Journal of Developmental and Behavioral Pediatrics最新文献

Objective: Sleep quality and quantity are critical for preschoolers' physical, cognitive, social, and emotional development. This study examined the individual and environmental factors associated with preschoolers' sleep problems. Specifically, we investigated the direct effects of maternal parenting behavior and the indirect effects mediated by preschoolers' effortful control.

Method: A total of 774 mothers with preschool-aged children (aged 3-6 years) participated in this study. They completed a questionnaire assessing their parenting behavior, as well as their children's effortful control and sleep problems.

Results: Our analysis yielded 3 major findings. First, we found that rejecting and chaotic maternal parenting behaviors were directly associated with sleep problems in preschoolers. Second, preschoolers' effortful control mediated the relationship between positive maternal parenting behavior and preschoolers' sleep problems. Third, among the 3 dimensions of negative maternal parenting behavior, the mediating effect of effortful control was observed only in the context of chaotic parenting.

Conclusion: These results suggest that maternal negative and positive parenting behaviors may be differentially related to preschoolers' sleep problems, with the former exhibiting a more proximal association and the latter potentially linked through mediated processes. Furthermore, when home environments are unpredictable or inconsistent, preschoolers may struggle to develop appropriate behavioral regulation, which can contribute to sleep problems.

Objective: There is growing literature emphasizing the importance of early and tailored parental disclosure of an autism diagnosis to their children. While there are barriers to disclosure, most parents agree that children have a right to know of their diagnosis, with early disclosure being associated with a better quality of life and self-image. Within the literature, however, there is scarcity of populations from the United States represented in qualitative disclosure studies. With the impact of culture and location on language, this study aims to address this gap.

Method: Caregivers of children with prior diagnosis of ASD (n = 16) were recruited to participate in semistructured interviews. Blinded transcripts of interviews were used to individually create codes that were formed into themes based on consensus of the researchers through thematic analysis.

Results: Of the 16 caregivers interviewed, 14 were White and all 16 were female. Twelve caregivers reported working or volunteering in areas with high exposure to the autism community. Thematic analysis yielded 4 themes relating to diagnosis disclosure: (1) Language of Disclosure, (2) Disclosure as a Journey, (3) Purpose of Disclosure, and (4) Process of Disclosure.

Conclusion: This exploratory, qualitative study examines caregiver's perspectives on the disclosure process, strengthening the consensus with emerging literature surrounding the process of disclosure and highlighting the role language plays in the disclosure process. More specifically, the metaphors used by parents to describe autism change from generally positive euphemisms to more well-balanced and realistic metaphors that encapsulate both triumphs and struggles that accompany an autism diagnosis.

Objectives: To assess the association between specific toilet training (TT) behaviors and functional constipation (FC) in young, healthy children.

Methods: This cross-sectional descriptive study distributed 2917 questionnaires to parents of healthy children across 38 nursery schools in Flanders. Parents were given questions regarding their child's TT and TT-related behaviors such as stool toileting refusal (STR), hiding, and requesting a diaper for defecation, along with questions about current stool issues, which involved assessing stool consistency using the Bristol Stool Chart.

Results: From a 42.1% (n = 1228) response rate, 1218 questionnaires were analyzed. Parents reported that during TT, 23.6% (n = 285; 95% confidence intervals [CIs], 21.2-26.0%) of their children refused to defecate on a potty, 13.0% (n = 157; 95% CI, 11.2-15.0%) hid while defecating, and 9.7% (n = 117; 95% CI, 8.1-11.5%) asked for a diaper to defecate. The prevalence of FC was 16.8% (n = 204; 95% CI, 14.7-19.0%). Chi-square tests showed significant associations between each of these TT behaviors and FC. The odds on FC was 2.8 (95% CI, 1.8-4.2) times higher when the child asked for a diaper, 3.2 (95% CI, 2.3-4.3) times higher in the presence of STR, and 3.7 (95% CI, 2.6-5.4) times higher for those who hid.

Conclusion: Refusing to defecate, hiding, and asking for a diaper have a significant association with FC, especially when multiple behaviors are present. These findings are clinically relevant for parents and pediatricians, aiding them in understanding behaviors that can be associated with FC and raising awareness to identify potential signs.

Objective: To describe clinician attitudes and practices regarding discussions about race-related topics with families of children aged 0 to 5 years.

Methods: The authors distributed a survey to the Reach Out and Read (ROR) medical provider network to assess clinicians' prior education, attitudes and clinical practice discussing the impact of racism on child health, racial identity formation, and development of ethnic-racial pride. The authors report item response frequencies with a sub-analysis of respondent race, ethnicity, level of training, and practice region and setting.

Results: Six hundred fifty-two surveys with 80% or more completion rate were analyzed. Over 90% of respondents agreed that racism affects child health. Although most agreed that clinicians have a role in discussing the impact of racism on a child's health, racial identity formation, and development of ethnic-racial pride with families, the majority did not regularly do so. Barriers included lack of time and education, clinician discomfort, and fear of damaging the therapeutic relationship. Many agreed that receiving education about these topics was very important, but fewer than 25% had prior education or knew of resources. Nearly 90% agreed that books and ROR can support these discussions; 79% were interested in additional ROR training.

Conclusion: Although surveyed clinicians agree that they have a role in discussing race-related topics with families with infants and young children, they do not feel equipped to have these discussions. Pediatricians are interested in incorporating culturally diverse, developmentally appropriate books, and ROR to discuss issues related to race.

Objective: Describe the engagement of opioid-exposed infants (OEI) with recommended developmental surveillance and supports in the first year of life.

Methods: We conducted a single-site retrospective cohort study of OEI delivered between 2016 and 2021, linking birth hospitalization, developmental follow-up (DFU) clinic, and early intervention (EI) records. Primary outcomes were attendance at DFU clinic and evaluation by EI. We used multivariable modified Poisson regression to examine how birthing parent-, infant-, and clinic-level factors are associated with service engagement.

Results: Of 256 OEI, 75% engaged in at least 1 developmental service. Referral and attendance rates at the DFU clinic were 69% and 33%, respectively. Ninety-three percent were referred to EI, 73% evaluated and 58% enrolled in services. EI evaluation was positively associated with prolonged infant hospitalization (adjusted risk ratio [aRR] 1.01; CI, 1.002-1.01) and exposure to antidepressants (aRR 1.23; CI, 1.02-1.49) and cocaine (aRR 1.28; CI, 1.09-1.50). Probability of attendance at DFU was higher for infants born to parents receiving care at an integrated perinatal substance use clinic (aRR 2.13; CI, 1.07-4.24) and exposed to antipsychotics (aRR 1.73; CI, 1.12-2.67), whereas those remaining in parental custody had lower probability of engagement (aRR 0.62; CI, 0.39-0.97).

Conclusion: Three-quarters of the OEI engaged in developmental surveillance services in the first year of life. Factors relating to disease severity, location of birthing parent care, birthing parent co-exposures, and parental custody were associated with engagement. Efforts to improve engagement in recommended follow-up should elicit the perspectives of caregivers to better understand the mechanisms that drive these differences.

Objective: Prenatal substance exposure (PSE) is a known risk factor for negative birth outcomes and long-term health outcomes like neurodevelopmental problems. Children in foster care have increased exposure to PSE and higher proportions of developmental delay compared with the general population. It is unclear whether differences still exist among developmental delay screening among children in foster care with and without PSE.

Methods: Data were extracted from patient medical records of a primary care clinic for children in foster care between January 1, 2018, and December 31, 2021. Cox proportional hazards regression generated hazard of positive developmental delay screening using the Ages and Stages Questionnaire-3 among those who with and without PSE controlling for sex, race, ethnicity, prematurity, caregiver type, as well as interaction between PSE and prematurity and PSE and race.

Results: The sample included 975 patients. 60.4% had PSE, and 62.6% had a positive developmental delay screening at least once. 52.9% were male, and 45.5% were White. Those who had PSE but were nonpremature had 1.14 (95% confidence interval, 1.01-1.29) times the hazard of positive developmental delay screening compared with those without PSE and prematurity. However, those with PSE and prematurity had 2.01 times the hazard of positive developmental delay screening than those without either condition.

Conclusion: Children in foster care with PSE are at risk for positive developmental delay screening compared with those without; however, those with both PSE and prematurity are at extra risk. This interaction should be considered when making inferences regarding developmental delay screening in this population.

Objective: The authors aimed to understand the experience of parents and caregivers during COVID-19, including the challenges they faced and what helped them cope using the Strengthening Families (SF) Approach and Protective Factors Framework's five factors: parental resilience, social connections, knowledge of parenting and child development, concrete support in times of need, and social and emotional competence of children.

Methods: The Family Snapshot Survey was developed to assess the impact of COVID-19 on family life, including items for quantitative analysis and 2 open-ended responses. This national survey of 9000 parents recruited from an opt-in internet panel was conducted in 3 waves of 3000 in November 2020, February 2021, and July 2021 using the online YouGov platform. The 2 open-ended responses are analyzed here using qualitative thematic analysis based on the SF Approach and Protective Factors Framework for caregivers with children aged 0 to 5 years.

Results: The SF factors were used to classify 770 responses, with many responses identified as containing multiple factors, representing their interrelated nature. A lack of concrete support was the most frequent challenge, and parental resilience was the most frequent support.

Conclusion: Access or lack of access to concrete support in times of need underscored many of the strengths and challenges, respectively. Participants described interactions between individual protective factors that allowed for safety, stability, or positive experiences. In future community policy creation, policymakers may look at how programs interact and allow families to access multiple protective factors at once, with a critical need for providing these concrete supports.