Susana R. Patton

Quality of life in paediatric migraine: characterization of age‐related effects using PedsQL 4.0

The aim of this study was to measure quality of life (QOL) across a broad age range of paediatric migraine patients. Children and adolescents (n = 686) with migraine completed the Pediatric Quality of Life Inventory, version 4.0 (PedsQL 4.0) and a standardized headache assessment at an initial clinic visit. The sample size for each PedsQL age group was: age 2-4 = 21, age 5-7 = 86, age 8-12 = 298, and age 13-18 = 281. Mean total score was 72.7 ± 14.8, significantly less than healthy norms (P < 0.01). Teens reported lower School Functioning than older and young children (P < 0.05) and young children reported lower Social Functioning than older children and teens (P < 0.001). A moderate relation was found between self and parent report. Age-related effects on QOL have implications for the evaluation and management of migraine in paediatric practice. The self and parent report forms of the PedsQL can be used in a practice setting.

Parental fear of hypoglycemia: young children treated with continuous subcutaneous insulin infusion

Background:  The objective of this study was to examine the association between parental fear of hypoglycemia and average daily blood glucose control of young children with type 1 diabetes receiving continuous subcutaneous insulin infusion (CSII). We hypothesized that parental fear of hypoglycemia would correlate positively with children’s average daily blood glucose control.

Adherence to Diet in Youth with Type 1 Diabetes

This article reviewed current findings on dietary adherence in youth with type 1 diabetes mellitus (T1DM), discussed factors predicting dietary adherence, and presented directions for future research. The included studies involved youth with T1DM, presented dietary adherence data specifically, and/or described usual dietary patterns in youth. Articles that explored predictors had to focus exclusively on dietary adherence. The final sample was 23 articles. Adherence articles were organized into two categories: eating behaviors and macronutrients and dietary recommendations. Rates of adherence to eating behaviors ranged from 21% to 95%. Studies examining macronutrients and dietary recommendations revealed higher than recommended intakes of fat and saturated fat and lower than recommended intakes of fruits, vegetables, and whole grains. Six studies investigated factors predicting dietary adherence. These studies revealed associations with child behavior problems and knowledge deficits. The available literature identified many youth with T1DM struggling with adherence and not meeting dietary guidelines for their disease. Future research should examine diet in youth exclusively on intensive insulin regimens, community-based predictors of diet, and the influence of mood on dietary adherence.

Differences in Family Mealtime Interactions between Young Children with Type 1 Diabetes and Controls: Implications for Behavioral Intervention

OBJECTIVE We examine clinically relevant differences in family mealtime behaviors for young children with type 1 diabetes mellitus (T1DM) and matched controls. METHODS One hundred and eighteen families (46% boys; M age = 5.0, SD = 1.5 years) had at least three home meals videotaped and coded for family behaviors. Analyses had adequate statistical power to detect medium effects. RESULTS Parents of children with TIDM offered a higher rate and frequency of commands to eat than controls. As the meal progressed, all parents worked harder at controlling mealtimes, while children ate less. Behaviors associated with lower dietary adherence and poorer glycemic control occurred on average 9 min of a typical 19 min meal for children with TIDM. CONCLUSIONS When differences in family mealtime behaviors have been found in other pediatric groups (e.g., cystic fibrosis), the results have directly informed the development of effective interventions. The clinically relevant results of this study can be used to inform interventions for young children with TIDM.

A Randomized Pilot Study of Behavioral Treatment to Increase Calorie Intake in Toddlers With Cystic Fibrosis

This pilot study examined a behavioral treatment to increase calorie intake in toddlers with cystic fibrosis. Eight toddlers were randomly assigned to behavioral plus nutrition (BEH) or nutrition intervention (NTR) conditions. Calorie intake and weight were measured at pre- and posttreatment. The BEH group showed a trend for changes in calorie intake pre- to posttreatment (p = .07; 40% increase). Results for the BEH and NTR groups did not differ significantly. Most participants achieved weight gains consistent with normal growth. Seventy-five percent had not shown this pattern during the year prior to intervention. These results support the feasibility and potential for behavioral interventions in this age group.

Feeding problems reported by parents of young children with type 1 diabetes on insulin pump therapy and their associations with children’s glycemic control

Objective: Previous research demonstrated high rates of perceived mealtime behavior problems in families of young children with type 1 diabetes who were managed with conventional therapy. Because of new insulin regimens that offer greater flexibility, reexamination of mealtime behaviors is required. We assessed parent‐reported mealtime behaviors in a sample of young children using an insulin pump. An additional aim was to evaluate the associations of two measures of parental feeding behavior with children’s glycemic control.

Mealtime interactions in families of pre-schoolers with type 1 diabetes

Abstract:  Objectives:  Parents of pre‐schoolers with type 1 diabetes report more behavioral feeding problems and concerns about the management of mealtime behavior than parents of age‐matched healthy control children. We compared mealtime interactions of 26 families of pre‐schoolers with type 1 diabetes (13 boys; mean age = 4.4 yr) and those of 26 families of age‐matched control children by using direct observation of meals.

Observational assessment of family functioning in families with children who have type 1 diabetes mellitus.

Objective: Children with type 1 diabetes mellitus have a complex treatment regimen that includes insulin therapy and dietary requirements (e.g., matching insulin and carbohydrate intake). Previous research has shown that parents of children with type 1 diabetes mellitus report significant mealtime challenges and higher parenting stress compared to parents of healthy controls. The objective of the current study was to compare family functioning in children with type 1 diabetes mellitus (ages 2-8) to a matched, healthy control sample. Sixty-six families (33 diabetes; 33 controls) participated in a home visit at which their evening meal was videotaped. Tapes were then coded using the McMaster Interaction Coding System to objectively assess family functioning. Results: Results indicated that families in the diabetes group demonstrated significantly poorer family functioning in a majority of areas (communication, affect management, family roles, overall functioning) compared to the healthy control sample. Additionally, families with lower socioeconomic status and families of male children evidenced poorer overall family functioning for both groups. Conclusions: Results also suggest that family-focused interventions for young children with type 1 diabetes should include components targeting family functioning in the areas of communication, affect management, and family roles.

Family functioning at meals relates to adherence in young children with type 1 diabetes

Aims:  This study examined associations between mealtime family functioning, dietary adherence and glycaemic control in young children with type 1 diabetes mellitus (T1DM). We hypothesised that poorer family functioning would correlate with poorer dietary adherence and glycaemic control.

A Comparison of Average Daily Risk Range Scores for Young Children with Type 1 Diabetes Mellitus Using Continuous Glucose Monitoring and Self-Monitoring Data

BACKGROUND Young children with type 1 diabetes are vulnerable to glycemic excursion. Continuous glucose monitoring (CGM), combined with variability statistics, can offer a richer and more complete picture of glycemic variability in young children. In particular, we present data for the Average Daily Risk Range (ADRR) and compare ADRR scores calculated using CGM versus self-monitoring of blood glucose (SMBG) data for young children. METHODS CGM and SMBG data from 48 young children with type 1 diabetes (mean age, 5.1 years) were used to calculate two separate ADRR scores, using SMBG data (ADRRs) and CGM data (ADRRc), for each child. Additionally, we calculated mean amplitude of glycemic excursion (MAGE) scores for children to examine the concurrent validity of the ADRRs and ADRRc. RESULTS Young childrens mean ADRRc score was significantly greater than their ADRRs score (55±12 and 46±11, respectively; P<0.001). In addition, 74% of the time the childrens ADRRc score reflected greater variability risk than their ADRRs score. Examining the concurrent validity, childrens ADRRc scores correlated positively with MAGE scores calculated using their CGM and SMBG data, whereas their ADRRs scores only correlated with MAGE scores calculated using SMBG. CONCLUSIONS ADRR scores generated for young children with type 1 diabetes demonstrate a high risk for glucose variability, but ADRR scores generated from CGM data may provide a more sensitive measure of variability than ADRR scores generated from SMBG. In young children with type 1 diabetes, ADRR scores calculated from CGM data may be superior to scores calculated from SMBG for measuring risk of excursion.