Minor head trauma in children: an intervention to decrease functional morbidity

Minor head trauma is common among children and evokes strong parental reaction. Parents often rush the child to an emergency department or consult their pediatrician by telephone despite the minor nature of the injury. In a previous report we showed that children with minor head trauma appear to have limitations in their usual daily activities and a high rate of school absenteeism. This study was a prospective, randomized trial of an intervention designed to reduce this functional morbidity after head trauma. Parents in the control group (n = 168) received routine discharge instructions. Parents in the intervention group (n = 153) received a discharge interview during which the nurse gave more explicit and behaviorally oriented instructions. The nurse also called intervention parents the next day to reassure them and to urge that the children return to their usual routine. One month after the injury a questionnaire was administered by telephone to assess physical health status, social or functional limitations, and behavior problems. The majority of parents (85%) were anxious, and this was not alleviated by previous experience with head trauma. Triage nurses incorrectly rated one third of the parents as not anxious. Physical health status, role activity indices, and behavior problems, were similar for the intervention and control groups 1 month after the head injury. Subsequent morbidity was highly correlated with parental anxiety. In managing children with minor head trauma, pediatricians and emergency department physicians must focus their discharge instructions on the parent's anxiety, emphasize the minor severity of the injury, and urge that the children return to their usual routine.     

Tales of pediatric asthma management: family-based strategies related to medical adherence and health care utilization

OBJECTIVES: To examine how family management styles, garnered from parent interviews about the effect of asthma on family life, are related to medical adherence and health care utilization. STUDY DESIGN: Eighty parents with a child with asthma were interviewed. Computerized monitoring of medication use was collected every 2 months for 1 year. Parents and children completed measures of medical adherence and health care utilization at the time of the interview and at 1-year follow-up. Three categories of disease management were identified: reactive, coordinated care, and family partnerships. Group comparisons were made by using analysis of variance with medical adherence and health care utilization as dependent variables. RESULTS: Management strategies revealed in the interview were distinguishable by adherence rates at the time of interview and 1 year after. Interview categories were also predictive of emergency department use at 1-year follow-up. The reactive group received a diagnosis of asthma 1 year after noting symptoms, in contrast with the other groups, who received a diagnosis within 6 months. CONCLUSIONS: The use of semistructured interviews may reveal important information about how families manage asthma. Further work may help identify areas amenable to intervention and provide a better understanding of why some families delay treatment.     

Enabling parents who smoke to prevent their children from initiating smoking: results from a 3-year intervention evaluation

OBJECTIVE: To evaluate effects of a home-based antismoking socialization program on the initiation of smoking among children whose parents smoke. DESIGN: Three-year randomized controlled trial. PARTICIPANTS: Parents who were current smokers and had a child in the third grade who had not tried smoking were eligible; 873 parents-offspring pairs met these criteria, completed baseline interviews, and were randomly assigned to the intervention or control condition; 776 children (89%) completed an interview 3 years after baseline and were included in the study. INTERVENTION: During 3 months, the intervention group (n = 371) received 5 printed activity guides, parenting tip sheets, child newsletters, and incentives; this group also received a booster activity guide 1 year later. The control group (n = 405) received fact sheets about smoking. RESULTS: Initiation of smoking (first instance of puffing on a cigarette) was reported by 12% vs 19% of children in the intervention vs control groups. Logistic regression analysis indicated that children in the control condition had twice the odds of reporting initiation of smoking as children in the intervention condition (adjusted odds ratio, 2.16; P<.001), after adjusting for child sex, parent sex, parent race, parent educational achievement, child's best friends' smoking, parent smoking rate at baseline, and parent cessation status. CONCLUSION: Children in the pre-initiation phase of smoking who receive antismoking socialization from their parents are less likely to initiate smoking, even if their parents smoke.     

A study of parent/grandparent education for managing a febrile illness using the CALM approach.

INTRODUCTION: The purpose of this study was to examine the effectiveness of fever management education in increasing knowledge, confidence, comfort, and satisfaction of the parent/grandparent. METHOD: A randomized repeated measures design was used to evaluate the effectiveness of an educational brochure and video. After baseline data were collected on parent/grandparents of children receiving standard care, each site was randomized into two groups: Group 1 parents were given a video and brochure about fever management as they left the clinic/office; Group 2 were shown the video and given the brochure before seeing their health care provider. The parent/grandparents of 216 children, mean age 21.8 months, completed the Fever Management Questionnaire (FMQ) at 48-72 hours, 1, 3, and 6 months post-education. RESULTS: Knowledge scores of parents/grandparents in both CALM groups were significantly higher than those in the control group at 48 hours and 1-month post-visit. By 6 months, the knowledge level of the parent/grandparents in CALM2, those who viewed the video in the office, was significantly different from the other two groups. Satisfaction, comfort, and confidence of all three groups were high at all three points. Parents/grandparents in both CALM groups were highly satisfied with the education they received. DISCUSSION: Educating parent/grandparents about fever management using written and video materials is effective in increasing knowledge about fever management.     

An intervention to improve follow-up of patients with otitis media

We evaluated the effects of an educational intervention and telephone reminders on compliance with medication-taking and appointment-keeping for children with otitis media. During an initial interview we examined parents' health beliefs and other factors associated with compliance in our outpatient setting. The children were then systematically assigned to one of five study groups (G1-5). Parents in G1 received an educational session with a nurse and two follow-up telephone reminders. Parents in G2 received only two telephone reminders. Parents in G3 met with the nurse for an educational session only. Parents in G4 were exempted from interventions, while parents in G5 were exempted from the interventions and the initial interview. The telephone reminder significantly increased the return rate for follow-up appointments (p less than 0.05). This effect was not enhanced by combining it with an educational intervention focusing more on medication compliance. Relatively simple and inexpensive interventions such as the ones described here improve follow-up appointment-keeping for children with otitis media. This enhanced compliance behavior is important in obtaining better health outcomes for children with acute illnesses.     

Morbidity following minor head trauma in children

Head trauma, the most common form of accidental injury among children, is a source of concern for parents and pediatricians. Parents worry about a child's loss of intellectual function. Pediatricians often see the well-documented sequelae of severe head trauma as a basis for parental instructions on observation of a child after minor head injury. A prospective study of 321 children, 6 months to 14 years of age, who had sustained minor head injury within the previous 24 hours was conducted in the emergency department of the Children's Hospital of Philadelphia. Parents of all children completed a ten-minute triage questionnaire and received discharge instructions after their child had received standard medical management. One month after the injury, a questionnaire was administered in a telephone interview to assess the child's physical health status, social or functional limitations, and behavior problems. Physical morbidity was rare, and headache, the most frequent complaint, occurred in only 7% of the children. However, parents reported substantial functional morbidity, and there were significantly more behavioral problems in the 2- to 14-year-old head trauma patients than reported for the standard normal population. Therefore, children who have sustained minor head trauma manifest substantial functional morbidity despite the rarity of physical sequelae. This functional morbidity probably reflects parental overreaction and possibly family dysfunction. It is recommended that pediatricians who have determined that a child's head injury is mild should focus parental education on the rarity of physical sequelae and the importance of the child's returning to a normal routine.     

Use of the child development review increases residents' discussion of behavioral problems.

OBJECTIVE: To assess whether use of a parent questionnaire, the Child Development Review (CDR), before health maintenance examinations (HMEs) increases parent identification and increases resident discussion and documentation of behavioral issues for toddler and preschool-aged children. STUDY DESIGN: Quasi-experimental design using convenience samples with comparisons before and after questionnaire implementation. SAMPLE: Children 15 to 47 months of age and their parents attending a hospital-based, primary care clinic serving a low-income population, and the residents caring for them. METHODS: Participants were enrolled into early control, concurrent control, and intervention groups. All parents completed an exit interview about 9 behavioral issues and were asked if they had discussed these issues with the doctor. Before the visit, the intervention group parents completed the CDR, which was available for the residents to review. Information from the CDR and exit interview, and resident documentation were compared for control and intervention groups. RESULTS: There were 122 intervention and 135 control group HMEs. Parents using the CDR identified more behavioral issues for their children at the exit interview (median, 2.0 vs 1.0, P =.01). The 6 issues on both the CDR and the exit interview accounted for this increase. Intervention group parents reported discussion of more behavioral issues (median, 2.0 vs 0.0, P <.001). Discussion increased for all issues. Documentation was not increased for the intervention group. CONCLUSION: Use of the CDR before HMEs increased parent identification and reported discussion of behavioral topics for toddler and preschool children.     

Factors associated with refusal of childhood vaccines among parents of school-aged children: a case-control study

BACKGROUND: The rate of nonmedical exemptions to school immunization requirements has been increasing, and children with exemptions have contributed to outbreaks of vaccine-preventable diseases. OBJECTIVES: To determine why parents claim nonmedical exemptions and to explore differences in perceptions of vaccines and vaccine information sources between parents of exempt and fully vaccinated children. DESIGN: Case-control study. SETTING: Colorado, Massachusetts, Missouri, and Washington. PARTICIPANTS: Surveys were mailed to the parents of 815 exempt children (cases) and 1630 fully vaccinated children (controls randomly selected from the same grade and school) recruited from 112 private and public elementary schools. Surveys were completed by 2435 parents (56.1%). MAIN OUTCOME MEASURES: Parental reports. RESULTS: Most children (209 [75.5%] of 277) with nonmedical exemptions received at least some vaccines. The most common vaccine not received was varicella (147 [53.1%] of 277 exempt children). The most common reason stated for requesting exemptions (190 [69%] of 277) was concern that the vaccines might cause harm. Parents of exempt children were significantly more likely than parents of vaccinated children to report low perceived vaccine safety and efficacy, a low level of trust in the government, and low perceived susceptibility to and severity of vaccine-preventable diseases. Parents of exempt children were significantly less likely to report confidence in medical, public health, and government sources for vaccine information and were more likely to report confidence in alternative medicine professionals than parents of vaccinated children. CONCLUSION: Continued efforts must be made to educate parents about the utility and safety of vaccines, especially parents requesting nonmedical exemptions to school immunization requirements.     

Teaching children clean intermittent self-catheterization (CISC) in a group setting

ObjectiveTo teach children to perform clean intermittent self-catheterization (CISC) at our institution, the nurse practitioner uses a step-by-step approach in combination with an instruction model in an outpatient setting. For a small group of children the procedure remains difficult to learn. For them, we developed a multidisciplinary, group-wise training program.Patients and methodsSmall groups of children, aged 7–12 years, and their parents consulted our clinic during six meetings. The group training was provided by a pediatric urology nurse practitioner, physiotherapist and behavioural practitioner. Using a tell/show/do method each intervention was instructed group wise. The actual CISC was performed individually within a private setting. Elements of the training were: sharing of mastery and difficulties with other children/parents, cognitive restructuring to enhance understanding and motivation, handling and trying out of devices, relaxation as a response to physical stress, and supporting parental guidance.ResultsThe preliminary results of seven children were successful after group-wise intervention. Children were less anxious and more cooperative. Parents could share their difficulties dealing with their child at home and were given suggestions to help their children with CISC.ConclusionGroup interactions and a multidisciplinary approach seems to be of great help in learning CISC for selected children.     

Education in childhood asthma: A preliminary study of need and efficacy

This study initially assessed in parents of children with asthma, their knowledge of the condition and its management. Using a knowledge questionnaire a mean score for 30 parents of 69.1% was found, with a range between 44% and 86%. The study went on to examine whether an educational intervention program for parents could both improve knowledge and lower morbidity. The results for 14 parents who completed the educational intervention program were compared to those for 14 parents who did not complete the program. Both groups showed an increase in knowledge at 1 and 3 months after their initial interview ( P <0.005) but the active group had significantly better knowledge at 1 month ( P <0.0001) and 3 months ( P < 0.001) compared to the control group. There was no change in morbidity in either group as assessed by hospital admissions, visits to a doctor, days off school and number of wheezing episodes. We have shown that knowledge can be improved by an educational program for parents of children with asthma but have not been able to demonstrate an effect on short-term morbidity.     

Pre-admission management of acute gastroenteritis

Objective : Acute gastroenteritis contributes to significant morbidity and need for hospital admission. The current literature suggests outpatient management is often inappropriate. This study examines the pre-admission management of children admitted with acute gastroenteritis to a major children's hospital.
Methodology : Information was obtained from parental questionnaires and the medical notes for 164 children.
Results : Parents were poorly informed regarding appropriate home management Over 70% sought professional advice prior to admission, usually from their general practitioner. Although 58% received advice on fluid therapy, an oral rehydration solution was recommended for only 32%. and only 9% actually used one before admission. Advice regarding fluid requirements was usually inadequate. Inappropriate medications were prescribed for 22% of children, including antibiotics (15.4%). antidiarrhoeals (1.2%) and anti-emetics (5.5%). Hospitalized children were generally well nourished with minimal dehydration and electrolyte disturbance.
Conclusions : Oral rehydration therapy is utilized rarely and medications are over-utilized in home management of gastroenteritis. Education of parents, general practitioners and hospital doctors is essential to optimize outpatient management The impact of optimal outpatient management on hospital admission rates and morbidity requires formal assessment.     

Feeding behavior problems in children with cystic fibrosis in the UK: prevalence and comparison with healthy controls

BACKGROUND: Feeding behavior problems contribute to inadequate dietary intake for many patients with cystic fibrosis (CF). However, to establish effective intervention programs, more needs to be known about the occurrence and distribution of these difficulties. The aims of this study were to establish the prevalence and range of disruptive child behaviors (DCB) in patients with CF and the inappropriate parental responses (IPR) during mealtimes and to compare the results with those of healthy children. METHODS: In study A, parents of 108 patients (aged 1-7 years) completed a Behavioural Paediatric Feeding Assessment Scale comprising two domains: DCBs and IPRs during mealtimes. Parents rated the frequency of the behaviors and responses and identified those they considered problematic. In study B, data from the CF group (n = 69, aged 1-12 years) were compared with 69 age- and sex-matched control subjects. RESULTS: Parents of children with CF aged 5 to 8 years recorded significantly more DCBs than those in all other age ranges. These parents also reported significantly more IPRs than did parents of children aged 9 to 12 years and 13 to 17 years. Parents of children with CF reported significantly more DCBs and IPRs than did those of the control subjects. There were significantly more problematic DCBs and IPRs in the CF group than in the control group for children aged 5 to 8 years and 9 to 12 years but not for those aged 1 to 4 years. CONCLUSIONS: Parents of children with CF report more feeding behavior problems than do those of healthy control subjects. The high prevalence of feeding behavior problems in older children suggests that preventative and reactive interventions must continue throughout childhood and vary according to the child's developmental abilities.     

Fever management: Evidence vs current practice

Fever is a very common complaint in children and is the single most common non-trauma-related reason for a visit to the emergency department. Parents are concerned about fever and it’s potential complications. The biological value of fever (i.e., whether it is beneficial or harmful) is disputed and it is being vigorously treated with the belief of preventing complications such as brain injury and febrile seizures. The practice of alternating antipyretics has become widespread at home and on paediatric wards without supporting scientific evidence. There is still a significant contrast between the current concept and practice, and the scientific evidence. Why is that the case in such a common complaint like fever The article will discuss the significant contrast between the current concepts and practice of fever management on one hand, and the scientific evidence against such concepts and practice.     

Duration of recognized fever in febrile seizure predicts later development of epilepsy

Background: The current report examines the risk of and predictors for developing epilepsy in children with febrile seizure (FS). The present study addresses two factors that were previously identified as predictors of recurrent FS in previous reports: maximum temperature and duration of fever prior to the initial FS. Methods: Children aged 6 months–6 years with an initial simple FS were eligible for the study. The interview included questions about the child's illness, family history of seizures, and other exposure information. In particular, they were asked about the duration of recognized fever prior to the seizure. After the initial interview, parents were called every 3–4 months to ascertain whether any further seizures had occurred and the circumstances under which such seizures occurred. Follow up ≥3 years was attempted for all children. Statistical analysis was done with χ² test, Fisher's exact test, Mann–Whitney U‐tests and logistic regression analysis. Results: Five of 92 children (5.4%) experienced unprovoked seizures and were considered part of an epilepsy group. In four of these five patients, the duration of recognized fever prior to FS fell more than ±2.5 SD outside the distribution for the non‐epilepsy group. Either an unusually short or long recognized fever prior to the initial FS was associated with an increased risk of unprovoked seizures. Conclusions: The duration of recognized fever appears to provide useful information about the risk for the later development of epilepsy.     

Education in childhood asthma: a preliminary study of need and efficacy

This study initially assessed in parents of children with asthma, their knowledge of the condition and its management. Using a knowledge questionnaire a mean score for 30 parents of 69.1% was found, with a range between 44% and 86%. The study went on to examine whether an educational intervention program for parents could both improve knowledge and lower morbidity. The results for 14 parents who completed the educational intervention program were compared to those for 14 parents who did not complete the program. Both groups showed an increase in knowledge at 1 and 3 months after their initial interview (P less than 0.005) but the active group had significantly better knowledge at 1 month (P less than 0.0001) and 3 months (P less than 0.001) compared to the control group. There was no change in morbidity in either group as assessed by hospital admissions, visits to a doctor, days off school and number of wheezing episodes. We have shown that knowledge can be improved by an educational program for parents of children with asthma but have not been able to demonstrate an effect on short-term morbidity.     

父母短期教育干预对学龄前儿童焦虑的影响

目的 探讨父母接受短期教育干预对学龄前儿童焦虑的影响。方法 Spence 学龄前儿童焦虑量表得分≥ 48 分（≥ 48 分者认为有焦虑情绪）的 49 名儿童随机分为干预组和对照组。干预组儿童家长进行 6 次关于儿童焦虑管理的集体教育课程,对照组只进行随访。干预后 3 个月和 6 个月分别用焦虑量表再次进行测评,比较两组间的差异。结果 最终完成整个观察研究的干预组有 21 例,对照组 22 例。3 个月后,干预组仍≥ 48分的儿童比率低于对照组（62% vs 91%,PPPP结论 早期对父母进行短期教育干预可有效缓解学龄前儿童的焦虑,其远期效果有待进一步随访观察。     

Parental food allergy information needs: a qualitative study.

OBJECTIVE: To examine information needs and preferences of parents regarding food allergy. DESIGN: Qualitative study including in-depth semi-structured interviews and focus group discussions. Data were audio-recorded, transcribed verbatim and analysed using the constant comparative method, aided by participant checking of interview summaries, independent reviewers and qualitative analysis software. PARTICIPANTS: 84 parents of children with food allergy. SETTING: Three paediatric allergy clinics and a national consumer organisation. RESULTS: Most parent participants had received third level education (72%) and 39% had occupational backgrounds in health and education. Parents experienced different phases in their need for information: at diagnosis when there is an intense desire for information, at follow-up when there is continuing uncertainty about allergy severity and appropriate management, and at new events and milestones. They preferred information to be provided in a variety of formats, with access to reliable individualised advice between clinic appointments, within the context of an ongoing relationship with a health professional. Parents wished to know the reasoning behind doctor's opinions and identified areas of core information content, including unaddressed topics such as what to feed their child rather than what to avoid. Suboptimal information provision was cited by parents as a key reason for seeking second opinions. CONCLUSION: Parents with children with food allergies have unmet information needs. Study findings may assist in the design and implementation of targeted educational strategies which better meet parental needs and preferences.