Journal of Child Health Care

Providing safe drinking water, sanitation and hygiene (WaSH) in geographically isolated settings is a global public health priority. Prevalence of WaSH practices among mothers and diarrhoea among their children (birth to 59 months) was studied in nine randomly selected tribal villages of Mokhada in Palghar, Maharashtra, India. A community-based cross-sectional survey among 577 mother–child pairs was performed. Participants were recruited from the anganwadi list of enrolled children through household visits. WaSH index was used for assessing WaSH practices. Well was the major (47%) drinking water source. Almost 70% treated and covered the stored drinking water. Nearly 75% of the mothers used soap for washing hands before food and 35% after defecation. Open drains and open defecation were observed in 99% and 50% of households, respectively. The median score for drinking water index was 3 (interquartile range (IQR) = 2), personal hygiene index (PHI) was 2 (IQR = 2), household hygiene index (HHI) was 2 (IQR = 1) and composite index (CI) was 6 (IQR = 2). Prevalence of diarrhoea among children was found to be 33.4% and was significantly associated with poor HHI (p = .007), PHI (p < .001) and CI (p < .001). Measures to provide basic WaSH resources combined with efforts to create awareness would ensure improved WaSH practices and prevent diarrhoea.

Aboriginal and Torres Strait Islander children experience a higher prevalence of disability and socio-economic disadvantage than other Australian children. Early intervention from across the health, education and social service sectors is vital for improving outcomes, but families face a number of barriers to service access which impede intervention. This study aimed to inform ways to improve access to services for families of urban-dwelling Aboriginal children with a range of disabilities. A qualitative approach was taken to explore providers’ perceptions of factors that either impeded or enabled families’ access to services. In this research, the term ‘provider’ refers to individuals who are employed in a range of sectors to deliver a service involving assessment or management of an individual with a disability. Semi-structured in-depth interviews with 24 providers were conducted. Data analysis was informed by the general inductive approach and then applied deductively to the candidacy framework to generate additional insights. Candidacy focuses on how potential users access the services they need and acknowledges the joint negotiation between families and providers regarding such access. Our research identified that candidacy was influenced by the historical legacy of colonisation and its ongoing socio-cultural impact on Aboriginal people, as well as funding and current policy directives. Enacting culturally sensitive and meaningful engagement to better understand families’ needs and preferences for support, as well as support for providers to develop their understanding of family contexts, will contribute to facilitating service access for Aboriginal children with a disability.

A prospective comparative study was conducted in 487 pediatric patients (69% male, mean age = 6.4 ± 4.0) to evaluate (a) the incidence, intensity, and characteristics of pain in pediatric patients at home during the first 24 hours and 5 days after surgery and (b) the factors associated with higher pain intensity, including the impact of an application (App) compared to the paper-and-pencil approach. Postoperative pain was assessed by patients or their parents at home using the ‘Bambino Gesù’ Children’s Hospital (Ospedale Pediatrico Bambino Gesù, OPBG) tool for participants aged 4–17 years or the Faces, Legs, Arms, Cry, and Consolability scale for participants less than four years old. Participants were assigned to two groups: those who used the paper-and-pencil version of the pain scale and those who used the App. Overall, 209 of the 472 (44%) participants reported pain during the first 24 hours, and 92 of the 420 (22%) reported pain between one and five days after surgery. Higher pain intensity scores were associated with being in the App group, directly assessing own pain, and using the OPBG tool. The App was effective in facilitating pain assessment. Health professionals could empower pediatric patients and their parents in assessing pain at home through a dedicated App.

Chronic pain in adolescents can be highly impairing. Parental reactions to their child’s pain are important factors influencing pain perception and pain-related impairment in children and adolescents. The present study aimed to examine parental accommodation of pain symptoms using the Inventory of Parent Accommodations of Children’s Symptoms (IPACS) to provide empirical support for the utility of this measure in parents of adolescents with chronic pain. We examined the prevalence, nature, and correlates of accommodation behaviors in 66 adolescents with chronic pain and their parents using the IPACS. All parents reported some level of accommodation of their child’s pain symptoms. After controlling for pain severity, parental accommodation was associated with functional impairment. In addition, parental accommodation mediated the link between parental catastrophizing reactions to pain and child impairment and between child anxiety and depressive symptoms and child impairment. The IPACS appears to be a useful measure of parental accommodation of pain. Parental accommodation should be included as an intervention target when necessary. It is important to educate families about the negative consequences that can be related to excessive accommodation of pain symptoms and to provide effective resources to manage the impact of chronic pain and replace accommodation with more adaptive pain coping strategies.

Youth with type 1 diabetes (T1DM) can face many challenges when adhering to their complex regimen in the context of their peer crowd. The aim of this study was to determine if peer crowd affiliation was associated with adolescents’ adherence behaviors, perceived peer support, and metabolic control. A sample of 128 adolescents with T1DM completed the Peer Crowd Questionnaire, Diabetes Social Support Questionnaire–Friends Version, and Self-Care Inventory–Revised, and HbA1c readings were collected during their clinic visit. Results from this study suggest that adherence behaviors mediated the relationship between Jock peer crowd affiliation and metabolic control. Results also suggested that perceived peer support did not mediate the relationship between peer crowd affiliation and metabolic control through adherence behaviors. When examining the path coefficients for the purposed models, results showed a positive relationship between adherence and metabolic control, and more perceived peer support was related to worse metabolic control. Adolescents who identified mostly with the Jock peer crowd may hold lifestyle values that are consistent with the diabetes regimen which may make their diabetes management easier. In general, adolescents with T1DM may have a more multifaceted aspect of one’s identity and therefore, their peer crowd affiliation is not as salient.

The aim of this study is to evaluate the associations between having parents with substance use problems, and having suffered neglect within the family, and behavioral problems (psychological and drug use) among adolescents. All the participants were enrolled on the socio-educational parole scheme, ‘Assisted Freedom’. In this cross-sectional study, 150 adolescents were interviewed using the Drug Abuse Screening Test, Teen Addiction Severity Index, and Childhood Trauma Questionnaire. Ninety-five percent of the participants were male (n = 143), aged 13–17. Thirty percent of adolescents had a parent who used substances and had experienced neglect from their families. Those adolescents who were living with both parents (odds ratio adjusted (ORA) = 2.7, 95% confidence interval (CI) = 1.13–6.37), from a low-income family (ORA = 6.7, 95% CI = 1.85–24.22), experienced hallucinations (ORA = 2.8, 95% CI = 1.25–6.14), had problems controlling violent behavior (ORA = 2.6, 95% CI = 1.12–5.87), and were physically neglected (ORA = 3.0, 95% CI = 1.24–7.49) were more likely to have parents who used substances and to have experienced parental neglect. This article concludes that adolescents, who are on parole, come from families with high level of psychosocial vulnerabilities, including substance use, experience neglect by their families leading to adverse emotional and psychological states.

Children’s long- and short-term health and developmental outcomes can be improved when families are engaged and supported, and inform care planning. Family-centred care (FCC) underpins policy directions for universal, community-based, child and family health services in the early years, although its implementation in this context is poorly understood. This systematic scoping review of the current literature aimed to improve understanding of FCC implementation in maternal, child, and family health universal services. Key databases and grey literature were searched using descriptors of maternal, child, and family health population and context, and FCC concept. Reference checking identified further literature for analysis. Thirteen included papers reported on nine studies from Australia, New Zealand, and the United Kingdom. Limited participant representation of fathers and diverse community members was evident. Deductive thematic analysis identified four areas of FCC demonstrated in this literature: respectful relationships, effective communication to foster shared understanding, flexible and contextualized care, and support for autonomy and agency. The literature demonstrated the interplay between organizational, professional, and recipient factors and their impact on the implementation of FCC. For successful FCC implementation, all these elements should be considered.

Efforts to improve the quality of care for children have focused on the patient-centered medical home (PCMH), defined by the National Committee for Quality Assurance (NCQA). Little research has focused on caregivers’ role in choosing physicians for children. This study aims to determine whether healthy caregiving behaviors and specific behaviors are associated with children’s receipt of PCMH care. Using data from the 2016–2017 National Survey of Children’s Health, which includes information on child-rearing behaviors, we estimated logistic regressions, controlling for children’s and caregivers’ characteristics, to quantify possible associations. We found that each additional healthy child-rearing practice followed increased a child’s chance of receiving PCMH care by 4.5% (p < 0.001). Being breastfed (children aged 0–5 years), sharing ideas with their caregiver (children aged 6–17 years), their caregiver ensuring homework is finished (children aged 6–17 years), and having TV time monitored (all ages), each increased the likelihood of PCMH use. These findings show that caregiving behavior is independently associated with locus of care. Future research is warranted as educating caregivers about healthy child-rearing may lead them to seek higher quality care for their children. Also, evaluating the effect of behaviors on health outcomes associated with PCMH would be valuable.

Transitional care for young people with long-term conditions emphasizes the importance of supporting parents, particularly in relation to promoting adolescent healthcare autonomy. Yet, little practical guidance is provided, and transitional care remains suboptimal for many families. This study aimed to examine how parents understand and experience their caregiving role during their child’s transition to adult services, to identify parents’ needs, and to inform service improvements. Focus groups were undertaken with parents of young people with brittle asthma, osteogenesis imperfecta, or epilepsy. Data were analysed using interpretative phenomenological analysis. Participants (n = 13) described how their parenting roles extended beyond what they consider usual in adolescence. These roles were presented as time consuming, stressful, and unrelenting but necessary to protect children from harm in the face of multiple risks and uncertainties. Such protective strategies were also perceived to hinder adolescent development, family functioning, and their own development as midlife adults. Finding a balance between protecting immediate health and long-term well-being was a major theme. Participants called for improved support, including improved service organization. Recommendations are provided for working with parents and young people to manage the risks and uncertainties associated with their condition, as part of routine transitional care.

Childhood obesity worldwide affects 5.6% or 38.3 million children under five years of age. The longer children are overweight or obese, the more likely they are to become obese adults with all the contingent morbidity involved. An extensive number of preventive interventions to combat childhood obesity have been carried out worldwide. This article reports a systematic review of interventions aimed to reducing or preventing obesity under-fives. The search was performed with six different databases: Web of Science, PsycINFO, Cochrane, PubMed, Medline, and CINAHL. Studies meeting the inclusion criteria were independently assessed using Joanna Briggs Institute methodology. Thirty studies involving 23,185 children across nine countries were included. Twenty-two were randomised controlled trials, and 8 quasi-experimental pretest/post-test design with comparison. These studies fell into four different categories: home-based interventions with family involvement (n = 12), preschool/early childhood settings (n = 9), multicomponent interventions across multiple settings (n = 6) and healthcare setting (n = 3). Future research should focus on increasing the accessibility of education on diet and physical activity for deprived families as well as the cultural acceptability of interventions to prevent childhood obesity.