Maternal Concern Research Articles

Associations between maternal concern about child\u2019s weight and related behaviours and maternal weight-related parenting practices: a cross-sectional study

BackgroundParents influence their children’s weight-related behaviours through their parenting practices, which are often a focal point of obesity prevention interventions. This study examined associations of maternal concern about their child’s weight, dietary intake, physical activity, and media use with maternal food, physical activity, and media parenting practices.MethodsMothers (n = 310) reported their level of concern regarding their child’s weight and related behaviours and their weight-related parenting practices when their child was 5 years of age as part of the Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program. We used linear regression analyses with estimation by generalized estimating equations to examine associations of maternal concern and maternal parenting practices.ResultsSlightly more than 60% of mothers reported at least one concern related to their children’s weight or related behaviours. Excessive media use was the most commonly endorsed concern among mothers (45.2%). Compared to mothers who were unconcerned about their child’s weight, mothers who were concerned about their child weighing too much reported higher levels of controlling feeding practices, i.e., restrictive feeding, lower levels of co-participation of physical activity, and higher levels of using media to control child behaviour. Mothers who were concerned their child weighed too little reported higher levels of controlling feeding practices, i.e., restrictive feeding, pressure to eat. Similarly, mothers who were concerned about their child’s eating (eating too much or too little) reported higher levels of controlling feeding practices. Mothers who were concerned about their child using too much media reported higher levels of using media to regulate their child’s behaviour and providing opportunities for their child to use media.ConclusionMothers who were concerned about their child’s weight, dietary intake, physical activity and media use reported higher levels of controlling parenting practices, i.e., pressure to eat, and lower levels of health promoting parenting practices, i.e., co-participation in physical activity. Longitudinal research is needed to elucidate temporal order and specific mechanisms of these associations.

Factors Associated with Maternal Worry about Her Young Child Exhibiting Choosy Feeding Behaviour.

Choosiness in young children is a normal behaviour that sometimes worries parents. The study aimed to investigate factors that are associated with a mother being worried about her child’s choosy feeding behaviour. Parents of singleton children from the Avon Longitudinal Study of Parents and Children (n = 5710) completed a questionnaire assessing perception of their child’s choosy feeding behaviour at 15 months of age and whether this choosiness worried them. Feeding behaviours and practices throughout the first 15 months were captured. Multinomial logistic regression models with three levels of worry (not at all, a bit and greatly) as the dependent variables tested associations with variables from pregnancy and infancy. Half of the children (56%) were described as choosy at 15 months; of these 27% had mothers who were a bit worried and 5% greatly worried. Mothers showed greater odds of being worried if the child was first born, difficult to feed or refused solids by 6 months of age. Worried mothers had shown greater odds of introducing lumpy foods late (after 9 months). Feeding vegetables regularly by 6 months was associated with lower odds of worry at 15 months. Support and advice to parents at the start of complementary feeding could help to alleviate worry. Parents should be reassured that choosiness is a normal part of child development.

Mothers\u2019 and Fathers\u2019 Worry and Over-Control: One Step Closer to Understanding Early Adolescent Social Anxiety

This study investigated the links between parental worry, parental over-control and adolescent social anxiety in parent-adolescent dyads. Using a longitudinal sample of adolescents (Mage = 14.28) and their parents (224 mother–daughter, 234 mother–son, 51 father–daughter, and 47 father–son dyads), comparisons were conducted using cross-lagged path models across two time points. We used adolescent reports of social anxiety and feelings of being overly controlled by parents, and mother and father self-reports of worries. Our results show that boys’ social anxiety predicted higher perceived parental overcontrol, whereas girls’ social anxiety predicted higher paternal worry over time. In addition, girls’ reports of feeling overly controlled by parents predicted higher maternal worry but lower paternal worry over time. For boys, feeling overly controlled predicted less social anxiety instead. The study illustrates how mothers and fathers might differ in their behaviors and concerns regarding their children’s social anxiety and feelings of overcontrol.

Perceived child eating behaviours and maternal migrant background

The Child Eating Behaviour Questionnaire (CEBQ) is a well-established instrument in the study of obesity-related eating behaviours among children. However, research using the CEBQ in multicultural samples is limited. This study aims to identify and examine differences in child eating behaviours as reported by Swedish-born and non-Swedish-born mothers living in Sweden. Mothers (n = 1310, 74 countries of origin, mean age 36.5 years, 63.6% with higher education, 29.2% with overweight or obesity) of children aged 3–8 years (mean age 4.8 years, 18.1% with overweight or obesity) completed the CEBQ. Responses were analysed using CEBQ subscales Food Responsiveness, Emotional Overeating, Enjoyment of Food, and Desire to Drink, clustering into Food Approach, and subscales Satiety Responsiveness, Slowness in Eating, Emotional Undereating, and Food Fussiness, clustering into Food Avoidance. Data were compared across seven regional groups, divided by maternal place of birth: (1) Sweden (n = 941), (2) Nordic and Western Europe (n = 68), (3) Eastern and Southern Europe (n = 97), (4) the Middle East and North Africa (n = 110), (5) East, South and Southeast Asia (n = 52), (6) Sub-Saharan Africa (n = 16), and (7) Central and South America (n = 26). Crude, partly and fully adjusted linear regression models controlled for child's age, gender and weight status, and mother's education, weight status and concern about child weight. The moderation effect of maternal concern about child weight was examined through interaction analyses. Results showed that while Food Approach and Food Avoidance behaviours were associated with maternal migrant background, associations for Food Fussiness were limited. Notably, mothers born in the Middle East and North Africa reported higher frequencies of both Food Approach (except for Enjoyment of Food) and Food Avoidance. The study highlights the importance of examining how regionally-specific maternal migrant background affects mothers' perceptions of child eating behaviours.

Effect of fetal movement counting on prenatal attachment and maternal worries among primigravida mothers in selected hospital, Mysuru.

Effect of fetal movement counting on prenatal attachment and maternal worries among primigravida mothers in selected hospital, Mysuru.

A study to assess the effect of fetal movement counting on prenatal attachment and maternal worries among primigravida mothers in selected Hospital, Mysuru

A study to assess the effect of fetal movement counting on prenatal attachment and maternal worries among primigravida mothers in selected Hospital, Mysuru

Validation of the Chichewa Perinatal PTSD Questionnaire and Chichewa Child Health Worry Scale

Malawian mothers regardless of gestation at birth find pregnancy to be a stressful period that triggers worry due to a fear of maternal death. Research has mostly focused on maternal depressive symptoms regardless of gestation. Limited literature exists on posttraumatic stress symptoms and maternal worry. The purpose of this study was to translate and validate the Perinatal PTSD Questionnaire and Child Health Worry Scale for assessment of posttraumatic stress symptoms and worry about child’s health, respectively, among Malawian women. The process of assuring the accuracy of the translation involved having five native English-speaking nurse researchers and eight Malawian nurse-midwives in a focus group review the translations. We then psychometrically tested the instruments with 30 postpartum mothers at Kamuzu College of Nursing and Queen Elizabeth Central Hospital. Findings from the nurse researchers and the nurse-midwives agreed with most of the translations and modifications were done to improve the adaptations. The instruments were administered to the postpartum mothers. The Chichewa Self Reporting Questionnaire was used as the standard for assessment of perinatal emotional distress symptoms. Both the Chichewa Perinatal PTSD Questionnaire and Chichewa Child Health Worry Scale had high internal consistency and showed strong to moderate correlations with the Chichewa Self Reporting Questionnaire. The mothers agreed that the questions were easy to understand and culturally sensitive, although a few questions were seen as distressing. Future adaptations need to consider testing the instruments in mothers throughout infancy and utilizing other gold standard instruments for validation.

Mother-Toddler Cortisol Synchrony Moderates Risk of Early Internalizing Symptoms.

Cortisol synchrony is the degree to which mother-toddler cortisol levels are mutually regulated within a dyad. Synchrony's impact on toddler development is not well understood, so this study investigated how synchronous cortisol levels (reactivity and total concentration) in mother-toddler dyads moderates the association between risk factors (i.e., maternal worry, toddler inhibition) and early internalizing symptoms. Seventy mothers and their 2-year-old toddlers provided interpretable saliva samples. Behavioral observations were made to assess the toddler's temperament at age 2, and mothers reported on their toddler's internalizing symptoms when toddlers were 2- and 3-years-old. Results suggest that mother-toddler synchrony in total cortisol concentration moderates the relation between risk factors and internalizing symptoms. Specifically, toddler inhibition and maternal worry were less associated with concurrent toddler internalizing symptoms when dyads demonstrated greater cortisol synchrony in total concentration. Further, synchrony in total cortisol levels marginally moderated the association between toddler inhibition and future internalizing symptoms, such that inhibited toddlers were less likely to demonstrate internalizing symptoms at age 3 when dyads demonstrated more cortisol synchrony. This suggests that cortisol synchrony may serve as an advantageous context that reduces the risk of developing of internalizing symptoms and augments the field's understanding of the implications of shared physiological responses within mother-toddler dyads.

The role of sociodemographic factors in maternal psychological distress and mother-preterm infant interactions.

Preterm birth has been associated with greater psychological distress and less positive mother infant interactions than were experienced by mothers of full-term infants. Maternal and infant sociodemographic factors have also shown a strong association with psychological distress and the mother-infant relationship. However, findings on their effects over time are limited. In this longitudinal analysis, we explored the relationship of maternal and infant sociodemographic variables (maternal age, maternal education, marital status, being on social assistance, maternal race, infant birth weight, and infant gender) to maternal psychological distress (depressive, posttraumatic stress, anxiety, parenting stress symptoms, and maternal worry about child's health) through 12 months corrected age for prematurity, and on the home environment, and mother-infant interactions through 6 months corrected age for prematurity. We also explored differences related to maternal obstetrical characteristics (gestational age at birth, parity, mode of delivery, and multiple birth) and severity of infant conditions (Apgar scores, need for mechanical ventilation, and infant medical complications). Although the relationship of maternal and infant characteristics with these outcomes did not change over time, psychological distress differed based on marital status, maternal education, infant gender, and infant medical complications. Older mothers provided more a positive home environment. Mother-infant interactions differed by maternal age, being on public assistance, maternal race, infant gender, and infant medical complications. More longitudinal research is needed to better understand these effects over time in order to identify and support at-risk mothers.

Civil Unrest in the Context of Chronic Community Violence: Impact on Maternal Depressive Symptoms.

To examine changes in maternal-child health surrounding the April 2015 civil unrest in Baltimore, Maryland, following Freddie Gray's death while in police custody. We conducted cross-sectional Children's HealthWatch surveys January 2014 through December 2015 in pediatric emergency departments and primary care clinics on maternal-child health and June 2015 through October 2015 on daily and community routines. We used trend analysis and piecewise logistic regression to examine effects of time, residential proximity moderation, and mediation analysis to assess proximity and maternal-child health relations via maternal concerns. Participants comprised 1095 mothers, 93% of whom were African American and 100% of whom had public or no insurance; 73% of participants' children were younger than 24 months. Following the unrest, prevalence of maternal depressive symptoms increased significantly in proximal, but not distal, neighborhoods (b = 0.41; 95% confidence interval [CI] = 0.03, 0.79; P = .03). Maternal concerns were elevated in proximal neighborhoods and associated with depressive symptoms; mediation through maternal concern was not significant. Five months after the unrest, depressive symptoms returned to previous levels. Civil unrest has an acute effect on maternal depressive symptoms in neighborhoods proximal to unrest. Public Health Implications. To mitigate depressive symptoms associated with civil unrest, maintain stability of community routines, screen for maternal depressive symptoms, and provide parent-child nurturing programs.

Perception of pregnant women about self-care and maternal care

Objective: to understand the perception of self-care and maternal care in the discourse of pregnant women under the psychosocial perspective. Methods: qualitative study with data collection performed through a semi structure interview with ten pregnant women. The technique of content analysis, associated with the computer program Atlas TI, was used. Results: two analytical categories were identified, self-care: taking care of one’s own body and maternal care. Postmodern thinking influenced the self-care actions of pregnant women. However, maternal care was not directly influenced and pregnant women showed indicators of primary maternal concern, such as feelings and attitudes that provide the baby with comfort, protection and comfort. Conclusion: the self-care actions performed by the pregnant women showed concern about the aesthetic appearance at the expense of attitudes to preserve health and quality of life.

Maternal Near-miss at University Hospitals With Cesarean Overuse: An Incident Case-control Study

(Acta Obstet Gynecol Scand. 2016; 95(7):777–786) An important cause of maternal health concern, cesarean section (CS) is known to have some correlation with maternal near-miss (MNM). The objective of this study was to investigate the frequency, causes, risk factors, and perinatal outcomes of MNM. Between March 2012 and May 2014, this incident case-control study was conducted at 3 university hospitals in Tehran with high CS rates.

Feeding and Mealtime Correlates of Maternal Concern About Children's Weight

ObjectiveTo examine associations between maternal concern regarding their children becoming overweight and two domains of weight-related parenting; child feeding practices and family meal characteristics. DesignCross-sectional study. ParticipantsLow-income mothers (n = 264; 67% non-Hispanic white) and their children (51.5% male, aged 4.02–8.06 years). Variables MeasuredMaternal concern and feeding practices, using the Child Feeding Questionnaire. Meal characteristics were assessed using video-recorded meals and meal information collected from mothers. AnalysisThe authors used MANOVA and logistic regression to identify differences in maternal feeding practices and family meal characteristics across levels of maternal concern (none, some, and high). ResultsApproximately half of mothers were not concerned about their child becoming overweight, 28.4% reported some concern, and 19.0% had high concern. Mothers reporting no concern described lower restrictive feeding compared with mothers who reported some or high concern (mean [SE], none = 3.1 [0.1]; some = 3.5 [0.1]; and high = 3.6 [0.1]; P = .004). No differences in other feeding practices or family meal characteristics were observed by level of concern. Conclusions and ImplicationsConcern regarding children becoming overweight was common. However, concern rarely translated into healthier feeding practices or family meal characteristics. Maternal concern alone may not be sufficient to motivate action to reduce children's risk of obesity.

Practicing maternal virtues prematurely: The phenomenology of maternal identity in medically high-risk pregnancy

ABSTRACTIn this study, we examine the phenomenology of maternal identity development among U.S. women hospitalized with medically high-risk pregnancies (MHRP). We conducted 16 in-depth interviews with women and found that they drew on culturally normative notions of maternal nurture, worry, and sacrifice to construct maternal identity in the context of MHRP. Based on our findings, we suggest that MHRP shape women's sense of connection to and distinctive cognitive representations of their fetus. We conclude that hospitalization simultaneously promotes and challenges women's early maternal identifications.

Testing the direction of effects between child body composition and restrictive feeding practices: results from a population-based cohort

Background: Parental restrictive feeding (i.e., limiting food intake of children) has been linked to childhood overweight. However, the directionality of the causal pathway remains unknown.Objective: The objectives of this study were to examine the bidirectional association of maternal restrictive feeding with children's weight and body composition across childhood and to explore a possible mediating role of maternal concern about child weight.Design: Data were available for 4689 mother-child dyads participating in Generation R, a prospective birth cohort in the Netherlands. At ages 4 and 10 y, restrictive feeding was assessed with the parent-reported Child Feeding Questionnaire, and children's body mass index (BMI) was measured. At age 6 y, fat mass index (FMI) and fat-free mass index (FFMI) were measured with dual-energy X-ray absorptiometry. Both directions of the relation between restriction and child body composition were examined with multivariable linear regression analyses and cross-lagged modeling. Mediation analyses were performed to examine concern about child weight (mother reported at child age of 10 y) as a potential mediator.Results: Higher child sex- and age-adjusted BMI SD scores (zBMI) at age 4 y predicted more restrictive feeding at age 10 y (B = 0.15; 95% CI: 0.11, 0.18). Both sex- and age-adjusted FMI SD scores (zFMI) and sex-and age-adjusted FFMI SD scores (zFFMI) at 6 y were also positively associated with restrictive feeding at 10 y. Maternal concern about child weight partially mediated these associations from child body composition to restrictive feeding (e.g., for zBMI at 4 y: Bindirect = 0.10; 95% CI: 0.07, 0.13). There was no temporal association from restrictive feeding at age 4 y to child zBMI at age 10 y after adjustment for baseline zBMI.Conclusions: The continued use of restrictive feeding practices at age 10 y appeared to be primarily a response of mothers to an unhealthy weight of their child rather than a cause of children's overweight. Guidelines discouraging restrictive feeding for preventing childhood overweight should therefore be reconsidered.

Association Between Maternal Stress, Work Status, Concern About Child Weight, and Restrictive Feeding Practices in Preschool Children

Objectives To examine the relationship between maternal stress, work status, concern about child weight, and the use of restrictive feeding practices among mothers of preschool children. Methods 285 mothers of 2-to-5-year-old children completed an on-line survey. Questions included demographics, items from the Depression Anxiety Stress Scale, and the Child Feeding Questionnaire. Linear regression and ANOVA examined the relationship between maternal stress, work hours, concern about child weight, and the use of restrictive practices for one 2-to-5-year-old child living within the home. Results Mothers were 32.6 ± 5.2 years of age and spent 39.7 ± 12.0h/week at work. Seventy-one percent worked full time. Children were 3.4 ± 1.0 years of age and 51% male. Stress (3.41 ± 0.77, p ≤ 0.001) and concern about child weight (3.41 ± 0.77, p ≤ 0.00) were associated with the use of restrictive feeding practices. Mothers with severe/extremely severe stress used restriction more than mothers with normal stress, respectively (3.63 ± 0.80, 3.30 ± 0.81, p = 0.03). No difference was found among mothers with mild/moderate stress (3.50 ± 0.63, p = 0.06). There was no association between work hours (p = 0.50) or work status (p = 0.91) and the use of restrictive feeding practices. Conclusions Maternal stress and concern about child weight were associated with the use of restrictive feeding practices. Considering the current rates of childhood obesity in the United States, understanding factors that influence a child's food environment is advantageous and can help improve maternal and child health.

Too salty: biochemical markers to validate maternal concern of breastmilk supply

Early concern over low milk supply is a significant predictor of early cessation of breastfeeding. Thus, identifying at-risk mother-infant dyads by eliciting these concerns at early postpartum visits may allow for interventions to prevent breastfeeding cessation. However, maternal concerns may represent either appropriate perception of suboptimal milk production or a misperception of suboptimal milk production in the setting of normal lactation. An objective, biochemical marker that distinguishes between these two would aid the clinician in identifying those at highest risk for failure—those with concern for low milk supply and truly suboptimal milk production. In this volume of The Journal, Murase et al demonstrate that an elevated ratio of breast milk sodium to potassium (Na:K) is found more commonly in mothers expressing milk supply concern. Used in this way, the elevated breast milk Na:K could be used to validate maternal concerns and coordinate appropriate support. Furthermore, an elevated Na:K at day 7 was assocated with a ~20% incidence of stopped breastfeeding at 60 days, irrespective of early maternal concerns. Thus, in addition to validating maternal concerns, this simple biochemical measure made at day 7 could help clinicians identify the mothers at highest risk of stopping breast feeding whether they have concerns or not. Clearly, the maturation of breast milk over the first week of life as dictated by the changes in mammary gene expression is dynamic and variable among breastfeeding mothers. This reports shows that Na:K is an objective measure of milk maturation, and a potential screening tool to target those who may benefit from interventions aimed at optimizing breastfeeding success. Article page 294 ▶ The Relation between Breast Milk Sodium to Potassium Ratio and Maternal Report of a Milk Supply ConcernThe Journal of PediatricsVol. 181PreviewWe report that, among exclusively breastfeeding mothers at day 7 postpartum, those with milk supply concerns were significantly more likely to exhibit biochemical evidence of less progress toward mature lactation (elevated ratio of breast milk sodium to potassium concentration). Furthermore, an elevated ratio of breast milk sodium to potassium concentration was predictive of early weaning. Full-Text PDF

Challenges and Progress in Building a Comprehensive Statewide System for Fetal Alcohol Spectrum Disorders Prevention in Hawai'i.

Introduction Fetal Alcohol Spectrum Disorders (FASD) has been a maternal and child public health concern in Hawai'i for over the past decade. Methods A historical assessment of FASD related activities was conducted to map the challenges and progress made in building a comprehensive statewide system for FASD prevention and intervention in an island state. Results Progress has primarily been reflected in increasing the number of individuals receiving FASD education and training, as well as some initiatives in public awareness. The creation of a State FASD Coordinator position was significant in catalyzing support for FASD initiatives and extending collaborative networks with national experts/teams, community-based organizations, and other local agencies to leverage resources in a time of economic strain. Major challenges and barriers included loss of the FASD Coordinator position, reliance on external resources and lack of local capacity for training and education integration into existing practice systems, and inadequate surveillance infrastructure. Discussion Lack of funding and resources were a common factor overall, and impeded the development of a state strategic plan which was needed to guide overall efforts and policies into a more coordinated system to reduce and prevent FASDs in Hawai'i.

Inclusion and the practice of repeating Kindergarten in Australia

International evidence indicates there may be little or no academic benefit for children who are retained, and the possibility of negative long term socio-emotional outcomes for these children. Drawing on data from the nationally representative Longitudinal Study of Australian Children (n = 4464), this paper provides an Australian perspective on the practice of grade retention, specifically investigating repeating the Kindergarten year. Our results indicated that nearly half of grade retention occurring by Year 6 occurs in the Kindergarten year, the main reasons being related to learning and behavioural difficulties. The analyses identified a number of child and family factors associated with grade retention, the strongest predictors being maternal mental health and parental receptive language concern, with school readiness, receptive language skills, and child hyperactivity also relevant factors. The paper considers implications for early intervention to support children’s academic trajectories through school.

Magnitude of Unintended Pregnancy and its Determinants among Pregnant Women Visiting Dilla University Referral Hospital, South Ethiopia

Background: Unintended pregnancy is important maternal public health concern both in the developing and developed world. The proportion of unintended pregnancies is alarmingly high in Ethiopia and there is enormous information gap on the determinants of unwanted and mistimed pregnancy. Objectives: To determine magnitude of unintended pregnancy and its determinants among pregnant women visiting antenatal and postnatal care clinic at Dilla University Referral Hospital. Methods: Institution based cross-sectional study was conducted on 290 women attending antenatal clinic and Postnatal women at Dilla University Referral Hospital from February to June, 2016. Using consecutive arrival of client systematic sampling technique was conducted based on the patient flow per month. A structured questionnaire survey was used to collect data the data was entered and processed by IBM SPSS statistics version 20 for analysis. Descriptively frequencies and percentage was used and association between unintended pregnancy and independent variables were assessed using logistic regression. Results: The prevalence of unintended pregnancy is 36.9%. The study revealed that women less than 20 years old were about 2 times higher risk of having unintended pregnancy compared to 30 years and above women (AOR=1.84, CI: 1.02-4.29). Likewise, compared to married women singles were 2 times more likely to have unintended pregnancy (AOR=1.78; CI: 1.048- 5.078) and illiterate women were found to be less likely to have unintended pregnancy (AOR=0.074; CI: 0.021-0.263) according to multi-variable analysis. Conclusion: From the finding significant proportion of women (36.9%) had unintended pregnancy. Age of women, marital status and educational status were the variables significantly affecting the level of unintended pregnancy.