Height of primary school children and parents' perceptions of food intolerance

In the national study of health and growth parents'' responses to a self completed questionnaire were used to categorise children according to their experience of food intolerance. The heights of the children in each group were then compared. Useful responses to the questions on food intolerance were received for 6813 (85%) children in the sample and measurements of height obtained for 7856 (98%). Children with food intolerance were shorter than other children. A difference in height of about 1·5 cm remained after adjusting for social and biological factors and some common symptoms in childhood using multiple regression. The number of different types of food avoided was associated with shortness in the food intolerant group but not in the non-food-intolerant group.Regardless of the underlying aetiology, these findings suggest that parents'' complaints of food intolerance in their children should be taken seriously.     

What worries parents when their preschool children are acutely ill,and why: a qualitative study.

OBJECTIVE: To identify and explore parents'' concerns when young children become acutely ill. DESIGN: Qualitative study making use of semi-structured one to one and group interviews with parents of preschool children. SETTING: Disadvantaged inner city community. SUBJECTS: 95 parents of preschool children. RESULTS: Fever, cough, and the possibility of meningitis were parents'' primary concerns when their children became acutely ill. Parents'' concerns reflected lay beliefs, their interpretation of medical knowledge, and their fears that their child might die or be permanently harmed. Parents worried about failing to recognise a serious problem. Concerns were expressed within the context of keenly felt pressure, emphasising parents'' responsibility to protect their child from harm. They were grounded in two linked factors: parents'' sense of personal control when faced with illness in their child and the perceived threat posed by an illness. CONCLUSIONS: Better understanding of parents'' concerns may promote effective communication between health professionals and parents. Modification of parents'' personal control and perceived threat using appropriate information and education that acknowledge and address their concerns may be a means of empowering parents.     

Parental Perception of Weight Status: Influence on Children’s Diet in the Gateshead Millennium Study

Objective

Recognising overweight and obesity is critical to prompting action, and consequently preventing and treating obesity. The present study examined the association between parental perceptions of child weight status and child’s diet.

Methods

Participants were members of the Gateshead Millennium Study. Parental perception of their child’s weight status was assessed using a questionnaire and compared against International Obesity Task Force cut-offs for childhood overweight and obesity when the children were aged 6–8 years old. Diet was assessed at age 6-8years old using the FAST (Food Assessment in Schools Tool) food diary method. The association between parental perception and dietary patterns as defined by Principal Components Analysis, was assessed using multivariate regression after adjustment for child’s gender, child’s weight status, maternal body mass index (BMI), maternal education and deprivation status.

Results

Of the 361 parents who provided complete data on confounders and on their perception of their child’s weight status, 63 (17%) parents perceived their child as being of ‘normal’ weight or ‘overweight’ when they were actually ‘overweight’ or ‘obese’, respectively. After adjustment for confounders, parents who misperceived their child’s weight had children with a lower ‘healthy’ dietary pattern score compared to children whose parents correctly perceived their weight (β = -0.88; 95% CI: -1.7, -0.1; P-value = 0.028). This association was found despite higher consumption of reduced sugar carbonated drinks amongst children whose parents incorrectly perceived their weight status compared to children whose parents perceived their weight correctly (52.4% vs. 33.6%; P-value = 0.005).

Conclusions

In conclusion, children whose parents did not correctly perceive their weight status scored lower on the ‘healthy’ dietary pattern. Further research is required to define parents’ diets based on their perception status and to examine if a child’s or parent’s diet mediates the association between parental perception and child weight.     

Living with a crucial decision: a qualitative study of parental narratives three years after the loss of their newborn in the NICU

Background

The importance of involving parents in the end-of-life decision-making-process (EOL DMP) for their child in the neonatal intensive care unit (NICU) is recognised by ethical guidelines in numerous countries. However, studies exploring parents'' opinions on the type of involvement report conflicting results. This study sought to explore parents'' experience of the EOL DMP for their child in the NICU.

Methods

The study used a retrospective longitudinal design with a qualitative analysis of parental experience 3 years after the death of their child in four NICUs in France. 53 face-to-face interviews and 80 telephone interviews were conducted with 164 individuals. Semi-structured interviews were conducted to explore how parents perceived their role in the decision process, what they valued about physicians'' attitudes in this situation and whether their long-term emotional well being varied according to their perceived role in the EOL DMP.

Findings

Qualitative analysis identified four types of perceived role in the DMP: shared, medical, informed parental decision, and no decision. Shared DM was the most appreciated by parents. Medical DM was experienced as positive only when it was associated with communication. Informed parental DM was associated with feelings of anxiousness and abandonment. The physicians'' attitudes that were perceived as helpful in the long term were explicit sharing of responsibility, clear expression of staff preferences, and respectful care and language toward the child.

Interpretation

Parents find it valuable to express their opinion in the EOL DMP of their child. Nonetheless, they do need continuous emotional support and an explicit share of the responsibility for the decision. As involvement preferences and associated feelings can vary, parents should be able to decide what role they want to play. However, our study suggests that fully autonomous decisions should be misadvised in these types of tragic choices.     

Your child is dead.

OBJECTIVE--To determine parent''s views on how death of their children should have been handled. DESIGN--Retrospective questionnaire survey of parents who had experienced death of their child. SETTING--Charitable organisation of bereaved parents. SUBJECTS--150 bereaved parents, all members of the organisation, of whom 120 (80%) participated voluntarily in the study. MAIN OUTCOME MEASURES--Child''s age; date and cause of death; details of person breaking the news and handling of the interview; time parents spent with dead child, their attitude to requests for organ donation, and follow up support received. RESULTS--122 children''s deaths were described; the largest single group was due to road traffic accidents, 16 were suicides, and eight were murders. Twice as many interviews were rated as sympathetically or reasonably handled as badly or offensively handled (68 v 34). The interview ratings depended on the sensitivity and personal skills of the interviewers rather than on their previous contact or professional position; police were rated as more sympathetic than doctors and nurses. Of 109 respondents, 81 had seen their child''s body, 44 of whom thought that sufficient time had been denied. Of the 28 parents who did not see the body, 17 subsequently stated their regret. In 82 parents organ donation had not been discussed. Only 16 parents recorded any follow up support from hospital staff and very few support at the time. CONCLUSIONS--The consistency of the responses suggests a serious need to revise the in service training and education of the police and health professionals in their approach to informing of death; organ donation should be discussed sensitively and parents allowed time with their dead child with fewer restrictions.     

The association of television and video viewing with fast food intake by preschool-age children

Objective: To examine the extent to which television (TV) and video viewing is associated with consumption of fast food by preschool‐age children. Research Methods and Procedures: In a cross‐sectional study of 240 parents of children ages 2.0 to 5.9 years, parents reported the number of hours their child watched TV/videos on an average weekday and weekend day in the past month; a daily, weighted average of TV/video viewing was then calculated. The main outcome was parents’ report of their children's fast food intake, using the question, “How many times a week does your child eat at fast food restaurants such as McDonald's, Burger King, or Kentucky Fried Chicken?” dichotomized to (never/<1 vs. ≥1 time/wk). The association of TV/video viewing with fast food intake was evaluated by multiple logistic regression before and after adjusting for several potential confounders. Results: Twenty‐two percent of parents reported that their child ate at fast food restaurants at least once per week. After adjusting for parents’ age, race/ethnicity, and household income as well as child's age and sex, for each 1‐hour increase of TV/video watched per day, the odds ratio (OR) for consuming fast food ≥1 time per week was 1.60 (95% confidence interval, 1.03 to 2.49). After further adjustment for socio‐environmental factors that might serve as proxies for the availability of healthy food options, such as parental time constraints and the availability and high cost of fresh fruits and vegetables in their neighborhoods, the OR for consuming fast food ≥1 time per week was minimally attenuated (OR, 1.55; 95% confidence interval, 1.04 to 2.31). Discussion: TV/video viewing was correlated with fast food consumption among preschool children in this study. Our findings raise the possibility that greater exposure to TV and videos may influence preschool children's consumption of unhealthful foods.     

Use of automobile seat restraints by children in two Canadian cities.

A telephone survey was conducted in Montreal and Calgary to determine the extent to which parents use safety restraints for their children in cars, the types of restraints used and the factors associated with such use. Of the combined sample 39% reported that their child regularly used a restraint, and 47% of the children in Montreal and 55% of those in Calgary wore an age-appropriate safety device. Birth order and the child''s and the respondent''s ages were significantly related to the use of restraints. However, the respondent''s use of seatbelts was the factor most likely to affect the rate of use of restraints for children. Although a large proportion of the parents with younger children owned a carseat, one in four did not use it regularly. Parents who did not use carseats believed they were useless or dangerous; many preferred to hold the child in their laps or arms. The seatbelt law in Quebec and the existence of a carseat rental program in Calgary appear to have had some influence on the rate of the use of restraints for children.     

Bioethics for clinicians: 9. Involving children in medical decisions

Medical decisions involving children raise particular ethical issues for physicians and other members of the health care team. Although parents and physicians have traditionally made most medical decisions on behalf of children, the developing autonomy of children is increasingly being recognized in medical decision-making. This poses a challenge for physicians, who must work with the child''s family and with other health care practitioners to determine the child''s role in decision-making. A family-centred approach respects the complex nature of parent-child relationships, the dependence and vulnerability of the child and the child''s developing capacity for decision-making.     

Child fostering as a reproductive strategy among Southern African pastoralists

Information on child fosterage was obtained on 1902 individuals in the course of collecting 611 reproductive histories from Herero and Mbanderu pastoralists in northwestern Botswana in southern Africa. The hypothesis that women foster out their children as a strategy for increasing the number of children they produce is tested. Analysis of these data indicate that sex and birth year of children and parents' marital status significantly influence a child's risk of being fostered, but the relationship of fostering to fertility is unclear. More recently born individuals, females, and children born to parents who were not married to each other are more likely to be fostered than older individuals, males, and children born to parents who were married to each other. A child's risk of being fostered does not appear to be influenced by mother's age if the parents were married to each other, while children born to parents who were not married to each other are more likely to be fostered if the mother is very young, but this pattern is not clear. No association between fostering and mortality was found.     

Diarrhoea in Kwashiorkor

Diarrhoea was a common problem in the kwashiorkor seen in Kampala, contributing to the mortality and delay in recovery. Enteric infection was found in only a few children (8%), but when present it caused particularly severe diarrhoea and was frequently complicated by septicaemia.Sugar intolerance often occurred to lactose and other sugars, both monosaccharide and disaccharide. The children were most commonly intolerant of lactose, and some of these may have had a hereditary lactase deficiency.Antibiotics are rarely indicated for the treatment of diarrhoea in kwashiorkor in Kampala. If reducing substances are found in the stool of a child on a milk diet, a diet based on sucrose is substituted, and if intolerance persists a fructose diet is given. A few children are intolerant of all sugars, including fructose, and for these the prognosis is grave.     

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.     

Barriers to Provider-Initiated Testing and Counselling for Children in a High HIV Prevalence Setting: A Mixed Methods Study

Background

There is a substantial burden of HIV infection among older children in sub-Saharan Africa, the majority of whom are diagnosed after presentation with advanced disease. We investigated the provision and uptake of provider-initiated HIV testing and counselling (PITC) among children in primary health care facilities, and explored health care worker (HCW) perspectives on providing HIV testing to children.

Methods and Findings

Children aged 6 to 15 y attending six primary care clinics in Harare, Zimbabwe, were offered PITC, with guardian consent and child assent. The reasons why testing did not occur in eligible children were recorded, and factors associated with HCWs offering and children/guardians refusing HIV testing were investigated using multivariable logistic regression. Semi-structured interviews were conducted with clinic nurses and counsellors to explore these factors. Among 2,831 eligible children, 2,151 (76%) were offered PITC, of whom 1,534 (54.2%) consented to HIV testing. The main reasons HCWs gave for not offering PITC were the perceived unsuitability of the accompanying guardian to provide consent for HIV testing on behalf of the child and lack of availability of staff or HIV testing kits. Children who were asymptomatic, older, or attending with a male or a younger guardian had significantly lower odds of being offered HIV testing. Male guardians were less likely to consent to their child being tested. 82 (5.3%) children tested HIV-positive, with 95% linking to care. Of the 940 guardians who tested with the child, 186 (19.8%) were HIV-positive.

Conclusions

The HIV prevalence among children tested was high, highlighting the need for PITC. For PITC to be successfully implemented, clear legislation about consent and guardianship needs to be developed, and structural issues addressed. HCWs require training on counselling children and guardians, particularly male guardians, who are less likely to engage with health care services. Increased awareness of the risk of HIV infection in asymptomatic older children is needed. Please see later in the article for the Editors'' Summary     

Congenital Cerebral Palsy,Child Sex and Parent Cardiovascular Risk

Objective

Genes associated with cardiovascular disease may also be risk factors for congenital cerebral palsy (CP) and these associations may be modified by sex, since there is an increased risk of CP in male children. We investigated the association between CP of the child with cardiovascular disease in parents, taking sex of the child into consideration.

Methods

All parents of non-adopted singletons born in Denmark between 1973 and 2003 were included. Parents of a child with CP, confirmed by the Danish National CP registry, were considered exposed. Cox proportional hazards regressions were used to model risk of cardiovascular outcomes for exposed parents compared to all other parents beginning at the child’s 10^th birthday.

Results

We identified 733,730 mothers and 666,652 fathers among whom 1,592 and 1,484, respectively, had a child with CP. The mean age for mothers at end of follow up was 50±8 years. After adjustment for maternal age, parental education, child’s sex, child’s residence, child being small for gestational age and maternal hypertensive disorder during pregnancy, mothers of CP male children had an excess risk of cardiovascular disease (HR: 1.52, 95% CI: 1.16-2.00), attributable mostly to an increased incidence of hypertension and cerebrovascular disease. After additional adjustment for preterm birth, the association was markedly attenuated for cardiovascular disease (1.34, 95%CI: 1.02 - 1.76), became nonsignificant for hypertension, but remained significant for cerebrovascular disease (HR: 2.73, 95% CI: 1.45- 5.12). There was no increased risk of cardiovascular events in mothers of female CP children, or fathers of CP children of any sex.

Conclusions

Women that have a male child with CP are at increased risk for premature cardiovascular disease. Part of this association may be related to risk factors for preterm births.     

Grateful parents raising grateful children: Niche selection and the socialization of child gratitude

Given that children’s exposure to gratitude-related activities may be one way that parents can socialize gratitude in their children, we examined whether parents’ niche selection (i.e., tendency to choose perceived gratitude-inducing activities for their children) mediates the association between parents’ reports of their own and their children’s gratitude. Parent-child dyads (N = 101; children aged 6–9; 52% girls; 80% Caucasian; 85% mothers) participated in a laboratory visit and parents also completed a 7-day online diary regarding children’s gratitude. Decomposing specific indirect effects within a structural equation model, we found that parents high in gratitude were more likely to set goals to use niche selection as a gratitude socialization strategy, and thereby more likely to place their children in gratitude-related activities. Placement in these activities, in turn, was associated with more frequent expression of gratitude in children. We describe future directions for research on parents’ role in socializing gratitude in 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.     

Respiratory Symptoms in Children and Parental Smoking and Phlegm Production

A study of respiratory symptoms in 2,426 schoolchildren aged 6-14 years was carried out in Aylesbury, Buckinghamshire, in 1971. The prevalence of cough in the children was associated with the parents'' smoking habits; prevalence was lowest where both parents were non-smokers, highest where both parents smoked, and lay between these two levels where only one parent smoked. A close association was found between parents'' and children''s respiratory symptoms that was independent of parents'' smoking habits. There was no suggestion that exposure to the cigarette smoke generated when parents smoked had any more than a small effect upon the child''s respiratory symptoms. While the sharing of genetic susceptibility between parents and children is a factor, therefore, cross infection, particularly in the families where parents smoke, is an important element in the association.     

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.     

DXA measurements confirm that parental perceptions of elevated adiposity in young children are poor

Objective: To compare parental assessments of child body weight status with BMI measurements and determine whether children who are incorrectly classified differ in body composition from those whose parents correctly rate child weight. Also to ascertain whether children of obese parents differ from those of non‐obese parents in actual or perceived body weight. Research Methods and Procedures: Weights, heights, BMI, and waist girths of New Zealand children ages 3 to 8 years were determined. Fat mass, fat percentage, and lean mass were measured by DXA (n = 96). Parents classified child weight status as underweight, normal‐weight, slightly overweight, or overweight. Centers for Disease Control and Prevention 2000 percentiles of BMI were used. Results: Parents underestimated child weight status. Despite having 83% more fat mass than children with BMI values below the 85th percentile, only 7 of 31 children with BMI values at or above the 85th percentile were rated as slightly overweight or overweight. In the whole sample, participants whose weight status was underestimated by parents (40 of the 96 children) had l9% less fat mass but similar lean mass as children whose weight status was correctly classified. However, children of obese and non‐obese parents did not differ in body composition or anthropometry, and obese parents did not underestimate child weight more than non‐obese parents. Discussion: Because parents underestimate child weight, but BMI values at or above the 85th percentile identify high body fat well, advising parents of the BMI status of their children should improve strategies to prevent excessive fat gain in young children.     

Predictors of Children's Secondhand Smoke Exposure at Home: A Systematic Review and Narrative Synthesis of the Evidence

Background

Children''s exposure to secondhand smoke (SHS) has been causally linked to a number of childhood morbidities and mortalities. Over 50% of UK children whose parents are smokers are regularly exposed to SHS at home. No previous review has identified the factors associated with children''s SHS exposure in the home.

Aim

To identify by systematic review, the factors which are associated with children''s SHS exposure in the home, determined by parent or child reports and/or biochemically validated measures including cotinine, carbon monoxide or home air particulate matter.

Methods

Electronic searches of MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Knowledge to July 2014, and hand searches of reference lists from publications included in the review were conducted.

Findings

Forty one studies were included in the review. Parental smoking, low socioeconomic status and being less educated were all frequently and consistently found to be independently associated with children''s SHS exposure in the home. Children whose parents held more negative attitudes towards SHS were less likely to be exposed. Associations were strongest for parental cigarette smoking status; compared to children of non-smokers, those whose mothers or both parents smoked were between two and 13 times more likely to be exposed to SHS.

Conclusion

Multiple factors are associated with child SHS exposure in the home; the best way to reduce child SHS exposure in the home is for smoking parents to quit. If parents are unable or unwilling to stop smoking, they should instigate smoke-free homes. Interventions targeted towards the socially disadvantaged parents aiming to change attitudes to smoking in the presence of children and providing practical support to help parents smoke outside the home may be beneficial.