Children younger than 4 years and their substance-dependent mothers in the child welfare clinic

AIM: To explore the prevalence of substance dependency among mothers of small children and to evaluate the value of a routine-style maternal report on social support, child's somatic health history and child caregiving experiences to differentiate the substance-dependent group from the non-dependent group. METHODS: Mothers (n = 413) of children less than 4 y in the child welfare clinics filled in the Substance Abuse Subtle Screening Inventory (SASSI, Miller 1985) and questionnaires concerning social support, somatic history of the child, difficulties in social environment and in caring for the child. RESULTS: The prevalence of substance dependency was 5.8%. The maternal perceptions of the child's somatic history could not differentiate the dependent from the non-dependent group, while the child caregiving difficulties were more often present in the group of substance-dependent mothers. The combined group of substance dependency and substance use was significantly associated with low social support and difficulties in social environment. CONCLUSIONS: The prevalence of substance dependency among mothers of small children is considerable and significantly associated with child caregiving difficulties and low social support, while the perceptions on the somatic health of the child did not differentiate the dependent from the non-dependent group. This suggests the value of considering the maternal experiences in caring for the child and well-being of the mother during check-ups in the child welfare clinic in order to identify the mother-child pairs at risk.     

Problems of early infancy, formula changes, and mothers' beliefs about their infants

Problems of early infancy are sometimes managed by changing an infant's formula from a cow milk formula to a soy protein or casein hydrolysate formula ("special formulas"). This study was designed to determine the frequency of formula changes, mothers' reports of problems that lead to such a change, and mothers' beliefs about the causes of these problems. Mothers of 189 breast-feeding (BF) and 184 formula-feeding (FF) infants were enrolled postpartum. Follow-up data were obtained by telephone interviews at 4 months. After starting a cow milk formula, 11% of the BF and 25% of the FF infants were given special formulas. Mothers frequently reported problems related to feeding, bowel movements, and crying behavior; 32% of infants with such problems were given special formulas. Excessive crying and colic were the most common problems leading to a formula change. When a formula was changed, mothers more frequently believed that the cause of the problem was intrinsic to the child (P less than 0.001) and that their infant had had a "disease or illness" (P less than 0.001). When formula changes occurred, 26% of mothers believed that their infants were allergic to cow milk. These beliefs may affect a mother's perceptions of her child's vulnerability.     

Parenting a child with cancer: promotion and prevention-focused parenting

Applying regulatory focus theory (RFT), it was predicted that, among survivors of childhood cancer, quality of life (QoL) may be compromised by prevention-focused parenting (the focus on avoiding negative outcomes), rather than promotion-focused parenting (the focus on approaching positive outcomes). Interviews with mothers of survivors of Acute Lymphoblastic Leukaemia (ALL) and tumours of the Central Nervous System (CNS) were coded for reports of parenting and related to child QoL. Parents reported overall more promotion than prevention; however, mothers of children with tumours of the CNS reported more prevention-focus than mothers of children with ALL. Furthermore, prevention focus was related to child QoL, regardless of diagnosis. The study points toward the value of further development of RFT in clinical contexts.     

Parents' reactions at 24-48 hrs after a preschool child's head injury.

OBJECTIVES: Our objectives were, first, to compare mothers' and fathers' early reactions (stressors, concerns) to the preschool child's head injury, their perceptions of the child's injury severity, and their social support and mental health; second, to compare families with a child in the pediatric intensive care unit (PICU) vs. general care unit (GCU) on these variables; and third, to describe the relationships between parents' early reactions and perceived and objective injury severity, their social support, and mental health. DESIGN: Analysis of data collected in the hospital 24-48 hrs after the child's admission as part of a longitudinal study of parent and family functioning after a preschool child's head injury. SETTING: Seven tertiary care centers: three free-standing children's hospitals and four comprehensive hospitals. PARTICIPANTS: Participants were 182 mothers and 64 fathers of 183 preschool children (ages 3-6) hospitalized for head injury, half in a PICU. INTERVENTIONS: Data collection. MEASUREMENTS AND MAIN RESULTS: We measured parents' early reactions (stressors, concerns), influenced by parent mental health, social support, and objective and perceived injury severity. Mothers reported more stress than fathers regarding the child's behavior and emotions, communication with staff, and their parental role. Mothers in the PICU group reported more concern about the child's future and more stress regarding the child's appearance, sights and sounds of the unit, and procedures done to the child than mothers in the GCU group. Fathers in the PICU and GCU groups reported similar levels of stress and concern. Mothers' reactions were influenced by objective and perceived injury severity, social support, and psychological distress. Fathers' reactions were influenced by objective injury severity and psychological distress. CONCLUSIONS: Although mother-father couples rated their child's injury severity similarly, mothers experienced more stress than fathers. Social support decreased the stress for mothers but not for fathers. The experience of pediatric head trauma was more stressful for mothers of children in the PICU than mothers of children in the GCU.     

The genetic-environmental etiology of parents' perceptions and self-assessed behaviours toward their 5-month-old infants in a large twin and singleton sample

BACKGROUND: Given the importance of parenting for the child's early socio-emotional development, parenting perceptions and behaviours, and their correlates, should be assessed as early as possible in the child's life. The goals of the present study were 1) to confirm, in two parallel population-based samples, including a large sample of twins, the factor structure of a new self-administered questionnaire assessing both parents' specific parenting perceptions and behaviours toward their 5-month-old infants (i.e., parental self-efficacy, perceived parental impact, parental hostile-reactive behaviours and parental overprotection), 2) to identify the specific risk factors associated with the negative side of these parenting dimensions, 3) to document the genetic-environmental etiology of these parenting dimensions through the twin method. METHODS: Parents (2,122 mothers and 1,829 fathers) of 5-month-old infants, and parents of 5-month-old infant twins (510 families) completed the questionnaire (28 items). The data were submitted to a series of confirmatory factor analyses. The contribution to parenting of a variety of risk factors was examined in the two samples using regression analyses. A series of quantitative genetic analyses were performed to quantify the different sources of variation in parenting. RESULTS: A consistent factor structure was found across informants and across samples. There were significant mean differences in parenting between mothers and fathers, as well as between parents of twins and parents of singletons. A differentiated pattern of association with risk factors was found for each dimension of parenting. The twin analyses revealed that shared environment accounted for each parenting dimension. Maternal hostile-reactive behaviours were also moderately related to genetic factors in the child and this association was mainly mediated by the infant difficultness. CONCLUSIONS: The overall pattern of results was consistent with Belsky's (1984) view of parenting as multiply determined. The longitudinal follow-up of these families should provide the means for testing developmental models about the determinants and outcomes of these parenting dimensions.     

The effects of maternal social phobia on mother-infant interactions and infant social responsiveness

BACKGROUND: Social phobia aggregates in families. The genetic contribution to intergenerational transmission is modest, and parenting is considered important. Research on the effects of social phobia on parenting has been subject to problems of small sample size, heterogeneity of samples and lack of specificity of observational frameworks. We addressed these problems in the current study. METHODS: We assessed mothers with social phobia (N = 84) and control mothers (N = 89) at 10 weeks in face-to-face interactions with their infants, and during a social challenge, namely, engaging with a stranger. We also assessed mothers with generalised anxiety disorder (GAD) (N = 50). We examined the contribution to infant social responsiveness of early infant characteristics (neonatal irritability), as well as maternal behaviour. RESULTS: Mothers with social phobia were no less sensitive to their infants during face-to-face interactions than control mothers, but when interacting with the stranger they appeared more anxious, engaged less with the stranger themselves, and were less encouraging of the infant's interaction with the stranger; infants of index mothers also showed reduced social responsiveness to the stranger. These differences did not apply to mothers with GAD and their infants. Regression analyses showed that the reduction in social responsiveness in infants of mothers with social phobia was predicted by neonatal irritability and the degree to which the mother encouraged the infant to interact with the stranger. CONCLUSIONS: Mothers with social phobia show specific parenting difficulties, and their infants show early signs of reduced social responsiveness that are related to both individual infant differences and a lack of maternal encouragement to engage in social interactions.     

Investigating Pathways to Behavioural Problems in Children of Teenage,Middle Age,and Advanced Age Mothers in Canada

Behavioural problems in the first five years of life can lead to long-term problems and may have adverse effects on families, school, and the child’s well-being. The objective was to investigate three comprehensive models to explore the pathways that lead to behavioural problems in children of teen, middle age, and advanced age mothers in Canada. This was based on the analysis of the National Longitudinal Survey of Children and Youth. Mothers were grouped into: teen (15–19 years), middle age (20–34 years), and advanced age (35+ years). Using Bronfenbrenner’s theoretical framework, behavioural problems were the outcome measured when the child became 4–5 years old. The predictors examined when the child was 0–1-year-old, and 2–3 years old and were fitted within the systemic levels of the framework. Structural equation modeling was performed separately for each age group. A total of 4787 mothers were analyzed. In all models, neighbourhood quality significantly predicted socioeconomic status (SES), and SES significantly predicted depression. In the teen mother group, only greater depression significantly predicted greater behavioural problems for the child (p = 0.038). In the middle age group, greater depression significantly predicted greater child behavioural problems (p < 0.001); and parenting significantly predicted lower child behavioural problems (p < 0.001). In the advanced age group, only parenting significantly predicted lower behavioural problems (p = 0.005). The pathways from depression and parenting to the behavioural problems differed among the groups. Our results highlight the importance of developing targeted interventions to reduce behavioural problems in children separately by maternal age.     

Is my child normal yet? Correlates of vulnerability

There are some children whose parents believe them to be unusually susceptible to medical or developmental problems--"vulnerable"--despite a lack of objective evidence of any difficulty. The "vulnerable child syndrome" refers to a constellation of behaviors that are thought to develop as a result of this excessive parental anxiety and subsequent difficulties in limit setting. In this study, the sense of vulnerability expressed by mothers concerning their healthy 3-year-old children is explored; children born prematurely and with considerable neonatal morbidity are compared with children born at full-term. Sense of vulnerability is assessed through the use of a simple instrument, the use and validity of which are described. Mothers of premature infants described a significantly greater sense of vulnerability concerning their children than did mothers of full-term infants. Mothers with more education described a greater sense of vulnerability than did less well-educated mothers, although mothers who claimed greater well-being and marital satisfaction described a lesser sense of vulnerability. Mothers with a greater sense of vulnerability concerning their children also reported more behavior problems, especially in the sphere of discipline, peer relationships and self-control, and in internalizing and somatic symptoms. Pediatricians can intervene in the development of the vulnerable child syndrome by recognizing those children at special risk and helping their parents to nurture their health and independence.     

Maternal depressive symptoms at 2 to 4 months post partum and early parenting practices

OBJECTIVE: To determine whether maternal depressive symptoms, reported when infants are 2 to 4 months old, are associated with mothers' early parenting practices. DESIGN: Secondary data analyses collected from the National Evaluation of Healthy Steps for Young Children. Data sources included newborn enrollment questionnaires and parent interviews when infants were 2 to 4 months old. Maternal depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. SETTING: Twenty-four pediatric practices across the United States. PARTICIPANTS: A total of 5565 families enrolled in Healthy Steps; 4874 mothers (88%) completed 2- to 4-month interviews and provided Center for Epidemiologic Studies Depression Scale data; 17.8% of mothers reported having depressive symptoms. MAIN OUTCOME MEASURES: Ten parenting practices assessed in 3 domains: safety (sleep position and lowering water temperature), feeding (cereal, water, or juice; continuing breastfeeding), and practices to promote child development (showing books, playing with infant, talking to infant, and following 2 or more routines). RESULTS: Mothers with and without depressive symptoms reported similar uses of safety and feeding practices. Mothers with depressive symptoms had reduced odds of continuing breastfeeding (adjusted odds ratio [AOR], 0.73; 95% confidence interval [CI], 0.61-0.88), showing books (AOR, 0.81; 95% CI, 0.68-0.97), playing with the infant (AOR, 0.70; 95% CI, 0.54-0.90), talking to the infant (AOR, 0.74; 95% CI, 0.63-0.86), and following routines (AOR, 0.61; 95% CI, 0.52-0.72). CONCLUSION: Maternal depressive symptoms are common in early infancy and contribute to unfavorable parenting practices.     

Latina mothers' attributions, emotions, and reactions to the problem behaviors of their children with developmental disabilities

We examined the applicability of attribution theory to mothers' perceptions and reactions to their child's problem behavior. Participants were 149 Latina mothers of children with developmental disabilities who were interviewed regarding specific incidents in which their child exhibited a behavior problem. The findings indicate that most mothers viewed their child as not being responsible for the behavior problem. Furthermore, as predicted by attribution theory, mothers who ascribed relatively high responsibility to the child were significantly more likely to report negative emotions (anger and frustration) and aggressive/harsh behavioral reactions than mothers who ascribed low responsibility. Also. mothers were more likely to ascribe high responsibility to the child when the problem was characterized as a behavioral excess than as a behavioral deficit. The results provide support for the applicability of an attributional framework and may have important implications for helping parents in addressing the problem behaviors of their children with developmental disabilities.     

Parenting by anxious mothers: effects of disorder subtype, context and child characteristics

Background: There has been increasing research interest in parenting by anxious adults; however, little is known about anxiety‐subtype effects, or effects of the context in which parenting is assessed. Methods: Two groups of anxious mothers, social phobia (N = 50), generalised anxiety disorder (N = 38), and nonanxious controls (N = 62) were assessed with their 4.9‐year‐old children in three tasks: two presented threat specifically relevant to each maternal disorder, namely, a social threat task where the child had to give a speech, and a nonsocial threat task where the child had to explore potentially scary objects; the third was a nonthreat task (playing with play dough). Seven parenting dimensions were scored. Effects on parenting of maternal anxiety subgroup and task, and their interactions, were examined, as were effects of earlier child behavioural inhibition and currently manifest anxiety. Results: There were no parenting differences between maternal groups in the nonthreat play‐dough task; parenting difficulties in the two anxious groups were principally evident in the disorder‐specific challenge. Parenting differences between nonanxious and anxious mothers occurred independently of child characteristics. There was little evidence for particular forms of parenting difficulty being unique to maternal disorder. Conclusions: Anxious mothers’ parenting difficulties emerge when occurring under challenge, especially when this is disorder‐specific. These effects should be considered in research and clinical practice.     

Impact of delayed development in premature infants on mother-infant interaction: a prospective investigation

We examined events that precede a diagnosis of developmental delay by comparing 16 very low birth weight premature infants whose condition was diagnosed as developmental delay at 18 months corrected age with 16 matched developmentally normal infants. All infants were observed with their mothers during maternal visits to the nursery and during home visits 1, 3, 6, and 9 months after discharge. The mothers' reactions to their infants were rated at these times. All the children were followed up at a neonatal clinic, and detailed clinic records were used to document the time when a physician first suspected a delay and when this delay was first mentioned to the mother. The results indicate that parents had usually been told of their child's handicap by the time the child was 6 to 9 months old; yet mothers of the delayed children changed the interaction with their children as early as 1 month after discharge from hospital. These mothers initially touched, smiled at, and talked to their developmentally delayed infants significantly more often, but by 9 months they did so much less often than mothers of nondelayed children. The degree of change in mothers' behavior was related to their psychosocial background, with better-adjusted mothers showing the most change. We conclude that mothers' statements about their infants are usually valid and that physicians may share their potential concerns about infants more freely.     

Parental stress, psychosocial problems and responsiveness in help-seeking parents with small (2–45 months old) children

Experienced parental stress in 75 mothers and 65 fathers seeking help for their young child (M = 14.5 months; SD = 9.4 months) in a Specialist Child Health Centre was examined and related to child problem load, psychosocial problems and parental problems in responding to the child's signals and demands. Maternal stress level was compared with a population-based sample of 1500 mothers with children of similar ages. The measure of parental stress was a revised Swedish version of the American Parenting Stress Index (Parent Domain). Mothers in the clinical sample indicated higher levels of parental stress compared to fathers in the same families and to mothers in the comparison sample. A clear association was found between higher stress and a global clinical assessment of parental unresponsiveness to the child. Child problem load was associated with mothers' overall stress level. A clinical estimate of the parents' psychosocial situation was also associated with mothers' and fathers' stress level, and gave a large unique contribution to the variability in mothers' stress scores. It was concluded that focus in intervention programs should be on the whole family, and that the father should be seen as a resource that might well be more involved in the caretaking of the child. The study also clearly demonstrated the discriminant and construct validity of the parental stress instrument.     

Factors influencing mothers' learning from paediatric therapists: a qualitative study

A paradigm shift in community-based paediatric therapy has changed the role of parents from passive observers to active partners. As a result, therapists need to acquire an expanded set of skills, which include partnership building and teaching to ensure effective service delivery. This qualitative study explored factors influencing mothers' learning about their child's special needs from their child's therapist. Nine mothers were interviewed regarding their experiences working with, and learning from, their therapists. The interviews were audiotaped, transcribed verbatim, and thematically analyzed. Two major themes emerged: Relationship: More Than Just a Client; and Learning: The Best Teaching Needs a Relationship. Mothers were content with their therapists' approach to teaching, even when it differed from their own typical learning style. Therapists need to be cognizant of their relationship with mothers and ensure that the mothers' needs are being met.     

Different priorities: a comparison of parents' and health professionals' perceptions of quality of life in quadriplegic cerebral palsy.

OBJECTIVE: Almost all children with quadriplegic cerebral palsy (CP) have feeding difficulties. Our aim was to identify the major determinants of feeding-related quality of life (QoL) in children with quadriplegic CP from the perspective of parents and to compare findings with the perceptions of health professionals. DESIGN: Qualitative cross-sectional study. METHODS: A trained facilitator conducted four semi-structured focus groups with parents (n = 21) of children with quadriplegic CP attending a multi-disciplinary feeding clinic at a paediatric teaching hospital in Sydney, Australia, between November 2003 and February 2005. All sessions were audio- and video-taped. NVivo software was used to facilitate thematic analysis of the transcribed audiotapes and to compare them with data from focus groups conducted by the same research team with health professional participants. RESULTS: Parental perceptions clustered into the same five themes described by health professionals (parent-child interaction; delivery of health services; the child's emotional well-being; the child's physical well-being, and socialisation), but the content of the subthemes and the values attached differed, for example health professionals valued weight gain, whereas parents valued their child feeling loved. Health professionals did not consider the full range of issues important to families. The differences in priorities for treatment outcomes negatively affected the parent-health professional relationship. CONCLUSIONS: Disparities between parents' and health professionals' perceptions provide useful insight into communication between the two, identify the range of issues important to families, and highlight the parents' expert role in assessing the child's emotional and social well-being. The five themes identified provide a framework for a comprehensive evaluation of the health status of children with quadriplegic CP and feeding difficulties.     

Annotation: The 'effects' of parenting reconsidered: findings,challenges, and applications

BACKGROUND: Questions remain concerning the 'effects' of parenting on behavioural/emotional problems in children. This annotation discusses recent findings concerning the parenting 'effects' literature and identifies areas in need of further research. METHOD: The review begins by examining theories and definitions of parenting, and then considers research findings on the predictors of parent-child relationships and their effects on behavioural/emotional adjustment in children. Evidence for causal processes are then examined in light of findings emphasizing the need to consider the impact of larger systems on child's well-being, bi-directional processes in parent-child interactions, and alternative hypotheses suggested by behavioural genetics. RESULTS: Different kinds of evidence suggest strong links between parent-child relationship quality and children's well-being, but difficulties remain for drawing causal connections. The need for greater integration among research traditions and the need for theory development are highlighted. In addition, although a substantial and robust research base exists on parent-child relationships, the applicability of these findings to clinical settings is uncertain. CONCLUSIONS: Substantial progress has been made in our understanding of the nature of parent-child relationships and their developmental effects, but a number of basic conceptual and methodological and clinical questions continue to need rigorous study.     

The relationship between parental perceptions of diabetes and glycaemic control.

AIM: To measure the relationship between perceived child competence, parental self-efficacy, and children's glycaemic control. METHODS: Cross-sectional outpatient based questionnaire survey of 78 parents of children aged 6-12 years with insulin dependent diabetes mellitus, diagnosed for at least one year. Parental perceptions of their child's competence were assessed, together with parental perceptions of their own self-efficacy in managing their child's diabetes. Glycaemic control was assessed by the average annual HbA1C level. RESULTS: The response rate was 64.5% (51 parents); 82% were mothers and the socioeconomic class and ethnicity spread was representative of the general population. The mean age of the children was 10 years and duration of diabetes 4.4 years. Poorer glycaemic control was associated with higher perceived child competence, together with lower perceived age of responsibility, lower perceived seriousness, and less frequent blood tests. Higher parental self-efficacy and higher perceived child competence predicted a higher level of normalisation, as did lower perceived seriousness, a lower perceived parental responsibility for management, and a less protective style of parenting. CONCLUSION: Parents' perceptions of their children's diabetes are significantly related to glycaemic control; however, those who appear more competent at managing diabetes may overestimate their child's capabilities, leading to poorer glycaemic control.