The impact of maternal smoking during pregnancy on depressive and anxiety behaviors in children: the Norwegian Mother and Child Cohort Study.

BACKGROUND: Maternal smoking during pregnancy (MSDP) is associated with multiple adverse childhood outcomes including externalizing behaviors. However, the association between MSDP and internalizing (anxiety and depressive) behaviors in offspring has received less investigation. We aimed to assess the association between MSDP and childhood internalizing (anxiety and depressive) behaviors in a very large, well-characterized cohort study. METHODS: We assessed the association between MSDP and internalizing behaviors in offspring utilizing information drawn from 90,040 mother-child pairs enrolled in the Norwegian Mother and Child Cohort Study. Mothers reported smoking information, including status and frequency of smoking, twice during pregnancy. Mothers also reported their child's internalizing behaviors at 18 months, 36 months, and 5 years. Associations between MSDP and childhood internalizing behaviors, including dose-response and timing of smoking in pregnancy, were assessed at each time point. RESULTS: MSDP was associated with increased internalizing behaviors when offspring were aged 18 months (B = 0.11, P <0.001) and 36 months (B = 0.06, P <0.01), adjusting for numerous potential confounders. Higher rates of smoking (e.g., >20 cigarettes per day) were associated with higher levels of internalizing behaviors. Maternal smoking during early pregnancy appeared to be the critical period for exposure. CONCLUSIONS: We found evidence supporting a potential role for MSDP in increasing internalizing (anxiety and depressive) behaviors in offspring. We also found evidence supportive of a possible causal relationship, including dose-dependency and support for a predominant role of early pregnancy exposure. Further investigation utilizing genetically informed designs are warranted to assess this association.

Association between parent and child dietary sodium and potassium intakes as assessed by 24-h urinary excretion

The aim of this study was to assess the association between parent and child sodium (Na) and potassium (K) intake as assessed by 24-h urinary excretion (24hUE). Primary school children and their parent(s) provided one 24-h urine sample and information on cooking and children's discretionary salt use. Valid urine samples were provided by 108 mothers (mean age 41.8 (5.1) (SD) years, Na 120 (45) mmol/day) (7.0 g/day salt equivalent) and 40 fathers (44.4 (4.9) years, Na 152 (49) mmol/day (8.9 g/day salt), and 168 offspring (51.8% male, age 9.1 (2.0) years, Na 101 (47) mmol/day (5.9 g/day salt). When adjusted for parental age, child age and gender a 17 mmol/day Na (1 g/day salt) increase in mother's 24hUE was associated with a 3.4 mmol/day Na (0.2 g/day salt) increase in child's salt 24hUE (p = 0.04) with no association observed between father and child. Sixty-seven percent of parents added salt during cooking and 37% of children added salt at the table. Children who reported adding table salt had higher urinary excretion than those who did not (p = 0.01). The association between mother and child Na intake may relate to the consumption of similar foods and highlights the importance of the home environment in influencing total dietary sodium intake.

Mother and toddler activity in the zone of proximal development for pretend play as a predictor of higher child IQ

This study investigated the pretend play of mother—toddler dyads in relation to later child IQ. Twenty-one toddlers were videotaped in monthly play sessions with their mothers, from age 8 to 17 months, and later assessed at 5 years of age on the Stanford-Binet IV. Children's and mothers' pretend play levels and frequencies were measured using Brown's (1997) Pretend Play Observation Scale. Dyadic play activity was analyzed using the conceptual frameworks of scaffolding and Vygotsky's Zone of Proximal Development (ZPD). Toddlers later assessed as having higher IQ demonstrated more rapid learning in the ZPD for pretend play and experienced earlier maternal transfer of responsibility for play. These findings support other evidence on the differential early development of high ability or gifted children and the role of caregiver interactions in that development.

Putting the Research to Use: This study provides evidence that gifted children show differential development, in this case more rapid learning, from the first year of life. It also demonstrates how responsive parental interactions can support this advanced development. For family and professional caregivers, the findings imply that optimum caregiving for the young gifted child involves interactions that are both responsive to individual potential and appropriately challenging. In regard to the methodological challenges of researching early giftedness, the study demonstrated that the constructs of the ZPD and scaffolding were useful frameworks for investigating early gifted development and caregiver influences on that development. Pretend play activity was also shown to be an effective measure and a useful context for the study of gifted development in infants and toddlers. It would be valuable for future researchers in this area to utilize similar approaches that are grounded in the unique developmental characteristics of young children, and that aim to account for the interactive contexts that are so important in children's lives. The field of gifted education, in general, would also benefit from an increased awareness and exploration of the role of play in the development of intellect, imagination and creativity.

Child weight status: Relationships with mother-child mealtime interactions and child eating behaviours

This doctoral thesis highlighted how mother-child interactions surrounding responsiveness, affect, maternal control and child compliance may be influential to children’s self-regulatory behaviours around food and eating, in turn impacting their weight. Support was found for the potential role of such interactions as risk factors in childhood overweight and obesity.

What about the mother and family when an infant doesn`t sleep?

Becoming a new parent is a time of enormous change in the lifestyle of women, particularly as women are expected to take on prime responsibly for caring for the child. Motherhood can be exhausting and lonely as women cope with the demands of a new baby. These demands are exacerbated when infants do not sleep. This causes many parents to seek professional intervention with persistent infant sleep problems. Through focus group interviews, this study sought to understand the experiences of 28 women and families in how they coped with and managed an infant with sleep problems. Results indicated that women experienced major role confusion as they internalised the image that 'a good mother does it all'. Persistent infant crying and their own sleep deprivation exacerbated their loss of identity and shattered their self image, and caused anger and confusion in some partners. Each woman sought primary health care support through a five day residential stay in an Early Parenting Centre in Victoria. The women found that this professional support facilitated confidence building and feelings of normality. Most important, staff encouraged the women to feel good about themselves and their ability to manage future sleep problems.

Mutually responsive orientation: a novel observational assessment of mother-child mealtime interactions

Mother-child mealtime interactions during preschool years is an important but overlooked factor when evaluating the influence of parent-child relationships on child eating and weight. This paper describes the validation of the Mutually Responsive Orientation (MRO) coding system adapted for assessing parent-child interactions during food preparation and consumption situations. Home-based mealtimes of 94 mothers and their children (3.03 ± 0.75 years) were filmed at two time points, 12-months apart. Filmed dimensions of mutual mother-child responsiveness, shared positive affect, maternal control relating to food and child compliance were assessed. Objective BMI and maternal reports of parenting, feeding, child eating, diet and child temperament were also collected. Correlations, repeated measures ANOVAs and regressions were performed to examine the validity of MRO variables and their stability across both time points. Validation analysis showed the MRO coding system performed as expected: dyads with higher MRO scores expressed lower control/power assertion, lower child non-compliance, and greater committed compliance. The measure demonstrated sensitivity to specific contexts: maternal responsiveness, mother and child positive affect were higher during food consumption compared to food preparation. Coded dimensions were stable across time points, with the exception of decreases in maternal responsiveness in food consumption and child non-compliance in food preparation. MRO and maternal dimensions were correlated with maternally reported parenting and feeding measures. Maternal responsiveness (inversely) and child responsiveness (positively) were concurrently associated with child fussy eating, and child refusal was prospectively and inversely associated with child fussy eating. Findings suggest the adapted MRO coding system is a useful measure for examining observed parent-child mealtime interactions potentially implicated in preschoolers' eating and weight development.

Parent-proxy and child self-reported health-related quality of life: using qualitative methods to explain the discordance

Background: Although parent-proxy reports of health-related quality of life (HRQOL) are only moderately correlated with child reported HRQOL, it remains unknown why these scores differ. The aim of this study was to use a qualitative methodology to examine why parents and children report different levels of HRQOL.

Method: The sample consisted of 15 parent–child pairs. A think-aloud technique was used where parents and children were given a generic HRQOL instrument (KIDSCREEN) and instructed to share their thoughts with the interviewer. Qualitative analyses were conducted to assess whether parents and children base their answer on different experiences or reasoning, have different response styles, or interpret the items differently.

Results: There was discordance between parents and children, in terms of rating scale and in terms of the reasoning for their answer. Children tended to have different response styles to parents, where for example, children tended to provide extreme scores (highest or lowest score) and base their response on one single example, more than parents. Parents and children interpreted the meaning of the items very similarly.

Discussion: This study provides evidence to suggest that discordance among parent-child pairs on KIDSCREEN scores may be as a result of different reasoning and different response styles, rather than interpretation of items. These findings have important implications when parent-proxy reported HRQOL is used to guide clinical/treatment decisions.

Mental health promotion and socio-economic disadvantage: lessons from substance abuse, violence and crime prevention and child health

Issue addressed: Mental health promotion aimed at populations with low socio-economic status (SES) may benefit by investigating prevention strategies that effectively address related child and adolescent problems.
Methods: Evidence from a number of literature reviews and program evaluations was synthesised. First, the impact of SES on development from childhood to adulthood is considered in light of research on substance
abuse, violence, crime, and child development problems. Second, evaluations of interventions are reviewed to identify those that have shown outcomes in research studies (efficacy) or in real-world settings (effectiveness) in reducing developmental problems associated with low SES. Low SES is measured in different ways including low levels of education and/or income or definitions that combine several variables into a new indicator of low SES.
Results: Factors associated with low SES are also associated to varying extent with the development of violence and crime, substance abuse and child health problems. Interventions that address underlying determinants of low SES show strong efficacy in decreasing adolescent crime and violence and effectiveness in improving child health outcomes. Although there is limited efficacy evidence that substance abuse prevention can be effectively addressed by targeting low SES, programs designed to improve educational pathways show some efficacy in reducing aspects of adolescent substance use.
Conclusion: Mental health promotion strategies can draw on the approaches outlined here that are associated with the prevention of child and adolescent problems within low SES communities. Alternatively, such interventions could be supported in mental health promotion policy as they may assist in preventing related problems that undermine mental health.

Managing professionals : the emerging leadership role of Victorian Maternal and Child Health coordinators

Drawing on research into cultural and organizational change in the Victorian Maternal and Child Health Service during the 1990s, this paper examines implications for the nursing leadership provided by service coordinators. The project included a quantitative survey of nurses and semistructured interviews with managers and coordinators. Under a strongly neoliberal state government in Victoria, Australia, services were fundamentally restructured through tendering processes. A competitive, productivist culture was introduced that challenged the professional ethos of nurses and a primary health orientation to the care of mothers and infants. This paper focuses on the pressures that the entrepreneurial environment presented to maternal and child health nurses' identity and collegial relations and to the coordination role. It argues that coordinators emerged as a Significant nursing management group at the interface of administrative change and the management of professional practice. Although many nurses skilfully negotiated tensions with peers and management, their leadership role needs further clarification and support.

Healthy eating, activity and obesity prevention: a qualitive study of parent and child perceptions in Australia

Preventative health strategies incorporating the views of target participants have improved the likelihood of success. This qualitative study aimed to elicit child and parent views regarding social and environmental barriers to healthy eating, physical activity and child obesity prevention programmes, acceptable foci, and appropriate modes of delivery. To obtain views across a range of social circumstances three demographically diverse primary schools in Victoria, Australia were selected. Children in Grades 2 (aged 7–8 years) and 5 (aged 10–11 years) participated in focus groups of three to six children. Groups were semi-structured using photo-based activities to initiate discussion. Focus groups with established parent groups were also conducted. Comments were recorded, collated, and themes extracted using grounded theory. 119 children and 17 parents participated. Nine themes emerged: information and awareness, contradiction between knowledge and behaviour, lifestyle balance, local environment, barriers to a healthy lifestyle, contradictory messages, myths, roles of the school and family, and timing and content of prevention strategies for childhood obesity. In conclusion, awareness of food ‘healthiness’ was high however perceptions of the ‘healthiness’ of some sedentary activities that are otherwise of benefit (e.g. reading) were uncertain. The contradictions in messages children receive were reported to be a barrier to a healthy lifestyle. Parent recommendations regarding the timing and content of childhood obesity prevention strategies were consistent with quantitative research. Contradictions in the explicit and implicit messages children receive around diet and physical activity need to be prevented. Consistent promotion of healthy food and activity choices across settings is core to population prevention programmes for childhood obesity.