Observing the neighborhood multidimensionality and overweight in children of different developmental stages-the emergence of an unusual association.

The present study examines whether the association of the neighborhood environment and overweight in children is moderated by age. This was a cross-sectional study of 832 children aged 3 to 10 years living in the city of Oporto (Portugal). Children were recruited under the scope of the project "Inequalities in Childhood Obesity: The impact of the socioeconomic crisis in Portugal from 2009 to 2015." Overweight was defined according to the International Obesity Task Force criteria. Parents completed a self-administered questionnaire capturing sociodemographic characteristics and their perceptions of their neighborhood environment. Logistic regressions were used to examine the influence of parental perceived neighborhood characteristics (latent variables: attractiveness, traffic safety, crime safety, and walkability) on overweight in children. A stratified analysis by age category was conducted. Overall, 27.8% of the children were overweight, 17.4% were aged 3 to 5 years, and 31.8% were aged 6 to 10 years. Children aged 3 to 5 years were more sensitive to the neighborhood environment than children aged 6 to 10 years. For children aged 3 to 5 years, the risk of overweight was inversely associated with neighborhood crime safety (OR = 1.84; 95% CI 1.07-3.15; p = 0.030).    Conclusion: Our study suggests the existence of a sensitive age period in childhood at which exposure to a hostile neighborhood environment is most determining for weight gain. Until today, it was thought that the impact of the neighborhood environment on younger children would be less important as they are less autonomous. But it may not be true. What is Known: • The neighborhood environment may adversely affect children's weight status. However, the moderating role of child age in the association between neighborhood environment and overweight is uncertain. What is New: • The study highlights that the association between the neighborhood environment and child overweight is attenuated by age. It is stronger for preschoolers than for early school-age children.

Parental Perceptions of Physical Activity and Risk of Disease Associated with Sedentary Behaviours in Infants and Toddlers.

OBJECTIVES: The current study intends to measure parents' perceptions of newborn and toddler physical activity. METHODS: A Cross-sectional study was conducted at the pediatric clinic at a University Hospital in Riyadh. The parents or guardians of children 0 to 3 years of age, healthy infants, and toddlers who visited the vaccination and pediatric clinic at a University Hospital in Riyadh, were recruited. The Parental Perceptions of Physical Activity Scale (PPPAS) was translated into the Arabic language. The Chi-square test was applied to observe the association between categorical variables. P value < 0.05 was considered to be statistically significant. RESULTS: A total of 383 parents were recruited. There was a significant association observed between physical activity and income, employment, and education. A significant association was observed between the following perceptions; the child enjoys physical activity, it increases the child's fitness level, the strength of the muscles, flexibility, and life span, improves happiness, keeps the child active, and provides a sense of achievement, and decrease future weight problems. CONCLUSION FOR PRACTICE: The study determined that parental inclination towards engaging in a physical activity intervention for their infants, as well as identifying any concerns that may impact their children's adherence to physical activity was satisfied.

What is already known on this subject? Youth health is crucial since cardiovascular disease and obesity are linked to sedentary behaviors in children and will persist into adulthood.What this study adds? The study addresses the concerns of parents regarding physical activities which is an emerging concern for children's health. It investigates the viewpoint of parents about physical activities and the risk of diseases that may develop due to sedentary behaviors among infants and toddlers.

A Prospective Study of Parental Perceptions of Rapid Whole-Genome and -Exome Sequencing among Seriously Ill Infants.

Rapid diagnostic genomic sequencing recently became feasible for infants in intensive care units (ICUs). However, research regarding parents' perceived utility, adequacy of consent, and potential harms and benefits is lacking. Herein we report results of parental surveys of these domains from the second Newborn Sequencing in Genomic Medicine and Public Health (NSIGHT2) study, a randomized, controlled trial of rapid diagnostic genomic sequencing of infants in regional ICUs. More than 90% of parents reported feeling adequately informed to consent to diagnostic genomic sequencing. Despite only 23% (27) of 117 infants receiving genomic diagnoses, 97% (156) of 161 parents reported that testing was at least somewhat useful and 50.3% (88/161) reported no decisional regret (median 0, mean 10, range 0-100). Five of 117 families (4.3%) reported harm. Upon follow-up, one (1%) confirmed harm to child and parent related to negative results/no diagnosis, two (2%) reported stress or confusion, and two (2%) denied harm. In 81% (89) of 111 infants, families and clinicians agreed that genomic results were useful. Of the families for whom clinicians perceived harm from genomic testing, no parents reported harm. Positive tests/genomic diagnosis were more frequently perceived to be useful by parents, to benefit their infant, and to help manage potential symptoms (p < .05). In summary, the large majority of parents felt that first-tier, rapid, diagnostic genomic sequencing was beneficial for infants lacking etiologic diagnoses in ICUs. Most parents in this study perceived being adequately informed to consent, understood their child's results, and denied regret or harm from undergoing sequencing.

Challenges encountered by parents from urban, lower social economic class in changing lifestyle behaviors of their children who are overweight or obese.

BACKGROUND: Parents from urban, lower social economic classes often encounter unique challenges in their lives, which shape how they work with their children who are overweight or obese to change their exercise and eating behaviors at home. The present study took an initial step to address a gap in the literature by describing the challenges that parents from lower social economic classes in an urban city encountered in changing exercise and eating behaviors of their children who are overweight or obese. METHODS: A conversational style semi-structured interview with prompts and probes was conducted to 44 parents whose child is overweight or obese. Inductive content analysis and constant comparison was used to analyze the data. Data trustworthiness was established by using a variety of strategies. RESULTS: Two major themes with eight sub-themes emerged from the data: Challenges to promote a healthy active lifestyle, and challenges from their child's development and lifestyle behavior. Eight sub-themes were: (1) Need for effective strategies for a lifestyle behavior change, (2) monitor and promote healthy choices, (3) money, time, and dangerous neighborhood, (4) scientific knowledge to promote a healthy active lifestyle, (5) developmental changes of adolescence, (6) unmotivated and lack of persistence, (7) sneaking eating, and (8) peer pressure. CONCLUSION: The challenges, from economic to parenting, are certainly of importance, and understanding these challenges will be crucial to help school-based professionals develop interventions. Those identified challenges should be clearly placed within family-school collaboration practices.

Vaccination coverage and the factors influencing routine childhood vaccination uptake among communities experiencing disadvantage in Vellore, southern India: a mixed-methods study.

BACKGROUND: In 2015, the Vellore district in southern India was selected for intensified routine immunization, targeting children from communities experiencing disadvantage such as migrant, tribal, and other hard-to-reach groups. This mixed-methods study was conducted to assess routine immunization coverage and the factors influencing childhood vaccination uptake among these communities in Vellore. METHODS: We conducted a cross-sectional household survey (n = 100) and six focus group discussions (n = 43) among parents of children aged 12-23 months from the known communities experiencing disadvantage in Vellore during 2017 and 2018. Multivariate logistic regression was conducted to examine associations between the parental characteristics and children's vaccination status in the household survey data; the qualitative discussions were analyzed by using the (previously published) "5As" taxonomy for the determinants of vaccine uptake. RESULTS: In the household survey, the proportions of fully vaccinated children were 65% (95% CI: 53-76%) and 77% (95% CI: 58-88%) based on information from vaccination cards or parental recall and vaccination cards alone, respectively. Children whose mothers were wage earners [Adjusted prevalence odds ratio (aPOR): 0.21, 95% CI = 0.07-0.64], or salaried/small business owners [aPOR: 0.18, 95% CI = 0.04-0.73] were less likely to be fully vaccinated than children who had homemakers mothers. In the focus group discussions, parents identified difficulties in accessing routine immunization when travelling for work and showed knowledge gaps regarding the benefits and risks of vaccination, and fears surrounding certain vaccines due to negative news reports and common side-effects following childhood vaccination. CONCLUSIONS: Vaccination coverage among children from the surveyed communities in Vellore was suboptimal. Our findings suggest the need to target children from Narikuravar families and conduct periodic community-based health education campaigns to improve parental awareness about and trust in childhood vaccines among the communities experiencing disadvantage in Vellore.

Parental perceptions and practices regarding sugar intake by school-aged children: A qualitative study with Portuguese parents.

Excessive sugar intake is one of the factors contributing to the alarming rates of childhood obesity and overweight in Portugal. Children's preferences and food consumption patterns are largely determined by the foods that are more familiar to them. Parents and caregivers are responsible for shaping children's eating habits since they are the ones who choose the food available in the household. The present study explores parental perceptions about sugar and sugar intake and its consequences on children's health. Moreover, we also examined the practices that parents use to regulate their children's diet, namely, to promote the consumption of desired foods (e.g., vegetables) and limit the intake of undesired food (e.g., sweets), and the perceived barriers and facilitators of sugar intake regulation. To this end, 42 interviews were conducted with parents of school-aged children (ages 6-10 years). A thematic analysis revealed that parents perceive sugar as highly negative (e.g., "evil", "poison", "addiction") and its consumption as harmful (e.g., hyperactivity; overweight). Nonetheless, the view that sugary food consumption is not necessarily problematic was also common. Indeed, most parents considered that sugar intake should be regulated but not forbidden. To control the intake of sugary foods (e.g., sodas, cookies), they reported using strategies such as restriction, explanation, or negotiation. Several barriers to sugar intake regulation were identified (e.g., birthday parties, parents' lack of knowledge), but also a few facilitators (e.g., bringing food from home to school). Our findings may inform the development of interventions or policies to promote healthier eating habits in school-age children.

Parental perception of neonatal transfers from level 3 to level 2 neonatal intensive care units in Calgary, Alberta: qualitative findings.

BACKGROUND: Retro-transfers from level 3 to 2 NICUs in Alberta's regionalization of neonatal care system are essential to ensure the proper utilization of level 3 NICUs for complex neonatal cases. Parents often experience distress that relates to the transfer of their neonates to another hospital. Limited information is available regarding parental perceptions of distress during transfers for neonates requiring care between NICUs in the current Canadian context. The objective of this study was to investigate: 1) what caused parents distress and could be changed about the transfer process and 2) the supports that were available to help ease parental distress during the transfer process. METHODS: Parents of singleton infants retro-transferred from level 3 to 2 NICUs in Calgary, Alberta between January 1, 2016, and December 31, 2017, were invited to participate in the study. Questionnaires were self-administered by one parent per family. A thematic deductive approach was employed by the researchers to analyze the qualitative data. RESULTS: Our response rate was 39.1% (n = 140). We found three themes for causes of parental distress and supports available to ease parental distress during the transfer, including communication between staff members and parents, details about the transfer process, and the care received throughout and shortly after the transfer process. CONCLUSION: Parents should receive at least 24 h of notice, regular transfer updates, employ anticipatory preparation strategies, and foster more open communication between parents and health care professionals to help ensure parental satisfaction.

The Correlation Between Parental Perceptions and Readiness to Change with Participation in a Pediatric Obesity Program Serving a Predominantly Black Urban Community: A Retrospective Cohort Study.

BACKGROUND: This study assessed whether maternal BMI and perceptions about weight and reported level of readiness to change was correlated with compliance to a pediatric lifestyle modification program targeting a hard-to-reach urban population with a high prevalence of severe obesity. METHODS: The Parental Readiness Questionnaire (PRQ) was administered to the child's mother at program entry. The PRQ consisted of forty-seven multiple-choice and 10-point Likert scale questions regarding family demographics, exercise and eating habits, attitudes about health, body image, and weight, and the desire to improve nutrition and physical activity. Analysis was performed on PRQs of participants to compare parental perceptions and readiness for change with compliance to program requirements. Analysis was conducted on 596 questionnaires and compliance was categorized into three groups based on attendance to follow-up visits. RESULTS: Significant differences were found between short-term and long-term follow-up groups in regards to parental perception of one's health as well as the health, weight, and body image of their child. Differences were found in perceptions of one's own weight and body image as well as the health of one's self and child between the group with a maternal BMI < 35 and the group with a maternal BMI ≥ 35. A lower maternal BMI was associated with a better perception of one's own weight, body image, and health, as well as the health of the child. CONCLUSION: Positive parental perceptions on weight were correlated with improved compliance to a pediatric lifestyle modification program.

Parents accurately perceive problematic eating behaviors but overestimate physical activity levels in preschool children.

PURPOSE: The aim of this study is to examine the associations between parents' perceptions of their child's physical activity and eating behaviors to actual physical activity, body mass index percentage (BMI%), and body fat percentage (BF%). A secondary aim is to examine additional parental determinants to child's physical activity. METHODS: Participants were preschool children (N = 114, 59 females, Mage= 4.06) from three University-sponsored centers and parents (N = 114, 107 mothers). Parents self-reported physical activity, perceptions of child's physical activity, and completed "The Child Eating Behavior Questionnaire". Children physical activity was collected with accelerometers. RESULTS: Whereas 97% of the 68 parents with children meeting physical activity guidelines accurately identified their child as active, 93% of the 14 parents with children not meeting physical activity guidelines inaccurately identified their child as active (X2(1, N = 82) = 0.58, p = 0.446)). Regarding eating behaviors, child BMI% was moderately correlated with parent's perceptions of their child's Emotional Overeating (r(74) = 0.416, p < 0.001) and Food Responsiveness (r(74) = 0.543, p < 0.001). Parent's engagement in vigorous physical activity demonstrated a positive relationship to child's physical activity (r(78) = 0.297, p = 0.008). CONCLUSION: Parents of inactive children have inaccurate perceptions of their child's physical activity. The association between children's BMI% and eating behaviors indicates parents can accurately perceive problematic eating behaviors. Parents, who accurately perceive their child's behaviors, may be in a better position to identify deficiency and seek early intervention. Additionally, parent's physical activity may have implications to children's physical activity. LEVEL OF EVIDENCE: Level V: Descriptive cross-sectional study.

A cross-sectional survey of parental attitudes towards Human papillomavirus vaccination exclusion categories in Brazil.

BACKGROUND: In 1988, Brazil established a constitutional right to health and universal access to health care for all Brazilians through the creation of the Unified Health System (SUS). As part of its efforts to fulfill this right, the quadrivalent Human papillomavirus (HPV) vaccine was introduced into the national immunization program in 2014. The non-discriminatory provision of healthcare goods, facilities, and services is a fundamental part of the right to health. Yet HPV vaccination was limited to females aged 9-13, despite the universal nature of SUS and scientific support for the vaccination of males and older females. The purpose of this cross-sectional study was to describe parental attitudes regarding age- and gender-based HPV vaccination exclusions, as well as parental knowledge of HPV and the HPV vaccine. METHODS: Data were gathered from parents with children aged 9-17 in a health post located in the municipality of Mauá (São Paulo, Brazil) through interviewer-administered questionnaires. We analyzed attitudes regarding HPV vaccination and its eligibility guidelines by comparing parents of HPV vaccine eligible and ineligible children. RESULTS: In this low-income population, the majority of the 219 parents surveyed supported the inclusion of males and females over 13 into the HPV vaccination program; support for the non-discriminatory provision of the HPV vaccine was high among parents - especially if financially accessible. Additionally, there were high levels of knowledge and positive parental attitudes regarding HPV vaccination safety and efficacy among both parent groups suggesting information accessibility - a key component of the right to health and informed decision-making. CONCLUSIONS: Support for the expansion of HPV vaccination for excluded populations exists, and is not based on current eligibility, or differential knowledge and attitudes about the vaccine. Moving forward, careful consideration of gender- based eligibility for vaccination, informed decision-making, and the importance of community participation in health policy development and implementation may be gleaned from the case of Brazil and beyond.

Parental Perceptions, Risks, and Incidence of Pediatric Unintentional Injuries.

INTRODUCTION: More than 9,000 children die annually from various causes of unintentional injury. Of all the pediatric unintentional injuries occurring in the United States, 8.7 million are treated in emergency departments, and 225,000 require hospitalization annually. Health education programs are available to address these injuries. The objective of this research was to examine the distribution of self-reported high priority injury risks in an urban Midwestern pediatric level 1 trauma center and investigate the relationship between parental perceptions and injury-prevention behaviors. Prevalence rates for 3 data sources are compared. METHODS: Missouri Information for Community Assessment (MICA) was categorized to mirror variables corresponding with risks of injury presented in the Safe 'n' Sound (SNS) program. Level 1 trauma center data were examined to determine how the variables were distributed compared with MICA data and with the parent-reported levels. RESULTS: A total of 429 SNS surveys were compared with ED data and MICA data. For SNS users, car crashes were identified as the highest risk, specifically due to the use of incorrect car seats. The injuries seen most often in the emergency department were falls, and falls were also the most prevalent injury captured by MICA. Controlling for demographics, parental perceptions predicted several risks for injury. DISCUSSION: Because parental perceptions are significantly related to risks of injury, prevention programs aiming to decrease injuries could focus on the perceptions. Not only can perceptions be used to tailor health communication materials, these perceptions can be the targets of change. Further work might investigate the extent to which changes in perceptions result in increased adoption of safety practices.

Identification of Preferred Healthy Weight Counseling Approaches for Children in the Dental Setting.

OBJECTIVE: There is a gap in the literature regarding optimal methods for the dental team to help address the childhood obesity epidemic; accordingly, this investigation sought to identify preferred communication approaches the dental team can rely upon to initiate dialogue with caregivers regarding the weight of their children. STUDY DESIGN: A structured interview guide containing seven potential Healthy Weight Counseling (HWC) approaches and eight follow up questions was developed, pilot-tested, revised and utilized as a structured interview guide. Interviews were conducted at the Children's Clinic at the School of Dentistry at the University of North Carolina at Chapel Hill (UNC-CH) with 50 participants who are English-speaking caregivers of children ages 4-12. RESULTS: Ninety-four percent of the participants were receptive to HWC in the dental setting. Caregivers indicated varying levels of acceptance for the seven HWC-approaches based on specific word choices in each approach. Sixty percent preferred HWC to be delivered with the child not present while 34% preferred the child's presence and 6% had no preference. CONCLUSIONS: Caregivers were open to weight-related conversations in the dental setting but to be well received, the dental team must choose their approach carefully and establish the proper doctor/patient relationship prior to HWC delivery. An individualized HWC-approach tailored to the specific needs of each family is indicated.

'Hu Hong' (bad thing): parental perceptions of teenagers' sexuality in urban Vietnam.

BACKGROUND: Teenagers under 18 years old in Vietnam are considered as minors who usually lack the autonomy to make decisions. They are also sometimes viewed as contributors to social evils including crime, violence and substance use. Moreover, most Vietnamese teenagers have unsafe sex before marriage. The objective of this study is to explore the parental perceptions relating to their teenagers' sexuality, particularly the social and cultural forces, that may hinder access to sexuality information. METHODS: Guided by a Community Advisory Board (CAB), this qualitative study uses four focus group discussions (FGDs) consisting of 12 mothers and 12 fathers, as well as twelve individual in-depth interviews (IDIs) with a diverse sample of parents of teens in Ho Chi Minh City (HCMC), Vietnam. Content and discourse analysis were conducted, based on Foucauldian concepts. RESULTS: Four themes emerged: 1) Meanings of sexuality and sexuality education, 2) Early sexual intercourse destroys teenagers' future, 3) Teenagers are not hu hong (spoil/bad thing), are innocent and virgin, and 4) Policing and controlling of sexual intercourse among teens. Parents did not view their teenage children as sexual beings; those who are sexual are considered hu hong. Parents believed that teens need to be policed and controlled to prevent them from becoming hu hong, particularly girls. Controlling of sexuality information by parents was therefore common in HCMC, but differed by gender and educational levels of parents. For example, fathers more than mothers were not comfortable teaching their teenage children about sex and sexuality. Parents with higher education police their teenage children's usage of the Internet and social media, while parents with lower education control who can be friends with their teenage children. CONCLUSIONS: Vietnamese parents in general have negative views of sex and sexuality education for their teenage children. Recognizing that many Vietnamese teenagers have unsafe sex before marriage, parents need to change their perceptions and understand the importance of comprehensive sexuality education (CSE), which are included in UNESCO, UNFPA and UNICEF-developed CSE tools.

Parents reported reduced symptoms and improved satisfaction after fundoplication and their perceptions were an important outcome measure.

AIM: Fundoplication is required for children with chronic recurrent gastro-oesophageal reflux disease (GERD). The aim of this study was to report parental perceptions of symptoms and overall satisfaction with the long-term course following fundoplication with special reference to patients with GERD risk factors. METHODS: We studied 34 patients, with a median age of 6.5 ± 4.9 years, who received fundoplication between 2001 and 2005. Clinical information and surgical complications were recorded. Parents were interviewed to evaluate post-operative symptoms, mode of nutrition and satisfaction. RESULTS: The median follow-up time was 7.3 years. Comorbidities were neurological impairment in 15 patients, other gastrointestinal disorders in seven patients and isolated GERD in 12 patients. The parents reported that fundoplication effectively treated initial reflux symptoms in 60% and improved symptoms in 37%. Vomiting and reflux-associated pain were treated most effectively. Pulmonary symptoms often remained unchanged in neurologically impaired children. Redo fundoplication was necessary in seven patients. Only two parents regretted consenting to surgery. CONCLUSION: A high percentage of parents reported improved gastrointestinal reflux-related symptoms and a high level of satisfaction following fundoplication. Parental perceptions of GERD symptoms should be an important outcome measure when assessing the efficacy of antireflux surgery in children in routine clinical follow-up.

Parents' perceptions are that their child's health-related quality of life is more impaired when they have a wheat rather than a grass allergy.

AIM: It is unknown whether food allergies have greater impact on quality of life than respiratory allergies. This study compared health-related quality of life (HRQoL) in children allergic to wheat or grass. METHODS: We surveyed 63 children with wheat allergies (median age of five) and 72 with grass allergies (median age 12), with their parents. The Child Health Questionnaires for parents (CHQ-PF28) and children (CHQ-CF87) were applied. RESULTS: The parents of children in the wheat group recorded significantly lower CHQ-PF28 scores for the impact of their child's allergy on general behaviour, general health perceptions, parental impact of emotions and time and family activities, than the parents of children with grass allergies (p values ≤0.001). However, parents in the grass group recorded lower scores for the change in health item than the parents of children with wheat allergies (p = 0.020). In the grass group, children and parents reported similar scores for the different questions, but there was poorer correlation between parents and children in the wheat allergy group. CONCLUSION: HRQoL was lower in children with wheat than grass allergies according to parental reports, with more consistent perceptions of HRQoL among parents and children in the grass allergy than wheat allergy group.

Parental and staff perspectives of NICU research procedures.

BACKGROUND: There are limited data on parental perception of infant participation in minimal risk and minor increase above minimal risk research focusing on the NICU population. The study objective was to assess parental and NICU staff perceptions concerning minimal risk and minor increase above minimal risk in the NICU setting. METHODS: Parents of infants and NICU staff were presented with a combination of 4 infant scenarios and 5 hypothetical research procedures. These assessed participants' willingness to allow their infant to participate in research and their attitude towards obligation to assist future children. Linear and hierarchal linear models analyzed the association and interaction effects on the likelihood to consent to research procedures. RESULTS: Sixty parents and 30 NICU staff members were surveyed. Parents' acceptability for each of the five research procedures ranged from 31 % to 83 %. Parent gender, age, race/ethnicity, insurance, education and history of previous child in the NICU were not associated with the likelihood to consent to the research procedures. Acceptability for each of the five research procedures among NICU staff ranged from 19 % to 98 %. There were no significant differences between NICU staff's and parents' responses for 4 of 5 research procedures. A minority of parents and nurses (38.3 % and 40 % respectively), compared to a majority of physicians (66.7 %), agreed or strongly agreed that parents have a responsibility to involve their children in low risk medical research in order to help future children, even if this would not help their own child. Lower agreement with obligation to help future children (p < 0.01) and higher education (p = 0.01) were associated with a decreased likelihood to consent to research procedures. CONCLUSION: In our study population, common NICU-related research procedures were considered appropriate and acceptable to a diverse group of NICU parents representing a wide range of race/ethnic and socioeconomic strata. Current regulations guiding informed consent for minimal and minor increase over minimal risk research in the NICU environment appear ethically consistent with a diverse group of parents and providers.

Anthropometric, lifestyle and parental characteristics associated with the prevalence of energy intake misreporting in children: the GRECO (Greek Childhood Obesity) study.

The objectives of the present study were to identify childhood energy misreporting, and evaluate characteristics that are associated with its prevalence in a nationwide cross-sectional sample of Greek schoolchildren. Under the context of the GRECO (Greek Childhood Obesity) study, data from a total of 4547 children aged 10-12 years and 2318 parents were included in the analysis. Anthropometric, lifestyle and parental characteristics plus psychological concerns were investigated in relation to the prevalence of energy misreporting. Of the included children, 36 % were classified as energy under-reporters and 16 % as over-reporters. Multinomial logistic regression analysis revealed that the most important predictors of energy under-reporting (URP) were children's BMI (OR 1·11, 95 % CI 1·09, 1·14) and weight satisfaction (OR 0·87, 95 % CI 0·78, 0·97). In the case of energy over-reporting (ORP), children's BMI (OR 0·87, 95 % CI 0·84, 0·90), meal and snack consumption frequency (OR 1·52, 95 % CI 1·32, 1·75), female sex (OR 0·65, 95 % CI 0·45, 0·90), and maternal education (OR 0·95, 95 % CI 0·91, 0·99) remained as significant predictors. Additionally, parental perception that the body weight of their children was normal reduced the odds of URP (OR 0·69, 95 % CI 0·48, 0·99) and ORP (OR 0·53, 95 % CI 0·31, 0·93). In conclusion, the present study confirms that the issue of URP and ORP in childhood populations is evident and quite serious. Although there are no definite guidelines on how to use data obtained from misreporters in an epidemiological dataset, validity of reported energy intake seems to be influenced by children's BMI and weight satisfaction, as well as by parental perceptions regarding their children's weight.

Parenting in Complex Conditions: Does Preterm Birth Provide a Context for the Development of Less Optimal Parental Behavior?

OBJECTIVE: To examine the predictive value of parent, infant, and contextual factors related to preterm childbirth for later parenting behaviors. METHODS: Mothers (n = 217) and fathers (n = 204) of term, moderately preterm, and very preterm infants were interviewed 1 month postpartum using the Clinical Interview for Parents of high-risk infants (CLIP), to assess their experiences and perceptions related to the pregnancy, delivery, infant, hospitalization, support system, and their narratives. Their responses were factor analyzed and entered into prediction models of parental behaviors (National Institute of Child Health and Human Development observations) 6 months postpartum. RESULTS: Preterm birth was associated with negative experiences and concerns in parents. Regression analyses revealed, however, that irrespective of preterm birth, negative and unrealistic parental perceptions predicted less sensitive, more intrusive, and more withdrawn behavior. CONCLUSIONS: Not prematurity per se, but particularly the presence of negative perceptions in parents, is predictive of difficulties in parent-infant interaction. The CLIP is a potentially useful instrument to identify families at risk.

A tale worth telling: the impact of the diagnosis experience on disclosure of genetic disorders.

BACKGROUND: Research suggests children with genetic disorders exhibit greater coping skills when they are aware of their condition and its heritability. While the experiences parents have at diagnosis may influence their decision to disclose the diagnosis to their children, there is little research into this communication. The aim of the current study was to examine the relationship between the diagnosis experience and the disclosure experience for parents of children with developmental disorders of a known genetic aetiology: parents of children with 22q11.2 deletion syndrome (22q11DS) were compared with a group of parents with children affected with other genetic diagnoses, with a similar age of diagnosis (e.g. fragile X syndrome) and a group where diagnosis generally occurs early (i.e. Down syndrome). METHOD: The sample comprised 559 parents and caregivers of children with genetic developmental disorders, and an online survey was utilised. Items from the questionnaire were combined to create variables for diagnosis experience, parental disclosure experience, child's disclosure experience, and parental coping and self-efficacy. RESULTS: Across all groups parents reported that the diagnosis experience was negative and often accompanied by a lack of support and appropriate information. Sixty-eight per cent of those in the 22q11DS and 58.3% in the Similar Conditions groups had disclosed the diagnosis to their child, whereas only 32.7% of the Down syndrome group had. Eighty-six per cent of the Down syndrome group felt they had sufficient information to talk to their child compared with 44.1% of the Similar Conditions group and 32.6% of the 22q11DS group. Parents reported disclosing the diagnosis to their child because they did not want to create secrets; and that they considered the child's age when disclosing. In the 22q11DS and Similar Conditions groups, a poor diagnosis experience was significantly associated with negative parental disclosure experiences. In the Similar Conditions group, a poor diagnosis experience was also significantly associated with a more negative child disclosure experience. CONCLUSIONS: As expected this study highlights how difficult most parents find the diagnosis experience. Importantly, the data indicate that the personal experiences the parents have can have a long-term impact on how well they cope with telling their child about the diagnosis. It is important for clinicians to consider the long-term ramifications of the diagnosis experience and give the parents opportunities; through, for instance, psychoeducation to prepare for telling their child about the diagnosis. Further research is warranted to explore what type of information would be useful for parents to receive.

Disrupted bonds - parental perceptions of regionalised transfer of very preterm infants: a small-scale study.

BACKGROUND: Routine regionalised transfer of preterm infants occurs throughout Westernised countries. Transfer to lower acuity units occurs once infants are ready for convalescence and signals an infant's improving health. However, many parents find transfer traumatic. AIMS: To investigate parents' perceptions of preterm infants' transfer; to provide neonatal clinicians with insights to facilitate optimal service provision. METHODS: Participants had experienced their baby born at less than 29 weeks gestation, and subsequent transfer. Six parents were interviewed. DESIGN: Data were analysed using a general inductive approach. FINDINGS: Three themes were interpreted through data analysis: NICU - incomparable haven; abandonment; and parental expertise side-lined. These themes represent a journey of interrupted identity that parents undergo when their baby is transferred to another unit. CONCLUSION: Despite studies recommending more family-centred transfer planning, gaps persist. Nursing care might be enhanced by incorporating insight into parental experiences and promotion of collaborative changes within and between units.