bluuebunny/crossref_metadata_2025 huggingface dataset:
Infants who stay in foster care: child characteristics and permanency outcomes of legally free children first placed as infants
Authors: Kemp  , Bodonyi
Published: March 2003

Despite growing concern in the United States about the number of children who are entering child welfare care as infants, little empirical attention has been given to the sizable group of these children who are not reunified with their biological families and who then remain in care for long periods. This study examined length of stay and permanency outcomes for 458 legally free children who initially entered out‐of‐home care as infants. Using a Cox proportional‐hazards event history model, the study also explored the effects of race/ethnicity and gender on the likelihood of these children achieving a permanent placement (legalized adoption or guardianship) within a reasonable period of time. African–American children and boys were found to be significantly less likely to achieve permanence than Caucasian children or girls. Across all groups of children in the sample, however, long stays in care were the norm. These findings suggest the need for flexible approaches to permanency, for efforts to better differentiate among infants in care, and for attention to children’s long‐term developmental needs as well as to strategies that better assure placement stability.
Assimilation, control, mediation or advocacy? Social work dilemmas in providing anti‐oppressive services for Traveller children and families
Authors: Cemlyn S.
Published: March 2003

This paper explores dilemmas facing social work in England in providing anti‐oppressive services for Travellers, particularly those who lack secure sites. A context is provided by outlining the conflict between Travellers and the majority society, and its expression in oppressive legislation, policy and practice. The implications of the corporate local authority role for relationships between Travellers and social services, and the specific history of Travellers and welfare, are also explored. The remainder of the paper draws on findings from a Nuffield‐funded study of policy and provision by English social services departments for Traveller children and families. Provision is undermined by mutually difficult relationships between Traveller communities and social services, and competing demands on social services in relation to professional values and support of Travellers’ rights, and their simultaneous contribution to local authority control of unauthorized camping. However, newer developments in some social services departments may be able to generate more positive relationships with Travellers, to promote their individual and cultural rights, and build partnerships with voluntary agencies which have a significant role in work with Travellers. The implications for social services departments wishing to develop their policies and practice with Traveller families are outlined.
The symptom‐carrying child as a preserver of the family unit
Authors: Yahav R. , Sharlin S.A.
Published: March 2003

The aim of this study was to investigate the operational validity of the theoretical concept of the ‘symptom‐carrying child’. Its purpose was to examine whether, and to what extent, the symptom‐carrying child plays a central role in maintaining the internal balance and unity of the family, and whether he holds a focal position in ‘triangulation’. The research hypothesis was based on theories of family therapy, in particular on the concepts of the ‘identified patient’, and ‘triangulation’. Our major question was whether symptomatic children would be more likely than non‐symptomatic children to exhibit greater responsibility and involvement in their parents’ marriage, and as such act as preservers of the family unit. Subjects in each of the groups participating in this study were identified in treatment centres for children and adolescents using the Achenbach Self‐report Questionnaire. Subjects included males and females aged 10–17, who had either internalized or externalized symptoms and no history of organic or psychotic disorders. The research groups also included each child’s parents and the sibling closest in chronological age, who served as an additional control group. A total of 118 children from nuclear, two‐parent families participated in the study. It was found that symptom‐carrying children exhibited greater involvement and responsibility in their parents’ marriage than non‐symptom‐carrying children. Likewise symptomatic children reported that they had greater influence on their parents than children without symptoms.
The implications of adoption for donor offspring following donor‐assisted conception
Authors: Blyth Eric , Crawshaw Marilyn , Haase Jean , Speirs Jennifer
Published: March 2003

In this paper the authors, all experienced social workers with research and practice interests in assisted conception, review practices concerning access to genetic origins information in adoption, and consider to what extent these may be relevant for practice in donor‐assisted conception. The paper concludes with policy and practice recommendations that take account of the views of donor offspring and their desire for increased information about their genetic heritage.
Social workers’ attitudes towards family group conferences in Sweden and the UK
Authors: Sundell Knut , Vinnerljung Bo , Ryburn Murray
Published: March 2003

The New Zealand family group conference (FGC) approach to decision making in child welfare and protection has attracted strong interest among policy makers and professionals all over the world. While New Zealand’s legislation makes use of FGCs more or less mandatory in child protection, other countries permit social workers to refer families to an FGC at their own discretion. Knowledge about social workers’ attitudes towards the model is thus paramount if we want to understand implementation and evaluations of FGCs outside New Zealand. This study looks at attitudes towards and actual referrals to FGCs amongst 219 social workers from 18 local authorities in Sweden and the UK. Results reveal an overwhelmingly positive attitude towards FGCs in both countries. Given these attitudes it was striking that only 42% of the social workers had initiated at least one FGC over an 18‐month period. The number of implemented FGCs was almost exactly the same in Sweden and the UK, after adjusting for time and number of social workers. Possible explanations for this paradox are discussed, using data from the survey and child welfare literature.
How does the intervention of cardiac surgery affect the self‐perception of children with congenital heart disease?
Authors: Wray  , Sensky
Published: March 2003

Background There is little published information about the self‐perceptions of children with chronic physical diseases and the ways in which self‐perceptions might change as a result of treatment. An innovative measure of self‐perception is described, suitable for use by children of widely varying ages as well as by parents.

Methods The instrument used assessed eight constructs contributing to self‐perception, and also measured differences between perceptions of actual and ideal self. Children (n= 31; age 5–15 years) with congenital heart disease (CHD) were assessed prior to surgery and 1 year post‐operatively. Comparisons were made with children before and 1 year after bone marrow transplantation (BMT), and with healthy children.

Results There were no differences between the groups in ideal self‐perceptions, but the CHD children rated themselves as weaker, more frightened and more ill than the healthy group. Given the differences in symptomatology and illness experience of children with cyanotic and acyanotic lesions, surprisingly few differences emerged in the self‐perceptions of these two groups, although differences were found among younger and older children assessed separately. Significant improvements were found in self‐perceptions of the CHD and BMT groups following treatment, and at follow‐up, no significant differences remained between the CHD and healthy groups. In the latter, self‐perception was largely unchanged between the two assessments.

Conclusions Assessment of self‐perception should be an integral part of the assessment of health outcomes in childhood illness. The study demonstrated the significant improvement in self‐perception following surgery for CHD. The results also support the validity, reliability and sensitivity to change of the assessment measure.
The lifestyle assessment questionnaire: an instrument to measure the impact of disability on the lives of children with cerebral palsy and their families
Authors: Mackie P C , Jessen E C , Jarvis S N
Published: March 2003

Suitable measures of health and morbidity are less readily available for children than they are for adults. We present a measure, which is used to describe the impact of impairment and disability on the lives of children with cerebral palsy and their families. The development of this measure involved data collected from 691 children with cerebral palsy contained within the North‐East England Cerebral Palsy Register and born between 1960 and 1985. Uniquely, multidimensional scaling techniques were used to derive dimensions analogous with those described in the International Classification of Impairments, Disabilities, and Handicaps. We present the analyses undertaken to test the properties of the tool, which show that it is a reliable and valid measure of the disadvantages experienced by children with cerebral palsy.
Differences in problems of motivation in different special groups
Authors: Kunnen E. S. , Steenbeek H. W.
Published: March 2003

In general, children with a range of special needs have below‐average motivation and perceived control. We have investigated whether differences exist between the types of problem in different special groups. Theory distinguishes between two types: low motivation and perceived control can be based either on a low perceived contingency, or on a low perceived competence. These two types of problem require different intervention strategies. The development of these types is related to several factors that might vary systematically in different special groups: specific histories of experience of success and failure, the possibilities of perceiving contingencies, and the kind of feedback and attributions from important others. We asked teachers to rate their pupils and found, in accord with our expectations, that children with social, emotional and behavioural problems, children with moderate learning difficulties and children with specific learning difficulties have more problems in perceived competence than children with physical or visual impairments. There was a non‐significant tendency in the expected direction for children with physical impairments to have lower perceived contingency scores than the other groups. We conclude that caution is required in generalizing research findings from one special group to another, and in the application of intervention techniques that have been developed for one particular group.
Adaptation of parents in relation to their 6‐month‐old infant’s type of disability
Authors: Pelchat D. , Ricard N. , Bouchard J‐M. , Perreault M. , Saucier J‐F. , Berthiaume M. , Bisson J.
Published: March 2003

The adaptation of parents to a disabled infant was studied in relation to the type of disability presented by the baby. Participants were divided according to three types of disability and one control group: parents of infants with (1) Down’s syndrome (DS), (2) congenital heart disease (CHD), (3) a cleft lip and/or palate (CLP), and (4) no disability (ND). The data were collected using a self‐administered questionnaire given to each parent 6 months after the birth of their baby. The measures included parenting stress, stress appraisal, and psychological distress. Overall, the results indicate that parents of infants with DS and parents of infants with CHD report greater levels of parenting stress and psychological distress than parents of babies with CLP or non‐disabled infants. Mothers were found to report greater levels of stress and distress overall, but differences across diagnostic groups were similar for mothers and fathers. The implications of the findings for theory and clinical intervention are discussed.
Developing rational protocols for paediatric psychopharmacological prescribing
Authors: Gringras P. , McNicholas F.
Published: March 2003

The number of child psychiatrists, paediatricians and general practitioners prescribing psychotropic medication for children in the UK is increasing. Medication is being used not just to treat children of normal intelligence with hyperkinetic disorder or depression, but also to modify behavioural problems in children with developmental disorders and severe learning difficulties. Literature reviews highlight the lack of robust randomized controlled drug trials on which to base clinical practice and the authors have found no appropriate existing protocols to help develop a systematized approach.

Against such a background the authors have developed a comprehensive set of protocols covering prescribing details for individual drugs, and also addressing issues such as informed consent, long‐term monitoring and school liaison. All children referred to the authors’ clinics go through a standardized decision‐making process. This article describes both the protocols themselves and the philosophies that guided their development. The authors describe how such a system benefits the children, their families, general practitioners and schools, whilst also facilitating audit and research.
Issues to consider in the evaluation of speech and language therapy for preschool children
Authors: Roulstone S. , Glogowska M. , Enderby P. , Peters T. J.
Published: March 2003

This paper reviews some of the methodological issues involved in the design of a randomized controlled trial currently underway in Bristol. The trial compares the progress of preschool children randomly allocated to a ‘watching‐waiting’ control group with the experimental group who have immediate access to therapy. This paper reviews a number of relevant studies, which have either followed up preschool children with early language delays or have investigated the effects of therapy with this age group. The basic design of the trial is outlined along with a discussion of the sample, the measurements used and the therapy given.
Crying patterns of Korean infants in institutions
Authors: Lee K
Published: March 2003

This study investigates whether the crying pattern of infants reared in institutions is different from those reared at home in the same cultural backgrounds. Ninety‐five institutional infants and 143 home infants, aged 2–18 weeks were studied through diaries, recorded by children’s care‐givers or mothers. Results showed that the crying duration of the infants in institutions was almost double that of infants at home (86 vs 45 min/day) and contact period with the care‐givers was half that of home infants (136 vs 279 min/day). In addition, the duration of periods when the babies were alone was much longer in the institution group (1089 vs 1002 min/day). There was a tendency for both groups of institution and home infants to cry more during the evening (from 18.00 to 24.00 h) but there was no definite peak of crying at any age except the slight increase of crying after 12 weeks for the institution group. When compared with research on Western infants, the daily crying durations of both institution and home infants fall short of those of their Western counterparts. The effect of care‐giving style on the crying pattern, including physical proximity, is discussed.
Risk factors for failure to thrive: a population‐based survey
Authors: Wright C , Birks E
Published: March 2003

Aim To identify whether differences exist between failure to thrive children and controls in either demographic characteristics or parental rating of their eating and other behaviour.

Methods As part of an intervention study, 97 children with failure to thrive were identified by population screening and received a standardized assessment by their health visitor at a median age of 15.1 months. This included standard questions to parents concerning their perception of their child’s feeding history and behaviour. Their responses were compared with the parents of 28 normally growing children aged 16–18 months, systematically sampled from the same district.

Results Cases had fallen through a mean of 1.69 weight standard deviation score and were markedly underweight for height. The case families had similar levels of deprivation, both to controls and city norms, and only four showed evidence of major neglect. Failure to thrive children had significantly more infancy feeding problems and were introduced to solids and finger foods later than controls; they were significantly more often described as variable eaters, undemanding and shy and less often as hungry. Cases liked most foods, but significantly less so than controls.

Conclusions This suggests that the role of deprivation and neglect has been overstated and that undemanding behaviour, low appetite and poor feeding skills may contribute to the onset and persistence of failure to thrive.
Psychosocial impact of an X‐linked hereditary disease: a study of Alport syndrome patients and family members
Authors: Pajari H. , Sinkkonen J.
Published: March 2003

A nationwide search for patients with Alport syndrome (AS), a hereditary nephritis with sensorineural hearing loss and occasional ocular anomalies, was performed. As AS is usually transmitted in an X‐linked fashion, its form is usually severe in male and mild in female patients. Semi‐structured interviews were conducted with 24 patients with AS and their family members from 17 families and 11 pedigrees. The emphasis was on psychosocial stress experienced in everyday life, as well as the influence of AS on family relationships, especially mother–son relationships. Special attention was paid to children’s reactions and feelings as well as the coping strategies of the family.

Denial was the most common psychological defence found in our study. We found several cases where AS had led to chronic mental suffering. One of the patterns was a combination of maternal depression and an overprotective attitude toward an AS‐affected son. In other instances, depressive symptomatology and anxiety were seen in connection with complications and an adverse outcome of the disease.

Families with any AS manifestations should be encouraged to discuss openly the past histories of family members, their fears, feelings of guilt, hopes and expectations. The role and empathic attitude of the clinician is crucial in this process. Mildly affected mothers who have sons with AS are especially in need of psychological support. Professional psychological help should be made available but not given routinely.
Dyslexia: a developmental language disorder
Authors: Simpson S
Published: March 2003

The acquisition of literacy in an alphabetic script such as English makes heavy demands on linguistic skills. The relation between spoken and written language however, is far from straightforward. This article reviews the research that suggests that phonological processing skills are crucial in the translation of symbols to sounds, and the development of rapid and automatic decoding skills. It examines research that indicates that children whose phonological processing skills are compromised in some way, are at‐risk of experiencing difficulties in the acquisition of literacy; it supports the suggestion that dyslexia can be viewed as lying on the continuum of developmental language disorders. It goes on to relate theory to practice and discusses the responsibilities of health care professionals in relation to the early identification of dyslexia, and makes suggestions regarding intervention. In particular, it looks at the responsibilities of speech and language therapy services in the care and management of children with dyslexia.
Matching short break services for children with learning disabilities to family needs and preferences
Authors: McConkey R , Adams L
Published: March 2003

Short breaks or respite care is a much‐valued service by families and the demand for it is likely to exceed supply. It is all the more imperative that the services provided are matched to the needs and preferences of families. A census was undertaken within one Health and Social Services Board in Northern Ireland of families who received short break services for their child with disabilities during a 12‐month period. Information was also collected on pertinent child and family characteristics. This enabled profiles to be drawn up of the recipients of six types of short‐term breaks: (1) hospital‐based overnight care; (2) overnight stays in a residential home; (3) domiciliary service in the family home; (4) breaks provided in another family home; (5) residential holidays; and (6) breaks provided through leisure schemes organized after‐school or during holidays. A second study entailed interviews with families who were resident in one area served by a Health and Social Service Trust regarding their usage and preferences for each type of service noted above. This too identified variations in parental preferences and usage. This information gathered should assist commissioners in developing cost‐beneficial short break services although further research is needed to validate the possible predictors for each service.
Prevalence of imaginary companions in a normal child population
Authors: Pearson D , Rouse H , Doswell S , Ainsworth C , Dawson O , Simms K , Edwards L , Faulconbridge J
Published: March 2003

Approximately 1800 children between the ages of 5 and 12 years were randomly selected and asked whether they had present or past experiences of imaginary companions. It was found that 829 (46.2%) children reported experiences of imaginary companions. These findings were unexpected as previous studies had suggested that imaginary companions are generally experienced by fewer, much younger children. There were no significant differences in creativity scores between children who reported imaginary companions compared with those who did not. Imaginary companions were reported by more girls than boys, and were not restricted to very young children.
Infant motor development and equipment use in the home
Authors: Abbott A.L. , Bartlett D. J.
Published: March 2003

Forty‐three mother–infant dyads were recruited to determine the relationship between both total equipment use and the use of individual pieces of equipment and infant motor development. At 8 months of age, total and individual equipment use was determined by parental survey and infant motor development was assessed using the Alberta Infant Motor Scale. Statistically significant correlations were found for the relationships between total equipment use and infant motor development (r = −0.50, P = 0.001) and individual pieces of equipment [exersaucer (r = −0.58, P = 0.001), highchair (r = −0.32, P = 0.04), and infant seat (r = −0.32, P = 0.03)] and infant motor development. These findings suggest that infants who have high equipment use tend to score lower on infant motor development or that infants who have low equipment use tend to score higher on infant motor development. Limitations of this cross‐sectional study make it difficult to determine causality between these constructs. If equipment use is found to be causally related to infant motor development and predictive of later motor development in a future prospective study, parental education emphasizing the moderate use of equipment within the home environment might be warranted.
Bedwetting, behaviour and self‐esteem: a review of the literature
Authors: Redsell S A , Collier J
Published: March 2003

Aim The aim of this review was to examine the empirical evidence on the impact of bedwetting and its treatment on a child's self‐esteem and behaviour.

Inclusion criteria The inclusion criteria for this review were empirical studies conducted on children, aged 5–16 years old, with primary nocturnal enuresis using measures of self‐esteem or behaviour. Studies utilizing psychological measurement scales completed by children were the main focus although those that used scales completed by parents were also included.

Search strategies The electronic databases from 1981 to 1999 were searched, and hand searching of the literature dating back to 1973 was conducted using the reference lists of key papers.

Research findings Fifteen empirical studies matched the inclusion criteria. There was only one randomised‐controlled trial and the rest of the studies were cohort, case‐control or cross‐sectional design. Evidence of sample bias predominantly due to the use hospital‐based and/or ‘volunteer’ subjects was found in five studies. A further five studies used birth cohort data, which excludes important variables such as the impact of treatment. Four studies used single parent‐reported measures, which may under or over‐estimate the problem. No large cohort studies were available which compare the self‐esteem of bedwetting children with matched controls. The most interesting line of enquiry is pursued by studies looking at whether self‐esteem improves with successful treatment. However, the use of self‐selected subject groups does not make the current evidence convincing and more work is required to determine outcomes for all children. There is empirical evidence for increased behavioural problems in bedwetting children. Studies conducted on younger children report less behavioural problems with more reported in studies conducted on older children with complex wetting disorders. This may point towards wetting being the primary problem, but more work is needed, as causation in any direction is difficult to ascertain from the literature.
Children's representations of pets in their social networks
Authors: McNicholas J , Collis G M
Published: March 2003

Objectives To develop a child‐friendly methodology to study children's representations of social support available from their personal relationships; and to examine children's representations of support from their pets compared to support from human relationships.

Design Participants were 22 year‐3 primary school children aged 7–8 years. They were asked to list all the people and animals important to them and then to select a ‘top 10’ of most special relationships. Using a story‐based methodology, children were asked who from their ‘top 10’ they would turn to if they were the child in the story.

Results Consistency in the data indicated that the children could reliably discriminate between different relationships in terms of the support functions they serve. Pets were often ranked higher than certain kinds of human relationship, and they featured prominently as providers of comfort, esteem support and confidantes for a secret. Confidence in these findings is gained through pets not being nominated for functions they could not realistically perform.
Knowledge and attitudes in multicultural health care
Authors: Menon S , McKinlay IA , Faragher EB
Published: March 2003

Health professionals' knowledge of ethnic minority cultures and lifestyles was assessed to determine whether the respondents' cultural background and experience of working with ethnic minorities affected the health care delivered by them and to assess the need for training. Improving access to health services for ethnic minorities requires continuing education and training of all health professionals.
‘What is it?’: findings on preschoolers’ responses to play with medical equipment
Authors: McGrath P , Huff N
Published: March 2003

When young people enter a hospital they are exposed to a foreign world of unfamiliar people, medical equipment and language. Children diagnosed with leukaemia are particularly vulnerable to repeated exposure to these distressing hospital visits. Assessing a child's understanding of the stresses associated with treatment during hospitalization is now seen as a key element of caring for the paediatric patient. A population particularly vulnerable to the effects of the stress of intensive treatments during hospitalization are preschool children. In order to understand the impact on leukaemia preschool children of intensive hospital treatment it is necessary to have comparative information on healthy peers who have not been exposed to such treatment experiences. This article presents findings from recent qualitative research that explored the beliefs held by healthy preschoolers about what happens in hospital, what it means to be sick, their reactions to and knowledge of medical equipment and their level of knowledge regarding cancer and leukaemia. It is the hope and expectation that the findings will be used comparatively to contribute to a deeper understanding of the world of the child coping with leukaemia and related disorders.
Sudden Infant Death Syndrome — a defect in circulatory control?
Authors: Matthews T.
Published: March 2003

The majority of Sudden Infant Death Syndrome (SIDS) infants die during sleep and especially during the overnight sleep period. Recent evidence from SIDS cases, which occurred while on a cardiorespiratory monitor at home, has suggested that the mechanism of death involves circulatory failure, with the development of a shock like state, associated with a progressive bradycardia in the presence of continued breathing movements. In this paper we explore the circulatory effects of sleep and in particular the down regulation of the baroreceptor reflex, associated with a reduction in vasomotor tone and a fall in central venous return, cardiac output and blood pressure. This sequence of events would be exacerbated by many of the known SIDS risk factors, namely the prone sleeping position, overheating and co‐sleeping. Poor central venous return, with diminished cardic distension could induce a progressive bradycardia as occurs in adults with neuro‐cardiogenic syncope. Alternatively a reduced cardiac output could result in the rapid onset of severe hypoxia through poor lung perfusion. The effects of sleep on circulatory control deserve further study in infants.
The school experience of the child with cancer
Authors: Vance Y. H. , Eiser C.
Published: March 2003

Objective To review literature investigating school absence, behaviour problems and social relationships of children with cancer on return to school. Additionally, we reviewed interventions aimed at promoting successful school re‐entry for children with cancer, and increasing classmates and teachers understanding of childhood cancer.

Methods
Electronic searches were used to identify studies examining the effects of school re‐entry on children with cancer.

Results and Conclusions
School absences are higher for children with cancer than healthy children and those with other chronic conditions. Although there is mixed evidence about whether children have significant behavioural problems, studies involving social relationships generally conclude that children with cancer are more sensitive and isolated than peers, according to both peer and teacher report.
Communicating a diagnosis of developmental disability to parents: multiprofessional negotiation frameworks
Authors: Bartolo P.A.
Published: March 2003

It is a hard task for professionals to give and parents to receive the bad news about a child’s developmental disability. This study describes how findings about four preschool children, with difficulties suspected to lie within the autistic spectrum, were negotiated with parents by two multiprofessional groups, one in a Medical (Site M) and one in an Education setting (Site E). Each assessment was undertaken over half a day, the professionals jointly interacting with the child and family. All assessment discussions were audiotaped and each participant was interviewed after the assessment. Conversation analysis showed the activation of three major social‐interaction frameworks: professionals at both sites applied a parent‐friendly frame, but this was complemented by a hopeful‐diagnostic‐formulation frame at Site M, and a defocusing‐of‐bad‐news frame at Site E.
Facilitating factors and barriers to the implementation of intensive home‐based behavioural intervention for young children with autism
Authors: Johnson Emma , Hastings Richard P.
Published: March 2003

Background Although international interest in intensive home‐based early behavioural intervention for children with autism is increasing, there is little or no published research on the experiences of families conducting these programmes.

Methods One hundred and forty‐one UK parents conducting Lovaas‐style interventions with their young child with autism were asked to identify factors that acted as facilitative factors and barriers to the implementation of these programmes. Parents responded to written questions contained within a questionnaire survey, and their responses were subjected to a content analysis procedure.

Results Several of the facilitative factors and barriers were found to be similar. For example, a supportive therapy team was the most frequently cited facilitative factor, and problems recruiting and maintaining a suitable team was the most frequently reported barrier. Other factors seemed to be more independent constructs. For example, an important barrier was the lack of time and personal energy, but plenty of time and energy was not cited as a facilitative factor.

Conclusions The practical implications of these results for families and for services supporting families engaged in intensive early behavioural intervention are discussed. In addition, more general implications for the designers of behavioural intervention programmes are identified.
Assessing the quality of preschool child health surveillance in primary care: a pilot study in one health district
Authors: Hampshire A. J. , Blair M. E. , Crown N. S. , Avery A. J. , Williams E. I.
Published: March 2003

Objective To develop a framework for measuring the quality of preschool child health surveillance acceptable to primary health care teams and measurable at individual primary health care team level.

Design Published research evidence was identified and criteria developed by a local multidisciplinary expert group. The criteria were discussed with primary health care teams. How well they were achieved was assessed.

Setting Twenty‐eight general practices in one health authority area.

Methods Data collection included observation of baby clinics, interviews with health visitors and general practitioners (GPs), questionnaires to parents, collation of child health surveillance reviews recorded in personal child health records and immunization rates.

Results The criteria for assessing preschool child health surveillance were thought to
be acceptable and achievable by primary health care teams. Fifteen of the 22 criteria
used to assess baby clinics were met by over 90% of practices. Almost all
practices completed child health surveillance reviews within a standard time and
achieved 90% coverage for primary immunizations. At many practices, less
than 90% of parents felt welcome at the baby clinic, usually had enough time
to talk to their health visitor or had the purpose or results of the 6 to 8 week
child health surveillance review explained to them. GPs were less likely than health
visitors to discuss health promotion at child health surveillance reviews (χ2
11.52, P = 0.0007). Few practices had a call‐up and recall system for all reviews.

Conclusion The framework that we developed for assessing preschool child health surveillance was acceptable and achievable by primary health care teams.
Surveying and screening preschool language development in community‐focused intervention programmes: a review of instruments
Authors: Pickstone C. , Hannon P. , Fox L.
Published: March 2003

Preschool language intervention has come increasingly to the fore with the development of community‐focused interventions including Sure Start in the UK. Successful intervention methods may well be incorporated into mainstream service delivery, especially in areas of disadvantage. The question of whether such interventions will work and of their impact on children’s language development has focused attention on measures of language. This paper distinguishes two reasons for measuring language development: (1) surveying language; and (2) screening language. It goes on to suggest a set of criteria for selecting instruments for these applications. The review includes a wide range of language assessment instruments for preschool children and examines those most likely to be suitable. It suggests a role for paraprofessionals in survey and screening and argues that this may be advantageous in terms of reaching families and thereby achieving high levels of coverage of a population group. Finally, there is a discussion of the implications of such measures in community‐focused preschool interventions.
How do mothers’ childrearing histories, stress and parenting affect children's behavioural outcomes?
Authors: Assel M. A. , Landry S. H. , Swank P. R. , Steelman L. , Miller‐Loncar C. , Smith K. E.
Published: March 2003

Background

Information is needed to understand the role of low to moderate levels of mothers’ emotional stress and child characteristics (i.e. prematurity) on parenting behaviours and their impact on children's behaviour that might be deemed ‘challenging’ but not ‘disordered’.

Methods

The direct and indirect relations of maternal childrearing history and emotional stress, and observed parenting practices when children were 3 years of age on 4‐year child behavioural outcomes was examined in a sample of low‐income families with a term (n = 112) or preterm (n = 180) child. Parenting practices included displays of warmth and restrictiveness when interacting with their children. Child outcomes at 4 years included observation of social initiations with their mothers and maternal report of social and attentional problems.

Results

A Structural Equation Model building approach guided by specific hypotheses indicated that preterm as compared to full‐term children had more maternal reported social and attentional problems but did not differ in observed social initiating skills. Greater negative maternal childrearing history indirectly influenced social initiating skills through its direct influence on maternal emotional stress. Greater maternal emotional stress directly influenced mothers’ parenting that, in turn, directly influenced social initiating. Prematurity and a more negative childrearing history had a direct negative influence on the maternal report of social and attentional behavioural outcomes.

Conclusions

These findings delineate the effects of prematurity and maternal parenting on the behaviour of 4‐year‐old‐children and extend current knowledge of the influence of parental emotional stress on parenting. Even milder levels can negatively influence parenting, and in turn, contribute to children's less well developed social skills. The issues raised in this study could help with the identification and prioritization of medical and psychological services.
The meaning of parental illness to children: the case of inflammatory bowel disease
Authors: Mukherjee Suzanne , Sloper Patricia , Lewin Robert
Published: March 2003

Background Research on the impact of parental illness on children is sparse, and it remains unclear what kind of support, if any, families would value. This paper presents findings from the first investigation to explore the experiences of young people who have a parent with inflammatory bowel disease (IBD).

Design and methods This qualitative study involved interviews with 23 young people, aged between six and 20 years, who have a parent with IBD. A range of non‐verbal techniques was used to facilitate interviews with young children. Data were analysed using the framework approach.

Results Participants varied in their understanding and perception of their parent's condition and the extent to which they discussed it with family and friends. Some reported being unaffected by their parent's illness. The main negative effects on everyday life were restrictions on social activities, parents being unable to do housework, children having to be well‐behaved and parents becoming withdrawn or irritable. Experiences could lead to feelings of sadness, worry, anger and guilt. The few who reported positive effects described spending time with the parent while ill, being allowed to be more independent and being close as a family. Relatives, friends, neighbours, service providers and young people all played a role in helping to manage the situation, and most participants felt that their family did not need additional support. However, some young people would value advice and information regarding the condition and opportunities to meet others in a similar situation.

Conclusion IBD is a highly variable condition, with substantial differences in the extent to which it impinges on the lives of family members. In addition to supporting patients, health professionals have an important role to play in offering advice and information to others affected by the illness, including children.
Use of physiotherapy and alternatives by children with cerebral palsy: a population study
Authors: Parkes J. , Donnelly M. , Dolk H. , Hill N.
Published: March 2003

Objectives To describe the use of physiotherapy services and alternative therapies by a population of children with moderate to severe cerebral palsy (CP).

Design Descriptive cross‐sectional survey.

Subjects A total of 212 parents of children aged 4–14 years with moderate to severe CP were identified from the Northern Ireland Cerebral Palsy Register (NICPR) and a random subsample of their paediatric physiotherapists.

Main measures A standardized description of motor impairment or assessment form; a postal questionnaire to parents and paediatric physiotherapists (to validate parents’ reports of service use).

Response rates In total, 85% of parent questionnaires were returned and 100% of paediatric physiotherapists responded.

Results Service use among families was high; on average the families had contact with approximately seven services in a 6‐month time interval. The overwhelming majority of children (96%) received physiotherapy during the school term and most (59%) received treatment at least twice a week for 30 min; 43% of children had their physiotherapy discontinued over the summer holidays. Over one‐quarter (28%) of families had opted out of the NHS and bought alternatives like conductive education (21%) or private forms of conventional physiotherapy (16%). Children with more severe forms of CP, in special education, particularly at schools for physical disability, were high‐intensity users of the physiotherapy service. Despite this, 74% of parents wanted more physiotherapy for their child.

Conclusions and implications The demand for physiotherapy services is likely to continue given the relatively stable prevalence rate of CP, the proportion of children with disabling CP and the level of parent interest in the service. A number of quality aspects and gaps in the service have been identified.
The value of the PedsQLTM in assessing quality of life in survivors of childhood cancer
Authors: Eiser C. , Vance Y. H. , Horne B. , Glaser A. , Galvin H.
Published: March 2003

Aims  To determine differences in ratings of quality of life (QOL) depending on respondent (mother or child) and implications for the validity of measures of QOL, and interpretation of scores.

Method  Forty‐five survivors of acute lymphoblastic leukaemia (ALL) and 23 survivors of central nervous system (CNS) tumours and their mothers completed a generic measure of QOL: the Pediatric Quality of Life Inventory TM Version 4.0 (PedsQLTM4.0; Varni et al., 2001).

Results  Although correlations between mother and survivor ratings were largely moderate to good, further analyses showed that mothers reported QOL to be worse than survivors. Both mothers and survivors rated physical health worse than psychological health, and survivors of a CNS tumour had poorer QOL than survivors of ALL. Although survivors of ALL reported reasonably good physical health, their psychosocial health was more adversely affected.

Conclusions  Implications for further use of the PedsQLTM 4.0 in the clinical or research context are discussed. Incidental findings highlight some limitations of the PedsQLTM4.0 for work with this population.
A 6‐year follow‐up study of chronic constipation and soiling in a specialist paediatric service
Authors: Procter E. , Loader P.
Published: March 2003

Objective  Constipation and soiling is a relatively common condition in childhood and its course is often chronic. This study investigated long‐term outcome of children with chronic constipation and soiling by following up a cohort of children 6 years after their presentation to a specialist paediatric gastroenterology clinic with chronic constipation and soiling.

Design  Retrospective postal survey.

Setting/sample  All children referred in 1991 to a specialist paediatric gastroenterology clinic accepting both secondary and tertiary referrals.

Measures  A semi‐structured postal questionnaire was sent to all families, and the Strengths and Difficulties Questionnaire (SDQ) was sent to a random sample.

Results  The response rate (of those who could be traced) was 89%. Of these, over a third (36%) still had a problem with constipation and soiling and 17% were using regular laxatives. Three people still having problems with constipation and soiling in the sample were aged over 18 years. No significant difference was found with regard to age, sex or age at referral between the group that improved and the group that did not. Both groups felt they had suffered a high degree of distress because of the problem, with parents highlighting their powerlessness to help their child and the child identifying the embarrassment caused by the problem.

Conclusions  A significant number of children presenting to a specialist paediatric clinic continue to have problems for several years. Further research is needed to identify these cases and to identify which factors promote resolution of the problem.
Multimedia versus written information for nocturnal enuresis education: a cluster randomized controlled trial
Authors: Redsell S. A. , Collier J. , Garrud P. , Evans J. H. C. , Cawood C.
Published: March 2003

Objective  This study evaluated the impact of child‐focused information provision using a multimedia software package ‘All About Nocturnal Enuresis’ and written leaflets containing the same information for bedwetting children.

Design  A stratified cluster randomized controlled trial with data on 270 children collected longitudinally.

Setting  Fifteen school nurse‐led community enuresis clinics in Leicestershire, UK.

Main outcome measures  The outcome measures were becoming and remaining dry and time to dry, non‐attendance and dropout rates. The psychological measures completed by children were the impact of bedwetting and Coopersmith self‐esteem scales. Parents completed the maternal tolerance scale.

Results  No significant intervention effect was found for any of the outcome measures recorded during treatment, at discharge or six‐months post discharge.

Conclusions  Multimedia educational programs and written leaflets are widely used to enable children to learn more about their health‐related conditions. However, our result suggests that multimedia is no more effective than traditional materials at effecting health‐related behavioural change.