Communicating with parents in neonatal intensive care units: The impact on parental stress

ObjectiveTo analyse stress in parents whose infants with very low birth weight have just concluded high-level care in a Neonatal Intensive Care Unit (NICU). More specifically, we aimed 1) to identify groups of parents in the NICU who are particularly at risk of experiencing stress, and 2) to explore the effects of clinical staffś communication on parental stress.MethodsOur multi-center-study evaluated views from 1277 parents about care for 923 infants in 66 German NICUs. Answers were linked with separately evaluated medical outcomes of the infants. Separate generalised mixed models estimated the influence of personal, medical and communication-related characteristics on specific parental stress.ResultsParents of a younger age and those of infants with severe prognoses were more likely to experience stress. While empathetic communication as one aspect of staffś communication was shown as appropriate in reducing parental stress, an initial introduction and the quantity of information were only slightly associated with lower levels of stress.ConclusionResults provide evidence for the need to involve parents empathetically from the beginning of their child’s stay in the NICU.Practice implicationsStaff in the NICU should communicate empathetically and help to reduce stress in parents particularly at risk.     

A National Directory of Four Year Colleges,Two Year Colleges,and Post High School Training Programs for Young People With Learning Disabilities (Book)

Studied child- and parent-focused parenting stress in 71 clinically depressed and 53 nondepressed mothers of infants 3 to 13 months old. Depressed mothers reported more parenting stress and daily hassles, less marital harmony, and less social support than nondepressed mothers, and they were rated as less competent with their infant. Mothers of temperamentally difficult infants reported greater stress, and depressed women with difficult infants were highest in child-focused stress. In hierarchical multiple-regression analyses predicting child-focused stress, infant difficulty was the only significant predictor for depressed women, but nondepressed women's child-focused stress was predicted by both the demographic composite and infant difficulty. The depressed group's parent-related stress was predicted by depression level, infant temperament, and marital discord, but for nondepressed mothers, only the demographic factors and infant temperament were significant predictors. Depressed women reporting greater child- and parent-focused stress were independently rated as less competent parents than those under less stress.     

Acute stress disorder among parents of infants in the neonatal intensive care nursery

The authors examined the prevalence of acute stress disorder (ASD) in parents of infants hospitalized in the neonatal intensive care unit (NICU). Forty parents were assessed after the birth of their infants. Parents completed self-report measures of ASD, parental stress, family environment, and coping style: 28% of parents developed symptoms of ASD. ASD was associated with female gender, alteration in parental role, family cohesiveness, and emotional restraint. Family environment and parental coping style are significantly associated with the development of trauma symptoms. Results from this study suggest potential interventions to help minimize psychological distress in parents.     

乙型肝炎患儿父母心理健康状况对照研究

采用“家长生活调查问卷”对广州市就读专收ＨＡＡ阳性幼儿园的父母、未有就读任何幼儿园ＨＡＡ阳性儿童的父母、以及就读普通幼儿园健康儿童父母进行了调查，结果发现ＨＡＡ阳性儿童的父母由于承受较大的心理压力而出现更多的心理问题、这种压力影响到父母的身心健康。资料为社会保健提供了依据。     

The relationship between atopy and salivary IgA deficiency in infancy.

In a prospective study, infants born to atopic parents had a significantly higher prevalence of salivary IgA deficiency at all ages studied than control infants, and the mean non zero IgA level of the potentially atopic infants was significantly lower at 8 and 12 months than of control infants. Of the infants with atopic parents, the prevalence of IgA deficiency was not significantly greater in those who manifested atopic disease during the study period than in those who did not, but the levels were significantly lower at 4 months.     

Cortisol circadian rhythms and stress responses in infants at risk of allergic disease

BACKGROUND: The cortisol circadian rhythm and response to stressful stimuli are altered in children and adults with allergic disease, including asthma. It is not known whether these alterations precede or follow the onset of allergic disease. OBJECTIVE: We sought to evaluate the cortisol circadian rhythm and stress response among infants at risk for the development of allergic disease. METHODS: Infants with and without risk factors for allergic disease were evaluated at age 6 months. Saliva was obtained at 8 am, 2 pm, and 8 pm at home (n = 68) by parents when their infants were comfortable and in the clinic (n = 88) before and after their physical examination and vaccinations. Information regarding parental allergy and exposure to other children at home or in child care were obtained by questionnaire. RESULTS: In multivariate analysis the circadian rhythm of cortisol was flattened because of the lack of the expected morning surge of cortisol, resulting in decreased diurnal variation of cortisol in infants of mothers with allergy (P = .035) or asthma (P = .002) or an asthmatic father (P = .022). The cortisol stress response was greater in infants of mothers with allergy (P = .045) or asthma (P = .039), those with fewer siblings (P = .066), and those not entering day care early in life (P = .017). CONCLUSIONS: These alterations in both basal and stress levels of endogenous cortisol among infants predisposed to allergic disease might affect the development of allergic immune responses early in life through interactions with inflammatory mediators.     

Effects of parent training on infant sleeping patterns, parents' stress, and perceived parental competence.

First-time parent couples from childbirth classes were randomly assigned to a four-session training group (n = 29) or a control group (n = 31). Members of the training group were taught behavioral strategies to promote healthy, self-sufficient sleep patterns in their infants, whereas the control group received the same amount of personal contact without the behavioral training. Six sleep variables were derived from a daily infant sleep diary completed by parents at two time points. Results show that at age 6-9 weeks, infants in the training group displayed significantly better sleeping patterns than did control infants. Training group parents awakened and responded less often to infant signaling and reported greater parental competence. By contrast, control group parents indicated increased stress over time.     

Immunological development in infants of allergic parents

Serum immunoglobulins were determined every 4 months from cord blood to age 2 years in ninety-two infants of allergic parents. By 7 months of age, the concentration of IgA was significantly greater in infants who developed atopic dermatitis than those who did not. The IgA was also significantly greater than in matched non-allergic controls. The difference continued to the end of the 2-year study. No significant difference was found in the three groups for levels of IgG and IgM. These findings differ from the results of a previous report and possible explanations are presented.     

Der p I concentrations in mattress surface and floor dust collected from infants' bedrooms

Background Allergen exposure in early childhood is thought to be important for sensitization and subsequent development of asthma. Not much is known, however, about exposure of young children to allergens in the home. Objectives This study was designed to document dust mite allergen exposure in young children, and to determine wheither infants from atopic mothers (=‘high-risk’ infants) are exposed to lower concentrations of house dust mite alkrgen than infants from non-atopic parents (=‘low-risk’ infants). Methods Dust samples were taken in the homes of 104 infants (48 ‘high-risk’ and 56 ‘low-risk’ infants, selected by questionnaire) aged 3–15 months, from floors in different rooms and from the child's mattress surface. Results The majority of the infants were found to be exposed to Der p I concentrations of more than 2000 ng/g in dust collected from the surface of their mattresses. Lower Der p I concentrations were found in mattress surface dust from the beds of infants from atopic mothers than of infants from non-atopic parents. Also, lower Der p I concentrations were found in floor dust from the homes of infants from atopic mothers, Infant beds equipped with new mattresses, new blankets and top plastic sheeting had significantly lower Der p I concentrations than beds equipped with used mattresses and blankets, without top plastic sheeting. Conclusions Young children in the Netherlands are exposed to significant concentrations of Der p I in mattress surface dust. Allergic parents appear to provide their children with environments somewhat less rich in mite allergen than non-allergic parents.     

Are children at high familial risk of developing allergy born into a low risk environment? The PIAMA Birth Cohort Study

BACKGROUND: A family history of allergy, reflecting genetic risk factors, increases the risk of developing allergic diseases, but environmental factors, especially those present in early life, also contribute to the actual development of allergic phenomena. OBJECTIVE: To identify differences in lifestyle between allergic and non-allergic parents, which may influence the prevalence of environmental risk factors in their homes. METHODS: Data were collected in a Dutch birth cohort study by postal questionnaire about 2 months before and 3 months after the birth of the child. RESULTS: Of the 3147 infants in the study 1910 (61%) had two non-allergic parents, of 315 infants (10%) only the mother was allergic, of 787 infants (25%) only the father was allergic and 135 (4%) infants had two allergic parents. If both parents were allergic, 53% reported that allergy was taken into consideration when they furnished their home and significantly more of their homes were free of cats and free of cigarette smoke; adjusted odds ratio's for two allergic parents vs. two non-allergic parents were 0.30 (confidence interval (CI) 0.17-0.50) for the presence of cats and 0.46 (CI 0.27-0.75) for smoking in the home. Parental allergy was also associated with having a smooth floor in the baby's bedroom and with postponement of the introduction of fruits and vegetables until the age of 26 weeks. The presence of dogs at home, the prevalence of mothers' smoking during pregnancy and the decision to breast feed were unrelated to parental allergy. CONCLUSION: We conclude that studies on the relationship between allergy in parents and allergy in their offspring should always consider the home environment as a potential confounder. For allergy prevention our results imply that among allergic parents there is awareness and willingness to take measures that reduce exposure to indoor allergens.     

Impact on maternal parenting stress of receipt of genetic information regarding risk of diabetes in newborn infants.

Our objective was to investigate whether notification of high-risk status for type 1 diabetes in newborn infants results in an increased maternal-parenting stress level when compared with notification of low-risk status for type 1 diabetes. Maternal parenting stress level was assessed at 5-7 weeks postpartum (baseline) and was reassessed 4-5 months after parents were informed of their newborn infants' genetic screening results (follow-up). Parenting stress level was measured using the total stress score (TSS) of the Parenting Stress Index/Short Form. The outcome variable, change in TSS, was calculated by subtracting the baseline TSS from the follow-up TSS. Demographic variables such as maternal race, maternal age, maternal education level, maternal marital status, child's birth order, and total family income were assessed through a structured phone interview at the time of baseline assessment. The risk factor of interest was the child's human leukocyte antigen (HLA) status for type 1 diabetes, i.e., whether child was at a high or moderate (combined into "high") genetic risk or at a low genetic risk for type 1 diabetes. A sample of 88 mothers (23 with a high-risk child and 65 with a low-risk child) was evaluated. Baseline median TSSs were 65 and 74 for mothers of low-risk infants and mothers of high-risk infants, respectively. Both groups' median TSS decreased between baseline and follow-up. No significant differences were found between change in TSS and maternal age, race, education level, marital status, total family income, or child's birth order. Although the median decrease in TSS was smaller in mothers with a high-risk child when compared with mothers of a low-risk child, this difference was not statistically significant. We did not find an association between newborn's HLA status and change in maternal TSS. The results of this study suggest that notification of high-risk status for type 1 diabetes in newborn infants may not result in an increased level of parenting stress among mothers.     

Adrenocortical and behavioral attunement in parents with 1-year-old infants

Sethre-Hofstad et al. [2002, Psychoneuroendocrinology 27:731-747] found that behaviorally well-attuned or sensitive parents showed better physiological attunement with their 2- to 4-year-old toddlers' adrenocortical responses to a potentially challenging task than less sensitive parents. In the present study we aimed to replicate this finding in a sample of 83 parents with 15-month-old infants. Parental and infant cortisol responses were assessed using saliva samples collected before and 21 min after the child's confrontation with a stranger and a moving robot. Infant behaviors reflecting distress/uncertainty during the stranger-robot session were rated from videotape. Parental sensitivity was observed during a parent-infant teaching episode. Our findings replicate those of Sethre-Hofstad et al. [2002, Psychoneuroendocrinology 27:731-747] by showing correlated parent-infant cortisol responses for sensitive parents but not for less sensitive parents. Furthermore, sensitive parents cortisol responses were associated with their children's distress/uncertainty during the stranger-robot episode, whereas this was not true for less sensitive parents. Results indicate an important connection between behavior and physiology in parent-infant interactions that deserve more research.     

Mothers of very low birth weight infants have less atopy than mothers of full-term infants

BACKGROUND: Studies on the pregnancy outcome of asthmatic mothers have suggested an increased rate of preterm deliveries. In contrast, our earlier study suggests that mothers of very low birth weight (VLBW) (<1500 g) infants less frequently had atopy than did mothers of full-term infants. METHODS: We inquired about symptoms of atopy and doctor-diagnosed atopy in parents of 370 infants of VLBW (<1500 g) and 544 parents of full-term infants. Odds ratios for atopic symptoms and diagnosed atopy were calculated, and groups were compared with a trend test. RESULTS: Mothers of preterm infants of birth weight (BW) <1000 g significantly less often had physician-diagnosed allergic rhinitis (AR) (P=0.02). Among all the mothers, a trend test showed that maternal AR was significantly (P=0.03) higher in parallel with a higher infant BW. Fathers of infants with different BWs showed no differences in prevalence of atopic symptoms. CONCLUSION: We thus infer that maternal balance between T-helper type 1 (Th1) and Th2 cells, shifted towards Th2 in those with AR, may have a favourable effect on maintenance of pregnancy before gestational week 30.     

Impact on maternal parenting stress of receipt of genetic information regarding risk of diabetes in newborn infants

Our objective was to investigate whether notification of high-risk status for type 1 diabetes in newborn infants results in an increased maternal-parenting stress level when compared with notification of low-risk status for type 1 diabetes. Maternal parenting stress level was assessed at 5–7 weeks postpartum (baseline) and was reassessed 4–5 months after parents were informed of their newborn infants' genetic screening results (follow-up). Parenting stress level was measured using the total stress score (TSS) of the Parenting Stress Index/Short Form. The outcome variable, change in TSS, was calculated by subtracting the baseline TSS from the follow-up TSS. Demographic variables such as maternal race, maternal age, maternal education level, maternal marital status, child's birth order, and total family income were assessed through a structured phone interview at the time of baseline assessment. The risk factor of interest was the child's human leukocyte antigen (HLA) status for type 1 diabetes, i.e., whether child was at a high or moderate (combined into “high”) genetic risk or at a low genetic risk for type 1 diabetes. A sample of 88 mothers (23 with a high-risk child and 65 with a low-risk child) was evaluated. Baseline median TSSs were 65 and 74 for mothers of low-risk infants and mothers of high-risk infants, respectively. Both groups' median TSS decreased between baseline and follow-up. No significant differences were found between change in TSS and maternal age, race, education level, marital status, total family income, or child's birth order. Although the median decrease in TSS was smaller in mothers with a high-risk child when compared with mothers of a low-risk child, this difference was not statistically significant. We did not find an association between newborn's HLA status and change in maternal TSS. The results of this study suggest that notification of high-risk status for type 1 diabetes in newborn infants may not result in an increased level of parenting stress among mothers. Am. J. Med. Genet. 86:219–226, 1999. © 1999 Wiley-Liss, Inc.     

Low Birth Weight and Parenting Stress During Early Childhood

Identified factors associated with parenting stress among theparents of low birth weight children participating in a prospectivelongitudinal study. The child's developmental status and thequalify of the infant-parent relationship contributed to earlychildhood parenting stress beyond the contribution of neonatalmedical risk, which was a significant predictor until the concurrentmeasure of child developmental status was entered in the regressionanalysis. Results are consistent with a model of processes underlyingthe experiences of parents of medically vulnerable infants presentedby the Goldberg and Marcovitch (1986) model. Replication ofthese findings among parents of specific subgroups of low birthweight children represents a direction for future research.     

Speech perception of infants with high familial risk for dyslexia differ at the age of 6 months

As yet relatively little is known of the earliest signs of dyslexia. We present evidence showing that the speech perception of 6-month-old infants from dyslexic families differs significantly from that of infants from control families with normal reading parents; the former group needed a significantly longer duration to categorize speech sounds as long. The same difference appeared in their dyslexic parents. This study shows that differences in categorizing speech sounds according to duration, which is crucial to intelligibility in Finnish, are a factor associated with familial risk for dyslexia already at infancy, which persists until adulthood in many of those suffering from dyslexia.     

Posttraumatic stress and behavior problems in infants and toddlers with burns

This study assessed posttraumatic stress disorder (PTSD) and behavior problems in young children with burns and examined individual, injury-related, and family-related determinants. Seventy-six children, aged 12-49 months, were assessed at an average of 15 months after their burn injury, using parents as informants on the posttraumatic stress disorder semi-structured interview and observational record for infants and young children and the child behavior checklist. Ten children (13.2%) met the alternative criteria for PTSD proposed by Scheeringa et al. Number of PTSD symptoms were associated with family-related variables (maternal PTSD, quality of family relations). Compared to community norms, children with burns showed less externalizing behavior problems, and internalizing behavior problems were within the normal range. Overall, behavioral adjustment was associated with the quality of family relations (cohesion, expressiveness, conflicts). Whereas behavior was found to be normal in young children with burns, this study provides evidence for a substantial prevalence of PTSD.     

Assessment of parent understanding in conferences for critically ill neonates

ObjectivesThis study aimed to characterize the use and impact of assessments of understanding in parent-clinician communication for critically ill infants.MethodsWe enrolled parents and clinicians participating in family conferences for infants with neurologic conditions. Family conferences were audio recorded as they occurred. We used a directed content analysis approach to identify clinician assessments of understanding and parent responses to those assessments. Assessments were classified based on an adapted framework; responses were characterized as “absent,” “yes/no,” or “elaborated.”ResultsFifty conferences involving the care of 25 infants were analyzed; these contained 374 distinct assessments of understanding. Most (n = 209/374, 56%) assessments were partial (i.e. okay?); a minority (n = 60/374, 16%) were open-ended. When clinicians asked open-ended questions, parents elaborated in their answers most of the time (n = 55/60, 92%). Approximately three-quarter of partial assessments yielded no verbal response from parents. No conferences included a teach-back.ConclusionsAlthough common, most clinician assessments of understanding were partial or close-ended and rarely resulted in elaborated responses from parents. Open-ended assessments are an effective, underutilized strategy to increase parent engagement and clinician awareness of information needs.Practice implicationsClinicians hoping to facilitate parent engagement and question-asking should rely on open-ended statements to assess understanding.     

Parental response to cystic fibrosis: a contextual analysis of the diagnosis phase.

A contextual framework guided the measurement of specific stressors encountered by parents of children recently diagnosed with cystic fibrosis (CF). Three variables were assessed within the context of the parenting role: illness-specific tasks, normal parenting tasks, and strains in family roles. These situation-specific stressors were contrasted with global measures of parenting stress in their ability to predict depression. Sixty-four parents (36 mothers, 28 fathers) of infants and toddlers recently diagnosed with CF completed a structured interview and standardized measures in the home. Parents reported elevations in both situation-specific and global parenting stress, and a greater number of depressive symptoms than a norm group. Mothers reported significantly greater strain in managing their caregiving role and higher levels of depression than fathers. Controlling for situation-specific parenting stress and marital satisfaction, regression analyses indicated that role strain related to CF was associated with greater depression in mothers, but not fathers. Furthermore, stressors measured contextually rather than globally accounted for substantially greater proportions of the variance in depression. The findings highlight the need to measure ongoing strains specific to the medical condition, and to assess role-related changes.     

Determinants of parenting stress in home apnea monitoring

Studied mothers of 30 infants who suffered an apneic episode and were subsequently placed on home apnea monitors, using measures of parenting stress, family resources and support, family coping activities, health locus of control, and maternal coping style involving preferences for information under threat. Comparison groups included mothers of 30 infants with mild congenital heart lesions and 30 mothers of normal healthy infants. Home monitoring was associated with increased levels of parenting stress; monitored infants were perceived as more demanding, and their mothers reported less attachment to the child. However, the magnitude of the differences between mothers of monitored and unmonitored infants was relatively small, and parenting stress outcome was more closely related to preexisting levels of family resources than to the child's health status. No significant relationship was found between stress outcome and family coping or maternal coping style.