Jane M. Brotanek

Secular Trends in the Prevalence of Iron Deficiency Among US Toddlers, 1976-2002

OBJECTIVE To examine secular trends in iron deficiency among US children 1 to 3 years old. DESIGN Secular trend analyses of the National Health and Nutrition Examination Survey II-IV. SETTING Large-scale national survey conducted by the National Center for Health Statistics from 1976 to 2002. PARTICIPANTS US children 1 to 3 years old. Outcome Measure Prevalence of iron deficiency. RESULTS Between 1976 and 2002, there was no change in iron deficiency prevalence in US toddlers. Iron deficiency prevalence remained unchanged in Hispanic and white toddlers but decreased among black toddlers. Across all 3 survey waves, racial/ethnic disparities in iron deficiency persisted between Hispanic and white toddlers, with a disparity ratio of at least 2. Iron deficiency prevalence remained high (20%-24%) in overweight toddlers, significantly higher than in those at risk for overweight (11%) and in normal weight or underweight toddlers (8%). Iron deficiency prevalence decreased from 22% to 9% in toddlers in poor households but remained unchanged in toddlers in nonpoor households (7%). In multivariable analyses, Hispanic, younger, and overweight toddlers had higher odds of iron deficiency. CONCLUSIONS Despite the decline in iron deficiency prevalence among 1-year-old, black, and poor children, iron deficiency prevalence in US toddlers overall has not changed in the last 26 years and remains elevated in certain high-risk groups: Hispanic, younger, and overweight toddlers. Efforts to reduce the prevalence of iron deficiency in infancy and early childhood are urgently needed and should target high-risk groups.

Inadequate Access to Care Among Children With Asthma From Spanish-Speaking Families

Despite substantial asthma prevalence and morbidity, children from Spanish-speaking families are at high risk of inadequate maintenance therapy. The reasons for this remain unclear. The objective of this study was to compare patterns of asthma morbidity and access to care of children with asthma from Spanish-speaking and English-speaking families.Cross-sectional data from a nationally representative sample of children with asthma 2-17 years of age were analyzed from the 1999 National Health Interview Survey, conducted in both English and Spanish, with the preferred language identified at the time of the interview.Among the 1,228 children with asthma (physician-diagnosed asthma by parent report), 66 (3%) were from Spanish-speaking families and 1,162 (97%) were from English-speaking families. In a logistic regression model adjusting for gender, insurance, poverty (above or below the federal poverty level, based on reported family income and the U.S. Poverty Threshold produced annually by the Census Bureau), and race/ethnicity, children with asthma from Spanish-speaking families were one-third less likely to have a usual health care provider (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.1-0.8) than children with asthma from English-speaking families. Latino ethnicity was not independently associated with diminished continuity of care. These data indicate that children with asthma from Spanish-speaking families are less likely to experience continuity of health care than their counterparts from English-speaking families. Differences in continuity of care may contribute to inadequate asthma maintenance therapy among these children.

The importance of cultural competency in general pediatrics.

Purpose of review There is a growing awareness of the importance of cultural competency in pediatrics. The authors review the most recent studies that examine the impact of cultural competency on general pediatric care, explore cultural beliefs and practices affecting clinical care, and describe culturally sensitive interventions designed to address racial/ethnic health disparities. Recent findings The beneficial effects of cultural competency embrace health outcomes, quality of care, and patient satisfaction, while failure to consider language and culture can have serious adverse consequences for clinical care, including patient safety and healthcare access. A five-component model of cultural competency has been developed, and a growing literature details an array of normative cultural values, folk illnesses, parent beliefs/practices, and provider behaviors that can have a profound impact on pediatric care. Culturally sensitive interventions are being developed to lessen racial/ethnic health disparities. Summary A goal for the pediatrician is to provide culturally competent healthcare by using trained medical interpreters with limited English-proficient families, being familiar with normative cultural values that affect the healthcare of commonly encountered racial/ethnic groups, and asking about folk illness beliefs and ethnomedical treatments.

Reasons for prolonged bottle-feeding and iron deficiency among Mexican-American toddlers: an ethnographic study.

OBJECTIVE Several studies have shown that prolonged bottle-feeding is associated with iron deficiency. Mexican-American toddlers are the racial/ethnic group at greatest risk for prolonged bottle-feeding and iron deficiency, yet no studies have examined reasons for prolonged bottle-feeding in Mexican-American toddlers. The objective of this study was to assess infant feeding beliefs, knowledge, and behaviors among Mexican-American parents. METHODS Ethnographic interviews were conducted of parents of Mexican-American toddlers 15 to 48 months old at 3 community sites. A 31-question moderators guide addressed 4 domains: knowledge and cultural beliefs; sources of nutritional information; anticipatory guidance; and suggestions for ways to change infant feeding practices. Interviews were audiotaped, transcribed, and analyzed using grounded theory. RESULTS Thirty-nine parents were interviewed; the mean parental age was 29 years, and mean child age, 2.2 years. Parents cited convenience as a reason for prolonged bottle-feeding, and believed that they should give toddlers as much milk as they want. Many parents lacked essential knowledge regarding infant feeding practices and iron deficiency, including when to stop bottle-feeding, health problems caused by prolonged bottle-feeding, the quantity of milk to give a child >1 year old, and iron deficiency as a complication of prolonged bottle-feeding. Parents reported not receiving enough education from physicians, and they supported educational interventions on healthy infant feeding practices, including refrigerator magnet charts, videos, brochures, and teaching by physicians. CONCLUSIONS Parents of Mexican-American toddlers often are unaware of the adverse consequences of prolonged bottle-feeding and developmental problems associated with iron deficiency. Parents supported educational interventions, including videos, brochures, and refrigerator magnet charts on healthy infant feeding practices.