Julie Lawrence

Family Discipline Incidents: An Analysis of Parental Diaries

Abstract This study focuses on day-to-day parental disciplinary techniques, what provokes their use with their preschool children, and their outcome. Two hundred and seven parental diary anecdotes of disciplinary incidents with under five-year-old children, were analysed to determine the sequence of events. Children’s disruptive/aversive behaviour was the antecedent for a parental intervention in one third of the incidents, while making a demand occurred in about a quarter of incidents. Parental verbal instruction was the most commonly used first disciplinary technique followed by verbal warning, time-out and praise. In many situations, parents used several different disciplinary techniques to accomplish a child’s compliance. Children showed the most committed compliance after positive and neutral disciplinary strategies. New Zealand parents were shown to use complex communication, positive consequences, and mild punishment as disciplinary techniques, rather than power assertive or negative methods, and these strategies were on the whole effective.

Targeting Sleep, Food, and Activity in Infants for Obesity Prevention: An RCT

An RCT comparing effects of a conventional food and activity intervention versus a sleep behavior intervention on infant growth from birth to 2 years. OBJECTIVE: The few existing early-life obesity prevention initiatives have concentrated on nutrition and physical activity, with little examination of sleep. METHODS: This community-based, randomized controlled trial allocated 802 pregnant women (≥16 years, <34 weeks’ gestation) to: control, FAB (food, activity, and breastfeeding), sleep, or combination (both interventions) groups. All groups received standard well-child care. FAB participants received additional support (8 contacts) promoting breastfeeding, healthy eating, and physical activity (antenatal–18 months). Sleep participants received 2 sessions (antenatal, 3 weeks) targeting prevention of sleep problems, as well as a sleep treatment program if requested (6–24 months). Combination participants received both interventions (9 contacts). BMI was measured at 24 months by researchers blinded to group allocation, and secondary outcomes (diet, physical activity, sleep) were assessed by using a questionnaire or accelerometry at multiple time points. RESULTS: At 2 years, 686 women remained in the study (86%). No significant intervention effect was observed for BMI at 24 months (P = .086), but there was an overall group effect for the prevalence of obesity (P = .027). Exploratory analyses found a protective effect for obesity among those receiving the “sleep intervention” (sleep and combination compared with FAB and control: odds ratio, 0.54 [95% confidence interval, 0.35–0.82]). No effect was observed for the “FAB intervention” (FAB and combination compared with sleep and control: odds ratio, 1.20 [95% confidence interval, 0.80–1.81]). CONCLUSIONS: A well-developed food and activity intervention did not seem to affect children’s weight status. However, further research on more intensive or longer running sleep interventions is warranted.

Lactation Consultant Support from Late Pregnancy with an Educational Intervention at 4 Months of Age Delays the Introduction of Complementary Foods in a Randomized Controlled Trial

BACKGROUND Although the WHO recommends that complementary feeding in infants should begin at 6 mo of age, it often begins before this in developed countries. OBJECTIVE Our objective was to determine whether lactation consultant (LC) support, with educational resources given at 4-mo postpartum, can delay the introduction of complementary foods until around 6 mo of age. METHODS A total of 802 mother-infant pairs were recruited from the single maternity hospital serving Dunedin, New Zealand (59% response rate) and randomly assigned to the following: 1) usual care (control group); 2) infant sleep education intervention (Sleep); 3) food, activity, and breastfeeding intervention (FAB); or 4) combination (both) intervention (Combo). Certified LCs delivered 3 intervention sessions (late pregnancy and 1-wk and 4-mo postpartum). The 4-mo contact used educational resources focused on developmental readiness for complementary foods. Age when complementary foods were introduced was obtained from repeated interviews (monthly from 3- to 27-wk postpartum). RESULTS A total of 49.5% and 87.2% of infants received complementary foods before 5 and 6 mo of age, respectively. There was evidence of group differences in the number of infants introduced to complementary foods before 5 mo (P = 0.006), with those receiving support and resources (FAB and Combo groups combined; 55.6%) more likely to wait until at least 5 mo compared with controls (control and Sleep groups combined; 43.3%) (OR: 1.52; 95% CI: 1.08, 2.16). However, there was no evidence they were more likely to wait until 6 mo of age (P = 0.52). Higher maternal age, higher parity, and a less positive attitude toward breastfeeding were positively associated, and drinking alcohol during pregnancy was negatively associated, with later age of introduction of complementary foods. CONCLUSIONS Providing an LC and educational resources at 4-mo postpartum to predominantly well-educated, mainly European, women can delay the introduction of complementary foods until 5 mo of age, but not until the WHO recommendation of 6 mo. This trial was registered at clinicaltrials.gov as NCT00892983.

Anticipatory guidance to prevent infant sleep problems within a randomised controlled trial: infant, maternal and partner outcomes at 6 months of age

Objective To evaluate the effectiveness of sleep education delivered antenatally and at 3 weeks postpartum to prevent infant sleep problems at 6 months of age. Design Sleep intervention within a randomised controlled trial for the Prevention of Overweight in Infancy (POI) study. Participants 802 families were randomly allocated to one of four groups: usual care (control), sleep intervention (sleep), food, activity and breastfeeding intervention (FAB), and combined group receiving both interventions (combination). Interventions All groups received standard Well Child care. The sleep intervention groups (sleep and combination) received an antenatal group education session (all mothers and most partners) emphasising infant self-settling and safe sleeping, and a home visit at 3 weeks reinforcing the antenatal sleep education. FAB and combination groups received four contacts providing education and support on breast feeding, food and activity up to 4 months postpartum. Outcome measures Here we report secondary sleep outcomes from the POI study: the prevalence of parent-reported infant sleep problems and night waking, and differences in sleep duration. Additional outcomes reported include differences in infant self-settling, safe sleep practices, and maternal and partner reports of their own sleep, fatigue and depression symptoms. Results Linear or mixed linear regression models found no significant intervention effects on sleep outcomes, with 19.1% of mothers and 16.6% of partners reporting their infant’s sleep a problem at 6 months. Actigraphy estimated the number of night wakings to be significantly reduced (8%) and the duration of daytime sleep increased (6 min) in those groups receiving the sleep intervention compared with those who did not. However, these small differences were not clinically significant and not observed in 24 hours infant sleep diary data. No other differences were observed. Conclusion A strategy delivering infant sleep education antenatally and at 3 weeks postpartum was not effective in preventing the development of parent-reported infant sleep problems.

Parenting style and family type, but not child temperament, are associated with television viewing time in children at two years of age.

Objectives Despite the American Academy of Pediatrics (AAP) recommending that electronic media be avoided in children under two years of age, screen use is common in infants and toddlers. The aims of this study were to determine how parenting style, infant temperament, and family type are associated with television viewing in two-year-old children. Study design Participants were from the Prevention of Overweight in Infancy (POI) randomized controlled trial (n = 802) (Dunedin, New Zealand). Demographic information was collected at baseline (late pregnancy), and television and other screen time assessed by questionnaire at 24 months of age. Parenting style (Parenting Practices Questionnaire), infant temperament (Colorado Childhood Temperament Inventory), and family type (7 categories) were reported by both parents. Results Data were available for 487 participants (61% of the original participants). Median television viewing was relatively low at 21 minutes per day, or 30 minutes in those watching television (82%). Children who watched television played with mobile phones (12% of children) or iPads/tablets (22% of children) more frequently than children who did not (6% of children). In terms of parenting style, children of more authoritarian mothers (β = 17, 95% CI: 6–27 minutes), more authoritarian partners (β = 14, 95% CI: 2–26 minutes), or more permissive mothers (β = 10, 95% CI: 3–17 minutes) watched significantly more television. No significant relationships were observed between child temperament and time watching television after adjustment for confounding variables. Children from “active” families (as rated by partners) watched 29 minutes less television each day (P = 0.002). Conclusions Parenting style and family type were associated with television viewing time in young children, whereas child temperament was not.

A Qualitative Study of How Preschoolers’ Problematic Sleep Impacts Mothers

ABSTRACT Background: Sleep disturbances are common among preschool-aged children. As children’s problematic sleep is commonly defined by subjective reports from parents as to how the issue affects them, we took a qualitative approach to explore the perceptions and experiences of mothers and main caregivers of preschoolers with problematic sleep. The aim was to understand their firsthand experiences. Methods: Purposive sampling was used to identify mothers of 3- to 4-year-olds whose sleep was a problem for them. Semistructured interviews were conducted with 16 mothers. The interviews were analyzed for anticipated and emergent themes, the latter generated from exploring the impact of the child’s sleep problems on the mother herself. Results: Mothers described difficulties mainly with bedtime resistance and night waking and the adverse consequences affecting siblings and partners. Predominant themes falling under the umbrella of emotional responses (e.g., resignation, guilt or shame, confusion or frustration, and defeat) and daytime functioning (e.g., exhaustion, moodiness, poorer concentration, less socializing) emerged from mothers describing the impact the child’s sleep problem had on her personally. Conclusions: This study highlights the overwhelming impact a child’s sleep problems can have on a mother both emotionally and physically, and expressions of shame and guilt suggest some mothers assume much of the responsibility for their child’s sleep problem. The findings provide insight into understanding mothers’ personal responses in dealing with their preschoolers’ sleep that could be useful to assist health professionals in history taking and establishing a treatment plan.

Identifying developmental features in students’ clinical reasoning to inform teaching*

Abstract Background: There is increasing evidence that students at different levels of training may benefit from different methods of learning clinical reasoning. Two of the common methods of teaching are the “whole – case” format and the “serial cue” approach. There is little empirical evidence to guide teachers as to which method to use and when to introduce them. Methods: We observed 23 students from different stages of training to examine how they were taking a history and how they were thinking whilst doing this. Each student interviewed a simulated patient who presented with a straightforward and a complex presentation. We inferred how students were reasoning from how they took a history and how they described their thinking while doing this. Results: Early in their training students can only take a generic history. Only later in training are they able to take a focused history, remember the information they have gathered, use it to seek further specific information, compare and contrast possibilities and analyze their data as they are collecting it. Conclusions: Early in their training students are unable to analyze data during history taking. When they have started developing illness scripts, they are able to benefit from the “serial cue” approach of teaching clinical reasoning.

Physical activity and inactivity trajectories associated with body composition in pre-schoolers

Background/objectivesEarly childhood is characterised by rapid development and is a critical period for the establishment of activity behaviours. We aim to examine how physical activity (PA) and sedentary behaviour (SB) track during the first 5 years of life, and to investigate associations between trajectories and body composition at 5 years of age.Subjects/methodsA total of 438 participants (50% male) wore an Actical accelerometer for 5 days at at least two of 1, 2, 3.5 and 5 years of age. Spearman correlation coefficients examined PA tracking from age 1 to 5 and trajectories of PA and SB were estimated using discrete mixture modelling. Regression models tested associations between both PA and SB trajectories and body composition measures.ResultsTracking coefficients for PA ranged from r = 0.31–0.51 across the ages, with similar tracking observed for sedentary behaviour (r = 0.21–0.39). Four distinct trajectory patterns were identified separately for PA and SB: consistently low, consistently high, increasing and decreasing. BMI and waist circumference were not significantly associated with PA trajectories, but those in the consistently high activity group had significantly lower % body fat (95% CI) at age 5 (14.3%; 13.5, 15.2) than those in the consistently low (16.8%; 15.6, 18.2) or increasing (15.7%; 14.7, 16.7) groups (P = 0.017). Sedentary behaviour trajectories were not associated with any of the anthropometric measures at age 5 (P > 0.05).ConclusionsPhysical activity and sedentary behaviour tracking is broadly similar from infancy to early childhood. Children with consistently higher levels of physical activity have reduced body fat at 5 years of age, although differences are relatively small.

The Role of Parent and Child Self-Regulation in Children's Glycemic Control.

Objective: Type 1 diabetes mellitus (T1DM) is a lifelong, metabolic disorder, typically arising in childhood and adolescence. Despite recent advances in diabetes management techniques, glycemic control remains substandard for many individuals This study examined the role of parental and child self-regulation in predicting effective glycemic control in children and adolescents with Type 1 diabetes mellitus (T1DM). Method: Sixty-three families (with children aged 3–18 years) with T1DM participated. Child, maternal, and paternal measures of temperament, including surgency (behavioral self-regulation), negative affect (emotional selfregulation), and effortful control (cognitive self-regulation) were collected, along with demographic information and haemoglobin A1c (glycemic control). Results: Higher parental and child effortful control was associated with better glycemic control. Higher child negative emotionality was associated with poorer glycemic control. No significant interactions between child and parent measures were identified. Conclusions: Both parental and child self-regulation play an independent role in glycemic control, and serve as targets for intervention in improving diabetes management in children and adolescents.

Family discipline practices with infants at six months of age

ABSTRACT Objectives: To determine the frequency of 14 discipline strategies used by mothers (n = 564) and fathers (n = 335) in caring for their six-month old infant. Methods: Data on discipline practices were obtained from families participating in an obesity prevention trial (Prevention of Overweight in Infancy). Each parent was asked to indicate the frequency of using 14 different discipline strategies during the previous week with their infant. Associations between the use of these strategies and parity, deprivation, parental ethnicity, depression symptoms and infant sex were investigated. Results: Parents reported using both positive (mean: 8.8 for mothers and 7.9 for partners) and negative (0.7 for mothers and 0.7 for partners) strategies over the past week. At six months, positive strategies such as smiling, praising and distraction were most commonly reported (≥87% for both mothers and partners), negative strategies such as smacking, time out and shouting being reported infrequently (≤8% for all). Discipline requiring a level of cognitive understanding not developed at six months was reasonably common, including reasoning (17.7% for mothers, 23.4% for partners), negotiation (6.2%, 11.7%) and ignoring (26%, 19%). Multivariate analysis demonstrated that mothers with more than one child had a lower positive discipline index than those with only one child (difference, 95% C.I.: 1.05 (0.57, 1.54). An increase of one point on the 10-point hostile parenting scale was associated with an increase of 0.18 (0.04, 0.31) for the mothers and 0.47 (0.23, 0.70) for partners on the negative strategy index. Conclusions: Discipline strategies emerge early in infancy and are associated with family size and parental hostility.