Follow up of victims of fabricated illness (Munchausen syndrome by proxy).

Fifty four children were studied 1-14 (mean 5.6) years after fabrications of illness had been identified. Thirty of the 54 children were living in families with their biological mothers and 24 were with other family members or in substitute families. Further fabrications were identified for 10 children who had been living with their mothers and there were 'other concerns' for a further eight children. Thirteen children residing with mother and 14 not residing with mother at follow up had a range of disorders including conduct and emotional disorders, and problems related to school, including difficulties in attention and concentration and non-attendance. Overall, 20 children (49% of those successfully followed up) had outcomes that were considered to be unacceptable.     

Children raised in fatherless families from infancy: a follow-up of children of lesbian and single heterosexual mothers at early adolescence

BACKGROUND: An increasing number of lesbian women and single heterosexual women are bringing up children with no male involvement. This study follows up to adolescence a sample of children raised in fatherless families from birth or early infancy. METHODS: Twenty-five lesbian mother families and 38 families headed by a single heterosexual mother were compared with 38 two-parent heterosexual families. The quality of parenting by the mother, and the social and emotional development of the child, were assessed using standardised interview and questionnaire measures administered to mothers, children and teachers. RESULTS: Children in fatherless families experienced more interaction with their mother, and perceived her as more available and dependable than their peers from father-present homes. However, there were no group differences in maternal warmth towards the children. Mothers raising their child without a father reported more severe disputes with their child than did mothers in father-present families. The children's social and emotional development was not negatively affected by the absence of a father, although boys in father-absent families showed more feminine but no less masculine characteristics of gender role behaviour. No major differences in parenting or child development were identified between families headed by lesbian and single heterosexual mothers. CONCLUSIONS: The presence or absence of a father in the home from the outset does appear to have some influence on adolescents' relationships with their mothers. However, being without a resident father from infancy does not seem to have negative consequences for children. In addition, there is no evidence that the sexual orientation of the mother influences parent-child interaction or the socioemotional development of the child.     

Mothers in an Urban Township in Zambia

Two hundred and forty-nine mothers living in an urban township were followed at their home from delivery for 1 year. Sixty-four families were lost to follow up due to moving house. The neonatal mortality was 50.6 per thousand and the infant mortality 118 per thousand live births. Child loss increased after parity 8 of the mother. The mean (SD) weight of mothers was 56.8 kg (8.8), the mean height 157.8 cm (6.1) and the mean ponderal index 22.53 (3.51). The mid-arm circumference was 26.1 cm (2.8). Body size varied considerably with around 10 per cent of mothers being undernourished and 10 per cent obese. Weight and mid-arm circumference generally decreased after 6 months post-partum. Breast feeding became less frequent after 8 months and by a year four babies had stopped receiving any breast milk. Average birth intervals were around 30 months, but thirty-seven mothers (20 per cent of multiparous mothers) had intervals of less than two years often following the loss of a previous child. Women generally received less education than their husbands with 35 (17 per cent) having had no education and only 23 (11 per cent) with some secondary education. Thirty-five mothers (18 per cent) had no men living at home with them although some fathers provided support. By one year fifteen fathers had abandoned the mother. Incomes of most families were insufficient and half the mothers worked, usually by selling food at the market or outside their homes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Children Raised in Fatherless Families from Infancy: Family Relationships and the Socioemotional Development of Children of Lesbian and Single Heterosexual Mothers

The aim of the study was to investigate family functioning and the psychological development of children raised in fatherless families from their first year of life. Thirty lesbian mother families and 42 families headed by a single heterosexual mother were compared with 41 two-parent heterosexual families using standardised interview and questionnaire measures of the quality of parenting and the socioemotional development of the child. The results show that children raised in fatherless families from infancy experienced greater warmth and interaction with their mother, and were more securely attached to her, although they perceived themselves to be less cognitively and physically competent than their peers from father-present families. No differences were identified between families headed by lesbian and single heterosexual mothers, except for greater mother-child interaction in lesbian mother families.     

Children's perspectives on their relationships with their nonresident fathers: influences, outcomes and implications

BACKGROUND: Children's relationships with their nonresident fathers, and associations between these relationships, children's relationships with mothers and stepfathers, and the children's adjustment were studied in 162 children from single-parent and stepfamilies, selected from a representative community sample in the UK, studied at 2 time points two years apart. METHOD: Children were interviewed about their relationships with their nonresident fathers, mothers and stepfathers; mothers reported on children's adjustment, and other family variables. RESULTS: Positive child-nonresident father relationships were correlated with (a) contact between child and father, (b) the quality of the mother-child relationship, and (c) the frequency of contact between the mother and her former partner. Conflict between child and father was correlated with conflict between child and mother, and child and stepfather. Child-nonresident father contact and relationships were stable over 2 years, and related to children's adjustment; these associations were stronger for children from single-parent families than for those with stepfathers, and for those whose mothers had been first pregnant as teenagers. CONCLUSIONS: Associations between the quality of children's relationships with nonresident fathers and their adjustment need to be considered within the framework of the larger family system; child-father relationships are particularly important for children from 'high risk' families.     

Long‐term effects of a home‐visiting intervention for depressed mothers and their infants

Background: Whereas preventive interventions for depressed mothers and their infants have yielded positive short‐term outcomes, few studies have examined their long‐term effectiveness. The present follow‐up of a randomised controlled trial (RCT) is one of the first to examine the longer‐term effects of an intervention for mothers with postpartum depression and their infants at school‐age. In early infancy, the intervention was found effective in improving mother–infant interaction and the child’s attachment to its mother. Methods: Twenty‐nine mother–child pairs who completed the intervention are compared with 29 untreated mother–child dyads as to the quality of maternal interactive behaviour and the child outcomes of attachment security to the mother, self‐esteem, ego‐resiliency, verbal intelligence, prosocial behaviour, school adjustment, and behaviour problems at age 5 (M = 68 months). Results: In the total sample no lasting treatment benefits were found, but in families reporting a higher number of stressful life events, children in the intervention group had fewer externalising behaviour problems as rated by their mothers than children in the control group. Conclusions: In the context of multiple stressful life events the intervention served as a buffer by preventing the development of externalising problems in the child. The results warrant cautious interpretation because of the relatively small sample size and differential attrition revealing the mothers that completed the follow‐up assessment to have improved less on maternal sensitivity following the intervention than the mothers who did not participate in the follow‐up.     

Subsequent pregnancy in mothers of infants with congenital heart disease

Pregnancy rates for mothers of infants with conotruncal cardiac malformations and mothers of healthy control infants were compared for a 3-year period. Mothers of infants who died of congenital heart disease had the highest pregnancy rates, followed by control mothers, and then by mothers of surviving infants with congenital heart disease. Comparison in relation to the number of living children showed similar subsequent pregnancy rates for mothers of deceased infants with congenital heart disease and mothers of control infants, but lower rates for mothers of surviving infants with congenital heart disease. "Replacement" of a deceased infant occurs frequently, apparently in order to achieve a desired family size, whereas decreased reproduction in families of living infants with congenital heart disease may reflect the psychosocial and economic impact of the continuing care of a child with severe heart disease.     

Experience of parenthood, couple relationship, social support, and child-rearing goals in planned lesbian mother families

BACKGROUND: The phenomenon of planned lesbian families (i.e., two-mother families in which the child was born to the lesbian relationship) is relatively new and very little research has been conducted among those families. The overall aim of this research was to examine whether planned lesbian mother families differ from heterosexual families on factors that are assumed to influence the parent-child relationship, such as experience of parenthood, child-rearing goals, couple relationship, and social support. METHOD: A hundred lesbian two-mother families were compared with 100 heterosexual families having naturally conceived children. A variety of measures were used to collect the data, including questionnaires and a diary of activities kept by the parents. RESULTS: Lesbian parents are no less competent or more burdened than heterosexual parents. Both lesbian and heterosexual parents consider it important to develop qualities of independence in their child. However, 'conformity' as a child-rearing goal is less important to lesbian mothers. Furthermore, lesbian social mothers feel more often than fathers in heterosexual families that they must justify the quality of their parenthood. CONCLUSION: There are few differences between lesbian couples and heterosexual couples, except that lesbian mothers appear less attuned to traditional child-rearing goals and lesbian social mothers appear more to defend their position as mother.     

Child abuse and non-organic failure to thrive: similarities and differences in the parents

A group of 39 mothers who had a physically abused child at an average of 6 years previously and a group of 14 mothers who had a child with non-organic failure to thrive (NOFTT) 13 years ago were reviewed. Each child was compared with a child matched for age and sex and for ethnic group, residential area and social class of the parents. The mothers from the NOFTT group knew less than their comparison mothers about their child's education and on a personality test were less able at intellectual and abstract concepts. The abuse group mothers were more mobile and more isolated than their comparison group. They were less likely to have been brought up by their own parents and had more negative feelings towards their fathers. They had lower self-esteem and higher expectations for their children than the comparison mothers On a personality assessment they were more assertive, demanding and suspicious than the comparison mothers, Although child abuse and non-organic failure to thrive have been described as part of the same spectrum, the characteristics of the parents on follow-up are different. As some of the adverse characteristics of the parents persist long after the presenting incident, the need for a long term treatment programme aimed at supporting children who remain in these families is recommended.     

Cohort comparison study of children whose mothers have acquired immunodeficiency syndrome and children of well inner city mothers

The virus or viruses (human immunodeficiency virus) associated with the acquired immunodeficiency syndrome may be transmitted in utero or perinatally from an infected mother to her baby. Infected adults may remain asymptomatic for months to years, during which time a mother could transmit the virus. It is not known to what degree a mother may transmit the virus perinatally or whether postnatal transmission is possible. We studied a cohort of children whose mothers had been reported to have acquired immunodeficiency syndrome, comparing human immunodeficiency virus-seropositive with seronegative children as well as a cohort of inner city children with similar socioeconomic characteristics whose mothers are well. Three (12%) of 25 children whose mothers have acquired immunodeficiency syndrome were seropositive compared with none of 44 children whose mothers were well. The seropositive children had lower T4A:T8 lymphocyte ratios than children in the other groups. Nine children of affected mothers were young enough to have been born within their mother's incubation period and were seronegative and well. When compared with seronegative children the seropositive children did not have greater contact with their ill mothers, either in types of physical interaction or in length of time lived together. Although this study cannot preclude the possibility of postnatal nonsexual transmission, it does present evidence against it.     

Parent Perspectives on Sleep and Sleep Habits Among Young Children Living With Economic Adversity

ObjectiveTo examine the perspectives of ethnically diverse, low-income parents of young children regarding sleep, sleep habits, and preferences for sleep promotion for themselves and their children.MethodWe recruited a sample of mothers who had a 15- to 60-month-old child enrolled in the Special Supplemental Nutritional Program for Women, Infants and Children in a Northeastern U.S. city. We used a convergent mixed-methods design to conduct semistructured interviews and questionnaires to measure parent sleep quality (Pittsburgh Sleep Quality Index), sleep apnea (Berlin Apnea Questionnaire), mood (Centers for Epidemiological Studies of Depression), children's sleep (Children's Sleep Habits Questionnaire), and behavior (Child Behavior Checklist).ResultsThirty-two mothers (M age = 30.97 [SD 6.34] years; n = 21 [65%] African American) and children (N = 14 [44% female]; M age =38 [SD 12.63] months) participated. Children's average sleep duration was 10 hr, which is below the recommendation for this age group; overall sleep difficulty was high despite most mothers reporting that their children had normal sleep. Five children had abnormal Child Behavior Checklist scores, suggesting internalizing and externalizing behaviors. More than half of the mothers had poor sleep quality and 24 (75%) were at high risk for sleep apnea. Mothers viewed sleep as important for themselves and their children and identified both effective and ineffective practices to promote sleep, including practices learned from their own families.ConclusionsEthnically diverse mothers who are living with economic adversity value sleep for themselves and their children. The high value placed on sleep, despite misconceptions about normal sleep, suggest opportunities to promote sleep interventions. The content and delivery methods should be tailored to their knowledge, preferences, and cultural practices.     

The needs of children whose mothers have HIV infection

AIM: To ascertain the psychological, social, and educational needs of children born to mothers with HIV infection. METHODS: Review of case records of 120 children and 86 mothers. RESULTS: The cohort of 120 children were born to 92 women, and followed up for a median duration of 48 months (mean (SD) 51.1 (34.1), range 0.3-132). Sixteen children were infected with HIV, 15 were of indeterminate status, and 89 uninfected. Eighty one children (68%) were cared for by their birth mother, of whom 52% were single women and 23 (38% of 61) known to have symptomatic HIV disease. Twenty five mothers of 32 children had died; the child's mean (SD) age at maternal death was 66.9 months (37.7) (range 4-128). Compared with uninfected children, more infected children knew of their mother's diagnosis (31% v 5%) and mothers were also more likely to disclose their own illness to educational authorities (77% v 13%). A larger proportion of infected children had special educational needs (69% v 13%). Only 33 children (28%) were known not to be receiving any support from the voluntary or statutory agencies. CONCLUSION: The results highlight the multiple needs of children living with maternal HIV infection, which require dedicated resources and commitment from health, education, and social work agencies and the voluntary sector. We propose the model of chronic illness as the standard of care for these children.     

Amphetamine addiction during pregnancy: 14-year follow-up of growth and school performance

Sixty-five children born to women who all abused amphetamine during pregnancy have been followed prospectively since their birth in 1976-77. At the age of 14-15 years, information about growth and school achievement was collected from school records. For comparison of school achievements the means of schoolmates were used, and for growth a group of Stockholm children born in the same year. By the age of 14 years only 14 children (22%) had stayed with their biological mothers for the whole period since birth. In the eighth grade, 10 (15%) were one grade lower than indicated by their biological age. The norm for Sweden is less than 5%. The means of the points in mathematics, Swedish language and sports were statistically below those of their classmates. At the age of 10 years the girls were significantly shorter and lighter than their peers born in 1976. At the age of 14 years the boys were statistically taller and heavier than their peers. It can be concluded that maternal amphetamine abuse during pregnancy will influence children at least up to the age of 14–15 years even though many of them have been living in foster homes since a young age.     

Malnutrition among children of adolescent mothers in a squatter community of Recife, Brazil

In a study of 357 first time mothers in a squatter community of Recife it was found that 1 in 10 were less than 15 years old and 60 per cent less than 20 at the time of their first delivery. Two groups of mothers were distinguished, viz. adolescent mothers with a mean (SD) age at first delivery of 16.7 (0.78) years and older mothers with a mean (SD) age at first delivery of 25 (0.79). More than a third were living in common-law union. Of the adolescent mothers only 58 per cent were living with the child's father. A further 23 per cent had received financial support from their own parents during the pregnancy. The rest were expelled from home. The adolescent mothers were generally worse off with a per capita income generally half of that of older mothers. About a quarter of all children studied were below the 10th centile of NCHS standards (23 per cent by weight/age; 28 per cent by height/age). The undernourished first born was 2.5 times more likely to have an adolescent mother, four times more likely to be in a household with low income, and two times more likely to have an illiterate mother as compared to the first borns who remain well nourished. The implications of these findings for urban primary health care programmes are further discussed.     

Difference in mother-child interaction between preterm- and term-born preschoolers with and without disabilities

Aim: To investigate differences in the quality of mother–child interaction between preterm‐ and term‐born children at age 5, and to study the association of mother–child interaction with sociodemographic characteristics and child disability. Methods: Preterm children (n = 94), born at <30 weeks’ gestation and/or birth weight <1000 g, and term children (n = 84) were assessed at corrected age of 5 using a mother–child interaction observation. Disabilities were assessed using an intelligence test, behaviour questionnaires for parents and teachers, and motor and neurological examinations. Results: Mothers of preterm‐born children were less supportive of and more interfering with their children’s autonomy than mothers of term‐born children. This difference was only partly explained by sociodemographic factors. Dyads showed a lower quality of mother–child interaction if children had a severe disability, especially when mothers had a lower level of education. Conclusion: Five years after birth, mother–child interaction of very premature children and their mothers compared unfavourably with term children and their mothers. Mothers with sociodemographic disadvantages, raising a preterm child with severe disabilities, struggle most with giving adequate sensitive support for the autonomy development of their child. Focused specialized support for these at risk groups is warranted.     

A family clinic--optimising care for HIV infected children and their families

A family clinic providing specialist paediatric and adult medical, testing, counselling, and terminal care services for families living with HIV was set up at a paediatric tertiary care hospital in London in 1991. During the first five years, until April 1996, 185 children from 149 families attended, including 119 infected children, of whom 32 have died. Only 5% of mothers were born in the UK; the rest were born in 24 different countries, the majority in sub-Saharan Africa. Less than a quarter of children were cared for by both parents, 61% by mothers alone, and 11% by guardians or foster parents. Of the adult attendees, 76% were women, and more than half were untested when they first attended the clinic. Provision of a family planning service within the family clinic was initiated as a result of women presenting with unplanned pregnancies. Shared care with local clinics is increasing, but with the complexity around the management of paediatric HIV infection, particularly with regard to antiretroviral treatments, there is need for continued specialist input. Coordination among specialist and locally based family services is required to provide flexible, accessible, and up to date care for families living with HIV infection in London.     

A family clinic—optimising care for HIV infected children and their families

A family clinic providing specialist paediatric and adult medical, testing, counselling, and terminal care services for families living with HIV was set up at a paediatric tertiary care hospital in London in 1991. During the first five years, until April 1996,185 children from 149 families attended, including 119 infected children, of whom 32 have died. Only 5% of mothers were born in the UK; the rest were born in 24 different countries, the majority in sub-Saharan Africa. Less than a quarter of children were cared for by both parents, 61% by mothers alone, and 11% by guardians or foster parents. Of the adult attendees, 76% were women, and more than half were untested when they first attended the clinic. Provision of a family planning service within the family clinic was initiated as a result of women presenting with unplanned pregnancies. Shared care with local clinics is increasing, but with the complexity around the management of paediatric HIV infection, particularly with regard to antiretroviral treatments, there is need for continued specialist input. Coordination among specialist and locally based family services is required to provide flexible, accessible, and up to date care for families living with HIV infection in London.