Stress, cortisol and well-being of caregivers and children in home-based child care: a case for differential susceptibility

Background We examined whether children cared for by stressed caregivers show lower socio‐emotional well‐being and more stress, compared with children cared for by less stressed caregivers. Methods Perceived stress and cortisol levels of professional caregivers (n= 44), and associations with children's (n= 44) well‐being and cortisol levels in home‐based child care were examined. Results Caregiver perceived stress and cortisol levels were related to children's well‐being but not to children's cortisol levels. Children's social fearfulness acted as a moderator between caregivers' mean ratio of diurnal change in cortisol and children's well‐being. When caregiver cortisol levels decreased, more fearful children were reported higher on well‐being than less fearful peers. In contrast, when caregiver cortisol levels increased, more fearful children were reported lower on well‐being. Conclusions The findings point to differential susceptibility. Child care organizations and parents need to notice that a non‐stressful child care environment is in particular important for children with a difficult temperament.     

Agreement between children and parents demonstrated that illness-related absenteeism was validly reported by children

ObjectivesTo examine the agreement between children's and parents' reporting of illness-related absenteeism from school and to examine predictors for disagreement between children and parents.Study Design and SettingA total of 8,438 schoolchildren aged from 5 to 15 years (grade 0–8) and one parent of each child were invited to participate in the Hi Five baseline study. The response rate for children answering a questionnaire was 89% (n = 7,525), and 36% of the parents (n = 3,008) participated in a weekly illness registration study using text messages (short message service) over a period of 22 weeks. Text messages and questionnaire data were linked at the individual level, leaving 2,269 child–parent pairs in the analysis, corresponding to 27% of the eligible sample.ResultsThe agreement between children's and parents' reports of illness-related absenteeism was good, with high absolute agreement and slight to moderate Ƙ values. Agreement was lowest for 6- to 8-year-olds and highest for 11- to 12-year-olds. Children's reports of illness symptoms and parents' reports of their children's illnesses in the preceding week were strong predictors for children reporting illness-related absenteeism when parents did not.ConclusionIllness-related absenteeism can be reported by children, and children report higher prevalence of illness-related absenteeism than parents.     

Translating the tears: parents' use of behavioural cues to detect pain in normally developing young children with everyday minor illnesses or injuries

Objectives The objectives of this paper were to (i) identify the behavioural cues used by parents to detect young children's transient pain from minor illnesses or injuries (‘everyday pain’); and (ii) perform an initial psychometric evaluation of the Parents' Post‐operative Pain Measure (PPPM) in the context of children's everyday pain. Method Cross‐sectional Internet survey. Results One thousand seven hundred sixteen parents of children (1–6 years) completed the survey. The parents reported more behaviours when children had pain from minor illnesses than from minor injuries (9.6 ± 3.9 vs. 2.5 ± 2.3, P < 0.001). Principal component analysis of the PPPM revealed a two‐factor solution for illness‐related pain and a three‐factor solution for injury‐related pain. Behavioural cues varied with characteristics of children (age, gender and prior hospital experience) and parents (gender, age and parenting experience). Conclusions The PPPM is a promising tool for parental assessment of children's pain in everyday situations. Further research is needed to determine its utility in facilitating communication between parents and healthcare professionals, and in improving the management of young children's pain.     

Engaging Indigenous families in a community‐based Indigenous early childhood programme in British Columbia,Canada: A cultural safety perspective

This article is part of a larger study that explored how an Indigenous early intervention programme in British Columbia (BC), Canada, known as the ‘Aboriginal Infant Development Program’ (AIDP), influenced family and children's health and well‐being and was responsive to child health inequities. Postcolonial feminist and Indigenous feminist perspectives provided a critical analytical lens to this qualitative inquiry. The study was undertaken with AIDPs based in diverse community organisations located in off‐reserve urban municipalities throughout the province of BC. From September 2013 to March 2014, in‐depth, semi‐structured interviews were undertaken with: Indigenous primary caregivers (n = 10), Indigenous Elders (n = 4), AIDP workers (n = 18) and administrative leaders (n = 3). The purpose of this article is to examine and analyse the findings that focus on how AIDP workers supported family and children's health and well‐being by transforming their routine policies and practices in ways that fostered caregivers' active engagement in their programmes. Findings centre on three main themes: (i) overcoming mistrust; (ii) ‘being willing to move a step forward’ and (iii) resisting what's taken‐for‐granted. These inter‐related themes are examined and discussed in relation to the concept of cultural safety. The findings have international relevancy for social and healthcare community‐based programmes that are questioning how to engage with parents who may be hard to reach as a result of multi‐faceted social and structural factors.     

Family friends: New resources for psychosocial care of chronically III children in families

The Family Friends Program matches volunteers over the age of 55 with chronically ill and disabled children aged 12 and under. The older volunteers visit the children at least once a week in the children's homes. They provide psycho‐social support to the children, parents, and other family members. Results of a program evaluation indicate that the volunteers benefit the parents by providing lay counseling, emotional support, and encouragement. Parents report feeling better about themselves and their ability to cope with the stresses of caring for their ill or disabled child. Improvements in the children's behavior and parents’ motivation were observed.     

Can AIDS stigma be reduced to poverty stigma? Exploring Zimbabwean children's representations of poverty and AIDS

Objective We use children's drawings to investigate social stigmatization of AIDS‐affected and poverty‐affected children by their peers, in the light of suggestions that the stigmatization of AIDS‐affected children might derive more from the poverty experienced by these children than from their association with AIDS. Methods A qualitative study, in rural Zimbabwe, used draw‐and‐write techniques to elicit children's (10–12 years) representations of AIDS‐affected children (n= 30) and poverty‐affected children (n= 33) in 2009 and 2010 respectively. Results Representations of children affected by AIDS and by poverty differed significantly. The main problems facing AIDS‐affected children were said to be the psychosocial humiliations of AIDS stigma and children's distress about sick relatives. Contrastingly, poverty‐affected children were depicted as suffering from physical and material neglect and deprivation. Children affected by AIDS were described as caregivers of parents whom illness prevented from working. This translated into admiration and respect for children's active contribution to household survival. Poverty‐affected children were often portrayed as more passive victims of their guardians' inability or unwillingness to work or to prioritize their children's needs, with these children having fewer opportunities to exercise agency in response to their plight. Conclusions The nature of children's stigmatization of their AIDS‐affected peers may often be quite distinct from poverty stigma, in relation to the nature of suffering (primarily psychosocial and material respectively), the opportunities for agency offered by each affliction, and the opportunities each condition offers for affected children to earn the respect of their peers and community. We conclude that the particular nature of AIDS stigma offers greater opportunities for stigma reduction than poverty stigma.     

The importance of emotions: the socialisation of emotion in parents of children with autism spectrum disorder

Parents play a critical role in the development of children's emotional competence; however, little research examines parents’ emotion socialisation practices among children with autism spectrum disorder (ASD). In this study, we compared the emotion socialisation practices of parents of children with ASD and to those of parents of children that are typically developing. The Coping with Children's Negative Emotions Scale was used to assess parents’ reactions to children's emotions in both the typically developing sample (n?=?138) and the sample of children with ASD (n?=?22). An analysis of covariance revealed significant differences in responses to anger and fear. Group was entered as the independent variable and the dependent variable was parents’ responses to children's expressions of negative emotion. Covariates included child gender and child age. These results demonstrate a need for research examining the relationship between, and moderators of, parents’ emotional reactions and the development of emotional competence in children with ASD. Furthermore, these results have implications for early intervention practice as parent–child interactions have been shown to affect child outcomes.     

Parents' decision following the Food and Drug Administration recommendation: the case of over‐the‐counter cough and cold medication

Background In 2007, the Food and Drug Administration (FDA) recommended against parents administering over‐the‐counter cough and cold medications (OTC‐CCM) to children under 2 years of age because serious and potentially life‐threatening side effects can occur. This study examined the impact of FDA's recommendations against giving children under 2 years old OTC‐CCM. Methods We asked parents (n= 377) whether they knew of and trusted the FDA recommendations, as well as whether they intended to follow them. We also examined parents' knowledge, perceptions and behaviours with respect to OTC‐CCM. Results About 33% of our sample had never heard of the FDA recommendations. Of those who were aware, 32.9% intended to continue administering OTC‐CCM, and another 36.7% were not sure what to do. Our results indicate that parents who trust the FDA recommendations are significantly more likely to stop giving OTC‐CCM to their children. However, almost half did not trust the FDA recommendations or were not sure whether to trust them. Our results indicate that parents who trust the FDA recommendation are significantly more likely to discontinue using OTC‐CCM. Our data also reveal that many parents give more than one drug simultaneously (32.9%), cannot identify the active ingredient(s) (28.9%) or fail to store the medications in a safe place (86.1%). Conclusion Parents' confidence in the FDA recommendations predicted whether they would continue or stop administering OTC‐CCM to their children. Our findings illustrate the urgent need for widespread public education about OTC‐CCM products to ensure children's safety.     

Attachment and emotional understanding: a study on late-adopted pre-schoolers and their parents

Objective The aim of this study was to characterize the role of attachment in adoption, first by assessing the influence of adoptive parents on their late‐adopted children and second by investigating the role of children's attachment on an emotional understanding task. Design On children's arrival into adoptive families, parents' attachment was evaluated. After 12–18 months, children's attachment towards mothers and fathers was assessed. Twelve months later, children participated in an emotional understanding task. Method Parents' attachment was assessed using the Adult Attachment Interview. Children's attachment and emotional understanding were evaluated respectively using the Manchester Child Attachment Story Task and the Test of Emotion Comprehension. Results A correspondence of 80% (security vs. insecurity) and 60% (security vs. avoidant or ambivalent insecurity K= 0.40) between mothers' and children's pattern of attachment was found. A secure state of mind in both adoptive parents was a protective factor towards children's attachment disorganization. Finally, there was a significant association between children's security of attachment and their performance on the emotional understanding task. Conclusion Adoption appears to be an intervention that assures the adoptive child an opportunity to catch up on emotional development and to partially resolve prior traumatic attachment experiences; adoptive parents play a central role in the emotional adjustment of their children.     

Parental Incarceration as a Risk Factor for Children in Homeless Families

The current study aimed to describe the prevalence of children of incarcerated parents (COIP) in a sample of homeless/highly mobile children, examine the relationship between parental incarceration and other risk factors, and investigate the effect of parental incarceration on child academic and mental health outcomes. The authors compared COIP (n = 45) to children whose parents were never incarcerated (n = 93) within a sample of 138, 4‐ to 7‐year‐old ethnically diverse children residing in emergency homeless shelters. Children's caregivers provided information about children's history of parental incarceration and other family experiences. Children's teachers reported academic and mental health outcomes in the subsequent school year. Compared to children with no history of parental incarceration, COIP experienced more negative life events. Regression models revealed that a history of parental incarceration was a significant predictor of teacher‐reported internalizing problems. These results have implications for the identification and treatment of the highest risk homeless/highly mobile children.     

Healthy weight maintenance strategy in early childhood: The views of black African migrant parents and health visitors

In Europe and the US, childhood obesity is found to be higher in migrant children from black African communities and other visible minority ethnic groups. However, very little is known about the factors that contribute to the significant rates of obesity in these groups. The material for this study is drawn from a community‐based qualitative study that examined the sociocultural, familial and environmental factors that either facilitate or hinder healthy weight in black African children during early childhood. The participants for the study were black African parents (n = 30) and health visitors (n = 32), residing and working in the East Midlands, UK. The participants were purposively selected according to an inclusion/exclusion criterion and invited to participate in seven focus groups (FG‐7) conducted for parents (FG‐4) and health visitors (FG‐3) at a time and place convenient to the participants, between March and June 2018. The focus groups examined a number of issues, including the participants’ views on the barriers and facilitators to achieving and maintaining a healthy weight. Thematic analysis was used to identify themes within the data. Although participants were knowledgeable about the need for a healthy weight in early childhood, the parents discussed how immigration status and experiences of discrimination had an impact on their children's diet and well‐being, also discussing how structural factors influenced the decisions they made regarding healthy weight in early childhood. While the health visitors in general felt they did not have the skills to advise black African parents about the cultural influences on diet during early childhood, findings highlighted a need for a system‐based approach in meeting the nutritional needs of black African children. This study concludes by suggesting the need for broad social‐environment and economic changes that address factors such as migration status, deprivation and discrimination, coupled with culturally specific healthy diet messages.     

Are family‐centred principles,functional goal setting and transition planning evident in therapy services for children with cerebral palsy?

Background Family‐centred service, functional goal setting and co‐ordination of a child's move between programmes are important concepts of rehabilitation services for children with cerebral palsy identified in the literature. We examined whether these three concepts could be objectively identified in programmes providing services to children with cerebral palsy in Alberta, Canada. Methods Programme managers (n= 37) and occupational and physical therapists (n= 54) representing 59 programmes participated in individual 1‐h semi‐structured interviews. Thirty‐nine parents participated in eleven focus groups or two individual interviews. Evidence of family‐centred values in mission statements and advisory boards was evaluated. Therapists were asked to identify three concepts of family‐centred service and to complete the Measures of Process of Care for Service Providers. Therapists also identified therapy goals for children based on clinical case scenarios. The goals were coded using the components of the International Classification of Functioning Disability and Health. Programme managers and therapists discussed the processes in their programmes for goal setting and for preparing children and their families for their transition to other programmes. Parents reflected on their experiences with their child's rehabilitation related to family‐centredness, goal setting and co‐ordination between programmes. Results All respondents expressed commitment to the three concepts, but objective indicators of family‐centred processes were lacking in many programmes. In most programmes, the processes to implement the three concepts were informal rather than standardized. Both families and therapists reported limited access to general information regarding community supports. Conclusion Lack of formal processes for delivery of family‐centred service, goal‐setting and co‐ordination between children's programmes may result in inequitable opportunities for families to participate in their children's rehabilitation despite attending the same programme. Standardized programme processes and policies may provide a starting point to ensure that all families have equitable opportunities to participate in their child's rehabilitation programme.     

Teaching reading in the early years: exploring home and kindergarten relationships

This study investigated the relationship between home and kindergarten with regard to helping children with reading in Jordan. Interviews with parents of four‐ to five‐year‐old kindergarten students (n = 40) and their teachers (n = 20) were conducted. Results indicated that, although there was cooperation between parents and teachers, the role of teachers in encouraging parental involvement in their children's reading was quite limited. Results also indicated that teachers consider parental involvement as unhelpful since (1) they look at parents as unqualified persons to take a role in teaching reading, and (2) parents usually pressure teachers to employ inappropriate methods to teach children how to read. However, parents expressed their willingness to be involved when teachers give them the opportunity. Most parents think they need to know the appropriate methods to teach children how to read. This study identified the need for educating parents about kindergarten goals and appropriate activities.     

Dyadic and Triadic Family Interactions as Simultaneous Predictors of Children's Externalizing Behaviors

The purpose of this study was to investigate the relationship between dyadic and triadic family interactions and their association with the development of children's externalizing behaviors. Data were obtained from a longitudinal study of family interactions (N = 125), followed from before parents had their first child until children were 7 years old. Family interactions (marital, father–child, mother–child, and triadic mother–father–child) were observed in separate interaction tasks when children were 24 months old as predictors of children's externalizing behaviors at age 7 (n = 71 children). Results demonstrated that the triadic measure of competitive coparenting and the dyadic mother–child interaction characterized by negative emotional socialization related to children's later externalizing behavior, even after controlling for covariates and effects of all other family interaction variables. Results emphasize the importance of examining the family holistically and provided new information for designing more effective whole‐family interventions to reduce the development of children's externalizing behaviors.     

Are children rational decision makers when they are asked to value their own health? A contingent valuation study conducted with children and their parents

Despite the importance of including children's preferences in the valuation of their own health benefits, no study has investigated the ability of children to understand willingness‐to‐pay (WTP) questions. Using a contingent valuation method, we elicit children's and parents' WTP to reduce children's risk of an asthma attack. Our results suggest that children are able to understand and value their own health risk reductions, and their ability to do so improves with age. Child age was found to be inversely related to parents' and children's WTP. The results also suggest that non‐paternalistic altruism is predictive of children's WTP. For parents, care for their own health was found to be inversely related with their WTP for children's risk reductions. Comparison of parents' and children's WTP suggests that parents are willing to sacrifice for their child's health risk reduction an amount that is approximately twice that of their children. The analysis of matched pairs of parents and children suggest that there are within‐household similarities as the child's WTP is positively related to parents' WTP.     

Financial Parenting,Financial Coping Behaviors,and Well‐Being of Emerging Adults

The goal of this study was to consider the role of parents in the development of their children's financial independence by the time the children are old enough to enter college. Using data from 2,098 first‐year university students, we examined two pathways to emerging adults' financial, psychological, and personal well‐being, combining research on the positive effects of family financial environment and future‐oriented coping behaviors. Two findings are of particular note. The quality of parent‐child communication regarding financial topics proved to be the most potent predictor of children's financial, psychological, and personal well‐being. Further, parents' expectations had a significant indirect influence (via financial coping behaviors) on their children's well‐being. Implications for promoting financial self‐sufficiency among young adults are discussed.     

Two-year follow-up of the 'Families for Health' programme for the treatment of childhood obesity

Background The high prevalence of obesity in children in the UK warrants continuing public health attention. ‘Families for Health’ is a family‐based group programme for the treatment of childhood obesity. Significant improvements in body mass index (BMI) z‐score (?0.21, 95% CI: ?0.35 to ?0.07, P= 0.007) and other health outcomes were seen in children at a 9‐month follow‐up. Aim To undertake a 2‐year follow‐up of families who attended ‘Families for Health’ in Coventry, to assess long‐term outcomes and costs. Methods ‘Families for Health’ is a 12‐week programme with parallel groups for parents and children, addressing parenting skills, healthy lifestyles and emotional well‐being. The intervention was delivered at a leisure centre in Coventry, England, with 27 overweight or obese children aged 7–13 years (18 girls, 9 boys) and their parents, from 21 families. A ‘before‐and‐after’ evaluation was completed with 19 (70%) children followed up at 2 years. The primary outcome was change in BMI z‐score from baseline; secondary outcomes were children's quality of life, parent–child relationships, eating/activity habits and parents' mental health. Costs to deliver the intervention and to families were recorded. Results Mean change in BMI z‐score from baseline was ?0.23 (95% CI: ?0.42 to ?0.03, P= 0.027) at the 2‐year follow‐up and eight (42%) children had a clinically significant reduction in BMI z‐score. Significant improvements were seen in children's quality of life and eating habits in the home, while there were sustained reductions in unhealthy foods and sedentary behaviour. Fruit and vegetable consumption and parent's mental health were not significantly different at 2 years. Costs of the programme were £517 per family (£402 per child), equivalent to £2543 per unit reduction in BMI z‐score. Conclusions Improvements in BMI z‐score and certain other outcomes associated with the ‘Families for Health’ programme were sustained at the 2‐year follow‐up. ‘Families for Health’ is a promising new childhood obesity intervention, and a randomized controlled trial is now indicated.     

Levers and barriers to patient-centred care with children: findings from a synthesis of studies of the experiences of children living with type 1 diabetes or asthma

Background The last 50 years have seen a sea change in approaches to health care with children, from a time when children were routinely separated from parents while in hospital, to current recognition of the importance of placing the experiences of children and their families at the heart of care. Yet, there is a gap in the evidence about how children's involvement might be best achieved.This study aimed to synthesize findings of children's experiences of long‐term illness and, from this, to identify levers and barriers to patient‐centred care with children. Methods A synthesis of studies of the experiences of children living with type 1 diabetes or asthma. Data sources Eight health and social care databases, bibliography searches and consultation with field experts and first authors of included studies. Eligibility criteria Qualitative studies with children 10 years (mean) and younger on their experiences of living with type 1 diabetes or asthma. Main results Findings suggest key ‘levers’ to patient‐centred care with children include: (1) engagement with children's expertise about their own lives: their personal and social experiences of their care, including how these are affected by their relative lack of power in some settings; (2) exploring children's understandings and preferences in terms of their physical sensations and day‐to‐day experiences; (3) willingness to find resources to engage with even the youngest children; (4) avoiding age‐based assumptions about children's contributions to their care. Discussion and conclusions Action on the above ‘levers’ may present a range of challenges in healthcare settings not least because it represents a move away from medicine's historical focus on children's developing competencies to engage rather with children's social realities from the earliest ages.     

Establishing Reliability and Validity for “Make My Day” – A New Tool for Assessing Young Arab‐Israeli Children's Typical Daily Activities

There is a paucity of literature regarding the daily routines of young children (4–7 years) and their perception of their performance. Research indicates that children's involvement in treatment therapy improves their self‐consciousness, which contributes in return to the therapy's progress. Until recently, occupational therapists set goals for children by involving their parents in the planning. However, recent studies indicate that children are aware of their performance and can provide reliable data, given an evaluation that is adapted to their stage of development. “Make My Day” (MMD) is a new evaluation developed for young children, which provides information regarding the child's performance with respect to their daily activities. The MMD incorporates two versions – one for the children's self‐report and the other for the parent's report. Participants included 62 healthy 4‐ to 7‐year‐old children of Arab‐Israeli decent and their parents. They were assessed using the MMD, Perceived Efficacy and Goal Setting (PEGS), Time Organization and Participation (TOPS) and a socio‐demographic questionnaire. Correlations between the MMD and the TOPS/PEGS were examined regarding the differences between children's and parents' reports of performance in three age groups (concurrent validity). Results demonstrated that children's self‐report of their occupational performance in daily tasks are reliable and valid. Thus, occupational therapists may obtain data from the child himself or herself and not only from the parents. Further research on the MMD is recommended in other clinical populations to increase our knowledge of their daily functioning and of MMD's validity. Copyright © 2013 John Wiley & Sons, Ltd.     

Pyschosocial factors associated with children's cycling for transport: A cross-sectional moderation study

Promoting children's cycling for transport is a useful strategy to increase their physical activity levels. No studies have examined to which extent children's psychosocial characteristics play a role in their transportation cycling. Furthermore, insights into the association between children's independent mobility (IM) and transportation cycling is lacking in Europe. This study examined (1) the association of children's psychosocial characteristics with transportation cycling and its moderating effect of child's gender, parents' educational attainment and IM, and (2) the association between children's IM and transportation cycling.Children (n = 1232, aged 10–12 yrs) completed an online questionnaire at school assessing their psychosocial characteristics related with transportation cycling. Parents reported child's usual transportation cycling and the distance their child is allowed to cycle unsupervised (IM). Hurdle models were used to estimate associations between independent variables and odds of being a cyclist and with minutes of transportation cycling among those cycling. Data were collected during November–December 2014 across Flanders, Belgium.Children's perceived parental modeling, parental norm, peers' co-participation, self-efficacy and IM were positively related to the odds of being a cyclist, perceived benefits were negatively associated. Parental modeling, siblings' modeling, self-efficacy and parental norm were more strongly related to the odds of being a cyclist among children with a low IM. Friends' modeling was significantly related with odds of being a cyclist among boys. IM and parental norm (only among boys) were positively related to the time spent cycling. Targeting children, their friends and parents seems therefore most appropriate when aiming to increase children's transportation cycling.