What are parents worried about? Health problems and health concerns for children

Development and Validation of the Parents' Health Literacy Scale for Children with Asthma (PHLSCA)

OBJECTIVE

This study aimed to develop and validate an instrument to assess the health literacy of parents of children with asthma in a Chinese context.

METHODS

The preliminary Parents' Health Literacy Scale for Children with Asthma (PHLSCA) was developed based on a literature review and refined to 45 items through two rounds of expert consultation using the Delphi method. A total of 481 parents of children with asthma were recruited from seven hospitals across four provinces in China between February and April 2019. Principal component analysis (PCA) and confirmatory factor analysis were conducted to evaluate the structural and construct validity of the scale.

RESULTS

The development and validation processes led to a 38 items scale comprising three subscales, namely: Health Knowledge (11 items), Health Skills (19 items) and Health Behavior (8 items). The scale demonstrated good reliability, with an internal consistency of Cronbach's α = 0.956 and a split-half reliability of r = 0.887 (p < 0.01). The Item Content Validity Index (I-CVI) ranged from 0.81 to 1.00, and the Scale-CVI was 0.842. The correlation coefficients and factor analysis results indicated good construct validity, with the factors explaining 59.33% to 62.90% of the variance in each subscale.

CONCLUSIONS

The final version of the questionnaire (PHLSCA) has been demonstrated to be a valid and reliable tool for assessing the health literacy of parents of Chinese children with asthma.

Parental practices and perspectives on health and digital technology use information seeking for children aged 0-36 months

BACKGROUND

Parents commonly seek information to support the health and well-being of their children. The increasing availability of health information online and social changes related to the COVID-19 pandemic may have changed what information is sought, from whom, where, and why. This qualitative study explored parents' practices and perspectives on seeking health and digital technology use information for their young children.

METHODS

Twenty parents, living in Australia (7 rural, 3 remote, and 10 metropolitan), with children aged 0-36 months completed a semi-structured interview.

RESULTS

Parents commonly turned to friends and family and online sources to access health information for their young children. For all types of health information, including digital technology use, themes were identified surrounding aspects of information sources participants valued and accessibility of health services. Perceived credibility and trustworthiness, relatability with other parents, ease of accessibility and convenience, and actionable, bite-sized information were valued. Reduced accessibility to health services due to COVID-19 and geographical location, and need for agency in managing their child's health influenced parents' choice of source of information. Few participants actively sought information about digital technology use for their young child, with the main focus on screen time.

CONCLUSION

Interactions with family and friends and online sources are important to parents when accessing health information for their child. Parents valued information sources which they considered trustworthy, credible, and relatable, as well as easily accessible and convenient. SO WHAT?: Dissemination of health information reflecting these values may empower parents during this early stage of parenthood.

Parent-Reported Visual Concerns in Children with Cerebral Visual Impairment Presenting to a Pediatric Neurology Clinic

Purpose

Children with cerebral visual impairment (CVI) present with delayed developmental milestones. Pediatricians and pediatric neurologists are usually the first point of contact, and eye exam largely remains referral based. This study documented the visual concerns reported by parents of children with CVI visiting a pediatric neurology clinic. Additionally, we investigated the association between visual concerns, functional vision measures and visual functions.

Patients and Methods

A cross-sectional study was undertaken in children with CVI (chronological age range: 7 months-7 years). Visual concerns reported by the parents/caregivers were documented as open-ended statements. Additionally, a functional vision assessment was conducted using the CVI Range instrument with phase 1, 2 and 3 indicating low, moderate and high visual functioning, respectively. Grating acuity and contrast sensitivity were measured using Teller acuity cards-II and Ohio contrast cards respectively.

Results

A total of 73 children (mean age of 2.84 ± 1.87 years) were recruited. Sixty-eight parents reported visual concerns that were broadly grouped into 14 unique concerns. Nineteen parents (27.9%) reported more than one visual concern. Difficulty maintaining eye contact and recognizing faces were the top two visual concerns in phases 1 and 2. Missing objects in the lower visual field was the top concern in phase 3. A larger number of visual concerns were reported in phase 1 (43%) than phase 2 (40.6%) and phase 3 (16.2%). Multiple regression analysis revealed that grating acuity, contrast sensitivity and chronological age were able to predict the functional vision, F (3, 55) = 63.0, p < 0.001, r² = 0.77.

Conclusion

Targeted questions enquiring about eye contact and face recognition can be included in history elicitation in children with CVI in pediatric neurology clinics. In the presence of visual concerns, it will be important to assess grating acuity and contrast sensitivity. A poor functional vision score requires referral for eye examination and vision rehabilitation services.

Parent, teacher, and nurse concerns and school doctor actions: an observational study of general health checks

OBJECTIVE

To evaluate the association between the concerns of parents, teachers, and nurses regarding each child's well-being and the school doctor actions conducted in routine general health checks.

DESIGN

A blinded, observational study. Prior to the health check parents, teachers, and nurses completed questionnaires assessing their concerns. Doctors, blinded to the responses, routinely examined all children accompanied by parents and reported their actions after each health check. Multilevel logistic regression was used to analyse the association of the concerns with the actions.

SETTING

21 primary schools in four municipalities in Finland.

PARTICIPANTS

Between August 2017 and August 2018, we randomly recruited 1341 children from grades 1 and 5, aged 7 and 11 years, respectively.

OUTCOME MEASURES

Outcome measures were the respondents' concerns and the school doctor actions. The extent of concerns was assessed on a five-point Likert scale. Concern refers to 'Quite a lot or a great deal of concern' by at least one respondent. The school doctor actions included instructions and/or significant discussions, prescriptions, laboratory tests and/or medical imaging, scheduling of follow-up appointments, referrals to other professionals, and referrals to specialised care.

RESULTS

Altogether, respondents were concerned about 47.5% of children. The top three concerns comprised growth/and or physical symptoms (22.7%), emotions (16.2%), and concentration (15.1%). All concerns were associated with some type of school doctor action (ORs: 1.66-4.27, p≤0.05); but only concerns regarding growth and/or physical symptoms were associated with all actions. Almost all concerns were associated with referrals to other professionals (ORs: 1.80-4.52, p≤0.01); emotions had the strongest association OR 4.52 (95% CI 3.00 to 6.80, p&lt;0.0001).

CONCLUSIONS

Health checks by school doctors may lead to referrals of children to other professionals especially for children's psychosocial problems. This should be considered when developing the roles, training, and multiprofessional collaboration of school health care professionals.

TRIAL REGISTRATION

NCT03178331.

Top 10 (plus 1) research priorities for expectant families and those with children to age 24 months in Alberta, Canada: results from the Family Research Agenda Initiative Setting (FRAISE) priority setting partnership project

OBJECTIVE

The study objective was to identify the top 10 research priorities for expectant parents and caregivers of children up to age 24 months.

DESIGN

A priority setting partnership using a modified James Lind Alliance approach was implemented. First, a core steering committee was formed, consisting of 17 parents, clinicians and community agency representatives. Second, through in-person collaboration with steering committee members, we developed and distributed a survey to identify research priorities across 12 topics. In total, 596 participants consented and 480 completed the survey. Survey responses were grouped and themed into codes during a consensus-building workshop with steering committee members (n=18). Research and practice experts were consulted to provide feedback on which themes had already been researched. An in-person (n=21) workshop was used to establish the top 34 priorities, which were circulated to the broader steering committee (n=25) via an online survey. Finally, the core steering committee members (n=18) met to determine and rank a top 10 (plus 1) list of research priorities.

SETTING

This study was conducted in Alberta, Canada.

PARTICIPANTS

Expectant parents and caregivers of children up to age 24 months.

RESULTS

Survey results provided 3232 responses, with 202 unique priorities. After expert feedback and steering committee consensus, a list of 34 priorities was moved forward for final consideration. The final top 10 (plus 1) research priorities included three priorities on mental health/relationships, two priorities on each of access to information, immunity and child development, and one priority on each of sleep, pregnancy/labour and feeding. Selecting 11 instead of 10 priorities was based on steering committee consensus.

CONCLUSIONS

The findings will direct future maternal-child research, ensuring it is rooted in parent-identified priorities that represent contemporary needs. To provide meaningful outcomes, research in these priority areas must consider diverse socioeconomic backgrounds and experiences.

Guidelines for caregivers and healthcare professionals on speaking to children about overweight and obesity: a systematic review of the gray literature

Caregivers and healthcare professionals (HPs) are increasingly concerned about childhood obesity. A critical consideration of caregivers and HPs is discussing weight status without provoking disordered eating. Given the complexity of these interacting concerns, major health advocacy groups have independently published guidelines for having conversations with children about overweight/obesity. The current investigation represented the first-ever systematic review of these guidelines to analyze their content, consistency, actionability, or scientific support. To conduct a systematic review, the authors performed a web-based search using the terms parent/HP, guidelines, child, and overweight/obesity that identified 59 guidelines on childhood obesity broadly, of which 13 provided explicit direction on how the caregiver or HP should approach a conversation about overweight with a child. Within these 13 guidelines, nine topic domains were identified: attitude modeling (covered by 31% of guidelines), behavior modeling (61%), dietary recommendations (54%), physical activity (46%), body acceptance and self-esteem (69%), conversation advice (92%), contact with HP (46%), talking about "weight" versus "overall health" (54%) and external factors (e.g., bullying, media) (54%). Although guidelines presented similar content, several inconsistencies in recommendations emerged. Notably, only three of the 13 guidelines referenced any scholarly sources and only a small minority of advice was actionable by caregivers or HPs. It is evident that guidelines for caregivers and HPs on speaking to children about obesity offer inconsistent advice, minimally based on empirical evidence. Future guidelines should aim to unify their messages for caregivers and HP and be better supported by empirical data.

Psychological differences between toilet trained and non-toilet trained 4-year-old children

OBJECTIVE

Late to complete toilet training has been associated with many psychological factors including behavior and mood problems. Unfortunately, the majority of the research is specific to children with elimination disorders or children identified as incontinent after the age of 7 years. The current study addressed gaps in the literature by comparing the psychological functioning of children not toilet trained by their 4-year-old well child care visit with their toilet trained peers.

DESIGN AND METHODS

Parent reports of internalizing and externalizing behavior using the Child Behavior Checklist (CBCL) were compared across groups, non-toilet trained and toilet trained, for 150 children recruited during their 4-year-old well child health care visit. Independent samples t tests of group means and χ² analyses were performed on all CBCL scales.

RESULTS

Results found no clinically or statistically significant differences between groups on parents' reports of internalizing and externalizing behavior. The current study provides no evidence that delays in successfully completing toilet training by 4 years of age were related to psychological problems for this sample of children.

PRACTICE IMPLICATIONS

Nursing professionals in primary care settings are positioned to provide anticipatory guidance to parents of children not yet toilet trained. Findings from the current study offer evidence that delays in toilet training might not be related to psychopathology, and these children are not likely to require intervention outside the pediatric setting and could be effectively managed by primary care health providers employing evidence-based toilet training protocols.

Need for global core competencies in Child Health and the Environment: a Canadian perspective

Children are the planet's most valuable resource. Mortality rates and longevity in children are improving; however, morbidity related to early-life exposures is increasing and with it health spending. A focus on identifying and addressing environmental components related to not only chronic childhood illnesses but also major adult mortalities would help contain current healthcare budgets. Child Health and the Environment (CHE) is an emerging discipline dedicated to managing early-life exposures (prenatal and childhood) on health outcomes throughout life. In Canada, as well as around the world, recognition of this area is growing, but progress has been slow and training of physicians is lacking. The WHO works closely with the Children's Environmental Health Clinic in Canada as well as collaborating centres around the world to build awareness of environmental health issues and promote improved care of children. Core competencies in CHE for physicians would provide an important step forward.

Le counseling auprès des adolescents et des parents au sujet du cannabis : une introduction pour les professionnels de la santé

L’usage de cannabis est fréquent chez les adolescents du Canada, mais les jeunes en reconnaissent les dangers potentiels et s’attendent de plus en plus à ce que des dispensateurs de soins bien informés leur parlent d’usage de substances psychoactives dans leur pratique quotidienne. Le présent point de pratique propose de solides outils fondés sur des données probantes pour aider les professionnels de la santé à parler d’usage de cannabis à des fins non médicales (récréatives) et des risques qui s’y associent. Les auteurs expliquent comment rendre le milieu clinique sécuritaire pour parler de substances psychoactives avec les jeunes et suggèrent des stratégies précises pour leur parler d’usage de cannabis de manière efficace et adaptée à leur développement. Conformément aux publications scientifiques récentes, ils recommandent des questionnaires de dépistage pour contribuer à structurer les échanges et déterminer quels adolescents pourraient profiter d’interventions plus spécialisées. Puisqu’un adolescent sur six qui expérimente le cannabis finit par en faire un usage abusif, l’évaluation de la volonté des adolescents à modifier leurs comportements à risque représente un aspect essentiel des soins, conjointement avec l’établissement d’objectifs complémentaires et l’aide aux familles. Enfin, des ressources pour les praticiens et les parents sont recommandées.

Tant les parents que les adolescents se préoccupent des effets et des dommages potentiels du cannabis et des autres substances psychoactives (1,2). De nombreux adolescents considèrent les professionnels de la santé comme des sources d’information fiables sur les substances psychoactives et s’attendent à ce qu’ils abordent l’usage ou les risques qui s’y associent lors des rendez-vous de santé (3). Dans le rôle de facilitateurs et de courtiers du savoir, les dispensateurs de soins (DdS) peuvent entretenir un dialogue efficace avec les jeunes et leur famille.

Counselling adolescents and parents about cannabis: A primer for health professionals

While cannabis use among adolescents is frequent in Canada, youth do recognize the potential harms, and increasingly expect knowledgeable health care providers to discuss substance use in everyday practice. This practice point provides sound, evidence-based tools to help health professionals address nonmedical (recreational) cannabis use and its related risks. After highlighting how to make the clinical setting a safe space for youth to talk about psychoactive substances, specific strategies for approaching cannabis use in effective, developmentally appropriate ways are described. Consistent with current literature, screening questionnaires to help structure discussion and identify adolescents who may benefit from more specialized interventions are recommended. Because one in six adolescents who experiments with cannabis goes on to misuse it, appraising their willingness to change risky behaviours is a key aspect of care, along with supportive goal-setting and helping families. Recommended resources for practitioners and parents are included.

We Asked, They Told Us: The Use of an Electronic Survey to Address Parental Health Concerns for Children

Population health includes medical conditions and social determinants of health, and it can be measured through community health needs assessments (CHNAs). A pediatric hospital utilized a survey to ask parents to rank different health topics based on the severity they present to children in the St. Louis Metropolitan for 2 installments of a CHNA (2016 and 2019). Between November 2015 and April 2016, 1156 parents and, between May 2018 and September 2018, 1022 parents responded to the Parent Health Concerns Survey. Respondents were most likely to be 25 to 44 years old, white, educated, have an income of at least $60 000, and work-related insurance. The top needs identified in 2016 and 2018 were lack of exercise and bullying, respectively. Depression saw the largest increase. Emerging topics in 2018 include tobacco/smoking, depression, and health insurance access. Our findings suggests that pediatricians should be prepared to address concerns across a wide variety of topics.

Application of latent class analysis in assessing the awareness, attitude, practice and satisfaction of paediatricians on sleep disorder management in children in Italy

AIM

To identify subgroups regarding paediatricians' awareness, attitude, practice and satisfaction about management of Sleep-Disordered Breathing (SDB) in Italy using Latent Class Analysis (LCA).

METHODS

A cross-sectional study was conducted on a large sample of Italian paediatricians. Using a self-administered questionnaire, the study collected information on 420 Paediatric Hospital Paediatricians (PHPs) and 594 Family Care Paediatricians (FCPs). LCA was used to discover underlying response patterns, thus allowing identification of respondent groups with similar awareness, attitude, practice and satisfaction. A logistic regression model was used to investigate which independent variables influenced latent class membership. Analyses were performed using R 3.5.2 software. A p-value<0.05 was considered statistically significant.

RESULTS

Two classes were identified: Class 1 (n = 368, 36.29%) "Untrained and poorly satisfied" and Class 2 (n = 646, 63.71%) "Trained and satisfied." Involving paediatric pneumologists or otorhinolaryngologists in clinical practice was associated with an increased probability of Class 2 membership (OR = 5.88, 95%CI [2.94-13.19]; OR = 15.95, 95% CI [10.92-23.81] respectively). Examining more than 20 children with SDB during the last month decreased the probability of Class 2 membership (OR = 0.29, 95% CI [0.14-0.61]). FCPs showed a higher probability of Class 2 membership than PHPs (OR = 4.64, 95% CI [3.31-6.55]).

CONCLUSIONS

These findings suggest that the LCA approach can provide important information on how education and training could be tailored for different subgroups of paediatricians. In Italy standardized educational interventions improving paediatricians' screening of SDB are needed in order to guarantee efficient management of children with SDB and reduce the burden of disease.

Using epidemiological data to identify needs for child-rearing support among Chinese parents: a cross-sectional survey of parents of children aged 6 to 35 months in 15 Chinese cities

Background

The quality of the family environment—in particular, the kind of parenting children receive in their early years—plays a critical role in influencing children’s growth and development. To facilitate the development and delivery of appropriate parenting and family interventions for Chinese parents, this study explores the prevalence of the difficulties that may arise in the course of child-rearing, the associated sociodemographic factors and parents’ help-seeking behavior.

Methods

A cross-sectional self-reporting survey was conducted with a sample of 2229 parents of children between 6 and 35 months of age. Using a stratified random-digit design, parents from 15 Chinese cities were surveyed to determine their child-rearing difficulties, support-seeking behavior and their preferences for service delivery. The sociodemographic factors that influenced major child-rearing difficulties were analyzed using bivariate and logistic analyses.

Results

The majority (87.5%) of Chinese parents of children aged 6–35 months reported experiencing child-rearing difficulties. Nearly one third (31.5%) of parents reported experiencing major difficulties. Feeding and sleep problems were most often reported. Regression analysis revealed that major child-rearing difficulties most often involved male children (OR = 1.35, 95% CI 1.11–1.64), single-child households (OR = 1.38, 95% CI 1.07–1.77), and households with financial problems (OR = 1.40, 95% CI 1.06–1.85). Just over one third of parents (33.44%) sought professional support, while 21.37% had attended a parenting course in the past year. Prefer ways of sourcing parental support included professional online platform (69.24%), self-help books (43.70%), face-to-face consultation (24.99%), and attending lectures (36.57%).

Conclusions

Child-rearing difficulties are common among parents of children between 6 and 35 months of age in Chinese cities. The family with boys, single-child, financial problems, and father not joining in child-rearing may face the high risk to major child-rearing difficulties. The national initiative to provide more guidance and support for child-rearing difficulties is worthwhile, as is the development of online parenting programs.

A Qualitative Study of Women's Recall of Content and Skills Developed in Group Prenatal and Well-Baby Care 2 Years Later

INTRODUCTION

Group prenatal and well-baby care is a system of health care visits that occur in a group setting. Each individual session lasts approximately 2 hours, allowing more time for education and support than can occur in an individual visit. Compared with individual care, research suggests that group care is associated with similar or better short-term outcomes, but no studies have yet examined potential long-term benefits beyond one year postpartum. The purpose of this qualitative descriptive study was to elicit women's recall about content covered in group prenatal and well-baby care and whether they were or were not continuing to use skills discussed during group prenatal and well-baby care 2 or more years after their group ended.

METHODS

Eligible women participated in group prenatal and/or well-baby care between 2008 and 2012, were aged at least 18 years, and were English-speaking. Of the 127 eligible women, 32 were reached and 17 agreed to participate. Women were interviewed on average 3 years after group prenatal or well-baby care ended using a semistructured interview guide. Transcripts were reviewed and coded by each team member. Final codes and themes were identified using an iterative review process among the research team.

RESULTS

Three themes were identified: sustained change, transferable skills, and group as a safe haven. All women were still using strategies discussed during group and had made sustained improvements in nutrition, stress management, and/or in the quality of their interactions with their children, partner, or families. The group environment was described as a safe haven: a respectful, nonjudgmental space that allowed women to share and support each other while learning new skills.

DISCUSSION

This is the first study to document that group prenatal and well-baby care is associated with long-term benefits in areas not yet reported in the literature: nutrition, family communication, and parenting.

The effect of early child care attendance on childhood asthma and wheezing: A meta-analysis

OBJECTIVE

Research evidence offers mixed results regarding the relationship between early child care attendance and childhood asthma and wheezing. A meta-analysis was conducted to synthesize the current research evidence of the association between early child care attendance and the risk of childhood asthma and wheezing.

METHOD

Peer reviewed studies published from 1964-January 2017 were identified in MEDLINE, CINAL, and EMBASE using MeSH headings relevant to child care and asthma. Two investigators independently reviewed the selected articles from this search. All relevant articles that met our inclusion criteria were selected for further analysis. Data were extracted from studies that had sufficient data to analyze the odds of asthma or wheezing among children who attended child care.

RESULTS

The meta-analysis of 32 studies found that (1) early child care attendance is protective against asthma in children 3-5 years of age but not for children with asthma 6 years of age or older. (2) Early child care attendance increases the risk of wheezing among children 2 years of age or younger, but not the risk of wheezing for children over 2 years of age.

CONCLUSIONS

This meta-analysis shows that early child care attendance is not significantly associated with the risk of asthma or wheeze in children 6 years of age or older.

Priority setting in paediatric preventive care research

OBJECTIVES

To identify the unanswered research questions in paediatric preventive care that are most important to parents and clinicians, and to explore how questions from parents and clinicians may differ.

DESIGN

Iterative mixed methods research priority setting process.

SETTING

Toronto, Ontario, Canada.

PARTICIPANTS

Parents of children aged 0-5 years enrolled in a research network in Toronto, and clinicians practising in Toronto, Ontario, Canada.

INTERVENTIONS

Informed by the James Lind Alliance's methodology, an online questionnaire collected unanswered research questions in paediatric preventive care from study participants. Similar submissions were combined and ranked. A consensus workshop attended by 28 parents and clinicians considered the most highly ranked submissions and used the nominal group technique to select the 10 most important unanswered research questions.

RESULTS

Forty-two clinicians and 115 parents submitted 255 and 791 research questions, respectively, which were combined into 79 indicative questions. Most submissions were about nutrition, illness prevention, parenting and behaviour management. Parents were more likely to ask questions about screen time (49 parents vs 8 clinicians, p<0.05) and environmental toxins (18 parents vs 0 clinicians, p<0.05). The top 10 unanswered questions identified at the workshop related to mental health, parental stress, physical activity, obesity, childhood development, behaviour management and screen time.

CONCLUSION

The top 10 most important unanswered research questions in paediatric preventive care from the perspective of parents and clinicians were identified. These research priorities may be important in advancing preventive healthcare for children.

Hispanic Mothers' Views of the Fathers' Role in Promoting Healthy Behaviors at Home: Focus Group Findings

BACKGROUND

Overweight and obesity prevention interventions rarely take into account the unique role of fathers in promoting healthy home environments.

OBJECTIVE

To use qualitative methodology to examine the views of Hispanic mothers of children aged 2 to 5 years regarding fathers' roles in promoting healthy behaviors at home.

DESIGN

Nine focus groups were conducted in Spanish with Hispanic mothers of preschool-aged children (N=55) from October to December 2015.

PARTICIPANTS/SETTINGS

Hispanic mothers were recruited from churches, community agencies, and preschools located in five Zip codes in the southwest part of Oklahoma City, OK.

ANALYSIS

Questions examined the views of Hispanic mothers regarding fathers' roles in promoting healthy behaviors at home. Focus groups were audiorecorded, transcribed in Spanish, translated into English, and coded and analyzed for themes by two coders using NVivo version 10 software.

RESULTS

Four themes were identified: fathers' disagreement with mothers about food preferences and preparation, fathers' support for child's healthy eating, fathers' support for child's physical activity, and fathers' lack of support for a healthy home food environment. Fathers' traditional expectations about the type of foods and portion sizes adults should eat conflicted with mothers' meal preparations. Mothers reported that, although they favored eating low-calorie meals, the meals fathers preferred eating were high-calorie meals (eg, quesadillas). In general, fathers supported healthy eating and physical activity behaviors for their children. Supportive behaviors for children included preparing healthy meals, using healthier cooking methods, grocery shopping with their children for healthy foods, and asking the child to participate in household chores and/or play sports. Fathers' unsupportive behaviors included bringing high-calorie foods, such as pizza, and sugary drinks into the home, using sweets and savory foods for emotion regulation, and displaying an indulgent parental feeding style.

CONCLUSIONS

Mothers' views of fathers' perceived roles in child eating and physical activity, and maintaining a healthy eating environment, have important implications for the success of promoting healthy behaviors in the homes of Hispanic families.

Environmental pediatrics: an introduction and evaluation of online resources

INTRODUCTION

The World Health Organization (WHO) estimates that three million children under the age of 5 die annually from environmentally related disease. In the United States, the cost of environmentally related public health concerns is estimated as greater than $55 billion. Environmental exposure is among parents' top health concerns for children. Yet, the study of the effects of environmental exposure on health outcomes is a developing field, and clinicians feel inadequately prepared to address these concerns. The Children's Environmental Health Clinic (ChEHC) is the first clinic of its kind in Canada. Their website includes a list of online resources on major topics related to child health and the environment. There has not yet been an objective evaluation of the comprehensiveness of the topics or scientific quality of the information on the website. This study seeks to offer an accessible introduction to the field of environmental pediatrics, including an online resource for evidence-based information on key topics in the field. These resources assist in disease prevention, health promotion, education, and the increasing need to balance environmental health risks.

METHODS

A scoping review of scientific and gray literature in the field of environmental pediatrics was performed to inform a written introduction to the field and to identify gaps in the content of the ChEHC website. The content of the ChEHC website was then objectively evaluated using the National Network of Libraries of Medicine checklist for health websites.

RESULTS

Ten categories within the field of environmental pediatrics emerged from the literature review. A small number of gaps were identified on the website and in the literature. The content of the ChEHC website was found to be of high quality.

FUTURE DIRECTIONS

The website will be updated using the results of the study as a guide, to make it as relevant, complete, and evidence-based as possible.

CONCLUSIONS

Environmental pediatrics is an important, emerging topic. There is a need for accessible, evidence-based pediatric environmental health resources for clinicians and the general public. The products of this study (a publication and website) respond to that need and thus assist in disease prevention and health promotion.

Parental Perceptions of Family Centered Care in Medical Homes of Children with Neurodevelopmental Disabilities

Life course theory sets the framework for strong inclusion of family centered care (FCC) in quality medical homes of children with neurodevelopmental disabilities (CNDD). The purpose of this study was to explore the perceptions of families with their experiences of FCC in medical homes for CNDD. Using a structured questionnaire, the Family-Centered Care Self-Assessment Tool developed by Family Voices, this study surveyed 122 parents of CNDD in a large urban area during 2010-2012. Data collected information on FCC in the provision of primary health care services for CNDD and focused on family-provider partnerships, care setting practices and policies, and community services. Frequency analysis classified participants' responses as strengths in the "most of the time" range, and weaknesses in the "never" range. Only 31 % of parents were satisfied with the primary health care their CNDD received. Based on an accepted definition of medical home services, 16 % of parents reported their CNDD had most aspects of a medical home, 64 % had some, and 20 % had none. Strengths in FCC were primarily evident in the family-provider partnership and care settings when focused on meeting the medical care needs of the child. Weaknesses in FCC were noted in meeting the needs of families, coordination, follow-up, and support with community resources. Improvements in key pediatric health care strategies for CNDD are recommended. CNDD and their families have multifaceted needs that require strong partnerships among parents, providers, and communities. Quality medical homes must include FCC and valued partnerships with diverse families and community-based providers.

Health-Related Internet Use by Informal Caregivers of Children and Adolescents: An Integrative Literature Review

Background

Internet-based health resources can support informal caregivers who are caring for children or adolescents with health care needs. However, few studies discriminate informal caregivers’ needs from those of their care recipients or those of people caring for adults.

Objective

This study reviews the literature of health-related Internet use among informal caregivers of children and adolescents.

Methods

A total of 17 studies were selected from literature searches conducted in 6 electronic databases: PubMed, Cochrane, CINAHL, PsycINFO, ERIC, and EMBASE. All databases searches were limited to articles published in the years 2004 to 2014 in peer-reviewed publications. Search terms consisted of “health-related Internet use,” “eHealth,” “Internet use for health-related purpose(s),” “Web-based resource(s),” and “online resources,” combined with informal caregiver (or “parents”) of “child,” “adolescent,” “student,” “youth,” and “teen.” The age range of the children receiving care was limited to younger than 22 years. Their informal caregivers were defined as persons (parents) who provided unpaid care or assistance to a child or an adolescent with health problems.

Results

Among 17 empirical studies, the majority of informal caregivers of children with medical issues were the parents. Quantitative studies (14/17, 77%) reported prevalence and predictors of health-related Internet use, while mixed-methods and qualitative studies (3/17, 24%) investigated informal caregiver perceptions of helpful health-related Internet use and barriers of use. The prevalence of health-related Internet use varied (11%-90%) dependent upon how health-related Internet use was operationalized and measured. Disease-specific information was used for decision making about treatment, while social support via virtual communities and email were used for informal caregiver emotional needs. A digital divide of Internet access was identified in lower educated minorities. Most studies had methodological challenges resulting from convenience sampling, cross-sectional surveys, lack of theoretical frameworks, or no clear definitions of health-related Internet use.

Conclusions

This study provides an important understanding of how family members use Internet-based information and support systems during child caregiving. Healthcare providers and policy makers should integrate family needs into their current practices and policies. Further rigorous research is required to design efficient and effective nursing interventions.

Using parental perceptions of childhood allergic rhinitis to inform primary care management

OBJECTIVE

To describe parents' experience with their child's allergic rhinitis (AR) to inform management by the primary care provider (PCP).

STUDY DESIGN

Two hundred parents with a child 7 to 15 years old with AR symptoms within the past 12 months completed a paper survey.

RESULTS

The child's AR was identified as a significant problem in spring (89.3%), fall (63.4%), summer (50.3%), and winter (21.4%); 51.3% had persistent disease. AR symptoms most commonly interfered with the child's outdoor activities and sleeping, and frequently bothered the parent and other family members. Most parents (88.3%) wanted to know what their child was allergic to and had many concerns about treatment options. A total of 62.9% had sought AR care from the PCP in the past 12 months.

CONCLUSIONS

Many families experience significant morbidity from their child's AR and turn to their PCP for help. We identified opportunities for the PCP to reduce AR morbidity.

Bullying, adverse childhood experiences and use of texting to promote behavior change

PURPOSE OF REVIEW

This article addresses three areas in which new research demonstrates the potential to impact the health of children and adolescents: bullying, adverse childhood experiences (ACEs) and texting to promote behavior change.

RECENT FINDINGS

Recent research on bullying emphasizes its impact on children with chronic medical conditions, and highlights cyber bullying as a rising issue. ACEs are now recognized as risk factors for many health issues, particularly mental health problems. Text messaging is a promising new method to communicate with parents and adolescent patients.

SUMMARY

Pediatric healthcare providers can help patients with chronic medical problems by addressing bullying at well child visits. Screening for ACEs may identify children at risk for mental health issues. Incorporating text messaging into clinical practice can improve disease management and patient education.