THE CHILD'S SEXUAL LIFE—A Consideration of Clinical Implications

A healthy sexual life begins in childhood, and the groundwork for later difficulties also begins in childhood. For the child, sexuality is a rather general, pleasurable excitation, not a specific genital stimulation. Excessive attention to the perineal area, operation upon or injury to the genital area and injections are vicissitudes which may have an unhealthy influence on later sexual development. Healthy and informed parental attitudes are the key here, just as they are in the normal exhibitionism, curiosity and intense emotional attachments to parents. Parents infect children, healthily or unhealthily, with their attitudes. In healthy growth exhibitionism and peeping become transformed in socially acceptable ways. In unhealthy growth, either perversions or strong reactions like over-modesty or shame result. Masturbation is common and transitory in most children. Parents, and especially pediatricians to whom parents turn, have a golden opportunity to direct healthy growth by being well informed about the infant and child''s sexual growth and thus be enabled to advise upon or manage the common developmental phenomena with good commonsense and patience. Infants and children do not enter the world possessing the morals, standards or inhibitions of adults.     

Attitudes towards carrier testing in minors: a systematic review

The objective of this article is to review the attitudes of the different stakeholders (minors, healthcare professionals, parents and relatives of affected individuals) towards carrier testing in minors. The databases Pubmed, Google Scholar, Psychinfo, Biological Abstracts, Francis, Anthropological Index online, Web of Science, and Sociological Abstracts were searched using key words for the period 1990-2004. Studies were included if they were published in a peer reviewed journal in English and described the attitudes of minors, parents or healthcare professionals towards carrier testing in minors in a family context. The results were presented in a summary form. In total 20 relevant studies were retrieved (2 studies reported the attitudes of two stakeholders). Only one study reported the attitudes of adolescents, two studies reported the attitudes of adults who had undergone carrier testing in childhood. In total six studies have been retrieved discussing the parental attitudes towards carrier testing in their children. Over all studies, most parents showed interest in detecting their children's carrier status and responded they wanted their child tested before the age of majority: some parents even before 12 years. Eight studies were retrieved that reported the attitudes of relatives of affected individuals. Most were in favor of carrier testing before 18 years. The studies retrieved suggest that most parents are interested in the carrier status of their children and want their children to be tested before they reach legal majority (and some even in childhood). This can lead to tensions between parents and healthcare professionals regarding carrier testing in minors. Guidelines of healthcare professionals advise to defer carrier testing on the grounds that children should be able to decide for themselves later in life to request a carrier test or not.     

Androgen insensitivity syndrome (AIS): emotional reactions of parents and adult patients to the clinical diagnosis of AIS and its confirmation by androgen receptor gene mutation analysis

The emotional reactions of parents and adult patients on disclosure of the clinical diagnosis of androgen insensitivity syndrome (AIS) and its later confirmation by gene mutation analysis were assessed. A semistructured interview and three questionnaires were used. Parents came from 18 different families with a total of 20 children (15 complete AIS, 5 partial AIS), 19 raised as girls, 1 as a boy. Ten adult women with complete AIS came from six families. The short-term reaction upon the clinical diagnosis was in the majority of both parents and adult patients associated with shock, grief, anger, and shame and in the mothers and adult patients with guilt. Emotional reactions were more long-lasting in mothers and adult patients than in fathers. The confirmation by DNA analysis did not alter the actual feelings of both parents. Adolescents with AIS should be informed completely - but in a step-by-step way - about their condition, since adult patients indicated that they had suffered from being not at all or misinformed about AIS in their adolescence.     

Early separation and sibling incest: A test of the revised Westermarck theory

This was a follow-up study of earlier reported findings by the present investigators suggesting, albeit equivocally, that separation during early childhood inhibited later sexual acts of a potentially procreative nature between siblings but did not deter other sexual activity. The present study surveyed 170 subjects, mostly in the Toronto area, by telephone and mail. Respondents reporting potentially procreative, postchildhood sexual acts (attempted or completed genital intercourse) with siblings were compared with those reporting sexual relationships excluding procreative acts, and a third sample reporting no postchildhood sibling sexual behavior. Consonant with expectations from the earlier study, prolonged separation during early childhood was associated with procreative postchildhood sexual activity but not with other postchildhood sexual activity. Contrary to predictions, however, both sexual activity groups reported significantly more nudity and physical contact with siblings during childhood than subjects reporting no sexual activity. The findings are discussed in terms of a revised version of the Westermarck hypothesis, which is consistent with a domain-specific approach to evolved incest avoidance mechanisms.     

The relationship between parents' anti-fat attitudes and restrictive feeding

Objective: Anti‐fat prejudice is a common attitude in our society, and it has implications for those who hold and are targets of this prejudice. Little is known, however, about how parents’ anti‐fat attitudes impact the ways they feed their young children. We hypothesized that parents’ attitudes about weight would predict parents’ restrictive feeding practices above and beyond the effects of the child's actual weight and the parents’ concern about child overweight. Research Methods and Procedures: A total of 126 mothers and 102 fathers returned surveys about anti‐fat attitudes, feeding practices (restriction for weight and restriction for health), and concern about child overweight. Results: Parental concern about child overweight was related to higher restrictive feeding practices for both mothers and fathers. Parents’ anti‐fat attitudes also predicted restrictive feeding above and beyond the effects of parent and child BMI and parental concern about overweight. Discussion: These findings suggest that parents’ anti‐fat attitudes impact the way they feed their children.     

Childhood Obesity: Do Parents Recognize This Health Risk?

Objective: This study examined parents’ understanding of excess weight as a health risk, knowledge of healthy eating habits, and recognition of obesity in their children. Research Methods and Procedures: An anonymous questionnaire was distributed during well‐care visits involving children 4 to 8 years of age at a pediatric faculty practice. Parents indicated their level of concern about excess weight and other familiar health risks using a four‐point Likert scale, answered multiple‐choice questions concerning healthy eating patterns, and communicated their perceptions about their child's weight using a visual analog scale. A parent's perception was considered “accurate” if it deviated from the child's growth chart percentile by <30 points. Results: Of the 83 parents surveyed, 23% (19/83) had overweight children (≥95th percentile of age‐ and gender‐specific BMI growth charts). These parents did not differ from other parents in their level of concern about excess weight as a health risk or in their knowledge of healthy eating patterns, but the two groups of parents did differ in the accuracy of their perceptions about their children's weight. Only 10.5% of parents of overweight children (2/19) perceived their child's weight accurately compared with 59.4% of other parents (38/64; p < 0.001). Parents of overweight children invariably underestimated their children's weight. The median difference between their perception and the growth chart percentile was ?45 points. Discussion: Given that most parents of overweight children fail to recognize that their child has a weight problem, pediatricians should develop strategies to help these parents correct their misperceptions.     

Family background characteristics and relationship satisfaction in a native community in Canada

Abstract

Using data collected from a Native Canadian community by Embree (1993), we examine the influence of personal and family background characteristics on satisfaction with spousal relationships, both legal marriages and cohabitations. Of special interest are the quality of relationships with parents while growing up, alcohol abuse by the parent(s), and the experience of sexual abuse during childhood. Personal traits such as age, sex, and gender role attitudes and the respondent's own drinking behavior are also considered. Path analytic techniques model both the direct effects of independent variables on relationship satisfaction as well as the role of personal consumption of alcohol as an intervening variable in level of satisfaction with a relationship. The results of the analysis indicate that personal consumption of alcohol and the experience of sexual abuse during childhood are the best direct predictors of level of satisfaction with the current relationship, with higher alcohol consumption and experience of sexual abuse related to lower satisfaction. Age also has a significant direct, though smaller, positive influence on relationship satisfaction. Sexual abuse and the respondent's sex are also linked to level of satisfaction through personal alcohol consumption. With personal alcohol use, both the respondent's sex and the experience of sexual abuse during childhood have a significant effect, with males and those sexually abused as children reporting higher levels of alcohol consumption. The socialization explanation of the intergenerational consequences of parental behavior argues that parental role models are primary to the future family formation behavior of children. Consistent with this hypothesis, the findings concerning sexual abuse, in particular, as a predictor of both personal alcohol use and relationship satisfaction seem to underscore the importance of antecedent family characteristics in influencing later adjustment to adult roles and responsibilities.     

Characterization of Courtesy Stigma Perceived by Parents of Overweight Children with Bardet-Biedl Syndrome

Background

A child’s obesity is generally perceived by the public to be under the control of the child’s parents. While the health consequences of childhood obesity are well understood, less is known about psychological and social effects of having an obese child on parents. We set out to characterize stigma and courtesy stigma experiences surrounding obesity among children with Bardet-Biedl syndrome (BBS), a multisystem genetic disorder, and their parents.

Methods

Twenty-eight parents of children with BBS participated in semi-structured interviews informed by social stigmatization theory, which describes courtesy stigma as parental perception of stigmatization by association with a stigmatized child. Parents were asked to describe such experiences.

Results

Parents of children with BBS reported the child’s obesity as the most frequent target of stigmatization. They perceived health care providers as the predominant source of courtesy stigma, describing interactions that resulted in feeling devalued and judged as incompetent parents.

Conclusions

Parents of children with BBS feel blamed by others for their child’s obesity and described experiences that suggest health care providers may contribute to courtesy stigma and thus impede effective communication about managing obesity. Health care providers may reinforce parental feelings of guilt and responsibility by repeating information parents may have previously heard and ignoring extremely challenging barriers to weight management, such as a genetic predisposition to obesity. Strategies to understand and incorporate parents’ perceptions and causal attributions of their children’s weight may improve communication about weight control.     

Parental recognition of overweight in school-age children

Objective: Examine the accuracy of parental weight perceptions of overweight children before and after the implementation of childhood obesity legislation that included BMI screening and feedback. Methods and Procedures: Statewide telephone surveys of parents of overweight (BMI ≥ 85th percentile) Arkansas public school children before (n = 1,551; 15% African American) and after (n = 2,508; 15% African American) policy implementation were examined for correspondence between parental perception of child's weight and objective classification. Results: Most (60%) parents of overweight children underestimated weight at baseline. Parents of younger children were significantly more likely to underestimate (65%) than parents of adolescents (51%). Overweight parents were not more likely to underestimate, nor was inaccuracy associated with parental education or socioeconomic status. African‐American parents were twice as likely to underestimate as whites. One year after BMI screening and feedback was implemented, the accuracy of classification of overweight children improved (53% underestimation). African‐American parents had significantly greater improvements than white parents (P < 0.0001). Discussion: Parental recognition of childhood overweight may be improved with BMI screening and feedback, and African‐American parents may specifically benefit. Nonetheless, underestimation of overweight is common and may have implications for public health interventions.     

The Controversy Over Pediatric Bariatric Surgery

Despite the reported limited success of conventional treatments and growing evidence of the effectiveness of adult bariatric surgery, weight loss operations for (morbidly) obese children and adolescents are still considered to be controversial by health care professionals and lay people alike. This paper describes an explorative, qualitative study involving obesity specialists, morbidly obese adolescents, and parents and identifies attitudes and normative beliefs regarding pediatric bariatric surgery. Views on the etiology of obesity—whether it should be considered primarily a medical condition or more a psychosocial problem—seem to affect the specialists’ normative opinions concerning the acceptability of bariatric procedures as a treatment option, the parents’ feelings regarding both being able to influence their child’s health and their child being able to control their own condition, and the adolescents’ sense of competence and motivation for treatment. Moreover, parents and adolescents who saw obesity as something that they could influence themselves were more in favor of non-surgical treatment and vice versa. Conflicting attitudes and normative views—e.g., with regard to concepts of disease, personal influence on health, motivation, and the possibility of a careful informed consent procedure—play an important role in the acceptability of bariatric surgery for childhood obesity.     

A Longitudinal Study on Early Hospitalized Airway Infections and Subsequent Childhood Asthma

Background

Acute airway infections, including bronchiolitis, are common causes of early childhood hospitalization. The development of later asthma may be related to early airway infections in young children. This study is to investigate the relationship between hospitalized airway infections (HAI) in young children (< 3 years old) and later childhood asthma.

Methods

Hospitalized children (< 3 years old) with bronchiolitis or other acute airway infections (other HAI group) from 1997-2000 were retrieved from the National Health Insurance Research Database of Taiwan, and compared to age- and gender-matched subjects with regards to asthma until 10 years of age; and potential comorbidities and medical care conditions.

Results

In total, 3,264 children (1,981 with bronchiolitis; 1,283 with other HAIs) were compared to 18,527 controls. The incidence of childhood asthma was higher in the study (16.2%) than the control (11.7%) group, and most cases were diagnosed between 3-5 years old. The hazard ratios were 1.583 (95% CI: 1.414-1.772) and 1.226 (95% CI: 1.053-1.428) for the bronchiolitis and other HAI subgroups, respectively, compared to the control group, and 1.228 (95% CI: 1.075-1.542) in the bronchiolitis subgroup compared to the other HAIs subgroup. A significantly higher odds ratio (1.973, 95% CI: 1.193-3.263) for the children with congenital heart disease (CHD) in the bronchiolitis subgroup was found at an age of 3-5 years compared to the control group.

Conclusions and Clinical Relevance

Young children (< 3 years old) hospitalized due to acute HAIs are at a higher risk of developing childhood asthma at age 3 to 10 years. The parents of children with HAIs at age 0 to 2 years should be informed for the higher risk of developing childhood asthma, especially in children with CHD and bronchiolitis.     

Disclosure of personal medical information: differences among parents and affected adults for genetic and nongenetic conditions

Protecting the confidentiality of medical information has been an issue of great interest in the fields of bioethics, public policy, and law. Few empirical studies have addressed patient experiences and attitudes toward disclosure of private medical information in multiple contexts such as health insurance, employment, and the family. Furthermore, it is unclear whether differences exist in experiences and attitudes about privacy between those living with a serious medical condition versus those who have a child with a medical condition. The study sought to determine whether attitudes and experiences related to medical privacy and confidentiality differ between affected adults and parents of affected children. Interviews were conducted with 296 adults and parents of children with sickle cell disease (SCD), cystic fibrosis (CF), or diabetes mellitus (DM). This cross-sectional study collected data regarding their experiences, attitudes, and beliefs concerning medical privacy and confidentiality. Multinomial logistic regression analysis was conducted on quantitative data. Qualitative analysis was conducted on data from open-ended response items. Parents disclose their child's diagnosis to others more often than affected adults disclose their own disease status. Parents are less likely than affected adults to regret their disclosure, to hope others do not find out, to have been pressured to share information, and to be asked about their disease by employers. Affected adults express greater concern about disclosure, a greater prevalence and greater fear of discrimination, and experience greater pressure from family members to disclose. Clinicians and researchers working with these populations should consider these differences in privacy and disclosure. Further study is necessary to examine the implications of these differences in attitudes and experiences concerning insurance, employment, and social interactions among persons with these conditions.     

Parental generalized EEG alpha activity predisposes to spike wave discharges in offspring

Familial and twin studies have shown that the individual variability of the normal human electroencephalogram (EEG) is largely genetically determined. In epileptology, these genetic parameters of the EEG background activity are almost totally neglected. The aim of the present study has been to investigate whether a special genetic type of background activity might be related to the pathogenesis of epilepsy. EEG recordings of parents of 257 epileptic children were evaluated retrospectively. Some 156 healthy adults served as controls. Special attention was paid to alpha activity extending to the frontal region, both in bipolar and in referential recordings (Alpha I). Alpha I was found significantly more often in parents of children with primary generalized epilepsy (18%) compared with parents of children with focal epilepsy (8%) or controls (9%). In a second step, parental EEGs of children with different EEG patterns associated with epilepsy were studied. Alpha I was found significantly more often in parents of children with focal sharp waves and generalized spikes and waves (26%) than in parents of probands with focal sharp waves without additional generalized spikes and waves (8%) or in controls (9%). Parents of probands with theta rhythms and spikes and waves had alpha I significantly more often (18%) than parents of probands with theta rhythms without additional spikes and waves (8%) or controls (9%). The findings reveal a clear correlation between the type of EEG background activity in parents and the EEG characteristics in their children, thus pointing to common mechanisms.     

Social Skills as a Predictor of Postsecondary Outcomes for Individuals Who Are Deaf

Social skills function as a vehicle by which we negotiate important relationships and navigate the transition from childhood into the educational and professional experiences of early adulthood. Yet, for individuals who are deaf, access to these opportunities may vary depending on their preferred language modality, family language use, and educational contexts. Drawing upon available data in the National Longitudinal Transition Survey 2 (NLTS2) and controlling for demographic covariates, we examine the predictive role of social skills in high school on postsecondary education, employment, independent living, and self-beliefs. Parents’ ratings of social skills in their children who are deaf (from the first wave, when students were in high school) strongly positively predicted graduation from postsecondary settings up to ten years later, but did not predict employment or independent living outcomes.     

Sociodemographic and motivational characteristics of parents who volunteer their children for clinical research: a controlled study.

OBJECTIVE--To determine the sociodemographic and motivational characteristics of parents who volunteer their children for clinical research. DESIGN--A questionnaire was administered to parents who volunteered their children for a randomised, double blind, placebo controlled trial of a drug to treat asthma and to a control group of parents whose children were eligible for the trial but had refused the invitation. SETTING--A children''s hospital in Australia. SUBJECTS--68 Parents who had volunteered their children and 42 who had not; a response rate of 94% and 70%, respectively. MAIN OUTCOME MEASURES--Responses of parents to questionnaire designed to assess their perceptions, attitudes, and health seeking behaviour as well as sociodemographic data. RESULTS--Volunteering parents were less well educated with only 15% (10/68) of mothers and 16% (11/68) and of fathers having had a tertiary or university education compared with 26% (11/42) of mothers and 45% (19/42) in the non-volunteering group. Fewer volunteering parents had professional or administrative jobs than did non-volunteering parents (mothers 6% (4/68); fathers 9% (6/68) v mothers 14% (6/42); fathers 31% (13/42)). Volunteering parents had less social support, and they displayed greater health seeking behaviour and consumed more habit forming substances. They were motivated by a desire to help others and to contribute to medical research, but they were also searching for more information and better ways to help their own children. CONCLUSION--Parents who volunteer their children for medical research are significantly more socially disadvantaged and emotionally vulnerable.     

Caregivers' attitudes and practices: influence on childhood body weight

Childhood excess weight is probably associated with, or reflected in, parental attitudes. The objective of this study was to study the relationships between childhood excess weight and parental attitudes. The study subjects were 53 boys and 56 girls, aged 6-10, regularly attending schools in Porto Alegre, south Brazil, and one of their parents or caregivers. Attitudes of the parents or caregivers were assessed by the Child Feeding Questionnaire (CFD). Weight and height of the children were measured, parents self-reported their weight and height and body mass indexes were calculated for both. The WHO criteria for overweight and obesity were used for the adults. The CDC criteria for overweight and risk for overweight were used for the corresponding children. Boys presented excess weight more often than girls. The parents of children with excess weight showed higher scores for perceived child weight, concern about child weight, restriction and monitoring. In logistic regression, excess weight in children was associated with perceived child weight, restriction and male sex; pressure to eat was negatively associated with excess BMI. In Porto Alegre, south Brazil, excess body weight in children aged 6-10 is associated with parental perceived child weight and concern about it, monitoring and restriction; being a boy increases the odds of being overweight.     

Dermatoglyphics in beta-thalassemia major]

The features of dermatoglyphics in 39 children with beta-thalassemia major and in 47 their parents are studied. The control were 70 healthy children. The patients with beta-thalassemia had more often the prevailence of whorls over other finger patterns. There was an increase of the "atd" angle and some increase in the ridge of counts. Parents had also an increase of the amount of whorls, but this increase was less pronounced than under beta-thalassemia. The changes of the dermatoglyphics in parents of children affected with beta-thalassemia major are suggested to ba a phenotypic feature of heterozygous carrier of the mutant gene.     

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.     

Correlates of Participation in a Pediatric Primary Care‐Based Obesity Prevention Intervention

The purpose of this study was to examine the correlates of participation in a childhood obesity prevention trial. We sampled parents of children recruited to participate in a randomized controlled trial. Eligible children were 2.0–6.9 years with BMI ≥95th percentile or 85th to <95th percentile if at least one parent was overweight. We attempted contact with parents of children who were potentially eligible. We recruited 475 parents via telephone following an introductory letter. We also interviewed 329 parents who refused participation. Parents who refused participation (n = 329) did not differ from those who participated (n = 475) by number of children at home (OR 0.94 per child; 95% CI: 0.77–1.15) or by child age (OR 1.07 per year; 95% CI: 0.95–1.20) or sex (OR 1.06 for females vs. males; 95% CI: 0.80–1.41). After multivariate adjustment, parents who were college graduates vs. <college graduates were less likely to participate (OR 0.62; 95% CI: 0.46–0.83). In addition, parents were less likely (OR 0.41; 95% CI: 0.31–0.56) to participate if their child was overweight vs. obese. Among the 115 refusers with obese children, 21% cited as a reason for refusal that their children did not have a weight problem, vs. 30% among the 214 refusers with overweight children. In conclusion, parents of preschool‐age children with a BMI 85–95th%ile are less likely to have their children participate in an obesity prevention trial than parents of children with BMI >95th%ile. One reason appears to be that they less frequently consider their children to have a weight problem.