The emotional and social concerns of mothers of children with cleft palate: A cross-sectional study

PROBLEM

Among birth defects, a cleft palate is one of the most common defects globally, with a prevalence rate of 1 in 700 live-born children per annum. Caring for a child with cleft palate is considered a challenge for mothers who provide around clock care for these children. Despite this, there is limited knowledge of their experiences and needs particularly in low resource settings.

BACKGROUND

Previous literature emphasized that mothers of children with cleft palate face many challenges involving emotional distress, social isolation, and financial burden.

QUESTION

To investigate the emotional and social concerns of mothers of children with Cleft Palate compared to mothers of children without cleft palate.

METHODS

A comparative study design was conducted at the Jordanian Royal Medical Services using convenience sample of 312 mothers of children with and without cleft palate in Jordan.

FINDINGS

There was a significant difference in the presence of anxious feelings between mothers of children with cleft palate and those mothers without cleft palate children. Within group comparison for mothers of children with cleft palate has shown a significant difference in their social concerns with regards to social support and child's future.

DISCUSSION

Mothers of children with cleft palate reported significantly higher levels of sadness feelings. These emotions could be attributed to several factors, including the financial burden associated with medical treatment and interventions, the burden of caring for a child with special needs, the social stigma related to the child's appearance, the lack of public awareness, and the insufficient social support services.

CONCLUSION

Mothers of children with Cleft Palate experience a considerable amount of emotional and social concerns which require urgent interventions.

Evaluation of Anxiety in Turkish Parents of Newborns with Cleft Palate with or Without Cleft Lip

OBJECTIVE

(1) To compare anxiety between parents of newborns with cleft lip and palate (CLP), isolated cleft palate (CP), and healthy newborns and (2) to evaluate anxiety between parental dyads within these groups.

DESIGN

A cross-sectional study.

SETTING

University Hospital.

PARTICIPANTS

Surveys were completed by 20 mothers and 20 fathers of newborns with CLP, 21 mothers and 21 fathers of newborns with CP, and 23 mothers and 23 fathers of healthy newborns (controls).

MAIN OUTCOME MEASURE

The State-Trait Anxiety Inventory (STAI) assessed parental anxiety. Mothers of newborns with a cleft reported on concerns regarding cleft-related issues and facial appearance.

RESULTS

State and trait anxiety were generally in the moderate range for parents of newborns with a cleft, while control parents had low state anxiety and moderate trait anxiety. Mothers of newborns with CP and CLP had significantly higher state and trait anxiety levels than control mothers (p < .05). Fathers of newborns with CLP had a higher state anxiety level than control fathers. When maternal and paternal anxiety was compared within the groups, only trait anxiety scores were significantly higher in mothers of newborns with CLP than that of fathers (p < .05). More than half of mothers of newborns with a cleft were concerned about their newborn's feeding, speech, and palate.

CONCLUSIONS

Parents of children with a cleft may need psychological support in the early postnatal period. It is important for neonatal cleft team providers to help reduce parental anxiety and educate families about cleft care, with a focus on feeding.

Stress and Coping Strategies in Malay Parents of Children with Cleft Lip and/or Palate

OBJECTIVE

This study was aimed at describing the level of stress and types of coping strategies used among Malay parents of children with cleft lip and/or palate (CL/P).

DESIGN

Cross-sectional study.

SETTING

A dental clinic and a general hospital.

PARTICIPANTS

Parents (N = 84) whose children were less than 12 years old with CL/P.

METHODS

Socio-demographic data and clinical characteristics of CL/P were collected. Self-administered validated Malay versions of the stress scale from the Depressive, Anxiety and Stress Scale-42 (DASS-42) and COPE Inventory questionnaires were used. Descriptive statistics and Multivariate Analysis of Covariance were used for data analysis.

RESULTS

The prevalence of stress among parents of children with CL/P was 21.4% [95% confidence interval (12.4, 30.4)]. The most common coping strategies were problem-focused (mean 58.15, standard deviation (SD) 7.75), followed by emotion-focused (mean 54.05, SD 4.78). The adjusted mean score for overall coping strategies was significantly different between stressed and non-stressed parents after adjustment for education, number of children, sex of child with CL/P, and cleft type [F (df) = 4.174 (3,74), P = .009]. There was a significant mean difference between stressed and non-stressed parents for avoidant coping strategies [P = .003]. Problem-focused and emotion-focused coping strategies did not differ after Bonferroni correction.

CONCLUSIONS

Around a fifth of parents caring for children with CL/P experienced stress and avoidant coping strategies were more common among stressed parents. Multi-disciplinary team care should provide social support to parents of children with CL/P.

Parental Stress, Infant Feeding and Well-being in Families Affected by Cleft Lip and/or Cleft Palate: The Impact of Early Follow-up

OBJECTIVE

To document the impact of early follow-up by specialized cleft nurses (SCNs) provided to families affected by cleft lip and/or palate (CL/P) and the status of parental stress, infant feeding and well-being.

DESIGN

Prospective inclusion of a control group, which only received standard care, followed by an intervention group that also received early SCN follow-up.

SETTING

The cleft lip and palate team at Oslo University Hospital, Norway.

PARTICIPANTS

Seventy families (69 mothers and 57 fathers) distributed into an intervention group (n = 32) and a control group (n = 38).

INTERVENTION

SCNs provided a consultation at the maternity ward and a follow-up conversation by phone or face-to-face at scheduled times for six months.

OUTCOME MEASURES

Parental Stress Index (PSI), Perceived Stress Scale (PSS-14), feeding questionnaire, survey of infant diets, weight percentiles.

RESULTS

The mothers reported higher stress scores than the fathers, but in the control group only in the PSI parent domain at T2 and T3 (P = .007, P = .018). Infants in the intervention group used pacifiers less frequently than in the control group (55.2% vs. 81.1%, P = .023). Otherwise, no significant differences were found between the groups. Overall, the infants received less breast milk than norms.

CONCLUSION

Contextual strategies for early follow-up of families affected by clefts need to be developed, with an emphasis on involving fathers and those parents reporting elevated stress and/or feeding difficulties. There is a need for diagnosis-specific guidelines about the use of pacifiers as well as collaboration between the health professionals involved to increase breastmilk feeding.

Situational analysis of nutritional status among 1899 children presenting with cleft lip and/or palate in Indonesia

Background

Given the increased risk of malnutrition in children with cleft lip and/or palate (CLP), determining their nutritional status is critical for preventing adverse surgical risks. However, no such disaggregated, national-level data are available in Indonesia. We aimed to determine the nutritional status of patients with clefts in Indonesia and to identify problems and solutions for malnutrition cases within the population.

Methods

In this cross-sectional study, we considered records of individuals who underwent primary surgery for CLP in Smile Train-sponsored facilities in Indonesia between 1 January 2016 and 31 December 2021 (n = 18 480). We only included children under the age of five with an evaluation date prior to admission date and excluded subjects with invalid data values. We classified their nutritional status by z-scores according to the World Health Organization Child Growth Standard (2006). Malnutrition cases cover four indicators - stunting, wasting, underweight, and overweight. We compared the prevalence for malnutrition cases in children under the age of five using national health survey data.

Results

We included 1899 records following data validation. The national prevalence of stunting (24.4%), wasting (12.5%), and overweight cases (12.9%) was high, while underweight cases (6.8%) were comparatively low. Statistical analyses showed significant differences in nutritional status based on length/height-for-age between girls and boys aged 0-5 months (P = 0.008) and 48-60 months (P = 0.001), and based on body mass index-for-age (P = 0.000) between girls and boys aged 0-5 months. Girls in different age groups exhibited a statistically significant difference in nutritional status based on length/height-for-age (P = 0.002) and weight-for-age (P = 0.017). Concurrent stunting and overweight were the most common forms of concurrent malnutrition (8.7%). We found a significant difference in the prevalence of underweight (P = 0.001) and overweight (P = 0.000) cases between children with CLP and those without CLP.

Conclusions

Our findings highlight the importance of nutritional interventions for children with orofacial clefts in Indonesia, and the importance of age and gender in their design and implementation. Further investigation is necessary to explore the risks of overweight and concurrent malnutrition among this population.

Isolation, Uncertainty and Treatment Delays: Parents' Experiences of Having a Baby with Cleft Lip/Palate During the Covid-19 Pandemic

OBJECTIVES

Previous literature finds that having a child with a cleft lip and/or palate (CL/P) may pose social and emotional challenges for parents. For parents of children born during the Covid-19 pandemic, such challenges may be heightened. Further, novel demands brought about by the pandemic could have caused additional hardships. The aim of this study was to describe the impact of the pandemic on new parents through qualitative exploration of their experiences.

DESIGN

Semi-structured interviews were conducted with 14 parents of children born in the United Kingdom with CL/P between January and June 2020, around the start of the pandemic. Data were analysed using inductive thematic analysis.

RESULTS

Three themes, with sub-themes, were identified. The first theme, "Changes to Healthcare: The Impact of Restrictions and Reduced Contact", discussed the impact of the pandemic on perinatal care, the care received from the specialist CL/P teams, and parents' experiences of virtual consultations. The second theme, "Family Functioning During the Pandemic", covered parental anxiety, fathers' experiences, and social support. The third theme, "Surgical Prioritisation: Delays and Uncertainty", addressed changes to surgical protocols, coping with uncertainty, complications associated with delayed surgery, and how parents created positive meaning from this period.

CONCLUSIONS

A range of increased and additional psychosocial impacts for parents were identified, along with several coping strategies, utilization of social support, and the positive aspects of their experiences. As the pandemic continues, close monitoring of families affected by CL/P remains imperative, particularly for those at risk of emotional distress.

Evaluating caregiver stress in craniosynostosis patients

OBJECTIVE

Caregiver stress from a child's diagnosis can impact a caregiver's ability to participate in treatment decisions, comply, and manage long-term illness. The aim of this study was to compare caregiver stress in children with craniosynostosis at diagnosis and postoperatively.

METHODS

This prospective study included caregivers of pediatric patients with craniosynostosis receiving operative intervention. Demographics and Parenting Stress Index, Short Form (PSI-SF) and Pediatric Inventory for Parents (PIP) surveys at baseline (preoperatively) and 3 and 6 months postoperatively were completed. PSI-SF scores between 15 and 80 are considered normal, with > 85 being clinically significant and requiring follow-up. Higher PIP scores represent increased frequency and difficulty of stressful events due to the child's illness. Pairwise comparisons were performed using the Wilcoxon signed-rank test. Multivariate analysis was performed to assess for PSI-SF and PIP predictors.

RESULTS

Of 106 caregivers (84% Caucasian), there were 62 mothers and 40 fathers. There were 68 and 45 responses at 3 and 6 months postoperatively, respectively. Regarding the baseline group, more than 80% were between 20 and 40 years of age and 58% had less than 2 years of college education. The median household income fell in the $45,001-$60,000 bracket. There was no significant difference between median baseline PSI-SF score (65, IQR 51-80) and those at 3 months (p = 0.45) and 6 months (p = 0.82) postoperatively. Both median PIP frequency (89 vs 74, p < 0.01) and difficulty (79 vs 71, p < 0.01) scores were lower at 3 months, although no significant difference was observed at 6 months (frequency: 95 vs 91, p = 0.67; difficulty: 82 vs 80, p = 0.34). Female sex, uninsured status, and open surgery type were all risk factors for higher parental stress.

CONCLUSIONS

Stress levels ranged from normal to clinically significant in the caregivers, with sex, uninsured status, and open repair predicting higher stress. Stress decreased at 3 months postoperatively before increasing at 6 months. Intervention targeting caregiver stress should be explored to maintain lower stress observed at 3 months after surgery.

Validity and reliability of the Family Empowerment Scale for parents of children with cleft lip and/or palate

BACKGROUND

Empowerment is recognized as a crucial concept in strengthening the position of parents in healthcare services. This study aimed to evaluate the validity and reliability of the Turkish Family Empowerment Scale (FES).

METHODS

This methodological study was conducted between January and March 2021, with 348 family members actively caring for their children in the age group of 0-18 years with cleft lip and/or palate (CL/P). The English FES was translated into Turkish using back translation and modified so that it is generic and convenient for all families. The construct validity, internal validity, internal consistency, and split-half test reliability and responsiveness of the Turkish FES were examined.

RESULTS

The original FES structure with three factors (family, health services provided to the child and community participation) and 34 items was verified in Turkish culture. This obtained structure can explain 66% of the variance of the relevant concept. Scores of parents ranged between 34 and 170 points. Increasing scores indicated a positive significance regarding family empowerment. The Cronbach's α reliability coefficient of the scale was calculated as 0.976.

CONCLUSION

The study findings and the goodness-of-fit values indicated that the FES and its Turkish version are a valid and reliable measurement instrument to be used in Turkish culture.

Psychosocial repercussions experienced by parents who care for infants with syndromic orofacial clefts

Abstract Objectives: to understand the psychosocial implications experienced by caregiving parents, resulting from the care of the child with cleft lip and/or palate associated with the syndrome. Methods: a cross-sectional and qualitative study, guided by the Consolidated Criteria for Reporting Qualitative Research tool, carried out between January and May 2019. Data collection was carried out through semi-structured interviews that were audio-recorded and transcribed in full. Thematic content analysis was used as the methodological framework and Symbolic Interactionism as the theoretical framework. Results: the participants were 16 caregiving parents. Four categories were listed: implications for diagnosis and treatment initiation, implications for financial issues and paid activities, implications for the care process, and implications for access to health resources. Conclusion: it was found that psychosocial implications experienced by these informal caregivers are multifaceted and complex, and that knowing them will enable planning and implementation of actions that contribute, in addition to the children's rehabilitation process, to the health and quality of life of those who care.

Parent's Experiences During Orthodontic Treatment of Their Children With Cleft Lip and Palate: Phenomenological Study

OBJECTIVES

Cleft lip and palate (CLP) is a congenital anomaly that affects not only the patients but also their family members and companions. Identifying the problems encountered by patients with CLP and their families can greatly help clinicians in efficient treatment planning to obviate the treatment needs and promote the quality of life of patients. This study aimed to determine the experiences of the parents of children with CLP undergoing orthodontic treatment.

METHODS

This study was conducted based on descriptive phenomenology using the Colaizzi's 7-step analysis method of phenomenological data. The private orthodontic clinics of Kermanshah city were evaluated in this study. The participants included the parents of children with CLP younger than 15 years who had presented to the clinics seeking orthodontic treatment. In-depth semistructured interviews with open-ended questions were used to collect information regarding the experiences of parents in this process. The collected data were analyzed using the Colaizzi's 7-step analysis.

RESULTS

Qualitative analysis of the interviews yielded 271 codes, 18 subthemes, 7 themes, and 3 main themes including fatigue (exhaustion, helplessness, and incompetence), self-reliance (mutual support and empathy), and the need for social support (counseling services and citizenship rights).

CONCLUSION

In general, the results revealed that parents of children with CLP under orthodontic treatment are vulnerable due to their previous adverse experiences in the course of treatment of their children and need support in several physical, psychological, social and spiritual domains.

Maternal and paternal anxiety levels through primary lip surgery

AIM

The aim of this study was to evaluate the anxiety levels of the parents of infants with cleft lip and palate (CLP) before and after primary lip surgery.

MATERIALS AND METHOD

Forty mothers (mean ages: 31.9 ± 6.16 years) and 40 fathers (mean ages: 34.6 ± 5.91 years) of infants with CLP were included in this study. They were asked to answer the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and Spielberger's State-Trait Anxiety Inventory (STAI) just 1 h before the primary lip surgery (T0) and 1 month after (T1) surgery. Student t-test and Mann-Whitney U test were used for inter-group comparison, the paired-sample t was used for the intra-group comparisons (p < 0.05).

RESULTS

There were no statistically significant differences for the comparisons of state (STAI-S) and trait (STAI-T) anxiety or APAIS scores between the parents. While state anxiety scores of the mothers increased significantly post-surgically, APAIS scores showed significant decreases in both parents (p < 0.05). APAIS scores of the fathers with bilateral CLP infants were significantly higher (p < 0.05) than the fathers of unilateral ones. The parents with local anesthesia experience showed significantly lower APAIS scores (p < 0.05). A negative correlation was present between maternal age and STAI-T, whereas a positive correlation was present between paternal age and the anxiety.

CONCLUSIONS

The anxiety levels of the parents were similar. Parents asked for more information about the anesthesia than the surgery, therefore communication with the anesthesiologist in the preoperative period is important. Routine assessment of parents' stress and psychosocial support should be provided by the cleft team.

Social Experiences of Turkish Parents Raising a Child With Apert Syndrome: A Qualitative Study

OBJECTIVE

Apert syndrome is a rare and understudied craniofacial condition with regard to its psychosocial impact on children and their parents. Due to the lack of studies focusing solely on the social experiences of children and families with Apert syndrome, it is difficult to develop interventions and strategies to support well-being and positive adjustment for this particular population. This study addressed this gap by assessing the unique social experiences of parents who are raising their children with Apert syndrome including difficulties they face and strategies they use to cope with challenges.

DESIGN

Descriptive qualitative study using thematic analysis.

PARTICIPANTS

Participants included 21 parents of 12 children (aged 1-12 years) with Apert syndrome (9 couples, 2 fathers, and 1 mother) who were recruited from a pediatric neurosurgery unit in Turkey.

RESULTS

The qualitative analysis yielded four main themes describing the experiences of parents including (1) social challenges; (2) coping with negative reactions; (3) promoting socialization and independence; and (4) sources of strength.

CONCLUSIONS

Parents reported several challenges, including social stigmatization, and utilized a range of strategies to support both their own and their child's positive adaptation and resiliency, including the use of religion and reliance on their spouses for support. Results offer clinically relevant insights about the strengths and challenges of families coping with Apert syndrome.