sought information for children of all ages. Sixty-one percent of first-time users explored 1 module. First-time users were most interested in television/media use (16%), smoke exposure (14%), attention-deficit/hyperactivity disorder screening (12%), and asthma assessment (11%). At-risk children were identified in 52% of sessions. Eighty-seven percent of first-time users who completed the asthma assessment had children whose asthma was uncontrolled. Twenty-eight percent of users responded to > or = 1 question on the exit survey. Of those, 48% had less than a high school education, and 26% had never used the Internet. Approximately one half found the kiosk easy to use (57%) and the information easy to understand (55%); 66% said there was at least some new information. Fifty-five percent planned to try some of the things they had learned, and 49% intended to talk to their child's doctor about what they had learned. User-driven computer kiosks were used in community settings to obtain child health information. Users found the kiosks easy to use. Additional study on improving use and understanding the impact is needed.

Beliefs and attitudes about influenza immunization among parents of children with chronic medical conditions over a two-year period.

Influenza vaccination is recommended for children with chronic medical conditions yet is infrequently performed. The reasons for low influenza vaccination rates in this group have not been well studied. We assessed and compared parents of children with chronic medical conditions regarding their beliefs and attitudes about influenza vaccination in 2003 and 2004. Parents of 2- to 13-year-old children with chronic medical conditions from health centers in low-income urban neighborhoods completed a 19-question survey, mailed following the 2002-2003 and 2003-2004 influenza seasons. Parent-reported influenza vaccination rate declined from 2003 (44%) to 2004 (25%). The most important factors related to influenza vaccination status were perceived doctor's recommendation (odds ratio [OR] = 6.0, 95% confidence interval [CI] = 3.7-9.7), parents' belief that the child should be vaccinated (OR = 5.4, 95%CI = 3.3-8.8), relatives' belief that the child should be vaccinated (OR = 1.7, 95%CI = 1.1-2.7), easy access to the doctor's office for a flu shot (OR = 2.4, 95%CI = 1.4-4.2), and receipt of a reminder from the doctor's office (OR = 1.7, 95%CI = 1.1-2.6). In 2004 compared with 2003, fewer parents reported getting a reminder, and fewer believed that their child's doctor recommended flu vaccine. Doctors' recommendation that children with chronic medical conditions should receive an annual influenza vaccine and vaccine availability are important factors that resulted in a higher likelihood of influenza vaccination. Our findings that fewer parents reported receiving reminders and that fewer children were vaccinated in 2004 suggest that sustained improvements in vaccination rates may require continual changes in the format and delivery method of vaccination reminders from physicians.