From financial hardship to child difficulties: main and moderating effects of perceived social support

Background There is an unequivocal relationship between socio‐economic status and child well‐being. The Family Stress Model of economic hardship proposes that this relationship is mediated by financial hardship, parenting stress and parenting behaviours. In this study, the Family Stress Model is tested and analysis is extended to examine main and moderating effects of social support. Methods A survey incorporating well‐validated measures of financial hardship, parenting stress, parenting behaviours and child difficulties was sent to 1296 parents who had utilized universal family support services in Alberta, Canada. A total of 923 parents (71%) responded. Hierarchical linear regression was employed to investigate the mediating roles of financial hardship, parenting stress and parenting behaviours, and to investigate main and moderating influences of parental social support. Results The study findings generally support the Family Stress Model. The relationship between socio‐economic status and child difficulties was mediated by financial hardship and parenting stress. Higher levels of parental social support were associated with lower levels of parenting stress, ineffective parenting and child difficulties. Parental social support was important irrespective of parenting stress levels. Conclusions The study findings add to the now critical mass of data showing that parent–child health and well‐being is inextricably linked with parental social support. While there is a burgeoning literature on parent training, far less research attention has been given to the development and evaluation of strategies to strengthen parents' social relationships. This is an important direction for future research.     

Parental fatigue and parenting practices during early childhood: an Australian community survey

Background Parenting behaviours are influenced by a range of factors, including parental functioning. Although common, the influence of parental fatigue on parenting practices is not known. The first aim of this study was to investigate the relationship between fatigue and parenting practices. The second aim was to identify parental psychosocial factors significantly associated with fatigue. Methods A sample of 1276 Australian parents, of at least one child aged 0–5 years, completed a survey. Demographic, psychosocial (social support, coping responses) and parental sleep and self‐care information was collected. Hierarchical regression was performed to assess the contribution of fatigue (modified Fatigue Assessment Scale) to parental practices (warmth, irritability and involvement), and parenting experiences (Parenting Stress Index, Parenting Sense of Competence Scale). Hierarchical multiple regression assessed the contribution of a range of parental sleep, psychosocial (social support, coping responses) and self‐care variables to fatigue when demographic characteristics were held constant. Results Higher fatigue was significantly associated with lower parental competence (β=?0.17, P < 0.005), greater parenting stress (β= 0.21, P < 0.005) and more irritability in parent–child interactions (β= 0.11, P < 0.005). Several psychosocial characteristics were associated with higher parental fatigue, including inadequate social support, poorer diet, poorer sleep quality and ineffective coping styles including self‐blame and behaviour disengagement. Conclusions Fatigue is common, and results suggest that fatigue contributes to adverse parental practices and experiences. However, possible risk factors for higher fatigue were identified in this study, indicating opportunities for intervention, management and support for parents.     

Siblings' caring roles in families with a child with epilepsy

Despite large amounts of care for chronic conditions being provided within the family, information regarding the extent to which siblings contribute to informal care practices in families where a child has a chronic condition is limited. This article draws on multiple perspective data from 24 families that had a child with epilepsy. In doing so, the article illustrates siblings' significant contribution to caring for their brother or sister and further develops the alert assistant concept. Two additional distinct caring roles that the siblings took on are also outlined – the substitute parent and parenting assistant roles. The relationship between siblings' socio‐demographic characteristics and their caring responsibilities is also explored. The paper's findings are that siblings who were older, female and those in families with a higher child to parent ratio took on more caring responsibilities. Consequently, this article contributes to the currently limited literature on siblings who care for a chronically ill brother or sister by increasing understandings of different caring roles and experiences of chronic illness in families.     

The health of children in sole‐parent families in New Zealand: results of a population‐based cross‐sectional survey

Objective: To investigate whether children in sole‐parent families in New Zealand bear excess risks of poor mental and physical health relative to children in two parent families. Data sources and statistical methods: The data source was the 2006/07 New Zealand Health Survey, a nationally representative household survey that sampled 502 children (5‐14 years) of sole mothers and 1,281 children of partnered mothers. Results: Children of sole mothers were 1.26 (0.94 – 2.69) times as likely as children of partnered mothers to return a low PhS score. Adjusting for maternal health and family socio‐economic disadvantage eliminated this weak association (which in any case was of borderline statistical significance). Children of sole mothers were more than twice as likely as children of partnered mothers to return a low PsS score, adjusting for demographic variables only. Conclusions: There is only a weak negative association (if any) between sole‐parenting and child physical health, but a stronger association with child mental health – consistent with most of the New Zealand and international literature. The association with child mental health is largely (but possibly not completely) ‘explained’ by the poorer mental health of sole‐parents and the poorer socio‐economic circumstances of single‐parent families (on average). Implications: These findings support policies aiming to improve access of sole‐parents and their children to community mental health services, and (more especially) policies aiming to ameliorate the disadvantaged economic circumstances of single parent families.     

Parenting Stress,Dinnertime Rituals,and Child Well‐being in Working‐Class Families

This study examined the extent to which family dinnertime rituals serve a protective role for families experiencing high levels of stress. Using data from a longitudinal study of working‐class couples, the role of dinnertime rituals as a moderator of mothers' and fathers' parenting stress and child psychosocial outcomes was investigated. Greater dinnertime rituals reported by fathers moderated the effect of parenting stress on internalizing problems for girls, but not for boys. Fathers' reports of dinnertime rituals were related to fewer behavioral symptoms, internalizing problems and externalizing problems, and greater adaptive skills for girls. No significant interaction effects for mothers' parenting stress or rituals were found, but there were significant main effects of mothers' parenting stress and dinnertime rituals on child outcomes. These findings suggest that dinnertime rituals can potentially moderate the effects of parenting stress on child outcomes and fathers and daughters showed the greatest benefits of these family practices.     

Factors influencing parenting in early childhood: a prospective longitudinal study focusing on change

Background Parenting influences child outcomes but does not occur in a vacuum. It is influenced by socio‐economic resources, parental health, and child characteristics. Our aim was to investigate the relative importance of these influences by exploring the relationship between changing parental health and socio‐economic circumstances and changes in parenting. Methods Data collected from the Avon Longitudinal Study of Parents and Children were used to develop an eight‐item parenting measure at 8 and 33 months. The measure covered warmth, support, rejection, and control and proved valid and reliable. Regression analysis examined changes in financial circumstance, housing tenure, marital status, social support, maternal health and depression, and their influence on parenting score. The final model controlled for maternal age, education, and baseline depression. Results Most mothers reported warm, supportive parenting at both times. Maternal depression was the only variable for which both positive and negative change was associated with changes in parenting score. Less depression was associated with better parenting scores and more depression with worse parenting scores. Improvements in social support and maternal general health were both associated with improved parenting scores, but for neither of these variables was deterioration associated with deterioration in parenting scores. Worsening financial circumstances predicted deterioration in parenting score, but improvements were not predictive of improvements in parenting. Conclusions Programmes aiming to improve parental health and social support are likely to return greater dividends with regard to improving parenting than programmes that aim to reduce family poverty.     

Mother–Child Interactions and the Associations with Child Healthcare Utilization in Low-Income Urban Families

Studies have demonstrated that low-income families often have disproportionately high utilization of emergency department (ED) and hospital services, and low utilization of preventive visits. A possible contributing factor is that some mothers may not respond optimally to their infants’ health needs, either due to their own responsiveness or due to the child’s ability to send cues. These mother–child interactions are measurable and amenable to change. We examined the associations between mother–child interactions and child healthcare utilization among low-income families. We analyzed data from the Nurse-Family Partnership trial in Memphis, TN control group (n = 432). Data were collected from child medical records (birth to 24 months), mother interviews (12 and 24 months postpartum), and observations of mother–child interactions (12 months postpartum). We used logistic and ordered logistic regression to assess independent associations between mother–child interactions and child healthcare utilization measures: hospitalizations, ED visits, sick-child visits to primary care, and well-child visits. Better mother–child interactions, as measured by mother’s responsiveness to her child, were associated with decreased hospitalizations (OR: 0.51; 95% CI: 0.32, 0.81), decreased ambulatory-care-sensitive ED visits (OR: 0.65, 95% CI: 0.44, 0.96), and increased well-child visits (OR: 1.55, 95% CI: 1.06, 2.28). Mother’s responsiveness to her child was associated with child healthcare utilization. Interventions to improve mother–child interactions may be appropriate for mother–child dyads in which child healthcare utilization appears unbalanced with inadequate primary care and excess urgent care. Recognition of these interactions may also improve the care clinicians provide for families.     

Physicians' attention to parents' concerns about the psychosocial functioning of their children.

BACKGROUND: Epidemiological data indicate that approximately 20% of children have psychosocial problems, yet less than 2% of children are seen by mental health specialists each year. Primary care physicians tend to identify children with psychosocial problems when parents discuss concerns with them. OBJECTIVE: To examine factors related to physicians' attention to parental disclosures. DESIGN: Parents reported the psychosocial functioning of themselves and their children. Physicians reported the psychosocial functioning of 75 children and whether the parent disclosed psychosocial concerns to them. SETTING: Ambulatory care clinic of a community-based, university-affiliated, residency training program. PARTICIPANTS: Seventy-five parents of children aged 2 to 16 years who presented for routine primary care, and 26 physicians. MAIN OUTCOME MEASURES: Beck Depression Inventory (parental distress), Eyberg Child Behavior Inventory (child behavior problems), physician and parent report. RESULTS: Physicians identified 50.0% of children with clinically significant behavior problems. Logistic regression indicated that parental disclosure was the only significant predictor of physician identification (P < .002). When children had clinically significant behavior problems, physicians were more likely to report disclosures by parents (45.0% vs 5.7% for parents of children with and without behavior problems, respectively). Physicians were more likely to report parental disclosure when parents reported personal psychosocial distress (38.9% for distressed vs 5.7% nondistressed parents). CONCLUSIONS: Parental disclosure of concerns was a better predictor of physician identification of child psychosocial problems than was the presence of child behavior problems. Physicians responded more frequently to the disclosures of potential problems by parents of children with clinically significant psychosocial problems. They also attended more frequently to disclosures about behavior problems when the parent was also experiencing psychosocial distress.     

Parenting Stress, Difficult Child Behavior, and Use of Routines in Relation to Adherence in Pediatric Asthma

The main purpose of this study was to evaluate the role of child behavior problems, parenting distress, and child routines in relation to children's adherence to daily medication in pediatric asthma. Participants included 45 asthmatic children and their families. Assessment included questionnaires, a medication dose-count monitor, and a brief telephone interview with the parent. Significant negative correlations were found between child care routines and both parenting distress and difficult child behavior. Medication adherence was significantly and positively correlated with both parental distress and difficult child behavior but was not significantly related to parent use of routines.     

Out‐of‐school time activity participation profiles of children with physical disabilities: a cluster analysis

Objective To determine out‐of‐school activity participation profiles of school‐aged children with physical disabilities. Methods Activity participation profiles were determined by cluster analysing 427 children's responses on multiple dimensions of participation (intensity, location, companionship, enjoyment, preference) in five activity types (recreational, active physical, social, skill‐based, self‐improvement). Socio‐demographic, child, parent, family and environmental predictors of group membership were determined, along with child functioning, socio‐demographic, self‐concept and social support variables significantly associated with group membership. Results The cluster analysis revealed four groups, labelled Social Participators (a highly social and neighbourhood‐focused group), Broad Participators (a group of high participators who enjoy participation), Low Participators (a group with low enjoyment and weak preferences) and Recreational Participators (a group of younger children who participate in recreational activities with family members). The groups showed meaningful differences across a range of socio‐demographic, child, parent, family and environmental variables. Conclusions The findings support an affective and contextual view of participation, indicating the importance of motivational theory and a person–environment approach in understanding the complexity of children's out‐of‐school activity participation.