Journal of Child Health Care recent issues

A simple act?

Carter, B. — Fri, 20 Nov 2009 06:44:34 PST

Children's tonsillectomy experiences: influencing factors

Crandall, M., Lammers, C., Senders, C., Braun, J. V. — Fri, 20 Nov 2009 06:44:34 PST

The aim of this study was to explore factors influencing children’s (7—13 years) tonsillectomy experiences and outcomes. A prospective, repeated measures, design was used to investigate the effect of age, gender, ethnicity, time, and previous pain, hospitalization and surgery on children’s (N = 60) perceptions of anxiety, pain intensity, quality of pain and sleep, and oral intake. The relationship between postoperative pain and anxiety was also examined. Using a diary, three days of data were collected. Descriptive statistics, Pearson correlation coefficient, and a mixed linear regression model were used for analysis. Children’s tonsillectomy experiences and outcomes were affected by time, previous experience, age, and anxiety. Moderate correlations were found between level of anxiety and pain intensity. These findings provide clinicians with additional knowledge to guide their perioperative practice and care of children.

'They wouldn't know how it feels . . .': characteristics of quality care from young people's perspectives: a participatory research project

Moules, T. — Fri, 20 Nov 2009 06:44:35 PST

Literature suggests there is a need to hear from children themselves about the quality of healthcare they receive and, although their views are increasingly sought, little is known about children’s definitions of ‘high or low quality care’. This article reports on a participatory, qualitative study that set out to explore with children and young people whether they could be involved in monitoring the quality of hospital care. Nine young people played an active role in the research process, collecting data from an additional 129 participants aged between 9 and 14. Five characteristics of quality care were identified: ‘technical expertise’, ‘friendly staff ’, ‘respect’, ‘choice’ and ‘explanations’.

After-school program to reduce obesity in minority children: a pilot study

Fri, 20 Nov 2009 06:44:35 PST

This study explored a community-based after-school program’s effect on obesity in minority children. Study participants included 178 third through fifth graders (47% Latino, 25% Asian, and 18% African-American) enrolled in America SCORES Bay Area. Outcomes were attendance, change in fitness (20-meter shuttle test), and body mass index (BMI) z-score over eight months. At baseline, 52 percent of children were overweight or obese. Children attended SCORES > 4 days/week and fitness significantly improved (p < 0.01). BMI z-score decreased by 0.04 (p = 0.10) overall, and by 0.05 (p = 0.08) among obese children, but increased among African-American children. These results suggest that SCORES increases fitness and may improve BMI in some minority children. Effect modification by race may relate to differential growth patterns or engagement in SCORES. These findings suggest community-based programs could effectively address obesity. A randomized trial of the SCORES program is warranted to rigorously examine this type of after-school program’s impact on child health.

Review: Functional behavioral assessment as a model for multidisciplinary assessment and treatment

Olson Page, L., Golden, J. A. — Fri, 20 Nov 2009 06:44:35 PST

Behavior, whether internalizing or externalizing, constitutes a primary challenge in any inpatient setting. In many cases, behavior may interfere with progress during inpatient treatment, resulting in the need for a behavioral strategy for those concerns. A multidisciplinary team approach is often necessary to fully identify and remediate interfering difficulties. Functional behavioral assessment (FBA) is a team-based technique that offers a positive option to these types of difficulties. This article provides a rationale for and delineates the use of FBA as a strategy for assessment and treatment for a complex care patient. Two uncontrolled case studies (pediatric rehabilitation and cancer) are used to illustrate the use of FBA in the tertiary hospital setting. Both cases demonstrated improvements in behavior with limited resources (time and training) needed to implement behavioral plans. Additional case-controlled research is needed to demonstrate the feasibility and utility of FBA as a strategy for multidisciplinary treatment planning and intervention.

The association of continuity of care on the diagnosis of hypertension in children and adolescents

Benson, L. J., Cohn, R., Kaelber, D. C. — Fri, 20 Nov 2009 06:44:35 PST

Hypertension among pediatric patients is an underdiagnosed condition. As continuity of care has been found to increase quality of pediatric care, we undertook this study to assess effect of continuity on diagnosis of pediatric hypertension. This is a retrospective analysis of 774 hypertensive patients, ages 3—18 years between June 1999 and October 2007 within the MetroHealth System in northeastern Ohio. The proportion of hypertensive patients diagnosed was assessed using coding within the electronic medical record. Continuity was assessed using the usual provider of care, defined as the number of visits to the most frequent provider divided by the total number of visits in the study period. Overall continuity did not have a statistically significant association with diagnosis (OR 0.7, CI 0.4—1.4). Our research indicates that continuity does not significantly affect diagnosis of hypertension in pediatric patients. Other approaches should be investigated to improve the significant underdiagnosis of pediatric hypertension.

Decreasing pediatric patient anxiety about radiology imaging tests: prospective evaluation of an educational intervention

Fri, 20 Nov 2009 06:44:35 PST

This trial investigated anxiety levels and effect of an educational coloring book (CB) among pediatric patients about to undergo radiology imaging tests. Control group (N = 101) and intervention group (N = 175) children ages 3—10 years and their parents were surveyed to determine anxiety levels before the imaging test, with the intervention group being surveyed after patient and parental review of the CB. Anxiety was low for all subjects overall compared with findings from previously published literature, perhaps related to systemic measures to make children’s hospitals more child friendly in recent years. Review of the CB was not associated with decreased anxiety among patients or parents. However, among a subgroup with higher baseline parental anxiety, there was a trend toward lower patient anxiety in the intervention group. Most parents indicated that the CB was informative and helped them and their child be less worried, and that they were pleased to have received the CB.

Exploring three-year-old children in a primary child health care situation

Harder, M., Christensson, K., Soderback, M. — Fri, 20 Nov 2009 06:44:35 PST

In the Swedish Primary Child Health Care (PCHC) children participate in regular health visits. In these visits children as actors demonstrate their subjective maturity through bodily and verbal expressions. The aim of this study was to explore three-year-old children’s expressions when they take part as actors in a PCHC situation. An explorative design with a hermeneutic approach and video observations was used. Twenty-nine children participated. The findings exhibit a variation of expressions in the situation conceptualized as actions in a progression of states: from a state of getting ready to a state of being ready and further to a state where the child strengthens their own self. This progression is dynamic and coloured with the states of not being ready or of being adverse. The conceptualization of children’s expressions can contribute towards encouraging nurses’ sensitivity when inviting and guiding children in PCHC situations.

Taking a deep breath . . . or two ... or three?

Carter, B. — Thu, 27 Aug 2009 08:13:46 PDT

The perceptions and preferences of parents of children with tracheostomies in a study of humidification therapy

McNamara, D. G., Dickinson, A. R., Byrnes, C. A. — Thu, 27 Aug 2009 08:13:46 PDT

This article reports a grounded theory study which was the qualitative phase of a randomized-controlled trial in children with tracheostomies comparing two techniques for providing humidified inspired gases. Semi-structured interviews were conducted with eight mothers of children with tracheostomies recruited from the trial, one mother who was not involved in the trial and four experienced nurses. Data were analysed using open, selective and theoretical coding. A core category was identified of parents managing the child’s care in response to a set of problematic and constraining states. Parents were seen to utilize strategies of constant checking, becoming the expert, the family pulling together and electing to use preferred technology. The findings of this study mirror those of previous studies and reinforce the primacy of caregivers as managers of their child’s health care. Mothers elected to use or not use a given technology within this context, utilizing a process of balancing.

Improving hospital care for young children in the context of HIV/AIDS and poverty

Richter, L., Chandan, U., Rochat, T. — Thu, 27 Aug 2009 08:13:46 PDT

Paediatric wards in South African government hospitals are occupied predominantly by children with HIV and AIDS-related illnesses. Although access to anti-retroviral treatment for adults is being scaled up, it is likely to be many years before South Africa achieves anywhere near universal access for children. Currently, most children living with HIV or AIDS are identified only when they become acutely or chronically ill and/or hospitalized, if at all. In the absence of treatment, the stress of caring for ill and hospitalized HIV-positive children often results in emotional withdrawal among both health professionals and caregivers. The demoralizing cycle of repeated admissions, treatment failure and death also affect the quality of the care given to HIV-negative children in over-burdened wards. This article describes the development of simple, low-cost and context-relevant interventions to improve the care environment for young hospitalized children within the context of the HIV/AIDS epidemic and poverty.

Acute effects of Yakson and Gentle Human Touch on the behavioral state of preterm infants

Im, H., Kim, E., Cain, K. C. — Thu, 27 Aug 2009 08:13:46 PDT

Two weeks of touch intervention, either Yakson or Gentle Human Touch (GHT) have been shown to reduce the levels of stress hormones. This study evaluated the acute impact of both interventions on state during and immediately after touch. Forty preterm infants with a gestational age of ≤34 weeks received either Yakson or GHT for 15 days. A significantly greater sleeping state was identified in both groups after touch. This effect was significantly stronger with Yakson than GHT. During touch, about half the Yakson infants showed an arousal effect while the GHT infants showed little change. Both interventions left the babies calmer after touch. This calming effect is consistent with the previously observed effect on stress hormones and should be beneficial in terms of growth and development. Yakson had an arousing effect on a subset of the infants during touch, which possibly could be beneficial in terms of social development.

The specificity of post-concussive symptoms in the pediatric population

Falk, A.-C., Von Wendt, L., Soderkvist, B. K. — Thu, 27 Aug 2009 08:13:46 PDT

The study compared patterns of reported symptoms between a mild head injury group and a group of children with abdominal complaints visiting an emergency department. Children (0—15 years) admitted to an emergency department during a three-month period with a history of head injury and a comparison group of children were included. Medical records at the time of injury were reviewed and follow-up questionnaires focused on presumed symptoms related to concussion at three months post-visit. The comparison group reported significantly more change in behaviour than the head injury group. However, for the older children, higher intensity of symptoms was reported by the comparison group compared to the head injury group. Initial differences in the amount and presence of symptoms between the two groups did not reflect the findings at three months; both groups reported symptoms or changes at three months after the event. Evaluating children aged under five, their symptoms and recovery patterns after a head injury is recommended.

how do mothers and fathers who have a child with a disability describe their adaptation/ transformation process?

Pelchat, D., Levert, M.-J., Bourgeois-Guerin, V. — Thu, 27 Aug 2009 08:13:46 PDT

This qualitative study explored the adaptation/transformation process in mothers and fathers at the individual, parental, marital and extrafamilial levels, and the similarities and differences in their experience of living with a child with cerebral palsy. Interviews were conducted with 13 mothers and 13 fathers of children with cerebral palsy. The results show that mothers and fathers are more likely to view the situation differently than similarly. For both parents, the situation offers the potential for transformation. Complementarity between mothers and fathers is an important factor in each of the adaptation or transformation subsystems. Both parents embark on a journey that changes their beliefs about difference, apply their new knowledge to every aspect of their life, and endeavour to normalize their situation.

A self-harm training needs assessment of school nurses

Cooke, E., James, V. — Thu, 27 Aug 2009 08:13:46 PDT

Self-harm is acknowledged to be increasing and is especially prevalent in young people. School nurses are central to adolescent mental health, delivering initial and sustained intervention. However, few studies have considered their experiences and training needs in fulfilling this role. This training needs assessment explored the self-harm training needs of school nurses within one UK primary care trust by utilizing questionnaires and interviews developed specifically for the study. School nurses felt frustrated and inadequate when working with young people who self-harm. The majority had attended self-harm training, yet felt that it only helped a little. Nurses desired training, particularly in practical approaches when working with young people who self-harm, however, analysis suggested that they also needed underpinning theoretical knowledge. Therefore, this study highlights the need for self-harm training for school nurses, incorporating both practical approaches and theoretical knowledge, to ensure that young people who self-harm receive an effective, high-standard service.

Family--school connections and internalizing problems among children living with asthma in urban, low-income neighborhoods

Murdock, K. K., Robinson, E. M., Adams, S. K., Berz, J., Rollock, M. J.D. — Thu, 27 Aug 2009 08:13:46 PDT

Children with asthma living in urban environments are at risk for experiencing internalizing problems and difficulties at school due to social context and health-related stressors. Parent confidence and participation in the school and children’s attitudes about school were explored in association with children’s depressed mood and school anxiety. Forty-five parent—child dyads were recruited from urban community health centers. Most participants were members of ethnic minority groups. Hierarchical multiple regression analyses revealed that higher levels of parent confidence in the school were associated with fewer symptoms of school anxiety in children. Children’s attitudes toward school moderated the relation between parent participation in the school and children’s depressed mood. Specifically, lower levels of parent participation were associated with higher levels of depressed mood only for children with the least positive school attitudes. Although preliminary, these results suggest the importance of attending to family—school connections to optimize the school-related psychological functioning of children living with asthma in urban environments.

Risk-taking behaviour in adolescence: a literature review

Leather, N. C. — Thu, 27 Aug 2009 08:13:46 PDT

This article gives a review of the literature outlining risk-taking behaviour in the adolescent population, linking this to developmental tasks. The review includes reference to health, peers, parenting, self-esteem and quality of life issues. A theoretical overview of the research area in general is presented and links to social and society issues. The possible causes of risk-taking, including alcohol, drugs and violence, are considered and factors reviewed.

Children's Nursing Education: Members club or street party?

Randall, D., McTaggart, I. — Wed, 20 May 2009 08:34:14 PDT

Creating space: hospital bedside displays as facilitators of communication between children and nurses

Lewis, P., Kerridge, I., Jorden, C. F.C. — Wed, 20 May 2009 08:34:14 PDT

Over the past decades there has been a marked change in the physical environment of children's hospitals and the configuration of individual bed spaces. No longer the stark, clinical spaces typical of years gone by, the modern hospital bed space hosts a variety of visual displays reflecting different aspects of the child's life. Building upon ideas introduced by Lewis and informed by a recent qualitative study into hospital bedside displays, this article discusses the role that displays can play in developing, deepening and enriching relationships between nurses, patients and their families in the paediatric hospital environment. It discusses the links between hospital and home, the specific function of the display of photographs and the nurse's role in `knowing' the patient and facilitating links between hospital and home. It concludes that nurses' conscious observations of a visually rich environment may make a positive contribution to the care that they deliver for the benefit of their patients and themselves.

Influences on nurses' scoring of children's post-operative pain

Simons, J., Moseley, L. — Wed, 20 May 2009 08:34:14 PDT

There is a lack of clarity as to why some nurses are not delivering optimal pain management to children post-operatively. This retrospective chart review study examined nurses' pain scoring on 175 children during the first 24 hours post-operatively. Data were analysed on the amount of assessments made, assessment scores recorded, as well as the age, gender and type of surgery performed. One-quarter of children had no assessment record of their pain in the first 24 hours post-operatively. When the pain tool was part of an observation chart, nurses recorded more pain scores. Nurses' scoring of children's pain is influenced positively by children under five years of age and those who undergo abdominal surgery. Nurses who had access to one document for recording vital signs as well as pain scores were more likely to assess and record a child's pain score than nurses who had to use a separate chart.

Dietary fibre, fluids and physical activity in relation to constipation symptoms in pre-adolescent children

Jennings, A., Davies, G. J., Costarelli, V., Dettmar, P. W. — Wed, 20 May 2009 08:34:14 PDT

Children with constipation are advised frequently to increase their activity levels, fluids and fibre intake. The aim of this study was to examine the prevalence of constipation symptoms in a group of schoolchildren while concurrently assessing their activity levels and fluid and fibre intakes. Eighty-four pre-adolescent children aged 7—10 years were recruited. All children completed a bowel function diary, an activity diary and a weighed food inventory for seven consecutive days. Of the children, 33 percent were found to experience constipation symptoms. Fluid and fibre intakes were higher in the children who did not experience constipation symptoms, but the results were not significant. Physical activity levels were found to be significantly higher in the children reporting constipation symptoms, with the most active children reporting low water intakes. This study has highlighted that constipation symptoms are a prevalent problem in children not seeking medical treatment.

Psychological outcomes in children following pediatric intensive care unit hospitalization: a systematic review of the research

Rennick, J. E., Rashotte, J. — Wed, 20 May 2009 08:34:14 PDT

A systematic review of published research on children's psychological outcomes following Pediatric Intensive Care Unit (PICU) hospitalization was conducted. Of the 275 papers published between 1970 and April 2008 which were identified using keywords, reference lists and one author's collections, a total of 28 papers met the inclusion criteria for this review. The papers fell into four categories based on the focus of the research: (1) children's PICU perceptions and recall; (2) children's psychological outcomes, broadly defined; (3) post-traumatic stress responses; and (4) general health status and quality of life. The findings suggest that PICU hospitalization can result in negative psychological sequelae in children, which can manifest themselves up to one year post-discharge. While a small number of studies have attempted to identify predictors of psychological outcome, this work remains in its infancy. The importance of the child's interpretation of the illness experience in influencing subsequent behavioral and emotional responses is highlighted.

Qualitative evaluation of a young carers' initiative

Richardson, K., Jinks, A., Roberts, B. — Wed, 20 May 2009 08:34:14 PDT

This focus of this article is a qualitative, evaluative study of three Crossroads young carers projects. Focus group discussions took place with 24 young people aged 11—16 years. Data were analysed using a thematic content analysis approach. The themes of the research were: experiences of being a young carer, peer support, opportunities for time out and purposeful activities. The personal characteristics of the participants give rise to a number of worrying conclusions, that relatively young people were found to be undertaking primary caring roles over long periods of time. However, the groups were found to provide opportunities for young carers to experience a positive environment, participate in purposeful activities and have the chance to develop new friendships. Nevertheless, the literature suggests that provision of such projects is inadequate and under-resourced, which may disadvantage further a group of young people who are known to come from lower income families.

Health care interventions for excessive crying in infants: regularity with and without swaddling

Blom, M. A., van Sleuwen, B. E., de Vries, H., Engelberts, A. C., l'Hoir, M. P. — Wed, 20 May 2009 08:34:14 PDT

This article describes two health care interventions developed to support parents whose infant cries excessively. Intervention 1 consists of advice to caregivers to bring about regularity and uniformity in daily infant care and to reduce external stimuli. Intervention 2 is the same advice accompanied by instructions to swaddle during sleep. Nurses can teach parents these interventions easily. The goal is to help infants to establish a stable sleep—wake rhythm, for overtiredness to disappear and excessive crying to stop. The approach is based on offering predictability, which helps to develop infant self-regulating ability. If the intervention succeeds, which is often the case, the baby cries less, drinks adequately, is able to fall asleep on their own and to sleep sufficiently, and therefore is no longer overtired. Parental stress is reduced, which could translate into an improvement in family health and quality of interaction between the parents and the child.

Fear, failure, outrage and grief: the dissonance between public outrage and individual action?

Jackson, D., Carter, B. — Tue, 24 Feb 2009 08:17:49 PST

Mad, sad and hormonal: the gendered nature of adolescent sleep disturbance

Vallido, T., Jackson, D., O'Brien, L. — Tue, 24 Feb 2009 08:17:49 PST

Up to 40 percent of adolescents experience some form of sleep difficulty, with adolescent girls often reporting higher levels of sleep disturbance and daytime fatigue than boys. This article explores the literature surrounding female adolescent sleep disturbance. The findings reveal that sleep problems in young women can be linked to girls being at an increased risk for puberty-related fatigue, sexual abuse, a higher prevalence of mental illness and sensitivity to familial disruption, and increased domestic and grooming expectations. Implications for nursing practice include initiating conversations about sleep, sleep disturbance and sleeping arrangements when working with adolescent girls. Nurses should gather accurate sleep histories, provide adolescent girls and their caregivers with information and recommend interventions to improve sleep if necessary. Nurses should remain sensitive to the confounding effects of pubertal status, menarche and the cyclic release of hormones when designing and conducting future research into female adolescent sleep disturbance.

Body image in adolescents with cerebral palsy

Hammar, G. R., Ozolins, A., Idvall, E., Rudebeck, C. E. — Tue, 24 Feb 2009 08:17:49 PST

The study aims to describe important features of body image in adolescents with motor disabilities and compare them against similar features in able-bodied peers. Relational aspects of body image were given preference in a questionnaire distributed to 35 adolescents with cerebral palsy and 98 adolescents with no known disabilities. Similarities were shown, but also significant differences, indicating a less favourable body image in adolescents with cerebral palsy. It is paramount for young people who are constantly reminded of physical restrictions to experience body vitality. Professionals need to consider the importance of how they interact with young people when seeking to promote a positive body image

Public health nurses' approaches to early childhood physical activity in Finland

Javanainen-Levonen, T., Poskiparta, M., Rintala, P., Satomaa, P. — Tue, 24 Feb 2009 08:17:49 PST

This study was conducted using five focus groups with 24 public health nurses from regional child health clinics in order to explore health professionals' perceptions concerning physical activity. Participants were professionally experienced (mean 13.9 years), female (mean 46.2 years) nurses with some training in health-enhancing physical activity. Frame analysis of verbatim transcripts resulted in four frames: the environmental frame, the family frame, the natural frame and the wellbeing and health frame. The importance of physical and social environment, especially the role of parents, was highlighted as determinants of physical activity. Furthermore, the natural characteristics of physical activity in early childhood and the benefits of physical activity for wellbeing and health were focused on within these frames. According to the findings, the sample of Finnish nurses approached physical activity multidimensionally. Further research is warranted to ascertain how these approaches come true in health care settings in Finland as well as elsewhere.

Factors predicting BCG immunization status in northern Nigeria: a behavioral-ecological perspective

Babalola, S., Lawan, U. — Tue, 24 Feb 2009 08:17:49 PST

This study examines the predictors of Bacille Calmette-Guérin (BCG) immunization status among infants in northern Nigeria using a behavioral-ecological model. The findings show only 37.3 percent of the children had received BCG vaccine, and reveal that BCG immunization status in northern Nigeria is influenced by multiple layers of factors, including child's characteristics, parental or household factors, community characteristics, vaccine supply and the policy environment. At the child's level, place of birth and ownership of an immunization card are the two most significant predictors. The parental and household predictors of BCG immunization status include maternal use of antenatal care, maternal knowledge about immunization, maternal exposure to child health information, social influence and paternal approval of immunization. Both the regularity of vaccine supply to the health facility and the state of residence are associated independently with BCG immunization status. These findings stress the need for interventions at multiple levels in order to increase BCG immunization status.

`Mommy knows best': parents' perceptions of their infant's health

Johnelle Sparks, P. — Tue, 24 Feb 2009 08:17:49 PST

The purpose of the research presented in this article is to analyze how parents assess their child's health, ranging from excellent to poor. Specifically, it asks how the sociodemographic and health characteristics of infants and parents influence parents' perceptions of their child's health status. The data for this research come from the Early Childhood Longitudinal Study — Birth Cohort (ECLS-B), which are able to address the relationship between sociodemographic covariates and parents' perceptions of their child's health. Binary logistic regression techniques are used in a nested manner to model the way in which parents arrive at a subjective measure of their child's health status. The results indicate that prior diagnoses of health conditions, interaction with the health care system, parents' assessment of their own health and poverty status influence how parents determine their child's health status.

Health counselling: parental-oriented health dialogue -- an innovation for child health nurses

Golsater, M., Enskar, K., Lingfors, H., Sidenvall, B. — Tue, 24 Feb 2009 08:17:49 PST

The Health Curve, used by nurses in community-based health care, is an educational tool for conducting goal-directed dialogues concerning lifestyle and health. The aim of this study was to investigate how child health nurses experienced the Health Curve as a tool for conducting dialogues with parents. Fourteen nurses were interviewed. The data were analysed according to qualitative analysis. The results showed that nurses working in child health care experienced the Health Curve as a useful tool for conducting health dialogues with parents. Through their work with the Health Curve, the nurses gained a greater insight into, and understanding of, the families' health and life situation. The results indicated that working with the Health Curve could increase the opportunity for nurses to provide parents with support early in the process, helping the family to lead a healthy lifestyle.