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Current Problems in Pediatric and... May 2016Approximately 20% of all children in the United States live in poverty, which exists in rural, urban, and suburban areas. Thus, all child health clinicians need to be... (Review)
Review
Approximately 20% of all children in the United States live in poverty, which exists in rural, urban, and suburban areas. Thus, all child health clinicians need to be familiar with the effects of poverty on health and to understand associated, preventable, and modifiable social factors that impact health. Social determinants of health are identifiable root causes of medical problems. For children living in poverty, social determinants of health for which clinicians may play a role include the following: child maltreatment, child care and education, family financial support, physical environment, family social support, intimate partner violence, maternal depression and family mental illness, household substance abuse, firearm exposure, and parental health literacy. Children, particularly those living in poverty, exposed to adverse childhood experiences are susceptible to toxic stress and a variety of child and adult health problems, including developmental delay, asthma and heart disease. Despite the detrimental effects of social determinants on health, few child health clinicians routinely address the unmet social and psychosocial factors impacting children and their families during routine primary care visits. Clinicians need tools to screen for social determinants of health and to be familiar with available local and national resources to address these issues. These guidelines provide an overview of social determinants of health impacting children living in poverty and provide clinicians with practical screening tools and resources.
Topics: Child; Child Abuse; Child Care; Child of Impaired Parents; Early Intervention, Educational; Environment; Family Health; Firearms; Health Literacy; Humans; Mass Screening; Poverty; Social Determinants of Health; Social Support; Substance-Related Disorders
PubMed: 27101890
DOI: 10.1016/j.cppeds.2016.02.004 -
Maternal and Child Health Journal Feb 2022Households experiencing "food insecurity" have limited access to food due to a lack of money or resources. Poor nutrition, from food insecurity, can impact physical and...
BACKGROUND
Households experiencing "food insecurity" have limited access to food due to a lack of money or resources. Poor nutrition, from food insecurity, can impact physical and cognitive development of children. Study objectives were to document the prevalence of Tennessee child care programs screening for food insecurity, explore differences between programs receiving child and adult care food program (CACFP) funding and those screening for food insecurity, and understand possible burdens food insecurity places on child care families as perceived by child care program directors.
METHODS
In this cross-sectional study of licensed Tennessee child care programs, a 10-question survey and four-question follow-up survey were electronically distributed. Analysis included descriptive statistics, a chi-square of programs receiving CACFP funds and screening for food insecurity, and themes analysis of open-ended responses.
RESULTS
The average child care program enrollment (N = 272) was 80.16 with programs serving mostly preschoolers (98.53%) and toddlers (91.91%). Over half (56.99%) of programs reported they received CACFP funding, yet only 9.19% screen for food insecurity. Chi-square analysis found that programs receiving CACFP funds differ significantly on whether they screen households for food insecurity [Formula: see text] (1, n = 237) = 16.93, p ≤ 0.001. Themes analysis (n = 41) revealed that many child care program directors do not view food insecurity as a burden for families.
CONCLUSIONS
Child care programs receiving CACFP funds are more likely to screen families for food insecurity than programs who do not. Programs indicate a willingness to include food insecurity screening questions on child care paperwork.
Topics: Adult; Child; Child Care; Cross-Sectional Studies; Family Characteristics; Food Assistance; Food Insecurity; Food Supply; Humans
PubMed: 34997439
DOI: 10.1007/s10995-021-03320-2 -
Journal of Nutrition Education and... Dec 2021Determine the impact of family child care home providers' nutrition knowledge, confidence, and perceived barriers on program nutrition best practices and written...
OBJECTIVE
Determine the impact of family child care home providers' nutrition knowledge, confidence, and perceived barriers on program nutrition best practices and written nutrition policies.
METHODS
Cross-sectional analysis of self-reported surveys of 49 female providers in Oklahoma City analyzed with Spearman correlation, multivariate linear and logistic regression (α < 0.05).
RESULTS
Confidence and barriers were significantly correlated (r(47) = -0.4, P = 0.004). Independent variables explained 36% of practices (r = 0.357). Nutrition knowledge (standard β = 0.442, P = 0.001) and confidence (standard β = 0.358, P = 0.008) were significantly associated with practices; barriers were not. No significant association between independent variables and written policies resulted.
CONCLUSIONS AND IMPLICATIONS
Provider nutrition knowledge and confidence appear to be suitable targets to improve nutrition practices. Further research can evaluate possible influences on the presence and quality of family child care home written nutrition policies and specific nutrition policy topics associated with healthier nutrition practices.
Topics: Child; Child Care; Child Day Care Centers; Child Nutritional Physiological Phenomena; Cross-Sectional Studies; Female; Humans; Nutrition Policy
PubMed: 34635431
DOI: 10.1016/j.jneb.2021.08.007 -
European Journal of Pediatrics Dec 2022Evidence-based practice (EBP) significantly improves the quality of healthcare, but its use in community pediatrics has not yet been proven. We aimed to assess how Dutch...
UNLABELLED
Evidence-based practice (EBP) significantly improves the quality of healthcare, but its use in community pediatrics has not yet been proven. We aimed to assess how Dutch community pediatricians use scientific findings and apply evidence-based practice in everyday well-child care. We interviewed a purposive sample of 14 community pediatricians in the Netherlands regarding their professional activities in daily practice, focusing on instances in which their professional knowledge was insufficient to address the issue at hand. We transcribed the interviews verbatim, and coded them using ATLAS.ti software. We structured the information using template analysis. Community pediatricians relied largely on guidelines of their own profession. If these were not sufficient, they first consulted other medical specialists or colleagues, or used different sources that they considered reliable. They only rarely performed an EBP search, and if so, only for somatic problems. For psychosocial problems, they used a strategy of extensive interaction with clients and members of multidisciplinary teams. We identified five barriers to performing an EBP search: (1) a conviction that not every community pediatrician needs to be able to perform an EBP search; (2) a conviction that an EBP search is not suitable for psychosocial problems; (3) lack of confidence in one's own abilities to perform an EBP search; (4) limited access to literature; (5) lack of time.
CONCLUSIONS
Community pediatricians rely on professional guidelines; this indicates a need to keep these up-to-date and user-friendly. Furthermore, pediatricians should be better trained in performing EBP searches, and in working in multidisciplinary teams, especially for psychosocial problems.
WHAT IS KNOWN
• Conducting an evidence-based practice search is considered indispensable to determine the best management of the patient's problem. • Conducting such a search is still considered challenging in many medical disciplines, including pediatrics.
WHAT IS NEW
• There is a need to strengthen skills of community pediatricians to find evidence on psychosocial problems and to present this effectively in multidisciplinary teams. • The pediatricians' broad use of other sources of evidence, like experts and online sources, shows the importance of critical evaluation skills.
Topics: Child; Humans; Child Care; Netherlands; Pediatricians; Referral and Consultation; Evidence-Based Practice
PubMed: 36169713
DOI: 10.1007/s00431-022-04624-3 -
PloS One 2020Providing for the needs of the vulnerable is a critical component of social and health policy-making. In particular, caring for children and for vulnerable older people...
Providing for the needs of the vulnerable is a critical component of social and health policy-making. In particular, caring for children and for vulnerable older people is vital to the wellbeing of millions of families throughout the world. In most developed countries, this care is provided through both formal and informal means, and is therefore governed by complex policies that interact in non-obvious ways with other areas of policy-making. In this paper we present an agent-based model of social and child care provision in the UK, in which agents can provide informal care or pay for private care for their relatives. Agents make care decisions based on numerous factors including their health status, employment, financial situation, and social and physical distance to those in need. Simulation results show that the model can produce plausible patterns of care need and availability, and therefore can provide an important aid to this complex area of policy-making. We conclude that the model's use of kinship networks for distributing care and the explicit modelling of interactions between social care and child care will enable policy-makers to develop more informed policy interventions in these critical areas. "The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped." - Hubert Humphrey Jr.
Topics: Child; Child Care; Family; Humans; Models, Statistical; Salaries and Fringe Benefits; Social Class; Social Networking; Social Support
PubMed: 33264347
DOI: 10.1371/journal.pone.0242779 -
American Journal of Public Health Dec 2023
Topics: Child; Adult; Humans; Child Care; Food; Child Day Care Centers; Nutrition Policy; Child Nutritional Physiological Phenomena
PubMed: 38118100
DOI: 10.2105/AJPH.2023.307497 -
American Journal of Public Health Dec 2023
Topics: Child; Adult; Child, Preschool; Humans; Food; Child Day Care Centers; Child Care
PubMed: 38118096
DOI: 10.2105/AJPH.2023.307473 -
Appetite Jul 2018Developing healthy eating behaviors and food preferences in early childhood may help establish future healthy diets. Large numbers of children spend time in child care,...
BACKGROUND
Developing healthy eating behaviors and food preferences in early childhood may help establish future healthy diets. Large numbers of children spend time in child care, but little research has assessed the nutritional quality of meals and snacks in family child care homes. Therefore, it is important to assess foods and beverages provided, policies related to nutrition and feeding children, and interactions between providers and children during mealtimes. We examined associations between the nutrition environments of family child care homes and children's diet quality.
METHODS
We assessed the nutrition environments of 166 family child care homes using the Environment and Policy Assessment and Observation (EPAO) (scores range: 0-21). We also recorded foods and beverages consumed by 496 children in care and calculated healthy eating index (HEI) (scores range: 0-100). We used a mixed effects linear regression model to examine the association between the EPAO nutrition environment (and EPAO sub-scales) and child HEI, controlling for potential confounders.
RESULTS
Family child care homes had a mean (standard deviation, SD) of 7.2 (3.6) children in care, 74.1% of providers were black or African American, and children had a mean (SD) age of 35.7 (11.4) months. In adjusted multivariable models, higher EPAO nutrition score was associated with increased child HEI score (1.16; 95% CI: 0.34, 1.98; p = 0.006). Higher scores on EPAO sub-scales for foods provided (8.98; 95% CI: 3.94, 14.01; p = 0.0006), nutrition education (5.37; 95% CI: 0.80, 9.94; p = 0.02), and nutrition policy (2.36; 95% CI: 0.23, 4.49; p = 0.03) were all associated with greater child HEI score.
CONCLUSIONS
Foods and beverages served, in addition to nutrition education and nutrition policies in family child care homes, may be promising intervention targets for improving child diet quality.
Topics: Child Care; Child Day Care Centers; Child, Preschool; Diet, Healthy; Feeding Behavior; Female; Food Preferences; Humans; Infant; Male; Multivariate Analysis; North Carolina; Nutrition Policy; Nutrition Surveys; Nutritive Value
PubMed: 29601921
DOI: 10.1016/j.appet.2018.03.024 -
Revista Brasileira de Enfermagem 2021Identify the theoretical concepts that have been used in the context of nursing care for hospitalized children. (Review)
Review
OBJECTIVE
Identify the theoretical concepts that have been used in the context of nursing care for hospitalized children.
METHODS
Scoping review was carried out according to the PRISMA-ScR methodology. The research limitations included: primary studies dealing with the use of theoretical concepts of nursing in the provision of care to hospitalized children, access in full text, in Portuguese or English and published between 2000 and 2019. Research was carried out on grassroots platforms (EBSCOhost, PubMed, SciELO and Web of Science), gray literature and in the bibliography of selected articles.
RESULTS
21 studies were found and 10 theoretical conceptions of nursing were identified, with family-centered care being the most used.
FINAL CONSIDERATIONS
The variability of the identified theoretical conceptions is emphasized, with no evidence to support the use of one in detriment of the other. A more integrative theoretical conception, which adds care centered both on the family and the child, emerges as a research trend.
Topics: Child; Child Care; Child Health; Child, Hospitalized; Humans; Nursing Care
PubMed: 34133680
DOI: 10.1590/0034-7167-2020-0265 -
Academic Pediatrics 2021Racism and poverty are intertwined throughout American society as a result of historic and current systemic oppression based on class and race. As the processes of...
Racism and poverty are intertwined throughout American society as a result of historic and current systemic oppression based on class and race. As the processes of pediatric preventive care, or well-child care, have evolved to better acknowledge and address health disparities due to racism and poverty, the structures of care have remained mostly stagnant. To cultivate long-term health and wellness of Black and Brown children, we must adopt an explicitly antiracist structure for well-child care. The pediatric medical home model is touted as the gold standard for addressing a host of health, developmental, and social needs for children and their families. However, the medical home model has not resulted in more equitable care for Black and Brown families living in poverty; there are ample data to demonstrate that these families often do not receive care that aligns with the principles of the medical home. This inequity may be most salient in the context of well-child care, as our preventive care services in pediatrics have the potential to impact population health. To appropriately address the vast array of preventive care needs of families living at the intersection of racism and poverty, a structural redesign of preventive care in the pediatric medical home is needed. In this paper, we propose a re-imagined framework for the structure of well-child care, with a focus on care for children in families living at the intersection of racism and poverty. This framework includes a team-based approach to care in which families build trusting primary care relationships with providers, as well as nonclinical members of a care team who have shared lived experiences with the community being served, and relies on primary care connections with community organizations that support the preventive health, social health, and emotional health needs of families of young children. Without a structural redesign of preventive care in the pediatric medical home, stand-alone revisions or expansions to processes of care cannot appropriately address the effects of racism and poverty on child preventive health outcomes.
Topics: Child; Child Care; Child Health Services; Child, Preschool; Family; Humans; Poverty; Racism; United States
PubMed: 34740416
DOI: 10.1016/j.acap.2021.08.004