Chinese,Vietnamese, and Asian Indian Parents' Perspectives About Well-Child Visits: A Qualitative Analysis

Objectives

Well-child visits are a critical component of pediatric health care; however, disparities in attendance and quality of care exist for Asian children. Limited research has explored Asian immigrant parents' perspectives about their well-child visit experience.

An educational booklet diminishes anxiety in parents whose children receive total parenteral nutrition

A major cause of anxiety in parents of hospitalized children is insufficient information about hospital procedures. In an effort to determine the extent to which parental anxiety could be diminished and knowledge and satisfaction enhanced in regard to total parenteral nutrition (TPN), we developed a booklet that describes the mechanics of TPN administration and related procedures. When informal discussions were held between parents and members of the nutritional support team during four alternating periods (every five to six months), parents of first-time recipients of TPN either did not receive the booklet (period 1, n = 20; period 3, n = 30) or received it (period 2, n = 23; period 4, n = 27). Within one week of TPN initiation, parents in both groups completed the Spielberger State-Trait anxiety scale, an attitude questionnaire, and a quiz on TPN. No differences between groups were found in ethnic background, socioeconomic status, severity of illness, age of children, or route of TPN administration. Predisposition to anxiety was also similar between the groups. In contrast, acute situational anxiety was significantly greater in the group with no booklet than in the booklet group. Parents in the no-booklet group demonstrated less comfort in the care of their children and less knowledge about TPN than did the booklet group. Written information provided to parents decreased their anxiety and increased satisfaction with patient care more successfully than did verbal communication. Such a booklet may reduce parentally induced anxiety in the child and facilitate parent-hospital staff interactions.     

Adolescent immunizations and other clinical preventive services: a needle and a hook?

Advances in technology have led to development of new vaccines for adolescents, but these vaccines will be added to a crowded schedule of recommended adolescent clinical preventive services. We reviewed adolescent clinical preventive health care guidelines and patterns of adolescent clinical preventive service delivery and assessed how new adolescent vaccines might affect health care visits and the delivery of other clinical preventive services. Our analysis suggests that new adolescent immunization recommendations are likely to improve adolescent health, both as a "needle" and a "hook." As a needle, the immunization will enhance an adolescent's health by preventing vaccine-preventable diseases during adolescence and adulthood. It also will likely be a hook to bring adolescents (and their parents) into the clinic for adolescent health care visits, during which other clinical preventive services can be provided. We also speculate that new adolescent immunization recommendations might increase the proportion and quality of other clinical preventive services delivered during health care visits. The factor most likely to diminish the positive influence of immunizations on delivery of other clinical preventive services is the additional visit time required for vaccine counseling and administration. Immunizations may "crowd out" delivery of other clinical preventive services during visits or reduce the quality of the clinical preventive service delivery. Complementary strategies to mitigate these effects might include prioritizing clinical preventive services with a strong evidence base for effectiveness, spreading clinical preventive services out over several visits, and withholding selected clinical preventive services during a visit if the prevention activity is effectively covered at the community level. Studies are needed to evaluate the effect of new immunizations on adolescent preventive health care visits, delivery of clinical preventive services, and health outcomes.     

Standards of care for students with type 1 diabetes: Ensuring safety, health and inclusion in school

Parents of children with type 1 diabetes commonly worry about the ability of school personnel to respond to their child’s diabetes needs, and may feel anxious about the health, safety and inclusion of their child in school. Physicians may be confronted by parents’ fears, anxieties and apprehension, and need to know how to make recommendations based on current best practice. The present article describes the school standards from the position paper of the Canadian Diabetes Association titled, “Standards of care for students with type 1 diabetes in school” and a resource booklet available through <www.diabetes.ca>. Highlights of the school standards provide reference to guide physicians in their advice and support of parents. Physicians can use these resources to enable parents to advocate their child’s care and support in the school setting.     

Children with health issues

All children, even the healthiest, have preventive and acute health care needs. Moreover, a growing number of children are chronically ill, with preventive, acute, and ongoing care needs that may be much more demanding than those for healthy children. Because children are unable to care for themselves, their parents are expected to provide a range of health care services without which the current health care system for children would not function. Under this "shadow health care system," parents or parent surrogates often need to be with the child, a requirement that can create difficulties for working parents, particularly for those whose children are chronically ill. How federal, state, and employer policies and practices mesh with the child health care needs of families is therefore a central issue in any discussion about work and family balance. In this article Mark Schuster, Paul Chung, and Katherine Vestal describe the health care needs of children; the essential health care responsibilities of parents; the perspective of employers; and the existing network of federal, state, and local family leave benefits that employed parents can access. They also identify current gaps in policies that leave unmet the needs of both parents and their employers. The authors suggest the outlines of a national family leave policy that would protect the interests of parents and employers. In essence, such a policy would build on the federal Family and Medical Leave Act, which gives some workers time off with no advance notice required and no loss of job or health insurance. But it would also include elements of California's Paid Family Leave Insurance, which expands coverage to more workers and provides partial pay during leave. Employers could be given some financial protections as well as protections against employee fraud and abuse. Such a policy, the authors conclude, would help to provide security to parents, minimize effects on employers, raise societal expectations for family-friendly work environments, and help maintain the parental shadow system of care on which health care professionals depend.     

Newly immigrant adolescents health and quality of life in Belgium: screening and prevention in school medicine]

OBJECTIVES: Little is known so far about the health of newly immigrant adolescents. The present study aimed to evaluate their health and quality of life (QoL) and to reinforce prevention and health promotion in school medicine. METHODS: One hundred and fifty-eight adolescents (mean age: 15,4 years) from 37 nationalities were included in the study in two health centers in Brussels. This study was carried out by medical records analysis and administration of a questionnaire about health and QoL (VSP-A) in several languages. RESULTS: The results showed adolescents in good physical health. Nevertheless their quality of life deteriorated over time in Belgium. The QoL was significantly lower for adolescents without social support: 48,0 (SD=13,5) vs 60,6 (SD=11,1) compared with adolescents with social support - i.e. with one resource person - on a scale from 0 to 100. Adolescents had many subjective health problems, like "the future" cited by half of them. CONCLUSION: This study shows the importance of developping a specific approach to newly immigrant adolescents health and the contribution of school medicine in the identification of biological, psychological and social needs and hightlights the preventive answers carried out by school medicine.     

Evaluation of a home based health record booklet.

Despite the widespread use of home based child health records of varying complexity in England, there is a notable absence of their evaluation. Such a record booklet developed in the West Lambeth Health Authority has been used by parents, doctors, and community nurses to build up an independent chronological record of a child''s birth statistics, health, growth, immunisation, development checks, and contacts with health services. A randomised controlled evaluation of the record, analyses of entries in it, and a survey of the views of mothers and health professionals using the record have been carried out. The need for such a record was confirmed by those questioned and analyses of entries in the booklet helped to modify and improve it. The evaluation was unable to show, however, any effect of the record on immunisation and developmental assessment service uptake. Its value in improving communication between the numerous health and other care agencies was dependent on its proper use.     

Preventive health care utilization. Prenatal and the first 3 years in a Utah population

The utilization of preventive health care services prenatally and for children up to 3 years old was determined by mailed questionnaire. The parents surveyed were randomly chosen from birth records provided by the Utah Bureau of Vital Records. "Adequate use of preventive services" was defined as six prenatal visits for a full-term pregnancy and as seven well-child visits during the first 3 years of life. Responses, received from 219 (36.5%) parents, indicated only 1 percent did not utilize adequate prenatal care. Women made an average of 11.3 visits during their pregnancies; 83 percent saw their prenatal health care provider at least 10 times. Well-child visits were less adequately utilized, an average of 6.3 visits per child. Fifty-six percent made fewer than seven visits; only 23 percent made all of the nine visits recommended by the American Academy of Pediatrics. Patients who made seven or more well-child visits were more likely to have received their fourth diphtheria, pertussis, tetanus (DTP) immunization and to have health insurance policies that paid for preventive health care services. Results indicate that families use preventive services more consistently before the birth of their children than after. Use of preventive services is associated with adequate insurance coverage and results in more thorough immunization.     

Maxillofacial and dental abnormalities in some multiple abnormality syndromes. "Cri du chat" syndrome, Wilms' tumor-aniridia syndrome; Sotos syndrome; Goldenhar syndrome]

The paper describes the maxillo-facial and dental anomalies observed in some chromosome and non-chromosome poly-malformative syndromes ("Cri du chat" syndrome; Wilms' tumour; Sotos' syndrome; Goldenhar's syndrome). The Authors emphasise the possibility of diagnosing these multiple deformity syndromes from maxillo-facial alterations in early infancy; anomalous tooth position and structure cal also be successfully treated immediately after the first appearance of teeth. This is a particularly promising field of pediatrics and preventive pediatric medicine.     

Patterns and perceptions of complementary/alternative medicine among paediatricians and patients' mothers: a review of the literature

For many families and their children, the use of complementary/alternative medicine (CAM) is an accepted adjunct or alternative to conventional therapy, even if data available in the literature regarding risks and adverse drug reactions (ADRs) pertaining to childhood populations are scarce. Moreover, despite widespread and increasing use of CAM, there are limited data on how paediatricians communicate with mothers and/or patients about CAM. Therefore, we report the studies available in the literature in the paediatric field and summarise what is known about ADRs and risks of CAM, taking into account in particular problems related to interactions between phytotherapy and conventional medicines and to counselling. Conclusion:from the analysis of the literature, some interesting aspects emerge: (1) the extent of CAM use in the paediatric field is increasingly sought by parents of children with chronic illnesses; (2) most parents who choose CAM medicine for their children believe that these therapies are "natural" and thus "safe" and (3) physicians often feel to know too little about CAM and wish to learn more for different reasons including "to dissuade whether the alternative method is unsafe and/or ineffective". Therefore, paediatricians should be prepared to discuss alternative therapies with parents, since talking about CAM may help to minimise the risks and to restrain parental misconceptions and doubts. Educational interventions for parents should also be performed to bring about a more aware use of traditional and alternative medicines.Abbreviations ADR adverse drug reaction - CAM complementary/alternative medicine     

Development and evaluation of an information booklet for adult survivors of cancer in childhood. The United Kingdom Children's Cancer Study Group Late Effects Group

AIMS: To determine the need for information among survivors of childhood cancer, to assess the acceptability of an information booklet, and to investigate the effectiveness of the booklet in increasing knowledge and influencing health related behaviours. SUBJECTS: Fifty survivors of childhood cancer (age range 14-32 years) who were consecutive attendees at a long term follow up clinic. METHODS: The booklet was developed for young people aged 14 years and above by the United Kingdom Children's Cancer Study Group Late Effects Group. Included is information about treatment of cancer, general advice about a healthy lifestyle, the rationale for long term follow up, and information about employment and life insurance problems. Survivors were interviewed at the follow up clinic, offered the booklet, and contacted approximately one week later for a telephone interview. The clinic interview assessed survivor's understanding of their illness and treatment and its impact on their lives, and their preferences for further information. The telephone interview determined survivors' general reaction to the booklet, whether it increased knowledge and influenced health related behaviours. RESULTS: All those interviewed accepted the written information and agreed to a follow up interview. Survivors were enthusiastic about being given more information. Over three quarters learned new information from the booklet. There were no indications that the information was associated with anxiety for any demographic or clinical subgroups. After reading the booklet there was an increased awareness of the risk from sunbathing (p < 0.05), and greater appreciation of the importance of follow up (p < 0.05). CONCLUSIONS: These results suggest that written information is likely to be an acceptable and effective supplement to discussions with medical professionals and may readily be incorporated into long term follow up clinics.     

A systematic review of lay views about infant size and growth

Objectives

To understand lay views on infant size and growth and their implications for a British population.

Methods

A systematic review of parental and other lay views about the meanings and importance of infant size and growth using Medline, PsycInfo, CINAHL, Sociological Abstracts, IBSS, ASSIA, British Nursing Index ChildData, Caredata, SIGLE, Dissertation Abstracts (US), Index to Theses. 19 studies, most of which reported the views of mothers, from the US, Canada, the UK and Finland were reviewed.

Results

Notions of healthy size and growth were dominated by the concept of normality. Participants created norms by assessing and comparing size and growth against several reference points. When size or growth differed from these norms, explanations were sought for factors that would account for this difference. When no plausible explanation could be found, growth or size became a worry for parents.

Conclusions

Parents consider the importance of contextual factors when judging what is appropriate or healthy growth. For public health advice to be effective, lay, as well as scientific, findings and values need to be considered.Growth and size in infancy matter to parents and professionals. Intervention in infancy has the potential to promote health throughout the life course.¹ Although the benefits (or otherwise) of early interventions may not be realised for many years, the beliefs and behaviours of individual lay persons (in this case, particularly parents) will affect the uptake of policy or interventions immediately. As Harden et al² point out, bringing together views and studies in a systematic way may deepen our understanding of public health issues. Systematic reviews also represent good stewardship in terms of the time of both participants and researchers.This paper describes a systematic review designed to understand lay (particularly parental) views of infant size and growth.     

Allergy from infancy to adolescence. A population-based 18-year follow-up cohort

Background  

Anxious parents have many concerns about the future health of their atopic infants. Paediatricians and primary care practitioners need to seek knowledge on long-term outcomes in order to cope with the increasing caseload of suspected allergy and the concerns of parents. The aim of the study was to assess suspected and diagnosed allergy in infancy as predictors of allergy and asthma in adolescence.     

Editorial: For crying out loud: Infant signaling and parental responsiveness

Crying represents a powerful signal for human newborns. How parents should respond has been a matter of debate, with some urging prompt responding and others expressing concern about spoiling. Despite the fervor of the debate, few longitudinal observational studies have addressed the question. A new study in this issue by Bilgin and Wolke provides important data about ignoring crying in early infancy and its predictive correlates. The results of their investigation are discussed in the context of attachment and behavioral theories.     

Early feeding problems in an affluent society. II. Determinants

The aim of this investigation was to identify different factors of importance for the occurrence of feeding problems during the first year of life. Forty-two infants, 3-12 months old, with feeding problems without any obvious medical explanation were matched to 42 controls with respect to age, sex and Child Health Centre (CHC) affiliation. Information was obtained by interviewing the parents and from medical records. Four factors emerged as being highly significant, namely "feeding problems presented by the parents during their own infancy" (p less than 0.001), "great anxiety experienced by the mother during the pregnancy" (p less than 0.02), "breast-feeding problems experienced by the mother" (p less than 0.001) and "ill-health in the mother" (p less than 0.001). A special study in which the maternal and paternal grandparents were interviewed, corroborated the parents' information on their own early feeding difficulties. This finding could explain a large proportion of the feeding problems that have no obvious medical origin.     

The physical, developmental, and mental health needs of young children in child welfare by initial placement type

The American Academy of Pediatrics recommends comprehensive assessments for children entering foster care. These children may be placed with biological parents, kin, or in nonrelative foster care. It is not known whether health-related needs differ by placement. Chart abstractions were conducted of child welfare and medical records of 1542 children, ages 3 months to 5 years 11 months, admitted to San Diego's sole emergency shelter/receiving facility from April 1, 1998, through June 30, 1999, for investigation of alleged maltreatment. Children were discharged to three placement types: biological parents (28.5%), kinship caregivers (28.4%), or nonrelative foster parents (43.1%). Overall, 86.7% of children studied demonstrated physical, developmental, or mental health needs, with more than half displaying two or more problems. More than half of the children had a "Suspect" score on the Denver-II; 70.3% of children with "Suspect" scores were found to have delay on a developmental evaluation. Almost one tenth of the sample were diagnosed with one or more mental health conditions. Few differences were found for physical, developmental, or mental health concerns by placement. Results suggest that young children placed with biological parents or in kinship care have similar needs to those of children placed with foster parents. This study confirms the importance of comprehensive assessments for young children removed from their homes, regardless of placement. It also illustrates a need for standardized assessment criteria, particularly for developmental and mental health status, and for collaborative care models for all young children entering the child welfare system, regardless of their placement following investigation.     

UK health visitors' role in identifying and intervening with infants at risk of developing obesity

Childhood obesity is associated with a number of modifiable risk factors that can be identified during infancy or earlier. In the UK, health visitors advise parents about infant feeding, but little is known about their role in obesity prevention. The aim of this study was to investigate the beliefs and current practices of UK health visitors in relation to recognising and intervening with infants at risk of developing obesity. Thirty members of the health visiting team were interviewed. The interviews were audio‐recorded and transcribed verbatim. Thematic analysis was applied using an interpretative, inductive approach. Health visitors were aware of some of the modifiable risk factors for childhood obesity such as infant feeding practices. They felt they had a role in advising parents about diet but did not formally identify and/or intervene with larger infants. Infant overweight was considered a sensitive issue that was difficult to raise with parents. They believed some parents preferred larger infants and were unaware that their feeding practices might be contributing to obesity risk. A need for training and guidance was identified together with strategies to overcome system barriers. Health visitors do not currently target parents of infants at risk of obesity largely because they do not perceive they have appropriate guidance and skills to enable them to do so. There is an urgent need for tools and training to enable all health care professionals to recognise and manage infants at risk of developing obesity without creating a sense of blame.     

Development and evaluation of an information booklet for adult survivors of cancer in childhood

AIMS—To determine the need for information among survivors of childhood cancer, to assess the acceptability of an information booklet, and to investigate the effectiveness of the booklet in increasing knowledge and influencing health related behaviours.
SUBJECTS—Fifty survivors of childhood cancer (age range 14-32 years) who were consecutive attendees at a long term follow up clinic.
METHODS—The booklet was developed for young people aged 14 years and above by the United Kingdom Children''s Cancer Study Group Late Effects Group. Included is information about treatment of cancer, general advice about a healthy lifestyle, the rationale for long term follow up, and information about employment and life insurance problems.
Survivors were interviewed at the follow up clinic, offered the booklet, and contacted approximately one week later for a telephone interview. The clinic interview assessed survivors'' understanding of their illness and treatment and its impact on their lives, and their preferences for further information. The telephone interview determined survivors'' general reaction to the booklet, whether it increased knowledge and influenced health related behaviours.
RESULTS—All those interviewed accepted the written information and agreed to a follow up interview. Survivors were enthusiastic about being given more information. Over three quarters learned new information from the booklet. There were no indications that the information was associated with anxiety for any demographic or clinical subgroups. After reading the booklet there was an increased awareness of the risk from sunbathing (p < 0.05), and greater appreciation of the importance of follow up (p < 0.05).
CONCLUSIONS—These results suggest that written information is likely to be an acceptable and effective supplement to discussions with medical professionals and may readily be incorporated into long term follow up clinics.