Program considerations in comprehensive care of chronically ill children.
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Biomedical subjects
Publications and source records attributed to J K Whitt.
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Child development literature suggests a relationship between mother-child interaction and enhanced infant development. We conducted a randomized clinical trial to determine if a pediatrician's guidance improves the mother-infant relationship and the infant's development. Thirty-two normal mothers and their healthy first-born infants were followed by one pediatrician at 2, 4, 8, 15, and 21 weeks of age. These dyads were randomly assigned to a control group, who received customary care, or to an intervention group, who also received guidance based on the infant's developmental status at each age. Just prior to a 27-week visit, the mother-infant relationship was assessed by a person blind to group assignment. Infant development was assessed with the Bayley Mental Scales of Infant Development and two of the Uzguris-Hunt Ordinal Scales. Intervention group mothers were rated significantly higher on sensitivity, cooperation, appropriateness of interaction, and appropriateness of play (P less than .05). Experimental infants were advanced on the Vocal Imitation ordinal scale. This study shows the effectiveness of this intervention on both the mother-infant relationship and infant development and supports pediatric involvement in this biosocial approach to well child care.
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Social skills and psychological adjustment for survivors of childhood cancer were investigated. Cancer survivors included 42 children and adolescents ranging in age at evaluation from 6 to 18 years with a mean age of 13.1 years. Measures included teacher and parent ratings of social skills and adjustment and parent ratings of family functioning. The findings showed that social skills and psychological adjustment as rated by both parents and teachers were primarily associated with academic functioning. In addition, family cohesiveness was found to account for nearly one third of the variance in survivors' adjustment when rated by teachers, and length of time off treatment accounted for a significant percentage of the variance in children's adjustment when rated by parents. The findings underscore the importance of a multi-informant approach to the assessment of psychological adjustment of pediatric cancer survivors and demonstrate the role of learning difficulties and family functioning in influencing social skills and adjustment for these children and adolescents.
The influences that link social factors and caries development are not well understood, although mediation by stress has been suggested. The association between caregiver stress and early childhood caries (ECC), in particular, remains unclear. The purpose of this study was to examine the relationships between parenting stress and ECC while controlling for behavioral and biological factors in a high-risk population. One hundred and fifty healthy children aged 18-36 months were examined in a cross-sectional study design. Parental interviews were conducted to obtain demographic, oral health behavior and parenting stress data. Clinical data included parent and child bacterial measures, fingernail fluoride analyses, caries prevalence and presence of child enamel hypoplasia. Bivariate analyses revealed that parenting stress predicted caries. Multivariate analyses demonstrated that a combination of psychosocial, behavioral, temporal and biological variables predicted ECC outcomes. Total parenting stress did not contribute independently to the best prediction model. Our findings suggest the need for the development of a multidimensional stress model that considers the parent-child dyad to elucidate further the link between psychosocial factors and ECC.
Separation and loss issues arise frequently in pediatric hospital settings. Three forms of psychiatry/psychology liaison are presented which demonstrate: 1. case-centered collaboration to address child and family concerns about death; 2. team-centered activities which link family and staff roles in the course of terminal illness; and 3. the development of a program mechanism to meet the needs of staff "survivors" of recurrent childhood deaths. These examples illustrate the enrichment which pediatric psychiatry/psychology liaison program offer when the conceptual model of liaison service and teaching operates flexibly on case, team, and program levels.