Correlates of child–father and child–mother attachment in the preschool years

The increase in fathers’ involvement in childrearing, particularly beyond infancy, warrants research exploring factors influencing the quality of child–father attachment relationships, and the impact of these relationships on children’s social development. The current investigation explored various correlates of preschoolers’ child–father attachment security to both parents, including contextual factors (i.e., socioeconomic status, child temperament, parenting stress), parental play sensitivity, and child social adaptation. Participants included 107 preschool-aged children (59 girls; M = 46.67 months, SD = 8.57) and their fathers and mothers. Results revealed that both mothers’ and fathers’ play sensitivity were associated with child attachment security after controlling for different contextual factors. Furthermore, the magnitude of the association between child conduct problems and child–father attachment insecurity was stronger than the corresponding association with child–mother attachment insecurity. Findings provide important information on caregiving factors associated with child–father attachment security in the preschool years and the importance of this bond to children’s social adaptation.     

Effect of maternal panic disorder on mother–child interaction and relation to child anxiety and child self-efficacy

To determine whether mothers with panic disorder with or without agoraphobia interacted differently with their children than normal control mothers, 86 mothers and their adolescents (aged between 13 and 23 years) were observed during a structured play situation. Maternal as well as adolescent anxiety status was assessed according to a structured diagnostic interview. Results showed that mothers with panic disorder/agoraphobia showed more verbal control, were more criticizing and less sensitive during mother–child interaction than mothers without current mental disorders. Moreover, more conflicts were observed between mother and child dyadic interactions when the mother suffered from panic disorder. The comparison of parenting behaviors among anxious and non-anxious children did not reveal any significant differences. These findings support an association between parental over-control and rejection and maternal but not child anxiety and suggest that particularly mother anxiety status is an important determinant of parenting behavior. Finally, an association was found between children’s perceived self-efficacy, parental control and child anxiety symptoms.     

Mother–child adrenocortical synchrony: Roles of maternal overcontrol and child developmental phase

An increasing amount of empirical attention is focused on adrenocortical synchrony as an index of biobehavioral co-regulation between parent and child in the context of early child development. Working with an ethnically diverse community sample of children (N = 99, 50.5% male, ages 9–12), we collected saliva samples from mother–child dyads prior to and after a laboratory-based performance challenge task, and tested whether maternal overcontrol and child age moderated dyadic synchrony in cortisol. Results revealed that cortisol levels between mothers and children were significantly positively correlated at pretask for dyads with mean age and older children only, at 25-min post-task for all dyads, and at 45-min post-task for all dyads. Higher overcontrol/older child dyads exhibited a unique pattern of cortisol synchrony wherein at pretask, mother–child levels had the strongest positive correlation, whereas at 25 and 45 min, mother–child cortisol levels were significantly inversely correlated. These findings contribute to theory and research on parent–child relationships by examining parenting behavior, developmental stage, and adrenocortical synchrony in tandem.     

Clinical prescribing of allergic rhinitis medication in the preschool and young school-age child: what are the options?

Allergic rhinitis (AR) is the most common chronic condition in children and is estimated to affect up to 40% of all children. It is usually diagnosed by the age of 6 years. The major impact in children is due to co-morbidity of sinusitis, otitis media with effusion, and bronchial asthma. AR also has profound effects on school absenteeism, performance and quality of life. Pharmacotherapy for AR should be based on the severity and duration of signs and symptoms. For mild, intermittent symptoms lasting a few hours to a few days, an oral second-generation antihistamine should be used on an as-needed basis. This is preferable to a less expensive first-generation antihistamine because of the effect of the latter on sedation and cognition. Four second-generation antihis-tamines are currently available for children under 12 years of age: cetirizine, loratadine, fexofenadine and azelastine nasal spray; each has been found to be well tolerated and effective. There are no clearcut advantages to distinguish these antihistamines, although for children under 5 years of age, only cetirizine and loratadine are approved. Other agents include pseudoephedrine, an oral vasoconstrictor, for nasal congestion, and the anticholinergic nasal spray ipratropium bromide for rhinorrhoea. Sodium cromoglycate, a mast cell stabiliser nasal spray, may also be useful in this population. For patients with more persistent, severe symptoms, intranasal corticosteroids are indicated, although one might consider azelastine nasal spray, which has anti-inflammatory activity in addition to its antihistamine effect. With the exception of fluticasone propionate for children aged 4 years and older, and mometasone furoate for those aged 3 years and older, the other intranasal corticosteroids including beclomethasone dipropionate, triamcinolone, flunisolide and budesonide are approved for children aged 6 years and older. All are effective, so a major consideration would be cost and safety. For short term therapy of 1 to 2 months, the first-generation intranasal corticosteroids (beclomethasone dipropionate, triamcinolone, budesonide and flunisolide) could be used, and mometasone furoate and fluticasone propionate could be considered for longer-term treatment. Although somewhat more costly, these second-generation drugs have lower bio-availability and thus would have a better safety profile. In patients not responding to the above programme or who require continuous medication, identification of specific triggers by an allergist can allow for specific avoidance measures and/or immunotherapy to decrease the allergic component and increase the effectiveness of the pharmacological regimen.     

Early mother–child attachment and behavior problems in middle childhood: the role of the subsequent caregiving environment

The current study investigated associations between early mother–child attachment, as well as mother–child and teacher–child relationships, and internalizing and externalizing behaviors in middle childhood. Data from the NICHD Study of Early Child Care and Youth Development were used. Findings from a series of individual growth curve analyses revealed that attachment security was negatively related to internalizing and externalizing behaviors, while insecure/other and avoidant attachment were positively related to internalizing behaviors. In addition, longitudinal associations were found between mother–child and teacher–child relationships and internalizing and externalizing behaviors across middle childhood. Implications for attachment theory are discussed.     

Does caregiver's social bonding enhance the health of their children?: the association between social capital and child behaviors

Little is known about the association between social capital and child behaviors. This study aims to investigate that association. A complete population-based, cross-sectional survey was conducted for all the caregivers with preschool children in a rural town in Okayama prefecture in Japan. Two dimensions of individual-level social capital and unhealthy child behaviors were reported by parent-administered questionnaire. We analyzed 354 preschool children (57.6% of all children for whom questionnaires were completed). Children whose main caregiver had high cognitive social capital were 89% less likely to miss breakfast (odds ratio [OR]＝0.11;95% confidence interval [CI]:0.01-1.03). Children whose caregiver had high structural social capital were 71% less likely to wake up late (OR＝0.29;95% CI:0.12-0.71) and 78% less likely to skip tooth brushing more than once per day (OR＝0.22;95% CI:0.05-0.93). Both cognitive and structural social capital were negatively associated with unhealthy child behaviors. A further intervention study is needed to confirm the impact of social capital on child behavior.     

Autonomy of the child in the South African context: is a 12 year old of sufficient maturity to consent to medical treatment?

Background

A child is a developing person with evolving capacities that include autonomy, mental (decisional) capacity and capacity to assume responsibility. Hence, children are entitled to participatory (autonomy) rights in South Africa as observed in the Children’s Act 38 of 2005. According to section 129 of the Act a child may consent to his or her own medical treatment provided that he or she is over the age of 12 years and is of sufficient maturity and decisional capacity to understand the various implications of the treatment including the risks and benefits thereof. However, the Act does not provide a definition for what qualifies as ‘sufficient maturity’ nor does it stipulate how health professionals ought to assess the decisional capacity of a child. In addition, South Africa is a culturally diverse country. The Western liberal notion of autonomy may not necessarily find equal prominence in the mores of people with a different worldview. Hence we demonstrate a few salient comparisons between legal liberal moral theory and African communitarianism as pertinent to the autonomy of the child.

Discussion

Children are rights-holders by virtue of their humanity. Their dignity as individual human persons affords them the entitlement to human rights as contemplated under the Constitution of the Republic of South Africa. However, contrary to the traditional Western notion of individual autonomous persons African societies hold a communalistic notion of person hence there is less regard for individual autonomy and rights with more emphasis on the communal good and maintaining the continuity of relationships and interdependencies shared within a community. A child considered in this view is not regarded as a full person. This implies that decisions concerning the child, including consent to medical treatment are discussed and determined by the community to which the child belongs. Lastly, in this article, we draw on the notion of capacity for responsibility to produce a pragmatic definition of sufficient maturity.

Conclusion

It seems reasonable to suggest a move away from a general legal age of consent for medical treatment toward more individualised, context-specific approaches in determining the maturity of a child patient to consent to medical treatment. Perhaps, decision-making with respect to consent to the medical treatment of a child belonging to a traditional African community where the notion of a person is embedded in communitarianism ought to involve the child’s parents/guardians/caregivers where possible provided that the best interests of the child are awarded priority.

     

Parent–child attachment,academic performance and the process of high-school dropout: a narrative review

Poor academic performance is a strong predictor of school dropout. Researchers have tried to disentangle variables influencing academic performance. However, studies on preschool and early care variables are seldom examined when explaining the school dropout process. We reviewed the literature on the relationship between caregiver–child attachment and academic performance, including attachment studies from preschool years, seeking out potential contributions to academic performance and the dropout process. The review was organized according to a model of four main mediating hypotheses: the attachment-teaching hypothesis, the social network hypothesis, the attachment-cooperation hypothesis, and the attachment self-regulation hypothesis. The results of the review are summed up in a model. There is some support for all four hypotheses. The review indicates that attachment and early care contribute substantially to dropout and graduation processes. Mediation effects should be given far more attention in future research.     

Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother–child bonding

Summary Background: Postnatal Depression has demonstrated long-term consequences on child cognitive and emotional development, however, the link between maternal and child pathology has not been clearly identified. Objective: This study examined whether maternal bonding to the infant and young child is impaired by maternal depressive symptoms. Methods: 101 mothers of newborn infants were recruited from local obstetric units and examined for psychopathology using Symptom Checklist, the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Bonding Questionnaire at two weeks, six weeks, four months and fourteen months postpartum. Results: Maternal depressive symptoms at 2 weeks, 6 weeks and four months postnatally but not at fourteen months of infant’s age were found to be strongly associated with lower quality of maternal bonding to the infant and child from two weeks until fourteen months of postnatal age. Even mild and unrecognized maternal depressive symptoms had a significant impact on maternal bonding, if they occurred during the first four months of life. Conclusions: This gives reason for increased concern for mother–infant dyads in the first few months after birth that could be regarded as a highly sensitive period for the development of the mother–child relationship. The findings warrant further studies and inspire the development of preventive programs focussing on infant and early childhood mental health by emphasizing protection and support during the first critical months.     

Does the national program of prevention of mother to child transmission of HIV (PMTCT) reach its target in Ouagadougou,Burkina Faso?

Background

In the context of universal access to prevention, treatment, care and support, each country has to ensure that 80% of women and children in need have access to PMTCT interventions.

Objective

To assess the PMTCT program achievement in Ouagadougou, the capital city of Burkina Faso.

Methods

Between August and October 2008, a cross sectional study was carried out in the five health districts of the Centre Health Region. We reviewed weekly statistics from all health care centres (HCC) to compute the coverage of PMTCT program. In 38 HCC with functional PMTCT program, we extracted data of interest from HCC registers and made direct observations of PMTCT services.

Results

The PMTCT program was implemented in 49% of HCC (target for the national program: 70%). Fifteen to 31% of these centers were often in shortage for PMTCT consumables. Patients'' privacy was not observed in 67% of Voluntary Counselling & HIV Testing wards. Care providers were not qualified enough to deliver PMTCT services. Vitamin A supplementation was not implemented. None of the facilities offered the whole package of PMTCT program interventions. HCC providing HIV testing in labour or in postnatal ward were consistently lacking. Only 86% of antenatal care new attendants benefited from pre-test counselling; 2.4% of pretested women were HIV-positive and 39% of positive mothers received antiretroviral prophylaxis.

Conclusion

Coverage and quality of PMTCT programme in the Centre Health Region in Burkina Faso are still limited. Particular support is needed for training, supervision and infrastructures upgrading.     

Parents: the best experts in child health care? Viewpoints from parents and staff concerning child health services

The aim was to describe what parents and staff think about child health care, to identify agreements and disagreements. A qualitative study was made with semi-structured interviews based on a phenomenographic approach. Sixty parents, 14 nurses and six doctors from southern Sweden were interviewed. Parents and staff emphasized two tasks as being of particular importance: support and check-ups. There was a conflict between parents' need for security versus integrity. Individual nurses experienced a conflict between what they wanted to do and what they felt that they had to do. The parents viewed parental education as a chance to exchange experiences with other parents and receive support from other adults, while the staff mainly saw it as an opportunity to inform parents and strengthen them in their parental role. The study gives grounds for reflection about how the work of child health care can be changed in the future.     

The impact of maternal psychopathology on child–mother attachment

This review aims to consider evidence for the impact of maternal psychopathology on the child’s attachment to the mother, and the role of this in mediating the known transmission of developmental and clinical risk to children. The studies reviewed focus on mothers with depression and psychotic disorder. A number of studies (mainly of mothers with depression) demonstrate an association between insecure/disorganised infant attachments and severe maternal psychopathology, whether chronic or current, in the presence of comorbid disorder, maternal insecure or unresolved attachment state of mind, trauma/loss, or low parenting sensitivity. Whether such effects last into middle childhood, however, is unclear. Our understanding of the role of attachment in determining developmental trajectories in this group is at an early stage. Some evidence suggests that attachment may have a role in mediating the intergenerational transmission of internalising and other problems in this group, although the presence of co-occurring contextual risk factors may account for the variability in findings. A multifactorial longitudinal approach is needed to elucidate such factors. However, the current literature highlights which subgroups are likely to be vulnerable and provides an evidence-based rationale for taking an attachment-based approach to intervention in this group.     

Poverty and child mortality in different contexts: can Mozambique learn from the decline in mortality at the turn of the 19th century in Stockholm?

Child mortality has declined in many low-income countries. However, in Sub-Saharan Africa, childhood mortality is still a major public health problem, which is worsening with some countries experiencing new increases in mortality due to HIV /AIDS. This lack of success in reducing child mortality is not only due to HIV /AIDS, but also to high numbers of deaths in other causes of death such as diarrhoea, pneumonia and neonatal causes, for which there are effective curative and preventative interventions. One problem seems to be in the access, coverage and implementation of these interventions, particularly among the poorer sections of the population. A related problem is the interventions that sometimes, when implemented, take place in environments in which they can only be expected to have limited effects. On the other hand in many developed countries infant and child mortality declined as social and economic changes of modernisation took place. However, the mechanisms that did bring about the decline are still not well understood. This paper discuss whether analyses of the historical decline of mortality in industrialised countries could contribute to knowledge in reducing the high child mortality in poor countries today, based on studies of child mortality in different social contexts in Mozambique 1973-1997 and Stockholm 1878-1925.     

‘More than a box of puzzles’: Understanding the parental experience of having a child with a rare genetic condition"

BackgroundChromosomal microarray (CMA) testing has been adopted as the first-tier diagnostic test for developmental disabilities. However, determining the clinical significance of the results is often complex. This qualitative study seeks to explore parental interpretation, adaption and coping in the context of ambiguous rare genetic findings in order to support parental adjustment and wellbeing.MethodsIn-depth interviews were conducted with parents (n = 30) of children identified with a rare genetic chromosomal abnormality.ResultsThree major themes were identified following a thematic analysis: ‘Learning of the Genetic Diagnosis', “The Reality of the Rarity’ and ‘Beyond Genetics: The Child Takes Centre Stage’. Findings demonstrated that parental adjustment to their child's genetic results are mediated by several factors including child difficulties and stage of development, clinician communication, perception of genetics, intrinsic coping strategies, access to practical and emotional support as well as broader contextual experiences.ConclusionThis study highlights the importance of considering the parental perspective in the context of genetic testing in clinical practice.     

Reflex regulation of the “spontaneous” activity of the chemoreceptors of the tongue

Summary The spontaneous activity of the chemoreceptors of the frog's tongue was studied during stimulation of the interoceptors of the stomach and of the sympathetic chain. It was found to be under the control of the nervous system, adapting the receptors to give improved perception, and it indicates the preparedness of these apparatuses to receive stimuli. Spontaneous activity may be fundamentally a partial principle of the functioning of receptor elements. Further electrophysiological investigations of this problem are proceeding.(Presented by Active Member AMN SSSR P. K. Anokhin) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 55, No. 8, pp. 7–11, August, 1963