How is my child doing - parental understanding of their children when a parent has cancer.

To explore the difficulties parents face when understanding their children's reactions to parental cancer and parents' reactions to their children's perceived needs.Qualitative interviews with cancer patients and their partners.Eleven patients and seven partners took part. Their children were aged 1-15 years. Eight patients were mothers and cancer was diagnosed median 28 (7-104) months ago.Inductive analysis with systematic text condensation.Parents were groping in the dark when understanding their children's reactions. They observed signs of distress in their children, but often avoided communication about emotional reactions. We suggest parental difficulties in containing own and children's emotions as an important cause for this situation.Parents lacked relevant support offers for the family as a unit. Identification of children's difficulties cannot be based on parental evaluation alone. We suggest family support as part of standard care for patients with minor children.

The Strengths and Difficulties Questionnaire is a usable way to address mental health at well-child visits in general practice - a qualitative study of feasibility.

BACKGROUND: Mental health problems is frequent among children and psychopathology in early childhood seems to predict mental disorders in adulthood. All Danish children are offered seven free well-child visits at their General Practitioner (GP) during their first 5 years of life. GPs have a unique position to address mental health problems at the well-child visits, but they lack a systematic approach when assessing children's mental health. The purpose of this study was to investigate if the Strengths and Difficulties Questionnaire (SDQ) is a usable way to address preschool children's mental health in general practice. METHODS: A qualitative study of feasibility. Parents completed an online version of the SDQ at home. At the well-child visit, the GP used the SDQ results as a basis for a talk about the child's mental health. Afterwards the author JS conducted semistructured interviews with both the parent and the GP over the phone. The interviews were descriptively analyzed using the Framework Approach. RESULTS: Five primary care centres with 22 general practitioners in both Copenhagen and Region Zealand participated. Twenty four parents completed the SDQ and were interviewed. Participating parents and GPs agreed, that the SDQ introduced mental health as a natural and important part of the well-child visit. Online access had clear advantages: time for reflection at home and preparation, plus a clear result summary for the GP. Some of the GPs were worried that the questionnaire would be too time consuming, and might compromise the individualistic style of general practice. Some parents were worried if children with minor problems would be diagnosed. CONCLUSIONS: The online SDQ was well-accepted and feasible in daily practice. Implementing the SDQ into the well-child visit could strengthen the focus on the child's mental health. However, before the SDQ can be generally implemented a guideline on how to utilize it in the well-child visit is needed, as well as studies of efficacy in this setting. TRIAL REGISTRATION: Not relevant.

Using a modified nominal group technique to develop general practice.

BACKGROUND: There are few areas of health care where sufficient research-based evidence exists and primary health care is no exception. In the absence of such evidence, the development of assisted support must be based on the opinions and experience of professionals with knowledge of the relevant field. The purpose of this research project is to explore how the nominal group technique can be used to establish consensus by analysing how it supported the development of structured, knowledge-based, electronic health records for preventive child health examinations in Danish general practice. METHODS: We convened an expert panel of five general practitioners with a special interest in the preventive child health examinations. We introduced the panel to the nominal group technique, a well-established, structured, multistep, facilitated, group meeting technique used to generate consensus. The panel used the technique to agree on the key clinical and socioeconomic themes to include in new electronic records for the seven preventive child health examinations in Denmark. The panel met three times over a four-month period between 2013 and 2014 and their meetings lasted between two-and-a-half and five hours. RESULTS: 1) The structured and stepwise process of the nominal group technique supported our expert panel's focus as well as their equal opportunities to speak. 2) The method's flexibility enabled participants to work as a group and in pairs to discuss and refine thematic classifications. 3) Serial meetings supported continual evaluation, critical reflection, and knowledge searches, enabling our panel to produce a template that could be adapted for all seven preventive child health examinations. CONCLUSION: The nominal group technique proved to be a useful method for reaching consensus by identifying key quality markers for use in daily clinical practice. Our study focused on the development of content and a layout for systematic, knowledge-based, electronic health records. We recommend the method as a suitable working tool for dealing with complex questions in general practice or similar settings, and we present and discuss modifications to the original model.

Motor function tests for 0-2-year-old children - a systematic review.

INTRODUCTION: There is no evidence on how motor function is best evaluated in children in a low-risk setting. The method used in the Danish Preventive Child Health Examination Programme (DPCHEP) in general practise has not been validated. The objective of this review was to identify existing motor function tests for 0-2-year-old children that were validated for use in the background population and which are suitable for use in the DPCHEP. METHODS: This systematic review was conducted in accordance with the PRISMA guidelines. A systematic literature search was performed in PubMed, Embase, SwedMed, PsycInfo and CINAHL in accordance with the inclusion and exclusion criteria. RESULTS: Five motor function tests were identified. The Alberta Infant Motor Scale (AIMS) exclusively assesses motor function, the Harris Infant Neuromotor Assessment also assesses cognition and the Early Motor Questionnaire (EMQ) additionally assesses perception-action integration skills. The Ages and Stages Questionnaire (ASQ) and The Brigance Infant and Toddler Screen include further aspects of development. All test methods, except for the AIMS, are based on parent involvement. CONCLUSIONS: For implementation in the DPCHEP, five motor function tests were potentially adequate. However, the time consumption and extensive use of tools render three of the five tests unsuitable for implementation in the existing programme. The two remaining tests, the ASQ and the EMQ, are parent questionnaires. We suggest that these should be pilot tested with a view to their subsequent implementation in the DPCHEP. It may be considered to present the test elements in a more manageable and systematic way, possibly with illustrations.

International variation in programmes for assessment of children's neurodevelopment in the community: Understanding disparate approaches to evaluation of motor, social, emotional, behavioural and cognitive function.

BACKGROUND: Few areas of medicine demonstrate such international divergence as child development screening and surveillance. Many countries have nationally mandated surveillance policies, but the content of programmes and mechanisms for delivery vary enormously. The cost of programmes is substantial but no economic evaluations have been carried out. We have critically examined the history, underlying philosophy, content and delivery of programmes for child development assessment in five countries with comprehensive publicly funded health services (Denmark, Finland, Norway, Scotland and Sweden). The specific focus of this article is on motor, social, emotional, behavioural and global cognitive functioning including language. FINDINGS: Variations in developmental surveillance programmes are substantially explained by historical factors and gradual evolution although Scotland has undergone radical changes in approach. No elements of universal developmental assessment programmes meet World Health Organization screening criteria, although some assessments are configured as screening activities. The roles of doctors and nurses vary greatly by country as do the timing, content and likely costs of programmes. Inter-professional communication presents challenges to all the studied health services. No programme has evidence for improved health outcomes or cost effectiveness. CONCLUSIONS: Developmental surveillance programmes vary greatly and their structure appears to be driven by historical factors as much as by evidence. Consensus should be reached about which surveillance activities constitute screening, and the predictive validity of these components needs to be established and judged against World Health Organization screening criteria. Costs and consequences of specific programmes should be assessed, and the issue of inter-professional communication about children at remediable developmental risk should be prioritised.

The Child Health System in Denmark: Current Problems and Successes.

In Denmark, child primary care is taken care of by general practitioners who have 6 months of pediatric training as part of their specialty training and, therefore, are qualified to work as gatekeepers for the secondary health care at the hospitals. As new, more expensive, drugs are increasingly prescribed, corresponding expenses pose serious threats to the economy at 18 pediatric departments. We will highlight the new developments in pediatric education: skills training and training of clinical reasoning.

Maternal pain influences her evaluation of recurrent pain in 6- to 11-year-old healthy children.

AIM: Children with recurrent pain rely on their parents to acknowledge it. We compared pain reported by healthy children and their mothers, to evaluate their agreement, and also looked at the effect of maternal health on children's pain. METHODS: This was a cross-sectional questionnaire-based survey in Danish public schools. The participants were 131 healthy children aged 6-11 years and their mothers. The main outcome measures were the prevalence of recurrent pain reported by the mother and child, agreements between their reports and any associations between the child's pain, socio-demographic characteristics and maternal health factors. RESULTS: Recurrent pain was reported by nearly one-third (31%) of the children and their mothers. A quarter (25%) of the mother-child pairs disagreed on the existence of pain in the child, and a third (33%) disagreed on the frequency and duration. When the data were adjusted for child characteristics and socio-demographic parameters, mothers who had chronic pain were five times more likely to report frequent pain in their children than mothers without pain. This is a new finding. CONCLUSION: Maternal health factors may influence her evaluation of her child's pain. Family health and pain behaviour should be considered when recurrent pain is suspected in a child.

The Danish preventive child health examination should expand on mental health and the well-being of the family.

INTRODUCTION: In Denmark, around one in six children has significant somatic, psychological or social health problems, often in combination. The preventive child health examinations have a high participation rate; and they produce significant findings, predominantly concerning the child's physical health. The aim of this study was to explore how the child's physical, cognitive and psychosocial health are examined and assessed at the health examinations of children aged 0-5 years in general practice. METHODS: Our study employed observations of the consultations as well as individual interviews. A total of nine doctors from seven clinics participated. We included 21 cases in our study, each consisting of a consultation and subsequent interviews with the child's parents and with the doctor. RESULTS: The examination of the child's physical health and development is an important feature of the health examination. Motor, cognitive, social skills and mental health are assessed globally through observation and communication with the child, and, to a lesser degree, through conversation with the parents. The child health examination rarely has a family perspective, unless the doctor is already aware of problems in the family. CONCLUSION: The preventive child health examination is an important platform for examination and dialogue concerning a child's health. The physical aspect works well, but there is a need for development of the assessment of the child's mental health and the well-being of the family. FUNDING: Postdoctoral Fellowships in General Practice/Family Medicine - Denmark. TRIAL REGISTRATION: not relevant.

GPs' strategies in exploring the preschool child's wellbeing in the paediatric consultation.

BACKGROUND: Although General Practitioners (GPs) are uniquely placed to identify children with emotional, social, and behavioural problems, they succeed in identifying only a small number of them. The aim of this article is to explore the strategies, methods, and tools employed by GPs in the assessment of the preschool child's emotional, mental, social, and behavioural health. We look at how GPs address parental care of the child in general and in situations where GPs have a particular awareness of the child. METHOD: Twenty-eight Danish GPs were purposively selected to take part in a qualitative study which combined focus-group discussions, observation of child consultations, and individual interviews with GPs. RESULTS: Analysis of the data suggests that GPs have developed a set of methods, and strategies to assess the preschool child and parental care of the child. They look beyond paying narrow attention to the physical health of the child and they have expanded their practice to include the relations and interactions in the consultation room. The physical examination of the child continues to play a central role in doctor-child communication. CONCLUSION: The participating GPs' strategies helped them to assess the wellbeing of the preschool child but they often find it difficult to share their impressions with parents.

Screening of vision and hearing in primary school children.

BACKGROUND: Hearing and sight are two basic senses in terms of education and profession. The World Health Organization (WHO) estimates that 15 million children worldwide suffer from uncorrected refractive disorders and another 275 million people are handicapped due to compromised hearing. In Indonesia, screening primary school children for hearing and vision is not part of the free public health-care system. Knowledge of the status of a child's hearing and vision may help secure the child's education and future profession. MATERIALS AND METHODS: In five primary schools in a poor urban neighborhood in Yogyakarta, Indonesia, we screened pupils from class 1 to 6, for vision and hearing handicaps, following the WHO's definitions of handicap. On location in the primary schools, we screened vision using a Snellen chart and hearing using distortion product otoacoustic emission (DPOAE). Those with vision below 6/18 were referred to an ophthalmologist and pupils with hearing below 30 decibels at 0.5, 1, 2, and 4 kilohertz were referred to an ear nose and throat (ENT) specialist for final testing. RESULTS: Totally, 775 pupils were vision screened and 777 pupils were hearing screened. We found that 2% were disabled by sight and 6% by hearing. CONCLUSION: Lost without proper education, these pupils can, with simple recommendations, have access to education. We recommend that Indonesia start screening its primary school pupils for hearing and vision to secure the country's future productivity and socioeconomic development.

"This is not normal ... "--signs that make the GP question the child's well-being.

BACKGROUND: The GPs are uniquely placed to recognise children with mental problems and emotional stress that influence their well-being. OBJECTIVES: The aim of the article is with focus on the GP's daily practice, to describe how the GP separates the healthy normal child's developmental crises from children with problems that need special attention and treatment. METHODS: A qualitative research design is used based on material from focus-group discussions and individual interviews with 28 GPs from a Danish county. Data was analysed descriptively. RESULTS: The GPs' attention was directed towards the contextual and relational sides. The GPs frequently became aware of a child in need during clinical work as a feeling of "this is not normal". This reaction could be triggered by the child's symptoms and problems, the parents' narrative of the child's daily life, the child's and the parents' communication and behaviour in the consultation, the family's use of the health care system and the doctor's knowledge of the family members. CONCLUSION: The GP is used to observe and reflect on what happens in the consultation room. The GP might benefit from a systematic attention to the contextual issues. The GPs are frontline workers; they need a good dialogue with the experts and relevant supervision from them to meet the challenge of recognising children in need. It takes more than insight and will from the professionals, it requires a socio-political and socio-economic effort.