Jackie Blissett

Pilot of 'Families for Health': community-based family intervention for obesity

Objective: To develop and evaluate “Families for Health”, a new community based family intervention for childhood obesity. Design: Programme development, pilot study and evaluation using intention-to-treat analysis. Setting: Coventry, England. Participants: 27 overweight or obese children aged 7–13 years (18 girls, 9 boys) and their parents, from 21 families. Intervention: Families for Health is a 12-week programme with parallel groups for parents and children, addressing parenting, lifestyle change and social and emotional development. Main outcome measures: Change in baseline BMI z score at the end of the programme (3 months) and 9-month follow-up. Attendance, drop-out, parents’ perception of the programme, child’s quality of life and self-esteem, parental mental health, parent–child relationships and lifestyle changes were also measured. Results: Attendance rate was 62%, with 18 of the 27 (67%) children completing the programme. For the 22 children with follow-up data (including four who dropped out), BMI z score was reduced by −0.18 (95% CI −0.30 to −0.05) at 3 months and −0.21 (−0.35 to −0.07) at 9 months. Statistically significant improvements were observed in children’s quality of life and lifestyle (reduced sedentary behaviour, increased steps and reduced exposure to unhealthy foods), child–parent relationships and parents’ mental health. Fruit and vegetable consumption, participation in moderate/vigorous exercise and children’s self-esteem did not change significantly. Topics on parenting skills, activity and food were rated as helpful and used with confidence by most parents. Conclusions: Families for Health is a promising new childhood obesity intervention. Definitive evaluation of its clinical effectiveness by randomised controlled trial is now required.

Intrinsic and extrinsic influences on children's acceptance of new foods.

The foods that tend to be rejected by children include those which may have greatest importance for later health. This paper reviews some of the intrinsic and extrinsic influences on preschool childrens eating behavior, with particular reference to their acceptance of new foods into their diet. Factors conceptualized as intrinsic to the child in this review include sensory processing, taste perception, neophobia, and temperament. The important extrinsic determinants of childrens food acceptance which are reviewed include parental and peer modeling, the family food environment, infant feeding practices including breastfeeding and age at weaning, concurrent feeding practices including restriction, pressure to eat, prompting and reward, and the taste & energy content of foods. Childrens willingness to accept new foods is influenced by a wide range of factors that likely have individual and also interactive effects on childrens willingness to taste, and then continue to eat, new foods. The literature lacks longitudinal and experimental studies, which will be particularly important in determining interventions most likely to be effective in facilitating childrens acceptance of healthy foods.

Stability and continuity of parentally reported child eating behaviours and feeding practices from 2 to 5 years of age

Previous research suggests that many eating behaviours are stable in children but that obesigenic eating behaviours tend to increase with age. This research explores the stability (consistency in individual levels over time) and continuity (consistency in group levels over time) of child eating behaviours and parental feeding practices in children between 2 and 5 years of age. Thirty one participants completed measures of child eating behaviours, parental feeding practices and child weight at 2 and 5 years of age. Child eating behaviours and parental feeding practices remained stable between 2 and 5 years of age. There was also good continuity in measures of parental restriction and monitoring of food intake, as well as in mean levels of childrens eating behaviours and BMI over time. Mean levels of maternal pressure to eat significantly increased, whilst mean levels of desire to drink significantly decreased, between 2 and 5 years of age. These findings suggest that childrens eating behaviours are stable and continuous in the period prior to 5 years of age. Further research is necessary to replicate these findings and to explore why later developmental increases are seen in childrens obesigenic eating behaviours.

Parental modelling and prompting effects on acceptance of a novel fruit in 2-4-year-old children are dependent on children's food responsiveness.

Few children consume the recommended portions of fruit or vegetables. This study examined the effects of parental physical prompting and parental modelling in childrens acceptance of a novel fruit (NF) and examined the role of childrens food-approach and food-avoidance traits on NF engagement and consumption. A total of 120 caregiver-child dyads (fifty-four girls, sixty-six boys) participated in this study. Dyads were allocated to one of the following three conditions: physical prompting but no modelling, physical prompting and modelling or a modelling only control condition. Dyads ate a standardised meal containing a portion of a fruit new to the child. Parents completed measures of childrens food approach and avoidance. Willingness to try the NF was observed, and the amount of the NF consumed was measured. Physical prompting but no modelling resulted in greater physical refusal of the NF. There were main effects of enjoyment of food and food fussiness on acceptance. Food responsiveness interacted with condition such that children who were more food responsive had greater NF acceptance in the prompting and modelling conditions in comparison with the modelling only condition. In contrast, children with low food responsiveness had greater acceptance in the modelling control condition than in the prompting but no modelling condition. Physical prompting in the absence of modelling is likely to be detrimental to NF acceptance. Parental use of physical prompting strategies, in combination with modelling of NF intake, may facilitate acceptance of NF, but only in food-responsive children. Modelling consumption best promotes acceptance in children with low food responsiveness.

Children of Mothers with Mental Ilness: Attachment, Emotional and Behavioural Problems.

This study describes the pattern of emotional and behavioural difficulties of children whose mothers have mental illness, and explores the relationship between children’s behavioural and emotional difficulties and maternal perceptions of attachment. Thirteen mothers previously admitted to psychiatric hospital for mental illness completed a measure of their own symptoms (Brief Symptom Inventory), their children’s emotional and behavioural problems (Strengths and Difficulties Questionnaire (SDQ)), and attachment security (Parent/Child Reunion Inventory) (n = 21). Mean scores for child SDQ profiles were found to be within the ‘normal’ range, although (on some indices) mothers reported more ‘case’ scores for their children, than would be expected from standardized norms. It was found that there were significant positive correlations between ‘insecurity’ scores and all problem scales of the SDQ. Best predictors from the Parent/Child Reunion Inventory factors for each SDQ scale are reported and discussed.

Maternal mind-mindedness during infancy, general parenting sensitivity and observed child feeding behavior: a longitudinal study

Maternal mind-mindedness, or the tendency to view the child as a mental agent, has been shown to predict sensitive and responsive parenting behavior. As yet the role of mind-mindedness has not been explored in the context of feeding interactions. This study evaluates the relations between maternal mind-mindedness at 6 months of infant age and subsequently observed maternal sensitivity and feeding behaviors with children at age 1 year. Maternal mind-mindedness was greater in mothers who had breast-fed compared to formula-fed. Controlling for breast-feeding, mind-mindedness at 6 months was correlated with observations of more sensitive and positive feeding behaviors at 1 year of age. Mind-mindedness was also associated with greater general maternal sensitivity in play and this general parenting sensitivity mediated the effect of mind-mindedness on more sensitive and positive feeding behaviors. Interventions to promote maternal tendency to consider their child’s mental states may encourage more adaptive parental feeding behaviors.

Dieting behaviour and views of young children in Wales

A study is reported into the dieting behaviour and views of young children in Wales during April-July 1994. Interviews were conducted with 100 boys and girls from two age groups (six and nine years old). The results indicated that over 50 per cent of the children thought it was healthy to be thin, 30 per cent expressed a desire to be thinner and 20 per cent reported cutting down on their food intake at some point in order to lose weight. Dieting behaviour and concerns were more common among overweight and female children. The results are discussed in relation to the various pressures children may experience to avoid being overweight.

Rated and measured impulsivity in children is associated with diminished cardiac reactions to acute psychological stress

This study examined the association between impulsivity and heart rate reactions to a brief psychological stress in pre-adolescent children. Impulsivity was assessed by two response inhibition tasks and maternal self-report. Heart rate was measured at rest and in response to a mental arithmetic challenge. Children high in impulsivity showed blunted cardiac stress reactions. This result resonates with previous findings that blunted stress reactivity is characteristic of a range of problematic behaviours often associated with impulsivity.

Lay support for pregnant women with social risk: a randomised controlled trial

Objectives We sought evidence of effectiveness of lay support to improve maternal and child outcomes in disadvantaged families. Design Prospective, pragmatic, individually randomised controlled trial. Setting 3 Maternity Trusts in West Midlands, UK. Participants Following routine midwife systematic assessment of social risk factors, 1324 nulliparous women were assigned, using telephone randomisation, to standard maternity care, or addition of referral to a Pregnancy Outreach Worker (POW) service. Those under 16 years and teenagers recruited to the Family Nurse Partnership trial were excluded. Interventions POWs were trained to provide individual support and case management for the women including home visiting from randomisation to 6 weeks after birth. Standard maternity care (control) included provision for referring women with social risk factors to specialist midwifery services, available to both arms. Main outcome measures Primary outcomes were antenatal visits attended and Edinburgh Postnatal Depression Scale (EPDS) 8–12 weeks postpartum. Prespecified, powered, subgroup comparison was among women with 2 or more social risks. Secondary outcomes included maternal and neonatal birth outcomes; maternal self-efficacy, and mother-to-infant bonding at 8–12 weeks; child development assessment at 6 weeks, breastfeeding at 6 weeks, and immunisation uptake at 4 months, all collected from routine child health systems. Results Antenatal attendances were high in the standard care control and did not increase further with addition of the POW intervention (10.1 vs 10.1 (mean difference; MD) −0.00, 95% CI (95% CI −0.37 to 0.37)). In the powered subgroup of women with 2 or more social risk factors, mean EPDS (MD −0.79 (95% CI −1.56 to −0.02) was significantly better, although for all women recruited, no significant differences were seen (MD −0.59 (95% CI −1.24 to 0.06). Mother-to-infant bonding was significantly better in the intervention group for all women (MD −0.30 (95% CI −0.61 to −0.00) p=0.05), and there were no differences in other secondary outcomes. Conclusions This trial demonstrates differences in depressive symptomatology with addition of the POW service in the powered subgroup of women with 2 or more social risk factors. Addition to existing evidence indicates benefit from lay interventions in preventing postnatal depression. This finding is important for women and their families given the known effect of maternal depression on longer term childhood outcomes. Trial registration number ISRCTN35027323; Results.

PA.04 ­Effects of additional lay support for pregnant women with social risk factors on antenatal attendance and maternal psychological health: a randomised controlled trial (ELSIPS)

Background Maternal, perinatal and child health outcomes appear worse in families with social risk factors. The current increase in use of lay support in this area lacks evidence. Methods Following routine midwife systematic assessment of social risk factors nulliparous women were randomly assigned to standard maternity care or the addition of referral to a Pregnancy Outreach Worker (POW) service. Primary outcomes were Edinburgh Postnatal Depression Scale1 (EPDS) 8–12 weeks postpartum and antenatal visits attended. Pre-specified powered subgroup comparisons were among women with two or more social risks. Results 662 women were randomly assigned to standard maternity care and 662 to addition of the POW service. The incidence of postnatal depression (defined as an EPDS ≥ 12) was reduced by 6% overall (relative risk (RR) 0.72 (0.55, 0.93) P = 0.01) and by 6% in the pre-specified subgroup. (RR 0.72(0.53, 0.98) P = 0P = 0.04) Results were consistent if a more stringent EPDS cut off is used. The mean EPDS improved overall (MD –0.59 [–1.24, 0.06]) and significantly in the subgroup ((MD –0.79 [–1.56,-0.02]). Maternal infant bonding was significantly improved. Antenatal attendances were high in the standard care control and did not increase further with the addition of the intervention (10.1 vs. 10.1 (mean difference (MD) –0.00, 95% CI [–0.37, 0.37]). Conclusions The provision of lay support to women with identified social risk factors has a modest effect on maternal mental health, particularly among women with more social risk: given known effects of maternal depression on child outcomes, this may be of major importance for society. Reference Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10 item postnatal depression scale. Br J Psychiatry 1987;150:782–6