Life after paediatric brain tumour; the perspectives of the survivors and their parents

AIMS

To explore how long-term and late effects of paediatric brain tumours influence the everyday lives of survivors at various ages and their parents.

DESIGN

A qualitative interview study using reflexive thematic analysis.

METHODS

We conducted individual interviews and focus groups with 14 paediatric brain tumour survivors aged 9-52 years and 16 parents, which were audiorecorded and transcribed. We inductively analyzed the data using Braun and Clarke's reflexive thematic analysis. Inductively derived themes were then mapped onto the components of the International Classification of Functioning, Disability and Health framework to examine the survivors' everyday functioning.

RESULTS

All survivors experienced ongoing long-term and late effects but with considerable variations in how these restricted the survivors' functioning and thus their ability to participate in everyday life activities (e.g. social, educational and work activities). All survivors expressed an explicit focus on and use of different strategies to manage their perceived functional limitations and participation restrictions. Many survivors expressed discrepancies between their own goals, expectations and actual abilities post-cancer; making them very aware of their limitations. In addition, many survivors and parents experienced ongoing concerns about the survivors' future, including the risk of late effects, relapse or other complications.

CONCLUSION

A wide range of long-term and late effects continue to affect the survivors and their parents' functioning and everyday lives. Their ongoing needs emphasize the importance of comprehensive, life-long follow-up care, as recommended.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The complex challenges across the biopsychosocial realms faced by the survivors supports the call for multidisciplinary survivorship care. Nurses are well positioned to lead such care, as they are trained to provide holistic care and thereby support survivors' functioning and activity participation in everyday life.

REPORTING METHOD

We used the COREQ guidelines when reporting the study.

PATIENT OR PUBLIC CONTRIBUTION

Two user representatives (one young adult PBT survivor and one mother of a PBT survivor) ensured the relevance and quality of the semi-structured interview guides prior to the interviews with the survivors and parents. The guides were sent to the user representatives by mail, and they provided their written feedback by mail to the first author.

Sick child's feeding practices and associated factors among mothers with sick children aged less than 2 years in Gamo zone, southern Ethiopia. Does the participation of fathers contribute to improving nutrition? A facility-based cross-sectional study

Background

Children's nutritional status can decline rapidly during or after a common childhood illness unless additional nutritional requirements associated with the illness are considered. Therefore, this study was aimed at assessing a sick child's feeding practices and associated factors among mothers who have sick children under 2 years of age in southern Ethiopia.

Methods

A facility-based cross-sectional study design was employed from 1 April 2022 to 30 April 2022. Data were collected through the questionnaire, entered into an open data kit (ODK), and exported into Statistical Packages for Social Sciences (SPSS) version 25.0 for analysis. A systematic random sampling technique was used to select study participants. Bivariable and multivariable logistic regression analyses were used to identify factors associated with sick child feeding practices. An adjusted odds ratio (AOR) with 95% confidence intervals (CIs) was used to determine the strength of the association. Statistical significance was declared at a p-value of <0.05.

Results

The overall magnitude of mothers' good sick child feeding practices was determined to be 45.0% (95% CI: 41.03, 48.97%). Being urban residents, being employed, having antenatal care (ANC) visits, having postnatal care (PNC) visits, counseling about child feeding, and fathers' involvement in sick child feeding increased the likelihood of sick child feeding practices by 4.4, 2.10, 2.31, 3.54, 2.11, and 2.54 times, respectively.

Conclusion

Sick child feeding practices were associated with having antenatal or postnatal visits, counseling about child feeding, and fathers' involvement in sick child feeding practices. Therefore, strengthening infant and young child feeding practices by showing special concern for the father's involvement is important to improve mothers' sick child feeding practices.

Impact of Low Birth Weight on the Prevalence and Economic Burden of Common Childhood Illnesses Among Under-Five Children in India: Findings From Nationally Representative Surveys

Background Common childhood illnesses such as diarrhea, fever, and acute respiratory infection impose substantial health burdens among under-five children, and Low Birth Weight (LBW) has been associated with an increased prevalence of these illnesses. However, the impact of LBW on healthcare utilization and the economic burden of these illnesses remains understudied. Aim To assess the impact of LBW on the prevalence, healthcare utilization, and Out of Pocket Expenditure (OOPE) for outpatient (OP) treatment of selected Common Childhood Illnesses (CCHI) among under-five children in India. Methodology This study utilized data from two nationally representative surveys conducted in India; National Family Health Survey (NFHS-5) (2019-2021) and the National Sample Survey Organization (NSSO) 75th Round Schedule Social Consumption: Health (2017-2018). Data from the NFHS-5 was analyzed to assess the impact of LBW on the prevalence of selected CCHI and healthcare utilization. Comparison of OOPE for OP treatment of selected CCHI between LBW and Normal Birth Weight (NBW) children done using the median OOPE for OP visits of CCHI estimated from the NSSO data. Results The two-week prevalence of selected CCHI among LBW and NBW children was found to be 20.0% (95% CI 19.6 -20.4) and 18.0% (95% CI 17.8 -18.2), respectively. There was no significant difference between LBW and NBW children on healthcare utilization for the treatment of CCHI; both groups had a similar proportion (around 70%) of formal medical treatment utilization for CCHI. The median OOPE spending for OP visits per episode of CCHI was comparable between LBW and NBW children. However, families of LBW children had higher annual OOPE spending for OP visits related to CCHI, with projected estimates of INR 1,446 ($19.56) for LBW children and INR 1,271 ($17.2) for NBW children. Conclusion LBW was associated with a higher prevalence of CCHI. Even though healthcare utilization was similar among LBW and NBW children, a higher prevalence of CCHI among LBW children led to higher OOPE. LBW children have approximately 13% higher annual OOPE spending for the OP visits related to selected CCHI compared to NBW children.

Changing bodies: A scoping review and thematic analysis of family experience during serious childhood illness

This scoping review has investigated experiences of children and parents encountering in-patient treatment for serious childhood illness, including current or potential use of technology as a support mechanism. The research questions were 1. What do children experience during illness and treatment? 2. What do parents experience when their child is seriously ill in hospital? 3. What tech and non-tech interventions support children's experience of in-patient care? The research team identified n = 22 relevant studies for review through JSTOR, Web of Science, SCOPUS and Science Direct. A thematic analysis of reviewed studies identified three key themes reflecting our research questions: Children in hospital, Parents and their children, and Information and technology. Our findings reflect that information giving, kindness and play are central in hospital experiences. Parent and child needs in hospital are interwoven and under researched. Children reveal themselves as active producers of pseudo-safe spaces who continue to prioritise normal child and adolescent experiences during in-patient care.

A multilevel analysis of factors associated with vitamin A supplementation among children aged 6-35 months in Ethiopia

Background

Vitamin A deficiency is among the leading preventable causes of childhood morbidity and mortality that might be attributable to the low uptake of vitamin A supplementation (VAS). Factors contributing to its low utilization are not researched at the national level and with the appropriate model. Therefore, this study aimed at identifying the magnitude and the individual- and community-level factors associated with vitamin A supplementation among children aged 6-35 months in Ethiopia.

Methods

We have used the Ethiopian mini demographic and health survey data, which was conducted from 21 March to 28 June 2019. A weighted sum of 2,362 mothers having children aged 6-35 was extracted. Considering the hierarchical nature of the data, we fitted the multilevel multivariable logistic regression model. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported and variables with a p-value of < 0.05 were declared to be significantly associated factors.

Results

In this study, 43.4% (95% CI: 41.4-45.4%) of children have taken the VAS. Moreover, the 12-23 age of the child (AOR = 2.64; 95% CI: 1.88-3.72), 30-34 age of the mother (AOR = 3.34; 95% CI: 1.21-9.20), middle household wealth status (AOR = 1.75; 95% CI: 1.06-2.90), and four and above antenatal care (AOR = 2.90; 95% CI: 1.90-4.43) are the individual-level factors associated with VAS whereas being from Amhara (AOR = 2.20; 95% CI: 1.29-3.76) and Tigray (AOR = 2.16; 95% CI: 1.17-3.98) regions is a community-level factor significantly associated with the uptake of VAS.

Conclusion

Overall, a low proportion of children have taken the VAS in Ethiopia. The higher age of the child and mother, full antenatal care, and improved wealth status positively influence VAS. Moreover, a child from the Tigray or Amhara regions was more likely to get VAS. Therefore, an intervention has to be designed to address the VAS uptake among young mothers, and working to improve the wealth status of the household would be helpful. Moreover, the advocacy of antenatal care and minimizing the regional disparity through encouraging the uptake in the rest of the regions would help increase the national-level uptake of VAS.

Outcomes of a pilot evaluation of a group urotherapy programme for children with complex elimination disorders: An Australian experience

Evidence-based interventions have continued to show positive effects on both reducing symptoms and helping children with elimination disorders achieve continence and manage troubling psychological distress. Despite this, there is a group of children who do not respond to standard treatments and are classified as having a complex elimination disorder. As a means of addressing the broader clinical challenge and implications of complex elimination disorders, a team of clinicians in Germany developed the Urinary and Faecal Incontinence Training Program for Children and Adolescents. A pilot investigation was undertaken to apply the Urinary and Faecal Incontinence Training Program for Children and Adolescents programme to children aged 6-12 years in an Australian context who met the complex elimination disorder diagnostic criteria, to determine if any subsequent change in the measures of life quality and general well-being was achieved. Findings suggest a reduction in the frequency of the child's symptoms and improvements in family quality of life measures. Qualitatively, children and parents perceived that their child's ability to now respond to stimuli and in so doing avert severe accidents was a major outcome of the programme and was able to increase a child's sense of acceptance of incontinence, improve levels of self-efficacy and increase self-awareness.

Prevalence of pneumonia and its determinant factors among under-five children in Gamo Zone, southern Ethiopia, 2021

BACKGROUND

Pneumonia, which is a form of acute lower respiratory tract infection, affects the lung parenchyma and destructs alveolar air space. Pneumonia is the leading cause of morbidity and mortality in under-five children. It was estimated that pneumonia kills 900,000 under-five children each year worldwide. Approximately 172 deaths per 1,000 live births occur in sub-Saharan African countries, with pneumonia being the major cause. This study aimed to assess the prevalence and determinant factors of pneumonia inunder-five children in southern Ethiopia.

METHODOLOGY

An institutional cross-sectional study was employed. A total of 239 child-caregiver pairs were included. Data were collected by trained nurses using a semi-structured questionnaire. The collected data were checked for completeness, coded and entered into EPI data version 4.6, and exported to SPSS version 25 for analysis. Results were reported as the mean, frequency, and percentile. Logistic regression was employed to assess statistically significant predictors of pneumonia. Variables with a p-value <0.05 were considered statistically significant factors of pneumonia.

RESULT

The prevalence of pneumonia in the study area was 30%. Among the factors assessed, place of food cooking-inside the living room [adjusted odd ratio (AOR) = 5.79, 95% confidence interval (CI): 2.47-13.58], nonexclusive breastfeeding (AOR = 3.26, 95% CI: 1.42-7.52), vitamin A supplementation status (AOR = 5.62, 95% CI: 2.65-11.94), and vaccination status (AOR = 3.59, 95% CI: 1.49-8.66) were significantly associated with the occurrence of pneumonia in under-five children.

CONCLUSION

This study showed that the prevalence of pneumonia was relatively higher in Arba Minch town than other parts of the country. Place of food cooking, nonexclusive breastfeeding, vitamin A supplementation status, and vaccination status of children were significant factors of pneumonia among under-five children. Enhancing caregivers'/mothers' awareness of predicted factors was needed to reduce the incidence of childhood pneumonia and to enhance children's quality of health.

Housing conditions as predictors of common childhood illness: Evidence from Nigeria Demographic and Health Surveys, 2008-2018

Several studies have examined the impacts of water, sanitation, hygiene, and general housing conditions on childhood health in developing countries. However, up-to-date knowledge and change pattern in common childhood illness prevalence over time are scarce in Nigeria. To contribute toward meeting the Sustainable Development Goals three and six, we used pooled data (N = 94,053) from the Nigeria Demographic Health Surveys from 2008 to 2018 to examine the trend and determinants of four childhood illnesses: diarrhea, fever, cough, and respiratory infection. Multivariate logistic regression was used to estimate the determinants of the four health outcomes. Our results indicate that between 2008 and 2018, the prevalence of childhood diarrhea, cough, and fever slowly declined. However, there was a drastic decline in childhood-related respiratory illness. Housing conditions, sanitation facilities, and water sources were significantly associated with childhood illness based on the logistic regression analysis. Based on our findings, we recommend general improvement in housing conditions that can eradicate childhood cough, fever, and respiratory infections.

Impact of Digital Educational Interventions to Support Parents Caring for Acutely Ill Children at Home and Factors That Affect Their Use: Protocol for a Systematic Review

Background

Urgent and emergency care health services are overburdened, and the use of these services by acutely ill infants and children is increasing. A large proportion of these visits could be sufficiently addressed by other health care professionals. Uncertainty about the severity of a child’s symptoms is one of many factors that play a role in parents’ decisions to take their children to emergency services, demonstrating the need for improved support for health literacy. Digital interventions are a potential tool to improve parents’ knowledge, confidence, and self-efficacy at managing acute childhood illness. However, existing systematic reviews related to this topic need to be updated and expanded to provide a contemporary review of the impact, usability, and limitations of these solutions.

Objective

The purpose of this systematic review protocol is to present the method for an evaluation of the impact, usability, and limitations of different types of digital educational interventions to support parents caring for acutely ill children at home.

Methods

The review will be structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and Population, Intervention, Comparator, and Outcome (PICO) frameworks. Five databases will be systematically searched for studies published in English during and after 2014: Medline, EMBASE, CINAHL, APA PsycNet, and Web of Science. Two reviewers will independently screen references’ titles and abstracts, select studies for inclusion based on the eligibility criteria, and extract the data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer if necessary. Risk of bias of all studies will be assessed using the Mixed-Methods Appraisal Tool (MMAT), and a descriptive analysis will be used to evaluate the outcomes reported.

Results

The systematic review will commence during 2021.

Conclusions

This systematic review will summarize the impact, usability, and limitations of digital interventions for parents with acutely ill children. It will provide an overview of the field; identify reported impacts on health and behavioral outcomes as well as parental knowledge, satisfaction, and decision making; and identify the factors that affect use to help inform the development of more effective and sustainable interventions.

International Registered Report Identifier (IRRID)

PRR1-10.2196/27504

Examining the expectations of healing care environment of hospitalized children with cancer based on Watson's theory of human caring

AIM

To describe the expectations of children with cancer about the healing care environment during hospitalization based on Watson's Theory of Human Caring.

DESIGN

A descriptive qualitative research design was used in this study.

METHODS

Data were collected between December 2019 and February 2020 from purposively selected children with cancer in a paediatric haematology and oncology clinic at a university hospital in Turkey. Twelve participants (7 females and 5 males) aged 10-17 were recruited to carry out individual semi-structured interviews. All interviews were recorded via a digital audio recorder and transcribed verbatim. The content analysis method was used to analyse the data.

FINDINGS

As a result of the analysis, three main themes with related sub-themes were identified that revealed the expectations of children with cancer: 'healing care behaviors', 'creating the physical environment of the hospital' and 'support from the social environment'.

CONCLUSION

Watson's Theory of Human Caring may be a useful and applicable guide for drawing a conceptual framework of the expectations of children with cancer regarding a healing care environment. The study revealed these children's need for humanistic, compassionate, honest and problem-focused care. In addition, participants wished for improvements in the physical environment. They also stated that they feel lonely and need social support from their family, peers and society.

IMPACT

This study presents a comprehensive picture of the expectations regarding a healing care environment (caring behaviours and physical and social aspects) of hospitalized children with cancer undergoing treatment. The qualitative findings generated by our study have the potential to facilitate these children's healthy adjustment to the hospital environment and procedures during hospitalization. Knowledge acquired through this study may be used to shape nursing care, enhance the healing care environment, and ensure that hospital design and setting are acceptable to and appropriate for paediatric patients.

Childhood infectious diseases and old age cognitive functioning: a nationally representative sample of community-dwelling older adults

BACKGROUND

Cumulative evidence suggests that health-related risk factors during midlife and old-age are associated with cognitive impairment. However, studies are needed to clarify the association between early-life risk factors and impaired cognitive functioning to increment existing knowledge.

OBJECTIVE

To examine the association between childhood infectious diseases and late-life cognitive functioning in a nationally representative sample of older adults.

PARTICIPANTS

Eligible respondents were 2994 community-dwelling individuals aged 65-85.

MEASUREMENTS

Cognitive functioning was assessed using the Mini-Mental State Examination (MMSE). Childhood infectious diseases (i.e. chicken pox, measles, and mumps) were self-reported. The study covariates were age, sex, highest educational level achieved, smoking status, body mass index, and depression. The primary statistical analysis examined the association between the number of childhood infectious diseases and total MMSE scores, accounting for all study covariates. Regression models of progressive complexity were examined for parsimony. The robustness of the primary results was tested in 17 sensitivity analyses.

RESULTS

The most parsimonious model was a linear adjusted model (Bayesian Information Criterion = 12646.09). Late-life cognitive functioning significantly improved as the number of childhood infectious diseases increased (β = 0.18; 95% CI = 0.11, 0.26; p < 0.001). This effect was not significantly attenuated in all sensitivity analyses.

CONCLUSION

The current study results are consistent with prior ecological findings indicating that some childhood infectious diseases are associated with better cognitive functioning in old-age. This points to an early-life modifiable risk factor associated with older-life cognitive functioning. Our results may reflect selective mortality and/or beneficial effects via hormetic processes.

Back to school with telepresence robot technology: A qualitative pilot study about how telepresence robots help school-aged children and adolescents with cancer to remain socially and academically connected with their school classes during treatment

Aim

To explore how an AV1 telepresence robot helps school-aged children and adolescents with cancer to remain socially and academically connected with their school classes during cancer treatment.

Design

Qualitative pilot study.

Methods

Data were collected through semi-structured interviews with school-aged children and adolescents (N = 3, 12-14 years) diagnosed with cancer, their parents (N = 3), teachers (N = 2), classmates (12-14 years, N = 15, focus group interviews) and healthcare professionals (N = 4). Participant observation was performed in the child or adolescents' homes and in the classrooms during education participation via an AV1 telepresence robot.

Results

Five themes emerged: expectations, sociality, learning, spatiality and technology. Participants experienced the robots as facilitating social interaction processes with classmates and inclusion in learning activities, reducing their sense of loneliness and lacking behind educationally. Nevertheless, multiple factors determine whether the robot is perceived as exclusive, including the technical functionality of the robot, spatiality in the classroom and mutual expectations of the parties involved.

Key challenges of health care workers in implementing the integrated management of childhood illnesses (IMCI) program: a scoping review

Background: Several evaluative studies demonstrate that a well-coordinated Integrated Management of Childhood Illnesses (IMCI) program can reduce child mortality. However, there is dearth of information on how frontline providers perceive IMCI and how, in their view, the program is implemented and how it could be refined and revitalized.Purpose: To determine the key challenges affecting IMCI implementation from the perspective of health care workers (HCWs) in primary health care facilities.Methods: A scoping review based on the five-step framework of Arskey and O'Malley was utilized to identify key challenges faced by HCWs implementing the IMCI program in primary health care facilities. A comprehensive search of peer-reviewed literature through PubMed, ScienceDirect, EBSCOhost and Google Scholar was conducted. A total of 1,475 publications were screened for eligibility and 41 publications identified for full-text evaluation. Twenty-four (24) published articles met our inclusion criteria, and were investigated to tease out common themes related to challenges of HCWs in terms of implementing the IMCI program.Results: Four key challenges emerged from our analysis: 1) Insufficient financial resources to fund program activities, 2) Lack of training, mentoring and supervision from the tertiary level, 3) Length of time required for effective and meaningful IMCI consultations conflicts with competing demands and 4) Lack of planning and coordination between policy makers and implementers resulting in ambiguity of roles and accountability. Although the IMCI program can provide substantial benefits, more information is still needed regarding implementation processes and acceptability in primary health care settings.Conclusion: Recognizing and understanding insights of those enacting health programs such as IMCI can spark meaningful strategic recommendations to improve IMCI program effectiveness. This review suggests four domains that merit consideration in the context of efforts to scale and expand IMCI programs.

Strengthening nutrition services within integrated community case management (iCCM) of childhood illnesses in the Democratic Republic of Congo: Evidence to guide implementation

In the Democratic Republic of Congo, 43% of children under 5 years of age suffer from stunting, and the majority (60%) of children, 6–59 months of age, are anaemic. Malaria, acute respiratory infections, and diarrheal diseases are common among children less than 5 years of age, with 31% of children 6–59 months affected by malaria. This qualitative implementation science study aimed to identify gaps and opportunities available to strengthen service delivery of nutrition within integrated community case management (iCCM) at the health facility and community level in Tshopo Province, Democratic Republic of Congo, through the following objectives: (a) examine cultural beliefs and perceptions of infant and young child feeding (IYCF) and child illness, (b) explore the perspectives and knowledge of facility‐based and community‐based health providers on nutrition and iCCM, and (c) gain an understanding of the influence of key family and community members on IYCF and care‐seeking practices. This study involved in‐depth interviews with mothers of children under 5 years of age (n = 48), grandmothers (n = 20), fathers (n = 21), facility‐based providers (n = 18), and traditional healers (n = 20) and eight focus group discussions with community health workers. Study findings reveal most mothers reported diminished quantity and quality of breastmilk linked to child/maternal illness, inadequate maternal diet, and feedings spaced too far apart. Mothers' return to work in the field led to early introduction of foods prior to 6 months of age, impeding exclusive breastfeeding. Moreover, children's diets are largely limited in frequency and diversity with small quantities of foods fed. Most families seek modern and traditional medicine to remedy child illness, dependent on type of disease, its severity, and cost. Traditional healers are the preferred source of information for families on certain child illnesses and breastmilk insufficiency. Community health workers often refer and accompany families to the health centre, yet are underutilized for nutrition counselling, which is infrequently given. Programme recommendations are to strengthen health provider capacity to counsel on IYCF and iCCM while equipping health workers with updated social and behavior change communication (SBCC) materials and continued supportive supervision. In addition, targeting key influencers to encourage optimal IYCF practices is needed through community and mother support groups. Finally, exploring innovative ways to work with traditional healers, to facilitate referrals for sick/malnourished children and provide simple nutrition advice for certain practices (i.e., breastfeeding), would aid in strengthening nutrition within iCCM.

Staff and Parent Perspectives on a Therapeutic Recreation-Based Bereavement Camp for Families Whose Child Has Died From Serious Illness

This study explores the nature of a therapeutic recreation-based bereavement camp for families whose child has died from serious illness. Open-ended surveys and interviews were conducted with parents attending a three-camp cycle over a 12-month period or a reunion camp. Thirteen parents completed open-ended surveys before and after each camp and six of these also completed interviews after the final camp. Six additional parents completed interviews after the reunion camp. Six staff working with families during the camps were also interviewed. Content analysis of surveys and thematic analysis of interviews revealed the aims, structure, and content of the camp. The findings suggest a model whereby shared experience allows for normalization and offers a nonjudgmental place to share stories, discuss difficulties come together as a family, and create a support network. These findings highlight the value of therapeutic recreation-based bereavement interventions for families whose child has died from serious illness.

The Role of Felt or Enacted Criticism in Parents' Decision Making in Differing Contexts and Communities: Toward a Formal Grounded Theory

Felt or enacted criticism was identified as a significant influence on White British parents' decision making during acute childhood illness in a substantive grounded theory "Containing acute childhood illness within family life." These parents sought to avoid further criticism, sometimes leading to delayed consultation. Using Glaserian grounded theory principles, we conducted a secondary analysis of data from three studies, to establish the transferability and modifiability of the original theory to other settings and communities in Ireland and England. Felt or enacted criticism was found to operate across the childhood age range, social groups, and settings. Parent's strategies to avoid criticism reduced contacts with health professionals, access to support and, more worryingly, communication about their child's health. These findings demonstrate the wider applicability, or "work" in Glaser's terms, of the concept in the English speaking Western world. Findings indicate the need for nurses to identify and mitigate sources of criticism.

"There's no acknowledgement of what this does to people": A qualitative exploration of mental health among parents of children with critical congenital heart defects

AIMS AND OBJECTIVES

The purpose of this study was to explore the psychological impact of parenting a child with a critical congenital heart defect and the feasibility and acceptability of integrating psychological services into paediatric cardiology care.

BACKGROUND

Children with critical congenital heart defect are at an increased risk for long-term behavioural, social and emotional difficulties. Data suggest that this risk is partially attributable to parental mental health, which is a stronger predictor of long-term behavioural problems in congenital heart defect children than disease-specific and surgical factors. Parental stress and mental health are thus important intervention targets, especially among high-risk families.

DESIGN

This article presents data from a qualitative study with 25 congenital heart defect parents (n = 15) and providers (n = 10).

METHODS

Using thematic analysis, semi-structured in-depth interviews were transcribed and coded by the first and second author to identify major themes and subthemes.

RESULTS

Results of the interviews were organised into four major themes: (i) the psychological impact of parenting a child with critical congenital heart defect, (ii) factors that influence the psychological impact of parenting a child with critical congenital heart defect, (iii) how and when to psychologically support congenital heart defect parents and (iv) feasibility and acceptability of integrating psychological support into congenital heart defect care. Providers and parents endorsed the integration of mental health treatment into routine congenital heart defect care and identified several practical issues related to feasibility (e.g., funding and space) that should be considered prior to implementation.

CONCLUSIONS

Parents of children with critical congenital heart defect need access to mental health services, and integrating these services into routine paediatric cardiology care is a novel and practical way for parents to receive the treatment they need.

RELEVANCE TO CLINICAL PRACTICE

Suggestions for how the field of paediatric cardiology could begin to integrate mental health services into congenital heart defect treatment are provided.

An exploration of co-parenting in the context of caring for a child prenatally diagnosed and born with a complex health condition

AIM

The aim of this study was to describe co-parenting communication in couples in the context of caregiving for children prenatally diagnosed and born with complex health conditions.

BACKGROUND

Foetal diagnosis of complex health conditions such as heart, central nervous system, or abdominal anomalies are confirmed more often than ever before. Following diagnosis, parents face challenges beginning before birth. The quality of co-parenting, when two individuals relate to each other as parents and share parental responsibilities, can have an impact on child health and development. Yet, little is known about co-parenting during the transition to parenthood after foetal diagnosis.

DESIGN

This secondary analysis of interview data was informed by Bowlby's theoretical work on a parent's view of self as caregiver and the literature on co-parenting.

METHODS

Data were drawn from a larger, mixed methods, longitudinal study and included audio-recorded interviews conducted with 16 parents participating as eight couples after foetal diagnosis during the third trimester of pregnancy in 2011-2012 and again when children were 14-37 months old in 2014. Analysis of interviews transcribed verbatim focused on co-parenting communication.

FINDINGS

Co-parenting communication regarding support, agreement and information sharing and a new category of shared meaning were related to the diagnosis before birth. Later, couples evolved in their co-parenting communication while caring for their toddlers and working towards achieving a sense of normalcy.

CONCLUSION

Variation in co-parenting communication among couples preparing and caring for children with complex health conditions, including the development of a shared meaning of the child's diagnosis, needs further investigation to inform nursing assessment and guide tailored interventions.

"Those who care much, understand much." Maternal perceptions of children's appetite: Perspectives from urban and rural caregivers of diverse parenting experience in Bangladesh

Appetite in children is an important determinant of nutritional intake and growth. The information used by caregivers to understand children's appetite can help inform infant and young child feeding promotion and appetite assessment. We conducted a qualitative study to (a) explore maternal perceptions and responses to children's appetite and (b) to identify how these factors differ by type of caregiver, level of maternal experience, and urban versus rural context. We used purposive sampling to recruit mothers and alternate caregivers into 14 total focus group discussions (six to eight participants in each group; N = 95) in both urban and rural settings in Bangladesh. To understand children's appetite, caregivers monitor children's dietary patterns, emotional signs, and physical and verbal cues. Healthy appetite was observed by willingness to eat diverse foods, finish offered portions, and by acceptance of foods without excessive prompting. Child illness was cited for a cause of low appetite, which was manifested through fussiness, and avoiding commonly consumed foods. Mothers described a limited set of feeding practices (offering diverse foods, playing, and cheering children with videos) to encourage consumption when children lacked appetite. Mothers' stress related to work was noted as a barrier to identifying appetite cues. Urban mothers described a lower access to instrumental social support for child feeding but informational support than mothers in the rural setting. Understanding caregivers' perceptions of children's appetite may inform strategies to improve responsive feeding and tool development to assess changes in appetite as early indicators of change in health or nutrition status among high-risk children.

Family Psychosocial Risk Screening in Infants and Older Children in the Acute Pediatric Hospital Setting Using the Psychosocial Assessment Tool

OBJECTIVE

To examine the validity of the Psychosocial Assessment Tool (PAT) with families of infants (<2 years) and children admitted to hospital with acute life-threatening illnesses.

METHODS

A total of 235 parents of 177 children admitted to oncology, cardiology, or pediatric intensive care completed the PAT and measures of acute stress, trait anxiety, family functioning, and quality of life, a mean 3.7 weeks following diagnosis. A modified PAT was used for families of infants, rendering two forms, PAT (<2) and PAT (2+).

RESULTS

Psychometrics for PAT (<2) and PAT (2+) were acceptable. PAT Total and Subscale scores for each version were significantly correlated with validation measures. Internal consistency for PAT subscales was variable. Receiver Operating Characteristics provided some support for PAT cutoffs. PAT scores across illness groups were comparable.

CONCLUSIONS

This study provides promising support for the PAT as a psychosocial screener for families of infants and older children across illness conditions.

Parenting interventions for childhood chronic illness: a review and recommendations for intervention design and delivery

Every day, thousands of children suffer the effects of chronic health conditions and families struggle with illness management and children's behavioural and emotional adjustment. Many parents experience difficulties with their caregiving role and lack confidence in their ability to manage their child's illness and ensure the child's well-being. While there is consistent evidence as to the extent and impact of childhood chronic illness, there is a paucity of evidence-based parenting approaches to help children with chronic health conditions and their families. This paper provides a narrative review of the current literature to examine relationships between chronic childhood illness, emotional and behavioural disorders and parenting. Key guidelines and recommendations for the development of evidence-based parenting programs for parents of children affected by chronic health conditions are provided.

Management of children's fever by parents and caregivers: Practical measurement of functional health literacy

Functional health literacy is founded on general and numerical literacy and practical skills and is required for the appropriate and effective management of health symptoms in children. This study aimed to assess the health literacy skills of parents and caregivers of preschool-aged children, using a progressive scenario describing a child with fever and presenting tasks relating to selection of a medicine and hypothetical dosing of their child. Participants (n = 417) from 33 childcare- and health-related sites in Sydney, Brisbane, Melbourne and Auckland completed the study. Participants' responses were largely appropriate regarding actions in response to worsening symptoms, selection of an appropriate product (from a limited range), whereby 84.5% of responses were for a single-ingredient paracetamol product and use of the package directions to state the frequency of dosing (93.1% of frequencies appropriate for paracetamol and 66.7% for ibuprofen). However, in only 50.8% of cases was an appropriate weight-based dose calculated, and doses were not measured to within 10% of the stated dose in 16.7% of cases. Future studies should focus on skill development via educational campaigns for parents and caregivers.

Beliefs regarding diet during childhood illness

Background:

Fifty percent to 70% of the burden of childhood diarrhea and respiratory infections is attributable to undernutrition. It is compounded by food restriction during illness due to false beliefs, leading to a vicious cycle of malnutrition and infection. In the long run, it decreases the child's productivity, which is an obstacle to sustainable socioeconomic development.

Objectives:

To assess the dietary practices during different illnesses, to study the role of education, culture and religion in feeding an ill child and to create awareness against detrimental practices.

Materials and Methods:

A cross-sectional study was undertaken among 126 caregivers of ill children using an open-ended pretested questionnaire. Statistical package for social sciences software was used for data analysis. Simple proportions, percentages and Chi-square were used.

Results:

Caregivers believed that a child must be fed less during illness. Educational status did not play a role in maintaining beliefs, but elders and religion did. Doctors too were responsible for unwanted dietary restrictions. Media did not have an impact in spreading nutrition messages. Decreased breast feeds, initiating bottle feeds, feeding diluted milk and reducing complementary feeds during illness was widely practiced. Calorie intake during illness was very less and statistically significant. Firmly rooted beliefs about “hot” and “cold” foods lead to restriction of food available at home.

Conclusions:

Healthy feeding practices were few, and inappropriate ones predominant. Dietary education was overlooked. While planning community-based nutrition programs, firmly rooted beliefs should be kept in mind. Involving the elderly caregivers and mothers actively along with the health workers is the need of the hour.

Risk factors for under-nutrition among children aged one to five years in Udupi taluk of Karnataka, India: A case control study

BACKGROUND

Despite her apparent economic success, India is plagued by a high burden of under-nutrition among children under five. This study was aimed at understanding some of the risk factors for under-nutrition in a region with favourable maternal and child health indicators.

METHOD

A case control study was carried out among children aged one to five years attending the paediatric outpatient department in six rural health care centres in Udupi taluk of Karnataka in Southern India. A total of 162 children were included in the study, of which 56 were cases. A semi-structured questionnaire was used to interview the caregivers of the children and the nutritional status was graded according to the Indian Academy of Paediatrics (IAP) grading of protein-energy malnutrition.

RESULTS

Under-nutrition was associated with illness in the last one month [OR- 4.78 (CI: 1.83 -12.45)], feeding diluted milk [OR-14.26 (CI: 4.65 - 43.68)] and having more than two children with a birth interval ≤2 years [OR- 4.93 (CI: 1.78 - 13.61)]. Lack of exclusive breast feeding, level of education of the caregiver and environmental factors like source of water did not have an association.

CONCLUSION

Childhood illness, short birth interval and consumption of diluted milk were some of the significant contributory factors noted among this population. Information, Education, Communication (IEC) campaigns alleviating food fads and promoting birth spacing is needed.

A study to assess catastrophic household expenditure on childhood illness in an urban slum in bijapur

Objective:

In this study, the various factors determining the out-of-pocket expenditure on child health care by households are discussed to answer the following questions: How much are households currently spending on child health care? Is there any role of socio-economic status of households on expenditure on child health care? What percentage of their income is spent on child health care and is it catastrophic?

Materials and Methods:

Four slums with a total a population of 7000 were selected for this study. Households where there is history of illness/ sickness in children under 5 years in last one month were included in the study.

Results:

There were a total of 218 episodes of child illness in the households. The household's belonging to socio- economic class I and II had higher spending on child's illness per episode as compared to households of socio- economic class III, IV, and V. Socioeconomic status was the key determinant of health care expenditure.

Conclusion:

In this study, it has been found that almost all the households suffered from catastrophic health expenditure.