Parental Child Health Research Articles

A Community-enabled Readiness for first 1000 Days Learning Ecosystem (CRADLE) for first-time families: study protocol of a three-arm randomised controlled trial

BackgroundEnhanced parenting self-efficacy (PSE) contributes to positive parenting and future parental-child health. First-time parents, in particular, are in need of support since the pregnancy until post-delivery to strengthen their early PSE. However, there is a lack of effective and sustainable relevant programmes in the community. The Community-enabled Readiness for first 1000 Days Learning Ecosystem (CRADLE) aims to develop a self-learning eco-community throughout the pregnancy and early childhood to promote PSE among first-time parents. We apply choice architecture strategy using behavioural nudges and midwife-led continuity care during the first 1000 days, and test their effects on PSE and mother-child health for first-time families in Singapore.MethodsThis three-arm randomised controlled trial will recruit up to 750 pregnant women from the KK Women’s and Children’s Hospital, Singapore. Participants will be randomly assigned to receive: (1) standard routine care; (2) behavioural nudges (text messages) along with the use of a social media platform; or (3) midwife-led continuity care involving individualised teleconferencing sessions, during pregnancy and post-delivery. Using web-based questionnaires, participants will be assessed for baseline socio-demography and health status in the first visit, with follow-up assessments in the third trimester, at birth, 6-week (primary end-point), 6-, 12-, 18- and 24-month post-delivery. The primary outcome is PSE. Secondary outcomes include health and birth experience, mental wellness, feeding practice, maternal and child nutritional status. Intention-to-treat and per-protocol analyses will be performed using general linear models to test the effects of interventions across three arms. Recruitment has begun in June 2020 and is estimated to complete in September 2022.DiscussionThis study may identify a sustainable effective strategy in the community by helping first-time parents to have a positive experience during the pregnancy, childbirth and parenthood, leading to an enhanced PSE and health outcomes for both mother and child. Findings from this study will provide insight into the implementation of early parenting and mother-child care programmes.Trial registrationClinicalTrials.gov NCT04275765. Registered on 19 February 2020.

Parent-child health- and weight-focused conversations: Who is saying what and to whom?

The purpose of this study was to examine the prevalence of health-focused (healthy eating, physical activity) and weight-focused (weight, dieting) parent-child conversations, and to understand who is talking and who is listening, by exploring the associations these conversations have with parent and child characteristics. The study population included 546 parents (age 27–36 years) who participated in Project EAT (Eating and Activity in Teens and Young Adults)-IV (2015–2016) and had a child aged 2–17 years. Cross-sectional prevalence ratios were calculated to identify associations between parent and child characteristics and the parent-child conversations. Conversations about healthy eating (82%) and physical activity (75%) were more prevalent than those about the child's weight (30%), and dieting (25%). In adjusted models, parents meeting physical activity recommendations had a higher prevalence of health-focused conversations (healthy eating PR = 1.10, 95% CI = 1.01, 1.20; physical activity PR = 1.12, 95% CI = 1.02, 1.24); whereas, weight-focused conversations were more common among parents who had recently dieted and perceived their child to be overweight. Health-focused and weight-focused conversations were highly common among the oldest children aged 9–17 years (health-focused = 90–93% and weight-focused = 42–53%); though, a substantial prevalence of health- and weight-focused conversations (>50% and ≥10%, respectively) also occurred with the youngest children (2–4 years). Findings suggest that parent-child health- and weight-focused conversations are common and that characteristics, including child's age and parents' physical activity, dieting, and perceptions of child weight, may be useful to consider in public health messaging, interventions, and family education that address parent-child communication.

When do parents and child health professionals agree on child's psychosocial problems? Cross-sectional study on parent-child health professional dyads.

BackgroundAbout one third of all parents have concerns about their child’s psychosocial development. Agreement between child health professionals (CHPs) and parents about such concerns may improve treatment adherence and outcomes. This study investigates which child, parenting and/or environmental stressors are associated with (dis)agreement in concerns regarding psychosocial problems in children, in parent-CHP dyads.MethodsDuring routine child health assessments, data were collected from a sample of children aged 14 months to 12 years (n = 3,870). CHPs registered the psychosocial problems that they identified, and parents reported their concerns. Child psychosocial stressors were measured with the ITSEA/CBCL, and the child’s history of psychosocial problems. Environmental stressors referred to stressful family/contextual situations in the past year, and parenting stressors to perceived parenting efficacy.ResultsThe CHPs and parents disagreed on 36.4 % of the children. CHPs based their identification of problems mainly on children’s history of past problem (OR = 5.85, 95 % CI = 4.74–7.22). Parental concerns were most likely in case of an increased ITSEA/CBCL score (OR = 7.69, CI = 5.39–10.97). CHP-parent agreement was more likely in case of a combination of child psychosocial, parenting and environmental stressors (OR = 35.58, CI = 24.11–52.48). Parental concerns not confirmed by the CHP were associated with higher educated parents, originating from an industrialized country, and younger children. The CHP-identified problems not confirmed by parental concerns were associated with older children.ConclusionAgreement between CHPs and parents is associated with a co-occurrence of child, parenting and environmental stressors. Improved agreement between CHP and parents will increase the likelihood of shared decision-making regarding follow-up care and compliance with advice.

Social Inequality in Early Childhood Health – Participation in the Preventive Health Care Program for Children

This paper asks how far socioeconomic differences in parental child health investments can be explained by personal and social resources within the family. Using SOEP data from the 2003 to 2008 newborn questionnaire, we estimate multiple logistic regressions to determine the effects of migration status, education, time resources, coping competencies, and social resources (in terms of shared parenthood and childcare support by the partner and relatives) on participation in the national German preventive health care program for children (U-Untersuchungen). First, our analyses reveal strong influences of maternal education and migration status, whereas social class plays no significant role for participation in preventive health checkups for children. Second, the likelihood of participation is higher the better mothers cope with motherhood and the more time they spend with their offspring. Finally, we find mixed effects of social resources ranging from a positive influence of parents living together, over no effect of childcare support provided by the father of the child, to a seemingly negative impact of support from further kin relations. All in all, personal and social resources do not seem to play a crucial role in explaining participation in child health programs in terms of social disparities between educational and ethnic groups. JEL Classification: I10

From financial hardship to child difficulties: main and moderating effects of perceived social support

There is an unequivocal relationship between socio-economic status and child well-being. The Family Stress Model of economic hardship proposes that this relationship is mediated by financial hardship, parenting stress and parenting behaviours. In this study, the Family Stress Model is tested and analysis is extended to examine main and moderating effects of social support. A survey incorporating well-validated measures of financial hardship, parenting stress, parenting behaviours and child difficulties was sent to 1296 parents who had utilized universal family support services in Alberta, Canada. A total of 923 parents (71%) responded. Hierarchical linear regression was employed to investigate the mediating roles of financial hardship, parenting stress and parenting behaviours, and to investigate main and moderating influences of parental social support. The study findings generally support the Family Stress Model. The relationship between socio-economic status and child difficulties was mediated by financial hardship and parenting stress. Higher levels of parental social support were associated with lower levels of parenting stress, ineffective parenting and child difficulties. Parental social support was important irrespective of parenting stress levels. The study findings add to the now critical mass of data showing that parent-child health and well-being is inextricably linked with parental social support. While there is a burgeoning literature on parent training, far less research attention has been given to the development and evaluation of strategies to strengthen parents' social relationships. This is an important direction for future research.

The Effectiveness of a Church-Based Family Focused Health Intervention: Correlates of Parent-Child Health Behavior Change

The Effectiveness of a Church-Based Family Focused Health Intervention: Correlates of Parent-Child Health Behavior Change

Children's Receipt of Health Care Services and Family Health Insurance Patterns

Insured children in the United States have better access to health care services; less is known about how parental coverage affects children's access to care. We examined the association between parent-child health insurance coverage patterns and children's access to health care and preventive counseling services. We conducted secondary analyses of nationally representative, cross-sectional, pooled 2002-2006 data from children (n = 43,509), aged 2 to 17 years, in households responding to the Medical Expenditure Panel Survey (MEPS). We assessed 9 outcome measures pertaining to children's unmet health care and preventive counseling needs. Cross-sectionally, among US children (aged 2 to 17 years) living with at least 1 parent, 73.6% were insured with insured parents, 8.0% were uninsured with uninsured parents, and the remaining 18.4% had discordant family insurance coverage patterns. In multivariable analyses, insured children with uninsured parents had higher odds of an insurance coverage gap (odds ratio [OR] = 2.45; 95% confidence interval [CI], 2.02-2.97), no usual source of care (OR = 1.31; 95% CI, 1.10-1.56), unmet health care needs (OR = 1.11; 95% CI, 1.01-1.22), and having never received at least 1 preventive counseling service (OR = 1.20; 95% CI, 1.04-1.39) when compared with insured children with insured parents. Insured children with mixed parental insurance coverage had similar vulnerabilities. Uninsured children had the highest rates of unmet needs overall, with fewer differences based on parental insurance status. For insured children, having uninsured parents was associated with higher odds of going without necessary services when compared with having insured parents.

CAREGIVING STRESS, IMMUNE FUNCTION, AND HEALTH: IMPLICATIONS FOR RESEARCH WITH PARENTS OF MEDICALLY FRAGILE CHILDREN

Caregiving stress has been associated with considerable demands imposed on parents responsible for the physical and emotional care of medically fragile children. With health care advances in medicine and technology, there are a growing number of children with chronic conditions and disabilities (i.e., the medically fragile) surviving longer and being cared for almost exclusively in the home by parents. The physical strains, financial constraints, emotional effects, and social isolation experienced by parents caring for children with such complex medical needs may ultimately impact their physical and emotional health. Stress associated with the caregiving of older adults has been shown to negatively impact on health and immune functioning with the potential for associated morbidity. Studies exploring the relationship of stress with biological markers of immune functioning in parents have not been widely conducted. Therefore, there is a great opportunity in parent-child health for researchers to investigate implications of stress on immune functioning and health outcomes in parents caring for medically fragile children at home. The purpose of this review article will be to provide an overview of the literature related to caregiving stress and immune functioning and to discuss implications for research in this area with parents of medically fragile children.

Promoting health and home safety for children of parents with intellectual disability: a randomized controlled trial

The objective of this study was to evaluate the efficacy of a home-based intervention targeted to parents with intellectual disability to promote child health and home safety in the preschool years. A total of 63 parents were recruited for the study with 45 parents (40 mothers and 5 fathers) from 40 families completing the project. The research design permitted comparison between the intervention and three alternative conditions with all parents receiving the intervention in an alternating sequence over the life of the project. The intervention consisted of 10 weekly lessons carried out in the parent’s home focusing on child health and home safety. The program was adapted to suit the Australian context from the UCLA Parent–Child Health and Wellness Project (Tymchuk, Groen, & Dolyniuk, 2000). Outcome measures assessed parental health and safety behaviours. Standard measures included parental health, intelligence and literacy. The intervention improved parents’ ability to recognize home dangers, to identify precautions to deal with these dangers and resulted in a significant increase in the number of safety precautions parents implemented in their homes with all gains being maintained at 3 months post-intervention. Parents’ health behaviours including improved understanding of health and symptoms of illness, knowledge of and skills needed to manage life-threatening emergencies, knowledge about visiting the doctor, knowing when to call, what information to provide and what questions to ask, and how to use medicines safely significantly increased. Again, all gains were maintained 3 months post-intervention. The intervention was effective regardless of parental health, literacy skills, and IQ. This form of home-based intervention promotes a healthy and safe environment which is a prerequisite to continuing parental custody.

Changes in the surgical management of necrotizing enterocolitis

JM is a 655 gram, 25-week-gestation female infant who was delivered vaginally to a 20-year-old Gravida 1 Para 0, white female. The maternal history revealed the following: blood type B , hepatitis screen negative, rubella immune, rapid plasma reagin (RPR) nonreactive. Prenatal care was started at approximately 8 weeks gestation. Pregnancy complications included maternal smoking, premature labor, and premature rupture of membranes 11 days before delivery. Medications during labor included ampicillin, Zithromax (Pfizer, New York, NY), and magnesium sulfate. The infant required intubation and ventilation, chest compressions, and 2 doses of epinephrine at delivery. Apgars were 1 and 6 at 1 and 5 minutes, respectively. Admitting diagnoses included respiratory distress syndrome (RDS), sepsis, extreme prematurity, and hypotension. The infant received a course of indomethacin (0.2 mg/kg MCN 0.1 mg/kg 0120 3 total doses) starting on day of life (DOL) 2 and completed on DOL 3. Oral feedings were never attempted. Nutrition was supplied with TPN until therapy. On DOL 5, she developed abdominal distension and significant discoloration of her abdominal skin. An abdominal x-ray revealed a pneumoperitonium with suspected intestinal perforation, and possible necrotizing enterocolitis (NEC) (Figs 1 and 2). A one-eighth-inch Penrose drain was inserted surgically approximately 3 inches into the right lower quadrant of the abdominal cavity. Air and bilious, dark-colored material was evacuated from the abdominal cavity at the time of drain placement. An abdominal x-ray obtained after the procedure showed evacuation of the free air (Fig 3). By DOL 12, the white blood cell (WBC) count remained persistently elevated, suggesting continued From the University of Cincinnati, Department of Parent Child Health Nursing, Cincinnati, OH; and Neonatal Nurse Practitioner Program, Pediatrix Medical Group of Ohio, Dayton, OH. Address reprint requests to Valerie K. Moniaci, Pediatrix Medical Group of Ohio, One Wyoming, Dayton, OH 45409. © 2003 Elsevier Inc. All rights reserved. 1527-3369/03/0302-$30.00/0 doi: 10.1053/nbin.2003.36104 Fig 1 Anterior-posterior (AP) radiograph showing evidence of NEC. Note the large pneumoperitoneum present. Fig 2 Left lateral decubitus radiograph showing evidence of NEC. Note the accumulation of air in the upper portion of the abdominal cavity.

Caution Against Near-Miss SIDS'

Parent-Child Health Supervisor SIDS Liaison Nurse Cura Visiting Nurse Association, Inc. Plymouth, MA

Sampling issues in parent-child nursing research: implications for nursing practice.

A S NURSES ARE increasingly expected to read and incorporate research findings into their practice, emphasis on the evaluation of such research becomes critical. Several critical and integrative reviews of nursing research have been published over the past decade (Beal & Betz, in press; Betz & Beal, in press; Brown, Kelen, & Moser, 1985; Cronenwett, 1982; Diers & Molde, 1979; Jacobsen & Meininger, 1985; Moody et al., 1988; Perlmutter, 1985; Selby et al., 1990; Silva, 1986; Strehle, 1981; Uman & Urman, 1990; Werley & Fitzpatrick, 1984, 1985, 1986). Only a few reviews have evaluated the research published in the subspecialty of parentchild health nursing (Beal & Betz, in press; Betz & Beal, in press) or specifically the sampling methodology used (Selby et al., 1990). Because the sampling method used during the conduct of the research so directly impacts on the reader’s ability to use the research findings in clinical practice, we chose to evaluate the sampling methods used in the parentchild research published during the past decade. The purpose of this article is to describe our review and the implications of our findings for the clinical practice of parent-child health nurses. Few studies have scientifically reviewed sampling methodology. Moody and colleagues (1988) in a review of the nursing research published from 1977 to 1988, found that most of these studies reported using small nonrandomized samples. Also, Jacobsen and Meininger (1985) reported that sample sizes were small and that sampling methods were not clearly described. Selby et al. (1990) in a more recent review of 30 randomly selected research reports published in 1986, found that nearly 97% contained at least one major deficiency in sampling methodology. Some of the deficiencies were as follows: (a) failure to describe the sampling frame, sample size, number of refusals, withdrawals and /or cases lost, and sampling methods used; (b) inappro-

Maternal-Newborn Nursing

Assistant Professor, Parent-Child Health Nursing, University of Rhode Island, Kingston, Rhode Island

Child health promotion practices

This study examined parent's child health promotion practices in seven areas: nutrition, safety, dental hygiene, immunization, personal hygiene, sleep and rest, and exercise. Parents of 605 children who were enrolled in 33 day care centers responded to a self-administered questionnaire. In general, parents followed health-promoting practices in all seven areas investigated. Factors influencing these practices also were explored. Implications for health education and counseling of parents are discussed.

Expectations for childbirth versus actual experiences: the gap widens.

MARGARETE SANDELOWSKI, R.N., Ph.D., is an assistant professor and coordinator of the graduate program in parent-child health nursing at the school of Nursing, Louisiana State University Medical Center in New Orleans

PARENTAL CHILD HEALTH (Including Infant Health)

PARENTAL CHILD HEALTH (Including Infant Health)