Dietary intake and health outcomes among young children attending 2 urban day-care centers.

OBJECTIVE: To assess the impact of the Child and Adult Care Food Program (CACFP) on diet and 3 health outcomes--weight-for-height status, dental caries (tooth decay) score, and number of days of illness--among preschool children attending 2 urban day care centers. DESIGN: Dietary intake and health outcome measures were assessed and compared for children attending 2 day-care centers in an urban community. Data were obtained for 14 days of dietary intake, which were analyzed for energy and 15 nutrients and 6 food groups; anthropometric measures, including weight-for-height; dental caries; and days of illness. SUBJECTS/SETTING: Forty 3- to 5-year-old black children from 2 day-care centers participated. One center participates in the CACFP. At the other center, children bring all meals and snacks from home. STATISTICAL ANALYSES PERFORMED: Data from the 2 groups of children were compared using parameteric and nonparametric t tests. RESULTS: Children receiving CACFP meals at day care had significantly higher mean daily intakes of vitamin A (804 +/- 191 vs 595 +/- 268 retinol equivalents), riboflavin (1.45 +/- 0.32 vs 1.21 +/- 0.22 mg), and calcium (714 +/- 180 vs 503 +/- 143 mg) than the children who brought all of their meals and snacks from home. Children who received CACFP meals also consumed significantly more servings of milk (2.9 +/- 0.9 servings vs 1.5 +/- 0.7) and vegetables (1.8 +/- 0.5 vs 1.2 +/- 0.5 servings) and significantly fewer servings of fats/sweets (4.6 +/- 1.3 vs 5.4 +/- 1.1 servings) than children who brought their meals. Weight-for-height status and dental caries scores did not differ between the 2 groups. Children from the center participating in the CACFP have significantly fewer days of illness (median 6.5 vs 10.5 days) than children from the nonparticipating center. APPLICATIONS: Nutritious meals provided by the CACFP can improve diets and may promote health among young, urban children. Registered dietitians can contribute to food assistance programs by intervening to enhance the quality of meals served and by examining the impact of participation on measures of diet quality and diet-related health outcomes.

A comprehensive school-based clinic: university and community partnership.

PURPOSE: To describe the evolution and current status of a university and community partnership engaged in operating an urban elementary school-based clinic (SBC) POPULATION: The children at the school who are eligible to receive care at the SBC include 500 elementary students and 200 adolescents who attend a magnet junior high school housed in the same building. The vast majority of the children attending the school are from families whose incomes are below the national poverty level. Eighty-five percent of the children are black. Fifteen percent are Hispanic, non-white. CONCLUSIONS: A variety of services and programs are offered to the children and their families for the promotion of health and the prevention of mental disorders. Service, education, and research occur simultaneously to achieve the multiple goals of the partners and participants. PRACTICE IMPLICATIONS: Advanced practice nurses can provide quality health and mental health care services for school-age children and their families through SBCs. Institutional partnerships, capitalizing on each other's strengths, can expand the availability of SBC offerings.

The influence of temperament on development during middle childhood.

Temperament continues to influence the development of children during their school-age years. No longer influenced primarily by their parents, school-age children interact with teachers and peers in situations that contribute toward goodness or poorness of fit.

The effects of child temperament, maternal characteristics, and family circumstances on the maladjustment of school-age children.

Eighty-nine mothers with children between the ages of 8 and 11 years reported perceptions of their child's adjustment and temperament, and described concurrent family circumstances such as socioeconomic status, level of parental distress, major life events experienced, maternal hassles, and their own psychiatric symptoms. A conceptual model hypothesizing the direct and indirect effects of family circumstances, maternal characteristics, and child temperament on the maladjustment of school-age children was tested using causal modeling with residual analysis. Fifty-six percent of child externalizing behavior was directly explained by the negative reactivity and nonpersistence of the child's temperament, and maternal hassles. A total of 33% of the variance of internalizing behavior was explained by the direct effects of negative reactivity of the child's temperament and maternal hassles. For both externalizing and internalizing behavior, a total of 54% of the variance in maternal hassles was explained by three variables: maternal psychiatric symptoms contributed 34%, major life events added 15%, and the intensity of the mother's temperament added an additional 5%. These three variables have a direct effect on maternal hassles and together had an indirect effect of .24 on child externalizing behavior through maternal hassles. Likewise, they have a direct effect on maternal hassles and together had an indirect effect of .31 on child internalizing behavior through maternal hassles.

Changes over time: a study of family bereavement following childhood cancer.

A longitudinal follow-up study which examined changes in 48 families over time (7-9 years) following a death of a child with cancer was conducted. The loss of a child required individual reorganization and adjustments within the family system. Changes in marital status and/or the addition of other children required adjustment in the relationships of family members. Some of the changes were developmental in nature while others, according to the informants, were directly related to the death of the child.

Pediatric nursing psychosocial care: a vision beyond hospitalization.

Families who have a child with a chronic condition often have multifaceted and ongoing stressors in their daily lives. New models of psychosocial family intervention need to be developed to empower families to manage their own needs as much as possible once their child returns home.

Family functioning during a critical illness: a systems theory perspective.

In this article the effects of critical illness on family functioning are described within a systems theory framework. As identified in the literature, family vulnerabilities and strengths that impede or support family functioning during the time a member has a critical illness are discussed. Strategies that nurses can use to assist families of critically ill patients are explored. A challenge to expand family-centered care across various settings is extended.

Behavioral disturbances among medically hospitalized school-age children.

The purpose of this study was to examine the behavioral disturbances of medically hospitalized school-age children. Seventy-six school-age children, between the ages of 8 and 12, were the subjects. The children's usual prehospital behavior was reported by their mothers who completed the Child Behavior Checklist (CBCL). The hospitalized children were compared with the standardized nonclinical norms on the CBCL. Fifty-one percent of the children scored in the clinical range on one or both of the broad bands measuring behavioral disturbances: 21% on externalizing symptoms and 47% on internalizing symptoms. Total behavior problems and externalizing behavior were slightly associated with low socioeconomic status but not with the number of previous hospitalizations. Internalizing problems were not related to socioeconomic status nor the number of previous hospitalizations. The need for specialized mental health services to this population is discussed.

The relationship of temperament to pre- and posthospitalization behavioral responses of school-age children.

The relationship of temperament to pre- and posthospital behavioral responses of school-age children was examined in this study. Seventy-five children, aged 8 to 12, who experienced unplanned hospitalizations were studied. Data were collected from the children's mothers who served as the primary informants. The mothers completed questionnaires describing their children's temperament and behavior pre- and posthospitalization. Temperament accounted for more than 50% of the variance in the children's behavior prior to hospitalization and at 1 week and at 1 month following discharge. The subjects' usual prehospitalized temperament was significantly more withdrawn than the established norms of the temperament instrument. However, the subjects did not differ from the norms at either 1 week or 1 month following discharge.

The psychosocial responses of school-age children to hospitalization.

This study examined the psychosocial responses of school-age children to hospitalization. The subjects were 50 children, between 8 and 12 years of age, who were unscheduled admissions. The children's usual pre-hospital behavior was compared to their behavior during the first week following hospitalization and one month after dismissal. Repeated measure analysis of variance was used to demonstrate that there was no change in the school-age children's behavior following hospitalization. A moderate relationship was found between the children's usual prehospital behavior and the number of previous hospitalizations. Family function was related only to the children's behavior one week after dimissal. the children's usual prehospital behavioral problems were related to their behavior at all three times. No relationship was found between the length of hospitalization or the number of previous hospitalizations and their post hospital behavior.

Breastfeeding multiples.

Although breastfeeding two or more infants requires greater organization and presents a challenge to the family, it may in the long run save time. Fatigue, the greatest deterrent to breastfeeding multiples, is common among all new mothers. It is essential for the nurse to demonstrate all of the potential positions for feeding, to stress adequate nutrition, and to encourage getting help from others so that the mother has time to rest each day. Nurses are in an optimal position for influencing successful breastfeeding for multiple birth parents. The dearth of knowledge about breastfeeding twins or other multiples indicates the need for research in this area.