Dietary and Physical Activity Patterns: Examining Fathers' Perspectives

PURPOSE.  Obesity adversely affects children, yet limited information is available on the familial environmental influence of fathers. The purpose of this study was to examine fathers' influences on their children's eating and activity patterns.
DESIGN AND METHODS. Participants for this mixed methods study was a convenience sample of 51 multi-ethnic fathers of children 8–12 years of age, who completed surveys addressing dietary and physical activity behaviors.
RESULTS.  An association was found between fathers' and children's weight status. Half the children snacked without parental guidance.
PRACTICE IMPLICATIONS.  Nurses need to assist children and their families to develop effective weight management strategies.     

Correlates of physical fitness and activity in Taiwanese children

Aim:  This cross-sectional study examined factors related to children's physical fitness and activity levels in Taiwan.
Methods:  A total of 331 Taiwanese children, aged 7 and 8, and their mothers participated in the study. Children performed physical fitness tests, recorded their physical activities during two weekdays and completed self-esteem questionnaires. Research assistants measured the children's body mass and stature. Mothers completed demographic, parenting style and physical activity questionnaires.
Results:  Attending urban school, lower body mass index (BMI), older age and better muscular endurance contributed to the variance in better aerobic capacity, and attending rural school and better aerobic capacity contributed to the variance in better muscular endurance in boys. Attending urban school, lower BMI and better athletic competence contributed to the variance in better aerobic capacity, and younger age, rural school and higher household income contributed to the variance in better flexibility in girls.
Conclusion:  Despite the limitations of the study, with many countries and regions, including Taiwan, now emphasizing the importance of improving physical fitness and activity in children, an intervention that is gender-, geographically, and developmentally appropriate can improve the likelihood of successful physical fitness and activity programmes.     

Ecological Differences in Weight, Length, and Weight for Length of Mexican American Children in the WIC Program

PURPOSE.  Examine factors common in the environments of children who obtain services from a WIC program to determine if differences in ecological/environmental factors can be found in the children who differ in weight , length , and weight for length.
DESIGN AND METHODS.  Cross-sectional study of 300 children , 100 each who were stunted , normal weight for length , or overweight. Instruments used were NCATS , ARSMA II , 24-hr diet recall , and Baecke Activity Questionnaire.
RESULTS.  Significant differences were present in children's diet , parents' BMI , parents' generation in United States , parents' activity levels , and maternal–child relationship.
PRACTICE IMPLICATIONS.  Encourage parents to adopt family approaches to encourage normal body size in children.     

Maternal Perspectives on Lifestyle Habits That Put Children of Mexican Descent at Risk for Obesity

PURPOSE.  This article presents the views that mothers of Mexican descent have related to lifestyle habits that put children at risk for obesity.
DESIGN AND METHOD.  A qualitative, naturalistic design using ethnographic interviews was selected for this study. Informational redundancy was reached with 9 mothers of Mexican descent. Spradley's Developmental Research Sequence guided data collection and analysis.
RESULTS.  Participants held views that were congruent with the American Academy of Pediatrics' recommendations.
PRACTICE IMPLICATIONS.  Findings provide nurses with knowledge on how mothers of Mexican descent view appropriate nutrition, discipline in feeding, and the place of physical activity and television in young preschool children's lives.     

Prevention of further weight gain in overweight school children, a pilot study

Background:  Involving school nurses in weight gain prevention activities in already overweight children may be a means to address childhood obesity prevention.
Objective:  To describe and evaluate a treatment method aimed for implementation in school care centres.
Methods:  Twenty families (20 overweight children aged 7 years) were interviewed at baseline with standardized questionnaires, received simple dietary and lifestyle advice. Weight was measured and advice/support by school nurses was available monthly during the 1-year period. A follow-up was made after 1 year. Changes in wellbeing, life style and body mass index (BMI) z -score were recorded and analysed. Experiences from parents and nurses were also examined.
Results:  A good (91%) or fair (54%) adherence to dietary advice was found in children who decreased or maintained their z -score respectively. Mean BMI z -score reduced [−0.16 (p = 0.03)] during the intervention period. Generally, parents and school nurses were satisfied with the programme, helping them to set limits and be more self-confident in their role as 'health adviser' respectively.
Conclusions:  Overweight progression in younger children is possible to modify by increased awareness of the problem, of their food habits and lifestyle practices. Providing school nurses with the knowledge to address the problem and working in collaboration with dieticians and a healthcare team can be an effective means to prevent further weight gain in overweight school-age children. Possibility of stigmatization was expressed thus efforts will need to be made to carry out such a programme to preserve the children's integrity and run activities in a discrete manner in the school environment.     

Randomized Prospective Study to Evaluate Child Abuse Documentation in the Emergency Department

Objectives:  The objective was to determine whether an educational intervention for health care providers would result in improved documentation of cases of possible physical child abuse in children <36 months old treated in the emergency department (ED) setting.
Methods:  This study had a statewide group-randomized prospective trial design. Participating EDs were randomized to one of three intervention groups: no intervention, partial intervention, or full intervention. Medical records for children <36 months of age were abstracted before, during, and after the intervention periods for specific documentation elements. The main outcome measure was the change in documentation from baseline. Generalized estimating equations (GEEs) were used to test for intervention effect.
Results:  A total of 1,575 charts from 14 hospitals EDs were abstracted. Hospital and demographic characteristics were similar across intervention groups. There were 922 (59%) injury visits and 653 (41%) noninjury visits. For each specific documentation element, a GEE model gave p-values of >0.2 in independent tests, indicating no evidence of significant change in documentation after the intervention. Even among the 26 charts in which the possibility of physical abuse was noted, documentation remained variable.
Conclusions:  The educational interventions studied did not improve ED documentation of cases of possible physical child abuse. The need for improved health care provider education in child abuse identification and documentation remains. Future innovative educational studies to improve recognition of abuse are warranted.     

The quality of paediatric nursing care: developing the Child Care Quality at Hospital instrument for children

Title.  The quality of paediatric nursing care: developing the Child Care Quality at Hospital instrument for children.
Background.  Recent years have shown a growing recognition of children's rights and the need to listen to and consult with children, especially at an international level, including in the hospital setting. Children's views should be considered in the planning and delivery of paediatric nursing care. However, previous work has tended to concentrate on medical rather than nursing care.
Method.  The CCQH instrument was developed in three phases. First, in 2004 following a literature review and interviews/drawings by hospitalized children ( n  = 40), the items were designed and an expert panel ( n  = 7) assessed the instrument's content validity (phase I). Revisions were made based on children's interviews ( n  = 8), children's questionnaires ( n  = 41, 16) and nurses' evaluations ( n  = 19, 198) in phases II and III in 2004 and 2005 respectively. Construct validity was assessed in phase III by means of principal component analysis. The instrument's reliability was statistically tested in phases II and III.
Findings.  The main quality categories were nurse characteristics, nursing activities and environment. For each category, Cronbach's alpha values improved during the development process. Principal component analysis supported the theoretical construct of the subcategories in the nursing activities and environment categories.
Conclusion.  The CCQH questionnaire is a promising instrument for use among children. Future research is needed to evaluate its suitability for completion by children of varying ages and in different cultures and healthcare settings.     

Relationship of working mothers' parenting style and consistency to early childhood development: a longitudinal investigation

Title.  Relationship of working mothers' parenting style and consistency to early childhood development: a longitudinal investigation.
Aim.  This paper is a report of a longitudinal study of the relationship of working mothers' parenting style to their children's social competence and vocabulary/motor/intellectual development.
Background.  With an increasing number of women choosing to remain in the workforce after starting a family, there has been a concomitant increase in use of non-parental childcare facilities to help look after the child while the mother is at work. This increase in non-parental care has led to a dramatic change in the traditional child-rearing environment.
Methods.  Long-term investigations were conducted over a period of 2 years in 41 Japanese government-licensed childcare facilities. Child development was evaluated by childcare professionals and parenting style was assessed by questionnaire. A total of 504 children and their mothers participated in the study. Data collection was carried out in 2004 and 2006.
Findings.  We found that the changes in parenting style were statistically significantly related to children's development after 2 years. For instance, changes in the parent-child playing routine contributed to the child's social competence (odds ratio = 11·088). Variation in working mothers' disciplinary practices was also associated with children's vocabulary development after 2 years (odds ratio = 2·246).
Conclusion.  Working mothers should increase interactions with their children in their free time to reduce the risk of developmental delay. Daily childcare support provided by family members or social organizations for long-term working mothers is helpful in mediating the negative relationship of mothers' working with children's development.     

Social Capital in an Impoverished Minority Neighborhood: Emergence and Effects on Children's Mental Health

PROBLEM:  This study aims to describe and analyze neighborhood effects on children's mental health, focusing on the emergence and effects of Social Capital or informal social control.
METHOD:  Focus groups of Hispanic and African American families raising children in a low-income, minority neighborhood.
FINDINGS:  Parents' alienation from and distrust of public sources of formal social control, such as policemen, prevented the emergence of positive informal social control.
CONCLUSION:  Psychiatric nurses and nurse practitioners must utilize public health and individual therapeutic approaches to prevent and treat children's mental health problems in disorganized, violent neighborhoods.     

Internationalizing the Broselow Tape: How Reliable Is Weight Estimation in Indian Children

Objectives:  The Broselow pediatric emergency weight estimation tape is an accurate method of estimating children's weights based on height–weight correlations and determining standardized medication dosages and equipment sizes using color-coded zones. The study objective was to determine the accuracy of the Broselow tape in the Indian pediatric population.
Methods:  The authors conducted a 6-week prospective cross-sectional study of 548 children at a government pediatric hospital in Chennai, India, in three weight-based groups: <10 kg ( n =  175), 10–18 kg ( n =  197), and >18 kg ( n =  176). Measured weight was compared to Broselow-predicted weight, and the percentage difference was calculated. Accuracy was defined as agreement on Broselow color-coded zones, as well as agreement within 10% between the measured and Broselow-predicted weights. A cross-validated correction factor was also derived.
Results:  The mean percentage differences were −2.4, −11.3, and −12.9% for each weight-based group. The Broselow color-coded zone agreement was 70.8% in children weighing less than 10 kg, but only 56.3% in the 10- to 18-kg group and 37.5% in the >18-kg group. Agreement within 10% was 52.6% for the <10-kg group, but only 44.7% for the 10- to 18-kg group and 33.5% for the >18-kg group. Application of a 10% weight-correction factor improved the percentages to 77.1% for the 10- to 18-kg group and 63.0% for the >18-kg group.
Conclusions:  The Broselow tape overestimates weight by more than 10% in Indian children >10 kg. Weight overestimation increases the risk of medical errors due to incorrect dosing or equipment selection. Applying a 10% weight-correction factor may be advisable.     

Social Issues Among Children With High or Intermediate Imperforate Anus: A Proxy Perspective

PROBLEM:  Children with imperforate anus (IA) may be psychosocially affected.
METHODS:  Parents of children with IA and parents in two comparison groups rated their children using a study-specific questionnaire and the Competence Scales in the Child Behavior Checklist (CBCL). Teachers rated Academic and Adaptive Functioning Scales in the Teacher's Report Form (TRF).
FINDINGS:  School items were rated favorably by the fathers of children with IA, and mothers reported less expression of their children's will. Children with IA were socially competent according to CBCL, although they received lower ratings on the TRF.
CONCLUSIONS:  Psychosocial issues seem to be challenging for children with IA, and this needs attention in care management.     

The Information Matters Project: health, medicines and self-care choices made by children, young people and their families: information to support decision-making. Study protocol

Title.  The Information Matters Project: health, medicines and self-care choices made by children, young people and their families: information to support decision-making. Study protocol.
Aim.  This protocol outlines a study to address knowledge gaps about the types and formats of children's information which could support decision-making in respect of health, medicines and self-care.
Background.  Partnership between the public and health services is seen as the key to a healthier society and cost-effective care. A requirement of participative models is the provision of high quality information. Little information is available specifically for children, young people and their families, and little evidence concerning types and formats which could support decision-making.
Methods.  A mixed-method study will be conducted through three inter-related phases. Tracer-conditions will be used to focus the research, with a specific, although not exclusive, emphasis on medicines. Phase 1: Context : systematic literature review and critical discourse analysis of currently available children's information. Phase 2: In-depth study : we will conduct focus groups, semi-structured interviews and non-participant observation to address a range of questions about what children think about currently available information sources (focus groups), what information children and their families need and how and when they and healthcare professionals use information sources to support decision-making concerning choice (interviews and observation). Phase 3 : data synthesis and comparative analysis.
Discussion.  Outcomes include the types, formats and characteristics of information likely to support children's decision-making and choices predominantly around medicines and clinical options.     

Antibiotics for nasopharyngitis are associated with a lower risk of office-based physician visit for acute otitis media within 14 days for 3- to 6-year-old children

Objectives  This study was designed to analyse factors potentially influencing children's return visits to physicians for symptoms of acute otitis media (AOM) within 14 days after being diagnosed with nasopharyngitis (NP), and the impact of recent antibiotic use.
Design  A controlled population-based pharmaco-epidemiological trial in 3- to 6-year-old children conducted from January to May 2000.
Setting  Three different geographical regions in France.
Participants  Among 2507 eligible children, 2456 could be analysed and 505 children had 634 office-based physician visits (OBPV) for NP symptoms.
Interventions  The statistical associations between antibiotics prescribed for NP and an OBPV for AOM within 14 days in a population-based study were analysed along with risk factors of AOM.
Main outcomes measure  Clinical events and antibiotic use.
Results  During the 2 weeks following physician-diagnosed NP, antibiotic use, especially a beta-lactam, significantly decreased the risk of OBPV for AOM in children (odds ratio = 0.2; 95% confidence interval = 0.09–0.7; P  = 0.002).
Conclusion  Antibiotics prescribed to children for NP seem to protect during the following 2 weeks against the risk of OBPV for AOM. It remains to be determined whether a subgroup at high risk of developing AOM after a viral infection exists and what might be the best strategy to adopt for NP in a national programme of optimal antibiotic use.     

Low-Income Mothers' Perceptions of Health in Their Children With Growth Delay

ISSUES AND PURPOSE. Parental characteristics are the strongest predictor of poor health for children. This study examined how low-income mothers of children with growth delay define health for their children, and the behaviors they use to monitor their children's health.
DESIGN AND METHODS. Naturalistic design using Kleinman's Explanatory Model approach and interviews with 22 mothers.
RESULTS. Mothers consider nutritious food as a primary contributor to their children's health and consider healthy children to be chubby. Other indicators of health include children's energy levels, provision of nutritious food, and physical and mental activity balanced with rest.
PRACTICE IMPLICATIONS. A mother's explanatory model of health for her child can guide health promotion targeted to the mother's beliefs.     

Evaluation of a Pilot Hospital-Based Community Program Implementing Fitness and Nutrition Education for Overweight Children

PURPOSE.  Evaluate the effect of the Kids Living Fit™ hospital-based intervention on body mass index (BMI) percentile, adjusted for age (months) and gender in children ages 8–12 years with BMI percentiles ≥ 85.
DESIGN AND METHODS.  Twelve weekly exercise sessions and three nutrition presentations were held. Nurses recorded BMI and waist circumference at baseline, week 12, and week 24. Participants completed food and activity diaries .
RESULTS.  Of the 32 participants enrolled, 16 completed all outcome measures and experienced a decrease in average BMI, BMI percentile, and waist circumference between baseline and weeks 12 and 24.
PRACTICE IMPLICATIONS.  Hospitals can offer exercise and nutrition programs to decrease childhood obesity in their communities.     

Integrated health programme: a workplace randomized controlled trial

Title.  Integrated health programme: a workplace randomized controlled trial.
Aim.  This paper is the report of a pilot study to assess if an Integrated Health Programme would reduce sick leave and subjective health complaints, and increase coping in a population of nursing personnel.
Background.  The work group in Norway with most sick leave is healthcare workers. More than 50% of the sick leave is because of subjective health complaints. Work place physical exercise interventions have a documented positive effect on sick leave.
Method.  After baseline screening, employees who had agreed to participate ( n  = 40) were randomized to an intervention or control group. The intervention group participated in an Integrated Health Programme twice weekly during working hours. The programme consisted of physical exercise, stress management training, health information and an examination of the participants' workplace. The control group was offered the same intervention after the project was finished. This study was carried out from 2001 to 2002.
Findings.  There were no statistically significant effects on sick leave or health-related quality of life. The intervention group reported fewer neck complaints compared to the control group, but otherwise there were no effects on subjective health complaints. However, the subjective effects were large and highly statistically significant, the intervention group reporting improvement in health, physical fitness, muscle pain, stress management, maintenance of health and work situation.
Conclusion.  The Integrated Health Programme was not effective in reducing sick leave and subjective health complaints, but may be of use to employers wanting to increase employee job satisfaction and well-being.     

Implementation of a nutritional programme in elderly people admitted to resident homes

Aim:  The aim was to test the hypothesis that education provided to staff regarding nutritional needs and individualizing nutritional care will improve the nutritional status and functional capacity of elderly people newly admitted to resident homes.
Design:  Pre- and posttest, quasi experimental.
Setting:  Resident homes.
Subjects:  Sixty-two residents (20 men, 42 women) in the experimental group and 53 (14 men, 39 women) in the control group were consecutively included. Mean age was 85 years.
Methods:  On admission and after 4 months, nutritional status was assessed using a combination of anthropometry (weight index, arm muscle circumference and triceps skinfold thickness) and biochemical measurements (serum albumin and transthyretin). Functional capacity and overall cognitive function were also assessed. In the experimental unit, the staff received education about nutritional needs and individualized nutritional care.
Results:  After 4 months the number of residents assessed as protein energy malnourished decreased from 20 to seven in the experimental (p = 0.004), and from 17 to 10 in the control group (p = 0.1). In the experimental group, motor activity (p = 0.006) and cognitive function (p = 0.02) increased. In the control group, motor activity decreased (p = 0.02).
Conclusions:  The results indicate that the intervention had effects, as the number of protein energy malnourished residents decreased in the experimental group and motor activity and cognitive function improved. No such improvements were seen in the control group.