Parental Adherence Research Articles

A Pilot Study Examining a School-Based Parent Engagement Intervention Following School Mental Health Screening

In this pilot study, we conducted a randomized controlled trial to examine the effects of a school-based engagement intervention on parent adherence to recommendations for children screened for social, emotional, behavioral, and adaptive problems at kindergarten entry. The aims were to evaluate the impact of an enhanced feedback session on parents’ adherence to service-engagement recommendations, compared to a standard feedback session, and to examine predictors of adherence to recommendations. Parent and teacher reports of the behavior assessment system for children, second edition, were used to screen children (N = 597). Parents of children identified as at risk for social, emotional, behavioral, and adaptive problems were randomized to the standard or enhanced feedback condition. Results offer preliminary evidence that the school-based engagement strategy following the screening resulted in increased parent adherence to sharing screening results with medical doctors. Analyses also revealed that after controlling for feedback condition, parents’ previous service use predicted adherence to the recommendation of sharing screening results with the teachers. These findings highlight the importance of continued examination of school-based engagement interventions for families in the early stages of seeking mental health services.

Parental Adherence to a Research Protocol to Investigate the Effect of the Wilbarger Therapressure ProgramTM: A Qualitative Study

Background: The Wilbarger Therapressure ProgramTM is a technique applied by parents at home for sensory overresponsivity in children. The program is anecdotally reported to be demanding on parents, which can affect parental adherence. Currently, there is an absence of high quality research to support the use of the program. This pilot study aimed at developing appropriate research protocols to investigate the effectiveness of the program on the stress response of children with sensory overresponsivity. This article reports on the second phase of the project.

수영장 서비스품질이 학부모 신뢰, 지속의도 및 추천의사에 미치는 영향

본 연구는 수영장 서비스품질이 학부모 신뢰, 지속의도 및 추천의사에 미치는 영향을 검증하는데 그 목적이 있다. 연구대상은 서울시에 위치한 수영장 5곳을 선정하여 레슨을 받고 있는 초․중․고등학생의 학부모를 대상으로 총 300부의 설문지를 배포하여 응답문항이 누락되었거나 불성실하게 응답하였다고 판단된 설문지 26부를 제외한 274부(91.3%)를 분석에 사용하였다. 수집된 자료는 IBM SPSS Statistics 21과 IBM AMOS 21을 이용하여 빈도분석, 탐색적 요인분석, 신뢰도분석, 확인적 요인분석, 상관관계분석, 구조방정식모형 분석을 통한 경로분석을 실시하였다. 이와 같은 방법을 통해 나타난 결과는 다음과 같다. 첫째, 수영장 서비스품질 중 지도자 요인은 학부모 신뢰에 영향을 미치지 않는 것으로 나타났다. 둘째, 환경 요인은 학부모 신뢰에 영향을 미치는 것으로 나타났다. 셋째, 프로그램 요인은 학부모 신뢰에 영향을 미치는 것으로 나타났다. 넷째, 상담 요인은 학부모 신뢰에 영향을 미치는 것으로 나타났다. 다섯째, 비용 요인은 학부모 신뢰에 영향을 미치는 것으로 나타났다. 여섯째, 학부모 신뢰는 지속의도에 영향을 미치는 것으로 나타났다. 일곱째, 학부모 신뢰는 추천의사에 영향을 미치는 것으로 나타났다. 따라서 수영장의 운영자 입장에서는 수영 레슨을 받는 학생들뿐만 아니라 실질적으로 레슨 등록을 결정하는 학부모들을 위하여 수영 레슨의 서비스품질에 대해 전반적으로 만반의 준비를 하여 학부모의 신뢰를 얻을 수 있도록 최선의 노력을 해야 할 것이다.

A randomized trial to reduce sugar-sweetened beverage and juice intake in preschool-aged children: description of the Smart Moms intervention trial.

BackgroundObesity in young children remains a public health concern, and maternal weight is one of the strongest predictors of obesity in early childhood. However, parental adherence in interventions for young children is often low and existing programs have had mixed success. An innovative approach to treatment is needed that increases adherence among mothers and improves weight-related behaviors simultaneously in mothers and children. The objective of the Smart Moms randomized controlled trial (RCT) is to test the efficacy of a 6-month primarily smartphone-delivered program to reduce sugar-sweetened beverage and juice consumption among children ages 3–5 whose mothers are overweight or obese. This paper describes the study design and intervention.Methods/DesignMother-child dyads were eligible if the mother was overweight or obese, owned a smartphone, and if the child was between the ages of 3–5 and consumed 12 oz or more per day of sugar-sweetened beverages (SSBs) and 100 % fruit juice. Participants were randomly assigned to the Smart Moms intervention or a waitlist control group. The intervention consisted of theoretically grounded and evidence-based behavioral strategies delivered through one group session, lessons on a mobile-optimized website, and text messages. Mothers submitted self-monitoring information via text message and received regular tailored feedback emails from interventionists. The primary outcome is change in child SSB and juice consumption and a secondary outcome is change in maternal weight.DiscussionThis Smart Moms study was designed to determine if a low-burden intervention delivered using mobile methods and targeted towards mothers could be effective at changing child sugar-sweetened beverage intake. Results will indicate if mobile-based methods can be a feasible way to engage mothers in family-based studies and will inform successful strategies to prevent childhood obesity through parent-targeted approaches.Trial registrationClinicaltrials.gov NCT02098902 (Registered March 25, 2014).

Positional plagiocephaly reduces parental adherence to SIDS Guidelines and inundates the health system

This study sought to better understand parent, grandparent and clinician views of prevention, treatment and costs of plagiocephaly. A qualitative study was conducted using focus groups and semi-structured interviews. A grounded theory approach was taken to build theories from the qualitative data collected. A subjectivist epistemological orientation was taken under the paradigm of positivism. Ninety-one parents, 6 grandparents and 24 clinicians were recruited from the community as well as primary and tertiary care clinics. Plagiocephaly worried most parents because it could permanently affect their child's 'looks' and some thought it would affect a child's development. Parents were 'willing to do anything' to prevent plagiocephaly including using products or sleeping positions that are contraindicated under sudden infant death syndrome guidelines. Parents found the care pathway convoluted and inconsistent messages were given from different health providers. For clinicians, the high prevalence of flat head is 'clogging up their patient pool', taking up time they used to spend with children with more severe conditions. There is a need to re-emphasize sudden infant death syndrome guidelines for families when they present with an infant with plagiocephaly. Stronger messaging regarding the lack of safety of current pillows marketed to prevent flat head may be useful to decrease their use. Increasing education for all health professionals including general practitioners, allied health and complementary health providers and standardizing assessment and referral criteria may allow the majority of diagnosis and treatment of positional plagiocephaly to occur at points of first contact (e.g. general practitioners, community nurse) and may prevent further burden on the health care system.

Application of Rasch analysis to the parent adherence report questionnaire in juvenile idiopathic arthritis.

BackgroundAdherence to treatment in children with juvenile idiopathic arthritis (JIA) is associated with better outcomes. Assessing patient adherence in JIA, as well as attitudes and beliefs about prescribed treatments, is important for the clinician in order to optimize patient management. The objective of the current study was to evaluate the psychometric properties of the Parent (proxy-report) Adherence Report Questionnaires (PARQ), which assesses beliefs and behaviors related to adherence to treatments prescribed for JIA.MethodsA Rasch analysis was conducted on data collected with parents of children with JIA from two studies in which the PARQ was used as a measure of adherence.ResultsThe PARQ showed preliminary evidence of multidimensionality with two factors, accounting for 38 % and 27 % of the variance respectively. The PARQ in its original version does not adhere to expectations of the Rasch model. A transformed version of the PARQ obtained by deletion of the general adherence scale and modification of visual analog scales into 5-point likert scales improved fit to the model and showed preliminary evidence of unidimensionality.ConclusionsThe PARQ was transformed based on the results of the Rasch analysis. The transformed version of the PARQ shows preliminary evidence of unidimensionality and may allow computation of a total score, although further testing is needed to verify these findings.

Bracing in Ponseti Clubfoot Treatment: Improving Parental Adherence Through an Innovative Health Education Intervention.

Clubfoot is the most common musculoskeletal birth defect, characterized by abnormal tendon and muscle development, leading to abnormal bone alignment of the feet. The Ponseti method is considered the gold standard in clubfoot treatment, and consists of a series of plaster castings, followed by 4 years of brace use. The most common cause of clubfoot relapse is nonadherence with the bracing protocol by the child's caretakers. The purpose of this study was to design, implement, and evaluate an educational bracing program for parents of children with clubfoot in an effort to improve bracing adherence. The educational bracing program for parents of children with clubfoot was designed with incorporation of findings from previous research, adult teaching methodology, and parental feedback. An educational brochure and a practice doll were created for use in educational sessions with parents during routine treatment visits. Two educational sessions were conducted with a health educator, employing identical questionnaires to assess changes in parental knowledge and skills upon completion of the program. Thirty parents completed the educational bracing program, and the majority reported increased knowledge and self-efficacy regarding the bracing protocol of the Ponseti method. In addition, the health practitioners who conducted the educational sessions witnessed an improved ability of all parents to apply the brace as directed, and to recognize and correct improper fit. Completion of the educational program by the parents resulted in immediate improvements in knowledge and skills related to clubfoot bracing. Given that noncompliance to the bracing protocol is the most common cause of clubfoot relapse, these immediate effects of the educational program are promising not only because they encourage proper brace use, but because these immediate improvements have the potential to reduce future rates of clubfoot relapse.

Reducing Therapist Contact in Parenting Programs: Evaluation of Internet-Based Treatments for Child Conduct Problems.

This study evaluated two Internet-based versions of Parent Management Training (PMT) and the effects of greatly reducing the contact required of a mental health professional on treatment of children referred for conduct problems. We were interested whether reduced contact with a therapist influenced treatment outcome, therapeutic alliance, parent adherence to treatment prescriptions, and parent reactions to and evaluations of the treatment procedures. Sixty children and their caregivers were assigned to receive either Full Contact PMT (with the amount of weekly contact similar to traditional PMT; approximately 50 minutes of direct therapist contact each week) or Reduced Contact PMT (with most information provided through recordings; approximately 10 minutes of therapist contact each week). Children in both groups showed significant and similar reductions in antisocial behaviors specifically, internalizing and externalizing symptoms more generally, and improvements in overall adaptive functioning. Therapeutic alliance also was similar across the two treatment groups. However, parents rated Full Contact treatment as more acceptable than the reduced version. Both treatments were similar in outcomes to in-person treatment as evaluated by a nonrandomized matched sample used as a benchmark in supplementary analyses. Overall, the findings indicate that therapist contact can be reduced while positive treatment outcomes are maintained but that interventions that reduce direct time with a therapist may be viewed less positively by clients.

Can we Introduce an Effective Lifestyle Modification Intervention among Children at Risk of Overweight and Obesity in the Conditions of Family Practice?

Background: Diet and physical activity are crucial in management of pediatric overweight and obesity, however family involvement has not been adequately studied in primary care. Goal: Assessment of the effectiveness of lifestyle modification intervention among overweight and obese children, addressing parental adherence. Methods: During the period of the study (from October 2013 until June 2014) 588 children have visited the family practice involved in the study because of many different reasons. Each child of this group of 588 children was screened for the risk of abdominal obesity. 106 children have matched the criteria of the risk of abdominal obesity. An intervention - “3-color signaling diet and increased physical activity was implemented for 24 weeks in a group of 106 subjects, aged 2-17, with waist circumference (WC) ≥ 75 percentile (in industrial region of Poland). Anthropometric parameters (BM, BMI and WC), blood pressure, fasting lipid fractions (TG, HDL-C) and plasma glucose (FPG) levels were measured before and after the intervention, and parents were filling out the survey, assessing their adherence to the program. Results: After 24 weeks, in all the subjects, regardless of their age and gender, the mean values of BMI, WC, and BP were statistically significantly lower (p<0.01) than their baseline parameters, and the HDL-C levels were higher. The parental survey revealed that 77.3% were adherent to the dietary (20.7% for 24 weeks), and 55.7% – to the physical activity recommendations (25.5% continuously). Conclusions: Lifestyle modification intervention that targets overweight and obese children and adolescents and their families, reinforcing weight loss goals is helpful in improving anthropometric and HDL-C results. The whole family needs to accept and adhere to the recommended diet and physical activity changes for at least 6 months. A parental perspective of barriers to compliance needs to be considered in designing an effective weight management intervention in primary care.

Vesico-ureteral reflux: Diagnosis and treatment recommendations

Vesico-ureteral reflux (VUR) is one of the most common urologic diseases in childhood. About every third child that presents with a urinary tract infection (UTI) has urinary reflux to the ureter or kidney. Demonstration of a backflow of urine into the ureters or kidneys proves vesicoureteral reflux. In unclear cases, a positioned instillation of contrast agent (PIC) cystogram might be performed and is able to prove vesico-ureteral reflux. Since low-grade VUR has a high probability of maturation and self-limitation, infants with VUR should be given prophylactic antibiotics during their first year of life, reevaluating the status of VUR after 12 months. The aim of any treatment is to prevent renal damage. The individual risk of renal scarring is decisive for the choice of adequate therapy. This risk is mainly dependent on reflux grade, age, and gender of the child as well as parental therapy adherence. In principle, therapeutic options include conservative as well as endoscopic or open surgical antireflux therapies. Decisions on treatment should be made individually with parents taking into account all the findings available.

The experience of taking methotrexate for juvenile idiopathic arthritis: results of a cross-sectional survey with children and young people

BackgroundChildren and young people (CYP) with juvenile idiopathic arthritis (JIA) are known to have impaired health-related quality of life (HRQoL), which is improved significantly for many by treatment with methotrexate (MTX). However, a significant proportion of CYP experience difficulties in taking MTX, which may reduce its potential benefits for HRQoL. The aim of this research was to examine how CYP with JIA perceive MTX treatment and how this relates to HRQoL.MethodsCYP aged 8–16 years taking MTX for JIA completed an adapted Parent Adherence Report Questionnaire, which contains 100 mm visual analogue scales, to assess difficulty taking MTX, adherence, frequency of negative reactions and helpfulness of MTX. They also completed the Pediatric Quality of Life Inventory (PedsQL) Generic and Rheumatology scales. We collected data on age, gender, JIA course, disease duration, MTX duration of use, route and dose. Number of inflamed and limited joints were indicators of disease severity.ResultsOne hundred sixteen CYP participated. Most considered MTX helpful (median 87; interquartile range (IQR) 50.75–98) and reported adherence was high (median 98; IQR 90–100). There was greater variability on scores for difficulty (median 22; IQR 2–69) and frequency of negative reactions (median 14.5; IQR 1.25–80). Mean (S.D.) scores on the PedsQL Physical and Psychosocial subscales were 71.63 (24.02) and 71.78 (19.59) respectively, indicating poorer HRQoL than that reported by healthy children. After controlling for demographic and disease variables, poorer physical HRQoL was significantly accounted for by greater difficulty in taking MTX. Poorer psychosocial HRQoL was significantly accounted for by subcutaneous MTX administration, a lower rating of MTX helpfulness and a greater reported difficulty in taking MTX.ConclusionsTaking MTX for JIA was viewed as helpful by most CYP but HRQoL was poorer in those who reported greater difficulty in taking MTX.

Family responses to a child with schizophrenia: An Indonesian experience.

Indonesian culture puts a high value on family bonding. Therefore, support and encouragement for each family member is high that any problems are the responsibility of the whole family. This paper explores the implications of the phenomena whether is a schizophrenic child in the family affected the parental relationship in Indonesian family and trying to find out the implication of parental relationship on medication adherence. This was a cross-sectional study which involved 180 parents of children with schizophrenia and parents with aged matched non-schizophrenic children as a control group; consisting of 45 parents of children with schizophrenia and 135 parents of non-schizophrenic children. The parental relationship was examined by using the Indonesian version of Family Adaptability and Cohesion Evaluation Scale IV (Indonesian version of FACES IV). Our study revealed that 75.6% parents of children with schizophrenia experienced a healthy parental relationship compared to 94.80% in the parents of non-schizophrenic children group. The most prevalent of unhealthy relationship among parents of children with schizophrenia was chaotic disengagement. Parental adherence to give medication for their child with schizophrenia was better if they had a healthy parental relationship. In conclusion, a small number of Indonesian parents with schizophrenic children experienced an unhealthy parental relationship. Therefore, psycho-education and supportive psychotherapy still needed to facilitate those families to express their emotion adapt and cope.

Factors Affecting Medication Adherence in Children Receiving Outpatient Pharmacotherapy and Parental Adherence

ProblemAlthough pharmacotherapy is an effective treatment for many psychiatric disorders in children and adolescents, medication adherence rates among children are low. This study clarifies factors affecting children's medication adherence and the role of parental involvement.MethodPatients aged 7–17 years with a history of psychotropic medication treatment and their mothers were included in this study. Each mother and child completed self‐administered questionnaires. Thirty mother–child pairs who fully completed the questionnaires were included in the analysis.ResultsMedication adherence was greater in children and mothers when mothers felt that “children's symptoms improved with treatment and medication.” Medication adherence in children and mothers significantly correlated with the child's reported trust in their parent.ConclusionsThe results suggest the need for psychosocial support that considers the influence of mothers on medication adherence in children treated in child psychiatry departments.

Improving parental adherence to a failed vision screening referral in the United States

Vision screening is an important function of the school nurse's role. Parental cooperation after a child's failed vision screening remains a problematic issue for school nurses, as research reveals inconsistent follow-up and a low rate of parental adherence to school nursing screening referral. Using a comparative descriptive design, the purpose of this investigation was to determine if there was an improvement in parental adherence after a failed vision screening referral in school-age children in an urban middle school setting when implementing an approach consisting of a comprehensive informative letter and telephone follow-up versus the use of a standard referral card commonly used in practice. Findings revealed a statistically significant increase in the number of school-age children who received professional eye care services with the use of the informative letter and telephone follow-up calls (P&lt;0.001), as well as an increase in the number of eye care appointments made (P&lt;0.001). Numerous barriers to care were identified. The use of an informative letter and follow-up telephone communication was effective in improving parental adherence to vision screening referral and demonstrates the essential role that school nurses have in promoting child health.

Examining treatment adherence among parents of children with autism spectrum disorder

BackgroundChildren with Autism Spectrum Disorder (ASD) participate in a variety of treatments, including medication, behavioral, alternative and developmental treatments. Parent adherence to these treatments is crucial for positive child outcomes. ObjectiveThe current study: 1) Explored patterns of parent adherence across the full range of treatments that are prescribed to children with ASD and, 2) Examined whether parent demographics, parent treatment attitudes, and child ASD severity contribute to parents' adherence across ASD treatments. MethodQuestionnaires were distributed to parents of children with ASD in a southeastern state. Parents (N = 274) were included if they were parenting a child with ASD who was receiving treatment for ASD symptoms. Paired t-tests and multiple linear regression were used to assess the study aims. ResultsAdherence to medication treatment was significantly greater than adherence to behavioral, developmental, or alternative treatments (adjusted p-values 0.0006, 0.0030, 0.0006 respectively). Perceived family burden of a treatment was associated with lower adherence to medication, developmental, and alternative treatments. Finally, greater ASD severity was associated with lower adherence to alternative treatments. ConclusionOverall, the independent variables accounted for more variance in adherence to medication and alternative treatments than in behavioral and developmental treatments. Parents' adherence to ASD treatment differs significantly by treatment type and is influenced by parental perceptions of the burden of treatment on the family. These findings highlight the importance of understanding and addressing the impact of ASD treatment regimens on family life.

Building capacity for rigorous controlled trials in autism: the importance of measuring treatment adherence.

Research groups across Europe have been networking to share information and ideas about research on preschool children with autism. The paper describes preliminary work to develop capacity for future multi-site randomized controlled trials of early intervention, with a specific focus on the need to measure treatment adherence where parents deliver therapy. The paper includes a review of randomized and controlled studies of parent-mediated early intervention from two sources, a recent Cochrane Collaboration review and a mapping of European early intervention studies in autism published since 2002. The data extracted focused on methods for describing parent adherence, that is, how and to what extent parents carry out the strategies taught them by therapists. Less than half of the 32 studies reviewed included any measure of parent adherence. Only seven included a direct assessment method. The challenges of developing pan-European early intervention evaluation studies are discussed, including choice of intervention model and of important outcomes, the need for translation of measurement tools and achievement of joint training to reliability of assessors. Measurement of parent-child interaction style and of adherence to strategies taught need further study.

Factors affecting children's adherence to regular dental attendance: A systematic review

Parents' adherence to regular dental attendance for their young children plays an important role in improving and maintaining children's oral health. The authors conducted a systematic review to determine the factors that influence parental adherence to regular dental attendance for their children. The authors searched nine electronic databases to May 2013. They included quantitative and qualitative studies in which researchers examined factors influencing dental attendance in children 12 years or younger. The authors considered all emergency and nonemergency visits. They appraised methodological quality through the Health Evidence Bulletins Wales methodological quality assessment tool. The authors selected 14 studies for the systematic review. Researchers in these studies reported a variety of factors at the patient, provider and system levels that influenced dental attendance. Factors identified at the patient level included parents' education, socioeconomic status, behavioral beliefs, perceived power and subjective norms. At the provider level, the authors identified communication and professional skills. At the system level, the authors identified collaborations between communities and health care professionals, as well as a formal policy of referring patients from family physicians and pediatricians to dentists. Barriers to and facilitators of parents' adherence to regular dental attendance for their children should be identified and considered when formulating health promotion policies. Further research is needed to investigate psychosocial determinants of children's adherence to regular dental visits.

Parent-mediated intervention: adherence and adverse effects

Purpose: The purpose of this study was to investigate parent implementation of home-based therapy regimens, and the relationship between implementation and family-level outcomes. Method: A stratified (by child age group) random sample of 538 families raising children with disabilities in Alberta, Canada took part. Participants completed the Family Life Survey, which incorporated child and family measures, and items measuring parent implementation of home-based therapy regimens. Results: Parents are more likely to implement therapeutic regimens when these are “enfolded” into other daily activities and routines. If parents have to “find a slot” in the daily routine to implement therapy, they will sacrifice personal leisure, participation in paid work, and time spent with other family members. Greater parent sacrifices/trade-offs was negatively associated with family well-being. Conclusion: As a general rule, children do well when their families do well, and families do well when they have the resources they need to juggle work and family and care demands. Recruiting parents as interventionists can tax family resources. Rehabilitation professionals must weigh up the pros and cons of parent-mediated intervention, and look to enfolding therapy into the everyday family routine.Implications for RehabilitationParents are more likely to implement prescribed therapeutic activities and exercises when these are “enfolded” into the everyday family routine.Higher levels of parental adherence and implementation of home-based therapy programs is associated with poorer family well-being.Rehabilitation professionals must weigh the pros and cons of parent-mediated intervention, and help families find ways to enfold intervention into their daily routine.

ADHERENCE TO DISCRETE‐TRIAL INSTRUCTION PROCEDURES BY RURAL PARENTS OF CHILDREN WITH AUTISM

Parents of children with autism spectrum disorders may not attempt treatment, even when effective treatment options are available. Little is known about how to improve frequency of attempts to implement treatment (‘treatment adherence’). We provided 32 rural parents of young children with autism spectrum disorders with either written or video training materials about how to implement discrete‐trial instruction and compared parental adherence between the written (control) and video (experimental) groups. Parents who received video instructions adhered to the training procedures to a significantly greater extent than did parents who received written instructions, suggesting that instruction format is a predictor of training success. Copyright © 2014 John Wiley &amp; Sons, Ltd.

Feeding Infants with Cow’S Milk and Soy Allergy: Social and Economic Aspects of Efficacy

AbstractAllergy to cow’s milk protein and/or soy is common among allergic diseases in infants. They appear at an early infant stage and remain important in clinical practice from one up to three years. According to clinical research, cow’s milk allergy affects about 1.9-4.9% of babies and infants, respectively, and in addition some of them also suffer from soy protein allergy. Dietary prevention of allergic protein by its elimination in food is a significant part of treatment, and allows adequate development of babies and restricts the risk of progressive allergic diseases. Securing exclusive breastfeeding is one of the basic principles in successful therapy treatment. However, there are cases when breastfeeding does not prevent the development of cross milk protein allergy. Only adequate special feeding formulas can provide both energy needs and sufficient quantity of proteins (8.9-11.5%) in food when breastfeeding is not possible. Knowledge of effective compensation mechanisms become apparent by analysing the situation in Europe and USA in the area of different available feeding formulas using both the medical insurance system and randomised formula providing tolerance of the mixture at about 90-95%. The goal of research was to determine the correlation between the availability of a special mixture, parental adherence and treatment outcomes. Applying special formulas is a routine part of treatment, and there is no doubt about its efficacy. No compensation mechanisms exist in present-day Latvia, and the current complicated economic situation in Latvia reduces the ability of parents to choose and buy appropriate formula food. Therefore, a substantial part of therapy treatment is unavailable to infants. Dietary prevention of allergic diseases in infants and small children in Latvia needs special consideration also because of poor knowledge of parents regarding the real situation.