Can mothers accurately describe their toddler’s weight? Results from the NOURISH cohort

A mother’s perception of her child’s weight may be more important in determining how she feeds her child, than the child’s actual weight status. Use of controlling feeding practices, prompted by perceptions and concerns about weight, may disrupt the child’s innate self-regulation of energy intake. This can promote overeating and overweight (Costanzo & Woody, 1985). This study describes mother’s perception of her child’s weight relative to the child’s actual weight. Mothers in the control group of NOURISH (n=276) were asked to describe their child as underweight, normal weight, or somewhat/very overweight via self-administered questionnaire when children were aged 12-16 months (Daniels et al, 2009). Child’s weight and length were measured by study staff. At assessment, mean age (sd) was 13.7(1.3) months, mean weight-for-age z-score (sd) was 0.6(0.8) (WHO standards, 2008), and 51% were male. Twenty-seven children were perceived as underweight (10%) and twelve children were perceived as overweight (4%). ANOVA revealed significant differences in weight-for-age z-scores across each category of weight perception, mean (sd) -0.2(0.5), 0.6(0.8) and 1.8(0.7) for underweight, normal weight and overweight respectively F(4, 288)= 15.6, (p<0.00). Based on WHO criteria only one of the 27 children was correctly perceived as underweight (WHO 2008). Similarly while 12 children were perceived as overweight, 88 were actually overweight/at risk. At group level, children of mothers who perceived their child as underweight were indeed leaner. However at the individual level mothers could not accurately describe their child’s weight, tending to over-identify underweight and perceive overweight children as normal weight.

“I’m Happy with Who I Am” : A Discursive Analysis of the Self-characterisation Practices of Boys in “Behaviour” Schools

In this chapter, I draw on poststructural theories of language to examine the self-characterisation practices of 33 boys attending special schools for students with disruptive behaviour. During a semi-structured interview, each boy was asked to describe his personality and then to choose from a selection of positive/negative word pairs. The objective was to determine whether these young people would characterise themselves in positive or negative ways. Participants were then asked if there was anything they would change about themselves if they could. Responses were analysed and compared against a discourse model developed from media reports and interviews with their principals. Findings suggest that while discourse may well ‘form the objects of which it speaks’ (Foucault, 1972, p. 49) in the eyes of teachers, principals, psychiatrists and paediatricians, it also offers a means through which the constituted subject can re-author itself in a more positive frame.

Environmental contributions to the leading causes of disease burden among Australian children

Although the effect of adverse environments on the well-being of children is an important global health issue, it remains underrecognized in health care and underconsidered in terms of both research and public policy. Children have developmentally distinct patterns of environmental exposure and susceptibilities that increase their risk of disease. Young children, especially those who are impoverished, have disproportionately heavier exposures to environmental threats in a given environment. They also have decreased metabolic capacity to detoxify and eliminate contaminants. Furthermore, rapid growth and development before and after birth and the continuing growth and postnatal maturation of the respiratory, immune, and neurological systems, in particular, make them increasingly vulnerable to environmental threats...

Masculinity, sexuality, theology and child sexual abuse by personnel in Christian institutions

There growing recognition that a contributor to the repeat crises of child sexual abuse (CSA) by personnel in Christian institutions (PICIs), is the often gendered culture of Christian institutions themselves. This work explores theological discursive constructions of masculinity and sexuality and their implications for addressing CSA by PICIs. The perspectives discussed here are of PICIs who participated in a research project conducted in Australia. From these perspectives male gendered and sexual performance is constructed through discourse as both an explanation and solution to offending behaviour. Similarly, sexuality is viewed as God-given, heteronormative and legitimately expressed only within the bounds of marriage. This work draws on Foucault and feminist discourses as they relate to CSA by PICIs and institutional discourses. This work offers a perspective of PICIs that may not otherwise be heard in the common discourses of CSA in Christian Institutions.

Issues to consider when developing mandatory reporting legislation and policy to improve discovery of child abuse

In the United Kingdom, recent investigations into child sexual abuse occurring within schools, the Catholic Church and the British Broadcasting Corporation, have intensified debate on ways to improve the discovery of child sexual abuse, and child maltreatment generally. One approach adopted in other jurisdictions to better identify cases of severe child maltreatment is the introduction of some form of legislative mandatory reporting to require designated persons to report known and suspected cases. The debate in England has raised the prospect of whether adopting a strategy of some kind of mandatory reporting law is advisable. The purpose of this article is to add to this debate by identifying fundamental principles, issues and complexities underpinning policy and even legislative developments in the interests of children and society. The article will first highlight the data on the hidden nature of child maltreatment and the background to the debate. Secondly, it will identify some significant gaps in knowledge that need to be filled. Thirdly, the article will summarise the barriers to reporting abuse and neglect. Fourthly, we will identify a range of options for, and clarify the dilemmas in developing, legislative mandatory reporting, addressing two key issues: who should be mandated to report, and what types of child maltreatment should they be required to report? Finally, we draw attention to some inherently different goals and competing interests, both between and within the various institutions involved in the safeguarding of children and the criminal prosecution of some offenders. Based on this analysis we offer some concluding observations that we hope contribute to informed and careful debate about mandatory reporting.

Patient engagement: What and who is it good for?

A huge and diverse literature emphasises that patient engagement is a key factor in: effective health service delivery; quality and safety; responsive health services; patient satisfaction; improved health outcomes; and reduced health care costs. Yet there are also cautionary caveats regarding this discourse. Additionally, although contemporary recommendations regarding good practice and National Health Standards point to the importance of patient engagement and health service providers are striving to implement them in practice, on the ground patient engagement is ‘all things to all people’ with widespread confusion about what patient engagement is and how it could be facilitated. In terms of scholarship, there is a dearth of theoretical and critical examination of what patient engagement constitutes, its application and effects. This analysis aims to contribute to scholarly debate and increased understanding of the use of patient engagement in health policy and practice.

Mandatory naptimes in child care and children's nighttime sleep

Objectives To examine the relationship between mandatory naptimes in child care and children's nighttime sleep duration, both concurrently and 12 months later once in school. Methods A sample of 168 children (50-72 months; 55% males) attending licensed child care centers were observed across their morning and throughout their scheduled naptime. Mandatory naptime was determined as the period in which children were not permitted any alternative activity except lying on their bed. Teachers reported each child's napping in child care. Nighttime and total sleep duration was reported by parents at 2 time points, in child care and in the second semester of their first school year. General linear models were used to examine group differences in sleep duration between children experiencing 0 to 60 minutes and >60 minutes of mandatory naptime, adjusting for key confounders. Path analysis was conducted to test a mediation model in which mandatory naptime is associated with nighttime sleep duration through increased napping in child care. Results Children who experienced >60 minutes of mandatory naptime in child care had significantly less nighttime sleep than those with 0 to 60 minutes of mandatory naptime. This difference persisted at 12-month follow-up, once children were in school. Napping in child care mediated the relationship between mandatory naptime and duration of nighttime sleep. Conclusions Exposure to mandatory naptimes of >60 minutes in child care is associated with decreased duration of nighttime sleep that endures beyond child care attendance. Given the large number of children who attend child care, sleep practices within these settings present an important focus for child health.

"It broke our hearts": Understanding parents' lived experiences of their child's admission to an acute mental health care facility

This article reports the evaluative findings of an Early Psychosis Education Program (EPEP) designed to support parents caring for their child who was recently admitted to the psychiatric intensive care unit of an inpatient mental health care facility in Australia. The EPEP offered education on mental illness, treatment options, and medication, as well as information on the recovery model of care. The EPEP was facilitated by two RNs and was evaluated for educational effectiveness using a simple pre- and postevaluation questionnaire. The evaluation revealed two themes expressed by parents: "We didn't see it coming," and "Hopelessness and helplessness." The themes highlighted the parents' lack of mental health care knowledge prior to the EPEP, which had a significant impact on the parents' experiences and well-being. The evaluative findings highlighted a need for a nurse-led EPEP within the community. A community EPEP has the potential to strengthen the partnership between parents, families, and mental health service providers and to help with the provision of a recovery framework of care.

Association between single-nucleotide polymorphisms in growth factor genes and quality of life in men with prostate cancer and the general population

Purpose Improved survival for men with prostate cancer has led to increased attention to factors influencing quality of life (QOL). As protein levels of vascular endothelial growth factor (VEGF) and insulin-like growth factor 1 (IGF-1) have been reported to be associated with QOL in people with cancer, we sought to identify whether single-nucleotide polymorphisms (SNPs) of these genes were associated with QOL in men with prostate cancer. Methods Multiple linear regression of two data sets (including approximately 750 men newly diagnosed with prostate cancer and 550 men from the general population) was used to investigate SNPs of VEGF and IGF-1 (10 SNPs in total) for associations with QOL (measured by the SF-36v2 health survey). Results Men with prostate cancer who carried the minor ‘T’ allele for IGF-1 SNP rs35767 had higher mean Role-Physical scale scores (≥0.3 SD) compared to non-carriers (p < 0.05). While this association was not identified in men from the general population, one IGF-1 SNP rs7965399 was associated with higher mean Bodily Pain scale scores in men from the general population that was not found in men with prostate cancer. Men from the general population who carried the rare ‘C’ allele had higher mean Bodily Pain scale scores (≥0.3 SD) than non-carriers (p < 0.05). Conclusions Through identifying SNPs that are associated with QOL in men with prostate cancer and men from the general population, this study adds to the mapping of complex interrelationships that influence QOL and suggests a role for IGF-I in physical QOL outcomes. Future research may identify biomarkers associated with increased risk of poor QOL that could assist in the provision of pre-emptive support for those identified at risk.

Is comfort important for optimal use of child restraints?

Suboptimal restraint use, particularly the incorrect use of restraints, is a significant and widespread problem among child vehicle occupants, and increases the risk of injury. Previous research has identified comfort as a potential factor influencing suboptimal restraint use. Both the real comfort experienced by the child and the parent’s perception of the child’s comfort are reported to influence the optimal use of restraints. Problems with real comfort may lead the child to misuse the restraint in their attempt to achieve better comfort whilst parent-perceived discomfort has been reported as a driver for premature graduation and inappropriate restraint choice. However, this work has largely been qualitative. There has been no research that objectively studies either the association between real and parental perceived comfort, or any association between comfort and suboptimal restraint use. One barrier to such studies is the absence of validated tools for quantifying real comfort in children. We aimed to develop methods to examine both real and parent-perceived comfort and examine their effects on suboptimal restraint use. We conducted online parent surveys (n=470) to explore what drives parental perceptions of their child’s comfort in restraint systems (study 1) and used data from field observation studies (n=497) to examine parent-perceived comfort and its relationship with observed restraint use (study 2). We developed methods to measure comfort in children in a laboratory setting (n=14) using video analysis to estimate a Discomfort Avoidance Behaviour (DAB) score, pressure mapping and adapted survey tools to differentiate between comfortable and induced discomfort conditions (study 3). Preliminary analysis of our recent online survey of Australian parents (study 1) indicates that 23% of parents report comfort as a consideration when making a decision to change restraints. Logistic regression modelling of data collected during the field observation study (study 2) revealed that parent-perceived discomfort was not significantly associated with premature graduation. Contrary to expectation, children of parents who reported that their child was comfortable were almost twice as likely to have been incorrectly restrained (p<0.01, 95% CI 1.24 - 2.77). In the laboratory study (study 3) we found our adapted survey tools did not provide a reliable measurement of real comfort among children. However our DAB score was able to differentiate between comfortable and induced discomfort conditions and correlated well with pressure mapping. Our results suggest that while some parents report concern about their child’s comfort, parent-reported comfort levels were not associated with restraint choice. If comfort is important for optimal restraint use, it is likely to be the real comfort of the child rather than that reported by the parent. The method we have developed for studying real comfort can be used in naturalistic studies involving child occupants to further understand this relationship. This work will be of interest to vehicle and child restraint manufacturers interested in improving restraint design for young occupants as well as researchers and other stakeholders interested in reducing the incidence of restraint misuse among children.

Translating training in the NYU Caregiver Intervention in Australia: Maintaining fidelity and meeting graduate standards in an online continuing professional education setting

The aim of this study was to develop an Internet-based self-directed training program for Australian healthcare workers to facilitate learning and competence in delivery of a proven intervention for caregivers of people with dementia: The New York University Caregiver Intervention (NYUCI). The NYUCI is a nonpharmacological, multicomponent intervention for spousal caregivers. It is aimed at maintaining well-being by increasing social support and decreasing family discord, thereby delaying or avoiding nursing home placement of the person with dementia. Training in the NYUCI in the United States has, until now, been conducted in person to trainee practitioners. The Internet-based intervention was developed simultaneously for trainees in the U.S. and Australia. In Australia, due to population geography, community healthcare workers, who provide support to older adult caregivers of people with dementia, live and work in many regional and rural areas. Therefore, it was especially important to have online training available to make it possible to realize the health and economic benefits of using an existing evidence-based intervention. This study aimed to transfer knowledge of training in, and delivery of, the NYUCI for an Australian context and consumers. This article details the considerations given to contextual differences and to learners’ skillset differences in translating the NYUCI for Australia.

Mandatory Reporting Laws and the Identification of Severe Child Abuse and Neglect

This book provides the first comprehensive international coverage of key issues in mandatory reporting of child abuse and neglect. The book draws on a collection of the foremost scholars in the field, as well as clinicians and practice-based experts, to explore the nature, history, impact and justifiability of mandatory reporting laws, their optimal form, legal and conceptual issues, and practical issues and challenges for reporters, professional educators and governments. Key issues in non-Western nations are also explored briefly to assess the potential of socio-legal responses sex trafficking, forced child labour and child marriage. The book is of particular value to policy makers, educators and opinion leaders in government departments dealing with children, and to professionals and organisations who work with children. It is also intended to be a key authority for researchers and teachers in the fields of medicine, nursing, social work, education, law, psychology, health and allied health fields.

A theoretical framework for designing and evaluating strategies to identify cases of serious child abuse and neglect

A central dimension of the State’s responsibility in a liberal democracy and any just society is the protection of individuals’ central rights and freedoms, and the creation of the minimum conditions under which each individual has an opportunity to lead a life of sufficient equality, dignity and value. A special subset of this responsibility is to protect those who are unable to protect themselves from genuine harm. Substantial numbers of children suffer serious physical, emotional and sexual abuse, and neglect at the hands of their parents and caregivers or by other known parties. Child abuse and neglect occurs in a situation of extreme power asymmetry. The physical, social, behavioural and economic costs to the individual, and the social and economic costs to communities, are vast. Children are not generally able to protect themselves from serious abuse and neglect. This enlivens both the State’s responsibility to protect the child, and the debate about how that responsibility can and should be discharged. A core question arises for all societies, given that most serious child maltreatment occurs in the family sphere, is unlikely to be disclosed, causes substantial harm to both individual and community, and infringes fundamental individual rights and freedoms. The question is: how can society identify these situations so that the maltreatment can be interrupted, the child’s needs for security and safety, and health and other rehabilitation can be met, and the family’s needs can be addressed to reduce the likelihood of recurrence? This chapter proposes a theoretical framework applicable for any society that is considering justifiable and effective policy approaches to identify and respond to cases of serious child abuse and neglect. The core of the theoretical framework is based on major principles from both classical liberal political philosophy (Locke and Mill), and leading political philosophers from the twentieth century and the first part of the new millennium (Rawls, Rorty, Okin, Nussbaum), and is further situated within fundamental frameworks of civil and criminal law, and health and economics.

Dietary intake of children aged 12-16 months and associations with maternal feeding beliefs and practices

This thesis provides the first detailed data describing the dietary intake of first-born Australian children aged 12-16 months. Overall, quality of intake could improve, with toddlers being exposed to energy-dense, nutrient-poor foods which may adversely affect the development of long-term healthy food preferences and growth trajectory. The leaner, but healthy weight toddler who exhibited more frequent food refusal was described a fussy eater or prompted higher maternal concern. However these behaviours are consistent with typical child development during the second year of life. Mothers can be supported to understand food refusal as manifestation of children's ability to self-regulate energy intake.

Community Resilience: Fostering Recovery, Sustainability, and Growth

In this chapter, the authors define community resilience and identify the components that predict it will occur. Three dimensions are highlighted: recovery, sustainability, and growth. Their discussion focuses on communities like those of Sudanese refugees who have experienced forced migration, emphasizing the importance that community plays to future adaptation. They show through their report on their research that community collaboration, shared identity, and empowerment increase bonding and bridging capital that promote the well-being of people under stress. They argue that an emphasis on community resilience places value on the social connections, policies, programs, and community context necessary for resilience in different cultures and contexts.