Parenting and feeding behaviors associated with school-aged African American and White children

Pediatric obesity is multifactorial and difficult to treat. Parenting and feeding behaviors have been shown to influence a child's weight status. Most prior studies have focused on preschool-aged White children. Additional complicating factors include parents' inability to accurately identify their child's abnormal weight status. Parenting and feeding behaviors used by 176 African American and White parents of school-age children were examined. Assessment included (a) identifying what behaviors were reported when parent expressed concern with child's weight and (b) the relationship of these behaviors on child's body mass index percentile (BMI%), considering ethnicity, socioeconomic status (SES), and parent's body mass index (BMI). Findings included African American parents and parents concerned about their child's weight exhibited increased controlling/authoritarian parenting and feeding behaviors. Parents were able to accurately identify their child's weight status. Parenting and feeding behaviors played a significant role in the children's BMI% even when controlling for ethnicity, SES, and parent's BMI.     

The relationship between parent emotion, parent behavior, and health status of young African American and Latino children

The purpose of this study was to examine the relationship between parent emotion and behavior and the functional health status of young African American and Latino children. Parents were interviewed, in English or Spanish, about their child's functional health status, parents' depression, and their parenting behaviors. Standard measures used included the Functional Status IIR, the Center for Epidemiologic Studies Depression Scale, and the Parent Behavior Checklist. One hundred ninety-six children's parents attending a nurse-managed, primary care clinic in an underserved area of San Francisco participated. Multivariate analysis showed that higher functional status was related to more nurturing (p < .05). Lower functional status was related to more discipline (p < .01) and increased parental depression (p < .01). Nurses, across all settings, play an integral role in assessing and promoting healthy child development and family functioning. Implementing a rapid screening test for depression and further assessment of parenting behaviors could identify those needing more assistance in developing positive parenting skills.     

Looking at childhood obesity through the lens of Baumrind's parenting typologies

Obesity is becoming the leading negative health outcome for the current generation of children to a greater degree than for any previous generation. Pediatric orthopaedic nurses encounter many patients and families with concerns about obesity and need the ability to promote parenting capacity in order to detect, prevent, or treat childhood obesity. Parenting is a complex process with numerous two-way interactions between the parent and child. Pediatric orthopaedic nurses affect parenting capacity daily as they care for families in all care settings. Many family researchers use Baumrind's parenting typologies (styles) and their correlations to child health outcomes in research. Understanding Baumrind's theories can help pediatric orthopaedic nurses understand the mechanisms parents use to affect the health outcomes related to the obesity of their children. Baumrind's is one parenting theory that can help demonstrate how parental behaviors and practices affect a child's self-concept and self-care development and ultimately a child's health promotion beliefs and practices related to obesity prevention and care that continue into adulthood. Nurses can use reviews of literature and application to practice of parenting styles to expand their repertoire of parent guidance and anticipatory teaching directed to the prevention and care of childhood obesity.     

Parenting stress, marital quality, and child behavior problems at age 7 years

The study examined the relationship of early family environment and infant characteristics with childhood behavior problems at age 7 years. Sixty-two mothers and 56 fathers of preterm (30-36 weeks gestation and greater than 1500 g) and full-term boys and girls completed the Parenting Stress Index, Dyadic Adjustment Scale, and a measure of socioeconomic status during the child's first year. When their child was age 7 years, parents completed the Eyberg Child Behavior Inventory Intensity (frequency of behavior) and Problem (impact of behavior) scales. Hierarchical regression analyses showed that parenting stress because of their child's distractibility during infancy predicted the frequency of childhood behavior problems at age 7 years for mothers and of the impact of behaviors on the mother and the father. The quality of the marital relationship during infancy predicted the frequency of behavior problems reported by fathers. Public health nurses are well positioned to assess parenting stress and marital quality and to provide support to families during the early stages of parenthood.     

The impact of chronic pain in children and adolescents: Development and initial validation of a child and parent version of the Pain Experience Questionnaire

Psychosocial factors are crucial for understanding and treating chronic pain in adults, but also in children. For children, very few questionnaires for a multidimensional pain assessment exist. In adults, the Multidimensional Pain Inventory (MPI; [Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 1985;23:345-56]) has been widely used to determine patients' adjustment to chronic pain. Using one section of the MPI as a model, we developed and evaluated the Pain Experience Questionnaire (PEQ) - child and parent version - that assesses the psychosocial impact of chronic pain in children and adolescents. As substantiated by confirmatory factor analysis in a sample of 111 children and adolescents (7-18 years) with chronic pain, the child PEQ entails the subscales pain severity, pain-related interference, affective distress and perceived social support. The parent version contains the subscales severity of the child's pain, interference and parental affective distress. Child and parent PEQ subscales were internally consistent. Age was unrelated to PEQ subscale scores. Girls and their mothers endorsed significantly greater pain severity, interference and affective distress. Validity analyses yielded a pattern of correlations with measures of depression, trait anxiety, pain activity, child behaviors, pain-related cognitions, and parenting behavior that is consistent with psychometric data of the adult MPI and previous findings on psychosocial aspects of chronic pediatric pain. Significant differences between children depending on patient status (participants in experimental or treatment studies, outpatients, inpatients) suggest external validity of the PEQ. Despite the preliminary nature of the psychometric evaluation, the child and parent PEQ seem promising for a comprehensive assessment of pediatric pain.     

Qualities of caregiver-child interaction during daily activities of children born very low birth weight with and without white matter disorder.

OBJECTIVE: The purpose of this study was to examine qualities of caregiver-child interactions during daily activities of healthy children born full-term and of children born prematurely and very low birth weight with and without white matter disorder. METHOD: Three groups of 12 caregiver-child dyads, representing three levels of child biological risk, were matched on birth history, maternal education, ethnicity, and child gender. Ten expert clinicians used videotapes to rate behaviors of caregivers and their 30-month-old children engaging in dressing and snack activities. Correlations between ratings of three qualities were examined: caregiver directiveness, caregiver engagement, and child engagement. RESULTS: There were no significant differences between groups for the average caregiver and child ratings. However, correlations between caregiver directiveness and caregiver engagement ranged across the three groups from greatest to least biological risk (i.e., r= .63, .35, -.67, respectively). In the full-term group, correlations between the caregiver qualities of directiveness and engagement and child engagement were r= .62 and -.69, respectively. In contrast, the correlations between the caregiver and child qualities were small in the two very-low-birth-weight groups. CONCLUSION: Results suggest patterns of caregiver interactions during daily activities may vary according to the child's level of biological risk. Caregivers of children with the greatest risk (i.e., white matter disorder) were both engaging and directive of their children during the activities, whereas caregivers of full-term children were less engaging when directive. The findings suggest that caregivers may be adjusting the level of their social and emotional assistance during caregiver-child interactions to the level of their children's abilities.     

Medical, psychologic, and legal aspects of child custody disputes

An increasing number of children seen in pediatric practice are children of divorce. The child is often involved in the conflict between his parents in regard to custody and visitation. The physician will want to be familiar with the historical background of child custody decisions and the present guidelines the courts are using in determining custody and visitation, together with the newer and controversial proposals concerning the elusive concept of "best interests of the child." It is important that the pediatrician recognize the usual phenomenology of the young child's response to family disruption, lest he ascribe it to some fault on the part of the current caretaker. Some children respond to disruption in the family with symptoms that warrant intervention directed toward helping the child. All cases warrant intervention designed to enhance the parenting ability of the custodial parent and to enlist the cooperation of the noncustodial parent to minimize adverse influences on the child's developmental agenda. The physician should be well prepared if he participates in court procedures regarding custody and visitation controversy.     

Parenting and Child Outcomes of HIV-Infected African American Mothers: A Literature Review

Parenting young children while living with HIV is an important public health concern. This article reviews maternal HIV and the impact it has on the parenting experience of African American mothers. Because living with HIV has been considered a family illness, the Family Systems Model provided a framework for this article. The model demonstrated an important link between maternal HIV and its impact on the health and wellbeing of not only the mother and her children, but her parenting and family roles as well. Research has documented an association between maternal HIV and negative parent–child outcomes among African American mothers. I examined studies on parenting and child outcomes among African American mothers living with HIV. The review assists in conceptualizing parenting with HIV as an area of increasing importance in health services delivery to HIV-infected African American mothers who are caring for young children.     

Mother's and Father's Responses to Signals of Children With Cerebral Palsy During Feeding

This paper describes mothers' and fathers' interactions in responding to children with cerebral palsy during a meal. Participants were 47 children aged 17–54 months, and their parents. Children were assessed via Bayley, Peabody Picture Vocabulary Test, Vineland, or observations, or all of these, and parents by Dyadic Adjustment Scale, Parenting Stress Index, and Reaction to Diagnosis Interview. Parent and child characteristics were related to interactions during lunch. Parents generally responded individually to signals; children gave nonspecific signals or signaled mothers more than fathers. Mothers responded significantly more often than did fathers, even controlling for frequency of signals. Undifferentiated signals were less often responded to by either parent. Parent–child interactions were not related to child's degree of motor impairment. Few significant relations existed between child gender, age, or cognitive function, and child or parent behaviors. Mothers' marital happiness related to father involvement in responding to child signals. Results are discussed in terms of parenting as a cooperative function.     

Continuity of medical care, health insurance, and nonmedical advice in the first 3 years of life

OBJECTIVES: The study seeks to evaluate whether continuity in medical care provides a mechanism that contributes to increased parental awareness of the importance of dental services, nutrition, and child development and whether health insurance encourages such continuity. METHODS: Data pertaining to medical utilization and dental, child nutrition, and child development counseling were extracted from the National Maternal and Infant Health Survey, 1988 and the 1991 Longitudinal Follow-up. These data permit the investigation of whether having continuity in medical care for a child increases the likelihood that the child's parent receives advice about dental health, nutrition, and child development. Restricting the analyses to Caucasian and African American women and excluding respondents with missing information on the child's health care utilization yielded 7056 participants. We created a set of binomial logit models, with correction for clustering (due to sample design). These models jointly estimate the likelihood that a child was classified as having continuity of care and the likelihood that the child's mother received advice about the 3 areas of interest. RESULTS: Private fee-for-service health insurance was found to increase the likelihood that a child receives continuity of care. When primary care was provided with high continuity of care, the probability that physicians provide mothers with dental, nutritional, and developmental advice was increased. CONCLUSIONS: These results suggest that continuity of care may have important spillover effects beyond direct medical care by improving maternal information about child dental care, nutrition, and developmental issues.     

Alternate child care, history of hospitalization, and preschool child behavior

BACKGROUND: With more single mothers entering the workforce due to welfare reform efforts, more hospitalized children from single-parent families will have experienced alternate child care arrangements where routine care is provided by adults other than the child's mother. OBJECTIVES: To investigate with secondary analysis of data whether experience with alternate child care has a moderating effect on the relationship between hospitalization and behavior of preschool children living in female-headed single-parent families. METHOD: A sample of 60 preterm and 61 full-term children who were 3, 4, or 5 years old was recruited for the larger longitudinal study. Behavior problems were measured with the Child Behavior Checklist. History of hospitalization and alternate child care arrangements were measured with the Life History Calendar. RESULTS: Preschool children who experienced hospitalization without alternate child care experience had more somatic complaints, but those with both hospital and alternate child care experience had fewer aggressive behaviors than other children. For children with a history of hospitalization, aggressive behaviors decreased as the proportion of the child's life in alternate child care increased. CONCLUSIONS: Experience with alternate child care may ameliorate some of the negative effects of hospitalization, and potentially other novel and negative experiences, for preschool children. This could be due to child care providing positive experiences with separation from the mother, a peer group with which to talk about the novel experience, or actual instruction about the novel experience.     

Parenting and childhood behavior problems: mothers' and fathers' voices

Through thematic analysis of interviews, we explored parents' perceptions of their child's behaviors and their own parenting. A purposive sample of four mothers and four fathers who reported behavior problems for their 7(1/2) year-old-child was selected from a larger study. Parents appraised their child positively despite episodic behavior problems, and described parenting in the context of financial difficulties, marital conflict, chronic illness, lack of support for parenting, and abuse in the parent's family of origin. Data suggest a need for timely mental health services to assist parents with managing their child's behaviors within the context of the family's situation.     

Cardiovascular risk factors and socioeconomic status in African American and Caucasian women

Self-reported cardiovascular risk factors of obesity, physical inactivity, and smoking in African American and Caucasian women in North Carolina were compared, controlling for socioeconomic status (SES). Participants were 1,945 women aged 23 to 53 years; 20.1% African American and 79.9% Caucasian. Of the African American women, 38.8% were obese, 51.7% were inactive, and 31.2% smoked; of the Caucasians, 19.9% were obese, 31.2% were inactive, and 33.8% smoked. SES differed significantly by race (p < 0.001). Low and middle SES African American women were much more likely than high SES African Americans to be obese, inactive, and smokers. Among Caucasian women, those with low SES had the greatest prevalence for all three risk factors. After controlling for income and education, African American women were more than twice as likely as Caucasian women to be obese and to be inactive, but were only half as likely to smoke. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21: 285–295, 1998     

HOME inventory and NCATS: Relation to mother and child behaviors during naturalistic observations

The purpose of this study was to determine the relationships among the Nursing Child Assessment Teaching Scale (NCATS), the Home Observation for Measurement of the Environment (HOME) inventory, and interactive behaviors observed in the home for fifty-three 3-year-old, prematurely born children and their mothers. The total HOME score showed high internal consistency, with moderate subscale levels. NCATS total score showed high internal consistency, but low to moderate subscale consistency. Combining NCATS subscales into a mother subscale and child subscale improved internal consistency. The HOME and the NCATS mother subscale correlated with observed maternal behaviors, but the NCATS child subscale was unrelated to child behaviors. Relationships between observed behaviors and HOME scores did not differ for high- and low-education mothers or for Caucasians and African Americans, but only low-education mothers and African Americans exhibited correlations between NCATS scores and observed behaviors. These results show the HOME, NCATS, and naturalistic observations measure related, but not overlapping, aspects of the mother's contribution to her relationship with her child, but the NCATS child subscale should be used with caution with 3-year-olds. © 1997 John Wiley & Sons, Inc. Res Nurs Health 20: 295–307, 1997     

Analysis of two measures of child behavior problems by African American, Latino, and non-Hispanic Caucasian parents of young children: a focus group study

This study examined how parents from different racial/ethnic, income, and language groups viewed two widely used parent-report measures of child behavior problems, the Child Behavior Checklist and the Eyberg Child Behavior Inventory. Seventy African American, Latino, and non-Latino Caucasian parents of preschoolers stratified by income met in 1 of 15 focus groups to discuss their perceptions of the instruments. Participants agreed that items on these instruments were relevant indicators of child behavior problems. Overall, parents found the items on both instruments useful, comprehensible, and acceptable. The findings support the use of these instruments in pediatric practice with ethnically diverse parents of young children.     

Assessment of acute pediatric pain: do child self-report, parent ratings, and nurse ratings measure the same phenomenon?

The purpose of this study was to determine the factors that are associated with child, parent, and nurse ratings of acute pediatric pain and distress during venipuncture. The behavior of eighty-five pediatric cancer patients during venipuncture was recorded by trained raters, and their observations were compared with ratings of pain and distress obtained from parents, pediatric patients, and pediatric nurses. Regression analyses indicated that ratings made by the child, parent, and nurse reflect different perspectives. Nurses' ratings were based upon overt distress, parents' ratings reflected their subjective perception of the child's pain, and the child's self-report was associated with the child's chronologic age.     

Measures of body size based on height, weight, and reported ideal weight: conceptual distinctions and empirical demonstrations.

Using height, weight, and self-reported weight, eight additional measures of body size were computed. The purpose of this paper was to specify conceptual distinctions and test hypothesized relationships among those newly constructed measures. Using a sample of healthy African American and European American women, correlations among the measures and race differences were assessed. High correlations suggested only two independent constructs, but theoretical considerations would suggest retaining, in addition to the traditional measure of body mass index, three new constructs: ideal body mass, a discrepancy measure, and a desirability measure. The only significant race difference was on ideal body mass. African American women reported a larger ideal body mass index than European American women. The use of actual versus self-report measures of height and weight, different conceptualizations of ideal weight, and clinical implications also were discussed.     

Association between self-report pain ratings of child and parent, child and nurse and parent and nurse dyads: meta-analysis

Title.  Association between self-report pain ratings of child and parent, child and nurse and parent and nurse dyads: meta-analysis.
Aim.  This paper is a report of a meta-analysis to investigate the association between self-report pain ratings for the dyads of child and parent, child and nurse and parent and nurse.
Background.  Existing research has shown conflicting results with regard to agreements of self-report pain ratings between the three dyads.
Data sources.  The CINAHL, Medline, Ovid and PsycINFO databases were searched using keyword, such as 'children/adolescents', 'parents/nurses', 'pain assessment', 'pain ratings', 'association' and 'agreement'. Studies published in English in or after 1990 were included.
Methods.  Meta-analysis methodology was applied to 12 pain assessment studies published between 1990 and 2007 which met the inclusion criteria. In the 12 studies a common effect size was estimated using the Pearson's correlation coefficient. Therefore, a fixed-effects model was chosen for this meta-analysis.
Results.  We found moderate summary effect sizes between self-reported pain ratings for the dyad of child and parent ( r  = 0·64) and the child and nurse dyad ( r  = 0·58) and a weak summary effect size of r  = 0·49 for the dyad of parent and nurse. The summarized effect sizes for each of the three dyads varied across the studies. A test of homogeneity ( Q -statistic) indicated that all effect size estimates were not homogeneous.
Conclusion.  Parents' and nurses' perceptions of children's pain should only be considered as estimates rather than expressions of the pain experienced, and not the same as children's self-reports. There is a need for education on selection of appropriate pain assessment scales in relation to the age and development of the child.     

An Examination of Parenting Variables and Child Self-Care Behavior Across Disease Groups

The present study examined the relationship of three parent-related variables, namely, perceived child vulnerability, parental overprotection, and parenting stress to child self-care behaviors among 200 children with Type 1 diabetes, asthma, or cystic fibrosis. A related goal of the study was to examine for illness- and age-related differences among the same variables of interest. Results indicated that higher levels of parenting stress were associated with lower parent ratings of their child’s self-care behaviors. Additional analyses of individual illness groups demonstrated that age was significantly related to both child and parent ratings of self-care only for the diabetes group, with older children engaging in lower levels of self-care. Such results support continued investigation of parent behaviors and beliefs as they relate to child self-care outcomes at different ages in pediatric chronic illness populations.