Routine Care Of Children Research Articles

Fathers’ child care time and mothers’ paid work: A cross-national study of Denmark, Spain, and the United Kingdom

In this study we use time-diary data from Denmark, Spain, and the United Kingdom to analyze how fathers’ child care differs across countries with distinct gender norms, family policies, and maternal employment rates. We pay particular attention to the role of mothers’ paid work time in influencing paternal child care. Results show that Danish fathers display the most involved child care behavior. Spanish fathers spend more time in child care than UK fathers, but Spanish fathers are less egalitarian than UK fathers regarding the relative contribution to the couple’s child care time. Women’s paid work is significantly associated with men’s routine child care, the most time-demanding and female-typed forms of parenting, but not with men’s interactive child care. The study suggests that maternal employment partly drives cross-national differences in fathers’ child care time, implying that women’s employment policies can influence active paternal involvement.

Educational differences in fathers’ time with children in two parent families: Time diary evidence from the United States

This paper examines educational differences in fathers’ time spent in primary and secondary childcare activities using the American Time Use Survey (2003–2013). Compared to fathers with lower educational attainment, well-educated fathers spend more engaged time with their children, where a child is the main center of attention. Although highly educated fathers are not more accessible to their children than fathers with less education, they spend more time in developmental childcare activities associated with positive outcomes for children. The effect of fathers’ education on time spent in routine childcare is completely explained by spouse’s education, whereas father’s time in managerial or developmental childcare activities is hardly affected. Overall, the results indicate distinct fathering practices by educational attainment, some of which are explained by spouse’s education.

Impact of Range of Motion Exercise Program for Hemodialysis Nurses on Quality of Life for Children with End-stage Renal Disease undergoing Hemodialysis Therapy

app < /span>roach. Aim of this study was to evaluate the impact of range of motion exercise program for hemodialysis nurses on quality of life for children with end-stage renal disease undergoing hemodialysis therapy. The study utilized a quasi-exp < /span>erimental design. It was conducted at Adult and Pediatric Hemodialysis Units in Benha University Hospital. The sample included 32 nurses working at the previously mentioned settings and 34 children undergoing HD therapy. Data were collected through the following tools; the first tool a structured interviewing questionnaire tool for nurses which included: nurses' characteristics, assessment of nurses' knowledge regarding HD and range of motion (ROM) exercise, nurses' attitude toward app < /span>lication of ROM exercise program. - The second tool was an observational checklist to assess nurses' performance regarding ROM exercise for children undergoing HD. The third tool involved: a) children' characteristics, b) Pediatric Quality of Life InventoryTM Version 4.0 scale. The study results concluded that, there were improvements in total mean scores of nurses' knowledge, performance and attitude after program implementation toward ROM exercise. As well as, there were statistically significant differences between the mean scores of children's QOL before and after implementation of ROM exercise program. The study recommended the integration of ROM exercise program in the routine care of children undergoing hemodialysis therapy. exercise

Paediatric early warning scores on a children's ward: a quality improvement initiative.

The aim of this quality improvement initiative was to incorporate a paediatric early warning score (PEWS) and track and trigger system in the routine care of children in an acute general children's ward at a regional hospital in the Republic of Ireland. In the absence of a nationally recommended specific PEWS strategy, a local plan was developed. The experience of structuring and implementing the PEWS and track and trigger system is presented in this article. Data from the first year of use were collected to evaluate the clinical utility and effectiveness of this system. In the busy acute children's service, the PEWS initiative was found to benefit processes of early detection, prompt referral and timely, appropriate management of children at potential risk of clinical deterioration. Nursing staff were empowered and supported to communicate concerns immediately and to seek rapid medical review, according to an agreed PEWS escalation plan. Outcomes were significantly improved.

Behavioral Functioning of Children of Abused Women Who Seek Services from Shelters or the Justice System: New Knowledge for Clinical Practice

Millions of women worldwide are victims of partner violence annually and their children are at-risk for psychological and physical dysfunctions. A total of 300 children (ages 18 months to 16 years), whose abused mothers sought safe shelter or a protection order for the first time, were studied. Data revealed internalizing behaviors, such as depression and externalizing behaviors, such as bullying decreased 4 months after mothers obtained help. Children’s scores from the shelter group indicated more dysfunction. Although no direct program was offered to the children studied, routine child care presents opportunities for nurses in pediatric settings to assess mothers for abuse and intervene with guided referrals and safety information that may promote better child functioning.

Beyond routine care for children with heart diseases from the vulnerable context: A clinical practice perspective

The statistics of children with heart diseases are notable in Namibia many of whom are from the rural area. While waiting for surgical corrections or when the child is a case for palliative care, these children have to be cared for at home, a task that can be doubtful for a rural caregiver. A qualitative, exploratory, phenomenological and contextual study was conducted to describe the experiences of rural caregivers regarding provision of home care for children with heart disease. The children’s experiences of living with the disease at home were also assessed because the burden of the diseases intensifies the demands for care. The findings revealed that both the caregivers and the children experience challenged emotions, disruptive social functioning, lacking of support from the family, lack of support from societal organisations as well as experiences of low vitality among the children. These experiences together, signify the overall poor coping by the caregivers and the children. Therefore, caring for a child with a heart disease at home requires a plan of individualized care which considers the context and the socio-economic status of the caregivers as the determinants for coping with providing care at home. Based on the findings, key recommendations were made among others to the clinical practice setting as an entry point to the care provided to these children. This paper provides a detailed description of the proposed health care intervention in the clinical setting to facilitate effective home care to children with heart diseases from the rural context.

Time with children and employed parents’ emotional well-being

Using the experience sampling method and survey data from the 500 Family Study this study examined how parents feel when they spend time with their children and whether their emotional experiences differ by type of activity and the parent’s gender. I found that mothers spent more time in childcare than fathers but this disparity was primarily due to mothers’ more frequent engagement in activities that were not child-centered (i.e., non-focused and passive childcare). Multilevel models further showed that engagement in these activities was related to higher positive affect. Shared meals and leisure activities were particularly beneficial to parents’ emotional well-being and the likelihood of engaging in them was not affected by parents’ paid work hours. By contrast, routine childcare was associated with increased stress and lower engagement but only among mothers. Mothers were also less likely to provide childcare in conjunction with their spouse. These findings reveal the subtle dimensions of the unequal division of childcare by gender.

Gender Ideology and the Sharing of Housework and Child Care in Sweden

We use the Swedish Young Adult Panel Study to study spouses’ gender ideology and women’s and men’s division of routine housework and child care. The results show that men with an egalitarian gender ideology spend 1 hour more in housework per week than do other men and that their spouses spend approximately 2 hours less in housework than do other women. Women’s gender ideology, in contrast, only seems to influence women’s own time spent in housework (and not their spouses’). Couples wherein the woman and/or the man have a strong egalitarian ideology display a more gender-equal division of child care. Equality in child care and housework are linked and men spend more time in housework when they live in a family with a gender-equal division of child care. In sum, an articulated gender consciousness is a prerequisite for a gender-equal division of unpaid work, even in gender-egalitarian Sweden.

Routine post-operative intensive care is not necessary for children with obstructive sleep apnea at high risk after adenotonsillectomy

ObjectivesPost-operative respiratory adverse events (AE) are frequent in children having adenotonsillectomy (AT) for obstructive sleep apnea (OSA). Many hospitals have a policy of routine admission to the intensive care unit (ICU) after surgery for children at highest risk. We aimed to determine the frequency and severity of post-operative AE in children admitted to ICU, to assess the appropriateness of this care plan. MethodsA retrospective chart review was carried out all children admitted to the pediatric intensive care unit after AT for OSA from January 2007 to December 2009. AE were classified as mild, including requirement for supplemental O2 or repositioning to improve airway or severe, including bag and mask ventilation, CPAP, re-intubation, placement of oropharyngeal airway or unplanned ICU admission for airway compromise. Results72 children were identified (21 female, median age 2.8 years). There were 29 AE in 26 patients (36%), including 23 (31.9%) who suffered a mild AE and 6 (8.3%) who had a severe AE. Age, sex, the presence of co-morbidity or the presence of severe OSA did not predict severe AE in this group. Median time to first AE was 165min. Four of the six severe AE occurred in the post-anesthetic care unit (PACU). There were 60 children who did not have an AE in PACU, of whom 59 did not have a severe AE in the post-operative period, giving a negative predictive value for no worse than a mild AE following an uncomplicated course in PACU of 98.3%. ConclusionsOur data confirm high rates of AE after AT for high risk patients, however, only 8% suffered a severe AE truly necessitating care in ICU. This outcome was very unlikely if an AE did not occur in PACU. We therefore conclude that routine post-operative ICU care for high risk children may be avoided if prolonged monitoring in the PACU is possible, with admission to ICU reserved for high-risk children with an early AE.

The Everyday Life of the Young Child Shortly After Receiving a Cancer Diagnosis, From Both Children’s and Parent’s Perspectives

Providing qualified, evidence-based healthcare to children requires increased knowledge of how cancer affects the young child's life. There is a dearth of research focusing on the young child's experience of everyday life. The purpose of this study was to explore young children's and their parents' perceptions of how cancer affects the child's health and everyday life shortly after diagnosis. Thirteen children with newly diagnosed cancer aged 1 to 6 years and their parents, connected to a pediatric oncology unit in Southern Sweden, participated in this study through semistructured interviews. Child and parent data were analyzed as a family unit, using qualitative content analysis. Everyday life was spent at hospital or at home waiting to go back to hospital. Analysis led to the following categories: feeling like a stranger, feeling powerless, and feeling isolated. The child wants to be seen as a competent individual requiring information and participation in care. Parents need to be a safe haven for their child and not feel forced to legitimize painful and traumatic procedures by assisting with them. Nurses play a major role in the lives of children. Research with and on the young child is necessary and a way of making them visible and promoting their health and well-being. Nurses need to reevaluate the newly diagnosed child's care routines so as to shift focus from the illness to the child. This requires competent nurses, secure in their caring role.

Development of an early nurse led intervention to treat children referred to secondary paediatric care with constipation with or without soiling

BackgroundConstipation is a common chronic childhood condition referred to secondary care. Effective treatment requires early intervention, prolonged medication to soften stools and behavioural support to achieve a regular habit of sitting on the toilet to pass a stool. The purpose of this audit and service development was to assess routine consultant paediatrician-led care against minimum standards and if appropriate to develop a nurse-led intervention. The new care package could then be tried out within general paediatric clinics in Glasgow as a service evaluation. NICE guideline (CG99) has a research recommendation to compare nurse-led care with routine consultant-led care.MethodsDesign was an audit then development of a nurse-led intervention followed by a service evaluation. Participants were children (age 0–13 years), referred by their General Practitioner (GP) to the Royal Hospital for Sick Children Glasgow, with constipation the main problem in the GP letter. The audit covered appointment waiting times, intervention provided, initial follow-up and parental satisfaction with routine consultant-led practice. The nurse-led intervention focused on self-help psychology practice with NICE guideline medical support. This was compared with routine consultant paediatrician care in a service evaluation.ResultsThe audit found consultant-led care had long waiting times, delayed initial follow-up and variable intervention. The new nurse-led intervention is described in detail. The nurse-led intervention performed well compared with consultant-led care. Less ‘nurse-led’ children, 3/45 (7%), were still constipated passing less than 3 stools per week compared with 8/58 (14%) receiving consultant-led care. Less ‘nurse-led’ parents, 10/45 (22%), reported their child having pain passing stools in the previous week compared with consultant-led care, 26/58 (45%). The proportion of children, over 4 years, free from soiling accidents was similar, 15/23 (65%) in the nurse-led group and 18/29 (62%) with consultant-led care. Parental satisfaction was slightly better in the nurse-led group.ConclusionIt is difficult to achieve minimum standards using routine consultant-led care for children referred by their GP with constipation. Nurse-led early intervention is feasible and has produced promising results in a service evaluation. An exploratory trial is planned to develop a teaching module, robust outcomes including costs and benefits, and methodology for a definitive trial recommended by NICE.

Time in Parenting Activities in Dual-Earner Families at the Transition to Parenthood.

Time in parenting was compared for new mothers and fathers in a sample of 182 dual-earner families. Parenting domains included positive engagement, responsibility, routine childcare, and accessibility. Time diaries captured parents' time use over a 24-hour workday and nonworkday when infants were 3 and 9 months old. Parents were highly involved with their infants. Mothers were more involved than fathers in positive engagement and routine childcare on both days and at each assessment, and allocated more available time on workdays to these domains than fathers, with one exception. Fathers and mothers allocated similar shares of available workday time to positive engagement at 9 months. Greater equity in responsibility and accessibility was found; Mothers spent more, and a greater share of, parenting time in responsibility than fathers on the 9-month workday only, and were more accessible on the 3 month workday only. Implications for parents in today's diverse families are discussed.

Dental health of young children prenatally exposed to buprenorphine. A concern of child neglect?

To study the oral health and dental neglect of prenatally buprenorphine-exposed 3-year-old children. The study consisted of 51 children who as newborns tested positive for buprenorphine in a urine screen. The control group comprised 68 children previously unexposed to narcotics. The dentist examined the children and interviewed their guardians. Buprenorphine-exposed children exhibited significantly more early childhood caries than did the control group. Caries indices, the number of decayed, missing and filled teeth or tooth surfaces and decayed teeth were greater in the buprenorphine-exposed children than the control children (p = 0.004, p = 0.004, p = 0.001, respectively). In the buprenorphine group, more children showed visible plaque (p = 0.003) and fewer children were caries-free (p = 0.009) than in the control group. The control children's teeth were also brushed more often than the buprenorphine-exposed children's teeth (p = 0.001) and the parents were more involved in their children's tooth brushing than were those in the buprenorphine-exposed group (p = 0.035). More caries and dental neglect were found in buprenorphine-exposed children than in controls. These findings highlight the importance of routine dental appointments, caries screening and preventive care for children in substance-abusing families.

A Pilot Study to Establish Better Eating Practices Using an Exam Room–Based Educational Video

Objective. To evaluate whether the introduction of an exam room–based educational video in a busy clinic setting can improve Hispanic caregiver knowledge, attitudes, and children’s eating practices. Results. Between June and September of 2010, 80 caregivers enrolled in the study and a total of 37 completed the entire study. The majority of caregivers were female (90%) and Hispanic (89.9%) with a mean age of 36.9 years (±10.9). At 1-month posttesting, compared with pretesting, caregivers report their child’s consumption of “any” vegetables increased (34% to 70%, P = .01) as did self-efficacy to control portions (55.6% to 81.1%, P = .01). On multivariable analysis, older caregivers were more likely to report improvement of vegetable consumption (adjusted odds ratio = 1.28; 95% confidence interval = 1.01-1.62, P = .04). Conclusion. There may be value in providing nutrition education to caregivers during routine child care using exam room–based educational videos.

Initial anticonvulsant monotherapy in routine care of children and adolescents: levetiracetam fails more frequently than valproate and oxcarbazepine due to a lack of effectiveness

Since anticonvulsants such as valproate or oxcarbazepine have quite a disadvantageous profile of possible adverse drug events (ADEs), safer alternatives are being sought. The newer anticonvulsant levetiracetam is often considered advantageous. We performed a chart review of children and adolescents aged from 0.5 to 16.9years, who had been started on an initial monotherapy with levetiracetam, valproate, or oxcarbazepine between 2007 and 2011, in order to analyze the therapy's failure rate during the first year. We differentiated failure of monotherapy due to a lack of effectiveness and due to ADEs. No psychometric tests were performed. Lack of effectiveness and inacceptable ADEs were assumed according to the judgment of physicians and families. Anticonvulsive monotherapy failed in 29/61 (48%) levetiracetam patients and in 18/49 (37%) valproate patients (for focal and generalized epilepsies; n.s.). This was caused by a lack of effectiveness in 25/61 (41%) levetiracetam patients and in 11/49 (22%) valproate patients (p ≤ 0.05). A modification of therapy due to ADEs was performed in 4/61 (7%) levetiracetam patients and in 7/49 (14%) valproate patients (n.s.). An anticonvulsive monotherapy failed in 21/42 (50%) patients treated with levetiracetam and in 10/34 (29%) patients treated with oxcarbazepine (for focal epilepsies; n.s.). Changes of monotherapy were caused by a lack of effectiveness in 17/42 (40%) of levetiracetam patients and in 6/34 (18%) of oxcarbazepine patients (p ≤ 0.05). ADEs leading to changes in therapy were reported for 4/42 (10%) of levetiracetam and 4/34 (12%) of oxcarbazepine patients (n.s.). An initial monotherapy of levetiracetam failed more frequently due to a lack of effectiveness than a monotherapy with valproate or oxcarbazepine. We found no significant difference in therapy failure due to ADEs.

Interventions for common perinatal mental disorders in women in low- and middle-income countries: a systematic review and meta-analysis.

To assess the effectiveness of interventions to improve the mental health of women in the perinatal period and to evaluate any effect on the health, growth and development of their offspring, in low- and middle-income (LAMI) countries. Seven electronic bibliographic databases were systematically searched for papers published up to May 2012 describing controlled trials of interventions designed to improve mental health outcomes in women who were pregnant or had recently given birth. The main outcomes of interest were rates of common perinatal mental disorders (CPMDs), primarily postpartum depression or anxiety; measures of the quality of the mother-infant relationship; and measures of infant or child health, growth and cognitive development. Meta-analysis was conducted to obtain a summary measure of the clinical effectiveness of the interventions. Thirteen trials representing 20 092 participants were identified. In all studies, supervised, non-specialist health and community workers delivered the interventions, which proved more beneficial than routine care for both mothers and children. The pooled effect size for maternal depression was -0.38 (95% confidence interval: -0.56 to -0.21; I (2) = 79.9%). Where assessed, benefits to the child included improved mother-infant interaction, better cognitive development and growth, reduced diarrhoeal episodes and increased immunization rates. In LAMI countries, the burden of CPMDs can be reduced through mental health interventions delivered by supervised non-specialists. Such interventions benefit both women and their children, but further studies are needed to understand how they can be scaled up in the highly diverse settings that exist in LAMI countries.

Routine Paediatric Sickle Cell Disease (SCD) Outpatient Care in a Rural Kenyan Hospital: Utilization and Costs

BackgroundMore than 70% of children with sickle cell disease (SCD) are born in sub-Saharan Africa where the prevalence at birth of this disease reaches 2% or higher in some selected areas. There is a dearth of knowledge on comprehensive care received by children with SCD in sub-Saharan Africa and its associated cost. Such knowledge is important for setting prevention and treatment priorities at national and international levels. This study focuses on routine care for children with SCD in an outpatient clinic of the Kilifi District Hospital, located in a rural area on the coast of Kenya.ObjectiveTo estimate the per-patient costs for routine SCD outpatient care at a rural Kenyan hospital.MethodsWe collected routine administrative and primary cost data from the SCD outpatient clinic and supporting departments at Kilifi District Hospital, Kenya. Costs were estimated by evaluating inputs - equipment, medication, supplies, building use, utility, and personnel - to reflect the cost of offering this service within an existing healthcare facility. Annual economic costs were similarly calculated based on input costs, prorated lifetime of equipment and appropriate discount rate. Sensitivity analyses evaluated these costs under different pay scales and different discount rate.ResultsWe estimated that the annual economic cost per patient attending the SCD clinic was USD 138 in 2010 with a range of USD 94 to USD 229.ConclusionThis study supplies the first published estimate of the cost of routine outpatient care for children born with SCD in sub-Saharan Africa. Our study provides policy makers with an indication of the potential future costs of maintaining specialist outpatient clinics for children living with SCD in similar contexts.

Is measuring bone age in children with Crohn's disease useful?

Impaired growth is common in children and adolescents with Crohn's disease, but it can be difficult to interpret growth status accurately. Bone age is a useful measure of skeletal maturity, but should serial bone-age estimation be part of the routine care of children with Crohn's disease?

The Adolescent Family Life Program: A Multisite Evaluation of Federally Funded Projects Serving Pregnant and Parenting Adolescents

We evaluated the effectiveness of care demonstration projects supported by the Title XX Adolescent Family Life (AFL) program, which serves pregnant and parenting adolescents in an effort to mitigate the risks associated with adolescent childbearing. This cross-site evaluation involved 12 projects and 1038 adolescents who received either enhanced services funded by the AFL program or usual care. We examined the effects of enhanced services on health, educational, and child care outcomes approximately 6 months to 2 years after intake and explored moderation of program effects by time since intake and project characteristics associated with outcomes. The odds of using long-acting reversible contraception (odds ratio [OR] = 1.58) and receiving regular child care (OR = 1.50) in the past month were higher in the intervention group than in the comparison group. Odds of a repeat pregnancy were lower (OR = 0.39) among intervention group adolescents than among comparison group adolescents within 12 months of intake. Several project characteristics were associated with adolescent health outcomes. These projects show promise in improving effective contraceptive use, increasing routine child care, and yielding short-term decreases in repeat pregnancy.

Prevalence of transcranial Doppler abnormalities in Nigerian children with sickle cell disease

Transcranial Doppler (TCD) ultrasonography helps to identify children with sickle cell disease (SCD) who are at an increased risk of stroke,making primary stroke prevention a reality. A cross-sectional study of145 Nigerian children aged ≥3 years with SCD was carried out to describe the pattern of cerebral blood flow (CBF) abnormalities. The mean time-averaged mean velocity (TAMV) was 152 ±27.0 cm/sec and122 ±22.0 cm/sec in Hb SS and Hb S1C group, respectively. Abnormal velocities were recorded in six (4.7%) of the Hb SS patients and none of the Hb S1C while conditional risk (CR) velocities were recorded in 19.7% of Hb SS (low conditional 11.0%, high conditional 8.7%) and low conditional in 5.6% of Hb S1C cases. Cerebral flow velocities showed a negative correlation with age and hematocrit. Compared with African-American children, Nigerian children with Hb SS disease have a considerably higher prevalence of CR velocities.