Parents Of At-risk Children Research Articles

How do parents access, appraise, and apply health information on early childhood allergy prevention? A focus group and interview study.

When parents want to make health-related decisions for their child, they need to be able to handle health information from a potentially endless range of sources. Early childhood allergy prevention (ECAP) is a good example: recommendations have shifted from allergen avoidance to early introduction of allergenic foods. We investigated how parents of children under 3 years old access, appraise and apply health information about ECAP, and their respective needs and preferences. We conducted 23 focus groups and 24 interviews with 114 parents of children with varied risk for allergies. The recruitment strategy and a topic guide were co-designed with the target group and professionals from public health, education, and medicine. Data were mostly collected via video calls, recorded and then transcribed verbatim. Content analysis according to Kuckartz was performed using MAXQDA and findings are presented as a descriptive overview. Parents most frequently referred to family members, friends, and other parents as sources of ECAP information, as well as healthcare professionals (HCPs), particularly pediatricians. Parents said that they exchanged experiences and practices with their peers, while relying on HCPs for guidance on decision-making. When searching for information online, they infrequently recalled the sources used and were rarely aware of providers of "good" health information. While parents often reported trying to identify the authors of information to appraise its reliability, they said they did not undertake more comprehensive information quality checks. The choice and presentation of ECAP information was frequently criticized by all parent groups; in particular, parents of at-risk children or with a manifested allergy were often dissatisfied with HCP consultations, and hence did not straightforwardly apply advice. Though many trusted their HCPs, parents often reported taking preventive measures based on their own intuition. One suggestion to react upon the many criticisms expressed by parents regarding who and how provides ECAP information is to integrate central ECAP recommendations into regular child care counseling by HCPs-provided that feasible ways for doing so are identified. This would assist disease prevention, as parents without specific concerns are often unaware of the ECAP dimension of issues such as nutrition.

Screen exposure time of children under 6 years old: a French cross-sectional survey in general practices in the Auvergne-Rhône-Alpes region

BackgroundThe advent of miniature, easy-to-use and accessible multimedia products is leading to screen exposure that begins in early childhood. Overexposure in preschool may lead to adverse effects. The main objective of this study was to determine the average daily time (ADT) spent by children under 6 years of age, followed in general practice, in front of television or interactive screens.MethodsA cross-sectional survey was conducted in the Auvergne-Rhône-Alpes region among randomly selected General Practitioners (GPs). The average daily screen time (ADST), regardless of the type of device (TVs, computers, tablets, smartphones, video game consoles), of the included children aged 0 to 2 years and 2 to 5 years was calculated from a self-questionnaire completed by the parents. A multivariate Poisson regression model was performed to analyse daily screen time, adjusted by factors selected on their clinical relevance and statistical significance.ResultsThe 26 participating GPs included 486 parents. They reported an ADST of 26 (± 44) minutes on weekdays and 30 (± 46) minutes on weekends for children under 2 years of age. For children over 2 years of age, the ADST was 66 (± 82) minutes on weekdays and 103 (±91) minutes on weekends. There was an association between the children’s average screen time and certain sociodemographic and environmental factors. Children whose parents had higher levels of education, those living in a family without TV screens or those who were well informed about the possible adverse health consequences of overuse of screens had lower average screen time. On the other hand, children of parents who spent more than 2 hours a day in front of screens, were more exposed.ConclusionsIn our survey, the ADST of children under 6 years of age followed in general practice was higher than the current recommendations. GPs can warn parents of preschool children of the effects of overexposure to screens, particularly parents of at-risk children.

Early parental knowledge of late effect risks in children with cancer.

Despite the pervasiveness of late effects in childhood cancer survivors, many parents feel inadequately informed about their child's risks. We assessed early parental knowledge of risks of late effects and predictors of increased knowledge. Parents of children receiving cancer treatment at Dana-Farber/Boston Children's Cancer and Blood Disorders Center were surveyed about their knowledge of their child's likelihood of eight late effects. Individual risk for each late effect (yes/no) was assessed using the Children's Oncology Group's Long-Term Follow-Up Guidelines v5 as a reference. Descriptive statistics were used to summarize knowledge scores; ordinal logistic regression was used to identify predictors of higher knowledge. Of 96 parent participants, 11 (11.46%) correctly identified all of their child's risks for the eight late effects. Five of eight was the median number of correctly identified late effect risks. Among 21 parents whose children were at risk for ototoxicity, 95% correctly identified this risk. Conversely, parents of at-risk children were less knowledgeable about risks of secondary malignancy (63% correct identification, of N=94 at risk), cardiac toxicity (61%; N=71), neurocognitive impairment (56%; N=63), and infertility (28%; N=61). Ordinal logistic regression analysis identified no significant differences in parental knowledge of late effect risks by any factors evaluated. Gaps in parental knowledge of potential late effects of childhood cancer treatment emerge early in a child's care, and parents are more knowledgeable about some late effects, such as ototoxicity, than others, such as infertility. As no child- or parent-specific factors were associated with increased knowledge of late effect risks, interventions must be applied broadly.

Parental involvement and the academic achievement and social functioning of Cuban school children

The goal of the current study was to investigate whether parental involvement is an important predictor of student outcomes within the Cuban school system, where extensive support for pupils’ progress and adjustment are available from the peer group, community, and family. The participants were 188 children in Grades 2 and 3 from four localities in Cuba. School-based involvement was significantly higher among parents of children not at risk for behavioral problems than among parents of at-risk children. Parental involvement in Year 1 did not significantly predict changes in student academic competency or total difficulties between Year 1 and Year 2. These results suggest that school-based parental involvement may be of some importance in the adjustment of Cuban children. Any effects of parental involvement, however, were not strong enough to cause changes in ratings of student adjustment and achievement from Year 1 to Year 2.

Perceived Barriers to Help-Seeking Among Parents of At-Risk Kindergarteners in Rural Communities

This study examined help-seeking and perceived barriers to children's mental health service utilization in a large sample of parents living in rural communities who are at various stages in the help-seeking process. The goals were to (a) obtain a demographic profile of at-risk kindergarteners and their parents, (b) examine parent-reported help-seeking behaviors, and (c) assess barriers to mental health service use. Parent and teacher report of the Behavior Assessment System for Children, Second Edition, were used to screen children (N = 597) at kindergarten entry and to identify their risk status. Parents also completed the Barriers to Participation Scale and reported the frequency of help-seeking behaviors related to their child's problems. Using a cutoff score of 1.5 standard deviations above the mean, nearly half (51%) of children were identified as at-risk (76% low risk, 24% high risk) for emotional, behavioral, social, and adaptive problems. Barriers and help-seeking did not differ across parents of low and high risk children. Among parents of at-risk children, only 33% believed their child had a problem. Parents sought informal help more often than professional help; however, medical doctors and school staff were sought most among professionals. The majority of parents (61%) endorsed at least one barrier that would interfere with mental health service use. Results highlight the importance of early school mental health screening and the need for interventions to increase parent problem recognition and engagement in mental health service utilization.

Comparing school environments with and without legislation for the prevention and management of anaphylaxis

School personnel in contact with students with life-threatening allergies often lack necessary supports, creating a potentially dangerous situation. Sabrina's Law, the first legislation in the world designed to protect such children, requires all Ontario public schools to have a plan to protect children at risk. Although it has captured international attention, the differences a legislative approach makes have not been identified. Our study compared the approaches to anaphylaxis prevention and management in schools with and without legislation. Legislated (Ontario) and nonlegislated (Alberta, British Columbia, Newfoundland and Labrador, and Quebec) environments were compared. School board anaphylaxis policies were assessed for consistency with Canadian anaphylaxis guidelines. Parents of at-risk children and school personnel were surveyed to determine their perspectives on school practices. School personnel's EpiPen5 technique was assessed. Consistency of school board policies with anaphylaxis guidelines was significantly better in a legislated environment (P=0.009). Parents in a legislated environment reported more comprehensive anaphylaxis emergency forms (P<0.001), while school personnel in nonlegislated environments reported more comprehensive forms (P=0.004). Despite school personnel in both environments receiving EpiPen5 training (>80%), suboptimal technique was commonly observed. However, school personnel in the legislated environment had better technique (P<0.001). Our results suggest that school boards in legislated environments have made greater efforts to support students at risk for anaphylaxis compared to nonlegislated environments. However, significant gaps exist in both environments, especially with respect to EpiPen5 administration, content, and distribution of anaphylaxis emergency forms, and awareness of school procedures by school personnel and parents.

How to Talk with Families About Genetics and Psychiatric Illnessby PeayHolly and AustinJehannine. New York, W.W. Norton and Company, 2011, 280 pp., $24.95.

Back to table of contents Previous article Next article Communications and UpdatesFull AccessHow to Talk with Families About Genetics and Psychiatric IllnessMarilyn E. Coors, Ph.D.Marilyn E. CoorsSearch for more papers by this author, Ph.D.Published Online:1 Sep 2011https://doi.org/10.1176/appi.ajp.2011.11030476AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by PeayHolly and AustinJehannine. New York, W.W. Norton and Company, 2011, 280 pp., $24.95.Patients who suffer with psychiatric illness often have questions about how the illness developed and the risks for other family members becoming affected. How to Talk with Families About Genetics and Psychiatric Illness responds to the increasing need for mental health clinicians to help families deal with these common questions, often based upon concepts from genetic medicine. The authors directly address the new psychiatric genetic research in an accessible manner and how, together with an individual's personal and family psychiatric history, genetics can provide information about likely causes of mental illness and the magnitude of risk. The book also provides guidance regarding how to initiate conversations when the clinician suspects that genetic information may address a patient's unspoken concern or help him or her cope or adapt to mental illness.Peay and Austin do not claim to equip clinicians to become genetic counselors, but the book does provide a basic overview of genetics 101 that is a useful resource for clinicians. One example of a particularly helpful tool that they have developed for explaining the etiology of mental illness is the “jar model.” The jar is a simple visual analogy to explain the two factors—genetic and environmental—that contribute to mental illness. The picture of the jar depicts how mental illness can develop in a way that anyone can understand, especially for those who do not have a good grasp of numbers. Moreover, I expect that their model will be particularly useful in explaining vulnerability factors to participants in my current research on informed consent for psychiatric genetic research.Following genetics 101, each chapter of the book is organized to provide examples of common questions and answers about psychiatric genetics. The earlier chapters are written for clinicians to use to discuss possible genetic contributions to the development and/or inheritance of mental illness. By way of example, Chapter 2 provides questions to assist the clinician who is not accustomed to talking about the genetics of mental illness while respecting a patient's right to not know as an option. Later chapters focus on common questions from the patient perspective. For example, one question that Chapter 6 addresses is “Why did you tell me that you think my risk to develop psychiatric illness is probably less than the 15% risk I found on the Internet?” In this example, the authors provide ways to explain to the patient about averaged risks and that in his or her case the clinician should also take into consideration the information provided that modifies risk for this unique situation.In addition, each chapter includes pertinent cases from Peay's and Austin's experience in genetic counseling. The cases bring each chapter's discussion around a particular topic to a conclusion, often including family history and the graphic pedigree. In Chapter 8 and Chapter 9, the cases focus on the subject of pregnancy and parents of at-risk children and affected children. One case involves parents who are both physicians and have an autistic child; they are expecting a second child. The authors explain how the clinician could address the parents' questions about the etiology of autism and a conversation about how the parents might manage the uncertainty regarding the baby's condition for the remainder of the pregnancy and early in the baby's life. Other chapters include cases about unaffected family members, genetic susceptibility testing, and genetic testing to inform medication strategy.While the consistent format of the book involves some redundancy for one who reads it from cover to cover, the layout increases its value as a resource on specific topics. How to Talk with Families About Genetics and Psychiatric Illness is a good source for mental health clinicians seeking assistance with common questions and also for unique situations that may arise in the course of practice. Genetic medicine is relatively new, and many clinicians self-report that they are uncomfortable with the coming onslaught of enormous amounts of data. For these reasons, the book's experienced-based discussions on a wide variety of topics can be extremely helpful in providing methods to clarify the issues.Aurora, Colo.The author reports no financial relationships with commercial interests.Book review accepted for publication April 2011. FiguresReferencesCited byDetailsCited ByNone Volume 168Issue 9 September 2011Pages 994-995 Metrics PDF download History Accepted 1 April 2011 Published online 1 September 2011 Published in print 1 September 2011

Perspectives on Obesity and Barriers to Control From Workers at a Community Center Serving Low-Income Hispanic Children and Families

Community center workers serving children and families in a predominantly Hispanic, low-income neighborhood were interviewed qualitatively, to ascertain their perspectives on obesity and barriers to control and prevention, to design a practical and culturally appropriate intervention for obesity control.1 All 19 respondents recognized obesity as a problem, identified healthy eating and physical activity as requisites for controlling obesity, and mentioned fast food and cultural influences in Hispanic families as contributory factors. Lack of time emerged as a major barrier to all preventive practices related to eating healthy or being physically active. Safety concerns and lack of safe places for walking and running were mentioned as a barrier to being physically active. Further studies have to be conducted with parents of at-risk children, to understand time constraints. Community health workers should be sensitive to issues of time constraints and incorporate time management recommendations into obesity prevention and education.

Measurements of temperament in the identification of children who stutter.

As an empirical check on widely held stereotypes and some assumed temperament proclivities of children at risk for stuttering, parents of at-risk children and a gender- and age-matched control group completed the 'Parent Childhood Temperament Questionnaire for 3-7-Year-Olds'. A discriminant analysis on the nine temperament dimensions revealed four dimensions which combined to discriminate significantly between the two groups, resulting in correct classification of 86.36% of the 22 children. The t-tests of difference on the four discriminating dimensions revealed that 'Mood', 'Adaptability', and 'Rhythmicity' were statistically significant in the direction of more positive temperament for at-risk children than for the control group. Results are discussed with respect to aetiology, stereotype, and the need for clinicians to focus parents on concrete behaviours when reporting on the emotional and behavioural style of their child.

Parental knowledge of bacterial endocarditis prophylaxis.

The aim of this study was to determine parental knowledge of bacterial endocarditis prophylaxis (BEP). Parents of 135 patients attending a pediatric cardiology clinic in a university center were mailed an eight-question survey pertaining to their knowledge of their child's cardiac disease, medications, and BEP. The patients' cardiac lesions and current medications were verified by a review of clinic and echocardiographic records. Each patient's need for BEP was determined according to American Heart Association (AHA) recommendations. Eighty-four (62%) parents returned complete surveys. The patients' mean age was 5 years with a range of 9 weeks to 19 years. Eighty-two (98%) respondents were high school graduates. Fifty-two (62%) respondents correctly defined endocarditis. Eighty-two (98%) parents knew the correct name of their child's cardiac condition and 27/32 (84%) knew the names of their child's current medications. Only 36/64 (56%) parents of at-risk children knew measures to prevent endocarditis. While most parents know the name of their child's heart lesion and current medications, parental knowledge of endocarditis and BEP was limited. Intensified education and awareness programs are needed in order to prevent potential major morbidity and mortality for pediatric patients with heart disease.