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A randomized controlled trial examining an exam room poster to prompt communication about weight.
Brown, CL, Howard, JB, Perrin, EM
Pediatric obesity. 2020;(7):e12625
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Abstract
BACKGROUND Recognition of childhood weight status is important to the adoption of healthy lifestyle behaviours. OBJECTIVES We assessed whether an exam room educational poster addressing weight and healthy lifestyle behaviours was acceptable to parents, prompted parent-provider communication or improved parental weight perception accuracy. METHODS In this multi-site randomized controlled trial, exam rooms were randomized to display the posters (English and Spanish) or not. Children ages 3 to 8 years (N = 965) attending well visits were weighed and roomed per usual clinic protocol. After the visit, parents completed a questionnaire assessing demographics, child weight status perceptions and whether they discussed weight status with provider or were shown growth charts. We used separate logistic regression analyses to examine associations between intervention status and: asking provider about child weight, being shown growth charts, and accuracy of weight perception, adjusting for covariates and clustering by exam room. RESULTS Of the parents who saw the poster, 97% liked seeing it and reported greater understanding of weight status visualization (96%) and healthy lifestyle behaviours (94%). Parents who saw the poster were more likely to report being shown a growth chart (OR 1.87, 95% 1.06, 3.30) but were not more likely to ask about their child's weight status nor accurately report their child's weight status. CONCLUSIONS An educational exam room poster about healthy weight was well-received by parents and prompted providers to show the child's growth chart but did not prompt parent-initiated conversations about weight status nor improve parental weight perception accuracy.
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Parental Perception of Children's Weight Status: Love Overpasses Scientific Evidence! A Cross-Sectional Observational Study.
Sirico, F, Fernando, F, Bianco, A, Loiacono, C, Nuccio, F, Gambardella, F, Palermi, S, Montagnani, S, Biffi, A
High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension. 2020;(1):29-34
Abstract
INTRODUCTION Age, gender, body mass index percentiles and the adherence to Mediterranean diet were investigated as potential predictor factors in this assessment. AIM: To assess the parental perception of children's weight status. METHODS This cross-sectional observational study was carried out during a corporate wellness program (Ferrari Formula Benessere) implemented by Ferrari S.p.A. and managed by Med-Ex s.r.l. The children's real weight status was assessed through Body Mass Index percentiles (ArthroPlus software-WHO). RESULTS 328 children (66.4%) were normal-weight, 10 were underweight (2%), 66 were overweight (13.4%) and 90 were obese (18.2%). 289 children (59%) were classified correctly by parents, while 205 children (41%) were not. 64 of 66 overweight children and 90 of 90 children with obesity have been completely underestimated (53 of 90 children with obesity were judged normal weight). The parents' probability to estimate children's weight status correctly decreased increasing body mass index percentiles paradoxically [OR = 0.96 (0.95-0.97)] and was lower in boys [OR = 0.65 (0.44-0.98)]. Although not statistically significant, children with higher adherence to Mediterranean diet seems to have higher probability to be correctly estimated [low adherence: reference, medium adherence: OR = 1.06 (0.61-1.85), high adherence: OR = 1.48 (0.81-2.75)]. CONCLUSIONS A high percentage of children is overweight or obese and almost half of parents classified their weight status incorrectly. Increasing children's body mass index percentiles decreases the probability to be correctly classified.
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Health-related quality-of-life in children with cystic fibrosis aged 5-years and associations with health outcomes.
Cheney, J, Vidmar, S, Gailer, N, Wainwright, C, Douglas, TA, ,
Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society. 2020;(3):483-491
Abstract
BACKGROUND The impact of early cystic fibrosis (CF) on health-related quality-of-life (HRQOL) in preschool children is poorly characterised, and data on relationships between HRQOL and health outcomes in young children with CF are limited. We aimed to characterise and compare parent-proxy and child-reported HRQOL and evaluate relationships with clinical outcomes at age 5-years. METHODS Subjects were participating in the multi-centre Australasian Cystic Fibrosis Bronchoalveolar Lavage (ACFBAL) trial investigating BAL-directed versus standard CF therapy. Children aged 5-years and their parents rated HRQOL using the Pediatric Quality of Life Inventory (PedsQL™) and Cystic Fibrosis Questionnaire-Revised (CFQ-R) questionnaires. RESULTS PedsQL and CFQ-R questionnaires were completed by 141 primary caregivers and 135 and 130 children, respectively. There were no differences in HRQOL between children randomised to BAL-directed versus standard CF therapy. Children with CF rated worse HRQOL than healthy children and there was poor parent-child concordance across HRQOL domains. Nutritional status, CF-CT scan score, forced expiratory volume in 1-second (FEV1), and pulmonary exacerbations correlated with HRQOL at age 5-years. FEV1 z-scores positively correlated with parent-proxy HRQOL in CFQ-R Respiratory (p = 0.018), Physical (<0.001), Emotional (p = 0.007) subscales and PedsQL Total-score (p = 0.021), Physical (p = 0.019) domains. Pulmonary exacerbation rates were inversely associated with parent-proxy CFQ-R Respiratory (p = 0.004), Physical (p = 0.022), PedsQL Total (p = 0.009) and Physical (p = 0.009) scores. CONCLUSION Parent-reported HRQOL is a meaningful clinical endpoint to evaluate interventions in young children. Parent and child HRQOL reports provide different, complementary information. A preschool version of the CFQ-R is needed to assess relationships between HRQOL and clinical outcomes in young children.
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Communication of children's weight status: what is effective and what are the children's and parents' experiences and preferences? A mixed methods systematic review.
Ames, H, Mosdøl, A, Blaasvær, N, Nøkleby, H, Berg, RC, Langøien, LJ
BMC public health. 2020;(1):574
Abstract
BACKGROUND Early intervention and conversation about a child's weight may offer an important chance of success in reducing weight and implementing a healthier lifestyle. This review explores the most effective ways to notify parents and children about the child's weight as well as their preferences and experiences around weight notification. METHODS We systematically searched nine databases for relevant primary research. Records were independently screened by two authors. We extracted data into a form designed for this review. Effect data was analysed using narrative synthesis and qualitative data using a best-fit framework synthesis. We assessed our confidence in the evidence using GRADE and GRADE-CERQual. RESULTS Studies of effect found that the format of feedback made little or no difference in parents attending further treatment, recognising their child as overweight or obese, reactions to the way the weight notification is given, motivation for lifestyle change, understanding how to reduce the risk of overweight, or taking any action. However, parents receiving feedback with motivational interviewing have somewhat greater satisfaction with the way the healthcare provider supports them. Qualitative studies found that parents had clear preferences for the format, timing, content and amount of information they wanted to receive in relation to both the weighing process and weight notification. They also had clear preferences for how they wanted health care providers to interact and communicate with them and their children. Both parents and children often felt that they were not receiving enough information and worried about how their results would be kept private. Many parents experienced an emotional response when told about their child's weight ranging from positive, disbelief and negative feelings. Those who reacted with disbelief or negatively were less likely to accept their child's weight status and/or act upon the notification letter. No studies reported results for children who were underweight. CONCLUSIONS Based on these qualitative results people working with weight assessment and notification programs should consider parents' preferences when developing feedback formats, considering the mode of feedback they are going to use and provide parents and children with tailored feedback and personalized follow up once a child is identified as overweight or obese.
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Confident Body, Confident Child: Outcomes for Children of Parents Receiving a Universal Parenting Program to Promote Healthful Eating Patterns and Positive Body Image in Their Pre-Schoolers-An Exploratory RCT Extension.
Hill, KE, Hart, LM, Paxton, SJ
International journal of environmental research and public health. 2020;(3)
Abstract
Objective: A four-arm randomized controlled trial (RCT) conducted in Victoria, Australia, previously evaluated parent-report outcomes following Confident Body, Confident Child: a program for parents to promote healthful eating patterns and positive body image in pre-schoolers. This exploratory study evaluated data from children of parents in the trial at 18 months follow-up. Method: Participants were 89 children (58 girls, 31 boys) of parents across all RCT arms (group A: Confident Body, Confident Child (CBCC) resource + workshop, n = 27; group B: CBCC resource only, n = 26; group C: nutrition booklet, n = 18; group D: wait-list control, n = 18). Children's eating patterns, body image and weight bias were assessed via play-based interview. Results: Children of CBCC parents reported higher body esteem. Children of nutrition booklet parents reported stronger weight bias. Children of CBCC workshop parents reported lower External Eating. Discussion: This exploratory study suggests that CBCC may promote healthy eating patterns and child body image 18 months after parents receive the intervention.
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Health-related quality of life of children and their parents 2 years after critical illness: pre-planned follow-up of the PEPaNIC international, randomized, controlled trial.
Hordijk, J, Verbruggen, S, Vanhorebeek, I, Güiza, F, Wouters, P, Van den Berghe, G, Joosten, K, Dulfer, K
Critical care (London, England). 2020;(1):347
Abstract
BACKGROUND Pediatric intensive care unit (PICU) survivors are at risk for prolonged morbidities interfering with daily life. The current study examined parent-reported health-related quality of life (HRQoL) in former critically ill children and parents themselves and aimed to determine whether withholding parenteral nutrition (PN) in the first week of critical illness affected children's and parents' HRQoL 2 years later. METHODS Children who participated in the pediatric early versus late parenteral nutrition in critical illness (PEPaNIC) trial and who were testable 2 years later (n = 1158) were included. Their HRQoL outcomes were compared with 405 matched healthy controls. At PICU admission, children had been randomly assigned to early-PN or late-PN. In the early-PN group, PN was initiated within 24 h after PICU admission. In the late-PN group, PN was withheld for up to 1 week in the PICU. Parents completed the Infant Toddler Quality of Life Questionnaire (ITQOL; age 2-3 years) or the Child Health Questionnaire-Parent Form 50 (CHQ-PF50; age 4-18 years). Besides, they completed the Health Utility Index (HUI) and the Short Form Health Survey (SF-12) regarding their child's and their own HRQoL, respectively. RESULTS For the total age group of 786 post-PICU survivors, parents reported lower scores for almost all HRQoL scales compared to healthy children. Age-specifically, younger critically ill children (2.5 to 3 years old) scored worse for growth and development and older children (4-18 years old) scored worse for role functioning and mental health. Parents' own mental and physical HRQoL was comparable to that of healthy control parents. No HRQoL differences were found between children in the late-PN and those in the early-PN group. CONCLUSIONS Parent-reported HRQoL of children 2 years after critical illness was impaired compared with healthy controls. In relation to their child's HRQoL, parents reported impairments in emotions, personal time, and family activities; however, their own HRQoL was not impaired. Withholding PN in the first week during critical illness had no impact on longer-term HRQoL of the child. TRIAL REGISTRATION Clinical trials, NCT01536275. Registered 22 February 2012.
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Effects of Discontinuing Methylphenidate on Strengths and Difficulties, Quality of Life and Parenting Stress.
Matthijssen, AM, Dietrich, A, Bierens, M, Kleine Deters, R, van de Loo-Neus, GHH, van den Hoofdakker, BJ, Buitelaar, JK, Hoekstra, PJ
Journal of child and adolescent psychopharmacology. 2020;(3):159-165
Abstract
Objectives: To study the effects of discontinuation of long-term methylphenidate use on secondary outcome measures of strengths and difficulties, quality of life (QoL), and parenting stress. Methods: Ninety-four children and adolescents aged 8 to 18 years who had used methylphenidate for over 2 years were randomly assigned to double-blind continuation of treatment for 7 weeks (36 or 54 mg extended release methylphenidate) or to gradual withdrawal over 3 to 4 weeks placebo. We used mixed models for repeated measures to investigate effects on parent, teacher, and child ratings of hyperactivity/inattention and comorbid symptoms with the Strengths and Difficulties Questionnaire (SDQ), investigator- and teacher-rated oppositional symptoms (Conners Teacher Rating Scale-Revised: short form [CTRS-R:S]), and parent-rated aggression with the Retrospective Modified Overt Aggression Scale. QoL was assessed with the Revised Questionnaire for Children and Adolescents to record health-related quality of life and parenting stress with the Nijmegen Parental Stress Index. Results: Hyperactivity/inattention scores from the parent- and teacher-rated SDQ (difference in mean change over time of respectively: -1.1 [95% confidence interval, CI, -2.0 to -0.3]; p = 0.01; -2.9 [95% CI -2.9 to -0.7; p = 0.01]) and oppositional scores of the teacher-rated CTRS-R:S (difference in mean change -1.9 95% CI [-3.1 to -0.6; p < 0.01]) deteriorated to a significantly larger extent in the discontinuation group than in the continuation group. We did not find effects on other symptom domains, aggression, QoL, and parenting stress after discontinuation of methylphenidate. Conclusion: Our study suggests beneficial effects of long-term methylphenidate use beyond 2 years for oppositional behaviors in the school environment. Similarly, beneficial effects were found on hyperactivity-inattention symptoms as rated by parent and teacher scales, confirming our primary study on investigator ratings of attention-deficit/hyperactivity disorder. However, discontinuation of methylphenidate did not appear to have impact on other comorbid problems or aspects of the child's or parental functioning.
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Interventions to Empower Adults with Eating Disorders and Their Partners around the Transition to Parenthood.
Sadeh-Sharvit, S, Sacks, MR, Runfola, CD, Bulik, CM, Lock, JD
Family process. 2020;(4):1407-1422
Abstract
The transition to parenthood is perceived as a stressful life event, when parents experience an immense change of their psychological focus and a reorientation of roles and responsibilities in the family system. This process may be even more challenging in the presence of a parental eating disorder history. This paper reviews the impact of parental eating disorders on the parents, the couple relationship, and their child during the perinatal period. A parental eating disorder is associated with more negative expectations of parental efficacy as well as specific difficulties in couple communication over the child's feeding, shape, and weight. Providers who better understand the effects of an eating disorder on parental functioning can more effectively intervene early on. We also present couple- or parent-based, empirically supported interventions for adults with eating disorders and their partners in the prenatal and postnatal periods: Uniting Couples in the treatment of Anorexia Nervosa (UCAN) and Uniting couples In the Treatment of Eating disorders (UNITE) both enhance recovery from the eating disorder through a couple-based intervention; the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA) incorporates the support of partners, when appropriate; Parent-Based Prevention (PBP) focuses on improving parental functioning and reducing risk of negative parental and child outcomes. Finally, we discuss the clinical implications of addressing parental eating disorders and encourage more research on these families.
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Effects and prevalence of responders after a multicomponent intervention on cardiometabolic risk factors in children and adolescents with overweight/obesity: Action for health study.
Brand, C, Martins, CML, Lemes, VB, Pessoa, MLF, Dias, AF, Cadore, EL, Mota, J, Gaya, ACA, Gaya, AR
Journal of sports sciences. 2020;(6):682-691
Abstract
This study aimed to verify the effect of a multicomponent intervention on cardiometabolic risk factors (CMRF), and to determine the prevalence of responders on CMRF among children and adolescents with overweight/obesity. This is a quasi-experimental study, developed with 35 children and adolescents with overweight/obesity (control group (CG) = 18; intervention group (IG) = 17), aged between 7 and 13 years. Participants in IG underwent a multicomponent intervention for 12 weeks. The following variables were evaluated: anthropometric measures, maturational stages and CMRF (body fatness, HOMA-IR, triglycerides, high-density and low-density lipoprotein) (HDL-C, LDL-C), total cholesterol (TC), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and AST/ALT ratio. Mixed analysis of variance and the prevalence of responders were used for statistical analysis. There was a significant time x group interaction on body fatness (p < 0.001), HOMA-IR (p = 0.01), HDL-C (p < 0.001), LDL-C (p = 0.009) and TC (p < 0.001). The prevalence of responders for CMRF in IG and CG was respectively: body fatness (47%; 0%; p = 0.04), HOMA-IR (58.8%; 16.6%; p = 0.04); triglycerides (17.6%; 5.5%; p = 0.31); HDL-C (76.4%; 5.5%; p = 0.01), LDL-C (35.3%; 5%; p = 0.08), TC (64.7%; 5%; p = 0.01), AST (5.8%; 0%; p = 0.87), ALT (29.4%; 11.1%; p = 0.24) and AST/ALT ratio (24.4%; 22.2%; p = 0.67). Multicomponent intervention induced positive changes on CMRF along with a higher prevalence of positive adaptations in IG than the CG in some of the cardiometabolic outcomes assessed.
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Can counter-advertising diminish persuasive effects of conventional and pseudo-healthy unhealthy food product advertising on parents?: an experimental study.
Dixon, H, Scully, M, Gascoyne, C, Wakefield, M
BMC public health. 2020;(1):1781
Abstract
BACKGROUND To help address rising rates of obesity in children, evidence is needed concerning impacts of common forms of marketing for unhealthy child-oriented food products and the efficacy of educational interventions in counteracting any detrimental impacts of such marketing. This study aims to explore parents' responses to advertising for unhealthy children's food products that employ different types of persuasive appeals and test whether a counter-advertising intervention exposing industry motives and marketing strategies can bolster parents' resistance to influence by unhealthy product advertising. METHODS N = 1613 Australian parents were randomly assigned to view online either a: (A) non-food ad (control); (B) conventional confectionery ad (highlighting sensory benefits of the product); (C) pseudo-healthy confectionery ad (promoting sensory benefits and health attributes of the product); (D) conventional confectionery ad + counter-ad (employing inoculation-style messaging and narrative communication elements); (E) pseudo-healthy confectionery ad + counter-ad. Parents then viewed various snacks, including those promoted in the food ads and counter-ad. Parents nominated their preferred product, then rated the products. RESULTS Exposure to the conventional confectionery ad increased parents' preference for the advertised product, enhanced perceptions of the product's healthiness and reduced sugar content and boosted brand attitude. Exposure to the pseudo-healthy confectionery ad increased parents' preference for the advertised product, and enhanced perceptions of healthiness, fibre content and lower sugar content. The counter-ad diminished, but did not eliminate, product ad effects on parents' purchasing preference, product perceptions and brand attitudes. The counter-ad also prompted parents to perceive processed foods as less healthy, higher in sugar and lower in fibre and may have increased support for advertising regulation. CONCLUSIONS Exposure to unhealthy product advertising promoted favourable perceptions of products and increased preferences for advertised products among parents. Counter-advertising interventions may bolster parents' resistance to persuasion by unhealthy product advertising and empower parents to more accurately evaluate advertised food products.