Introduction of solid food to young infants.

Timing of the first introduction of solid food during infancy may have potential effects on life-long health. To understand the characteristics that are associated with the timing of infants' initial exposure to solid foods. The 2000 National Survey of Early Childhood Health (NSECH) was a nationally representative telephone survey of 2,068 parents of children aged 4-35 months, which profiled content and quality of health care for young children. African-American and Latino families were over-sampled. Analyses in this report include bivariate tests and logistic regressions. 62% of parents reported introducing solids to their child between 4-6 months of age. African-American mothers (OR=0.5 [0.3, 0.9]), English-speaking Latino mothers (OR=0.4 [0.2, 0.7]), White mothers with more than high school education (OR=0.5 [0.2, 1.0]), and mothers who breastfed for 4 months or longer (OR=0.4 [0.3, 0.7]) were less likely to introduce solids early. Most parents (92%) of children 4-9 months of age reported that their pediatric provider had discussed introduction of solids with them since the child's birth, and provider discussion of feeding was not associated with the timing of introduction of solids. Although most parents recall discussing the introduction of solid foods with their child's physician, several subgroups of mothers introduce solid foods earlier than the AAP recommendation of 4-6 months. More effective discussion of solid food introduction linked to counseling and support of breastfeeding by the primary health care provider may reduce early introduction of solids.

One Hundred Intentional Acts of Kindness toward a Pregnant Woman: building reproductive social capital in Los Angeles.

This article describes the development of an innovative community-based program, One Hundred Intentional Acts of Kindness toward a Pregnant Woman (100 Acts), which seeks to increase reproductive social capital for pregnant women in south and central Los Angeles communities. Reproductive social capital includes features such as networks, norms, and social trust that facilitate optimal reproductive health within a community. 100 Acts was designed and developed by the Healthy African American Families project, using community participatory methods, to increase local community and social network support for pregnant women. Dialog groups with pregnant women identified specific actions that families, friends, and strangers might do to support pregnancies. Participants primarily wanted emotional and instrumental support from family and friends. From strangers, they wanted respect for personal space and common courtesy. Based on these results, the 100 Acts was created for use in the Los Angeles community. 100 Acts encourages and engages active participation from community members in promoting healthy pregnancies. By seeking to increase community-level reproductive social capital, 100 Acts shifts the provision of social support during pregnancy from a high-risk approach to a population approach. 100 Acts also establishes new social norms about how pregnant women are valued, treated and respected.

Where is the F in MCH? Father involvement in African American families.

OBJECTIVES: To: 1) review the historical contexts and current profiles of father involvement in African American families; 2) identify barriers to, and supports of, involvement; 3) evaluate the effectiveness of father involvement programs; and 4) recommend directions for future research, programs, and public policies. METHODS: Review of observational and interventional studies on father involvement. RESULTS: Several historical developments (slavery, declining employment for Black men and increasing workforce participation for Black women, and welfare policies that favored single mothers) led to father absence from African American families. Today, more than two thirds of Black infants are born to unmarried mothers. Even if unmarried fathers are actively involved initially, their involvement over time declines. We identified multiple barriers to, and supports of, father involvement at multiple levels. These levels include intrapersonal (eg, human capital, attitudes and beliefs about parenting), interpersonal (eg, the father's relationships with the mother and maternal grandmother), neighborhoods and communities (eg, high unemployment and incarceration rates), cultural or societal (eg, popular cultural perceptions of Black fathers as expendable and irresponsible, racial stratification and institutionalized racism), policy (eg, Earned Income Tax Credit, Temporary Assistance for Needy Families, child support enforcement), and life-course factors (eg, father involvement by the father's father). We found strong evidence of success for several intervention programs (eg, Reducing the Risk, Teen Outreach Program, and Children's Aid Society - Carrera Program) designed to prevent formation of father-absent families, but less is known about the effectiveness of programs to encourage greater father involvement because of a lack of rigorous research design and evaluation for most programs. CONCLUSION: A multi-level, life-course approach is needed to strengthen the capacity of African American men to promote greater involvement in pregnancy and parenting as they become fathers.

Pediatricians' roles in the provision of developmental services: an international study.

OBJECTIVE: To understand how early childhood developmental services are provided in other countries in comparison with the United States. BACKGROUND: Recent surveys document gaps in developmental services provided in the United States. Understanding pediatrician roles in other industrialized countries may shed light on how to meet emerging professional expectations around health promotion care and developmental services. DESIGN: : Using a typology of preventive and health promotion care, we conducted structured interviews and case vignettes to examine the roles of health professionals in (1) developmental assessment, (2) anticipatory guidance/health promotion, (3) problem-focused counseling, and (4) coordination of service needs. Participants included 20 child health experts and key informants in 10 countries. Roles and systems of providers of care were categorized into several organizational approaches based on these results. RESULTS: Pediatricians provide the continuum of primary care developmental services in only a few countries. In contrast to the United States, most of the studied countries have complementary roles for pediatricians and other nonphysician clinicians in preventive care. In many countries, nurses or general practice physicians provide most basic preventive care whereas pediatricians provide more specialized care for developmental/behavioral problems and chronic medical conditions. CONCLUSIONS: Recent studies that have documented the poor quality of early childhood health care are pressuring the US pediatric profession to meet increasing expectations in developmental services. Although US pediatricians struggle to incorporate recommendations into their daily practice, most other countries place responsibility for some preventive developmental services with community-based nurses or general practice physicians.