Child Care Health and Development最新文献

Aims

This study aims to assess the construct validity, inter-rater and intra-rater reliability and application of the newly developed Paediatric Posterior Drooling Scale (PPDS), a novel clinical screening tool that uses cervical auscultation (CA) to evaluate posterior drooling in children with neurological disorders.

Methods

In this cross-sectional observational study, 69 children with central neurological disorders aged 1–18 years (mean 8.4 years, 50 males, 19 females) were included for analysis. CA was used by expert and trained speech language therapists (SLT). Due to the correlation between posterior drooling and oropharyngeal dysphagia, two classification systems for eating and drinking ability were used for convergent construct validity calculations: the Functional Oral Intake Scale (FOIS) for children complemented with the Eating and Drinking Ability Classification System (EDACS) in the case of cerebral palsy.

Results

PPDS had a moderate, negative correlation with the FOIS (Spearman's rho = −0.54, p < 0.001) and a moderate, positive correlation with the EDACS (Spearman's rho = 0.70, p < 0.001). PPDS had an excellent intra-rater (intraclass correlation coefficient = 0.91, p < 0.001) and a good inter-rater reliability (intraclass correlation coefficient = 0.85, p < 0.001). The perfect agreement percentage of the test–retest reliability was high (84%) for the score 0.

Conclusions

The PPDS is a valid and reliable clinically applicable screening tool for assessing posterior drooling by the SLT. The PPDS enables SLTs to identify posterior drooling more efficiently, non-invasively and reliably in routine clinical settings. Timely recognition of posterior drooling can significantly impact clinical management, particularly by reducing respiratory complications. Performing subsequent PPDS assessments at different times when posterior drooling is suspected is important for the treating paediatrician to determine the underlying cause of posterior drooling. To establish the diagnosis of posterior drooling, the PPDS should not be used as a stand-alone tool but as a bridge between clinical observations and the need for an instrumental assessment.

Background

Poverty remains a significant determinant of childhood health outcomes in the United States. This study examines the relationship between household income and children's health outcomes in the United States, focusing on how income disparities contribute to health inequalities.

Methods

Utilizing a cross-sectional design with data from the 2021–2022 National Survey of Children's Health (NSCH), we analysed the health status of 104 746 children aged 0–17 years and explored chronic disease conditions, including obesity, asthma, anxiety and depression. Three logistic regression models were fitted to evaluate the association between household income, measured by federal poverty level (FPL) and overall health outcome, adjusted for age, biological sex, race, parental education and family structure.

Results

Approximately 92% of participants reported excellent or very good health, with those reporting poorer health more likely to come from lower income households. Children from families earning 0%–99% of the FPL had more than triple the odds of reporting good, fair or poor health compared with those earning ≥ 400% FPL or more (AOR = 3.16, 95% CI: 2.64, 3.78). An inverse dose–response relationship was observed, indicating that as household income increased, the likelihood of reporting adverse health conditions decreased across income groups, with no significant interactions noted between income and biological sex or race.

Conclusion

This cross-sectional study shows that household income predicts children's overall, physical and mental, emotional, developmental or behavioural (MEDB) health outcomes. Using recent national data, we found that income-related disparities were evident across multiple conditions, underscoring the need for interventions that address both healthcare access and broader socio-economic factors. Children from low-income households face higher health risks. Policies that expand preventive care, strengthen family supports and reduce structural inequities are critical to improving child health equity.

Background

Creating a supportive environment for the health and well-being of children with disabilities is essential to enhancing their quality of life and promoting positive outcomes for families and society. In South Korea, children with disabilities face numerous structural and social challenges that threaten their well-being and lower their life satisfaction. This study aimed to examine the factors affecting life satisfaction among school-attending children with disabilities aged 19 years or younger in South Korea, using a framework based on the social determinants of health.

Methods

A secondary data analysis was conducted using the 2022 Panel Survey of Disability and Life Dynamics by the Korea Disabled People's Development Institute. A total of 569 children were included. Variables were selected based on the five domains of the Healthy People 2030 framework: economic stability, education access and quality, health care access and quality, neighbourhood and built environment and social and community context. Hierarchical regression analysis was used to determine the influence of these factors on life satisfaction.

Results

Children with disabilities in South Korea reported lower life satisfaction than other vulnerable groups, which also face constraints on health and well-being due to socioeconomic, cultural or environmental factors. Significant predictors of life satisfaction were functional limitations, parental depression, type of education, experience with learning accommodations, satisfaction with disability welfare services, family strength, peer attachment, subjective health and self-esteem.

Conclusions

This study highlights the importance of addressing the social determinants of health that shape the life satisfaction of children with disabilities in South Korea. Future research should broaden the scope to include diverse populations and contexts, thereby informing more inclusive and tailored strategies to promote their health and well-being.

Background

Family-centred service (FCS) has been recognized as best practice in paediatric healthcare; however, its implementation remains quite challenging. Many service providers (SPs) lack confidence in applying FCS, hindering the translation of knowledge into clinical practice. This study aimed to evaluate the impact of an online FCS module on the self-reported skills, practice and confidence of SPs.

Methods

A quasi-experimental pre–post–follow-up design was used with 33 participants completing the pretest, 14 completing the post-test and 10 completing the follow-up test after 8 weeks. Self-perceived FCS practice and confidence were measured using the Measure of Processes of Care-Service Provider (MPOC-SP) and Confidence (MPOC-Con). Additionally, SPs' self-reported skills and practical application of FCS were assessed through a separate questionnaire. Repeated measures multivariate analysis of variance and the Friedman test were used to analyse changes in scores over time.

Results

Self-reported FCS skills improved significantly, with six of the eight items showing higher scores at the post-test and follow-up test than at the pretest. Participants' self-reported practical application also increased, with follow-up test scores being significantly higher than both pre- and post-test scores. The MPOC-SP and MPOC-Con domains showed significant improvements, particularly in the ‘providing general information’ domain of MPOC-SP, which improved gradually over time.

Conclusion

The online FCS module improved SPs' self-reported skills, confidence and family-centred practices. These findings suggest that web-based knowledge translation resources can bridge the knowledge-to-practice gap in FCS, although further research is needed to evaluate their long-term effects.

Background

Nowadays, families headed by a single mother who conceived by sperm donation are very common, especially in Western societies, Israel included. The current preliminary study examines the parental experience of single mothers, by choice, of children with a disability conceived through sperm donation.

Methods

The study employed semi-structured interviews of 11 single mothers. In the analysis of the interviews, four themes were determined: (1) the decision to become a single mother by sperm donation; (2) difficulties and hesitations in making decisions; (3) strengths and advantages as a single mother of a child with disabilities; (4) sources of support.

Results

The words of the mothers afford an observation into their inner world, enabling an understanding of the characteristics of their unique parenting, its difficulties and strengths.

Conclusion

The findings of the research may serve as an effective working tool, mainly for multi-professional teams in the field of treatment, health and education, to develop awareness of the experience of these mothers and formulate ways of assistance and support for them, thereby leading to coordinated and cooperative work.

Background

Health professionals are an important source of infant feeding advice in the first year of life. However, little is known about the impact of such advice provided as part of routine child health services on feeding practices and other child health behaviours. This study aimed to examine the association between parental engagement with health professionals for breast and formula feeding advice during the first 6 months of life and child health behaviours at 6, 12 and 24 months of the child's age.

Methods

Cross-sectional and longitudinal analyses of survey data from a randomised controlled trial in Australia were conducted. At 6 months, parents were asked what sources of information regarding breast and formula feeding they used; at 6, 12 and 24 months, they were asked about their child's nutrition, feeding and movement behaviours. Cross-sectional and longitudinal multiple logistic regression models examined the association between engagement with health professionals in the first 6 months of life and child health behaviours at 6, 12 and 24 months of age.

Results

A total of 1155 mothers completed the baseline survey, 947 (82%), 920 (80%) and 797 (69%) completed the 6-, 12- and 24-month surveys. Longitudinal modelling indicated that seeking health professional advice regarding infant feeding was associated with a lower likelihood of current breastfeeding (adjusted odds ratio = 0.54, 95% confidence interval = 0.41–0.71, p < 0.001). After adjustment for confounders, engagement with health professionals in the first 6 months of life was not associated with any other child health behaviours based on cross-sectional analyses.

Conclusions

These findings suggest that parental engagement with health professionals for infant feeding support may be a response to significant breastfeeding challenges or transitions in infant feeding, pointing to an opportunity to support more routine health promotion in child healthcare settings before such challenges arise.

Background

The growing global burden of paediatric chronic illnesses underscores the need to investigate the sociodemographic factors of family resilience, which is a vital adaptive mechanism for long-term health management. Therefore, this study evaluated the variations in family resilience across sociodemographic factors and identified clusters to guide tailored clinical interventions.

Methods

A cross-sectional survey was conducted to examine 1217 dyads of parents and children (aged 1–17 years) with chronic illnesses. The Chinese version of the Family Resilience Scale and a questionnaire developed by the authors were used to evaluate family resilience and sociodemographic factors, respectively. Data were analysed using linear regression to identify the effects of sociodemographic factors on family resilience. Hierarchical clustering was applied to identify clusters based on sociodemographic factors, and Bonferroni correction was used to compare differences in family resilience between the identified clusters.

Results

Three following clusters were identified: (1) families with low parental education, low family income and predominantly endocrine diseases (27.7%); (2) families with high parental education, high family income and predominantly cardiovascular diseases (11%) and (3) families with moderate parental education, moderate income and predominantly respiratory diseases (61.3%). Cluster 2 had the highest level of family resilience (M = 3.72, SD = 0.19), whereas Cluster 1 had the lowest level of family resilience (M = 2.67, SD = 0.20).

Conclusions

Family resilience in children with chronic illnesses varied significantly across different clusters of sociodemographic factors. Paediatric healthcare teams can support families and children in developing healthy coping mechanisms and provide customised interventions tailored to their sociodemographic status.

Background

Caregivers of children and youth with special healthcare needs (CYSHCN) often experience significant challenges accessing home and community-based services (HCBS), resulting in psychological distress, increased burden and decreased caregiver wellbeing. However, little is known about the associations between HCBS access and caregiver wellbeing in rural areas. Therefore, the purpose of this study was to (1) explore the associations between caregiver and child sociodemographic characteristics and HCBS access on caregiver wellbeing in a rural context and (2) add additional empirical support to an emerging theoretical framework.

Methods

This exploratory cross-sectional study used convenience sampling to recruit caregivers of CYSHCN (N = 162) from the north central Appalachian region of the United States. Electronic surveys included items related to sociodemographics and HCBS, along with the Depression, Anxiety, and Stress Scale, Post-Traumatic Growth Inventory, and Meaning in Life Questionnaire, which were guided by an emerging theoretical framework.

Results

Most caregivers reported caring for CYSHCN ages 2–17 (72.8%) with moderate-to-severe functional limitations (73.3%). Overall, caregivers reported mild-to-moderate depression, anxiety and stress; a medium-to-high degree of posttraumatic growth (PTG); and a greater presence of meaning in life. Caregiver wellbeing was associated with various sociodemographic characteristics and access to HCBS. Although challenges with HCBS access were related to psychological distress, they were also associated with PTG and meaning in life.

Conclusions

Caregivers who experienced psychological distress and challenges accessing HCBS also experienced PTG and meaning in life. Findings warrant therapeutic interventions designed to leverage caregiver empowerment and resilience, while exploring innovative care delivery methods in rural communities to improve health equity.

Background

It is unclear whether the underutilisation of the UK Children's Epilepsy Surgery Service (CESS) can be attributed to regional referral differences. This study develops a mapping tool to visualise CESS referrals, identifying any regional disparities and exploring the relationship between referrals and deprivation. Mapping posterior urethral valve (PUV) surgery referrals demonstrates the utility of this model for other health conditions.

Methods

Accepted CESS referrals within the catchment area of one centre between April 2017 and March 2022 were recorded in the Orion registry (n = 291). PUV referrals to one tertiary centre in the same region, between January 2013 and June 2023, were mapped using the same model (n = 212).

Results

Referral incidences per integrated care board (ICB) were calculated and visualised with choropleth maps. Pearson's correlation coefficient identified any relationship between referral incidence and population-weighted ICB deprivation scores.

CESS referral incidence ranged from 30.06 to 39.9 per million under-18s. PUV referral incidence ranged from 12.0 to 46.9 per million under-18 males, yielding a statistically significant difference in variability between the two groups (p = 0.04). Referral incidence was independent of deprivation (p = 0.29 and p = 0.13, respectively).

Conclusion

There is equity in CESS referrals within the region. The mapping tool is widely applicable, providing visually representable referral data without being patient-identifiable.