PARENT DEVELOPMENT

Today''s parents tend to be overwhelmed with advice from many sources. In his role as family counselor, the pediatrician must understand and consider the emotional development of parents in relation to their child''s development; otherwise, his advice and counsel do not “take” and he becomes tired and frustrated and angry.Parents progress through definite stages of development: Stage 1: Learning the cues—the struggle of the parents to interpret the infant''s needs. Stage 2: Learning to accept growth and development—the parent learning to accept some loss of control of the toddler. Stage 3: Learning to separate—the parent learning to allow the child to develop independently. Stage 4: Learning to accept rejection, without deserting—the struggle of the parents not to intrude and yet to be there when needed. Stage 5: Learning to build a new life having been thoroughly discredited by one''s teenager—the parent learning to live independently while the teenager struggles to develop his own identity.The pediatrician who is accepting, sensitive and a good listener and who keeps in mind that parents as well as children have capacities for growth and development, will be a potent factor in promoting good parent-child relationships and many times more effective in dealing with the child in health and disease.     

Child development; problems of discipline,authority and rebellion

It is only through the love and approval of the significant adults in a child's life that he is able to give up his primitive behavior for that which meets the demands of social living. Conflict over authority is only one of many conflicts. There are conflicts which arise inherently in a child's development. The task of the parents in the education of the child in our society is to enable the child to tolerate a certain amount of frustration and also a necessary degree of control of impulses so that he can live in a group and in conformity with the required standards. Increased rebelliousness and defiance are normally characteristic of certain periods of development in healthy children. These are when concerted discipline begins, and in early adolescence. But other events also may reactivate or stimulate attitudes of defiance and rebellion. Even in his rebellion, a child needs and expects his parents to stand for order, as well as for love. He expects that the parent will save him from the consequences of his own destructive impulses, which he as yet may not have the strength to withstand.Deep-seated or submerged factors in the parents may play a significant role in the discipline to which they subject their children. True permissiveness means allowing a child to develop according to his own rate of speed and his own potentialities as a unique individual. It includes refusing the child any type of behavior that will bring danger to him or to others.A parent who uses harsh and rigid forms of discipline may force a child into submission, rather than acceptance and understanding. This produces only surface conformity which hides insecurity and violent underlying destructiveness.     

CHILD DEVELOPMENT—Problems of Discipline,Authority and Rebellion

It is only through the love and approval of the significant adults in a child''s life that he is able to give up his primitive behavior for that which meets the demands of social living. Conflict over authority is only one of many conflicts. There are conflicts which arise inherently in a child''s development. The task of the parents in the education of the child in our society is to enable the child to tolerate a certain amount of frustration and also a necessary degree of control of impulses so that he can live in a group and in conformity with the required standards.Increased rebelliousness and defiance are normally characteristic of certain periods of development in healthy children. These are when concerted discipline begins, and in early adolescence. But other events also may reactivate or stimulate attitudes of defiance and rebellion. Even in his rebellion, a child needs and expects his parents to stand for order, as well as for love. He expects that the parent will save him from the consequences of his own destructive impulses, which he as yet may not have the strength to withstand.Deep-seated or submerged factors in the parents may play a significant role in the discipline to which they subject their children. True permissiveness means allowing a child to develop according to his own rate of speed and his own potentialities as a unique individual. It includes refusing the child any type of behavior that will bring danger to him or to others.A parent who uses harsh and rigid forms of discipline may force a child into submission, rather than acceptance and understanding. This produces only surface conformity which hides insecurity and violent underlying destructiveness.     

Specific Learning Disorders—Natural History and Current Views

Each professional, whether pediatrician, neurologist, psychiatrist, psychologist or teacher, in evaluating behavioral, neuromuscular, and emotional factors with the tools of his discipline, can arrive independently at very similar views regarding etiology and diagnosis of learning and language disorders. Even though this is possible, it is essential to have the many disciplines work together. This manner of sharing information is not only supportive to the patient, but to the physician as well.The pediatrician''s role does not stop, however, with the diagnosis, but continues with the working through of problems that the child and parents present to one another.     

Presymptomatic genetic testing in minors at risk of paraganglioma and pheochromocytoma: our experience of oncogenetic multidisciplinary consultation

The aim of the work was to define quality criteria for presymptomatic genetic testing in minors at risk of paraganglioma/pheochromocytoma. A 3-step multidisciplinary procedure was developed: 1) preparatory consultations for parents, providing decision support and advice concerning the way of informing the children; 2) consultation with the minor and blood sampling; and 3) announcement of the result of the genetic test to the minor and his/her parents. Twenty-three minors (mean age=9.22) were tested. The result was positive in 16 cases (presence of the familial mutation) and negative in 7. The 23 procedures were classified according to emotional reactions at the announcement of the result: calm (18/23) or tense (5/23). In parallel, 4 criteria for a good testing procedure was defined: 1) both parents agreeing to have their child tested when they felt ready; 2) parents being given advice concerning the way to inform their child; 3) the most appropriate time for testing being discussed for each child; and 4) avoidance of testing during medical examination periods for the carrier parent. The frequencies of the above criteria were as follows: 1 (17/23); 2 (19/23); 3 (17/23); and 4 (17/23). The overall quality of the testing procedure, calculated as the sum of the four criteria, differed significantly between calm and tense announcements (p<0.01). This study highlights the important role of careful preparation with the parents in emotional acceptance of the result of testing. The 4 criteria identified should be evaluated in further prospective studies.     

NEUROLOGICALLY HANDICAPPED CHILDREN—The Role of the Pediatrician in Rehabilitation

In the application of the broad services now available to assist a child having a major neurologic impairment, the pediatrician occupies an important role owing to his ability to consider the problem of the handicapped child in the context of his specialized knowledge of the developmental process. He thus has a large responsibility for interpretation of the problem to the child, to the parents and to his professional colleagues and for guidance of the rehabilitation regimen within the limits of the child''s developmental readiness for new experiences.The pediatrician has the opportunity to contribute significant clinical observations which may provide stimuli for future basic research and to exercise his skill as a practitioner of preventive medicine.Goals for the future achievement of the child having a major neurologic impairment must be set realistically and with great caution.     

Philosophy Behind Science: The European discoveries in prenatal ethnology and archeology of the mind

"On ne conna?t que les choses que l"on apprivoise, tu deviens responsable pour toujours de ce que tu as apprivoisé," Fedor-Freybergh once quoted in an editorial Saint-Exupéry. I remember Gupta quoting an old Indian physician on responsibility of the parents: "The somatic and mental characteristics of the child are predetermined. Valor, health, constitution, and intellect develop in the intrauterine child due to the physiological and spiritual harmony of his parents." The responsibility is not finished by medical observations or help to make the child become intelligent. I try to bring together some of the many ideas on prenatal life which grew during decenniums in Europe to blossom in sudden or quiet revelations and which are due to functions of the new being and the threefold or manyfold way behind him and his parents.     

Psychosocial Factors and Health Perceptions in Parents and Children Who Are Overweight or Obese

This study examined the relationships among weight status (BMI), health perceptions, and psychosocial characteristics in children, parents, and parent–child dyads. A convenient sample of 114 parent–child dyads participated. All children were overweight or obese. Parents and children completed questionnaires by self‐report or interview. Questionnaires included the Parenting Stress Index–Short Form (PSI), the Parents' Stage of Change (SOC) Questionnaire, and the Pediatric Quality of Life Inventory (PedsQL). Child's mean age was 10.34 years (s.d. = 1.87), mean BMI was 28.13 kg/m² (s.d. = 5.46), and mean BMI z‐score was 2.17 (s.d. = 0.38). Parent mean age was 37.28 years (s.d. = 12.66) and mean BMI was 34.07 kg/m² (s.d. = 8.18). Most parents (68.5%) reported that they and their children (70.7%) were African American and many (44.3%) reported that they and their children were Hispanic. Significant correlations included: child health perceptions and child BMI (r = 0.309, P < 0.001) and parent perception of weight and parent BMI (r = 0.691, P < 0.001). For parent–child dyads, one correlation approached significance (child health perceptions and parent stage of change (r = ?0.269, P < 0.01). Findings suggest that characteristics of parent–child dyads may be important considerations in the management of childhood obesity.     

Zhang Wentang北大核心CSCD

Although the times through which he lived were uncertain,at times cruel and predominantly harsh,the life of Zhang Wentang was one of pure scientific endeavour.The many obstacles which presented themselves during his lifetime would have discouraged and defeated most good men.It is the ultimate tribute to the man that he overcame so much hardship in his pursuit of knowledge and yet remained steadfastly focussed on his predetermined aims.While many good strong men deliver outstanding lifetime contributions from well supported positions it is often those who struggle most during their lives and rise above the drawbacks who deserve our greatest admiration — one such man was Zhang Wentang.     

Relief of pain by infiltration of autonomic ganglia with steroids.

When parents are concerned about the development of stuttering in their child they often consult their pediatrician or family physician. Theories on the development of stuttering are briefly examined in this article, and guidelines are provided to help the physician determine if the child''s dysfluencies are within the normal range. Referral to a speech therapist should be considered when any of the following are noted: excessive repetition of the first syllable of words; tremor of the muscles of mouth or jaw, increase in pitch or loudness, or evidence of fear or emotion as the child struggles with a word; evidence that the child avoids certain words or situations; and excessive concern of parents, teachers or the dysfluent individual. Two approaches to therapy, traditional and behavioural, are described. The latter has resulted in significant gains in fluency among stutterers.     

The Troubled Adolescent Patient—How the General Practitioner May Be Helpful

The disturbed adolescent is psychologically isolated from the worlds of childhood and adulthood. His sense of alienation results from both the upsurge of instinctual drives and his uneasy attempts to master changing physical attributes and new freedoms and responsibilities. The former result in conformity and in concerns about “normality.” The latter lead to confusion and to alternating rebellion and over-dependence.The general practitioner may be the first person consulted by the troubled adolescent or his parents. The physician''s sensitivity can be crucial in helping the family work together toward a solution. Persistent anxiety in either parent or child is in itself a problem. An understanding of those factors inherent in the adolescent experience may provide the physician with a recognition of disturbance denied by the adolescent with a facade of bravado or indifference.The physician must be prepared to help the adolescent accept a protracted period of stress, usually with only partial resolution of distressing problems.     

Parental misclassification of child overweight/obese status: The role of parental education and parental weight status

Childhood overweight and obesity is a major public health challenge for policymakers in many countries. As the most common supervisors of children’s activities, parents have a potentially important role to play in obesity prevention. However, a precondition for parents to improve their children’s diets, encourage them to be more physically active, or take them to see a doctor about their weight is for the parent to first recognize that their child is overweight or obese. This paper examines the extent of parental misclassification of child weight status, and its correlates, focusing on the role of parental education and the parent’s own obesity status. We find evidence that, among non-obese parents, those who are better-educated report their child’s weight status more accurately, but among obese parents, the better-educated are 45.18% more likely than parents with lower secondary education to give a false negative report of their child’s overweight/obesity; this may reflect social desirability bias.     

The Claude Bernard Distinguished Lecture. In pursuit of meaningful learning

The Bernard Distinguished Lecturers are individuals who have a history of experience and expertise in teaching that impacts multiple levels of health science education. Dr. Joel Michael more than meets these criteria. Joel earned a BS in biology from CalTech and a PhD in physiology from MIT following which he vigorously pursued his fascination with the mammalian central nervous system under continuous National Institutes of Health funding for a 15-yr period. At the same time, he became increasingly involved in teaching physiology, with the computer being his bridge between laboratory science and classroom teaching. Soon after incorporating computers into his laboratory, he began developing computer-based learning resources for his students. Observing students using these resources to solve problems led to an interest in the learning process itself. This in turn led to a research and development program, funded by the Office of Naval Research (ONR), that applied artificial intelligence to develop smart computer tutors. The impact of problem solving on student learning became the defining theme of National Science Foundation (NSF)-supported research in health science education that gradually moved all of Dr. Michael's academic efforts from neurophysiology to physiology education by the early 1980's. More recently, Joel has been instrumental in developing and maintaining the Physiology Education Research Consortium, a group of physiology teachers from around the nation who collaborate on diverse projects designed to enhance learning of the life sciences. In addition to research in education and learning science, Dr. Michael has devoted much of his time to helping physiology teachers adopt modern approaches to helping students learn. He has organized and presented faculty development workshops at many national and international venues. The topics for these workshops have included computer-based education, active learning, problem-based learning, and the use of general models in teaching physiology.     

THE ROLE OF PEDIATRICIANS IN GENERAL HOSPITALS

Besides the responsibilities of his own personal patients, the pediatrician has a community responsibility toward the hospital which is his workshop. His area of interest may include proper standards in the field of newborn and premature care, and control of communicable disease and hospital-acquired infection not only in the nursery but in the entire hospital—particularly staphylococcal infections. Finally, the pediatrician should see to it that not only the pediatric ward but the hospital as a whole, and the personnel working in it, provide a suitable emotional climate for the sick child.     

Examining the influence of sport program staff and parent/caregiver support on youth outcomes

Abstract

Youth participation in sport is associated with positive developmental outcomes. The development of life skills is especially important for urban youth of color who are often underserved and face poor long-term outcomes. To service the needs of underserved youth, community youth sport programs have begun to utilize sport-based positive youth development (PYD). Through this approach, key adult figures such as sport program staff and parents/caregivers have been identified as important mechanisms for life skill development and the transfer of learning. The aim of the current study sought to better understand how key adult figures influence life skill outcomes of urban youth of color involved in a community sport-based PYD program. Hierarchical linear regression analyses were used to examine the independent and interactive effects of staff support and parent/caregiver support on youth life skill and transfer of learning outcomes. Results indicated that staff support and parent/caregiver support predicted youth life skill and transfer of learning outcomes, both independently and, in some cases, interactively.     

Adoption and Children with Learning and Behavior Problems

One representative case study is used to illustrate the complex interaction of factors that can lead to tragic family dysfunction when an adopted child has learning and behavior problems. The presence of neurodevelopmental problems in an adopted child, special adoption issues and interparental and intraparental conflicts combine to place the child and his family at high risk. The child''s neurodevelopmental difficulties are expressed primarily as subtle learning and behavior problems which make him a focus for parental conflict. In addition, the adoption issues of difference, impermanence, feelings of mutual obligation and fear of abandonment are generally poorly understood and form the basis for the development of unique interactional patterns of communication. Finally, in the families studied, it was often found that the adopting parents had serious personal and/or marital difficulties.     

Increasing Fruit and Vegetable Intake and Decreasing Fat and Sugar Intake in Families at Risk for Childhood Obesity

Objective: The goal of this study was to evaluate the effect of a parent‐focused behavioral intervention on parent and child eating changes and on percentage of overweight changes in families that contain at least one obese parent and a non‐obese child. Research Methods and Procedures: Families with obese parents and non‐obese children were randomized to groups in which parents were provided a comprehensive behavioral weight‐control program and were encouraged to increase fruit and vegetable intake or decrease intake of high‐fat/high‐sugar foods. Child materials targeted the same dietary changes as their parents without caloric restriction. Results: Changes over 1 year showed that treatment influenced targeted parent and child fruit and vegetable intake and high‐fat/high‐sugar intake, with the Increase Fruit and Vegetable group also decreasing their consumption of high‐fat/high‐sugar foods. Parents in the increased fruit and vegetable group showed significantly greater decreases in percentage of overweight than parents in the decreased high‐fat/high‐sugar group. Discussion: These results suggest that focusing on increasing intake of healthy foods may be a useful approach for nutritional change in obese parents and their children.     

THE MISTREATED CHILD

“The battered child” has recently attracted the attention of physicians and social workers, but despite the fact that inflicted trauma produces characteristic x-ray changes, physicians are often reluctant to admit this cause. The neglected child may be more difficult to diagnose and is probably more common. The most typical example is the infant who is admitted to the hospital for “failure to thrive,” yet gains weight rapidly while away from his parents.The parents of both types of children are likely to be immature and inadequate, but much more study is required before the factors common to these parents are known, to say nothing of the means required for prevention and treatment.When the physician suspects that the parent is causing the difficulties manifested by the child, he should seek the help of a social worker in clarifying the situation and in contacting the appropriate social or legal agency. A greater awareness of the problems of these children should result in more rapid recognition of the condition, the establishment of well-defined methods of handling such cases, and ultimately better legislation to safeguard the child''s rights to a safe and healthy childhood.     

Parental perceptions of overweight counseling in primary care: the roles of race/ethnicity and parent overweight

Objective: To examine parental perceptions of primary care efforts aimed at childhood obesity prevention Methods and Procedures: We interviewed 446 parents of children, aged 2–12 years, with an age‐ and sex‐specific BMI ≥85th percentile; interviews occurred within 2 weeks of their child's primary care visit. We assessed parental ratings of the nutrition and physical activity advice received. Using children's clinical heights and weights and parents' self‐reported heights and weights, we classified children into three categories: BMI 85th–94th percentile without an overweight parent, BMI 85th–94th percentile with an overweight parent (adult BMI ≥25 kg/m²), and BMI ≥95th percentile. Results: In multivariate analyses, compared to parents of children with BMI ≥95th percentile, overweight parents with children whose BMI was 85th–94th percentile were more likely to report receiving too little advice on nutrition and physical activity (odds ratio (OR) 3.05; 95% confidence interval (CI) 1.49, 6.25) and to rate as poor or fair the quality of advice they received (OR 2.23; 95% CI 1.18, 4.24). Independently, African‐American (OR 2.55; 95% CI 1.18, 5.51) and Hispanic/Latino (OR 2.78; 95% CI 1.27, 6.10) parents were more likely than white parents to rate as poor or fair the quality of advice they received. Discussion: Parental overweight is associated with low subjective ratings of overweight counseling in pediatric primary care. Our findings of poorer perceived quality among racial/ethnic minority parents need further investigation.     

Daniel I.C. Wang: a tribute to an inspirational leader and colleague

Daniel I.C. Wang has been an influential leader of the biotechnology industry over the past four decades through his inspirational research activities, the legions of students and other researchers that have studied under him, his development of many research and educational initiatives, both nationally and internationally, and the advice he has given worldwide to companies, research institutions, universities, and governments. He has played an important role in the mentoring and nurturing of junior faculty members, and has been a supportive collaborator in research and teaching. This two-part article provides a brief overview of Danny Wang's many contributions to furthering the global development of biotechnology, with particular emphasis on his recent activities in Asia, and concludes with an account of his research collaborations with the author over the past two decades.