Fathers' Roles in the Care and Development of Their Children: The Role of Pediatricians

Caregiving Ability of Mothers of Children With Cancer: Qualitative Content Analysis

BACKGROUND

Childhood cancer confronts the child and the parents with considerable degrees of stress. Because caring for the child is mainly the role of the mother in most families, her ability to take care of the affected child is very important.

OBJECTIVE

To explore the caregiving ability of Iranian mothers who have children diagnosed with cancer.

METHODS

In this present study, which was conducted using the Directed Qualitative Content Analysis Method, 11 parents having children diagnosed with cancer and 5 professional caregivers working at the Department of Hematology and Oncology of Mofid Children Hospital in Tehran, Iran, were selected using purposeful sampling method. Data were collected through semistructured interviews. Data analysis was performed simultaneously with data collection using the Directed Content Analysis Approach.

RESULTS

Five main categories emerged, namely, care exhaustion, care confusion, spiritual conflict, care competence, and care preparedness that represent the beneficiaries' perception of the caring ability of Iranian mothers of cancer-afflicted children.

CONCLUSION

Study results revealed that the caregiving capacity of mothers nurturing cancer-stricken children can be evaluated across 5 domains, encompassing a spectrum of maternal requirements in child care. Improving these domains can elevate maternal caregiving proficiency, fostering self-care and enhancing care for the ailing child.

IMPLICATION FOR PRACTICE

A program can be developed based on the findings of the present study, in order to improve the caring ability of mothers of cancer-afflicted children, which results in improving the mother's care for her cancer-afflicted child.

Indian fathers' perceptions of young childcare and feeding - A qualitative study

The role of parents in fostering children's healthy habits is a robust area of research. However, most of the existing literature predominantly focuses on mothers' parenting practices. Given the emergence of nuclear, dual earning families and the recent surge in maternal employment in urban India, fathers' engagement in child rearing and feeding warrants attention. The purpose of this research was to document the views of Indian fathers about paternal parenting practices, with an emphasis on children's diet among other health behaviors. Thirty-three fathers of children aged 6-59 months from Kolkata, India took part in semi-structured interviews conducted either face-to-face or over Zoom/telephone in Hindi, Bengali, and English. The interviews were audio recorded, transcribed verbatim, and translated to English. The transcribed data were subjected to thematic analysis informed by the Template Analysis technique. Themes were detected using the NVivo software program. Overall, these Indian fathers played an important role in early childhood care and feeding as reflected in the following seven themes: (i) Involvement of fathers in various childcare activities; (ii) Implementation of responsive and non-responsive feeding practices; (iii) Concerns regarding fussy and slow eating; (iv) Concerns regarding excessive screen time; (v) Paternal vs maternal parenting; (vi) Barriers to routine engagement of fathers in childcare; (vii) Desire for more nutrition and health knowledge. This enhanced understanding of paternal parenting behavior supports the inclusion of fathers in future family-focused lifestyle interventions aimed at improving children's health outcomes, including their dietary habits.

The design and implementation of a multi-center, pragmatic, individual-level randomized controlled trial to evaluate Baby2Home, an mHealth intervention to support new parents

BACKGROUND

Becoming a parent is a transformative experience requiring multiple transitions, including the need to navigate several components of health care, manage any mental health issues, and develop and sustain an approach to infant feeding. Baby2Home (B2H) is a digital intervention built on the collaborative care model (CCM) designed to support families during these transitions to parenthood.

OBJECTIVES

We aim to investigate the effects of B2H on preventive healthcare utilization for the family unit and patient-reported outcomes (PROs) trajectories with a focus on mental health. We also aim to evaluate heterogeneity in treatment effects across social determinants of health including self-reported race and ethnicity and household income. We hypothesize that B2H will lead to optimized healthcare utilization, improved PROs trajectories, and reduced racial, ethnic, and income-based disparities in these outcomes as compared to usual care.

METHODS

B2H is a multi-center, pragmatic, individual-level randomized controlled trial. We will enroll 640 families who will be randomized to: [1] B2H + usual care, or [2] usual care alone. Preventive healthcare utilization is self-reported and confirmed from medical records and includes attendance at the postpartum visit, contraception use, depression screening, vaccine uptake, well-baby visit attendance, and breastfeeding at 6 months. PROs trajectories will be analyzed after collection at 1 month, 2 months, 4 months, 6 months and 12 months. PROs include assessments of stress, depression, anxiety, self-efficacy and relationship health.

IMPLICATIONS

If B2H proves effective, it would provide a scalable digital intervention to improve care for families throughout the transition to new parenthood.

Coronavirus disease 2019 vaccination among young children: Associations with fathers' and mothers' influenza vaccination status

Objectives

To examine the association between parents' influenza vaccination and their children's coronavirus disease 2019 (COVID-19) vaccination status.

Methods

Participants included father-mother dyads from Fathers & Families, a cohort of fathers and their co-parents living in the United States. Parents' influenza vaccination status and children's COVID-19 vaccination status were reported from June 2022-July 2023. Logistic regression was used to examine the association between parental influenza vaccination (both parents vs. neither parent vs. mother only vs. father only vaccinated) and child COVID-19 vaccination (received at least 1 vs. 0 doses). Models were adjusted for recruitment site, income, parent education, child race/ethnicity, child age, and childcare enrollment. Inverse probability weighting was used to account for selection bias into the father-mother dyad sample.

Results

Children were predominately non-Hispanic White (56 %) and aged 3-5 years (62 %). In most households, both parents (64 %) received the influenza vaccine and half (53 %) of children received the COVID-19 vaccine. One-in-four fathers (23 %) lacked knowledge about their child's COVID-19 vaccination eligibility. Compared to children with two unvaccinated parents, having only their father (adjusted odds ratio [AOR] = 2.84, 95 % confidence interval [CI]: 1.52-5.36), only their mother (AOR = 4.04, 95 % CI: 2.16-7.68), and both parents (AOR = 10.33, 95 % CI: 6.29-17.53) vaccinated against influenza was associated with higher odds of children receiving the COVID-19 vaccine.

Conclusions

Father and mother influenza vaccination is associated with child COVID-19 vaccination. Given many fathers were unaware their child was eligible for the COVID-19 vaccine, it is critical to tailor vaccine messaging for fathers.

Differences between parents' and paediatricians' perceptions of mild respiratory infections in childhood: contrast study

Introduction

Mild respiratory infections are a common reason for consultation in paediatrics, both in the emergency department and in primary care clinics. These conditions, mostly viral and self-limiting, have a significant impact on the healthcare system, school and work absenteeism, and family routines. Despite being common and banal illnesses from a medical perspective, they involve a significant concern in families. The main objective of the contrast study was to compare the perceptions of parents and paediatricians regarding mild respiratory infections in childhood and their impact on family conciliation.

Materials and methods

Two online, cross-sectional surveys were conducted among Spanish paediatricians and parents with children aged 6 months to 12 years, involving 504 paediatricians and 1,447 families, with questions on attitudes towards visits to the paediatric consultation, care burden of minor pathologies, work, and family conciliation, and treatment and prevention of these illnesses.

Results

Results showed significant differences in paediatricians' and parents' perceptions in many aspects. According to 34.5% of paediatricians and 27% of parents, families regularly go to the paediatrician without a scheduled visit. Only 4% of parents report having self-medicated their child, while paediatricians raise this percentage significantly to 48%. Regarding the question: "it is normal for a child to have an average of 4 colds a year," only 25.5% of the surveyed families "strongly agree" unlike to 70.2% of paediatricians. 72.8% of paediatricians "strongly agree" with: "in my opinion, it is good for children to get sick to improve their immune system" reduced to 45.9% of parents. Consultations for minor pathologies represent a "high workload" for 60.9% of paediatricians, while this opinion is agreed by only 18.9% of the parents.

Conclusion

Mild respiratory infections in childhood are perceived differently by paediatricians and parents. While paediatricians perceive them as a common and manageable phenomenon, parents tend to show higher concern and demand for medical attention. This study underlines the need to improve communication between paediatricians and parents to align perceptions, optimise the use of the health system resources, and improve the efficiency in the management of these common paediatric illnesses.

Guess Who's Coming to Clinic? Companions in a Pediatric Urology Clinic

INTRODUCTION

Understanding who accompanies children to clinic visits is necessary to engage stakeholders and tailor communication and educational materials. We undertook this study to describe the clinical companions for new patients in a general pediatric urology clinic.

METHODS

This retrospective cross-sectional study included all new urology patients aged less than 18 y at a single freestanding quaternary care children's hospital in selected months of 2019 and 2022. Data were collected on patient demographics, diagnosis, level of community disadvantage, and companion present. The number and identities of companions of patients living in more and less disadvantaged neighborhoods were compared.

RESULTS

Of 1940 patients, 1014 (52%) were accompanied by mothers alone, 266 (14%) by fathers alone, and 580 (30%) by both mother and father. Mothers were at 85% of clinical visits and fathers at 45% of visits. The likelihood of having one versus two parents present was similar in more and less disadvantaged areas (odds ratio [OR] = 1.11, 95% confidence interval: 0.80-1.55, P = 0.53). When one parent was present, the odds of being accompanied by the mother was lower for patients living in Area Deprivation Index 1-2 (less disadvantaged areas; OR = 0.38, 95% confidence interval: 0.23-0.62, P = 0.0001), and for the father to accompany children aged 12 y and more than infants (OR = 2.16, P = 0.0005) if there was only one parent present.

CONCLUSIONS

Our findings highlight opportunities to engage nonmaternal caregivers in pediatric urologic care, to further explore parental decisions around appointment attendance, and to optimize how clinical information is delivered to caregivers who are and are not present during appointments.

Paternal depression in the postpartum year and children's behaviors at age 5 in an urban U.S. birth cohort

OBJECTIVE

To investigate associations between postpartum depression in fathers and children's behaviors at age 5 in a national high-risk U.S. sample.

STUDY DESIGN

A secondary data analysis of 1,796 children in a national birth cohort study that oversampled non-marital births was conducted. Paternal depression was assessed 1 year after the child was born and children's behaviors were assessed by their primary caregivers when the children were 5 years old. Unadjusted and adjusted negative binomial regression models of associations between paternal depression and child behavior scores and logistic regression models of associations between paternal depression and high scores (at least 1.5 or 2.0 standard deviations above the mean) were estimated.

RESULTS

In negative binomial regression models that adjusted for child, paternal, and family characteristics and maternal depression, paternal depression was associated with a 17% higher total externalizing behavior score (Incidence Rate Ratio (IRR): 1.17; 95% Confidence Interval (CI): 1.07-1.27), a 17% higher aggressive subscale score (IRR: 1.17; 95% CI: 1.08-1.27), and an 18% higher delinquent subscale score (IRR: 1.18; 95% CI: 1.03-1.35). In adjusted logistic regression models for scores ≥2.0 standard deviations above the mean, paternal depression was associated with high total externalizing scores (e.g., Odds Ratio (OR): 3.09; 95% CI: 1.77-5.41), high aggressive behavior scores (OR: 2.40; 95% CI: 1.30-4.43), and high delinquent behavior scores (OR: 2.08; 95% CI: 1.01-4.27). There were suggestive but non-robust associations between paternal depression and attention problems and no associations between paternal depression and internalizing behaviors or social problems.

CONCLUSION

Fathers' depression at age 1 was associated with children's externalizing behaviors at age 5, an important developmental stage when children transition to school. These findings suggest a need to identify and support fathers with depressive symptoms to promote optimal child development.

The influence of antenatal imaging on prenatal bonding in uncomplicated pregnancies: a mixed methods analysis

BACKGROUND

Prenatal bonding describes the emotional connection expectant parents form to their unborn child. Research acknowledges the association between antenatal imaging and enhanced bonding, but the influencing factors are not well understood, particularly for fathers or when using advanced techniques like fetal magnetic resonance imaging (MRI). This study aimed to identify variables which may predict increased bonding after imaging.

METHODS

First-time expectant parents (mothers = 58, fathers = 18) completed a two-part questionnaire (QualtricsXM™) about their expectations and experiences of ultrasound (n = 64) or fetal MRI (n = 12) scans in uncomplicated pregnancies. A modified version of the Prenatal Attachment Inventory (PAI) was used to measure bonding. Qualitative data were collected through open-ended questions. Multivariate linear regression models were used to identify significant parent and imaging predictors for bonding. Qualitative content analysis of free-text responses was conducted to further understand the predictors' influences.

RESULTS

Bonding scores were significantly increased after imaging for mothers and fathers (p < 0.05). MRI-parents reported significantly higher bonding than ultrasound-parents (p = 0.02). In the first regression model of parent factors (adjusted R2 = 0.17, F = 2.88, p < 0.01), employment status (β = -0.38, p < 0.05) was a significant predictor for bonding post-imaging. The second model of imaging factors (adjusted R2 = 0.19, F = 3.85, p < 0.01) showed imaging modality (β = -0.53), imaging experience (β = 0.42) and parental excitement after the scan (β = 0.29) were significantly (p < 0.05) associated with increased bonding. Seventeen coded themes were generated from the qualitative content analysis, describing how scans offered reassurance about fetal wellbeing and the opportunity to connect with the baby through quality interactions with imaging professionals. A positive scan experience helped parents to feel excited about parenthood. Fetal MRI was considered a superior modality to ultrasound.

CONCLUSIONS

Antenatal imaging provides reassurance of fetal development which affirms parents' emotional investment in the pregnancy and supports the growing connection. Imaging professionals are uniquely positioned to provide parent-centred experiences which may enhance parental excitement and facilitate bonding.

Perinatal Mental Health: Father Inclusion At The Local, State, And National Levels

Fathers occupy a dual role in the realm of perinatal mental health: partner and parent. In fathers' role as partners, their support for mothers during pregnancy and postpartum is associated with improved maternal mental health. In their role as parents, fathers themselves are vulnerable to perinatal mood and anxiety disorder. This article aims to advance awareness of paternal perinatal mental health issues and impacts on families. We first review the evidence on paternal perinatal mental health. This evidence includes the critical role played by fathers in maternal perinatal mental health, the prevalence of paternal perinatal mood and anxiety disorder, the impact of paternal mental health on child and family well-being, and screening and treatment approaches. Next, we offer recommendations for more inclusive approaches at the local, state, and national levels aimed at improving parental mental health and health outcomes for fathers, mothers, and babies.

Material Hardship, Protective Factors, Children's Special Health Care Needs, and the Health of Mothers and Fathers

BACKGROUND

Parents of children with special health care needs (CSHCN) are at risk of poorer health outcomes. Material hardships also pose significant health risks to parents. Little is known about how protective factors may mitigate these risks and if effects are similar between mothers and fathers.

METHODS

This was a cross-sectional survey study conducted using the US 2018/2019 National Survey of Children's Health, including parents of children 0 to 17 with income <200% of the federal poverty level. Separately, for parents of children with and without special health care needs (N-CSHCN), weighted logistic regression measured associations between material hardship, protective factors (family resilience, neighborhood cohesion, and receipt of family-centered care), and 2 outcomes: mental and physical health of mothers and fathers. Interactions were assessed between special health care needs status, material hardship, and protective factors.

RESULTS

Sample consisted of parents of 16,777 children; 4440 were parents of CSHCN. Most outcomes showed similar associations for both mothers and fathers of CSHCN and N-CSHCN: material hardship was associated with poorer health outcomes, and family resilience and neighborhood cohesion associated with better parental health outcomes. Family-centered care was associated with better health of mothers but not fathers. Interaction testing showed that the protective effects of family resilience were lower among fathers of CSHCN experiencing material hardship.

CONCLUSIONS

Family resilience and neighborhood cohesion are associated with better health outcomes for all parents, though these effects may vary by experience of special health care needs, parent gender, and material hardship.

Exploring fathers' experiences of caring for a child with complex care needs through ethnography and arts-based methodologies

BACKGROUND

Although the number of children living with complex care needs (CCN) is increasing worldwide, there is limited data on the experience of fathers caring for children with CCN. This paper reports on findings specific to fathers' experiences of caring for their child with CCN and highlights recommendations provided for parents of children with CCN, service providers, and policymakers. The findings emerged from a larger study designed to examine how Canadian families of children with CCN participate in society.

METHODS

We used the qualitative research approach of ethnography and arts-based methodologies (ecomaps and photovoice) as well as purposive and snowball sampling techniques. Four parents were engaged as advisors and twenty-nine fathers participated in interviews (all were married or in a relationship; age range of 28 to 55 years). In line with an ethnographic approach, data analysis involved several iterative steps including comparing data from the first, second, and third set of interviews and refining themes.

RESULTS

One overarching theme, striving to be there for the child with CCN, was identified. Five supporting themes further exemplified how fathers strived to be there for their child: 1) contributing to the parental team through various roles; 2) building accessibility through adaptation; 3) engaging in activities with the child; 4) expressing admiration and pride in their children; and 5) meaning making. Recommendations for parents included making and nurturing connections and asking for help while recommendations for healthcare and social service providers included communicating authentically with families and listening to parents. Fathers also indicated that leadership and funding for programs of families of children with CCN should be priorities for policymakers.

CONCLUSIONS

In addition to documenting fathers' active involvement in their child's care and development, our findings provide new insights into how fathers make participation in everyday life accessible and inclusive for their children. Study findings also point to 1) priority areas for policymakers (e.g., accessible physical environments); 2) factors that are critical for fostering collaborative care teams with fathers; and 3) the need for complex care teams in the adult health care system. Implications for those providing psychosocial support for these families are noted as well as knowledge gaps worthy of future exploration such as the role of diversity or intersectionality in fathering children with CCN.

The experience of fathers of children hospitalised with advanced heart disease

BACKGROUND

There are little reported data on the perspectives of fathers caring for children with chronic conditions. Although survival of children with advanced heart disease has improved, long-term morbidity remains high. This study describes the experience and prognostic awareness of fathers of hospitalised children with advanced heart disease.

METHODS

Cross-sectional survey study of parents caring for children hospitalised with advanced heart disease admitted for ≥ 7 days over a one-year period. One parent per patient completed surveys, resulting in 27 father surveys. Data were analysed using descriptive methods.

RESULTS

Nearly all (96%) of the fathers reported understanding their child's prognosis "extremely well" or "well," and 59% felt they were "very prepared" for their child's medical problems. However, 58% of fathers wanted to know more about prognosis, and 22% thought their child's team knew something about prognosis that they did not. Forty-one per cent of fathers did not think that their child would have lifelong limitations, and 32% anticipated normal life expectancies. All 13 fathers who had a clinical discussion of what would happen if their child got sicker found this conversation helpful. Nearly half (43%) of the fathers receiving new prognostic information or changes to treatment course found it "somewhat" or "a little" confusing.

CONCLUSIONS

Fathers report excellent understanding of their child's illness and a positive experience around expressing their hopes and fears. Despite this, there remain many opportunities to improve communication, prognostic awareness, and participation in informed decision-making of fathers of children hospitalised with advanced heart disease.

Maternal and Paternal Adverse Childhood Experiences (ACEs) and Offspring Health and Wellbeing: A Scoping Review

BACKGROUND

Adverse childhood experiences (ACEs) are common, often co-occur, and are associated with poor health outcomes across the life course. Emerging research has emphasized the lasting consequences of ACEs across generations, suggesting parental ACEs are associated with poor physical and mental health outcomes in children. However, the individual effects of fathers' ACEs and pathways of transmission remain unclear. A scoping review was conducted to summarize the current knowledgebase of the intergenerational consequences of parental ACEs on offspring health, clarify pathways of transmission, understand how ACEs are operationalized in the intergenerational literature, and identify gaps in knowledge.

METHODS

Six electronic databases were searched for articles published in English from 1995 to 2022 relating to the long-term consequences of parental ACEs on offspring physical and mental health. Articles underwent title, abstract, and full-text review by two investigators. Content analysis was performed to integrate findings across the included studies.

RESULTS

The search yielded 14,542 unique articles; 49 met the inclusion criteria. Thirty-six articles focused exclusively on mothers, one solely on fathers, and 12 included both mothers and fathers in their analyses. Six studies used an expanded definition of ACEs. Both direct and indirect associations between parental ACEs and poor offspring outcomes were identified, primarily through biological and psychosocial pathways.

CONCLUSIONS

Findings underscore the importance and oversight of fathers and the need to solidify a unified definition and measure of ACEs. This review identified modifiable protective factors (social support, father involvement) and pathways of transmission (parental mental health, parenting); both having important implications for intervention development.

Paternal perspectives towards infant and young child feeding (IYCF): a qualitative analysis from Coastal South India

BACKGROUND

The infant and young child feeding practices (IYCF) decide child growth and well-being. Paternal perspectives and involvement in IYCF are of paramount importance and are grossly under-studied.

AIMS

To study the experiences and opinions of fathers of infants and young children towards feeding practices.

SETTINGS AND DESIGN

Two focus group discussions (FGD) were carried out in the community settings in Dakshina Kannada District, Karnataka State.

METHODS AND MATERIAL

FGDs were carried out in the areas of two selected primary health centres. FGD guide was used and the discussions were audio recorded. Themes were derived from the transcript.

RESULTS

Four main themes were generated from the transcripts of two FGDs. Lack of time to involve in child feeding, lack of felt need for increased involvement, sense of being complete in providing paternal care and readiness to learn were the generated themes. All participating fathers had favourable attitudes towards learning more about IYCF.

CONCLUSIONS

Lack of time felt need for higher paternal involvement in IYCF and sense of being complete in providing paternal care were the themes extracted, along with favourable attitude towards increasing their involvement in IYCF.

Glenohumeral internal rotation deficit in general population with shoulder pain: A descriptive observational study

Glenohumeral internal rotation deficit (GIRD) is one of the most important factors influencing injury risk in the arm of overhead athletes. Some studies have shown that the GIRD of athletes with shoulder pain was higher than those without shoulder pain, establishing a relation between shoulder pain and GIRD. However, there are no studies that relate to GIRD and shoulder pain or the risk factors that affect GIRD in the population with this ailment. This study aimed to: determine if GIRD could be found clinically and between which values it oscillates in patients with shoulder pain, and explore if there are any potential associations between GIRD and some sociodemographic data, and orthopedic or radiological findings. A descriptive observational study design was adopted to determine if GIRD could be found clinically in patients with shoulder pain and to gain further evidence in the potential associations between GIRD and sociodemographic data, and orthopedic or radiological findings. All those patients without exclusion criteria between October 1,2020 and March 31,2021 were included. Exclusion criteria consisted of being under 18 years old but younger than 80 years old, showing shoulder pain in both shoulders and having a joint prosthesis in at least one of the 2 shoulders, tumor, or infection. A total of 67 patients aged between 25 and 75 years (52.7 ± 11.8 years, 36 male and 31 female). More than 82% of patients with shoulder pain showed a GIRD higher than 20º. The mean GIRD was 37.6 ± 17.09º. The 95th percentile was 66.22º. From sociodemographic data could be extracted that: patients who have children showed a lower GIRD, patients with right shoulder pain, or whose dominance coincided with a painful shoulder showed a higher GIRD. The orthopedic findings revealed that patients with a positive Jobe test showed a lower GIRD. The linear model considering both sociodemographic and orthopedic findings showed that GIRD was reduced by having children and by BMI. GIRD shows a high incidence in patients with shoulder pain. The descendant, BMI, and positive Jobe test were negatively associated with the GIRD.

Toxic Stress as a Potential Factor Inducing Negative Emotions in Parents of Newborns and Infants with Cyanotic Congenital Heart Disease

BACKGROUND

Parents who have a newborn with a congenital heart defect experience negative emotions, which may determine the emotional state of their children.

METHODS

The study group included 154 parents of newborns and infants with cyanotic congenital heart disease, before cardiac surgery and after the procedure. HADS m and PSS-10 questionnaires were used to assess parental anxiety, depression, aggression, and the level of stress.

RESULTS

High levels of depression, anxiety, total HADS and stress were diagnosed in a large group of parents, regardless of the stage of cardiac surgery treatment. A high level of stress was associated with a higher prevalence of emotional disturbance both in the total HADS (overall) and in all its individual domains. Anxiety and depression were more common in mothers. A high level of stress was a significant predictor of anxiety and depression in parents.

CONCLUSIONS

A high level of stress was a significant predictor of anxiety and depression in parents of infants with congenital heart disease. The parents' psychological condition is one of many potential determinants over the course of their child's treatment and recovery.

Perceptions of Urban Father Support in Early Parenthood: A Critical Incident Analysis

Becoming a father is a common transitional event, however men are often not adequately prepared for their fathering role. The United States (U.S.) health care system does little to support fathers' parenting needs during the postnatal and infancy period. Moreover, father's support needs are often perceived as secondary to the mother's needs in the maternal-child system. It is important that fathers' social support needs be investigated in the first year of his newborn's life, especially in diverse populations. Therefore, the purpose of this study was to determine the social support needs of urban, African American fathers during early parenthood. Using the Critical Incident Technique (CIT), a descriptive, qualitative design was used to interview 35 fathers about their social support at 2-12 months after the birth of their baby. Using a semi-structured interview guide, fathers were asked to describe helpful and unhelpful events they experienced since the birth of their baby. Fathers reported 36 helpful events and 32 unhelpful events for an overall total of 68 events. Data was analyzed using House's Social Support Theory and the four social support categories: instrumental, informational, emotional, and appraisal. Using the CIT, main categories and subcategories were developed. The helpful categories included: 1) Helping father with infant care, 2) Providing information on infant care, 3) Receiving HCP assistance, 4) Managing relationships, and 5) Becoming a father. The unhelpful categories included: 1) Receiving unhelpful assistance, 2) Receiving unreliable or unwanted assistance, 3) Offering bad advice, 4) Conflicting relationships, 5) Conflicts with friends, 6) Unsatisfying HCP experience, and 7) Receiving no support from family/organizations. The results of the study validated House's Social Support Theory and served as an excellent framework for exploring social support needs in fathers. More research needs to be conducted on the social support needs of fathers during the first year of their infants' lives, especially with experienced African American fathers and nonresidential fathers, and how health care professionals (HCPs), specifically postnatal and child health nurses, can better support fathers during the infancy period.

Father's perceptions and care involvement for their very preterm infants at French neonatal intensive care units

Objectives

We aimed to evaluate (1) fathers' perceptions and care involvement for their very premature infants and their views of the hospitalization period based on parental reports and (2) their evolution over time.

Methods

We used an online parental survey to assess answers from parents of very preterm infants who were successfully discharged from French neonatal units. We analysed answers from February 2014 to January 2019 to an anonymous internet-based survey from the GREEN committee of the French Neonatal Society. Responses were compared for period 1 (P1, 1998 to 2013) and period 2 (P2, 2014 to 2019).

Results

We analyzed 2,483 surveys, 124 (5%) from fathers and 2,359 (95%) from mothers. At birth, 1,845 (80%) fathers were present in the hospital, but only 879 (38%) were near the mother. The presence of fathers in the NICU increased from P1 to P2 (34.5% vs. 43.1%, p = 0.03). Nearly two thirds of fathers accompanied their infants during transfer to the NICU (1,204 fathers, 60.6%). Fathers and mothers had similar perceptions regarding relationships with caregivers and skin-to-skin contact with their infants. However, more fathers than mothers felt welcome in the NICU and in care involvement regarding requests for their wishes when they met their infant (79% vs. 60%, p = 0.02) and in the presentation of the NICU (91% vs. 76%; p = 0.03). Mothers and fathers significantly differed in the caring procedures they performed (p = 0.01), procedures they did not perform but wanted to perform (p < 0.001), and procedures they did not perform and did not want to perform (p < 0.01).

Conclusion

Most fathers were present at the births of their very preterm infants, but fewer fathers were near the mother at this time. Less than two thirds of fathers accompanied their infants to the NICU. There should be further changes to better meet the specific needs of the fathers of infants requiring care in the NICU. Continuing assessment with an online questionnaire may be useful to monitor changes over time in father's involvement in NICUs.

Screening fathers for postpartum depression in a maternal-child health clinic: a program evaluation in a midwest urban academic medical center

BACKGROUND

Postpartum depression (PPD) impacts fathers as well as mothers, and is estimated to affect between 8 and 13% of fathers. Paternal PPD is a risk factor for worsened quality of life, poor physical and mental health, and developmental and relational harms in the father-mother-child triad. There are no current recommendations for PPD screening among fathers. Paternal PPD screening was piloted in an intergenerational postpartum primary care clinic.

METHODS

The pilot was carried out in an intergenerational postpartum primary care clinic located at a Midwest urban academic safety net health system from October 2021 to July 2022. Fathers actively involved in relationships with mothers or infants receiving primary care in the clinic were approached with mothers' permission. A novel survey instrument was used to collect demographic/social data, as well as mental health history and current stress levels; an Edinburgh Postnatal Depression Scale (EPDS) was also administered. Screenings were completed by social workers; data were collected in REDCap and descriptive statistics were calculated in SAS.

RESULTS

29 fathers were contacted and 24 completed screening (83%). Mean age was 31 years (range 19-48). Most (87%) identified as belonging to a racial or ethnic minority group. Fathers self-reported low rates of stress and preexisting mental health conditions, but 30% screened positive for PPD on EPDS (score of ≥ 8, or suicidal ideation). Gaps in health care were found, as one-quarter (26%) of fathers were uninsured and half (54%) did not have a primary care provider. After screening, two requested mental health services, and three established new primary care with a physician.

CONCLUSIONS

Participation was high in a PPD screening pilot for fathers in a primary care setting. This small sample of fathers demonstrated significant peripartum mental health challenges unlikely to have been identified otherwise. For some participants, engaging in PPD screening was an effective tool to prompt their subsequent engagement with general health care. This pilot is a step toward incorporating the health of fathers into models for supporting the health of families. Expanding screening for paternal PPD into routine primary care is necessary to reach more affected fathers.

Associations between parental and pre-adolescents' physical activity and diet quality: The role of parental child care involvement and child's sex

BACKGROUND

Research has demonstrated the importance of the family environment in the eating and activity levels of offspring. We examined the cross-sectional associations between moderate-to-vigorous physical activity (MVPA) and diet quality of parents and the MVPA and diet quality of pre-adolescents. Interactions were tested to assess whether the child's sex and the parental level of involvement in daily child care moderated these associations.

METHODS

Data from 2467 pre-adolescents (age 11.5 ± 0.2 years; collected in 2015-2016) and their parents or caregivers from a large-scale prospective birth cohort study in Amsterdam (ABCD-study) was used. Parents and pre-adolescents individually reported their diet quality and physical activity. Child care involvement was assessed using the Caregiver Child Interaction Scale. With hierarchical linear regression analyses, we assessed the independent contribution of fathers and mothers.

RESULTS

An association between mother-child MVPA was found (β = 0.013; 95 % CI: 0.006;0.021). The association between father-child MVPA was only significant for highly involved fathers (β = 0.014; 95 % CI: 0.004;0.023). The child's sex did not change these MVPA associations. Regarding diet quality, associations were found between mother-child diet quality score (DQS) (β = 0.254; 95 % CI: 0.192;0.316) and father-child DQS, with stronger associations between fathers and sons (β = 0.234; 95 % CI: 0.169;0.298) than between fathers and daughters (β = 0.114; 95 % CI: 0.047;0.181). Parental levels of involvement did not change these associations.

CONCLUSION

These findings demonstrate that both parental behaviours represent an important factor in physical activity and diet quality in pre-adolescents in a sex-specific manner. As such, it is essential to include both parents in research to obtain the necessary insights for developing effective interventions to promote children's healthy eating and physical activity behaviours.

Formative research to inform the future design of a multicomponent fatherhood intervention to improve early child development in Mwanza, Tanzania

Fathers can influence child development through various pathways, such as via their caregiving behaviors, marital relationships, and their psychosocial wellbeing. However, few parenting interventions have been designed to target these multiple dimensions among fathers with young children in low- and middle-income countries. In June 2022, we conducted qualitative formative research to explore the perceptions surrounding fatherhood and the underlying barriers and enablers to engaged fathering in Mwanza, Tanzania. We completed individual in-depth interviews with 29 fathers and 23 mothers of children under aged 2 years along with 5 community leaders and 3 community health workers. We also completed 10 focus group discussions: 4 with fathers, 2 with mothers, and 4 mixed groups that combined both fathers and mothers. In total, the sample included 120 respondents stratified from across 4 study communities. Data were analyzed using thematic content analysis. Respondents highlighted that poor couples' relationships (e.g., limited male partner support, male dominance in decision-making) and fathers' mental health problems (e.g., parenting stress) were major priorities affecting fathers. Father involvement in parenting, childcare, and household activities were generally low. These dimensions of fatherhood were interlinked (e.g., poor paternal mental health constrained marital relationships and parenting). A constellation of determinants impacted engaged fathering. Common barriers included poverty, restrictive gender attitudes and norms, men's limited time at home, and inadequate knowledge about caregiving. Key enablers included mutual respect in marital relationships and men's desires to show their love for their families. Our results highlight the cultural relevance and the need for multicomponent strategies that jointly target fathers' caregiving, marital relationships, and psychosocial wellbeing for enhancing nurturing care and promoting early child development in Tanzania. Study findings can be used to inform the design of a future father-inclusive, gender-transformative parenting intervention for engaging and supporting fathers with young children in the local cultural context.

Fathers, Breastfeeding, and Infant Sleep Practices: Findings From a State-Representative Survey

OBJECTIVES

To assess infant breastfeeding initiation and any breastfeeding at 8 weeks and safe sleep practices (back sleep position, approved sleep surface, and no soft objects or loose bedding ["soft bedding"]) by select paternal characteristics among a state-representative sample of fathers with new infants.

METHODS

Pregnancy Risk Assessment Monitoring System (PRAMS) for Dads, a novel population-based cross-sectional study, surveyed fathers in Georgia 2-6 months after their infant's birth. Fathers were eligible if the infant's mother was sampled for maternal PRAMS from October 2018 to July 2019.

RESULTS

Of 250 respondents, 86.1% reported their infants ever breastfed and 63.4% reported breastfeeding at 8 weeks. Initiation and breastfeeding at 8 weeks were more likely to be reported by fathers who reported wanting their infant's mother to breastfeed than those who did not want her to breastfeed or had no opinion (adjusted prevalence ratio [aPR] = 1.39; 95% confidence interval [CI], 1.15-1.68; aPR = 2.33; 95% CI, 1.59-3.42, respectively) and fathers who were college graduates than those with ≤high school diploma (aPR = 1.25; 95% CI, 1.06-1.46; aPR = 1.44; 95% CI, 1.08-1.91, respectively). Although about four-fifths (81.1%) of fathers reported usually placing their infants to sleep on their back, fewer fathers report avoiding soft bedding (44.1%) or using an approved sleep surface (31.9%). Non-Hispanic Black fathers were less likely to report back sleep position (aPR = 0.70; 95% CI, 0.54-0.90) and no soft bedding (aPR = 0.52; 95% CI, 0.30-0.89) than non-Hispanic white fathers.

CONCLUSIONS

Fathers reported suboptimal infant breastfeeding rates and safe sleep practices overall and by paternal characteristics, suggesting opportunities to include fathers in promotion of breastfeeding and infant safe sleep.

Fathers' Experiences of Childhood Cancer: A Phenomenological Qualitative Study

Research has shown differences in how fathers and mothers respond to a child's cancer diagnosis. Previous studies have highlighted that sociocultural norm shape fathers' experiences of their child's cancer diagnosis. Our phenomenological qualitative study aimed to examine the lived experiences of fathers whose children have been diagnosed with cancer and explore the impact of sociocultural gender roles. Fathers whose children were currently receiving treatment or had completed treatment in the previous 15 months were recruited from across Australia. Twenty-one fathers were interviewed. Five themes were identified: (a) Your world falls apart: Diagnosis and treatment; (b) Care for the child: Just the way it is; (c) Keeping strong: Finding ways to cope; (d) Employment: Practical and emotional support at work; and (e) Guilt, relief, and grief: Facing death. This study demonstrates the profound impact of a child's diagnosis on fathers and demonstrates that societal-cultural norms influence fathers' experience of childhood cancer.

Structured, multicomponent, community-based programme for women's health and infant health and development in rural Vietnam: a parallel-group cluster randomised controlled trial

BACKGROUND

Interventions to improve early childhood development have previously addressed only one or a few risk factors. Learning Clubs is a structured, facilitated, multicomponent programme designed to address eight potentially modifiable risk factors, and offered from mid-pregnancy to 12 months post partum; we aimed to establish whether this programme could improve the cognitive development of children at 2 years of age.

METHODS

For this parallel-group cluster-randomised controlled trial, 84 of 116 communes (the clustering unit) in HaNam Province in rural Vietnam were randomly selected and randomly assigned to receive the Learning Clubs intervention (n=42) or usual care (n=42). Women aged at least 18 years who were pregnant (gestational age <20 weeks) were eligible for inclusion. Data sources were standardised, and study-specific questionnaires assessing risks and outcomes were completed in interviews in mid-pregnancy (baseline), late pregnancy (after 32 weeks of gestation), at 6-12 months post partum, and at the end of the study period when children were 2 years of age. Mixed-effects models were used to estimate trial effects, adjusting for clustering. The primary outcome was the cognitive development of children at 2 years of age, assessed by the Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III) cognitive score. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000442303).

FINDINGS

Between April 28, 2018, and May 30, 2018, 1380 women were screened and 1245 were randomly assigned (669 to the intervention group and 576 to the control group). Data collection was completed on Jan 17, 2021. Data at the end of the study period were contributed by 616 (92%) of 669 women and their children in the intervention group, and by 544 (94%) of 576 women and their children in the control group. Children aged 2 years in the intervention group had significantly higher mean Bayley-III cognitive scores than those in the control group (99·6 [SD 9·7] vs 95·6 [9·4]; mean difference 4·00 [95% CI 2·56-5·43]; p<0·0001). At 2 years of age, 19 (3%) children in the intervention group had Bayley-III scores less than 1 SD, compared with 32 (6%) children in the control group, but this difference was not significant (odds ratio 0·55 [95% CI 0·26-1·17]; p=0·12). There were no significant differences between groups in maternal, fetal, newborn, or child deaths.

INTERPRETATION

A facilitated, structured, community-based, multicomponent group programme improved early childhood development to the standardised mean in rural Vietnam and could be implemented in other similarly resource-constrained settings.

FUNDING

Australian National Health and Medical Research Council and Grand Challenges Canada Saving Brains Initiative.

TRANSLATION

For the Vietnamese translation of the abstract see Supplementary Materials section.

Evaluation of the effectiveness of a postnatal support education program for husbands in promotion of their primiparous wives' perceived social support: a randomized controlled trial

BACKGROUND

Primiparous women experience various challenges if not provided with social support in the early postpartum period. Support in form of postpartum education programs is needed to improve mental well-being in primiparous women. The aim of this study was to determine the effect of a postnatal supportive education program for husbands on the perceived social support (primary outcome), and stress and maternal self-efficacy (secondary outcome) of their primiparous wives.

METHODS

This randomized clinical trial was performed on pregnant women referring to healthcare centers for routine care from September to November 2021 in Kermanshah, Iran. One hundred pregnant women were randomly divided in to intervention and control groups. Four 45-90 min online training sessions were held weekly for the husbands of the intervention group. The primiparous women completed the Postpartum Partner Support Scale, Perceived Stress Scale, and Postpartum Parental Expectations Survey before (third day after delivery, immediately and one month after completing the intervention. Data were analyzed using Fisher's exact test, Chi-square test, independent t-test, and repeated measures analysis of variance in SPSS version 24, and p < 0.05 was considered statistically significant.

RESULTS

In the control and intervention groups before the intervention, socio-demographic characteristics (P > 0.05), the mean scores of perceived social support (P = 0.11), maternal self-efficacy (p = 0.37) and perceived stress (p = 0.19) were not statistically significant. However, in the intervention group compared to the control group the mean scores of perceived social support (79.42 ± 7.17 vs. 37.26 ± 7.99, P < 0.001), maternal self-efficacy (186.22 ± 39.53 vs. 106.3 ± 32.88, P < 0.001) and perceived stress (16.36 ± 6.65 vs. 43.3 ± 7.39, P < 0.001) immediately after the intervention and the mean scores of perceived social support (84.4 ± 5.91 vs. 37.14 ± 6.63, P < 0.001), maternal self-efficacy (191.24 ± 38.92 vs. 112.34 ± 37.12, P < 0.001) and perceived stress (13.98 ± 4.84 vs. 39.06 ± 7.25, P < 0.001) one month after the intervention changed significantly.

CONCLUSION

The postpartum supportive education program for husbands was effective in promoting social support for primiparous women. Thus it can be introduced as routine care in the postpartum period.

TRIAL REGISTRATION

Clinical trial registration Iranian Registry of Clinical Trials; https://en.irct.ir/user/trial/56451/view (IRCT20160427027633N8), registered (15/06/2021).

Mental health as a family experience: Relationship of paternal characteristics with maternal perinatal depressive symptoms in a matched sample

The present study investigates the relationship between perinatal maternal depressive symptoms and paternal factors using linked maternal-paternal survey data. From October 2018 to July 2019, among a representative sample and 2-6 months following the birth of an infant, mothers and fathers completed surveys and reported depressive symptoms. Results from the linked dyadic data (n = 243) show the prevalence of maternal depressive symptoms, both overall (16%) and by marital status and paternal health care involvement. Viewing mental health as a family experience may further understanding of postpartum maternal mental illness.

Parental Postnatal Depression in the Time of the COVID-19 Pandemic: A Systematic Review of Its Effects on the Parent-Child Relationship and the Child's Developmental Outcomes

The international literature has shown that maternal and paternal postnatal depression (PND) is one of the most common mental illnesses in the perinatal period, with significant consequences for parent-infant relationships and infant development. The COVID-19 pandemic has increased the rates of prevalence of PND, exacerbating the mental health risk for new families. This systematic review aims to examine the effect of maternal and paternal PND on parent-infant relationships and children's development in the first 36 months after childbirth during the COVID-19 outbreak. Eligible studies were identified using the following databases: Medline, CINAHL, SCOPUS, PsycINFO, PsycARTICLES, ScienceDirect, and Web of Science. Of the 1252 studies considered, 10 studies met the inclusion criteria. Results showed that maternal PND significantly affected the quality of the early mother-infant relationship and the infant's motor, self-regulation, and socio-emotional development. In addition, the detrimental impact of maternal PND on the quality of early mother-infant relationships seems to become stronger as COVID-19 concerns increase. No studies included fathers. These findings strengthened the importance of planning targeted prevention and treatment strategies to prevent PND and its short- and long-term consequences, especially in the case of stressful and traumatic events. They also suggested the urgent need for further exploration of fathers.

Fathers' Experiences of Caring for a Child with a Chronic Illness: A Systematic Review

The prevalence of children living with chronic health conditions is increasing worldwide and can disrupt family roles, relationships, function, and parental involvement in family caregiving. The purpose of this systematic review was to explore fathers' experiences and involvement in caring for a child with a chronic condition. Systematic searches using seven databases were conducted. Study criteria included (1) peer-reviewed original research in English, Spanish, French, or Portuguese, (2) children less than 19 years of age with a chronic condition, (3) fathers (biological or guardian) as direct informants, and (4) outcomes addressing fathers' experience, perceptions, and/or involvement in the child's care. Data were synthesized from ten articles reflecting eight separate studies that utilized quantitative designs. Three areas of focus were identified: Family Functioning, Father's Psychological Health, and Need for Support. Data suggested increased involvement from the father in caring for their child with a chronic condition was associated with improved family functioning, increased anxiety and distress, decreased self-esteem, and increased need for support. This review revealed a paucity of data regarding fathers' experiences and involvement when caring for a child with a chronic condition, with that available primarily from developed countries. Rigorous empirical studies are needed to deepen understanding of how fathers are involved in the care of their child with a chronic condition.

It’s time to talk fathers: The impact of paternal depression on parenting style and child development during the COVID-19 pandemic

This study aimed to understand the relationship between paternal depression, parenting behavior and child developmental outcomes during the SARS-CoV-2 (COVID) pandemic. In addition, the paternal experience of the pandemic, such as the impact of lockdowns, was explored. Fathers of children aged 6–11 years old (n = 87) were recruited for an online cross-sectional survey. Data was collected through questionnaires and open-ended comments. Regression analysis indicated a higher level of self-reported depressive symptomology in fathers more severely impacted by the pandemic across financial, familial and health domains. Further, COVID-19 impact, but not paternal depression, was linked to fewer authoritative parenting behaviors, characterized as lower warmth and responsiveness. Paternal pandemic impact and depression symptoms were independently predictive of child cognitive scores, and both were associated with emotional and behavioral outcomes. A content analysis of open-ended responses from fathers noted that concerns for their children, work and mental health were most prevalent during the pandemic. However, several responders also reported no change or positive facets of lockdowns related to the pandemic. These finds are discussed in the context of a possible behavioural mechanism of action accounting for the effect of these factors on child development. Clinical implications include targeted interventions for at risk groups as well as psychoeducation for fathers that acknowledge difference in paternal coping and support seeking.

New Parent Support Needs and Experiences with Pediatric Care During the COVID-19 Pandemic

OBJECTIVES

Despite evidence for heightened psychiatric risk and unique parenting challenges during the COVID-19 pandemic, no research exists on the specific needs of parents of infants and responsiveness of pediatric care to their needs. We aimed to describe the support needs of new parents and explore their experiences with pediatric care.

METHODS

In late 2020 we conducted semi-structured interviews with 30 mothers of babies born or due that year. Interviews addressed perinatal experiences during the pandemic, with an emphasis on experiences related to social support. In an iterative, inductive process, thematic analysis was used to analyze the data.

RESULTS

This study identifies a set of support needs specific to the context of parenting an infant during the COVID-19 crisis: coping with the compound psychological impacts of the postpartum period and a pandemic; parenting in the absence of expected social support; risk assessment to keep infant and family safe. This study finds that policies implemented by health care providers to reduce risk of COVID-19 transmission came at a cost to new parents and parent-provider relationships. Participants reported mixed experiences with in-person and telehealth pediatric care, including inadequate and/or uncomfortable postpartum mental health screening and breastfeeding support, and identified specific features that constituted responsive care during the pandemic.

CONCLUSIONS

Normative changes associated with the postpartum period combined with complex adaptations necessitated by the COVID-19 pandemic presented substantial challenges for families with infants, even relatively privileged families. Providers can incorporate these findings to enhance support for families and promote maternal and child health.

The correlation between spousal support and postpartum depression in fathers

PURPOSE

This study was conducted using a descriptive design to examine the correlation between spousal support and postpartum depression (PPD) in fathers.

DESIGN AND METHODS

The participants of the study were the fathers of infants born in the obstetrics and gynecology clinic of a state hospital affiliated with the Ministry of Health in a province in Turkey.

FINDINGS

It was determined that while the possibility of paternal PPD was lower in the early postpartum period (p < 0.001), it increased in the late postpartum period (p < 0.001). A negative statistically significant correlation was identified between the Edinburgh Postnatal Depression Scale (EPDS) scores and the Spouse Support Scale (SSS) scores of the participants in the early postpartum period (p = 0.031). There was a highly negative significant correlation between late postpartum EPDS scores and the early (p < 0.001) and late period (p < 0.001) SSS scores. A highly negative significant correlation was observed between the mean score of the early spousal support period and the mean score of the late spousal support period (p < 0.001). In this study, spousal support decreased PPD in fathers.

PRACTICE IMPLICATIONS

This study indicated the necessity of routinely screening men for PPD symptoms. Early diagnosis and spousal support would contribute to reducing early and late paternal PPD, thus protecting the family's integrity.

Self-reported lifestyle behaviours in families with an increased risk for type 2 diabetes across six European countries: a cross-sectional analysis from the Feel4Diabetes-study

BACKGROUND

A healthy lifestyle decreases the risk of developing type 2 diabetes mellitus. The current cross-sectional study aimed to describe self-reported lifestyle behaviours and compare them to current health guidelines in European Feel4Diabetes-families at risk for developing type 2 diabetes across six countries (Belgium, Finland, Spain, Greece, Hungary and Bulgaria).

METHODS

Parents and their children were recruited through primary schools located in low socio-economic status areas. Parents filled out the FINDRISC-questionnaire (eight items questioning age, Body Mass Index, waist circumference, PA, daily consumption of fruit, berries or vegetables, history of antihypertensive drug treatment, history of high blood glucose and family history of diabetes), which was used for the risk assessment of the family. Sociodemographic factors and several lifestyle behaviours (physical activity, sedentary behaviour, water consumption, fruit and vegetable consumption, soft drink consumption, sweets consumption, snack consumption, breakfast consumption) of both adults and children were assessed by parental questionnaires. Multilevel regression analyses were conducted to investigate families' lifestyle behaviours, to compare these levels to health guidelines and to assess potential differences between the countries. Analyses were controlled for age, sex and socio-economic status.

RESULTS

Most Feel4Diabetes-families at risk (parents and their children) did not comply with the guidelines regarding healthy behaviours, set by the WHO, European or national authorities. Less than half of parents and children complied with the physical activity guidelines, less than 15% of them complied with the fruit and vegetable guideline, and only 40% of the children met the recommendations of five glasses of water per day. Clear differences in lifestyle behaviours in Feel4Diabetes-families at risk exist between the countries.

CONCLUSIONS

Countries are highly recommended to invest in policy initiatives to counter unhealthy lifestyle behaviours in families at risk for type 2 diabetes development, taking into account country-specific needs. For future research it is of great importance to focus on families at risk in order to counter the development of type 2 diabetes and reduce health inequity.

Parental Depression Screening in Pediatric Health Care Settings: A Scoping Review

BACKGROUND AND OBJECTIVES

Parental depression affects as many as 1 in 5 US families. Pediatric professionals can play an important role in detecting parental depression, yet most studies on parental depression screening focus only on the postpartum period. The authors performed this scoping review to understand the existing literature on parental depression screening outside the postpartum period (child >12 months old) and to identify knowledge gaps.

METHODS

Sources for this research include PubMed, CINAHL, SCOPUS, Web of Science, and APA Psych Info. We included English language papers concerning screening for maternal and/or paternal depression or mood disorders outside of the postpartum period by pediatric clinicians or in a pediatric health care setting. Extracted variables included publication year, title, author(s), country, geographic setting, clinical setting, child age range (in years), parental focus, sample size, study type, approach, screening instrument(s), and findings.

RESULTS

Forty-one papers were included. The proportion of positive parental depression screens was consistently high across the included studies. Relatively few structured screening programs outside of the postpartum period were identified, especially for fathers. The included studies suggest that screening can be accomplished in pediatric settings, but appropriate referral and follow-up of positive screens poses a major challenge. This review was limited to English language papers concerning parental depression outside of the postpartum period.

CONCLUSIONS

These findings suggest that screening for parental depressive symptoms outside the postpartum period could identify families in need of support. Research is required to identify best practices for referral and follow-up of parents who screen positive.

Voices of Fathers During Pregnancy: The MGH Prenatal Care Obstetrics Fatherhood Study Methods and Results

INTRODUCTION

Despite the growing recognition of father's importance for early family health and well-being, there has been very limited attention to men's own experiences and developmental needs antenatally, and specifically during their partner's prenatal care (PNC) visits. This study explores the feasibility of capturing men's own voices; documents their antenatal experiences and needs; assesses their treatment by Obstetric staff; and enquires about additional paternal information and skills desired and how best to provide them.

METHODS

All fathers accompanying their partners to PNC services during two weeks at Massachusetts General Hospital were invited to fill out an anonymous, 15-min, two-part, iPad survey.

RESULTS

430 fathers participated (85% of men approached). Fathers expressed high levels of joy and involvement with approaching fatherhood; but 55% also expressed substantial levels of stress, 26% acknowledged depressive symptoms, and 42% reported limited social support for becoming fathers. Substantial men's health needs were noted: 75% were overweight (including 24% obese); 36% lacked an annual physical; and 22% had unplanned pregnancies. Most men (85%) desired additional fathering skills. Fathers perceived being very positively treated by the Obstetric staff, though 33% were never asked any direct questions. Most fathers (68%) expressed a desire or openness for additional parenting information, across a wide range of reproductive health topics, and were very enthusiastic about antenatal fatherhood initiatives.

CONCLUSION

PNC sites provide a valuable locus for ascertaining men's/fathers' voices and could be enhanced to address their extensive antenatal needs and foster earlier paternal involvement to improve infant, family, and men's own health.

Exploratory study of fathers providing Kangaroo Care in a Neonatal Intensive Care Unit

AIM AND OBJECTIVES

To explore fathers' views and experiences of providing Kangaroo Care (KC) to their baby cared for in a Neonatal Intensive Care Unit (NICU).

BACKGROUND

Kangaroo Care has been known to improve the health outcome for preterm, low birth weight and medically vulnerable term infants and achieve the optimal perinatal health wellbeing for parents and infants. Historically, mothers are considered as the dominant KC providers, whereas fathers are spectators and have been overlooked. Little is known about the fathers' perspectives in providing KC in NICUs.

METHODS

Individual semi-structured interviews were conducted with 10 fathers who delivered KC to their baby when in the NICU. Data were analysed using Braun and Clarke's six-phase thematical framework. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was followed to report this qualitative study.

FINDINGS

Fathers in this study identified they were passing a silent language of love and connecting with their baby by the act of KC in a challenging environment. Three themes emerged: 'Positive psychological connection', 'Embracing father-infant Kangaroo Care' and 'Challenges to father-infant Kangaroo Care'.

CONCLUSION

The findings of this study show KC enhances the bonding and attachment between fathers and infants. The conceptualisation of the paternal role in caregiving to a newborn is evolving as a contemporary practice. Further research is warranted to confirm or refute the study findings. Policies and facilities should be modified to include father-infant KC within the fields of neonatal care.

RELEVANCE TO CLINICAL PRACTICE

It is important for nurses and other health professionals to support and enable fathers to give KC. Father-infant KC is recommended in neonatal care settings.

Association between parenthood and cardiovascular disease risk: Analysis from NHANES 2011-2016

The objective of this study was to examine the association between parenthood and cardiovascular disease (CVD) risk factors among a nationally representative sample of United States adults. A cross sectional analysis was conducted with adults aged 20-59 years from the National Health and Nutrition Examination Survey 2011-2016. Adults were classified as parents and non-parents based on the presence of children birth-17 years in the home. CVD risk factors assessed included: physical inactivity, obesity, blood pressure, HDL cholesterol, glycohemoglobin, and smoking status. Multivariable logistic regression models stratified by sex were used to examine the association between parenthood and each risk factor. 10,908 adults (5,329 [49%] male, weighted mean age 39.6 years) were included. In adjusted analyses, fathers had greater odds of obesity (OR: 1.22; 95% CI: 1.04-1.42) and lower odds of being a current smoker (OR: 0.82; 95% CI: 0.68-0.98) compared to non-fathers. Mothers had greater odds of physical inactivity (OR: 1.27; 95% CI: 1.03-1.56) and low HDL cholesterol (OR: 1.24; 95% CI: 1.06-1.45), and lower odds of being a current smoker (OR: 0.78; 95% CI: 0.63-0.96) compared to non-mothers. Parents with younger children in the household tended to have greater odds of CVD risk factors compared to non-parents. No clear patterns emerged in CVD factor risk based on the number of children in the household. Parents are at greater risk for several modifiable CVD risk factors. This illustrates the importance of including parental health promotion in settings that serve children and implementing policies that support parental health and wellbeing.

Stakeholder engagement in developing a father-inclusive early life obesity prevention intervention: First Heroes

Background

Although paternal involvement in the perinatal period is associated with benefits for maternal-child health and reduced obesity risk, fathers are seldom included in perinatal or obesity prevention efforts. Engaging community leaders and fathers as stakeholders in intervention development is a critical step in designing a father-inclusive intervention that is efficacious and responsive to their needs.

Methods

We conducted a structured engagement study, including community stakeholder engagement and qualitative interviews with new fathers, to inform the development of a prospective randomized controlled trial that includes mothers and fathers as equal partners in infant obesity prevention. We interpreted stakeholder feedback through the Consolidated Framework for Implementation Research (CFIR) framework.

Results

Between September 2019 and April 2020, we held a Community Engagement meeting, formed a Community Advisory Board, and conducted 16 qualitative interviews with new fathers. Stakeholder engagement revealed insights across CFIR domains including intervention characteristics (relative advantage, complexity, design quality & packaging), outer setting factors (cosmopolitanism and culture), individual characteristics (including self-efficacy, state of change, identification with the organization) and process (engagement and adaptation). Stakeholders discussed the diverse challenges and rewards of fatherhood, as well as the intrinsic paternal motivation to be a loving, supportive father and partner. Both community leaders and fathers emphasized the importance of tailoring program delivery and content to meet specific parental needs, including a focus on the social-emotional needs of new parents.

Conclusions

A structured process of multidimensional stakeholder engagement was successful in improving the design of a father-inclusive perinatal obesity prevention interventions. Father engagement was instrumental in both reinforcing community ties and increasing our understanding of fathers’ needs, resulting in improvements to program values, delivery strategies, personnel, and content. This study provides a practical approach for investigators looking to involve key stakeholders in the pre-implementation phase of intervention development.

Trial registration

ClinicalTrials.gov, NCT04477577. Registered 20 July 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04759-z.

Assessment of factors and father-infant attachment levels among Turkish's fathers of preterm infants

PURPOSE

Identify the factors affecting father-infant attachment among Turkishs fathers of preterm infants.

DESIGN AND METHODS

This cross-sectional study included 63 fathers of preterm infants between the ages of 6-12 months. Data were collected using the Father-Infant Descriptive Information Form and the Paternal-Infant Attachment Scale (PIAS). Descriptive statistics, independent sample t-tests, mann-whitney test, the kruskal wallis test, the tamhane test, spearman correlation analysis, and linear stepwise regression were used to evaluate the data.

RESULTS

The average PIAS scores of the fathers in the study was 62.97 ± 8.94. A statistically significant difference was found between the birth weight, clinical picture, and length of stay in the Neonatal Intensive Care Unit (NICU) and PIAS total score of preterm infants (p < 0.01). There was a significant difference between the unplanned hospitalization of the baby after discharge and the father's changing the baby's clothes and the PIAS score (p < 0.05). Birth weight and unplanned hospitalization explained 31% of PIAS total score.

CONCLUSIONS

According to the results, father-infant attachment levels of fathers of preterm infants were low. Father's involvement in changing the baby's clothes, preterm birth weight, clinical picture, and length of stay in the NICU were found to be associated with PIAS.

PRACTICAL IMPLICATIONS

It should be remembered that babies can be attached to their fathers as much as they are to their mothers. NICU nurses should initiate father-infant interaction early and ensure fathers' involvement in infant care in the NICU.

Social Support Reduces the Risk of Unfavorable Parenting Styles for Suicidal Behaviors in Early Adolescents

OBJECTIVE

Depression and perceived stress are important risk factors for suicidal behaviors among adolescents. The current study examined the joint effects of parenting styles on suicidal ideation (SI) and attempt (SA) in early adolescents while considering relevant individual factors, and evaluated whether social support can offset the risk.

METHODS

The present study was part of a large cohort study aiming at tracing the mental health and risk behaviors in adolescents, and we utilized baseline data collected from 645 4th grade students with complete assessment of suicidal behaviors, social support, parental bonding, depression, and perceived stress. Participants' mean age was 9.97 years (SD = 0.38) with 53.02% boys. Logistic regression was performed to analyze the associations between independent variables and youth suicidal behaviors.

RESULTS

16.28% students reported to have SI and 4.96% had SA. Depression (SI: OR = 3.66-3.89; SA: OR = 3.98-4.50), father's low care and high authoritarian (LCHA) (SI: OR = 3.04; SA: OR = 2.43), and low acceptance and high authoritarian (LAHA) (SI: OR = 3.58; SA: OR = 4.77) parenting styles were strong risk factors, while overall social support (SI: OR = 0.98; SA: OR = 0.97) was a protective factor of SI and SA for early adolescents. Perceived stress (OR = 1.07-1.08) and mother's LCHA parenting style (OR = 2.03) were risk factors of SI. Overall, a family with LCHA parenting (OR = 2.82) or LAHA parenting (OR = 3.35-3.72) regardless parental gender had increased risk for SI and SA.

CONCLUSION

Family and social factors are important to consider in suicidal prevention and interventions among early adolescents, in addition to assessing individual risk factors. HighlightsSuicidal ideations (16.28%) and attempts (4.96%) were prevalent in early adolescents at elementary schools. Depression status remains a significant risk factor for both SI and SA in early adolescents.Unfavorable parenting styles (LCHA or LAHA) increased the risk of SI and SA, especially received from father.Overall social support had independent protective effect on suicidal behaviors, when taking aforementioned individual and family risk factors into account.

Prospective Associations Between Fathers' Engagement in Infant Caregiving and Their Weight-Related Behaviors and Mental Health

Fathers’ engagement in infant caregiving is linked with positive social, emotional, and developmental outcomes in children; however, its relationship with fathers’ own health is largely unknown. This longitudinal study examined associations between fathers’ caregiving engagement with their 6-month-old infants and their physical activity, sugar-sweetened beverage (SSB) consumption, nighttime sleep duration, and depressive symptoms 6 months later when infants were 12 months old. Participants were 143 fathers of infants (62.7% non-Hispanic White, 82.3% with a bachelor’s degree). Fathers reported their frequency of engagement in seven caregiving activities when infants were 6 months old. Fathers’ physical activity, SSB consumption, nighttime sleep duration, and depressive symptoms were assessed when infants were 6 and 12 months old. Multivariate logistic regression analysis was used to assess if fathers who reported higher infant caregiving at 6 months had more positive health outcomes at 12 months, controlling for fathers’ age, race/ethnicity, education, employment, household income, and the outcome at 6 months. Fathers who reported higher caregiving engagement when infants were 6 months old had increased odds of being sufficiently physically active 6 months later (unadjusted odds ratio [OR] = 1.19, 95% confidence interval [CI] = [1.00, 1.41]; adjusted OR = 1.47, 95% CI = [1.11, 1.96]). No links were identified between fathers’ caregiving engagement and their SSB consumption, nighttime sleep duration, or depressive symptoms. In summary, fathers’ engagement in infant caregiving may be beneficial to their physical activity in the first year after birth. There was insufficient evidence in this study that the benefits of caregiving engagement were experienced broadly across multiple health outcomes.

Maternal Mental Health and Child Adjustment Problems in Response to the COVID-19 Pandemic in Families Experiencing Economic Disadvantage

Parents living in low-income contexts shouldered disproportionate hardships during the COVID-19 pandemic with consequences to maternal mental health and child adjustment. The current study uses a sample of first-time mothers (N = 147) of young toddlers, all living in low-income contexts, to examine the roles of pre-pandemic and COVID-19-specific risk and individual resilience factors in the prediction of changes to maternal mental health coinciding with the onset of the pandemic. Maternal mental health symptoms, in turn, were examined as predictors of child adjustment problems across 6 months of the pandemic and as a potential mechanism conferring pandemic risks to children. While pre-pandemic cumulative contextual risk (i.e., low income, single parent status, adolescent parent status, financial instability) did not predict changes in maternal mental health from prior to during the pandemic, COVID-19-specific health risks predicted changes in maternal mental health from before the pandemic, as well as across 6 months of the pandemic. Regarding individual resilience factors to changes in maternal mental health, pre-pandemic self-compassion predicted better maternal mental health during the pandemic, as did COVID-19-specific appraisal and coping strategies. In turn, maternal mental health predicted children's early pandemic levels of adjustment problems and changes in adjustment problems across 6 months of the pandemic, with maternal mental health serving an indirect pathway of COVID-19-specific health risks to children's adjustment. The findings highlight pathways of risk and resilience during a global health crisis and point to targets for interventions in community level crises to promote maternal and child mental health.

Early Life Adversity and Males: Biology, Behavior, and Implications for Fathers' Parenting

Fathers have an important and unique influence on child development, but influences on fathers' parenting have been vastly understudied in the scientific literature. In particular, very little empirical research exists on the effects of early life adversity (ELA; e.g. childhood maltreatment, parental separation) on later parenting among fathers. In this review, we draw from both the human and non-human animal literature to examine the effects of ELA, specifically among males, in the following areas: 1) neurobiology and neurocognitive functioning, 2) hormones and hormone receptors, 3) gene-environment interactions and epigenetics, and 4) behavior and development. Based on these findings, we present a conceptual model to describe the biological and behavioral pathways through which exposure to ELA may influence parenting among males, with a goal of guiding future research and intervention development in this area. Empirical studies are needed to improve understanding of the relationship between ELA and father's parenting, inform the development of paternal and biparental interventions, and prevent intergenerational transmission of ELA.

La surprotection parentale dans le contexte du cancer pédiatrique : état de la question

Cet article, bien que non exhaustif, présente un état actuel des connaissances empiriques et théoriques sur la surprotection parentale dans des familles où l’enfant est atteint d’un cancer. Nous abordons les caractéristiques de cette surprotection ainsi que la question de sa fonction adaptative et ses effets potentiellement délétères sur l’enfant dans ce contexte spécifique. Cette revue identifie également certains facteurs familiaux et sociétaux qui peuvent promouvoir la surprotection chez les mères et les pères, soulignant l’importance du contexte familial et sociétal dans l’étude des pratiques parentales en oncologie pédiatrique.

When the Bough Breaks: A systematic review and meta-analysis of mental health symptoms in mothers of young children during the COVID-19 pandemic

Parents have experienced considerable challenges and stress during the COVID-19 pandemic, which may impact their well-being. This meta-analysis sought to identify: (1) the prevalence of depression and anxiety in parents of young children ( Collapse

Key Words

• Angs
• COVID-19
• Depression
• Mütter
• ansiedad
• anxiety
• anxiété
• depresión
• depression
• dépression
• madres
• maternal mental health
• mères
• psychische Gesundheit
• salud mental
• santé mentale
• young children
• الكلمات الأساسية: كوفيد-19، الصحة النفسية ، الأمهات ، الاكتئاب ، القلق
• キーワード:COVID-19、メンタルヘルス、母親、抑うつ、不安
• 关键词:2019冠状病毒病
• 心理健康
• 抑郁
• 母亲
• 焦虑

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MESH Headings

• Anxiety/epidemiology
• COVID-19
• Child
• Child, Preschool
• Depression/epidemiology
• Female
• Humans
• Mental Health
• Mothers
• Pandemics
• Prevalence
• SARS-CoV-2

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Grants Collapse

Affiliation(s)

Nicole Racine Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada
Rachel Eirich Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada
Jessica Cooke Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada
Jenney Zhu Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada
Paolo Pador Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada
Nicole Dunnewold Health Sciences LibraryLibraries and Cultural ResourcesUniversity of CalgaryCalgaryAlbertaCanada
Sheri Madigan Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada

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The Roles of Mothers' Perceptions of Grandmothers' Gatekeeping and Fathers' Parenting Competence in Maternal Gatekeeping

OBJECTIVE

This study investigated how new mothers' perceptions of maternal grandmothers' gatekeeping behaviors and perceptions of fathers' parenting competence are associated with maternal gatekeeping behaviors.

BACKGROUND

In the development of coparenting relationships at the transition to parenthood, the roles of extended family members, although important, have received little research attention. Grandmothers' gatekeeping may serve as a reference for maternal gatekeeping behaviors, but its role depends on mothers' own perceptions of fathers' parenting competence.

METHOD

Mothers from 172 dual-earner, different-gender couples reported their own mothers' gatekeeping behaviors and their own perceptions of fathers' parenting competence at 3 months postpartum. Maternal gatekeeping behaviors toward fathers were reported by mothers at both 3 and 9 months postpartum.

RESULTS

When mothers perceived that maternal grandmothers engaged in higher levels of gatekeeping behaviors, mothers engaged in more gate-opening behaviors but only when mothers perceived fathers as highly competent. There were no significant associations between mothers' perceptions of grandmothers' gatekeeping and maternal gate-closing behaviors.

CONCLUSION

Adult mothers, who likely have developed their own sets of ideas about parenting, are still susceptible to support and criticism from their own mothers.

IMPLICATIONS

Practitioners would do well to encourage expectant and new parents to consider the role of extended family in the development of their coparenting relationships, and to develop plans for support-seeking, boundary management, and negotiation of conflicts. To help reduce maternal gate-closing and enhance maternal gate-opening behaviors, practitioners could support fathers' development of parenting skills and help mothers develop awareness of fathers' skills.

Association of child's disability status with father's health outcomes in Japan

Fathers' involvement in childcare has been increasing in recent years. However, very little is known about the health impact on fathers when they are caring for or living with a disabled child. This study aims to understand the psychological distress and subjective health outcomes among fathers living with a disabled child compared to fathers living without a disabled child. Data for this study were obtained from the Comprehensive Survey of the Living Conditions conducted by the Ministry of Health, Labour and Welfare in 2016. Multivariable logistic regression was used among 438 disabled-child and father dyads and 27,682 non-disabled-child and father dyads to analyse the association between a child's disability status with father's health outcomes. Fathers of disabled children had a higher prevalence of psychological distress (17% vs. 12%) and poor subjective health status (13% vs. 8%) than fathers of non-disabled children. A large proportion of disabled children were boys (70%) and had disability level 1 (47%). After adjusting for covariates, the odds ratio (OR) of having psychological distress (OR, 1.53; 95% CI, 1.19–1.97) and poor subjective health status (OR, 1.78; 95% CI, 1.34–2.36) among fathers of disabled children is significantly higher compared to fathers of non-disabled children. Unemployed fathers had a higher odds ratio of psychological distress (OR, 3.07; 95% CI, 2.49–3.79) and poor subjective health status (OR, 4.90; 95% CI, 3.95–6.09) compared to regular working fathers. Fathers of children with disabilities need greater physical and mental health and wellbeing support. They should be provided with additional support not just for their mental but also their subjective wellbeing.

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Fathers of disabled children have higher odds ratio of psychological distress.

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Fathers of disabled children have higher odds ratio of poor subjective health status.

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70% of disabled children were boys and 47% had mildest severity of disability.

US Parents' Acceptance of Learning About Mindfulness Practices for Parents and Children: National Cross-sectional Survey

BACKGROUND

Mindfulness practices are associated with improved health and well-being for children. Few studies have assessed parents' acceptance of learning about mindfulness practices.

OBJECTIVE

This study aims to assess parents' beliefs and interest in learning about mindfulness, including from their health care provider, and differences across demographic backgrounds.

METHODS

We conducted a national cross-sectional survey of parents with children aged 0-18 years in October 2018. Measures included beliefs and interest in learning about mindfulness. These measures were compared across demographic backgrounds using chi-square analysis. Multivariate linear and logistic regression analyses were used to perform adjusted comparisons between demographic backgrounds.

RESULTS

Participants (N=3000) were 87% (n=2621) female and 82.5% (n=2466) Caucasian. Most (n=1913, 64.2%) reported beliefs that mindfulness can be beneficial when parenting, 56.4% (n=1595) showed interest in learning about mindfulness to help their child stay healthy, and 40.8% (n=1214) reported interest in learning about mindfulness from their health care provider. Parents with a college degree 49.6% (n=444) were more likely to report interest in learning about mindfulness from a health care provider compared to those without 37.1% (n=768; P<.001). Parents interested in learning about mindfulness were more likely to be male 62.6% (n=223; P<.001). There was no significant difference in interest in learning about mindfulness from a health care provider based on race.

CONCLUSIONS

This study indicates that many parents believe mindfulness can be beneficial while parenting and are interested in learning how mindfulness could help their child stay healthy. Findings suggest there is an opportunity to educate families about mindfulness practices.