Traditional perspectives on child and family health

First Nations and American Indian communities experience significant health disparities compared with the general populations of Canada and the United States. Children from these communities experience higher rates of infant mortality, suicide and unintentional injury. From a traditional Lakota perspective, many of the health disparities faced in Aboriginal communities are linked to imbalances in the family and community. These imbalances can lead to detrimental behaviours, including substance abuse, alcoholism and domestic violence. The Medicine Wheel is a traditional symbol that can be used to attain a better understanding of these imbalances and how they relate to family and child health. However, significant differences exist between the perspectives of modern medical science and traditional cultures. To promote wellness and to prevent morbidity and mortality in a culturally appropriate way, current efforts need to focus attention on traditional cultural values and perspectives that incorporate the balance of the community and the health of the family. Traditionally, we understood that the health of the family and community has a significant impact on the health of children. To more effectively promote health and to prevent imbalance, children from these communities need to understand traditional values and to feel that they are an important link between traditional culture and future generations.     

Mental health in international adoptees as teenagers and young adults. An epidemiological study

Sweden has now around 38,000 individuals who have been adopted from other countries. Most often they are transracially adopted and have a different appearance from their new parents—"visible " adoptions. This study was made to explore the mental health of a teenager/young adult group that arrived with their families in the southernmost county of Sweden between 1970 and 1977. They were placed through the largest Swedish adoption agency at that time. One hundred and forty-seven families and their 211 adopted children, who were 13 years of age or older at the time of the investigation, were interviewed in their homes. CBCL, SCL-90, a self-esteem questionnaire, and two family relations inventories were also completed. Compared to nonadopted Swedish young persons of the same ages, who had been investigated with the same inventories in earlier epidemiological studies, the adoptees had as good mental health. The adoptees also reported good self-esteem. The pre-adoption conditions were more important than the age of arrival in itself for the risk of later maladaptation. Family relations, various aspects of identity, and peer relations explained much of the variance of mental health and self-esteem. Those who were most engaged in questions about their identity and felt mostly non-Swedish had more behaviour problems. The association, however, between the factor " Identity " and the mental health variables approached zero for the older subjects (18–27 years of age). The majority (about 90%) of the adoptees felt mostly Swedish. Seventy per cent didn't feel any connection to their country of origin.     

Longitudinal change in parenting associated with developmental delay and catch-up

The current study examined the predictors of parent-child relationship quality and developmental change in a sample of children adopted into the U.K. following severe early privation, and in a comparison sample of nondeprived, within-country adoptees. One hundred and fifty-eight children adopted from Romania and 52 U.K. adoptees were assessed at age 6 years; longitudinal data (age 4 and 6 years) were available on the 110 Romanian adoptees placed into U.K. homes before 24 months of age and all U.K. adoptees. Ratings of parent-child positivity and negativity during a semistructured interaction task were obtained from coders who were blind to the child's background. Results indicated that adoptive parent-child relationship quality was related to duration of deprivation and that cognitive/developmental delay mediated this association. The magnitude of this effect was modest and diminished over time. Longitudinal analyses revealed that positive change in parent-child relationship quality was most marked among children who exhibited cognitive catch-up between assessments. The direction of effects appeared to be primarily child to parent. The findings underscore the need for further research on the long-term impact of early experiences on psychosocial development.     

Early childhood caries in Indigenous communities: A joint statement with the American Academy of Pediatrics

The oral health of Indigenous children of Canada (First Nations, Inuit and Métis) and the United States (American Indian and Alaska Native) is a major child health issue. This is exemplified by the high prevalence of early childhood caries (ECC) with resulting adverse health effects, as well as high rates and costs of restorative and surgical treatments under general anesthesia. ECC is an infectious disease that is influenced by multiple factors, including socioeconomic determinants, and requires a combination of approaches for improvement. The present statement includes recommendations for oral health preventive and clinical care for young infants and pregnant women by primary health care providers, community-based health promotion initiatives, oral health workforce and access issues, and advocacy for community water fluoridation and fluoride varnish program access. Further community-based research on the epidemiology, prevention, management and microbiology of ECC in Indigenous communities would be beneficial.     

Risk for schizophrenia in intercountry adoptees: a Danish population-based cohort study

BACKGROUND: Increasing numbers of intercountry adoptees are reaching adulthood, the age of onset for most serious mental disorders. Little is known about the development of schizophrenia in intercountry adoptees, a group with potentially increased vulnerability. The aim of this study was to investigate the risk of developing schizophrenia in adoptees and in non-adoptees. METHODS: Utilising data from the Danish Civil Registration System, we established a population-based cohort of 1.06 million persons resident in Denmark before the age of 15, whose legal mother lived in Denmark at the child's birth. Intercountry adoptees were identified as children born abroad. Record linkage provided information on psychiatric admissions.RESULTS: Intercountry adoptees had an increased relative risk (RR) (RR = 2.90, 95% CI 2.41-3.50) of developing schizophrenia compared to native Danes. The increased risk was independent of age at onset and age at, or region of, adoption, and was not attributable to mental illness in a foster parent, the foster parent's age, or to urbanisation. The foster mother's own biological offspring had also an increased risk of developing schizophrenia (1.92, 95% CI 1.23-3.02). CONCLUSIONS: Young adult intercountry adoptees are at increased risk for schizophrenia. Although the underlying cause is unknown, a complex interplay of factors presumably may be involved, including heredity, adversity prior to adoption, and post-adoption adjustment difficulties during upbringing.     

Post-adoption contact, adoption communicative openness, and satisfaction with contact as predictors of externalizing behavior in adolescence and emerging adulthood

Background: This study examined the relation between three variables related to adoptive family relationships (post‐adoption contact between adoptive and birth family members, adoption communicative openness, and satisfaction with contact) and adoptee externalizing behavior in adolescence and emerging adulthood. Method: The study included 190 families of infant‐placed, domestic adoptees during childhood, adolescence, and emerging adulthood. Structural equation modeling (SEM) was used to analyze predictors of externalizing behavior from contact (adoptive parents and adolescent reports), adoption communicative openness (adoptive mothers), and satisfaction with contact (adoptive parents and adolescent). Results: Externalizing behavior showed moderate stability across childhood, adolescence, and emerging adulthood. Contact and adoption communicative openness were related to each other, but not to externalizing behaviors in adolescence or emerging adulthood. Controlling for the effect of Childhood Externalizing, adoptive families most satisfied with contact reported relative declines in adoptee externalizing behavior during adolescence compared to those in less satisfied families. Satisfaction was also indirectly associated with Emerging Adult Externalizing, through its effect on Adolescent Externalizing. Conclusions: Although contact and adoption communicative openness were highly correlated with each other, neither was related to adoptees’ externalizing behavior in adolescence or emerging adulthood. Family‐level satisfaction with contact was more predictive of externalizing outcomes.     

Comparison of impact on mood,health, and daily living experiences of primary caregivers of walking and non-walking children with cerebral palsy and provided community services support

Many children with cerebral palsy (CP), especially non-walkers, were previously reported to have cold extremities, pain, sleeping disorders, constipation, and impaired well-being – besides accompanying impairments. Most children had had one or more of these symptoms for more than 1 year, and the symptoms were largely untreated. This study (1) describes mood, health, and daily life experiences of the children's parents; (2) explains impact that the child's impairments and symptoms have on the family; and (3) investigates community services support. Information in this study was gathered from parents of 106 children, ages 5–16, with CP, who lived in northern Sweden. Compared with parents of walkers, parents with non-walking children and several disorders were more frequently anxious for their children's physical and psychological health; often experienced restricted time for themselves; reported frequent daily living interferences; and stated that their health was affected due to the child's health. 10 percent of all families reported that their need of community services support was unmet. To improve health and to provide good community services support for the entire family, regular follow-up and evaluation of the child's treatment and family support are important.     

International adoption: what is fact, what is fiction, and what is the future?

Despite the popularity of international adoption in North America and Western Europe as a means to build a family, the knowledge of health care professionals is often limited regarding the historical context of this phenomenon as well as the motivations and process experienced by adoptive parents. Although international adoption is viewed as an acceptable if not admirable method of forming kinships in accepting countries, opinions in the international community are mixed. Whether international adoptions increase or are drastically curtailed depends on addressing the misgivings that many countries have about placing their children abroad. Concerns center in two broad areas: sensitivity toward preservation of family and culture and whether the process has sufficient integrity to act in the best interests of children and birth parents.     

Prevalence and risk indicators of alcohol abuse and marijuana use among on-reserve First Nations youth

The objectives of the present study were to identify the prevalence of alcohol abuse and marijuana use among First Nations youth living on-reserve, and to identify independent risk indicators associated with these behaviours. Two hundred four students from the Saskatoon Tribal Council (Saskatchewan) who were enrolled in grades 5 through 8 were asked to complete a school health survey. The prevalence of alcohol abuse and marijuana use among First Nations on-reserve youth was 23.5% and 14.7%, respectively. Surprisingly, female First Nations youth were more likely to abuse alcohol and use marijuana than male First Nations youth. The prevalence of alcohol abuse and marijuana use among Saskatoon urban youth of the same age were only 5.4% and 2.7%, respectively. After regression analysis, five independent risk indicators were associated with alcohol abuse and marijuana use among First Nations on-reserve youth. The prevalence of alcohol abuse among First Nations on-reserve youth is higher than that in neighbouring urban youth of the same age.     

Early childhood caries in indigenous communities

The oral health of Indigenous children of Canada (First Nations, Inuit, and Métis) and the United States (American Indian, Alaska Native) is a major child health issue: there is a high prevalence of early childhood caries (ECC) and resulting adverse health effects in this community, as well as high rates and costs of restorative and surgical treatments under general anesthesia. ECC is an infectious disease that is influenced by multiple factors, including socioeconomic determinants, and requires a combination of approaches for improvement. This statement includes recommendations for preventive oral health and clinical care for young infants and pregnant women by primary health care providers, community-based health-promotion initiatives, oral health workforce and access issues, and advocacy for community water fluoridation and fluoride-varnish program access. Further community-based research on the epidemiology, prevention, management, and microbiology of ECC in Indigenous communities would be beneficial.     

Behavior problems and mental health contacts in adopted, foster, and nonadopted children

The implications of adoption for the emotional and behavioral adjustment of children have been an issue in child welfare for many years. Past research has suggested that adopted children are over-represented in mental health settings. In addition, some studies have suggested that adopted and nonadopted children differ on measures of social, emotional, behavioral, and cognitive functioning. The current study used data from a large, representative sample in the United States to examine whether adopted children are more likely to have had mental health contacts or emotional or behavioral problems than nonadopted children. Age of placement in the adoptive home was examined as a variable contributing to the adjustment of adopted children. Results suggest that adopted and foster children are more likely to have mental health contacts than nonadopted children. Results are mixed regarding whether adopted and foster children have more behavior problems than nonadopted children. However, significant differences between adopted, foster, and nonadopted children disappeared when a small group of influential cases were removed. This suggests that the differences seen between the groups reflect a small number of cases and are not representative of the groups of adoptees and foster children as a whole. The vast majority of adopted children showed patterns of behavior problems similar to those of nonadopted children. These results are discussed in relation to the past literature and areas for future research.     

Childhood drowning in Manitoba: A 10-year review of provincial Paediatric Death Review Committee data

BACKGROUND:

Drowning is the second leading cause of unintentional injury death for Canadian children up to 19 years of age. Specific regional drowning prevention strategies require a detailed understanding of patterns of injury, including risk factors. Paediatric death review committees have the opportunity to identify these risk factors, and to identify and advocate prevention strategies.

OBJECTIVES:

The purpose of the present study was to analyze Manitoba Paediatric Death Review Committee (PDRC) drowning data to identify drowning risk factors and potential prevention strategies.

METHODS:

A 10-year (1988–1997) review of the College of Physicians and Surgeons of Manitoba PDRC database was performed. Drowning deaths were summarized in terms of demographic variables and lack of supervision at the time of the drowning events.

RESULTS:

Seventy-three drowning deaths were reviewed by the PDRC during the study period. These children ranged from 29 days to 14 years of age. They included 50 boys and 30 First Nations children. The highest mortality rates were found in First Nations children (12.4/100,000 First Nations children compared with 1.9/100,000 non-First Nations children), boys (3.9/100,000 boys compared with 1.9/100,000 girls) and toddlers aged one to four years (5.9/100,000 children).

CONCLUSIONS:

Priority populations for drowning prevention in Manitoba include First Nations children, boys and toddlers. Death review committees can contribute to childhood injury prevention by reviewing injury deaths, analyzing and reporting injury mortality data, and identifying and advocating prevention strategies.     

Mental health service use in a community head start population

BACKGROUND: Evaluating access to and delivery of mental health services for young children was a primary objective of the national research demonstration program Starting Early Starting Smart (SESS). OBJECTIVE: To present preliminary findings on family mental health and use of services in a community Head Start population at time of entry into a longitudinal study as part of the SESS program. SUBJECTS: Children enrolled for Head Start entry in 1998 and 1999 (N = 290; mean age, 4.3 years). Of these children, 52% were boys. METHODS: Data on demographic factors, child and parent mental health, and service use were collected from the sample at baseline. Information was gathered from primary caregivers and teachers using standardized questionnaires and structured interviews. RESULTS: There was low concordance between parent and teacher ratings of child behavior. Factors predicting behavior problems in young children varied according to whether the parent or teacher rated the child as having behavior problems. Sex (male) and home environment were associated with teachers rating the child as having a behavior problem. Parent mental health problems and problems in the parent-child relationship were associated with parent ratings. Only home environment was associated with child-focused service utilization (services that help parents manage children's behavior). CONCLUSIONS: Demographic risk factors were not associated with child behavior problems or use of mental health services in this group of Head Start children. Findings suggest that children with behavioral problems have unmet mental health service needs. Interventions designed to address both parent mental health needs and sensitivity to the developmental needs of children may increase child-focused mental health service utilization.     

Well-Being in Middle Childhood: An Assets-Based Population-Level Research-to-Action Project

This paper presents findings from a population-level, research-to-action partnership project on children’s well-being during the middle childhood years. Relations between 4th graders’ (N = 3,026) well-being (composite of satisfaction with life, optimism, self-concept, overall health, and depressive symptoms) and their social and contextual assets (adult connectedness, peer connectedness, school experiences, health habits, after-school program participation) were examined via a school district-wide administration of the Middle Years Development Instrument (MDI)—a self-report, population-based survey administered by teachers to children in their classrooms. Findings corroborated the premise that children’s well-being is associated with their social and contextual assets. Specifically, after controlling for socioeconomic status and language background, significant and positive relationships were found between children’s well-being and the number of social and contextual assets reported, with each additional asset associated with a significantly higher level of well-being. In order to disseminate our findings to school and community stakeholder groups and to facilitate the translation of research into action, we developed geographical maps that illustrate the relationship between the children’s well-being composite and their social and contextual assets at the neighborhood-level. We conclude by addressing theoretical, methodological, and practical challenges of our research-to-action partnership, and by discussing the importance of collecting and disseminating population-level data on children’s well-being in combination with data on developmentally-relevant social and contextual factors that are amenable to change by school and community programs and initiatives.     

Plasticity of growth in height, weight, and head circumference: meta-analytic evidence of massive catch-up after international adoption

Are serious growth delays caused by malnutrition and neglect permanent or reversible? The effects of institutionalization and international adoption on children's physical growth are estimated with meta-analysis. Studies with sufficient data to compute differences between adoptees and the reference population (33 papers with 122 study outcomes) were collected through Web of Science, ERIC (Education Resource Information Center), PsycINFO (Psychological Literature), and Medline (U.S. National Library of Medicine) (1956-2006). The influence of pre- and postadoption care on height, weight, and head circumference was tested. Effect sizes (d) and confidence intervals (CIs) around the point estimate for the growth lag indices were computed. The more time spent in institutional care, the more the children lagged behind in physical growth (d = 1.71, 95% CI: 0.82-2.60, n = 893). At adoptive placement, the children showed large delays in height, weight, and head circumference (d = -2.39 to -2.60; n = 1331-3753). Although after adoption, they showed almost complete catch-up of height (d = -0.57, 95% CI: -0.87 to -0.27, n = 3437 adoptees) and weight (d = -0.72, 95% CI: -1.04 to -0,39, n = 3259 adoptees), catch-up of head circumference seemed slower and remained incomplete (d = -1.56, 95% CI: -2.27 to -0.85, n = 527). Later age at arrival was related to less complete catch-up of height and weight. International adoption leads to substantial catch-up of height and weight but not of head circumference, demonstrating differential plasticity of children's physical growth.     

Functions of social networks in maternal food choice for children in Mexico

Food choice for children has important implications in establishing early-life dietary habits and preferences. Food choice for children has been studied as parent–child dyad dynamics, but little is known about the extended system of relationships in maternal food choice for children. The objective of this study was to understand the functions of mothers' social networks in the food choices that mothers make for their children ages 1 to 5 years old in rural Mexico. In-depth interviews were conducted with 46 participants in three rural communities. The interviews inquired about participants' child-feeding practices, personal and local beliefs about child feeding and the individuals with whom they had conversations about food and child feeding. All interviews were conducted in Spanish, audio-recorded, transcribed verbatim, verified for quality and analysed using the constant comparative method. Five interconnected networks emerged, consisting of household family, non-household family, community, children's initial school and health and nutritional programme personnel. Each network had functions in food choice that ranged from shared food decision-making in the household family network to imparting formal dietary guidance in the health and nutritional programme personnel network. Across the networks, professionals, participants' mothers and mothers-in-law, community senior women and other women with children emerged as prominent figures whom participants would turn to for child-feeding advice. These findings provide empirical evidence that social networks, as an organized system of interconnected relationships, have vital functions in establishing social norms for food choices made for children that can be leveraged to promote healthy food choices.     

Caring for children,focusing on children

Two First Nations girls with leukemia received a significant amount of media attention in 2014 and 2015. In both cases, the parents refused to continue chemotherapy, the only proven effective treatment; they opted instead for a combination of traditional Aboriginal healing approaches and alternative therapies offered in a facility outside of the country. One child has died; the other relapsed and required chemotherapy to avoid death.Media reports were polarized, focusing either on the historical legacy of distrust felt by First Nations people when accessing health care, or the need for child protection services to intervene. One article in the Canadian Medical Association Journal focused on the legacy of mistrust and methods of countering it, but did not address the legal and ethical duties of physicians in such situations.The present commentary describes the events, responsibilities of professionals involved and a course of action for physicians when faced with similar circumstances.     

Early adolescent outcomes of institutionally deprived and non-deprived adoptees. III. Quasi-autism

BACKGROUND: Some young children reared in profoundly depriving institutions have been found to show autistic-like patterns, but the developmental significance of these features is unknown. METHODS: A randomly selected, age-stratified, sample of 144 children who had experienced an institutional upbringing in Romania and who were adopted by UK families was studied at 4, 6, and 11 years, and compared with a non-institutionalised sample of 52 domestic adoptees. Twenty-eight children, all from Romanian institutions, for whom the possibility of quasi-autism had been raised, were assessed using the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) at the age of 12 years. RESULTS: Sixteen children were found to have a quasi-autistic pattern; a rate of 9.2% in the Romanian institution-reared adoptees with an IQ of at least 50 as compared with 0% in the domestic adoptees. There were a further 12 children with some autistic-like features, but for whom the quasi-autism designation was not confirmed. The follow-up of the children showed that a quarter of the children lost their autistic-like features by 11. Disinhibited attachment and poor peer relationships were also present in over half of the children with quasi-autism. CONCLUSIONS: The findings at age 11/12 years confirmed the reality and clinical significance of the quasi-autistic patterns seen in over 1 in 10 of the children who experienced profound institutional deprivation. Although there were important similarities with 'ordinary' autism, the dissimilarities suggest a different meaning.     

Fragile families and child wellbeing

Jane Waldfogel, Terry-Ann Craigie, and Jeanne Brooks-Gunn review recent studies that use data from the Fragile Families and Child Wellbeing Study (FFCWS) to examine why children who grow up in single-mother and cohabiting families fare worse than children born into married-couple households. They also present findings from their own new research. Analysts have investigated five key pathways through which family structure might influence child well-being: parental resources, parental mental health, parental relationship quality, parenting quality, and father involvement. It is also important to consider the role of the selection of different types of men and women into different family types, as well as family stability. But analysts remain uncertain how each of these elements shapes children's outcomes. In addition to providing an overview of findings from other studies using FFCWS, Waldfogel, Craigie, and Brooks-Gunn report their own estimates of the effect of a consistently defined set of family structure and stability categories on cognitive, behavioral, and health outcomes of children in the FFCWS study at age five. The authors find that the links between fragile families and child outcomes are not uniform. Family instability, for example, seems to matter more than family structure for cognitive and health outcomes, whereas growing up with a single mother (whether that family structure is stable or unstable over time) seems to matter more than instability for behavior problems. Overall, their results are consistent with other research findings that children raised by stable single or cohabiting parents are at less risk than those raised by unstable single or cohabiting parents. The authors conclude by pointing to three types of policy reforms that could improve outcomes for children. The first is to reduce the share of children growing up in fragile families (for example, through reducing the rate of unwed births or promoting family stability among unwed parents). The second is to address the pathways that place such children at risk (for example, through boosting resources in single-parent homes or fostering father involvement in fragile families). The third is to address directly the risks these children face (for example, through high-quality early childhood education or home-visiting policies).     

A community-based study of childhood handicap in Oman.

This paper reports the findings of a preliminary survey carried out in an Omani community to assess the prevalence of handicap amongst children, and its impact on the family. The sample comprised of 492 children less than 15 years of age. The disabilities identified related to chromosomal abnormality, genetic, perinatal, and infectious factors. The presence of mental retardation, with associated social taboos, confounds the problem in Oman. The study showed that, although some handicapped children may be accepted within the family, there was a sense of shame and rejection vis-à-vis the community. The prevalence of 2 per cent is only the tip of the iceberg. The study defines the sociocultural aspects of the Omani society which are conducive to the perpetuation of this important health and social problem.