Quality of life, anxiety and concerns among statin-treated children with familial hypercholesterolaemia and their parents

AIM: To assess the quality of life, anxiety and concerns among statin-treated children with familial hypercholesterolaemia (FH) and their parents. METHODS: 69 FH children on statin therapy and 87 parents (51 families) participated in this study. Quality of life of the children, and anxiety levels of both the children and their parents, were investigated using self-report questionnaires. In addition, a questionnaire was designed to evaluate FH-specific concerns of these children and their parents on six different topics: 1, knowledge about FH; 2, experience of the disease; 3, family communication; 4, screening; 5, diet; and 6, experience of medication therapy. RESULTS: FH children and their parents reported no problems with regard to quality of life and anxiety. In contrast, the FH survey showed specific FH-related concerns. One-third of the children thought that FH can be cured, and 44% of the children suffered from the fact they have FH, but taking medication makes them feel safer (62%). The majority of the children kept a low cholesterol diet and more than 50% took care not to eat too much fat. Almost 38% of the parents experienced FH as a burden to their family and 79% suffered because their child had FH. CONCLUSION: These findings show that statin-treated children with FH and their parents did not report affected psychosocial functioning, but did show specific FH-related concerns.     

Parental concern towards the use of inhaled therapy in children with chronic asthma

BACKGROUND: Parental attitudes towards the use of inhaled therapy in children with chronic asthma influence treatment adherence and outcome. In the present study, we evaluated the perceptions and concerns of parents of children with chronic asthma towards inhaled therapy. METHODS: A self-administered standard questionnaire was distributed to parents of children attending the Paediatric Asthma Clinic. All these children required inhaled steroids for treatment. RESULTS: One-hundred and twelve of 170 parents (66%) surveyed were concerned with inhaled therapy. The most common concern with its use was medication side effects (91%), followed by 'inhaler dependency' (86%), cost of the inhaler (34%) and difficulty in using the inhaler (15%). Parental perception that the oral route was superior to the inhaled route, preference for the oral route for asthma prophylaxis and a higher steroid dose required for prophylaxis were more likely to be associated with concerns towards inhaled therapy. More importantly, these children were also more likely to miss > 25% of their prescribed doses of inhaled steroids (46 vs 22% in the group concerned about inhaled therapy compared with the group that was not concerned, respectively; P = 0.007) and had a higher mean number of nebulization treatments in the last year (3.2 +/- 2.9 vs 1.8 +/- 1.3 in the group concerned about inhaled therapy compared with the group that was not concerned, respectively; P = 0.01). CONCLUSIONS: A significant proportion of parents whose children were on inhaled prophylaxis had concerns towards the use of inhaled therapy. Parental concern towards inhaled therapy appeared to increase the problem of non-adherence to treatment. Education for these parents will need to be addressed to improve asthma management in our patient population.     

湖北仙桃农村留守儿童健康状况的初步研究

目的：研究湖北仙桃农村留守儿童营养状况、心理健康和身体健康状况。方法：对湖北仙桃农村6所小学4～6年级学生1000人进行问卷调查,包括一般情况问卷、家庭经济状况问卷、儿童抑郁问卷;并对其进行体格检查。与父母生活在一起,父母无外出打工经历的儿童作为对照组。结果：收回有效问卷875份,其中留守儿童590名,对照儿童285名。留守儿童平均体重35.5±7.1 kg,显著低于对照儿童的36.3±8.8 kg (P＜0.05);留守儿童体重/年龄z评分（-0.9811±0.54）也显著低于对照儿童（-0.7012±0.34）（P＜0.05）。但留守儿童身高、皮脂厚度、体重指数（BMI）以及基本营养状态与对照儿童相比差异无统计学意义。留守儿童抑郁平均得分显著高于对照儿童（11.4± 7.2 vs 8.0± 5.8,P＜0.01),抑郁发生率亦显著高于对照儿童(15.3% vs 6.0%,P＜0.01)。留守儿童扁桃体肿大发生率明显高于对照儿童(32.0% vs 23.2%, P＜0.01);呼吸道感染发生率（14.6%）显著高于对照儿童(14.6% vs 9.5%, P＜0.05);消化道感染发生率亦显著高于对照儿童(7.6% vs 3.9%, P＜0.05)。结论：留守儿童营养状况基本正常,但心理健康状况欠佳,且容易患呼吸道感染等常见病。     

Parental anxiety associated with referral of a child to a pediatric cardiologist for evaluation of a Still's murmur

OBJECTIVE: We assessed factors contributing to parental anxiety when children are referred to a cardiology clinic for evaluation of a Still's murmur. METHODS: Parents of 95 children completed questionnaires designed to assess family and patient characteristics, parents' ratings of their anxiety and the reassurance they received from their pediatrician, and current (state) and general anxiety levels. RESULTS: Parents reported anxiety about multiple issues including the need for medication (49%), sports restrictions (41%), cardiac surgery (29%), cardiac risk for siblings (20%), and premature death (13%). Of reporting mothers, 19% felt the murmur resulted from something they did wrong during pregnancy. Although 54% of parents were extremely reassured by their pediatrician, only 17% had no anxiety associated with the specialty visit. After reassurance from the cardiologist, 7% of parents had persistent anxiety. In multivariable analysis, 2 features, both related to the referring pediatrician, were significantly related to parental anxiety level. High parental anxiety was associated with lower pediatrician reassurance ratings and greater pediatrician practice years. CONCLUSIONS: Parental anxiety is common among parents of children referred for specialty evaluation. Educational strategies to improve pediatrician communication skills with parents may improve quality of care.     

白血病患儿及其父母心理特点调查分析

目的探讨初诊及长期无病生存白血病患儿的情绪、自我意识特征及其父母的情绪特点。方法选用儿童焦虑性情绪障碍筛查表、儿童抑郁障碍自评量表和Piers-Harris儿童自我意识量表分别对40例初诊白血病、20例长期无病生存白血病和50例正常对照儿童进行评定,同时采用焦虑自评量表、抑郁自评量表对两组白血病儿童的父母进行心理测评。结果白血病患儿的焦虑和抑郁总分均显著高于正常对照组(P值分别为0.028和0.045);其中长期无病生存组患儿在躯体化/惊恐、广泛性焦虑和社交恐怖分量表评分明显高于正常对照组(P值分别为0.002、0.019、0.001和0.000)。初诊组患儿在社交恐怖分量表得分亦显著高于正常对照组(P=0.004),在学校恐怖分量表得分显著低于正常对照组(P=0.020)。总体白血病患儿的自我意识总分低于正常对照组(P=0.003),其中长期无病生存组在焦虑、合群、幸福与满足分量表得分显著低于正常对照组(P值分别为0.041、0.037和0.037),但自我意识总分与正常对照组相比差异无显著性(P=0.581);而初诊白血病组患儿在自我意识总分及行为、智力与学校情况、躯体外貌与属性、焦虑分量表得分显著低于正常对照组(P值分别为0.007、0.001、0.005、0.031和0.001)。白血病组父母焦虑和抑郁得分均显著高于我国常模组(P0.001),其中初诊白血病组父母的焦虑和抑郁症状检出率显著高于长期无病生存组(P值分别为0.015和0.032)。患儿父母的焦虑和抑郁得分有明显的相关性(r=0.95,P0.001),但与患儿的焦虑、抑郁及自我意识得分均无显著相关性(P0.05)。结论白血病患儿及其父母较正常对照组有更多的焦虑和抑郁情绪,白血病患儿的自我意识降低。因此,应重视对白血病患儿及其父母进行心理辅导及治疗。     

Perception of fear, distress and pain by parents of children undergoing a micturating cystourethrogram: a prospective study

OBJECTIVES: To investigate whether parents' expectations of their child's fear, distress or pain during a micturating cystourethrogram (MCU) are realized. METHODOLOGY: Prospective study in which parents were asked to fill out two questionnaires using a visual analogue scale, one before (pre) and the other after the MCU procedure (post), was conducted at a tertiary level paediatric hospital in Sydney, Australia. The questionnaires were designed to compare the parents' anticipated and experienced anxiety about their child's procedure and their perception of fear, distress and pain in their child during and after the procedure. The parents' satisfaction with information provided to them on the procedure was also recorded. Twenty-five parents participated in the study. RESULTS: There were significant differences between anticipated and experienced parental anxiety. Parents' reporting of fear, distress and pain in their child during the MCU and after the procedure was lower than they had anticipated. There was a significant correlation between the parents' anxiety and their perception of severity of their child's fear (r = 0.52, P = 0.009), distress (r = 0.48, P = 0.017) and pain (r = 0.50, P = 0.01) during the procedure, but less so with the child's distress after the procedure (r = 0.39, P = 0.059). The parents were satisfied with the information given to them regarding the MCU procedure. CONCLUSIONS: Parents' perception of their child's fear, distress and pain during the MCU, as well as distress following the MCU, was not as severe as they had anticipated. Parental anxiety is an important factor in the perception of fear, distress and pain in children during and after the procedure.     

Parental perception, worries and needs in children with epilepsy

Despite advancement in medical care, prejudice and misunderstanding of epilepsy still exist. In this study, we investigate the problems faced by epileptic children, at home and in school, and make suggestions for improvement. Questionnaires were randomly distributed to parents of epileptic children attending normal and special classes (groups A and B, respectively). Return of questionnaires was anonymous. Ninety-one percent responded. Of the responders, 56 children were in Group A and 30 in Group B. Chronic and intractable epilepsy was more frequently observed in Group B than in Group A patients (47% vs 14%, p < 0.05). Main family concerns were seizures, school performance and side effects of medication. Half of the parents complained that their children were more restless and short-tempered. Only 43% of parents were aware that seizures were caused by abnormal brain discharges. Twenty percent thought swimming should be prohibited even if seizures could be controlled. Schools were informed of the disease by 84% of the families. Only 29% of parents knew the name and dose of the current medication. Information was considered adequate in 27% of patients. Drug compliance was better in epileptic children with associated handicaps than in those without handicaps. Half of the parents requested more information about epilepsy and closer communication between teachers and physicians. CONCLUSIONS: To establish comprehensive care that satisfies the needs of epileptic children and their families, further training of medical specialists in epilepsy and enhancement of networks among relevant organizations are needed.     

Parental report of health conditions and health care use among children with and without autism: National Survey of Children's Health

OBJECTIVE: To compare parent-reported prevalence of health conditions and health care use between children with and without autism. DESIGN: Cross-sectional analysis of the 2003 to 2004 National Survey of Children's Health. SETTING: Population-based sample across the United States. PARTICIPANTS: More than 100 000 parents. The main exposure was "autism" (not further defined), from response to the question: "Has a doctor or health professional ever told you that your child has autism?" MAIN OUTCOME MEASURES: Medical and mental health conditions and measures of health care use. RESULTS: Autism prevalence among children aged 3 to 17 years was 53 per 10 000 (95% confidence interval, 45-61 per 10,000), equating to a national estimate of 324 000 children (95% confidence interval, 274,000-375,000 children). Children with autism had a significantly (P<.001) higher prevalence of depression or anxiety problems (38.9% vs 4.2%) and behavioral or conduct problems (58.9% vs 5.2%) than children without autism. Respiratory, food, and skin allergies were reported by parents more often for children with autism, with food allergies having the strongest relative difference between the groups (odds ratio, 4.5; 95% confidence interval, 3.0-7.0). Children with autism had significantly (P<.001) higher mean physician visits over 12 months for preventive care, nonemergency care, and hospital emergency care, and were far more likely than children without autism to receive physical, occupational, or speech therapy (76.0% vs 6.3%), to need treatment or counseling for an emotional, developmental, or behavioral problem (75.4% vs 7.0%), and, among those taking a prescribed medication, to be using a medication long-term (51.4% vs 14.5%). CONCLUSION: We found markedly higher reports of concurrent conditions and health care use associated with childhood autism in this study.     

Parental attitudes and practices toward children as pedestrians

Community programs to reduce the toll from pedestrian injuries in childhood must include parents as a key element. This study, consisting of a survey questionnaire, was undertaken to provide information concerning current parent attitudes and practices that could be used to guide prevention programs. The survey consisted of 2464 questionnaires from parents of children in grades kindergarten to four in a suburban school district. Although 94% of parents did not believe that 5- to 6-year-old children can reliably cross streets alone, one third of parents allowed kindergarten-aged children to cross residential streets alone and first-grade children to walk alone to school. The presence of speeding traffic or the lack of safe places to walk did not influence parents in limiting their children's crossings. Few (17%) parents believed that children should be taught not to cross alone; one half of parents, including 41% of parents of kindergarten-aged children believed that children should be taught to cross busy streets without traffic lights. According to results of the study, parent expectations for their children's pedestrian skills may be inappropriate and may be a fruitful target for injury-prevention programs.     

Parental attitudes about confidentiality in a pediatric oncology clinic

Children and parents who attend pediatric oncology clinics often develop close relationships with other patients and may question clinic staff about another child's disease, therapy, or status. To assess parental attitudes concerning the dissemination of information by the clinic staff, questionnaires were mailed to the parents of all 154 patients who have attended pediatric oncology clinic since 1972. There were 100 (65%) responses including 77 from 99 living (78%) and 23 from 55 deceased patients (42%). Parents were asked whether clinic staff should respond completely to questions from other clinic parents regarding six aspects of their child's cancer. Percentages of parents who favored complete information sharing without their explicit consent about each of the aspects were as follows: diagnosis, 83%; medication/side effects, 85%; laboratory results, 66%; general status, 87%; occurrence of relapse, 77%; development of terminal phase, 67%. Neither the survival status (living v deceased) nor whether the patient was receiving therapy or not affected responses significantly. Benefit from receiving information about other children from clinic staff was reported by 82% of parents.     

Parental management of infants born following a cot-death victim who were monitored compared to infants who,despite similar histories,were not monitored: A controlled study

We studied 93 families who had previously lost a baby to cot-death. Of these, 31 chose cardiorespiratory monitoring (CRM) for their next child and were compared to 62 families who, despite similar histories, decided not to monitor their subsequent infant. A control group consisted of 50 families without history of cot death. The three objectives of this retrospective study were: (1) to gain insight into psychological factors which differentiate between parents who insist on monitoring their infant and those who do not; (2) to explore how parents of both groups cope with their feelings of anxiety and stress and; (3) to examine the effect of psychological factors on parental reactions to monitor alarms. Infants of the monitor group and the nonmonitor group were matched to the age reached by the previous cot-death victims at the moment of death. Parents who had experienced cot-death (91%) and 37% of the control group parents completed the State-Trait Anxiety Inventory (STAI) and a questionnaire, consisting mainly of multiplechoice questions. Results show that monitor parents and nonmonitor parents differ greatly in their expectations of and attributions to the equipment and in the way they process information about monitoring. More monitor parents attribute a protective value to CRM. Monitor parents reported to have been more stressed during pregnancy. Postnatally, monitor parents and nonmonitor parents did not experience different anxiety levels. Nonmonitor parents experienced a slight decrease of feelings of happiness over time. Mothers with high state anxiety scores noted more false bradycardia alarms than mothers with low scores. In contrast, fathers with high trait and state anxiety scores reported more technical false alarms than fathers with low anxiety scores. These differences between fathers and mothers in reports of alarms demonstrate the subjective character of the observations.     

Connections between parental eating attitudes and children's meagre eating: questionnaire findings

This study investigated whether young children's problematic, meagre eating is associated with the eating habits and attitudes of the parents. The subjects, 397 children, their mothers (n = 397) and fathers (n = 375) participated in a prospective atherosclerosis risk-factor intervention trial. The parents evaluated their own eating behaviour in questionnaires when their child was 13 mo old. The children's eating problems were recorded by the mothers when the child was 13 mo old, and by both parents when the child was 5 y old. At both ages, the weight and height of the children were measured. Problematic or maladaptive eating habits of the children were found to be connected to those of their parents. The mother's poor ability to enjoy eating, high tendency to snack and low tendency to eat only when hungry, as well as the father's difficulty in maintaining ideal weight significantly predicted persistent problems of meagre eating in their children. CONCLUSION: The study suggests that the eating habits and attitudes of parents may be reflected in the eating behaviour of young children.     

Association between caregivers’ anxiety and depression symptoms and feeding difficulties of preschool children: A cross-sectional study in rural China

PurposeTo investigate the prevalence of feeding difficulties in preschool children and explore the association between caregivers’ anxiety and depression symptoms and preschool children's feeding difficulties.MethodsThis cross-sectional study was conducted between June 2017 and January 2018 in rural areas of Anhui province, China. A total of 2231 preschool children and their caregivers were interviewed. Feeding difficulties of preschool children were reported by caregivers using the adapted Identification and Management of Feeding Difficulties (IMFeD) tool. Anxiety and depression symptoms of caregivers were evaluated via the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS).ResultsIn total, 54.1% of preschool children were reported to have feeding difficulties by their caregivers. Among all children, when the caregivers had symptoms of anxiety or depression, the children had a higher risk of feeding difficulties. Specifically, for caregivers’ anxiety symptoms, the odds ratios (ORs) of feeding difficulties in all children, left-behind children (LBC), and non-LBC were 1.91 (95% confidence interval [CI]: 1.42–2.57), 2.04 (95% CI: 1.34–3.09), and 1.86 (95% CI: 1.21–2.87), respectively; for caregivers’ depression symptoms, the ORs of feeding difficulties in all children, LBC, and non-LBC were 1.86 (95% CI: 1.46–2.39), 1.76 (95% CI: 1.24–2.51), and 2.08 (95% CI: 1.45–2.97), respectively. In addition, when caregivers who were parents or grandparents had anxiety or depression symptoms, their children had a higher risk of feeding difficulties. Specifically, for parents and grandparents with anxiety symptoms, the ORs of feeding difficulties were 1.84 (95% CI: 1.14–2.98) and 2.17 (95% CI: 1.46–3.22), respectively; for parents and grandparents with depression symptoms, the ORs of feeding difficulties were 2.03 (95% CI: 1.40–2.95) and 1.93 (95% CI: 1.37–2.73), respectively.ConclusionCaregivers’ anxiety or depression symptoms are positively associated with feeding difficulties in children.     

Health effects of family size: cross sectional survey in Chinese adolescents.

AIMS: To determine whether only children differ in terms of morbidity, nutritional status, risk behaviours, and utilisation of health services from children with siblings, in China. METHODS: A cross sectional survey was carried out using self completion questionnaires, anthropometry, and haemoglobin measurement in middle schools (predominant age 12-16 years) in three distinct socioeconomic areas of Zhejiang province, eastern China. RESULTS: Data were obtained for 4197 participants. No significant differences were found between only children and those with siblings for some key indicators: underweight 19% v 18%, suicide ideation 14% v 14%, and ever smoking 17% v 15%. Only children were more likely to be overweight (4.8% v 1.5%), and to have attended a doctor (71% v 63%) or dentist (17% v 10%) in the past year. Sibling children are significantly more likely to be anaemic (42% v 32%) and to admit to depression (41% v 21%) or anxiety (45% v 37%). However, after adjusting for area, sex, and parental education levels only two differences remained: sibling children are more likely to be bullied (OR 1.5, 1.1-2.0; p = 0.006) and are less likely to confide in parents (OR 0.6, 0.3-0.8, p = 0.009). There were no significant differences in the key parameters between first and second born children. CONCLUSIONS: We found no detrimental effects of being an only child using the indicators measured. Being an only child may confer some benefits, particularly in terms of socialisation.     

Visceral hyperalgesia in children with functional abdominal pain.

OBJECTIVE: Our purpose was to evaluate visceral sensitivity and psychologic profiles in children with functional gastrointestinal disorders. STUDY DESIGN: We measured visceral perception in the stomach and in the rectum by using an electronic barostat. Psychologic questionnaires were completed. Ten children with recurrent abdominal pain (RAP)(8 female, mean age 11.3 +/- 0.8 years), 10 children with irritable bowel syndrome (IBS) (8 female, mean age 13.0 +/- 0.9 years), and 15 control children (8 female, mean age 12.7 +/- 1.2 years) completed the study. RESULTS: Thresholds for visceral perception in the rectum were decreased in patients with IBS (P <.001 vs control patients) and in patients with RAP (P <.05 vs control patients). Children with IBS had lower thresholds than children with RAP (P <.01). In contrast, thresholds for perception were decreased in the stomach of children with RAP (P <.005 vs control patients) but not in children with IBS. There were elevated anxiety scores in 45% of patients. Duration of symptoms was associated with higher scores of anxiety (P <.001) and depression (P <.02). CONCLUSIONS: Hyperalgesia was demonstrated in children with RAP and IBS; sites of hyperalgesia appear to be associated with different symptom phenotypes; anxiety was common, and there was an association between the duration of symptoms and increased scores for both anxiety and depression.     

Septo-optic dysplasia/optic nerve hypoplasia: data from the National Cooperative Growth Study (NCGS)

We analyzed data from 65 children with septo-optic dysplasia (SOD) referred for evaluation and followed in the National Cooperative Growth Study (NCGS) Substudy 8 and from 758 children treated with growth hormone (GH) and followed in the NCGS core study. Compared to other children referred for evaluation of short stature, children with SOD were younger (mean age 3.7 +/- 3.6 vs 8.6 +/- 4.9 years), had less severe short stature (mean +/- SD height SDS -1.80 +/- 1.64 vs -2.17 +/- 0.95), and were more likely to be female (46% F vs 31% M). Children with SOD who received GH were older and shorter than those referred and untreated, but the gender distribution was similar. Other pituitary hormone deficits were reported in untreated patients, including thyroid hormone deficiencies (8%) and adrenocorticotropic hormone (ACTH) deficiency (3%), as compared to 27% and 24%, respectively, in GH-treated children. Data on adult height were available for 71 patients, who showed an average gain in height SDS of 1.17 +/- 1.49. GH therapy was well tolerated in children with SOD.     

“You gotta try it all”: Parents’ Experiences with Robotic Gait Training for their Children with Cerebral Palsy

ABSTRACT

Aims: Innovative robotic technologies hold strong promise for improving walking abilities of children with cerebral palsy (CP), but may create expectations for parents pursuing the “newest thing” in treatment. The aim of this qualitative study was to explore parents’ values about walking in relation to their experiences with robotic gait training for their children. Methods: Semi-structured interviews were conducted with parents of five ambulatory children with CP participating in a randomized trial investigating robotic gait training effectiveness. Results: Parents valued walking, especially “correct” walking, as a key component of their children's present and future well-being. They continually sought the “next best thing” in therapy and viewed the robotic gait trainer as a potentially revolutionary technology despite mixed experiences. Conclusions: The results can help inform rehabilitation therapists’ knowledge of parents’ values and perspectives, and guide effective collaborations toward meeting the therapeutic needs of children with CP.     

Bullying in schools: prevalence and short-term impact

OBJECTIVES: To estimate the prevalence of bullying in school children and to examine its association with common symptoms in childhood. DESIGN: Prospective survey using a pre-tested questionnaire for conducting a semi structured health interview. SETTING: Randomly selected Public and private schools in a rural area. SUBJECTS: Children aged 8-12 years studying in three schools and their parents. RESULTS: Bullying was reported by 157 (31.4%) of the 500 children interviewed. There was no significant difference in the prevalence of bullying amongst boys and girls in co-education schools. However, it was significantly low in schools enrolling girls alone. Teasing and keeping names were the commonest forms noticed. Causing physical hurt was reported bv 25 (16%) students. Only 24 (24%) parents were aware that their children were being bullied. Feeling sad, preferring to stay alone and frequent tearing of clothes were almost exclusively noted in bullied children and bullied children were more likely to report symptoms such as school phobia, vomiting and sleep disturbances. CONCLUSION: Bullying is a common phenomenon amongst school going children. Frequent bullying is associated with certain symptoms and school absenteeism. Healthcare professionals. should be aware of this phenmnenon so that they can diagnose the underlying cause when these symptoms are reported and plan for appropriate interventions.