Dietary Patterns of Children from the Amazon Region of Ecuador: A Descriptive, Qualitative Investigation.

Many young children in Ecuador suffer from high rates of malnutrition and stunting that affect their long-term growth and development. Little is known about the dietary patterns of children from the Amazon region who experience some of the highest rates of stunting (height-for-age) within Ecuador. Semi-structured interviews were conducted with 50 mothers of young children living in the Ecuadorian Amazon. In addition to descriptions of overall dietary patterns, three themes emerged from the interviews relating to strengths mothers have in feeding their children healthy diets: knowledge, autonomous and independent children, and supportive and responsive parenting. Five themes were found relating to barriers mothers have in feeding their children healthy diets. The first four themes concerned barriers (lack of knowledge of healthy foods, lack of access to healthy foods, not enough money, and child's health) related to multidimensional poverty. All these influenced the last theme found, namely, how difficult of an eater the child was. The implications of intervention efforts to reduce undernutrition and promote children's development by building on specific family and community strengths and identified barriers are also discussed in this paper.

Intervención basada en rutinas como apoyo a la participación familiar para el desarrollo del lenguaje en bebés prematuros / Routine based intervention to support family participation in language development in preterm babies

La prematuridad está asociada a riesgos en salud y neurodesarrollo, agravados por temores y desconocimiento de los padres para atender las necesidades del bebé. Por ello se requieren programas de atención temprana centrados en la familia y en entornos naturales, no disponibles en Ecuador. Este trabajo presenta la incidencia que puede presentar una intervención basada en rutinas (IBR) en la participación familiar para el desarrollo del lenguaje de sus bebés prematuros. Tres universidades internacionales y una organización no gubernamental que brinda servicio especializado, colaboraron en este estudio de casos que implementó durante 16 semanas la IBR con familias de bebés prematuros habitantes de sectores populares y usuarios de la ONG. Se recogieron datos cualicuantitativos pre- y postaplicación de la IBR. La ASQ-3 se aplicó para evaluar a los bebés y fortalecer el conocimiento de las familias sobre el desarrollo infantil. En una entrevista final, se analizan las percepciones de las madres sobre la incidencia de la intervención en participación familiar para el desarrollo del lenguaje de sus bebés. Los resultados evidencian cuantitativamente el avance de los bebés. Se destaca que las condiciones de desarrollo del bebé está mediada por las múltiples hospitalizaciones y poco conocimiento y temores de los padres sobre la condición de la prematuridad. Al finalizar, las familias manifiestan satisfacción con el proceso y reconocen el desarrollo del lenguaje de sus bebés como un resultado del incremento de la interacción familiar provocado por la IBR

Prematurity is associated with health and neurodevelopmental risks, aggravated by fears and lack of parental knowledge of their baby's needs. Therefore, early care programmes that focus on the family and natural environments, not available in Ecuador, are required. This paper presents the impact that a Routine Based Intervention (RBI) can have on family involvement in the development of their premature babies' language. Three international universities and a non-governmental organisation that provides specialist services collaborated in this case study, which implemented the IBR for 16 weeks with families of premature babies living in popular sectors and users of the NGO. Qualitative and quantitative data were collected pre- and post-implementation. The ASQ-3 was used to assess the babies and enhance the families' knowledge on child development. In a final interview, the mothers' perceptions of the impact of family involvement on their babies' language development were analysed. The results provide quantitative evidence of the babies' progress. It is noteworthy that the baby's developmental conditions were mediated by multiple hospitalisations and the parents' lack of knowledge about prematurity. At the end of the intervention, the families expressed their satisfaction with the process and recognised their babies' language development as a result of increased family interaction through the RBI

The Home Visit Rating Scales: Revised, restructured, and revalidated.

The Home Visit Rating Scales (HOVRS) were initially developed from field-based descriptions of successful home visits and are supported by home-visiting research in multiple disciplines. Four home-visiting practices scales include indicators of relationship building with families, responsiveness to family strengths, facilitation of parent-child interaction, and collaboration with parents. Three family engagement scales include indicators of parent-child interaction, parent engagement, and child engagement in the visit. The original version, the HOVRS-1, was validated using video and data from two Early Head Start home-visiting programs. Conceptual and structural changes for the HOVRS-3 were designed to improve readability, usability, and clarity. Newly trained observers used the HOVRS-3 to observe archived videos from the original measurement sample. The HOVRS-3 showed good interrater reliability, scale internal consistency, convergent validity, predictive validity, practical significance, and version stability. When the HOVRS-3 home-visit quality scores were higher, it was twice as likely for parenting scores to be average or better and for child language to be at age level or better at age 3 years, over and above parenting and child language at age 1 year. The HOVRS can guide observations of home-visit quality in infant-toddler and early childhood programs to improve home-visiting practices and family engagement.

Las Escalas de Evaluación de Visitas a Casa inicialmente se desarrollaron a partir de las descripciones sobre el campo de exitosas visitas a casa y las mismas están apoyadas por la investigación sobre la visita a casa en múltiples disciplinas. Las escalas de prácticas de cuatro visitas a casa incluyen indicadores de relaciones establecidas con familias, sensibilidad hacia los puntos fuertes de la familia, el facilitar la interacción entre progenitor y niño, y la colaboración con los progenitores. Las escalas de participación de tres familias incluyen indicadores sobre la interacción entre progenitor y niño, la participación del progenitor, y la participación del niño en la visita. Se validó la versión original, HOVRS-1, usando un video e información de dos programas de visitas a casa de Un Comienzo Temprano (Early Head Start). Se diseñaron cambios conceptuales y estructurales para HOVRS-3 para mejorar la legibilidad, la disponibilidad para el uso y la claridad. Nuevos observadores entrenados usaron HOVRS-3 para observar videos archivados acerca de las medidas de la muestra original - HOVRS-3 mostró buena confiabilidad entre los evaluadores, consistencia interna de la escala, validez convergente, validez de predicción, importancia práctica y estabilidad de la versión. Cuando los puntajes de calidad de HOVRS-3 sobre la visita a casa fueron más altos, la inclinación de los puntajes de crianza de ser promedio o mejores fue dos veces mayor, así como también fue el lenguaje del niño de estar al nivel de la edad o mejor a los 3 años, muy por encima del lenguaje de crianza y del niño a la edad de un año. Las Escalas de Evaluación de Visitas a Casa pueden guiar las observaciones de la calidad de la visita a casa en programas para infantes y niños pequeñitos y en la temprana niñez para mejorar las prácticas de visitas a casa y la participación de la familia.

Les Echelles d'Evaluation de la Visite à Domicile ont été initialement développées à partir de descriptions sur le terrain de visites à domicile réussies et sont soutenues par les recherches sur les visites à domicile dans de multiples disciplines. Quatre échelles de pratique de visites à domicile incluent des indicateurs de développement de la relation avec les familles, la réaction aux forces familiales, la facilitation de l'interaction parent-enfant, et la collaboration avec les parents. Trois échelles d'engagement de la famille incluent des indicateurs d'interaction parent-enfant, d'engagement parental, et d'engagement de l'enfant durant la visite. La version originale, abrégée en anglais HOVRS-1, a été validée en utilisant des vidéos et des données de deux programmes de visites à domiciles américains dans le cadre du programme d'aide aux enfants défavorisés de Early Head Start. Les changements conceptuels et structurels du HOVRS-3 ont été faits afin d'améliorer sa lisibilité, sa facilité d'utilisation et sa clarté. De nouveaux observateurs fraîchement formés ont utilisé les afin d'observer des vidéos mises en archive de l'échantillon original de mesure. Les HOVRS-3 ont fait preuve d'une bonne fiabilité d'inter-évaluateur, d'une bonne cohérence interne à l'échelle, de validité convergente et de stabilité de version. Lorsque les scores de qualité de la visite à domicile HOVRS-3 étaient plus élevés il était deux fois plus probable que les scores de parentage soient moyens ou mieux et pour le langage de l'enfant qu'il soit au niveau de l'âge ou mieux à l'âge de 3 ans, bien au dessus du parentage et du langage de l'enfant à l'âge de 1 ans. Les Echelles d'Evaluation de la Visite à Domicile peuvent guider des observations de la qualité de la visite à domicile chez les nourrissons-petits-enfants et de programmes de la petite enfance afin d'améliorer les pratiques de visites à domicile et d'engagement de la famille.

HOME VISIT QUALITY VARIATIONS IN TWO EARLY HEAD START PROGRAMS IN RELATION TO PARENTING AND CHILD VOCABULARY OUTCOMES.

Home-visiting programs aiming to improve early child development have demonstrated positive outcomes, but processes within home visits to individual families are rarely documented. We examined family-level variations in the home-visiting process (N = 71) from extant video recordings of home visits in two Early Head Start programs, using an observational measure of research-based quality indicators of home-visiting practices and family engagement, the Home Visit Rating Scales (HOVRS). HOVRS scores, showing good interrater agreement and internal consistency, were significantly associated with parent- and staff-reported positive characteristics of home visiting as well as with parenting and child language outcomes tested at program exit. When home-visiting processes were higher quality during the program, home visit content was more focused on child development, families were more involved in the overall program, and most important, scores on measures of the parenting environment and children's vocabulary were higher at the end of the program. Results showed that home visit quality was indirectly associated with child language outcomes through parenting outcomes. Observation ratings of home visit quality could be useful for guiding program improvement, supporting professional development, and increasing our understanding of the links between home-visiting processes and outcomes.

Academic outcomes of very low birth weight infants: the influence of mother-child relationships.

It is commonly accepted that parent-child interactions are bidirectional and complex and are influenced by many different factors. The current study examined the academic and behavioral skills in the early elementary years of preterm infants and the influence of their early mother-child interactions on these skills. Using a sample of 21 premature infants and their mothers, this study found that positive early interactions during feeding were related to later mutual enjoyment during a teaching task at school age, but early maternal depression was not. Early risk factors of premature infants, specifically the number of days spent on a ventilator, were positively related to maternal perceptions of hassle associated with feeding and negatively related to maternal sensitivity during feeding. Finally, mutual enjoyment was strongly associated with language, cognitive, and behavioral skills at school age. These results suggest that it is not only the infant risk factors following a premature birth that influence later development but also the parent-child relationship and emphasize the importance of understanding and promoting these early positive parent-child interactions for premature infants.

Maternal intrusiveness, maternal warmth, and mother-toddler relationship outcomes: variations across low-income ethnic and acculturation groups.

The present study investigated the extent to which maternal intrusiveness and warmth during play, observed in 579 European American, 412 African American, and 110 more and 131 less acculturated Mexican American low-income families when children were approximately 15 months old, predicted 3 dimensions of the mother-toddler relationship 10 months later. Intrusiveness predicted increases in later child negativity in all 4 groups. Among African Americans only, this association was moderated by maternal warmth. Intrusiveness predicted negative change in child engagement with mothers only in European American families. Finally, near-significant trends suggested that intrusiveness predicted later decreased dyadic mutuality in European American and more acculturated Mexican American families, but not in African American or less acculturated Mexican American families.