Conquering the great divide: Rural mothers of children with chronic health conditions accessing specialist medical care for their children

BackgroundGlobally, the number of children with chronic health conditions (CHCs) is increasing and mothers are mostly responsible for their care.AimFew studies have focused on rural mothers and their experiences of sourcing health care for their children who have CHCs. The purpose of this study was to explore these experiences.MethodUsing a phenomenological approach, semi-structured interviews were conducted in early 2018. The Consolidated criteria for Reporting Qualitative research (COREQ) guidelines were followed. Sixteen rural mothers were interviewed regarding their experiences of accessing health care to provide optimal management of their children’s CHC.FindingsThematic analysis of resulting data revealed the overarching theme ‘Conquering the great divide’. From this overarching theme, four themes emerged. This paper focuses on the first theme, ‘Heading to the big smoke: access’.DiscussionRural mothers felt challenged accessing health care for their children in the major cities whilst also maintaining routine family life back home.ConclusionUnderstanding these rural women’s experiences could assist health care professionals to develop strategies to facilitate rural mothers accessing services for their children with a CHC.     

Prenatal hair nicotine analysis in homes with multiple smokers

Prenatal exposure to secondhand smoke (SHS) is responsible for adverse perinatal outcomes, including preterm birth. Smoking at home is the primary source of exposure to women during pregnancy. Hair nicotine analysis of mothers and infants was used to describe the relationship between prenatal SHS exposure and number of household smokers. Maternal hair nicotine was strongly correlated with the number of household smokers and was a more sensitive measure of household smoking than infant hair. Home smoking bans and focused public media campaigns on the harmful effects of SHS exposure are necessary prevention strategies to avoid adverse perinatal outcomes.     

Serum and hair zinc levels of infants and their mothers

ObjectivesThis cross-sectional study aimed to investigate the zinc status of mothers and their infants attending a well-child clinic.MethodsBlood and hair samples were collected from infants and their mothers at 2nd, 6th,12th month after delivery. Information on infant and their mothers’ dietary habits was gathered.ResultsOf all infants and their mothers, 54.6% and 12.6% had low hair zinc levels; 17% and 4.6% low serum zinc levels respectively. There was a positive relationship between mother's hair zinc level and her meat consumption at 2 and 6 months after delivery.ConclusionA significant number of infants and mothers had low hair zinc levels. Hair zinc concentrations of infants decreased significantly towards the end of first year. This may be due to low zinc intake of mothers. The main contribution of our study to the literature was the positive relationship between the red meat intake and maternal hair zinc levels.     

Communicating with dying children and their siblings: A retrospective analysis

Abstract

Recognition that children over age 4 with fatal illnesses generally anticipate their death has prompted more open communication between them and the adults caring for them. We investigated factors influencing the extent and success of such communication between parents, dying children, and their siblings, using data provided by 77 mothers who are members of the Compassionate Friends organization.

We found that those mothers who talked more freely with dying children also did so with the siblings and that communication was more open with older than with younger children. This dialogue was most helpful for both the dying children and their siblings if the former were mostly at home immediately before death, if there was extensive and specific discussion about death and dying, when a parent was the major discussant, and if the family's religious faith was also a significant source of support.

Following such discussions the emotional state of the dying children and the siblings contrasted markedly, with the latter showing significantly more sadness, anger, denial, and fear. We found that most mothers had apparently recovered well from their bereavement and that this recovery correlated with having been helped by their religious faith, having been the main discussants with the children about death, and with having the child away from home the greater part of the terminal phase. Recovery from bereavement was also better among those mothers whose dying children had been better adjusted emotionally.

We recommend that health professionals use all appropriate resources to encourage early, full, and candid discussions between dying children, their siblings, and their families.     

Sleep in mothers of children with epilepsy and its relation to their children's sleep

We conducted a cross-sectional study to examine sleep in mothers of children with epilepsy and its relation to their children's sleep. A total of 133 dyads of mothers and children with epilepsy aged 1.5–6 years were recruited between 2015 and 2018 from a children's hospital in northern Taiwan. Participating families provided demographic and health information, with children wearing an actigraphy monitor for 7 days and mothers completing sleep and depressive mood questionnaires. We found that 76 (57.1%) of the mothers had poor sleep quality, with 65 (48.9%) mothers having a clinically significant depressive symptom score. Mean actigraphic wake after sleep onset in children was 1.42 (standard deviation = 0.51) hours, with 126 (94.7%) of the children having a clinically significant sleep disturbance score. Multivariate regression analyses showed that higher depressive symptom scores in mothers (β = 0.14; p < .01) and higher sleep disturbance scores in children (β = 0.07; p = .04) were associated with poorer maternal sleep quality, even when maternal demographic characteristics and the child's clinical and epilepsy variables were considered. Findings from our study suggest that sleep disturbances are a shared problem for mothers and their children with epilepsy. Sleep in both mothers and their children with epilepsy should be evaluated in pediatric neurologic practices, with maternal depressive symptoms screened concurrently. Future pediatric epilepsy studies are warranted to examine whether a family-based intervention program would be effective to improve sleep in mother-child dyads and to promote better health and functioning of the entire family.     

Fatigue in the mothers of children with cerebral palsy

Purpose: To evaluate fatigue in the mothers of children with cerebral palsy (CP), and to determine its associations with clinical parameters of CP, depression and quality of life (QoL). Method: Ninety children (50 girls and 40 boys) with spastic CP and their mothers were included. Control group comprised mothers of healthy children. Gross motor function classification system (GMFCS) was used for determining functional status. Spasticity was evaluated by using modified Ashworth scale. Fatigue symptom inventory (FSI) was used for assessing maternal fatigue, Nottingham health profile (NHP) for maternal QoL, and Beck Depression Scale (BDS) for maternal depression. Results: Mothers of children with CP scored significantly higher in all FSI subgroups (intensity of fatigue, duration of fatigue and interference with QoL), all NHP subgroups and BDS (p?p?< 0.01). No association was found between FSI and clinical parameters of children with CP including age, gender, type of CP, tonus and functional impairment (p?>?0.05). Conclusions: Our findings indicate that fatigue levels of mothers with CP children are higher than those with healthy children and associated with depression and deterioration in QoL in terms of physical, social and emotional functioning. This should be considered while designing a family centred rehabilitation programme for children with CP.

• Implications for Rehabilitation

• Caring for a child with cerebral palsy has psychological, social and financial impacts on familiesand is associated with increased levels of fatigue among mothers.

• The capacity of current programs and services needs to be strengthened to accommodate theneeds of children with CP and their mothers in order to reduce fatigue of mothers.

• New programs need to be developed to provide psychosocial support for the mothers andto reduce their fatigue as they continue to care for their children.

• Provision of assistive technology devices (particularly suitable wheelchairs) will be useful inreduction of fatigue levels of mothers.

     

First aid intervention with mothers/caregivers of children affected by the Zika virus in Brazil

BackgroundChildren with microcephaly associated with the Zika virus are more likely to develop choking and apnea, so it is necessary that mothers of this population receive first aid training to cope with emergency situations that their children may experience.ObjectiveTo understand how an educational first aid intervention with mothers/caregivers of Brazilian children with congenital Zika virus syndrome impacts their management of seizures and choking.MethodA qualitative study conducted in a philanthropic institution with ten mothers/caregivers of children with congenital Zika virus syndrome. Data were collected between August and November 2018 through four focus groups with two meetings for intervention/educational workshops in first aid on situations of choking and seizure. After one month, two more meetings were held to evaluate the effectiveness of this action performed at home. The empirical material was submitted to Content Analysis, and discussed in the light of Paulo Freire's Pedagogy of Autonomy.ResultsThe mothers/caregivers performed ineffective and harmful behaviors to the children in situations of choking and seizure before the intervention. Thus, the intervention empowered these caregivers through an exchange of experiences which began to present discernment, autonomy, resolving capacity and confidence to act in these experienced situations. They also became knowledge disseminators for family members and neighbors.ConclusionThe educational intervention can have satisfactory results in training mothers/caregivers in first aid, highlighting the importance of this initiative to reduce the morbidity and mortality of children who experience choking and seizures.     

Diet and physical exercises for preschoolers with ADHD and their mothers: An intervention study

BackgroundAttention deficit hyperactivity disorder (ADHD) is a serious public health problem. Diet-focused approaches and physical exercise can be used to complement other ADHD management techniques.ObjectiveTo determine the prevalence of ADHD symptoms among preschoolers in nursery schools and to evaluate the educational interventions toward nutrition and physical exercise in mothers and their preschoolers with ADHD symptoms.Research methodologyA two-phase sampling method was employed. First, a cross-sectional survey was conducted to determine the prevalence of ADHD symptoms in four nursery schools (400 preschoolers aged between 3 and 6 years). Second, an intervention study (a quasi-experimental research design with one group completing the pre-test and the post-test) was performed on 36 preschoolers having ADHD symptoms and their mothers by using the educational intervention for mothers and photos and games about nutrition and physical exercise for the preschoolers with ADHD; mothers of four children out of the 40 refused to participate in the study. Data were analyzed using SPSS version 20. The paired t-test was used to determine significant differences between the groups. Differences were considered significant at P < 0.05.ResultsOf the 400 preschoolers, 10% had high ADHD symptoms. The mean score of mothers’ knowledge of nutrition and physical exercise improved after the implementation of the program (p = 0.01). In addition, preschoolers with ADHD enjoyed the session with photos and games (p = 0.01).Conclusions and ImplicationsEducational intervention significantly improved the knowledge of the mothers. Moreover, preschoolers with ADHD symptoms enjoyed the session with photos and games. This intervention appears to be feasible and promising for further investigation of its effects.     

Protecting sick children from exposure to passive smoking through mothers' actions: a randomized controlled trial of a nursing intervention

AIMS: The aim of this study was to evaluate the effectiveness of a nursing educational intervention with mothers of sick children to decrease passive smoking exposure. BACKGROUND: Passive smoking represents a serious health hazard and is a substantial threat to child health causing major risk factors for acute respiratory illness in children. Nurses are in a vital position to conduct health education to improve children's health, which is a legitimate activity in a pediatric ward. METHODS: A randomized controlled trial was conducted in the general paediatric wards of four major hospitals in Hong Kong. The participants were non-smoking mothers of sick children admitted to the paediatric ward and with smoking husbands living in the same household. FINDINGS: A total of 1483 women were randomized into the intervention (n = 752) and control (n = 731) group. The intervention group received from the nurses (1) standardized health advice; (2) two purpose-designed booklets about preventing exposure to passive smoking and helping fathers quit; (3) a no smoking sticker; and (4) a telephone reminder 1 week later. No intervention was given to the controls. Baseline comparison showed no significant differences between the two groups in the mothers' actions to protect the children from passive smoking exposure. More mothers in the intervention group than the control group had always moved the children away when they were exposed to the fathers' smoke at home at 3-month follow up (78.4% vs. 71.1%; P = 0.01) but became non-significant at 6 and 12 months. CONCLUSIONS: A simple health education intervention provided by nurses to the mothers in a busy clinical setting can be effective in the short-term to motivate the mothers to take actions to protect the children from exposure to passive smoking produced by the fathers.     

Use of nicotine patches in breast-feeding mothers: transfer of nicotine and cotinine into human milk

OBJECTIVE: Our objective was to assess the extent of exposure to nicotine and cotinine in breast-fed infants during maternal smoking and later during maternal use of the nicotine transdermal patch to achieve smoking cessation. METHODS: Fifteen lactating women (mean age, 32 years; mean weight, 72 kg) who were smokers (mean of 17 cigarettes per day) participated in a trial of the nicotine patch to assist in smoking cessation. Serial milk samples were collected from the women over sequential 24-hour periods when they were smoking and when they were stabilized on the 21-mg/d, 14-mg/d, and 7-mg/d nicotine patches. Nicotine and cotinine in milk were quantified by HPLC, and infant dose was calculated. Plasma concentrations of nicotine in the breast-fed infants were assessed, and the infants were also clinically assessed. RESULTS: Nicotine and cotinine concentrations in milk were not significantly different between smoking (mean of 17 cigarettes per day) and the 21-mg/d patch, but concentrations were significantly lower (P <.05) when patients were using the 14-mg/d and 7-mg/d patches than when smoking. There was also a downward trend in absolute infant dose (nicotine equivalents) from smoking or the 21-mg patch through to the 14-mg and 7-mg patches (P <.05 at both 14-mg and 7-mg doses, compared with smoking). Milk intake (shown as median and 25th to 75th percentile) by the breast-fed infants was similar while their mothers were smoking (585 mL/d [507-755 mL/d]) and subsequently when their mothers were using the 21-mg (717 mL/d [504-776 mL/d]), 14-mg (731 mL/d [535-864 mL/d]), and 7-mg (619 mL/d [520-706 mL/d]) patches (chi(2) = 3.19, P =.364). CONCLUSIONS: We conclude that the absolute infant dose of nicotine and its metabolite cotinine decreases by about 70% from when subjects were smoking or using the 21-mg patch to when they were using the 7-mg patch. In addition, use of the nicotine patch had no significant influence on the milk intake by the breast-fed infant. Undertaking maternal smoking cessation with the nicotine patch is, therefore, a safer option than continued smoking.     

Examining knowledge and traditional practices of mothers with children under five in Turkey on diarrhoea according to education levels

BackgroundDiarrhoea still ranks among the top causes of the deaths of children under five years old in the world. In solving this important health problem, it is necessary and imperative to know the health-related knowledge levels of mothers who take care of the child individually and the traditional practices they perform when their children are sick, in order to provide effective health education.AimThis study aims to examine the knowledge levels and traditional practices of mothers with children younger than 5 years old regarding diarrhoea in relation to their education levels.MethodsWe conducted a cross-sectional web-based survey. The population of this cross-sectional study consisted of mothers with children under the age of 5 who lived in the metropolitan city Bursa in the South Marmara Region of Turkey. The survey was applied among the mothers of children under the age of 5 using the snowball sampling method via mobile platforms. The data were collected via Google Forms using a “Socio-Demographic Data Collection Form”, an “Information Form on Measuring the Knowledge Level of Mothers on Diarrhoea” and a “Form on Main Traditional Practices Used When Children Have Diarrhoea in Turkey” prepared by the researchers after a review of the relevant literature.ResultsIn the study, the mean total diarrhoea knowledge score of the participating mothers was found to be 22.01 ± 3.72 (high). Multiple linear regression analysis was used to determine the relationship between the total diarrhoea knowledge scores of the participants and other variables. The difference in the knowledge scores based on education levels was statistically significant (p < .001). The most prevalently preferred traditional practice in the case of children''s diarrhoea was “feeding the child banana” (92.5%).ConclusionMaternal education level is determined to be a significant variable that positively affects diarrhoea knowledge levels.

KEY MESSAGES

• Diarrhoea continues to be among the top five preventable causes of death in the world and Turkey among children under the age of 5.
• The knowledge level of mothers about diarrhoea plays an important role in diarrhoea management. The level of knowledge about diarrhoea differs according to the education level of mothers.
• Traditional practices have an important place in the management of diarrhoea by mothers.

     

Child health promotion and protection among Mexican mothers

For numerous reasons, children of Mexican descent experience many health disparities. One strategy for addressing these disparities is to increase health promotion and protection behaviors that mothers use with their preschool children. Limited literature is available on such practices used by mothers of Mexican descent with their healthy preschool children. This study explored child health promotion and protection practices used by mothers of Mexican descent. A naturalistic design, guided by Spradley's ethnographic interview techniques, was selected for this study. The sample included 9 Mexican-descent mothers from an urban U.S. community with healthy preschool children. Despite significant challenges, participants promoted and protected the health of their preschool children by al cuidado (taking care) and by being al pendiente (being mindful) of balancing the health of their children's bodies, minds, and souls. Understanding these mothers' approaches allows the creation of culturally sensitive health programs that can build on existing maternal strengths.     

Managing infant feeding practices: the competing needs of bulimic mothers and their children

Aim. This paper seeks to explain how bulimic mothers accommodated infant feeding demands in conjunction with managing their disordered eating practices. Background. Eating disorders are chronic and disabling illnesses primarily affecting women. There are few qualitative studies describing bulimia in the context of motherhood. Design. The study employed an inductive qualitative approach. Methods. A purposive sample of childbearing women (n = 16), who self‐defined as living with an eating disorder, were recruited. Data were generated from one‐to‐one interviews; a thematic analysis identified key issues. Results. Participants were primarily responsible for ensuring child/ren’s socialisation processes, including modelling appropriate dietary behaviours and these demands often conflicted with their personal needs for food restraint. Pressures to participate in social activities with children were widely experienced as stressful especially when these events focused on food. Participants viewed early and repeated exposure to ‘healthy’ eating as protective against their children acquiring an eating disorder and in this respect commercial child‐care facilities provided alternative environments for children to explore food‐related activities. Conclusions. Participants employed a variety of strategies to ensure children’s exposure to normalising influences and socialising processes. Concerns about personal competencies with respect to food preparation and storage were articulated by all participants. Relevance to clinical practice. Professionals involved with providing care to mothers and their infants are well placed to support bulimic clients and to foster confidence in their mothering skills. Early and appropriate intervention is key to effecting positive changes in bulimic patterns, with potential benefits to women’s future health and well‐being and that of their children.     

Training mothers with mental retardation to discuss home safety and emergencies with their children

We trained three mothers with mental retardation to discuss categories of home dangers, ways to remedy those dangers, and to discuss emergencies with their eldest children following a multiple baseline procedure. Training the mothers concerning dangers and safety increased their knowledge while their discussions with their children increased the children's knowledge regarding those dangers and safety measures. No improvement in actual home safety was observed. This suggests that specific training to remediate home dangers is needed. In part two of the study, both the mothers' as well as the children's knowledge of emergencies improved as each emergency was introduced.     

A source of strength and empowerment? An exploration of the influence of disabled children on the lives of their mothers in Karachi,Pakistan

Purpose.?Previous literature has highlighted marginalisation and stigma of children with disabilities in developing countries, but few studies have explored the central care-giving environment and the relationship of the mother and her child with disabilities in this context. A group of women caring for children with disabilities in a low income community in Karachi, Pakistan was identified for the study. The aims were: (1) to explore the influence children with disabilities have on the daily lives of their mothers, (2) to describe the factors which influence the care-giving capacity of mothers.

Method.?A participatory qualitative research design was implemented. A women's group of caregivers of children with disabilities was formed. Several different tools were used during the course of the group meetings to facilitate discussion including social mapping. A thematic analysis of issues around care-giving and the relationship between the mother and her child with disabilities was conducted.

Results.?In a society where women may experience restrictions in freedom of movement and decision making, caring for a child with disabilities enabled women to move beyond traditional boundaries in seeking health and education services for their children. However, the gain in empowerment was counter-acted by a lack of care-giving support, a lack of appropriate services for health, rehabilitation and education of children with disabilities and stigma creating anxiety and stress for women.

Conclusion.?While children with disabilities do have some positive effects on the lives of their mothers, there are many more factors which create anxiety for this group of mothers (including a lack of care-giving support and stigma). Community-based rehabilitation strategies should consider the care-giving environment of children with disabilities and shift from a child only to family focus. Interventions which support, empower and strengthen the capacity of mothers are essential for the well being of their children with disabilities.     

The lived experiences of mothers who have children with congenital abnormalities in the Gert Sibande district

BackgroundMothers are regarded as primary care givers. The experience of having a child with congenital abnormality may have an impact on their psychological well-being. It was observed that the psychological well-being of mothers is often unattended by health professionals, including nurses and their families. Mothers make adjustments in their daily lives to ensure the child’s activities of daily living are attended. Therefore, this raises the need for the experience of mothers who have children with congenital abnormalities in the Gert Sibande district to be explored. Gert Sibande was chosen because it has been observed that several mothers who visit the clinic and outpatient department have children with congenital abnormalities.ObjectivesThe purpose of this study was to explore and describe the lived experiences of mothers who have children with congenital abnormalities.MethodA phenomenological study was conducted. Purposive sampling of 12 participants was done. The study used adjusted ecological model of health for guidance. Data gathering was done by self-report using unstructured face-to-face interviews until data saturation was reached.ResultsFive themes emerged from the study, which include ‘being hurt emotionally’, ‘sense of guilt’, ‘acceptance’, ‘support from family’ and ‘community reaction to the congenital abnormality’. The findings show that mothers were affected by having children with congenital abnormalities.ConclusionThe study revealed that mothers of children with congenital abnormalities experienced devastation, denial, guilt and lack of acceptance of their child’s condition. The study indicates that mothers require support from health care professionals, family and the community.     

Obesity in lower and middle socio-economic status mothers and their children

To identify potential nursing interventions for obesity in lower socioeconomic status populations, the relationships between maternal and child obesity, socioeconomic status, maternal nutritional knowledge, and locus of control for maternal weight in 144 children and their mothers were studied. Subjects were recruited from two clinic populations; Clinic 1 was of lower socioeconomic status than Clinic 2. As compared with those from Clinic 2, mothers from Clinic 1 were heavier, had less nutritional knowledge, and were more external with respect to locus of weight control. There was a trend for Clinic 1 children to be heavier than those in Clinic 2 but this finding was not statistically significant. The lower socioeconomic status children significantly resembled their mothers' adiposity (possibly foreshadowing adult obesity), however, the middle socioeconomic status children did not resemble their mothers.     

Developmental problems and interactions between mothers and prematurely born children

This study explored how the developmental status of 49 3-year-old prematurely born children related to the interactions between these children and their mothers. Two 2-hour observations of mother-child interactions, the Home Observation for Measurement of the Environment (HOME) inventory, a developmental assessment, and Nursing Child Assessment Teaching Scale (NCATS) were scored when the child was 3 years corrected age. The effects of specific developmental problems (cognitive, language, and attention) were examined by comparing subgroups with and without these problems. Children with normal IQs spent less time not playing and scored higher on the NCATS than children with low IQs. Mothers of children with normal IQs scored higher on provision of play materials on the HOME. The mothers of children with language concerns interacted less, talked less, were more negative, and scored lower on the HOME and NCATS than mothers of the children with normal language abilities. Children with attention problems were more active than children with normal attention spans. These findings suggest that mother-child interactions might be useful for identifying children at risk for developmental delay and that interventions with preschool children with developmental delays will probably be more effective if their mothers are helped to provide a more appropriate social environment.     

Journaling for self-care and coping in mothers of troubled children in the community

AimThis mixed method research explored the benefits of a six-week diary writing intervention, and the coping strategies utilized in a sample of affected mothers who have teenagers or adult children with emotional and/or behavioral issues.MethodsParticipants were assigned to write either a best possible self or a gratitude journal, and asked to make entries at least three times per week for six weeks. A snowball sample of 34 mothers completed the six-week journal and post-test.ResultsThe findings of paired t-tests indicated statistically significant increases in optimism and gratitude levels after completing the writing intervention. The mothers commonly used coping methods for parental distress were emotion-and meaning-focused coping. The three themes of journal writing experience were positive thinking, emotional well-being, and mental health self-care.ConclusionThe current study suggests that implementing a positive writing intervention is a practical means of promoting psychological well-being as a self-care strategy for this population.     

The physical health of rural mothers and their low birth weight children

The purpose of this research was to examine the physical health of rural mothers and their low birth weight children (< 2,500 gm). The health of rural mothers is of concern because rural families have poorer health than urban ones, and as the primary caregiver for the low birth weight child, mother's health affects the child's care and potentially the child's health. In this cross-sectional, exploratory study, in-home interviews were conducted with 48 mothers between 2 weeks and 18 months after their children were discharged from their birth hospitalization. Mothers' physical health and their perceptions of their children's health were assessed. The mothers were more concerned about their children's health than their own (p = .0005). The concerns included uncertainty about the children's future health, growth, and development. Suggestions for community health care providers are addressed.