Services and supports for young children with Down syndrome: parent and provider perspectives

Level of Family centered care and associated factors among parents of children with cancer at tertiary level hospital, Ethiopia

OBJECTIVE

To determining level and factors affecting Family Centered Care (FCC) in pediatric oncology unit of Tikur Anbessa Specialized hospital (TASH), Ethiopia.

METHOD

A cross sectional study was conducted from June to December 2022. Three hundred ninety-three parents of children with cancer were consecutively interviewed using Measure of Processes of Care (MPOC-20). Multivariable linear regression was used to identify independent predictors of FCC.

RESULT

The total MPOC 20 means was 3.71(SD = 1.04). The mean score for respectful and supportive care, coordinated and comprehensive care, enabling and partnership, providing specific information and providing general information were found to be 4.8, 4.6, 3.7, 2.3 and 2.6, respectively. Family employment (-0.33(95% CI = -0.63, -0.03; P = .029)), low family education (-0.40 (95% CI = -0.70, -0.11; P = .008)), referral cases (-0.37(95% CI = -0.59, -0.14; P = .001)), shorter time spent in hospital (-0.49(95% CI = -0.85, -0.12; P = .010)) and psychological distress (-0.01(95% CI = -0.026, -0.001; P = .028)) were associated with lower mean score of FCC.

CONCLUSION

The total FCC mean score was found to be low. From the five FCC components providing general and specific information scored the lowest mean level.

PRACTICE IMPLICATIONS

Mechanism to improve information delivery that address parents from different background and referred from other health facility should be in place in order to improve FCC level. In addition, the FCC should be designed to address parents of children with different lengths of stay.

Effect of sleep disordered breathing severity in children with Down syndrome on parental wellbeing and social support

INTRODUCTION

Sleep disorders, particularly sleep disordered breathing (SDB), are common in children with Down syndrome (DS). We investigated the relationship between SDB severity and parental psychological wellbeing and their perception of social support.

METHODS

44 children with DS (3-19 years) underwent overnight polysomnography and were categorised into three groups: primary snoring, Mild and Moderate/Severe obstructive sleep apnoea (OSA). Parents completed questionnaires about their child's behaviour (Child Behavior Checklist), sleep symptoms (Pediatric Sleep Survey Instrument) and SDB-related quality of life (OSA-18), together with the DUKE-UNC Functional Social Support (DUKE) and Psychological General Well-Being Index (PGWBI) questionnaires for themselves. 34 children completed a follow-up study after 2 years.

RESULTS

There were no significant differences between SDB severity groups for parental perceived social support or psychological wellbeing. Total scores on the DUKE were below average and PGWBI scores were indicative of moderate psychological distress in all three groups. Reduced perceived levels of social support were significantly correlated with externalising child behaviour and sleep disturbance. Diminished parental psychological wellbeing was also significantly correlated with increased sleep disturbances and reduced quality of life in children. At follow-up there were no significant changes in any questionnaire outcome, however parents of children with improved SDB severity had improved PGWBI vitality scores.

CONCLUSION

The degree of parent-reported sleep disturbance in children with DS was linked to suboptimal perceived parental social support and poor psychological wellbeing. Our results emphasise the need for enhanced awareness of the detrimental effects of sleep problems in children with DS on parental wellbeing.

Informing Clinical Practice Guidelines for Children and Youth With Down Syndrome: A Survey of Key Partners

PURPOSE

The purpose of this work was to describe input from key partners to inform the scope and priorities for a clinical practice guideline (CPG) pertaining to physical therapy services provided to children and youth with Down syndrome (DS).

METHODS

A 68-item survey was completed by interventionists and parents (n = 296) of children and youth with DS.

RESULTS

The most prevalent physical therapy interventions currently being performed included tummy time, postural control activities, activity-based interventions, and play-based interventions. Key partners agreed on the importance of specific clinical outcomes, needing guidance on frequency and dosage of interventions, common barriers to physical therapy intervention, and needing information for discharge criteria in a future CPG.

CONCLUSIONS

The results of this survey have given the CPG committee the necessary information to inform the CPG process for children and youth with DS.

Adaptation at the Family Level in Families of Individuals With Down Syndrome: A Scoping Review

Down syndrome (DS) is a chromosomal disorder associated with intellectual and physical disabilities and has historically been viewed by health care providers through a negative lens when considering the effect the condition has on the individual, family, and community. The purpose of this scoping review was to provide an overview of recent research concerning adaptation in families of individuals with DS with a focus on family adaptation rather than individual or dyadic adaptation. Three literature indexes were searched from 2017 to 2022, with 41 articles included. Foci of the studies included strength/resilience, stress/coping, and negative/challenge. Thirteen studies reported using a family framework. Multiple methodological approaches and family measures were used in the studies and are outlined. Findings from this review show there has been a shift in focus when researching families of individuals with DS from a negative and challenging experience to one of strength and resilience.

Observations of feeding practices of US parents of young children with Down syndrome

Parental behaviours influence food acceptance in young children, but few studies have measured these behaviours using observational methods, especially among children with Down syndrome (CWDS). The overall goal of this study was to understand parent feeding practices used during snack time with young CWDS (N = 111, aged 11-58 months). A coding scheme was developed to focus on feeding practices used by parents of CWDS from a structured home-use test involving tasting variously textured snack products. Behavioural coding was used to categorise parental feeding practices and quantify their frequencies (N = 212 video feeding sessions). A feeding prompt was coded as successful if the child ate the target food product or completed the prompt within 20 s of the prompt being given without a refusal behaviour. CWDS more frequently consumed the test foods and completed tasks in response to Autonomy-Supportive Prompts to Eat (49.3%), than to Coercive-Controlling Prompts to Eat (24.2%). By exploring the parent-CWDS relationship during feeding, we can identify potentially desirable parent practices to encourage successful feeding for CWDS. Future research should build upon the knowledge gained from this study to confirm longitudinal associations of parent practices with child behaviours during feeding.

Stressful experiences and coping strategies of parents of young children with Down syndrome: A qualitative study

BACKGROUND

Previous studies have focused mostly on the negative experiences of parents of children with Down syndrome. We aimed to explore both the stressful experiences and coping strategies of parents from a non-Western country.

METHODS

Twenty-six parents of children aged 8-48 months with Down syndrome were included. Semi-structured interviews were conducted, and the data were analysed using thematic analysis.

RESULTS

The main themes of the stressful experiences were emotional burdens, caregiving burdens, struggle against stigma and discrimination, concerns about the future, challenges related to health, education, and financial issues. Parents used a variety of coping strategies to overcome the challenges by seeking support and help, searching for information, accepting and adapting, and adopting optimistic attitudes.

CONCLUSION

Although being a parent of a child with Down syndrome has many challenges, most parents effectively used coping strategies and adapted their lives to their new parental roles in their child's early years.

Maternal perspectives: The needs of Saudi families of children with Down's syndrome

Down syndrome (DS) is a chromosomal condition that is affecting an increasing number of infants born in Saudi Arabia. This study investigates the needs of families with children with DS in Saudi Arabia from mothers' perspectives and in a cultural and religious context. An exploratory qualitative research design was used, and semi-structured interviews were conducted with 14 mothers of children with DS. Interview data were thematically analyzed. The most important need was found to be financial or tangible support. An increase in benefits or monthly financial allowances and social security insurance would address these concerns. Societal support is also needed; mothers want DS to be perceived differently and require more support, including better rehabilitation and education services. Informational support is needed to improve the conditions of children with DS. Recommendations for improving the quality of life of children with DS are discussed.

Service Use Patterns by Children With Down Syndrome in a Canadian Region

Children with Down syndrome require services from different sectors over time to optimize health and development, however, there is little information on longitudinal, cross-sector service use. Parents of children with Down syndrome attending a Canadian children's hospital participated in semistructured interviews covering life-time multiple sector service use. Five key service patterns were identified: (1) primary care physicians playing a circumscribed role; (2) a marked shift in public habilitative service receipt from development agencies in the preschool years to exclusive school delivery after school entry; (3) families obtaining private services to address gaps from public sector services; (4) a prominent role for parents to identify additional services; and (5) service variability as a function of timing and severity of medical comorbidity.

A pilot randomised controlled trial on the effectiveness of infant massage on the acceptance, commitment and awareness of influence in parents of babies with Down syndrome

BACKGROUND

The emotional state of parents of babies with Down syndrome affects their babies' development and their parent-child bonding. The aim for this study was to conduct a pilot randomised controlled evaluation of the effect of infant massage on parents of babies with Down syndrome.

METHODS

This pilot study compared two groups (intervention and control), each with 16 parents of babies with Down syndrome. Indices of acceptance, engagement and awareness of influence were measured at two different time points (pre-test and after 5 weeks) using the 'This Is My Baby' Interview. The allocation of families to each group was randomised. The experimental group performed infant massage, applied by the parents, for 5 weeks, every day for at least 10 min. The massage protocol was based on the methodology created by Vimala McClure. Parents in the control group received the intervention after completion of the study.

RESULTS

The indices of acceptance, commitment and awareness of influence improved in the experimental group and in the control group. The 2 × 2 mixed-model analysis of variance indicates a statistically significant group-by-time interaction for all indices (P < 0.001), which was significantly higher in the experimental group than in the control group.

CONCLUSIONS

The application of infant massage, by parents to their babies, improves the rates of acceptance, commitment and awareness of influence of parents of babies with Down syndrome in the short term.

Assessing co-occurring mental health conditions in a multidisciplinary Down syndrome clinic and the role of family history

Compared to the general population, individuals with Down syndrome (DS) are at a significantly increased risk to develop mental health conditions. This study sought to examine individuals with DS and co-existing mental health comorbidities at one DS specialty clinic. Retrospective chart review of medical records including demographics, genetic testing history, personal and familial mental health history, referrals for mental health indications, and recommendations was performed. Summary statistics, logistic regression, and log of odds were converted to odd ratios to assess associations and significance. The charts of 327 patients, average 19.4 years of age (1-70), were reviewed. Nearly half the participants (42.2%) had at least one diagnosis of a mental health condition. Those with a family history were significantly more likely to have a personal diagnosis of a mental health condition than those without a family history (p < 0.01). Moreover, those who completed referrals often received medical management recommendations (86%). This study highlights the prevalence of mental health comorbidities among individuals with DS, and the referral process for mental health conditions, at one DS specialty clinic. Further research is needed to investigate our family history findings, and to determine if these results are generalizable across other DS clinics.

The Journey: Parental Expectations and Perceptions of Therapy Services for Children With Down Syndrome

PURPOSE

The researchers sought to identify and describe parents' expectations and perceptions of therapy services received by their children with Down syndrome.

METHODS

This study used a qualitative descriptive approach conducted in 2 phases: individual semi-structured parent interviews followed by focus groups. Analysis of interview transcripts served as the basis for development of codes, categories, and themes describing parents' beliefs, values, and opinions of their children's therapy.

RESULTS

Within the metaphor of The Journey, 3 major themes emerged: Where are we going? Who's driving the car? What I really need for this trip.

CONCLUSIONS

Parents value the principles of family-centered care and want a partnership with therapists in caring for their children. Therapists can help parents of children with Down syndrome navigate their children's therapy services by establishing a relationship of trust and by communicating with respect, understanding, and compassion.

Eating behaviors in children with down syndrome: Results of a home-use test

Children with Down syndrome (DS) display a disproportionate number of health challenges, including feeding and swallowing difficulties and food texture sensitivities. To start addressing food texture challenges early in life, the aim of this research was to understand mealtime behaviors and identify preferred food textures of children with DS. Children (aged 11 to 58 months) with DS (n = 111) and without (typically developing, TD; n = 107) participated in a home use test evaluating snack products of varying textures. Parents recorded their children's reactions to each food product; a panel of trained coders coded videos for mealtime behaviors. Children were also identified as food texture sensitive (TS) or non-texture sensitive (NTS). Results showed that age, TS, the presence of a DS diagnosis and the TS*DS interaction influenced the child's behaviors to the food products. Children with DS were more likely to increase distance from the food, mouth/suck on the food, and less likely to chew/much on the food compared to children TD. Children with DS also ate significantly less than typically developing children. Similar mealtime behaviors were observed between the children with TD/<30 months of age and children with DS regardless of age (p < .05). While children with DS/TS had a higher disposition for the dissolvable texture, along with products that were salty and cheesy, children with DS/NTS had a greater tolerance for more textures in general, including crunchy and grainy. Overall, this research identified mealtime behaviors in children with DS, determined overall disposition of children with DS to foods of differences sensory properties, and demonstrated the influence of TS on a child's disposition to a food. This research will be extended to develop acceptable and innovative food products for children with DS/TS.

Family-centred care in early intervention: A systematic review of the processes and outcomes of family-centred care and impacting factors

Family-centred care (FCC) has been established as a best practice model for child disability services internationally. However, further empirical support is required to explore the operationalization and efficacy of FCC, in the absence of a universal practice model. This review aimed to identify the key processes and outcomes of FCC in early intervention (EI) settings and the factors that impact FCC. A systemic review was conducted exploring the processes and outcomes of FCC delivered to children predominantly aged 0-6 years with disabilities/suspected disabilities and families as part of EI or early services. The search procedure was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2009). Narrative analysis of data was guided by Braun and Clarke (2006, 2014). Data were presented as per the standards for reporting qualitative research (SRQR; O'Brien et al., 2014). Forty-two studies were included. The majority (90.5%) outlined the processes of FCC, with 59.5% of studies detailing outcomes. Processes were largely reported as qualitative data and/or subscales of the Measure of Processes of Care (MPOC; King et al., 1995), which were subsequently collated. Findings indicated eight key operational processes and corresponding outcomes. Variables that hinder or facilitate FCC included family/professional characteristics, family/service resources, and parent attitudes, engagement and agency. FCC was largely conceptualized as the application of services to children and their families. Critical perspectives on FCC are discussed. It is hoped this research will contribute to the development of a framework of FCC in EI to inform services provided to young children with complex needs and their families and future research.

Parenting a child with Down syndrome: A qualitative study of everyday practices in Danish families

Genetic counseling about Down syndrome is suggested to include information on a future family life. However, there is an insufficient knowledge on the potential impact of parenting a child with Down syndrome on parents' everyday practices. We aimed to address this gap by exploring the experienced everyday practices of parents in families where a child has Down syndrome. Taking a qualitative approach, we conducted semi-structured interviews with 25 parents of children with Down syndrome aged 4-12 years. Using reflexive thematic analysis, we identified two themes concerned with the parents' practice. The first, 'Supporting our child', describes how the parents perceived their child as a valuable human being and how this perception founded parents' support of the child's development and social interactions. The second, 'Managing our family life', demonstrates how the parents acted to manage a family life that had become the 'new normal' including being alert toward the child, shaping the practical and logistical framework of daily life, and balancing between being at home and away from home. Overall, the analysis presents an everyday practice aimed at a desirable future for the child with Down syndrome and at a management of everyday life on the family's own terms. In conclusion, this study provides specific knowledge on parents' everyday practice, which may inform genetic counseling about Down syndrome and be of value to service providers.

Support needs, coping, and stress among parents and caregivers of people with Down syndrome

BACKGROUND

Caregiving for an individual with Down syndrome (DS) results in needs that can impact the stress and wellbeing of the entire family. These needs may also vary over the lifespan of the individual with DS. Coping strategies may affect stress levels and reduce the effects of unmet needs.

AIMS

(1) Do important unmet needs (IUNs), coping, and stress vary between parents and caregivers of adults compared to children with DS? (2) What is the relationship between stress, coping, and needs for parents and caregivers of people with DS?

METHODS

152 parents and caregivers of people with DS of various age groups completed an online survey including: demographic information, Family Needs Survey - Revised, Questionnaire on Resources and Stress - Friedrich Version, and the Family Crisis Oriented Personal Scales. Comparisons of IUNs, coping and stress between caregivers of adults and caregivers of children with DS were conducted. Relationships between stress, coping, and needs were explored using correlations and multiple regression.

RESULTS

IUNs were greater for parents and caregivers of children than for parents and caregivers of adults. Stress level was positively correlated with the number of IUNs, and great use of coping strategies were associated with less stress and fewer IUNs. The coping styles that predicted stress were different for caregivers of children versus adults.

CONCLUSION

The results of this research highlight the importance of considering age in relation to needs and stress among families with a child with DS. Fostering effective coping strategies, including acquiring social support, is likely to support positive outcomes for caregivers of people with DS.

Care Coordination Needs of Families of Children with Down Syndrome: A Scoping Review to Inform Development of mHealth Applications for Families

Care coordination is a critical component of health management aimed at linking care providers and health-information-involved care management. Our intent in this scoping review was to identify care coordination needs of families of children with Down syndrome (DS) and the strategies they used to meet those needs, with the goal of contributing to the evidence base for developing interventions by using an mHealth application (mHealth apps) for these families. Using established guidelines for scoping reviews, we searched five databases, yielding 2149 articles. Following abstract and full-text review, we identified 38 articles meeting our inclusion criteria. Studies incorporated varied in regard to research designs, samples, measures, and analytic approaches, with only one testing an intervention by using mHealth apps. Across studies, data came from 4882 families. Common aspects of families' care coordination needs included communication and information needs and utilization of healthcare resources. Additional themes were identified related to individual, family, and healthcare contextual factors. Authors also reported families' recommendations for desirable characteristics of an mHealth apps that addressed the design of a personal health record, meeting age-specific information needs, and ensuring access to up-to-date information. These results will further the development of mHealth apps that are tailored to the needs of families with a child with DS.

Factors influencing access to early intervention for families of children with developmental disabilities: A narrative review

BACKGROUND

Early intervention (EI) can improve a range of outcomes for families of children with developmental disabilities. However, research indicates the level of access does not always match the level of need. To address disparities, it is essential to identify factors influencing access.

METHOD

We propose a framework where access to EI is conceptualised as a process that includes three main phases. A narrative review examined potential barriers, facilitators and modifiers of access for each phase.

RESULTS

The process of access to EI includes the following: 1) recognition of need, 2) identification or diagnosis and 3) EI provision or receipt. Several factors affecting access to EI for each phase were identified, related to the family, services, the intersection between family and services, and the context.

CONCLUSION

A broad range of factors appear to influence the process of access to EI for this population. Our framework can be used in future research investigating access. Broad implications for policy, practice and future research to improve access to EI are discussed.

Caregivers' perceptions and experience of caring for persons with Down syndrome in Kuwait: a qualitative study

Aim and Objective: This study aimed to explore how caregivers of persons with Down syndrome (DS) believe caring had an impact on their own lives. A secondary objective was to understand their experience of seeking educational, social, and health care services for the persons with DS. Methods: This qualitative exploratory study was conducted with 21 caregivers of persons with DS in Kuwait. Results: Caregivers struggled to accept the diagnosis initially that led them to search for answers to many of their concerns about raising a person with DS. For the caregivers, who mostly comprised of mothers, dealing with health conditions that persons with DS suffered from was initially difficult. Caring for these individuals led to heavy impact upon their caregivers' own lives who took extraordinary efforts to cope with the burden. Seeking quality education for the persons with DS and participation in social activities was also challenging, and the caregivers believed that better services, facilities, and benefits for the families of persons with DS may help them better cope with the socioeconomic and psychological burden. Conclusions: Improving the availability of specialized services, the delivery of guidance and counselling, and social integration may help overcome challenges of raising a person with Down Syndrome.

Family-centeredness of services for young children with Down syndrome: an observational study from Turkey

Background/aim

Physicians require information on the family centeredness of services for children with Down syndrome, one of the most frequently encountered disabilities in childhood. We aimed to determine the family-centeredness of services for young children with Down syndrome and using a bioecological theory framework we hypothesized that child, family and service-related factors would be associated with such services.

Materials and methods

In a crosssectional design, children with Down syndrome seen at Ankara University Developmental Pediatrics Division (AUDPD) between February 2020 and June 2020 were included if they had received services in the community for at least 12 months. Mothers responded to the measure of process of care-20 (MPOC-20) used to measure family centeredness.

Results

All 65 eligible children were included; 57% were boys and median age was 25.0 (IQR: 18.5–38.0) months. The MPOC-20 subscale scores were highest for the “respectful and supportive care (RSC)” (median 6.0; IQR: 4.8–6.8) and lowest for the “providing specific information” (median 3.0; IQR: 4.4–6.5) subscales. On univariate analyses, maternal education <high school was associated with scores ≤4 on the RSC (OR = 6.75; 95%CI = 1.77–25.64) and “enabling and partnership” subscales (OR = 3.10; 95%CI = 1.06–9.05); income ≤ minimum wage (OR=3.94; 95%CI=1.10-14.02) was associated with scores ≤4 on the RSC. In the multivariate logistic regression model, maternal education ≤ high school was independently associated with RSC scores ≤4 (OR = 5.13; 95%CI = 1.26–20.84).

Conclusion

Our findings imply that limitations in family-centeredness of community service for young children with Down syndrome. Deficiencies of services particularly for children with less educated mothers need to be urgently resolved.

Down syndrome caregivers' support needs: a mixed-method participatory approach

BACKGROUND

The purpose of the study was to explore the support needs of caregivers of children with Down syndrome from their perspective using a mixed-method participatory research approach.

METHODS

Concept mapping methodology was used to obtain caregiver perspectives. Twenty-one caregivers answered the question 'Are parents of individuals with Down syndrome supported, why or why not?' Caregivers were involved in the analysis of the data through concept mapping procedures.

RESULTS

Sorted data were analysed with multidimensional scaling and cluster analysis. Participants generated eight thematic clusters representing the support needs of caregivers of children with Down syndrome. The themes included online and social support, support system gaps, areas where support is lacking, Down syndrome community support, financial support, advocacy needs, educational support and concerns for community programming.

CONCLUSIONS

Themes align with previous research on support needs of parents of children with developmental disabilities. The study highlights the need for more local organisations to offer support that is affordable and accessible for families. Results will support future programme planning for services for individuals caring for those with Down syndrome.

Health-related quality of life and coping strategies among families with Down syndrome children in South India

Background

Down Syndrome (DS) is the most common chromosomal disorder associated with intellectual disability. Besides clinical management, additional support to cope with the demands of life is also necessary. These parents are frequently unstable and forego their Quality of Life (QoL), suffer additional economic difficulties, ill health and have lower well-being than families without disabilities. Hence, the study intends to evaluate the Health-Related QoL (HR-QoL) and coping strategies among families of DS children.

Methods

This explorative, cross-sectional study was conducted among parents/caregivers of DS children (n = 51). Socio-demographic details, HR-QoL, coping strategies and perspectives on having a child with disability were obtained through a standard questionnaire.

Results

Most DS children were upper and upper-middle class of urban background. The mean score of the QoL of the families was found to be 68.98%. The least and the most affected domains were cognitive functioning (71.67%) and worry (57.33%), respectively. Maximum coping was through the instrumental social support, active coping and religious coping. Though 27.45% were upset with the diagnosis, most had a "feeling of love" towards the child (72.55%). 50.98% had limited knowledge about DS and lacked organizational support (60.78%).

Conclusion

With increasing life expectancy, the gap continues concerning the assessment of needs beyond medical aid among DS children. Better HR-QoL and coping with the stress could be ensured by the provision of comprehensive health policies inclusive of training programs, stress management, as well as psychosocial and organizational support across any socio-economic strata.

Parent-reported ease of eating foods of different textures in young children with Down syndrome

Food texture has been identified as a significant contributor to feeding problems in children, particularly in children with Down syndrome (DS). This study examined the open-ended survey responses of parents describing which food textures were "easy" or "difficult" for their child with DS. The open-ended responses from the parents about textures and foods they considered "easy" or "difficult" for their child (n = 157) were coded into 26 texture categories. Chewy and firm were more frequently listed as "difficult" textures by parents. Textures found to be cited more frequently as "easy" textures included creamy, crispy/crunchy, dissolvable, mushy, puree, smooth, and soft. Age influenced the citation of specific textures. As age increased, crispy/crunchy, dry, and hard were more likely to be listed as "easy" while lumpy, mushy, and gooey/soggy/wet were less likely be listed as "easy." For "difficult" textures, as age increased, juicy was more likely to be listed as "difficult" while the textures of creamy, dry, lumpy, and tender were less likely to be "difficult." While this research provides information as to the food textures children with DS find "easy" or "difficult," further research is needed to better understand how to expand the variety of textures in the diets of children with DS.

Family-Centered Perinatal Services for Children With Down Syndrome and Their Families in Florida

OBJECTIVE

To examine the experiences of parents or caregivers of children with Down syndrome related to prenatal care, the birth setting, primary and specialty care, and care coordination.

DESIGN

Cross-sectional, mixed-methods study.

SETTING

Florida.

PARTICIPANTS

English- or Spanish-speaking parents/primary caregivers (N = 101) of children who were 0 to 18 years old, had a diagnosis of Down syndrome, and were born in Florida.

METHODS

Participants were identified through snowball sampling and completed an online version of the Family Experiences Survey. Analyses included descriptive statistics, Fisher exact tests, and content analysis of the open-ended questions.

RESULTS

Fewer than half of the 101 respondents reported receipt of adequate information after diagnosis of Down syndrome during the prenatal period (n = 18, 19.3%) or in the birth setting (n = 35, 41.2%). Most participants (52.9%-95.4%) reported that they received adequate time and specific information needed and that providers were sensitive to their feelings, values, and family customs during the prenatal period, in the birth setting, and during primary and specialty care. However, fewer than 60% of participants (19.3%-59.1%) recalled that they received information about Down syndrome or helpful programs such as Children's Medical Services, Early Steps, or Healthy Start either from prenatal care providers or in the birth settings.

CONCLUSION

Our findings highlight the critical role that perinatal care providers play in the establishment of access to and use of specialty care services for neonates with Down syndrome and emphasize the need for family-centered care in prenatal and birth settings.

Breastfeeding Experiences of Mothers of Children with Down Syndrome

Children with Down syndrome are less likely to be breastfed than typically developing children, and breastfeeding has a lower duration compared to recommendations of the World Health Organization. The aim of this study was to understand the breastfeeding experiences of mothers of children with Down syndrome, including their perceptions of the breastfeeding process and their specific practices. This is a qualitative study with 10 participants, mothers of children aged between 2 months and 9 years. Snowball sampling was used for participants' selection, and semi-structured interviews conducted in participants' households. Three categories emerged: "the breastfeeding experience," involving the process of breastfeeding, the breast milk, feelings, and difficulties of this practice; "experiences of health care," encompassing the support received by health professionals, dissatisfaction with health services, lack of support in breastfeeding, and discontent with health professional behavior; and "learning about Down syndrome," with search for information by parents and advice to health professionals. In this study, we found evidence that breastfeeding success relies very much on mothers' willingness and support of health professionals, namely, nurses. Findings from this study suggest that support of a multidisciplinary team is essential to the success of breastfeeding. Greater awareness is needed regarding the unique rewards and challenges of breastfeeding these infants, as well as how families cope with the ongoing challenges. Therefore, this research is relevant to understand the experiences of mothers of children with DS about breastfeeding, identifying the inhibiting factors, in order to create more appropriate strategies to intervene and implement practices that contribute to the support and promotion of breastfeeding. Results will also influence the education of health professionals, emphasizing the importance of multidisciplinary teams for a comprehensive care and contributing to increasing evidence available about this topic.

Parenting children with Down syndrome: Societal influences

Most studies of parenting children with Down syndrome (DS) have been conducted in industrialized countries. They suggest that sensitive communication on the part of professionals, and social support, can lead to acceptance and positive adjustments in the family. This study examined the impact of a diagnosis of DS on Ecuadorian families, in particular at how the diagnosis had been communicated and received, as well as the feelings and experiences which followed. Despite considerable progress in recent years, Ecuador is still marked by discriminatory attitudes which affect children with disabilities and their families, and by the persistence of widespread poverty. This qualitative study, conducted in Cuenca, Ecuador's third largest city, is based on a focus group discussion and four in-depth interviews with Ecuadorian parents of DS children attending a specialist center in the city. The study shows that, reflecting the effects of status differences and lack of appropriate training, professionals rarely communicate a DS diagnosis in an appropriate manner. Further, it is shown that lack of social support, and the widespread stigmatization confronting children with DS and their families, hinder development of positive and empowering adjustments that would best serve the child's and the family's interest.