Primary Caretakers Research Articles

An Exploration into Parallel Stories of Co-parenting

This research aims to gain insight into how divorced couples prolonged conflict influences co-parenting process and to identify the factors influencing the effectiveness of co-parenting arrangements and to identify challenges experienced during co-parenting. In-depth individual interviews were conducted with six couples practicing co-parenting in Kerala, each with at least one child. Interview followed a dyadic interview model and analysed using thematic analysis. Thematic analysis identified 4 key themes The four themes are; 1) Roles etched in stone (sub-themes; custodial arrangements, mother as a primary care taker, father as a breadwinner, divorce as a social problem). 2) Balancing the seesaw of co-parenting dimensions(sub-themes; co-parental communication, parenting practice, conflict resolution). 3) Riding the stormy sea (sub-themes; emotional rollercoaster, communication can be real challenge, troublesome other & I, parental alienation) 4) Finding solace in life’s storm (sub-themes; social buffers, professional assistance, spiritual fortitude). The research findings underscore the impact of traditional gender roles and societal expectations on post-divorce co-parenting, often relegating mothers to primary caregiving and fathers to financial roles, which limits fathers' emotional involvement and exacerbates mental well-being challenges for mothers. Effective communication is crucial for managing co-parenting complexities and minimizing conflicts arising from inconsistent practices and financial disparities. The study advocates for a parallel co-parenting approach that promotes autonomy for each parent, clear communication, and conflict resolution strategies, particularly benefiting high-conflict situations. By fostering flexible and resilient co-parenting dynamics, parallel parenting approach aims to improve emotional involvement from fathers, reduce societal stigma towards mothers, and ensure the stability and well-being of divorced families. The findings can help us understand the intricate challenges of co-parenting after divorce in Kerala.

The quality of life of primary caretakers of children with cerebral palsy

ABSTRACT Background: Cerebral palsy (CP) is a heterogeneous group of disorder affecting the development of movement and posture, which is permanent nonprogressive. Previous studies in different regions have shown links between caregivers’ mental health and children’s well-being. However, the lack of such detailed research for the caretakers of children with CP and correlation of quality of life affected the type and severity of the condition; this necessitates the development of a new study to assess caregivers’ quality of life. Aim: Quality of life among caregivers of disabled children is an important concern in healthcare. We aim to evaluate the quality of life among caregivers of children with CP and to assess the factors affecting the caregivers’ quality of life, namely, age, gender, type, and gross motor function in children with CP. Methodology: This was a cross-sectional observational study, conducted over a period of 6 months. It included the caregivers of children with CP at a tertiary care hospital of Mumbai. Data were collected using the WHO BREF questionnaire. The children were divided into two groups (2 to 7 years and 7 to 12 years). The qualities of life of the caretakers of these two groups were compared in four domains, namely, physical, psychological, social, and environmental. Results: The study included 50 participants. Mothers (80%) and fathers (10%) were the primary caregivers. Caretakers of the children with cerebral palsy showed significant affected quality of life as calculated from WHO QOL BREF score in both age groups (2–7 and 7–12 years) and in all domains. Overall, the most affected domain in our study was of psychological health and the least affected domain was of the environmental domain. Conclusion: This study provides a snapshot of the impact of having a child with cerebral palsy on the lives of the caregivers Most of the caregivers in the study were mothers, and quality of life was affected in all domains mainly in psychological and physical domains. The study showed that there is a need for interventions in caregivers which can have an indirect impact on the children with CP.

Dog owners' perceptions and veterinary-related decisions pertaining to changes in their dog's behavior that could indicate pain.

Assess dog owners' concern levels and veterinary care decisions pertaining to behaviors that might signify pain before and after receiving brief pain-related educational information. Additionally, evaluate dog owners' perceptions of a modified version of the Colorado State University Canine Acute Pain Scale to identify their dog's pain level, determine whether they should take their dog to the veterinarian, and describe their dog's pain to their veterinarian. 367 survey respondents who resided in the US and were the primary caretaker of at least 1 dog. An electronic survey was created in Qualtrics and distributed via Prolific. Data were analyzed. When assessing differences between participants' concern levels before and after educational pain-related information, significant differences were found for 2 of the 3 scenarios. Significant differences were also found between participants' veterinary-related behaviors before and after educational pain-related information for all 3 scenarios. The most common reasons for not seeking immediate veterinary care included elements related to cost, convenience, and dog-related stress during veterinary visits. Most participants reported finding the Canine Acute Pain Scale useful for identifying their dog's pain level (89%), determining whether they should take their dog to the veterinarian (84%), and describing their dog's pain to their veterinarian (89%). Owners' interpretations of and subsequent actions (or inactions) to behaviors that might suggest pain carry great implications for companion animals' overall well-being. Following exposure to brief educational material about signs and symptoms of canine pain, owners in our study reported significant increases in stated concern related to their dog's change in behavior and intention to seek veterinary care. These findings suggest that even very brief pain-related educational material can have a positive impact on owners' perceptions of canine behavioral changes and increase the possibility that they will seek veterinary care.

Behaviors suggestive of pain: the perceptions and veterinary-related decisions of cat guardians in the USA.

The aim of the study was to assess cat guardians' concern levels and veterinary care decisions pertaining to behaviors that might signify pain before and after receiving brief pain-related educational information. The secondary aims were to evaluate cat guardians' perceptions of the usefulness of a modified version of the Colorado State University Feline Acute Pain Scale (CSU-FAPS) in identifying their cat's pain level, determining if they should take their cat to the veterinarian and describing their cat's pain to their veterinarian. Participants were recruited through Prolific. An electronic survey was created in Qualtrics and distributed via a link offered in Prolific. A total of 362 surveys were completed by participants who resided in the USA and were the primary caretaker of at least one cat. Significant differences between participants' concern levels before and after pain-related educational information were found for two of the three scenarios. Significant differences were found between participants' veterinary-related behavior choices before and after pain-related educational information for all three scenarios. The most common reasons for not seeking immediate veterinary care included elements related to cost and stress for guardian and cat during veterinary visits. The majority of participants reported finding the CSU-FAPS useful for identifying their cat's pain level (90%), determining if they should take their cat to the veterinarian (86%) and describing their cat's pain to their veterinarian (92%). Guardians' interpretations of and subsequent actions to behaviors that might suggest pain carry great implications for feline health and wellbeing. After exposure to brief pain-related educational material, guardians in our study reported significant increases in stated concern related to their cat's change in behavior and intention to seek veterinary care. These findings suggest that even very brief pain-related educational material can have a positive impact on cat guardians' perceptions of feline behavior changes and increase the possibility they obtain appropriate veterinary care.

Perceived prolonged stress leads to difficulties in recognizing sadness from voice cues in men but not women.

It has long been known that stress has detrimental effects on cognition (e.g., Alderson & Novack, 2002; Lupien & Lepage, 2001), most notably documented for memory functions (e.g., Schwabe & Wolf, 2013). Interestingly, less is known about the effects of stress on other cognitive functions including language processing. Here, we have examined the effects of self-reported prolonged stress on recognition of emotional language content with a particular emphasis on gender differences. We tested how well 399 participants with different perceived stress levels recognized emotional voice cues. Findings confirm previous results from the emotional prosody literature by demonstrating that women generally outperform men in the vocal emotion recognition task. Crucially, results also revealed that medium levels of perceived stress impair the ability to detect sadness from voice cues in men but not women. These findings were not modulated by task demands (e.g., speeded response) or better acoustic discrimination abilities in women. Results are in line with the idea that perceived stress has a different impact on men versus women and that women have a higher level of experience in voice sadness recognition, potentially due to their predominant role as primary caretakers. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Mother-infant attachment from the perspective of young mothers: Does the data support a maternal instinct?

Some conceptualizations of attachment imply an instinctual behavior that occurs naturally. Mothers who endorse this view are at greater risk for psychological stress, depression, and harsh parenting styles if they do not feel an immediate bond with their infant postpartum. The purpose of this study is to explore actual experiences of attachment from the perspective of young mothers (N = 75, Mage = 19.45 years) and based on these findings the extent to which there is empirical support for a maternal instinct. Mothers were interviewed at home three times (2 weeks, four months, and seven months postpartum), and interviews were thematically analyzed using an open coding method. Three broad themes and six sub-themes emerged: 1) experiences with the immediacy of attachment at birth are diverse (traumatic birth experience, sense of a maternal identity), 2) contextual factors on the bonding experience (physical touch-based caretaking, parenting stress and depression), and 3) time spent parenting influences attachment (reciprocity, parental confidence/knowledge). In conclusion, we could not find empirical evidence to support an innate maternal instinct. Despite diverse experiences with felt attachment at birth, all mothers perceived that the mother-infant connection was influenced by contextual factors after birth and was strengthened over time with more care-taking experience. This suggests that mothers likely developed a “maternal instinct” through repetitive interaction with their infant as the primary caretaker rather than a genetic predisposition to be superior nurturing parents.

A Study of the Prevalence of Anemia in Children With Severe Acute Malnutrition at a Pediatric Tertiary Care Hospital in South India.

Introduction In developing countries such as India, severe acute malnutrition (SAM) has been a cause for great concern in the pediatric population. SAM is associated with significant morbidity and mortality in children less than 60 months of age and leaves them vulnerable to diseases due to a decrease in immunological response. Children with SAM are prone to infections, and due to nutritional deficiency, many have anemia whichmay be a direct or indirect cause of morbidity and mortality. They are affected by frequent respiratory and gastrointestinal infections. Methodology A cross-sectional study was conducted for a period of two months, from December 1,2023, to January 31, 2024, in children with SAM aged less than 60 months. A detailed history and demographic profile were taken and recorded in a predesigned proforma. Anthropometric measurements of the study subjects were recorded, and lab investigations included complete blood picture, serum iron, serum ferritin, serum folate, and serum vitamin B12 levels. The prevalence and severity of anemia were determined by assessing the hemoglobin levels. The data collected was analyzed in Excel sheets (Microsoft Corporation, Redmond, Washington, United States) and the results were depicted in the form of graphs. Results A total of 300 children were included in the study of which 22 children were aged less than six months and 278 children were in the age group of 6-60 months. The overall gender distribution was 124 (41.4%) males and 176 (58.6%) females. In the age group of <6 months, of the 22 children, six (27.27%) were females while 16 (72.72%) were male. In the age group of 6-60 months, of the 278 children, 170 (61%) were females while 108 (39%) were males. Of the total 300 children, 232 (77.3%) were found to be anemic, of which 54 (23.2%) had mild anemia, 162 (69.8%) had moderate anemia, and 16 (6.89%) had severe anemia. Low serum iron levels were detected in 134 (44.6%) with iron deficiency being more common in females; below-normal ferritin levels were seen in 153 (51%) cases. Folate levels were found to be deficient in 97 (32.3%) children while vitamin B12 levels were deficient in 186 (62%). Conclusion Anemia is a common occurrence in children with SAM. Prevention of anemia starts from the womb by improvement of maternal nutrition and iron, and folic acid supplementation during pregnancy. Exclusive breastfeeding up to six months of age and further continuation of breastfeeding coupled with initiation of home-available complementary feeding from the age of six months onwards go a long way in maintaining healthy nutrition status inchildren in the vulnerable age group of less than 60 months. Healthcare professionals should utilize thewell-baby and well-child visits to educate the parents and primary caretakers regarding the feeding practicesto prevent, detect, and treatanemia, which will help reduce the morbidity and mortality in children with SAM.

Embodying the nuclear: The moral struggle of family care in postfallout Japan

AbstractThis paper examines the moral struggle of family care by focusing on parents’ efforts to raise “healthy” children in irradiated environments of Fukushima following the 2011 Fukushima Daiichi nuclear disaster. Drawing on fieldwork between 2017 and 2020, it explores the lived experiences of primary caretakers, mostly mothers, as they strive to cultivate “health” in their children while negotiating conflicting logics of radiological exposure, risk assessment, and gendered childcare. Central to this endeavor is what I call an ethical labor of “balancing:” the daily negotiation between protecting children and allowing them to live fully in risk‐laden environments. Emphasizing intercorporeal and interpersonal aspects of embodied care, the paper examines the nuanced ways in which three mothers recalibrate notions of health, personhood, and responsibility to safeguard their children's everyday lives. Such notions of “health” carry significant implications for family dynamics amid the uncertainties of postdisaster life. By highlighting the critical role of family care in potentially stigmatizing environments, the paper advocates for developing frameworks that address the real‐life complexities of making life in an increasingly compromised world.

Understanding food safety challenges through a gender and social lens in low‐ and middle‐income countries

AbstractFood safety is crucial for ensuring the quality and safety of the global food supply. However, the gender and social dimensions of food safety are often overlooked and undervalued. Women, who are primary caretakers in households, play a vital role in food preparation, storage, and consumption. Gender inequality can result in limited access to resources and information needed for safe food handling and storage, increasing women's vulnerability to foodborne illnesses. Cultural practices, education, and income levels also impact food safety. These factors can contribute to disparities in food safety and increase the risk of foodborne illnesses among certain populations. Promoting gender equality, cultural sensitivity, and addressing income inequality are essential to ensure safe and secure food for all. Addressing these issues can lead to a more equitable and sustainable food system.

Bahraini Teachers’ Perceptions on the Challenges of Remote Teaching for Autistic Children

This research aims to understand how teachers of autistic children responded to teaching remotely during the COVID-19 pandemic. Six teachers who work in an autism centre took part in face-to-face semi-structured interviews in the Kingdom of Bahrain on their perspectives of teaching autistic children remotely and how their mothers adapted to this mode of teaching. The teachers reported that the unprecedented change was challenging for autistic children and their families, but especially for mothers, who were in all cases, the primary caretakers. The effectiveness of remote teaching depended on the cooperation and the willingness of the mother and child to engage in the process. Overall, teachers agreed that in comparison to face-to-face teaching, remote teaching was not a positive experience.

Keeper effect: Animals are more active in the presence of their caretakers.

Zookeepers are the primary caretakers of animals, providing daily care through frequent and close interactions. From the animal's perspective, most of these daily interactions are likely to have positive outcomes. With consistent and reliable interactions, a human-animal relationship is expected to develop. Our aim of this study was to investigate if the presence of the primary keeper in the public viewing area of zoo exhibits impacts the behavior of animals. We observed the behavior of 15 individuals of six species in the presence and absence of their primary keeper. Overall, we observed animals being more active in their keeper's presence than when the keeper was not present. When we considered if the keeper was nearby around times of offered opportunities to animals (e.g., feeding, enrichment, and training), our results showed that animals were equally as active when the keeper was present before an opportunity and when no opportunity was offered. These equal activity levels imply that the keeper is a cue for a forthcoming event to the animals, which reflects anticipatory behavior. Overall, we demonstrate that keeper presence is an environmental context in which animals behave differently than in keeper absence.

Study of Knowledge About the Developmental Milestones of Children in Primiparous Mothers

Background: Following the pivotal moment of childbirth, challenges may arise as children with developmental issues often experience delayed attention. Contributing to these delays is a lack of awareness regarding developmental milestones. Primiparous mothers, being primary caretakers, play a significant role in the timely identification. It is essential to educate them about developmental milestones enabling them to monitor their child’s growth trajectory and promptly address any delays. Emphasising the importance of ruling out developmental issues during the initial stages is imperative. Objective: To seek knowledge regarding developmental milestones at different stages among primiparous mothers. Materials and Methods: 95 participants from Ahmednagar district participated in this study. The selection of study subjects was based on criteria for inclusion and exclusion and consent in written form was obtained beforehand. The research included primiparous mothers. They were interviewed using a structured questionnaire based on children’s development milestones. Following that, the data was collected and appropriately analysed. Results: It was found that 42.11% of primiparous mothers had a good knowledge of the developmental milestones of their babies. Most of the knowledge (54.38%) was found in the initial milestones section, while the least amount (33.15%) was found in language. Conclusion: Among all the developmental domains, primiparous mothers have a thorough understanding of the initial milestones (54.38%) and the most limited understanding of language development (33.15%).

A Study on Quality of Sleep among Primary Caretakers of Patients Admitted in a Tertiary Care Centre in South India

A Study on Quality of Sleep among Primary Caretakers of Patients Admitted in a Tertiary Care Centre in South India

Exploring the Impact of Son Preference on the Well-being of Daughters in Tanzania: A Multifaceted Analysis

In Tanzania, entrenched cultural norms favoring male offspring significantly influence family dynamics and pose considerable challenges to the well-being of daughters. This phenomenon, known as son preference, manifests in biased resource allocation, limited educational opportunities, and distinct healthcare differentials. This study delves into the multifaceted consequences of son preference on Tanzanian daughters, particularly in the Arusha Region. The cultural roots of son preference in Tanzania can be traced to historical and societal norms, where male heirs are traditionally viewed as primary caretakers and providers for aging parents. This mindset leads to biased resource allocation, impacting daughters' access to essential resources such as education, healthcare, and nutrition. Educational disparities are particularly pronounced, limiting girls' prospects and perpetuating gender-based inequalities in the workforce. The study employs a mixed-method approach, combining qualitative and quantitative data collection and analysis. It adopts a descriptive survey design, conducted in all seven district councils of Arusha Region. Both probability and non-probability sampling techniques are applied to select respondents, encompassing young women, girls, and stakeholders from various organizations. Results indicate a prevalent acknowledgment of son preference, particularly in pastoralist and agro-pastoralist communities. The study reveals how son preference affects education, health, and economic opportunities for daughters. Educational disparities, early marriage, unequal access to health care, and limited economic prospects are identified consequences. To address these challenges, the study emphasizes the need for a comprehensive approach involving changes in societal attitudes, policies promoting gender equality, and initiatives to empower girls. By challenging ingrained cultural norms, fostering educational opportunities, and ensuring equal access to healthcare, Tanzania can work towards dismantling barriers hindering the potential of its daughters. The study contributes to the discourse on gender equality, advocating for interventions that ensure the holistic development and flourishing of Tanzanian daughters.

Adult Children’s Migration and Health-Related Quality of Life Among Older Nepali Adults

Traditionally, adult children have served as primary caretakers and providers for older Nepali adults. However, out-migration of adult children for employment and other opportunities is increasing. Health-related quality of life (HRQOL) in older Nepali adults in general and in the context of adult children’s migration is poorly understood. This study aims to assess HRQOL of older Nepali adults and its relationship with adult children’s migration. We used existing cross-sectional survey data on 260 older adults from Krishnapur municipality, which has witnessed a high rate of adult migration. HRQOL, quantified using the SF-12 scale, is expressed in terms of a physical (PCS) and mental (MCS) health component. A higher PCS and MCS score, each ranging from 0 to 100, indicates better physical and mental health, respectively. The correlates of HRQOL were assessed in simple and multiple linear regression. Participants had suboptimal HRQOL [mean (± SD): PCS = 40.4 ± 9.2 and MCS = 45.2 ± 7.7]. After adjusting for covariates, adult children’s migration was associated with lower MCS scores (β: -2.33, 95%CI: -4.21, -0.44). Individuals with more than one child had higher MCS scores (β: 2.14, 95%CI: 0.19, 4.09). Females (β: -3.64, 95%CI: -7.21, -0.06) and those with a history of unemployment (β: -6.36, 95%CI: -10.57, -2.15) had lower PCS scores than their respective counterparts. The presence of chronic conditions was associated with significantly lower PCS and MCS scores. Our findings suggest that adult children’s migration may negatively affect HRQOL among older Nepali adults, specifically their psychological well-being. Further research investigating potential moderating factors that may serve as important buffers is needed.

Cardiac Involvement in Pediatric Mucopolysaccharidoses Patients and their Genetic Profile: A Retrospective Single-center Study

Abstract Background: Mucopolysaccharidoses (MPS) are rare metabolic disorders of monogenic inheritance, with varying degrees of cardiac involvement due to undegraded glycosaminoglycans getting aggregated in the spongiosa of the cardiac valves, the myocardium, and myointima of the coronary arteries. This study is an effort to understand the cardiac involvement and genetic pattern of pediatric MPS patients at a tertiary care center in South India. Methods: This descriptive study was done by examining records in our hospital database for MPS patients in the age group of 0–15 years, diagnosed between January 2014 and January 2023. Of these patients, 37 patients with echocardiographic loops available in the hospital system were reevaluated by a single pediatric cardiologist to avoid observer bias. The underlying genetic spectrum was also reviewed. Results: The cohort comprised 67.5% of males and a median age of 9.8 years (interquartile range: 6.5–14.9 years) with a distribution of 37.8% MPS I, 32.4% MPS II, 13.5% MPS IV, and 10.8% MPS VI. Early cardiac involvement in the form of valvar thickening, predominantly left sided (mitral [92%] &gt;aortic [38%]), was seen across all MPS subtypes. We also noted an increased involvement of the tricuspid valve (38%) in our cohort. Moderate–severe valvar involvement was seen in 16% of the cohort, mostly MPS I, II, and VI patients, and more in the second half of the age group (&gt;6 years), suggesting an age-associated worsening of cardiac lesions. Genetic analysis done in 68% of the cohort detected 61% of pathogenic variants, with a predominance of missense mutation (43%). However, no genotype–cardiac phenotype correlation could be ascertained. Conclusions: We identified a high proportion of cardiac abnormalities in our pediatric MPS cohort, which ranged from isolated valvar thickening to a more severe clinical picture, including moderate-to-severe valvular insufficiency and/or stenosis and left ventricular hypertrophy. Cardiac pathology is an early manifestation and a known cause of mortality in many MPS subtypes. Echocardiography is a key diagnostic technique for early detection, careful monitoring, and guidance in the initiation of a timely intervention that will help curb its progression. Hence, the need arises to raise awareness among the primary caretakers of this subset of patients on the need for early cardiac evaluation with a detailed echocardiography.

Kesejahteraan Psikologis Pada Orang Tua Anak Penyandang Disabilitas Di Sanggar Inklusi Wijaya Kusuma Kabupaten Sukoharjo

Psychological well-being is a condition where individuals can accept their strengths and weaknesses as they are, have positive relationships with other people, are able to direct their own behavior, are able to develop their own potential in a sustainable manner, are able to control the environment and have a goal in their life. Parents of children with special needs experience many difficulties in everyday life due to certain limitations that the child has, requiring parents to seek education and ensure that the child gets the same opportunities as normal children, the child must also undergo special therapy to ensure that he develops normally. positive into adulthood. Therefore, the psychological well-being of parents needs to be achieved optimally because parents act as educators and primary caretakers of children which can increase positive development in children. The aim of this research was to determine the psychological well-being of parents of children with disabilities at the Wijaya Kusuma Inclusion Studio, Sukoharjo Regency. The results show that parents have demonstrated several characteristics of psychological well-being, namely in the aspects of self-acceptance, autonomy, mastery of the environment and positive relationships with other people.

Vitamin d levels in pediatric epilepsy patients on the anti-epileptic drugs at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Background: Epilepsy is a common neurological disorder of childhood repeatedly necessitating prolonged use of anticonvulsants. This study was done to evaluate the status of vitamin D in epileptic children. We targeted to describe the prevalence and risk factors for vitamin D deficiency among children with epilepsy. &#x0D; Methods: A hospital-based descriptive cross-sectional study design with prospective data collection was used among children with epilepsy on anti-epileptic drugs attending the Pediatric Neurology Clinic and their primary caretakers. For this study, a sample of 226 children and adolescents were included in the study and a blood sample for the determination of serum vitamin D was taken. The participants were interviewed, and medical records were thoroughly reviewed. Descriptive statistics and binary logistic regression analysis was done to assess determinants of vitamin D deficiency. . &#x0D; Results: In this study, the prevalence of vitamin D deficiency was found to be 42%. Children on polytherapy (AOR = 4.3 (1.2 - 16)), 3 or more AEDs (AOR = 0.1 (0.0 - 0.8)), female sex (AOR = 1.8 (1.7 - 2.6)), age &gt;15 years (AOR = 2.12 (1.0 - 1.5)), 4 months of exclusive breastfeeding (AOR = 5.6 (4.9 - 36)), family diet (AOR = 0.3 (0.1 - 0.8)) and non-ambulation (AOR = 1.7 (1.8 - 3.6)) were factors associated with being in the vitamin D deficiency group.&#x0D; Conclusion: According to this study patients who take Anti-Epilepsy drugs are at a higher risk of a poor vitamin D status. Based on this finding, the need for timely and appropriate vitamin D supplementation and periodic follow-up seems to be very evident.

The role of pediatricians in the diagnosis and management of IgE-mediated food allergy: a review.

Food allergy can often cause a significant burden on patients, families, and healthcare systems. The complexity of food allergy management requires a multidisciplinary approach involving different types of healthcare providers, including allergists, dieticians, psychologists, nurses, family practitioners and, of particular relevance for this article, pediatric primary caretakers. Pediatricians may be the first-line healthcare providers for food allergy: strategies for management and guideline adherence have been highlighted. This review article summarizes the up-to-date recommendations on the role of pediatricians in the diagnosis, management, and prevention of IgE-mediated food allergy. Early introduction of allergenic foods like peanut is known to be of importance to reduce the development of peanut allergy in infants, and pediatricians are essential for educating and supporting parents in this decision. In scenarios of limited allergist availability, as is often the case among rural, Medicaid and minority populations, pediatricians can assist in the evaluation and management of food allergy, and provide action plans, education and counselling for patients and families. Pediatric primary caretakers play a key role in the diagnosis, management, and prevention of IgE-mediated food allergy. As more diagnostic tools and therapies in food allergy become available, the need for a multidisciplinary team is paramount to optimize patient care.

From Maternal Preference to Shared Parenting: Child’s Well-Being. Lessons from the USA

The article concerns parenting after divorce or separation within the context of social changes. Special attention is paid to the principle of the welfare of the child, which is the most important criterion for deciding child custody. The child’s welfare is an open concept that grants a wide discretion to courts in choosing the best custodial arrangement for a child in a particular case. In this context, reference was made to the American experience on parenting after family break-up, separation or divorce. In the USA different theories were developed to explain which parenting model best fulfils the principle of the child’s welfare. This article discusses the tender years doctrine, primary care-taker preference, psychological parent doctrine and approximation rule. After a divorce, a mother was usually granted custody and a father paid child-support. He was placed in the background and excluded from the daily activities of his child. Currently, the theory of mother-nurturer and father-breadwinner is coming to an end; the father is no longer the only breadwinner responsible for providing the family an adequate standard for living, and the mother is no longer primarily responsible for the duties of childrearing and household chores. The changes taking place are reflected in struggling for equal treatment in the award of custody and abandoning the stereotypical approaches based on awarding custody automatically to mothers. A significant rise in the number of parents entering into joint custody arrangements is observed.