Micronutrient supplementation and child survival in India

India contributes to a large number and proportion of child deaths, both due to higher under five mortality rate and large child population cohort in the country. The micronutrient malnutrition is an ignored area as it is not a direct cause of child mortality but a contributory factor in many deaths. The repeated surveys and studies have noted that iron deficiency anemia, vitamin A deficiency, iodine deficiency are highly prevalent amongst the children in the country and the preventive interventions are reaching only small proportion of 10–50% of the targeted populations. The contribution of these micronutrients (Iron, Vitamin A, Iodine and Zinc) towards child survival depends upon number of factors that are responsible for child mortality, and these situations vary from region to region, time to time and depend upon number of other socio demographic characteristics of the population. This paper discusses that although there may be debate on the role of some micronutrients in reducing childhood mortality, there is no doubt that these micronutrients are needed in small amount for overall child development. These micronutrients, both directly and indirectly, contribute to the child survival and should reach to each and every child in the country and the strategy is proven cost effective.     

Current pediatric roles in child abuse and neglect.

Many pediatricians are being called on to undertake expanded roles in the field of child abuse and neglect, whether as a practicing pediatrician, a hospital-based child abuse consultant, or as a child protection team pediatrician. The practicing pediatrician must consider the diagnosis of child abuse and neglect, confirm the diagnosis, report all suspected cases to child protective services, hospitalize any abused child who needs protection, and provide preventive services. The hospital-based child abuse consultant should provide consultation to primary physicians, report seriously injured cases for the primary physician or surgeon, provide expert medical testimony on difficult to prove cases, teach house staff and medical students about child abuse and neglect, and improve treatment services for abused children who are hospitalized. The child protection team pediatrician will usually become involved in the broader problem of improving team decision making and the interagency system that deals with child abuse and neglect.     

Bildung und Erziehung in der frühen Kindheit

Early childhood experiences within the family are an important basis of lifelong learning. Nowadays, this early phase in a child’s development is considered an important element within the context of modern educational concepts, which are determined by a child’s competencies rather than by the curricula of formal educational institutions. Consequently, a new educational concept has been defined, and child-oriented educational goals have been framed. Whatever the approach, it is the family that is the child’s central, unique educational setting, and the skills that a child learns are the primary goal of early family education and upbringing. The ability to self-regulate, the ability to learn, and social and cultural competences holistically impact the development of a child’s personality. Topics dealt with in this article include the concepts of attachment, which is important for developmental–psychological parent counseling, and the sensitive parent–child relationship that is vital for a positive course in a child’s development. Finally, this article discusses how a child’s environment outside the family affects his or her early education and upbringing.     

Child care and our youngest children

Studies of child development confirm that experiences with people mold an infant's mind and personality. Caregiving is, therefore, central to development, whether the caregiver is a parent, a grandmother, or a teacher in a child care center. This article uses data from new, national studies of families to examine the state of child care for infants and toddlers. The story it tells is complex, as the authors outline the overlapping impacts that diverse child care settings and home situations have on children. Early exposure to child care can foster children's learning and enhance their lives, or it can leave them at risk for troubled relationships. The outcome that results depends largely on the quality of the child care setting. Responsive caregivers who surround children with language, warmth, and chances to learn are the key to good outcomes. Other quality attributes (like training and staff-to-child ratios) matter because they foster positive caregiving. Diversity and variability are hallmarks of the American child care supply. Both "wonderful and woeful" care can be found in all types of child care but, overall, settings where quality is compromised are distressingly common. Children whose families are not buoyed by good incomes or government supports are the group most often exposed to poor-quality care. Given this balanced but troubling look at the status of child care for infants and toddlers, the authors conclude that there is a mismatch between the rhetoric of parental choice and the realities facing parents of young children in the United States. They call on communities, businesses, foundations, and government to play a larger role in helping parents secure good care for their infants and toddlers.     

Child diet and mother–child interactions mediate intervention effects on child growth and development

This study examined whether child diet and mother–child interactions mediated the effects of a responsive stimulation and nutrition intervention delivered from 2009 to 2012 to 1324 children aged 0–24 months living in rural Pakistan. Results showed that the intervention improved children''s cognitive, language and motor development through child diet and mother–child interactions. Although the intervention did not improve child growth or socio‐emotional development, we observed positive indirect effects on child growth via child diet and on socio‐emotional development via both child diet and mother–child interactions. In addition, child diet emerged as a shared mechanism to improve both child growth and development, whereas mother–child interactions emerged as a distinct mechanism to improve child development. Nevertheless, our results suggest the two mechanisms were mutually reinforcing and that interventions leveraging both mechanisms are likely to be more effective at improving child outcomes than interventions leveraging only one of these mechanisms.     

Public health and child maltreatment prevention: the role of the Centers for Disease Control and Prevention

Child maltreatment is a serious and preventable public health problem. Recent studies indicate a dose-response relationship between exposure to child maltreatment and the presence of adult diseases, clearly positioning child maltreatment as a public health burden. This commentary describes the Center for Disease Control and Prevention's (CDC) public health approach to prevention, and identifies elements of the CDC role that are complementary to the efforts of criminal justice and child protective services. CDC's goal for child maltreatment prevention is to assure the widespread adoption of prevention and intervention strategies that are evidence based. Immediate and practical impact can occur by improving collection of child maltreatment data, emphasizing positive parenting skills, and promoting programs representing the best prevention practices in child maltreatment prevention.     

Next steps for federal child care policy

In Mark Greenberg's view, a national child care strategy should pursue four goals. Every parent who needs child care to get or keep work should be able to afford care without having to leave children in unhealthy or dangerous environments; all families should be able to place their children in settings that foster education and healthy development; parental choice should be respected; and a set of good choices should be available. Attaining these goals, says Greenberg, requires revamping both federal child care subsidy programs and federal tax policy related to child care. Today subsidies are principally provided through a block grant structure in which states must restrict eligibility, access, or the extent of assistance because both federal and state funds are limited. Tax policy principally involves a modest nonrefundable credit that provides little or no assistance to poor and low-income families. Greenberg would replace the block grant with a federal guarantee of assistance for all families with incomes under 200 percent of poverty that need child care to enter or sustain employment. States would administer the federal assistance program under a federal-state matching formula with the federal government paying most of the cost. States would develop and implement plans to improve the quality of child care, coordinate child care with other early education programs, and ensure that child care payment rates are sufficient to allow families to obtain care that fosters healthy child development. Greenberg would also make the federal dependent care tax credit refundable, with the credit set at 50 percent of covered child care costs for the lowest-income families and gradually phasing down to 20 percent as family income increases. The combined subsidy and tax changes would lead to a better-coordinated system of child care subsidies that would assure substantial financial help to families below 200 percent of poverty, while tax-based help would ensure continued, albeit significantly reduced, assistance for families with higher incomes. Greenberg indicates that the tax credit expansions are estimated to cost about $5 billion a year, and the subsidy and quality expansions would cost about $18 billion a year.     

Consistencies and Differences Across States in the Well-Being of Non-Hispanic White,Hispanic and Non-Hispanic Black Children in the United States

Most analysis of racial differences in child well-being in the United States focus only on national level data and most state-level analysis of child well-being focus only on the total child population (all races combined). This analysis addresses the two limitations in previous research noted above by providing a state-level analysis of child well-being for the three largest race/Hispanic groups, namely Non-Hispanic White, Hispanic and Non-Hispanic Black. The analysis is based ten commonly-used indicators of child well-being. First, the values for each of the ten indicators for each of three groups are examined in each state. This shows that the disadvantaged position of Hispanic and Non-Hispanic Black children relative to Non-Hispanic White children is pervasive across all ten indicators and all states. Next, the well-being of children in each state relative to the well-being of children in their group in other states is assessed using a ten-item composite index of child well-being. Results show there is only modest positive correlations of relative well-being among the states for all three groups. Only two states are in the top ten states for all three groups. Likewise, there are only two states that were among the ten worst states for all three groups. This analysis indicates that using child well-being measures for the total population in a state does not adequately reflect child well-being of Hispanic and Non-Hispanic Black children.     

Planning for health promotion in low-income preschool child care settings: focus groups of parents and child care providers.

OBJECTIVE: To identify potentially successful strategies, barriers, and facilitators for health promotion in preschool child care settings. METHODS: We conducted 6 focus groups including each of the following: parents of children attending child care centers and home-based family child care (2 in English, 1 in Spanish) and directors of child care centers and family child care providers (2 in English, 1 in Spanish). Systematic thematic analysis was conducted to generate themes to address study questions. RESULTS: A total of 24 parents and 45 child care providers, serving predominantly urban, low-income children in Boston, participated. Parents and child care providers agreed that in-person group discussions would be the most effective strategy for providing health education information to parents. Several barriers that could affect implementation emerged. First, some providers expressed frustration toward parents' attitudes about child safety and health. Second, there was diversity of opinion among providers on whether conducting health promotion activities was consistent with their training and role. In addition, literacy, language, and cultural barriers were identified as potential barriers to health promotion in child care. CONCLUSIONS: In order to be successful, health promotion strategies in child care settings will need to overcome tensions between providers and parents, allow professional growth of child care providers to serve in a health promotion role, and better integrate external health resources and personnel. Group sessions and peer learning opportunities that are culturally and linguistically sensitive are potentially successful strategies for implementation of health promotion interventions for many parents.     

A statewide survey of hazards in child care centers.

OBJECTIVES: The purpose of this study was to determine adherence to selected recommended safety standards in North Carolina child care centers. METHODS: A self administered questionnaire eliciting information about safety practices in child care was mailed to a randomly selected sample of 409 North Carolina child care centers. RESULTS: One hundred and ninety five usable questionnaires were returned from child care centers in 75 counties. Results indicated that all of the standards included in the state's child regulations were being adhered to by at least 80% of the centers. However, adherence to recommended standards not included in the state's regulations was quite variable, with one standard implemented by less than 5% of the centers. The lowest rates of adherence were found for standards specifying that resilient surface material be used under playground equipment (4%) and that certain foods that may present a choking hazard to small children not be served (27%). CONCLUSIONS: Many hazards not addressed in North Carolina child care regulations are present in child care centers. Some safety standards are not adhered to due to lack of knowledge or limited resources. Inclusion of national standards in state child care regulations appears to reduce, but not eliminate, the likelihood of hazards being reported. Further research should include on-site inspections and attention to safety in family child care.     

Towards a capability approach to child growth: A theoretical framework

Child malnutrition is an important cause of under‐5 mortality and morbidity around the globe. Despite the partial success of (inter)national efforts to reduce child mortality, under‐5 mortality rates continue to be high. The multidimensional approaches of the Sustainable Development Goals may suggest new directions for rethinking strategies for reducing child mortality and malnutrition. We propose a theoretical framework for developing a “capability” approach to child growth. The current child growth monitoring practices are based on 2 assumptions: (a) that anthropometric and motor development measures are the appropriate indicators; and (b) that child growth can be assessed using a single universal standard that is applicable around the world. These practices may be further advanced by applying a capability approach to child growth, whereby growth is redefined as the achievement of certain capabilities (of society, parents, and children). This framework is similar to the multidimensional approach to societal development presented in the seminal work of Amartya Sen. To identify the dimensions of healthy child growth, we draw upon theories from the social sciences and evolutionary biology. Conceptually, we consider growth as a plural space and propose assessing growth by means of a child growth matrix in which the context is embedded in the assessment. This approach will better address the diversities and the inequalities in child growth. Such a multidimensional measure will have implications for interventions and policy, including prevention and counselling, and could have an impact on child malnutrition and mortality.     

A Research Note on Statistical Methods Used to Create Indices of Child Well-Being

Growing numbers of researchers are combining individual indicators of child well-being into overall indices. This research note examines five different methodologies that have been used to construct an overall index of child well-being. All five methods are applied to four datasets and the results are examined in terms of consistency of results across methods. The datasets reflect child well-being indicators at the country, state, county, and neighborhood levels. The results show that all five of the approaches to index construction examined here produce very similar results. This is reflected in very high correlation coefficients with index values and rankings across geographic units. The findings suggest that rankings of geographic units on child well-being indices are likely to be robust regardless of the particular index methodology used.     

Child rearing and child outcomes in Japan and the UK

Abstract Japan and the UK are compared in relation to various child health outcomes. It is noted that in the rates of child abuse and criminal activity. Japan is in a more favorable position. Rates of behavior problems and suicide rates are very similar in the two countries. Consideration is given to the reasons for the differences. The rates of single parents and divorce are much lower in Japan. The rates of working mothers are about the same, but Japanese women work longer hours. However, it is suggested that more important differences may lie in the greater respect for authority and emphasis on discipline and conformity in Japan. The effects of industrialization on family life and on child development are summarized. It is suggested that the separation of the adolescent age group from the rest of the population has had especially negative results in Western industrialized countries. Various suggestions are made concerning the positive role that pediatricians can play in promoting child development. In particular, pediatricians are encouraged to support and not undermine parents, to involve fathers in management of illness and disability, to press for full implementation of the United Nations Convention on the Rights of the Child, and for ready availability of good substitute child care facilities.     

Longitudinal assessment of maternal parenting capacity variables and child adjustment outcomes in pediatric cancer

This preliminary investigation aimed to longitudinally examine parenting capacity variables, namely parental overprotection, perceived child vulnerability, and parenting stress and their relation to child adjustment in mothers of children on treatment for cancer. As part of a larger study, biological mothers (N=22) completed measures of parental overprotection, perceived child vulnerability, parenting stress, and child adjustment at Time 1 and a follow-up time point. Analyses were conducted to determine whether (1) levels of parental overprotection, perceived child vulnerability, and parenting stress declined from Time 1 to follow-up and (2) if Time 1 parenting capacity variables were associated with child adjustment at follow-up. Results revealed that parental overprotection, perceived child vulnerability, and parenting stress declined from Time 1 to follow-up, and levels of parental overprotection, perceived child vulnerability, and parenting stress at Time 1 were significantly related to child adjustment at follow-up. Collectively, the preliminary findings of this study indicate that mothers of children with cancer evidence improved parenting capacity over time. Furthermore, it seems that Time 1 parenting capacity variables are significantly related to later child adjustment.     

Comment comprendre et traiter l’« enfant-roi » et sa famille ?

Professionals of children’health in the physical domain as well as in the psychological are more and more confronted with family complaints concerning the particular symptom named “spoiled child”. This one examines the relationship in the bosom of the family as parent or child. The article suggests to think about questions that brings to light this behaviour: what is authority today? Is that required to set limits to child? How to combine affectional ties and educational duty? Thanks to the analysis of some references of the child’s psycho-affective development, we can establish a canvas for therapeutic management of “spoiled child” and his family.     

Beyond Munchausen syndrome by proxy: identification and treatment of child abuse in a medical setting

The condition widely known as Munchausen syndrome by proxy comprises both physical abuse and medical neglect and is also a form of psychological maltreatment. Although it is a relatively rare form of child abuse, pediatricians need to have a high index of suspicion when faced with seemingly inexplicable findings or treatment failures. The fabrication of a pediatric illness is a form of child abuse and not merely a mental health disorder, and there is a possibility of an extremely poor prognosis if the child is left in the home. In this statement, factors are identified that may help the physician recognize this insidious type of child abuse that occurs in a medical setting, and recommendations are provided for physicians regarding when to report a case to their state's child protective service agency.     

Paediatrics and child psychiatry: past, present and future

The historical development of the relationship between paediatrics and child psychiatry is outlined and the closer working relationships between the two disciplines over the past 30 years are noted. Various ways in which child psychiatrists can contribute to paediatric practice are described, as well as the degree to which paediatricians can contribute to an understanding of child psychiatric disorders. It is suggested that new developments in paediatric practice and an increase in interest in genetic and brain mechanisms in child psychiatric disorders, will increase the need for collaboration between the two specialties.     

The role of marital discord and parenting in relations between parental problem drinking and child adjustment

BACKGROUND: Research suggests that children exposed to parental drinking problems are at risk for maladjustment. However, the potential impact of drinking problems in a community sample and the processes involved in the relationship between parental drinking and child outcomes have rarely been examined. METHOD: A community sample of 235 mothers and fathers of kindergarten children completed measures of problem drinking symptoms, family functioning and child adjustment. RESULTS: Model tests indicate that problem drinking was associated with greater marital conflict, and that marital conflict was related to ineffective parenting which was in turn related to poorer child adjustment. CONCLUSIONS: Even in a community sample, parental problem drinking behaviors are associated with reduced family functioning that relates to child outcomes.     

Child and Family Factors Influencing the Clinical Referral of Children with Hyperactivity: A Research Note

This study examined child and Family factors associated with the clinical referral of pervasively hyperactive children. Fourteen children with pervasive hyperactive behaviour problems referred to a London child guidance service were compared with 13 nonreferred pervasively hyperactive children resident in the same geographic area. Child behaviour, parenting, and Family life factors were examined as determinants of referral. Preliminary results suggest that both child and parenting factors play an important role in determining whether a child with hyperactivity will be referred for child guidance. The best predictors of clinical referral were a parent's ability to cope with child behaviour, child emotional disturbance, School relationship problems, and parental disciplinary indulgence. Implications of referral bias for research and service planning are discussed.