A change of plans

Relationship-Based Care for Newborns With Down Syndrome and Endocardial Cushion Defect

Down syndrome with endocardial cushion defect is a challenging diagnosis for parents as well as members of the health care team. Utilizing a framework of relationship-based care, nurses are in a position to positively affect parents' experience by providing education, advocacy, and support from initial diagnosis through discharge. The plan of care is multidisciplinary and focuses on critical developmental needs, such as bonding and feeding. Because Down syndrome is associated with multiple anomalies, anticipatory guidance is needed to assist parents with establishing a health maintenance plan for their child after discharge.

Down or up? Explaining positive and negative emotions in parents of children with Down's syndrome: Goals, cognitive coping, and resources

BACKGROUND

Some studies find that parents of children with Down's syndrome may experience symptoms of depression, while other studies find that parents adapt well. This study aimed to clarify this variability in adaptive strength by investigating a stress-coping model to explain depressive symptoms and positive affect.

METHOD

Questionnaires were completed by 553 parents of children (aged 0-18) with Down's syndrome, containing measures of goal disturbance, cognitive coping, social support, partner bonding, and coping self-efficacy.

RESULTS

Different models for positive affect and depressive symptoms were found. The coping strategies of self-blame and rumination were positively related to depressive symptoms, and positive reappraisal was positively related to positive affect. Partner bonding characteristics played relevant roles in both models, as did coping self-efficacy and goal disturbance. Social support seemed mainly relevant in explaining positive affect.

CONCLUSIONS

Different psychological factors were related to depressive symptoms and positive affect in parents of children with Down's syndrome. Implications are discussed.

Hospitalizations of infants and young children with Down syndrome: evidence from inpatient person-records from a statewide administrative database

BACKGROUND

Although individuals with Down syndrome are increasingly living into the adult years, infants and young children with the syndrome continue to be at increased risk for health problems. Using linked, statewide administrative hospital discharge records of all infants with Down syndrome born over a 3-year period, this study 'follows forward' over 200 infants with Down syndrome from each individual's birth until they turn 3 years of age. By utilizing this procedure, we were able to assess the amount, reasons for, and timing of inpatient hospitalization and to investigate how congenital heart defects (CHDs) relate to hospitalization for young children with Down syndrome.

METHOD

This population-based, retrospective study used statewide administrative hospital discharge data. Subject inclusion criteria included residents of Tennessee, born between 1997 and 1999, and diagnosed with Down syndrome at birth. Inpatient records were linked to create person-record histories of hospitalization from birth to age 3. Main outcomes included the number of Non-birth Hospitalizations, length of stay, principal and other diagnosis codes to indicate reason(s) for hospitalization, and patient's age at first (non-birth) hospitalization. Procedure codes were added to determine if children with CHD were hospitalized primarily for operations on the heart.

RESULTS

Of 217 births, 213 children survived birth; 54% (115) had CHDs. Almost half (49.8%) of all children were hospitalized before age 3; these 106 children were admitted 245 times. Children with CHDs were 2.31 times more likely to be hospitalized than children without CHDs. Respiratory illnesses affected 64.9% of all hospitalized children with CHD, were the principal diagnoses in 38.3% of their hospitalizations, and were the main principal diagnoses for non-CHD children. Thirty-three (of 77) hospitalized children with CHD underwent cardiac surgeries, accounting for 19.3% of all admissions. Median time to first hospitalization was 96 days (CI: 78-114) for CHD infants, 197 days (CI: 46-347) for non-CHD infants.

CONCLUSIONS

Children with Down syndrome are at high risk for early hospitalization. Prevention and treatment of respiratory illnesses require more attention. Down syndrome is associated with early, serious, physical health problems and substantial inpatient care use.

Pais, filhos e deficiência: estudos sobre as relações familiares

Este artigo discute estudos sobre a família atual e as situações que ocorrem quando existe uma criança deficiente na família. Parte do princípio de que não se pode negar a importância de aspectos ambientais no desenvolvimento e de que as famílias são fundamentais para o desenvolvimento das crianças. Quando existe uma criança deficiente na família, esta não irá, necessariamente, causar transtornos familiares, mas a ocorrência destes dependerá de múltiplos fatores, desde as crenças dos pais até os recursos da família em lidar com a deficiência. Além disso, mostra que os pais desejam e merecem ser tratados de forma sensível pelos profissionais que atendem seus filhos.

Family photographs: expressions of parents raising children with disabilities

The purpose of this qualitative, descriptive study was to capture the everyday lives of parents raising a child with a disability. Fifteen parental dyads raising a child with Down syndrome, developmental disabilities, visual impairments, or speech disorders used a disposable camera to photograph images important to them. Interviews about these photographs reflected everyday life. Four themes emerged from content analysis of the photos: active activities, quiet activities, activities of daily living, and care of the child with a disability. Six themes emerged when discussing photographs participants would have liked to take but did not. These themes were acceptance, concern for the future, joys, struggles, balance of good and bad times, and normalcy. Findings support the usefulness of photography as a method of obtaining information from parents raising a child with a disability through qualitative means and provide nurses with a beginning understanding of these parents' lives.

Mothers of children with Down syndrome reflect on their postnatal support

OBJECTIVE

Since 1964, researchers have been examining the ways in which physicians deliver a postnatal diagnosis of Down syndrome (DS). Almost all of the studies, however, have been limited to reflections or very small sample sizes. The objective of this study was to document, in the most robust comprehensive way, the reflections of mothers in the United States who received diagnoses of DS for their children.

METHODS

An 11-page survey was mailed to 2945 persons on the membership lists of 5 DS parent organizations. The survey gathered both quantitative and qualitative data with yes/no questions, open-ended questions, and a series of statements asking the mothers to rate their level of agreement on a Likert scale of 1 to 7.

RESULTS

Of the 1250 responses (42.4%), 985 were from mothers who received postnatal diagnoses of DS for their children. The majority of these mothers reported being frightened or anxious after learning the diagnosis, and very few rated the overall experience as a positive one. Mothers reported that their physicians talked little about the positive aspects of DS and rarely provided enough up-to-date printed materials or telephone numbers of other parents with children with DS. Improvement has been made with time, albeit slowly.

CONCLUSION

Mothers have called on physicians to improve the way in which postnatal diagnoses are delivered. Specific recommendations are offered.