Showing posts with label parents. Show all posts
Showing posts with label parents. Show all posts

Monday, August 3, 2015

Sources for Infant Care Advice: What Are They and How Well Is That Advice Received?

By: Lewis First, MD, MS; Editor-in-Chief       

          A key component of every health maintenance visit is the advice we provide to parents who bring their infants and children to us.  In fact as pediatricians, we pride ourselves on making sure that advice is evidence-based and individualized for each patient and family under our care.  That being said, parents seek advice not just from pediatricians, but from birth hospital nurses, family and the media—at least according to a new study by Eisenberg et al. (2015-0551) being released this week. 
     The authors surveyed more than 1000 mothers from across the country regarding five key advice topics—immunization, breastfeeding, sleep position, sleep location and pacifier use. While the good news is that pediatricians are the most prevalent source of advice, mothers self-reported that they got no advice on sleep location or pacifier use, and about 1/5 of the sample stated they got no advice on breastfeeding or sleep position.  To find out how the other sources of advice performed, read the study yourself—although be ready to learn just how popular or unpopular family members and the media can be in also offering advice to your patients.   
     So do you agree with the findings in this study and are you surprised how often key areas of advice are not being received by families from pediatricians?  Does this mean the advice is not given, or it just doesn’t register given everything else a family wanted to learn during a visit?  To provide some further input on this study and what it means to all who practice, Drs. Scott Krugman and Carolyn Fowler provide their interesting opinion in an accompanying commentary (doi: 10.1542/peds.2015-1826).   
      Take my advice—and read this study and commentary and share the findings with families of infants as you provide your anticipatory guidance that will help insure they stay healthy in that important first year of life.

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Monday, July 20, 2015

Are Parental Requests for Antibiotics for Their Children Decreasing Over Time? New Survey Doses Out Some Interesting Findings

By: Lewis First, MD, MS; Editor-in-Chief  

          With the rise in antibiotic resistance over the past few decades, there has been an increased effort by all of us to become stricter in our use of these antimicrobials—but have those efforts paid off?  Vaz et al. (doi:10.1542/peds.2015-0883) opted to study this question by surveying 1500 parents of children less than 6 years of age to determine their knowledge and attitudes toward use of antibiotics.  The authors divided respondents in terms of their insurance status as being in Medicaid managed care or a commercial health plan. The results are worth reading and thinking about.  For example, while we’ve made some headway in more parents recognizing that green nasal discharge does not require a prescription for an antibiotic, the improvement is less visible amongst Medicaid-enrolled families who continue to request that unnecessary antibiotics be prescribed.  There are many other variables identified that may be causing parents to request unneeded antibacterial medication, and the authors do a nice job of identifying them in their study.
          So what does this study mean for your practice?  Do you agree that your patient education efforts have been in vain when it comes to reducing their requests for antibiotics in likely viral scenarios, or have you succeeded where this study has not?  Doctor Sharon Meropol and Doctor Mark Votruba (doi: 10.1542/peds.2015-1780) add their opinion in an accompanying commentary to this study that you should turn to after reviewing the published data, but just as importantly, we would love to hear your thoughts and ideas on what works when it comes to educating families and changing their antibiotic-seeking behavior by responding to this blog, sending us an e-letter or posting your thoughts on our Facebook or Twitter websites.  

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Friday, June 12, 2015

Forging Bonds in the NICU: Parenting and Maternal Sensitivity


By: Lydia Furman, MD,  Assistant Editor
      As a Case Western Reserve Universisty medical student, I and many others spent long and rewarding hours watching and coding videotape of mothers feeding their term and preterm infants as part of  Dr. John Kennell’s research elective which was a perennial favorite among students. Kennell, along with Dr. Marshall Klaus of “Bonding” fame are widely credited with bringing humane, sensitive, and parent-friendly practices to the Neonatal Intensive Care Unit. They also brought all of us, trainees and colleagues, along with them: there was no way to deny the importance of maternal sensitive touch while watching Dr. Kennell help a new mother connect with her premature infant. 
     After a very protracted birthing process, measures of parenting and maternal sensitivity have finally become accepted by many as mainstream and scientifically valuable research outcomes. Doctors Bilgin and Wolke (doi: 10.1542/peds.2014-3570) have done a great service in systematically examining the literature on this topic to compare mothers of preterm and term infants- is there a difference in sensitivity in how they respond to their infants? Fortunately, we are well past the question of whether this matters! 
     In this meta-analysis, the authors found that study heterogeneity was high, despite clear criteria for study selection, e.g.  the study must have used an observational instrument, must have included both term and preterm comparison groups, and was required to use a defined construct for the outcome (“…maternal sensitivity …defined as mother's ability to perceive and infer the meaning behind her infant's behavioral signals, and to respond to them promptly and appropriately; “maternal responsiveness”, such as providing stimulation to the infant or “maternal facilitation” such as positive regard and respect for the child’s autonomy...”). I note that the mean gestational age and birthweight of the studied “preterm” infants were 30.4 weeks and 1374 grams respectively, babies who would be considered relatively mature and stable in today’s NICU.
      In general, the results of the meta-analysis are both reassuring and intriguing. Of interest, half (exactly 50%) of the studies that could be included used a single “snap shot” observation period, rather than multiple measurements. This led me to wonder whether multiple measurements for hospitalized infants, for example weekly measures, might be a way to prospectively identify parents who are either doing very well in connecting with their infant, or more importantly, those in need of additional support and assistance. We have just learned from authors Bilgin and Wolke that gestational age and neonatal morbidity alone cannot guide us in finding parents at risk, and yet maternal sensitivity and responsiveness are linked to positive developmental outcomes (Magill-Evans et al. Child Health Care 2001).   We really need to find a way to identify those parents who need help, Just as growth and chemistry profiles are routinely measured and monitored, maybe it’s time to begin to have the same level of vigilance about parenting behaviors and skills?

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Monday, June 8, 2015

New Vaccine Studies Deal with Parental Vaccine Hesitancy


By: Lewis First, MD, MS; Editor-in-Chief 

     Recently several states have been engaged in legislative debates regarding whether to pass legislation that would improve vaccination rates, such as removing philosophical exemptions.  Why parents opt for such exemptions is concerning and not well understood.  One thought is that perhaps our communication with families might be a way to improve vaccine rates in children assuming we had a successful way to improve such communication with vaccine-hesitant families. 
      Interestingly enough, Dr. Henrikson et al. (doi:10.1542/peds.2014-3199) share the results of a randomized trial using a physician-targeted communication intervention to reduce vaccine hesitancy and improve physician confidence in talking about vaccines.  56 clinics and almost 350 mothers participated in this study with 30 clinics getting the intervention trainings and the rest being controls.  So did the intervention reduce vaccine hesitancy and improve physician confidence in talking about vaccines?  Sadly—not really—but please read this study to understand why the desired results may not have been achieved. 
          So if better targeted communication strategies don’t work, what can we discern at a population level as to what groups of patients are asking for philosophical exemptions and how have these patterns changed over time with the hope that perhaps by targeting specific populations in the community, one could learn more about these populations and in turn develop better ways or legislation to make philosophical exemptions less possible.   
     Doctors Carrel and Bitterman (doi:10.1542/peds.2015-0831) opted to look at schools in California with high, medium and low rates of personal belief or philosophical exemptions and look at differences in those populations in an interesting study also being released this week in our journal.  While some of the highest philosophical exemptions occur in public schools with high percentages of white students, charter status as well as in private schools, there was also a high rate of personal or philosophical exemption when a school also had a high number of medical exemptions—setting that community up for being at risk due to possibly diminished herd immunity.  
      So should we give up on our quest to improve the declining vaccination rates in this country?  Not so fast—as per the opinion of Drs. Julie Leask and Paul Kinnersley who comment on the role of physician communication and vaccine-hesitant parents in a commentary accompanying the Henrikson study. Inject some time in reading both studies and the commentary and hopefully you’ll be reenergized to continue to educate your patients and populations of patients at school meetings as well as your legislators on the importance of making sure our children are vaccinated.

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