Primary Care Pediatricians' Perceived Prevalence and Surveillance of Adverse Childhood Experiences in Low-Income Children.

OBJECTIVE: A recent policy statement from the American Academy of Pediatrics outlines the central role of pediatricians in screening for and addressing precipitants of toxic stress (e.g., adverse experiences). Despite these recommendations, it is unknown whether pediatricians are in fact screening for these precipitants. METHODS: A sample of 210 pediatricians serving low-income children completed a survey regarding their responses to adverse childhood experiences (ACEs). Participants were asked to estimate the prevalence of ACEs in their practice, their current practices, and recommendations for screening. RESULTS: For nearly all ACEs, pediatricians' estimates of the prevalence in their practice were lower than state-reported prevalence. For many ACEs, the number of pediatricians who support the need for recommended screening was far higher than the number who reported actually screening. CONCLUSIONS: Our findings suggest clinicians serving primarily low-income families recommend screening but may underestimate the prevalence of ACEs in their practice and may not be equipped to screen or address these matters consistently.

Trauma reactions in mothers and fathers after their infant's cardiac surgery.

OBJECTIVE: To investigate the prevalence and nature of trauma symptoms in mothers and fathers of infants who had cardiac surgery. METHOD: Parents of infants who underwent cardiac surgery before 3 months of age were recruited at the time of surgery. 77 mothers and 55 fathers completed the Acute Stress Disorder Scale 1 month after their infant was discharged from hospital. RESULTS: 26 of 77 (33.8%) mothers and 10 of 55 (18.2%) fathers satisfied criteria for acute stress disorder. For all symptom clusters, except dissociation, mothers had significantly higher mean scores (and therefore higher levels of symptoms) than did fathers, ps = .01, -.02. 83 percent of parents endorsed at least 1 trauma symptom and 11.4% endorsed only 1 symptom at a clinical level. Symptoms of dissociation were the most commonly endorsed by both parents, with each symptom in that cluster being endorsed at a clinical level by at least 26% of parents. CONCLUSIONS: Consistent with our hypotheses, approximately one-third of parents overall, as well as one-third of mothers and close to one-fifth of fathers, experienced trauma symptoms consistent with a diagnosis of acute stress disorder. Most parents experienced at least one symptom at a clinical level, with symptoms of dissociation being the most commonly endorsed symptom cluster. These findings highlight the need for clinical supports for parents.

Infant cardiac surgery and the father-infant relationship: feelings of strength, strain, and caution.

OBJECTIVE: The purpose of this study was to examine the father-infant relationship in infants with congenital heart disease (CHD). METHOD: Sixty-three fathers whose infants had cardiac surgery before 3 months of age reported on their attachment relationship with their infant within two months of hospital discharge using both qualitative and quantitative methods. RESULTS: Mean scores on the Paternal Postnatal Attachment Scale and scores for patience and tolerance were not different from previously published community norms, ps>.05. Scores for pleasure and interaction (t[50]=-2.383, p=.021, CI: -2.93, -.25) and affection and pride subscale (t[56]=-2.935, p=.005, CI: -1.20, -.23) were significantly lower than community norms. Additionally, 37% of fathers described feeling a strong relationship with their infant whereas 17% reported initial apprehension or condition-specific worry. Fathers with infants who spent fewer days at home prior to admission reported feelings of relationship strain as well as lower pleasure in interaction, affection and pride, patience and tolerance, and overall attachment quality. CONCLUSION: Having an infant with CHD affects some father-infant relationships differently than others with some fathers feeling closer to their infant and other fathers feeling reservation about getting too close. One explanation for these differences may be that spending a great deal of time in hospital restricts the number and quality of interactions infants have with their fathers. Opportunities for intervention include clinical psychosocial services encouraging fathers to interact with and provide physical care of their infant, especially if fathers perceive their infant as medically fragile.