Family Rules and Routines During the Early Phases of Pediatric Cancer Treatment: Associations With Child Emotional and Behavioral Health.

OBJECTIVE: Consistent family rules and routines promote positive adaptation to stress and may be protective to child emotional and behavioral functioning. Few studies have quantified family engagement in these behaviors during pediatric cancer treatment or examined associations with child emotional and behavioral health. METHODS: In this cross-sectional observational study, 86 primary caregivers of youth ages 2-14 years (M = 7.9) with an initial diagnosis of cancer within 16 weeks reported on their frequency of engagement in family rules and routines (e.g., sleep, schoolwork, and meal routines) before their child's cancer diagnosis and their current frequency of engagement in the same routines. Caregivers also reported demographics, psychosocial distress, and child emotional and behavioral health outcomes. Analyses examined demographic and psychosocial factors associated with engagement in rules and routines during cancer treatment, and associations with child emotional and behavioral health. RESULTS: Families reported a lower frequency of engagement in rules and routines during cancer treatment, compared to before treatment (mean difference 0.8 SDs [95% confidence interval 0.7-1.1 SDs]). Caregiver factors associated with lower engagement in rules and routines during treatment included being married, having lower educational attainment, and higher levels of psychosocial distress. Families who engaged in higher levels of rules and routines during treatment reported fewer child externalizing and behavioral challenges. There was limited evidence of association between family rules and routines and child internalizing outcomes. CONCLUSIONS: Results found that engaging in family rules and routines during cancer treatment was associated with fewer child behavioral challenges during treatment. Future directions include longitudinal examinations of family rules, routines, and child emotional/behavioral outcomes to examine directional impact over time.

Barriers and facilitators of family rules and routines during pediatric cancer treatment.

OBJECTIVE: Pediatric nurses work closely with families of children with new cancer diagnoses and can provide essential supports to promote coping and adjustment. This cross-sectional qualitative study aimed to gather caregiver perspectives on barriers and facilitators to adaptive family functioning during the early phases of cancer treatment, with a focus on family rules and routines. METHODS: Caregivers (N = 44) of a child diagnosed with cancer and receiving active treatment completed a semi-structured interview about their engagement in family rules and routines. Time since diagnosis was abstracted from the medical record. A multi-pass inductive coding strategy was utilized to extract themes identifying caregiver-reported facilitators and barriers to maintaining consistent family rules and routines during the first year of pediatric treatment. RESULTS: Caregivers identified three primary contexts that presented barriers and facilitators to engagement in family rules and routines: the hospital setting (n = 40), the family system (n = 36), and the broader social and community setting (n = 26). Caregivers reported barriers primarily related to the demands of their child's treatment, additional caregiving needs, and needing to prioritize basic daily tasks (e.g., food, rest, household needs). Caregivers reported that different networks of support across contexts facilitated family rules and routines by expanding caregiver capacity in distinctive ways. CONCLUSIONS: Findings provided insight into the importance of having multiple networks of support to extend caregiving capacity in the context of cancer treatment demands. PRACTICE IMPLICATIONS: Providing nurses with training to facilitate problem-solving skills in the context of competing demands may provide a new avenue of clinical intervention at the bedside.

Family rules, routines, and caregiver distress during the first year of pediatric cancer treatment.

OBJECTIVE: A new diagnosis of pediatric cancer may disrupt family functioning. The current study aimed to describe changes in family rules and routines during the first year of pediatric cancer treatment, and to explore associations with demographics, illness factors, and caregiver distress. METHODS: This exploratory mixed-methods, cross-sectional study examined 44 primary caregivers of youth in treatment for a new cancer diagnosis in 2019 and 2020, before the onset of the COVID-19 pandemic. Caregivers completed validated questionnaires assessing demographic and child illness characteristics, psychosocial distress, and cancer-related stressors, and participated in a semi-structured interview about family rules and routines. RESULTS: Caregivers reported changes in bedtime, mealtime, and school routines, relaxed behavioral expectations and rules around screen time, and new rules and routines around treatment, medications, and infection control. Caregivers with elevated levels of psychosocial distress reported more changed routines than caregivers with low levels of psychosocial distress. Caregivers who endorsed more cancer-related stressors reported more new rules and routines than those who reported fewer cancer-related stressors. Demographic and illness factors were not significantly associated with the number of changed, new, or stable family rules and routines. CONCLUSIONS: Families may relax rules and routines during the first several months of diagnosis, and this may be related to side effects of treatment and limited caregiver capacity. The long-term impact of changes in family rules and routines during cancer treatment warrants further study given that accommodating parenting strategies have been associated with adverse short- and long-term child health and behavior outcomes.

Impact of divorce on children: developmental considerations.

Although divorce can have significant negative impact on children, a variety of protective factors can increase the likelihood of long-term positive psychological adjustment. • Exposure to high levels of parental conflict is predictive of poor emotional adjustment by the child regardless of the parents' marital status. • Epidemiologic data reveal that custody and parenting arrangements are evolving, with more emphasis on joint custody and access to both parents by the child. • Pediatricians' knowledge of childhood development is essential in providing anticipatory guidance to parents throughout the divorce process and beyond.