Parents' perceptions of taking babies' rectal temperature.

OBJECTIVE--To explore the attitudes of parents to measuring their babies'' rectal temperature. DESIGN--Qualitative study using unstructured interviews of parents given "Baby Check," a scoring system designed to assess severity of illness in babies that includes measurement of rectal temperature. SETTING--One inner city general practice in Newcastle upon Tyne. SUBJECTS--42 parents of 34 babies under 6 months old. RESULTS--Parents were reluctant to measure rectal temperature in their babies; 37 parents spontaneously raised concerns. Fifteen did not undertake measurement, 16 did so once only, and 11 did so more than once. Parents'' concerns included a fear of hurting their child, anxieties about sexual intimacy and abuse, difficulty in comforting their child, and concern for their child''s feelings. Most (33) substituted axillary measurement. CONCLUSIONS--Parents'' preference for the axillary method of measuring temperature and resistance to using a rectal method in their children was based on several concerns. If parents are to be encouraged to use the rectal method of measuring temperature in sick babies any benefits must be set against the generation of considerable parental anxiety and the resources that would be necessary to negotiate with parents and change their views.     

Comparison of parents' expectations and importance ratings for specific aspects of childbirth.

We examined parents'' expectations of many aspects of the birth experience and compared them with the importance they attached to these aspects. Expectation was defined as a respondent''s rating that a given practice would be reality, and importance was defined as a respondent''s rating of the personal importance of a practice were all options possible. Subjects in the last 6 to 8 weeks of pregnancy were asked by their obstetricians to complete a questionnaire; 231 mothers and 227 fathers responded, for a response rate of 95%. In each of six subcategories parents'' importance ratings significantly exceeded their expectation ratings. Certain items were rated as relatively less important postnatally than prenatally and by multigravid women than by primigravid women. Parents'' perceptions of available options reflect consistent discrepancy with what they wish were possible. However, increased efforts to inform parents of existing options and to provide the rationale for specific practices may reduce the discrepancy between importance and expectations. This would in turn heighten the likelihood of a psychologically positive birth experience for parents.     

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.     

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.     

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.     

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.     

Maternal and paternal controlling feeding practices: reliability and relationships with BMI

Objective: This study aimed to examine the interrelationships between mothers' and fathers' reports on the child‐feeding questionnaire (CFQ), the BMI of parents and their children, and observations of parents' controlling feeding practices at mealtimes. Methods and Procedures: Twenty‐three mothers and twenty‐three fathers of children aged between 18 and 67 months reported on their child‐feeding practices, on their child's height and weight, and were observed during a normal family mealtime at home. Results: No associations were found between mothers' reported and observed feeding practices. Fathers' reported pressure to eat and restriction were associated with more controlling observed mealtime feeding practices. Mothers and fathers did not significantly differ in their reported or observed child‐feeding practices. Children's BMI was not related to maternal or paternal reported or observed feeding practices. More mealtime pressure was observed in parents with a higher BMI. Discussion: Fathers' self‐reports of their mealtime practices are reliable. Mothers' feeding practices may differ when fathers are present and further work should examine mothers at mealtimes with and without fathers. Although children's BMI was not related to parents' use of reported or observed control, parents with a higher BMI were more controlling, highlighting the importance of considering parents' own weight in future studies.     

Parents' perceptions of food intolerance in primary school children.

In a study of about 7000 children, parents'' perceptions were used to examine the prevalence of food intolerance, the types of food implicated, the association of intolerance with diseases, and the social background of those identified as being food intolerant. One hundred and ninety two children (3%) were perceived as being food intolerant, with a further 105 (2%) being classed as intolerant under a less stringent definition of intolerance. For 128 (67%) of these children a doctor was consulted. The pattern of food avoided was very similar in children for whom the decision to exclude certain foods was made by health staff and in those for whom the parents themselves made decisions about their child''s diet. A strong association was seen between the mother''s level of education and the child being perceived as being food intolerant. Between 20% and 30% of children with a disease associated with food intolerance--for example, eczema--had currently or previously avoided some types of food. The results of this study emphasise the need to develop criteria to tackle the growing demand for National Health Service treatment by parents who believe their child to be food intolerant.     

Cultural Identity and Internationally Adopted Children: Qualitative Approach to Parental Representations

Approximately 30 000 children are adopted across national borders each year. A review of the literature on the cultural belonging of these internationally adopted children shows substantial differences between the literature from English-speaking countries and that from France and Europe in general. The objective of this study is to start from the discourse of French adoptive parents to explore their representations of their child''s cultural belonging and their positions (their thoughts and representations) concerning connections with the child''s country of birth and its culture. The study includes 51 French parents who adopted one or more children internationally. Each parent participated in a semi-structured interview, focused on the adoption procedure and their current associations with the child''s birth country. The interviews were analyzed according to a qualitative phenomenological method, Interpretative Phenomenological Analysis. The principal themes that emerged from our analysis of the interviews made it possible to classify the parents into three different groups. The first group maintained no association with the child''s country of birth and refused any multiplicity of cultural identities. The second group actively maintained regular associations with the child''s country of birth and culture and affirmed that their family was multicultural. Finally, the third group adapted their associations with the child''s birth country and its culture according to the child''s questions and interests. Exploring parental representations of the adopted child enables professionals involved in adoption to provide better support to these families and to do preventive work at the level of family interactions.     

Exploring the Relation of Harsh Parental Discipline with Child Emotional and Behavioral Problems by Using Multiple Informants. The Generation R Study

Parental harsh disciplining, like corporal punishment, has consistently been associated with adverse mental health outcomes in children. It remains a challenge to accurately assess the consequences of harsh discipline, as researchers and clinicians generally rely on parent report of young children''s problem behaviors. If parents rate their parenting styles and their child''s behavior this may bias results. The use of child self-report on problem behaviors is not common but may provide extra information about the relation of harsh parental discipline and problem behavior. We examined the independent contribution of young children''s self-report above parental report of emotional and behavioral problems in a study of maternal and paternal harsh discipline in a birth cohort. Maternal and paternal harsh discipline predicted both parent reported behavioral and parent reported emotional problems, but only child reported behavioral problems. Associations were not explained by pre-existing behavioral problems at age 3. Importantly, the association with child reported outcomes was independent from parent reported problem behavior. These results suggest that young children''s self-reports of behavioral problems provide unique information on the effects of harsh parental discipline. Inclusion of child self-reports can therefore help estimate the effects of harsh parental discipline more accurately.     

Survey of parents' attitudes to the recommended Haemophilus influenzae type b vaccine program.

A survey was conducted in a general pediatric practice to determine parents'' attitudes to and compliance with the recommended Haemophilus influenzae type b vaccine program. Of 133 families surveyed 127 (95%) responded to the questionnaire. About one third of the parents did not have their children vaccinated. The decision against vaccination was made despite parent education, follow-up telephone contact and the pediatrician''s expressed support of the vaccine program. Most of the respondents (86%) had no previous knowledge of the vaccine. The factor of greatest concern was the possibility of an adverse reaction. This concern was significantly more common among the parents who decided not to have their children vaccinated than among those who had their children vaccinated (chi 2 = 6.52, p less than 0.025). One third of the parents who indicated that they intended to have their children vaccinated required a telephone reminder. The findings suggest a need for public education about the vaccine, with particular emphasis directed at allaying fears about side effects.     

Hospitals' response to the buckle-up baby legislation in Ontario.

Drivers in Ontario are legally responsible to ensure that infants and toddlers are restrained in a child safety seat or by a lap belt. In 1982 the minister of health sent a memorandum to all medical officers of health and the administrators and medical directors of all public hospitals in Ontario, urging them to encourage and assist parents in protecting their newborn children with safety seats. In 1983 the Toronto General Hospital established the Cooperative Hospital Infant Restraint Program (CHIRP) to study the feasibility of a "loaner" program for hospitals in metropolitan Toronto. The authors describe CHIRP and its objectives. They also report the results of a questionnaire they sent in 1984 to all Ontario hospitals that had a newborn or pediatric service to assess their response to the minister''s memorandum.     

Retrospective Reports of Child Feeding Practices,Current Eating Behaviors,and BMI in College Students

Research concerning child feeding practices has focused on children and adolescents, and little is known about how feeding practices used in childhood relate to eating behaviors and weight status in early adulthood. We assessed college students' and their parents' retrospective reports of child feeding practices used when the students were in middle childhood. We also assessed the college students' current reports of their eating behaviors using the Dutch Eating Behavior Questionnaire (DEBQ) and the Intuitive Eating Scale (IES), and measured their current BMI. Results showed that college students' and their parents' reports about previous parental use of child feeding practices were not correlated. Parent reports of their own use of child feeding practices were more related to students' eating behaviors and BMI than were students' recollections about feeding practices used by their parents. An analysis of gender effects showed that there were positive correlations between parental child feeding practices, BMI, and emotional eating for female students. These relationships did not exist for male students. The results suggest that child feeding practices recollected by parents are linked to the development of emotional eating and weight status of women in early adulthood.     

Effects of childhood cancer on long-term survivors and their families.

Problems experienced by families of long-term survivors of acute lymphatic leukaemia and Wilms''s tumour were investigated to find out the best way of using limited resources to improve management of such patients. All patients had received treatment at Alder Hey Children''s Hospital, and all had completed treatment at least two years before the study. A social worker interviewed the parents of each child. The results showed that various aspects of management needed improvement, including: information given to parents at diagnosis of their child''s illness and during subsequent treatment; continuity of care and multidisciplinary teamwork among those caring for the child; greater understanding by school teachers that such children have the same educational needs as others; wider communication by hospital staff with the child''s other relatives, particularly grandparents; financial help for parents; and marital counselling. To help implement these proposals full-time social workers were attached to the hospital. Preliminary results were encouraging, though it is too early to evaluate the long-term effects of the changes.     

Absence from school related to children's and parental smoking habits.

A sample of 2885 children aged 12 and 13 who completed a questionnaire survey in school in January 1987 were given a second questionnaire on a specified date in May 1987. The smoking habits, parental smoking habits, sex, and social background of the children who were present on both dates were compared with those of the children who were absent on the second occasion. Regular smoking was significantly more common among those absent for the second questionnaire: among boys 181/877 (21%) who never smoked, 109/486 (22%) who sometimes smoked, and 21/45 (47%) who regularly smoked were absent, and among girls the figures were 157/947 (17%), 117/487 (24%), and 17/43 (40%) respectively. Thus the odds ratio for those who sometimes smoked was 1.29 and for regular smokers 3.09 against those who never smoked. Whatever the children''s smoking habits, the proportion who were absent was higher when both parents or at least the mother smoked, the odds ratio being 1.39; the proportions absent were 203/1180 (17%) if neither parent or only the father smoked v 135/644 (21%) if both parents or only mother smoked for children who never smoked; 105/529 (20%) v 121/444 (27%) for those who sometimes smoked; and 10/27 (37%) v 28/61 (46%) for those who regularly smoked. Sex and social background had little effect, though there was an overall higher rate of absence among boys from industrial areas. The findings show a higher rate of minor ailments in children who smoke and in children whose mother smokes. If children are having frequent days off school for minor ailments possibly they or their parents would benefit from advice and help in stopping smoking.     

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.     

Two Randomized Trials Provide No Consistent Evidence for Nonmusical Cognitive Benefits of Brief Preschool Music Enrichment

Young children regularly engage in musical activities, but the effects of early music education on children''s cognitive development are unknown. While some studies have found associations between musical training in childhood and later nonmusical cognitive outcomes, few randomized controlled trials (RCTs) have been employed to assess causal effects of music lessons on child cognition and no clear pattern of results has emerged. We conducted two RCTs with preschool children investigating the cognitive effects of a brief series of music classes, as compared to a similar but non-musical form of arts instruction (visual arts classes, Experiment 1) or to a no-treatment control (Experiment 2). Consistent with typical preschool arts enrichment programs, parents attended classes with their children, participating in a variety of developmentally appropriate arts activities. After six weeks of class, we assessed children''s skills in four distinct cognitive areas in which older arts-trained students have been reported to excel: spatial-navigational reasoning, visual form analysis, numerical discrimination, and receptive vocabulary. We initially found that children from the music class showed greater spatial-navigational ability than did children from the visual arts class, while children from the visual arts class showed greater visual form analysis ability than children from the music class (Experiment 1). However, a partial replication attempt comparing music training to a no-treatment control failed to confirm these findings (Experiment 2), and the combined results of the two experiments were negative: overall, children provided with music classes performed no better than those with visual arts or no classes on any assessment. Our findings underscore the need for replication in RCTs, and suggest caution in interpreting the positive findings from past studies of cognitive effects of music instruction.     

First-Time Parents Are Not Well Enough Prepared for the Safety of Their Infant

Background

Unintentional falls and poisonings are major causes of death and disability among infants. Although guidelines are available to prevent these injuries, safety behaviours are not performed by parents, causing unnecessary risks. Little is known about safety behaviours of first-time parents and whether they behave according to these guidelines.

Aims/Objectives/Purpose

The objective of this study was to compare safety behaviours of first-time parents with those of non-first-time parents and to determine correlates of unsafe behaviour of parents of infants. We used self-report questionnaires to assess safety behaviours in a cross-sectional study sample.

Methods

A total of 1439 parents visiting a preventive youth healthcare centre in the Netherlands were invited to complete a questionnaire with regard to the prevention of falls and poisonings. Parents were categorized into first-time parents and non-first-time parents. Correlates of parents'' child safety behaviours were determined using multiple logistic regression analyses.

Results/Outcome

Most respondents were mothers (93.2%); 48.2% of families were first-time parents. The mean age of the infants was 7.2 months (SD 1.1; range 4–12), 51.8% were boys, and 34.5% of infants could crawl. First-time parents were more likely not to have a stair gate installed (OR 16.46; 95% CI 12.36–21.93); were more likely to store cleaning products unsafely (OR 4.55; 95% CI 3.59–5.76); and were more likely to store medicines unsafely (OR 2.90; 95% CI 2.31–3.63) than non-first-time parents. First-time parents were more likely to not have a window guard installed (OR 1.52; 95% CI 1.08–2.15) (all P<0.05).

Discussion/Conclusion

First-time parents are not well prepared for the safety of their infant, causing unnecessary risks. The various parents'' safety behaviours were influenced by different variables, for example, age of the infant, crawling of the infant, mother''s educational level, mother''s ethnicity, self-efficacy, vulnerability, severity.     

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.