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1.
《Child abuse & neglect》2014,38(12):1914-1922
Abusive head trauma (AHT) is still too common, and probably underestimated. It is the leading cause of death from child abuse. Crying is thought to contribute to the act of shaking. Objectives of this study were to (a) assess parents’ knowledge about infant crying, their ability to manage crying, and their knowledge about AHT; and (b) assess the feasibility and the impact of a simple educational intervention about crying and AHT with parents shortly after their child's birth. A short questionnaire was completed orally by the parents of 190 consecutive newborns in a maternity hospital at day 2 of life. Then, during the routine examination of the child, the pediatrician gave parents a short talk about infant crying and AHT, and a pamphlet. Finally, parents were contacted by phone at 6 weeks for the post-intervention questionnaire assessing their knowledge about crying and AHT. Among 202 consecutive births, parents of 190 children were included (266 parents; 70% mothers) over a 1-month period and answered the pre-intervention questionnaire. The intervention was feasible and easy to provide. Twenty-seven percent of mothers and 36% of fathers had never heard of AHT. At 6 weeks, 183 parents (68% of the sample; 80% mothers) answered the post-intervention questionnaire. Parents’ knowledge improved significantly post-intervention. Parents found the intervention acceptable and useful. Health care professionals such as pediatricians or nurses could easily provide this brief talk to all parents during systematic newborn examination.  相似文献   

2.
SYNOPSIS

Zeifman et al. present a study of fathers’ and non-fathers’ caregiving in response to infant crying. The associations among testosterone, amount of crying, and parental status were evaluated in a laboratory paradigm using a realistic infant simulator. Although fathers did not show lower levels of testosterone, men who listened to greater amounts of crying showed significant increases in testosterone, and men who increased in testosterone had less optimal caregiving. Hormonal influences on parental behavior, which have been studied extensively in non-human animals, are now being explicated in humans. Zeifman et al. help advance this area of research.  相似文献   

3.
The objective of this study was to describe caregiver perceptions about mental health services (MHS) after child sexual abuse (CSA) and to explore factors that affected whether their children linked to services. We conducted semi-structured, in-person interviews with 22 non-offending caregivers of suspected CSA victims < 13 years old seen at a child advocacy center in Philadelphia. Purposive sampling was used to recruit caregivers who had (n = 12) and had not (n = 10) linked their children to MHS. Guided by the Health Belief Model framework, interviews assessed perceptions about: CSA severity, the child's susceptibility for adverse outcomes, the benefits of MHS, and the facilitators and barriers to MHS. Interviews were audio-recorded, transcribed, coded, and analyzed using modified grounded theory. Recruitment ended when thematic saturation was reached. Caregivers expressed strong reactions to CSA and multiple concerns about adverse child outcomes. Most caregivers reported that MHS were generally necessary for children after CSA. Caregivers who had not linked to MHS, however, believed MHS were not necessary for their children, most commonly because they were not exhibiting behavioral symptoms. Caregivers described multiple access barriers to MHS, but caregivers who had not linked reported that they could have overcome these barriers if they believed MHS were necessary for their children. Caregivers who had not linked to services also expressed concerns about MHS being re-traumatizing and stigmatizing. Interventions to increase MHS linkage should focus on improving communication with caregivers about the specific benefits of MHS for their children and proactively addressing caregiver concerns about MHS.  相似文献   

4.
SYNOPSIS

Objective. Lower baseline testosterone (T) among men is generally associated with more sympathetic and nurturant responses to infant stimuli. The effect of exposure to infant crying on men’s levels of T, however, is not well understood. The present study aimed to measure men’s T responses to high and low levels of infant crying. Design. Changes in fathers’ (n = 18) and non-fathers’ (n = 28) salivary T levels from baseline were measured in response to caring for an infant simulator programmed to cry often (high-demand condition) or infrequently (low-demand condition) during a 20-min caregiving simulation. Results. Men exposed to low-demand conditions exhibited significant T reductions from baseline, whereas men in high-demand conditions exhibited increases in T. Compared to men who displayed decreases in T following the caregiving simulation, men who displayed increases in T provided less sensitive care. Conclusions. Results suggest a potential role of high levels of crying in provoking physiological reactions among men that may set the stage for hostile or aggressive responses. More research is needed to illuminate contextual factors that contribute to men’s variable responses to infant crying.  相似文献   

5.
Low incidence rates and economic recession have hampered interpretation of educational prevention efforts to reduce abusive head trauma (AHT). Our objective was to determine whether the British Columbia experience implementing a province-wide prevention program reduced AHT hospitalization rates. A 3-dose primary, universal education program (the Period of PURPLE Crying) was implemented through maternal and public health units and assessed by retrospective-prospective surveillance. With parents of all newborn infants born between January 2009 and December 2016 (n = 354,477), nurses discussed crying and shaking while delivering a booklet and DVD during maternity admission (dose 1). Public health nurses reinforced Talking Points by telephone and/or home visits post-discharge (dose 2) and community education was instituted annually (dose 3). During admission, program delivery occurred for 90% of mothers. Fathers were present 74.4% of the time. By 2–4 months, 70.9% of mothers and 50.5% of fathers watched the DVD and/or read the booklet. AHT admissions decreased for <12-month-olds from 10.6 (95% CI: 8.3–13.5) to 7.1 (95% CI: 4.8–10.5) or, for <24-month-olds, from 6.7 (95% CI: 5.4–8.3) to 4.4 (95% CI: 3.1–6.2) cases per 100,000 person-years. Relative risk of admission was 0.67 (95% CI: 0.42–1.07, P = 0.090) and 0.65 (95% CI: 0.43-0.99, P = 0.048) respectively. We conclude that the intervention was associated with a 35% reduction in infant AHT admissions that was significant for <24-month-olds. The results are encouraging that, despite a low initial incidence and economic recession, reductions in AHT may be achievable with a system-wide implementation of a comprehensive parental education prevention program.  相似文献   

6.
Shaking and smothering in response to infant crying are life-threatening child abuse. Parental childhood abuse history is known to be one of the most robust risk factors for abusing their offspring. In addition to childhood abuse history, other adverse childhood exposures (ACEs) need to be considered due to co-occurrence. However, few studies have investigated the impact of ACEs on caregivers shaking and smothering their infant. This study aims to investigate the association of ACEs with shaking and smothering among caregivers of infants in Japan. A questionnaire was administered to caregivers participating in a four-month health checkup between September 2013 and August 2014 in Chiba City, Japan, to assess their ACEs (parental death, parental divorce, mentally ill parents, witness of intimate partner violence, physical abuse, neglect, psychological abuse and economic hardship), and shaking and smothering toward their infants (N = 4297). Logistic regression analysis was used to examine the cumulative and individual impacts of ACEs on shaking and smothering. Analyses were conducted in 2015. A total of 28.3% reported having experienced at least one ACE during their childhood. We found that only witness of IPV had a significant association with shaking of infant (OR = 1.93, 95% CI: 1.03–3.61). The total number of ACEs was not associated with either shaking or smothering. Our findings suggest that shaking and smothering in response to crying can occur regardless of ACEs. Population-based strategies that target all caregivers to prevent shaking and smothering of infants are needed.  相似文献   

7.
BackgroundFollowing traumatization, caregiver support is a crucial factor contributing to children's successful management of posttraumatic reactions and their recovery. Caregivers who have been traumatically impacted themselves, however, may be compromised in this posttraumatic caregiving role. Although there are a number of evidence-based child trauma treatments that are effective in reducing children's trauma symptoms, the impact of child treatment on participating caregiver's posttraumatic symptoms (PTS) has received less attention.ObjectiveExplore PTS reduction caregivers experience through participation in their child's evidence-based trauma-focused mental health treatment.Participants and setting640 Child-Caregiver dyads referred for the Child and Family Traumatic Stress Intervention (CFTSI) following formal disclosure of abuse in a Child Advocacy Center (CAC).MethodsData were collected from 10 community treatment sites trained in CFTSI. A multi-site meta-analytic approach was used to evaluate pooled and site-specific therapeutic effect sizes for caregivers and children.ResultsCFTSI was associated with significant changes (Hedge's g = 1.17, Child-rated; g = 0.66, caregiver-rated) in children's PTS and with clinically meaningful improvements in PTS for 62% of participating caregivers who had started CFTSI with clinical levels of PTS as measured by the Post Traumatic Checklist–Civilian Version (PCL-C). The overall mean PCL-C change (9.31, SD = 12.9) in paired, pre-post PCL-C scores is close to a clinically meaningful change of 10 or higher. There was a robust moderate pooled effect size (g = 0.70, N = 640, p < 0.0001).ConclusionThe value of a reduction in caregiver PTS as a secondary outcome of children's trauma-focused treatment is discussed.  相似文献   

8.
BackgroundAbusive head trauma (AHT) is a severe form of child abuse causing devastating outcomes for children and families, but its economic costs in Canada has yet to be determined. The Period of PURPLE crying program (PURPLE) is an AHT prevention program implemented in British Columbia for which success in reducing AHT events was recently reported.ObjectiveThis study estimated the lifetime costs to society of incidental AHT events and compared the benefits and associated costs of AHT before and after the implementation of the PURPLE program.Participants and Setting: Children aged 0–24 months old with a definite diagnosis of AHT between 2002 and 2014 in British Columbia were included in this study.MethodsAn incidence-based cost-of-illness analysis, using the human capital approach was used to quantify the lifetime costs of AHT events according to their severity (least severe, severe and fatal). A cost-effectiveness analysis of the PURPLE program was conducted from both a societal and a health services’ perspectives using decision tree models.ResultsThere were sixty-four AHT events between 2002–2014, resulting in a total cost of $354,359,080 to society. The costs associated with fatal, severe and least severe AHT averaged $7,147,548, $6,057,761 and $1,675,099, respectively. The investment of $5 per newborn through the PURPLE program resulted in a $273.52 and $14.49 per child cost avoidance by society and by the healthcare system.ConclusionsThis study provides evidence to policymakers and health practitioners that investing upstream in well-developed AHT prevention programs, such as PURPLE, not only promote child safety and health, but also translates into avoided costs to society.  相似文献   

9.
SYNOPSIS

Author replies to commentaries on a paper reporting that different crying levels in infant simulators produce divergent testosterone (T) responses. Major points considered include that: human infant crying is similar to the crying of other mammalian young; increases in T following exposure to infant crying may mobilize paternal protection rather than paternal care; T changes in response to crying are embedded within a larger constellation of interdependent hormonal responses; more refined behavioral measures and more frequent hormone sampling would enhance researchers’ ability to detect individual differences in fathers’ caregiving behavior and make causal inferences. Implications for intervention and parent education are discussed.  相似文献   

10.
Objective. This study examined the association between newborns’ daily crying and five measures of new mothers’ emotional states. Design. One hundred seven new mothers responded via a one-time, anonymous, online survey that assessed their stress, well-being, emotion regulation, frustration, and coping skills. Mothers also reported their infant’s daily cry duration. Results. Average daily crying was related to mothers’ emotional experiences, and relations also existed among the five mental health measures. Regression models indicate the strongest predictors of frustration were infant’s average cry duration, maternal well-being, and infant’s health status at enrollment. Conclusion. Mental health professionals can support families through the normative, but often stressful, experience of their infant’s cries. However, a re-evaluation of the clinical criteria for excessive crying is needed, as the results suggest that mothers whose infants cry considerably less than the widely used Wessel’s 3-hour-per-day criterion for excessive crying experience significant negative mental health.  相似文献   

11.
Data from the NICHD Study of Early Child Care were used to assess whether regulable features of child-care homes affect children’s development. Child-care homes selected were those in which there were at least two children and the care provider received payment for child care (ns=164 when the study children were 15 months old, 172 at 24 months, and 146 at 36 months). Caregivers who were better educated and had received more recent and higher levels of training provided richer learning environments and warmer and more sensitive caregiving. Caregivers who had more child-centered beliefs about how to handle children also provided higher quality caregiving and more stimulating homes. In addition, when settings were in compliance with recommended age-weighted group size cut-offs, caregivers provided more positive caregiving. Quality of care was not related to caregivers’ age, experience, professionalism, or mental health, or to the number of children enrolled in the child-care home or whether the caregivers’ children were present. Children with more educated and trained caregivers performed better on tests of cognitive and language development. Children who received higher quality care, in homes that were more stimulating, with caregivers who were more attentive, responsive, and emotionally supportive, did better on tests of language and cognitive development and also were rated as being more cooperative. These findings make a case for regulating caregivers’ education and training and for requiring that child-care homes not exceed the recommended age-weighted group size.  相似文献   

12.
SYNOPSIS

Objective. The quality of parental caregiving has been shown to affect children’s development from birth onward. Therefore, it is important to detect parents at risk for low-quality caregiving as early as possible – preferably before birth. Design. Observations of expectant mothers’ and fathers’ behavior when exposed to infant crying were examined as predictors of the quality of caregiving toward their own infant 6 weeks postpartum. Eighty-eight expectant mothers and 57 of their male partners were tested during the third trimester of pregnancy. Parents were filmed individually while caring for a crying Simulator Infant for 15 min; the quality of their caregiving was rated on sensitivity and cooperation. Also, cognitive interference on a working memory task and the ability to regulate physical force when exposed to infant crying were assessed. When their baby was 6 weeks old, parents were filmed and rated for sensitivity and cooperation during a 15-min interaction with their own infant at home. Results. Prenatal quality of caregiving behavior toward a simulator infant predicted postnatal quality of caregiving toward the own infant in both mothers and fathers. Cognitive interference and the ability to regulate physical force did not predict postnatal quality of caregiving behavior. Conclusions. Expectant parents’ quality of caregiving behavior toward a crying simulator infant predicted both mothers’ and fathers’ postnatal quality of caregiving behavior. Future research is needed to determine whether the simulator infant may be a useful screening instrument and training tool for parenting skills in at risk groups of parents-to-be.  相似文献   

13.
ABSTRACT

The Powerful Tools for Caregivers (PTC) program is designed to help caregivers develop skills to improve their self-efficacy in caregiving. To demonstrate the effectiveness of the PTC program in Boise, Idaho, the program’s pre-survey (n = 277), end-of-program survey (n = 131), and 6-month follow-up post-survey data (n = 100) collected between 2011 and 2017 were analyzed in this study. The end-of-program survey data indicated that caregivers viewed the quality of the program to be excellent and that all of them felt more confident as a caregiver. Factor analysis and reliability testing on the pre-survey data confirmed that seven questions included in the pre- and 6-month follow-up post-survey instruments reliably measured a single factor named as caregiver confidence. A paired samples t-test on 76 complete sets of pre- and 6-month follow-up post-survey data on the seven questions revealed that caregivers improved their confidence in caregiving to a statistically significant level (p < .001, d = 45). Additional paired samples t-tests on each of the seven questions with the Bonferroni correction showed statistically significant improvements in three areas: making tough decisions (p < .001, d = .53), coping with emotions (p < .001, d = .54), and using stress-reducing activities (p < .007, d = .33). Caregivers experienced the greatest improvement in their confidence in making tough decisions. Despite these significant improvements, caregivers still struggled with finding ways to reduce stress and manage their emotions associated with caregiving as shown by the lowest pre- and 6-month follow-up post-survey scores. In addition to the study results, several considerations when synthesizing PTC research results are discussed.  相似文献   

14.
Handgrip force responses to infant signals were examined in a sample of 43 maltreating and 40 non-maltreating mothers. During a standardized handgrip paradigm, mothers were asked to squeeze a handgrip dynamometer at maximal and at half of their maximal handgrip strength while listening to infant crying and laughter sounds. Maltreating mothers used excessive force more often while listening to infant crying and laughter than non-maltreating mothers. Of the maltreating mothers, only neglectful mothers (n = 20) tended to use excessive force more often during crying than non-maltreating mothers. Participants did not rate the sounds differently, indicating that maltreating mothers cannot be differentiated from non-maltreating mothers based on their perception of infant signals, but show different behavioral responses to the signals. Results imply that, in response to infant signals (i.e., crying or laughing), maltreating mothers may be insufficiently able to regulate the exertion of physical force.  相似文献   

15.
BackgroundThe validated Predicting Abusive Head Trauma (PredAHT) tool estimates the probability of abusive head trauma (AHT) in children <3 years old with intracranial injury.ObjectiveTo explore the impact of PredAHT on clinicians’ AHT probability estimates and child protection (CP) actions, and assess inter-rater agreement between their estimates and between their CP actions, before and after PredAHT.Participants and SettingTwenty-nine clinicians from different specialties, at teaching and community hospitals.MethodsClinicians estimated the probability of AHT and indicated their CP actions in six clinical vignettes. One vignette described a child with AHT, another described a child with non-AHT, and four represented “gray” cases, where the diagnosis was uncertain. Clinicians calculated the PredAHT score, and reported whether this altered their estimate/actions. The ‘think-aloud’ method was used to capture the reasoning behind their responses. Analysis included linear modelling, linear mixed-effects modelling, chi-square tests, Fisher’s exact tests, intraclass correlation, Gwet’s AC1 coefficient and thematic analysis.ResultsOverall, PredAHT significantly influenced clinicians’ probability estimates in all vignettes (p < 0.001), although the impact on individual clinicians varied. However, the influence of PredAHT on clinicians’ CP actions was limited; after using PredAHT, 9/29 clinicians changed their CP actions in only 11/174 instances. Clinicians’ AHT probability estimates and CP actions varied somewhat both before and after PredAHT. Qualitative data suggested that PredAHT may increase clinicians’ confidence in their decisions when considered alongside other associated clinical, historical and social factors.ConclusionsPredAHT significantly influenced clinicians’ AHT probability estimates, but had minimal impact on their CP actions.  相似文献   

16.
SYNOPSIS

Objective: Infant cry, a major stressor for caregivers, is one of the leading triggers of child abuse. The present study examined the effects of spousal support, spousal presence, and the possible moderating effect of attachment insecurity on individuals’ subjective and physiological responses to infant cry. Design: Thirty-one healthy mothers (M age = 36 years) and their spouses participated in an infant crying paradigm, where mothers were tasked to listen to infant cries under three conditions: (1) alone, (2) in the same room as partner, without physical contact, and (3) in the same room as partner, with hand-holding. Attachment was determined using the Experiences in Close Relationship Questionnaire, and physiological response was ascertained from concentration of salivary α-amylase (sAA). After each cry sound, sAA level and subjective responses to infant cry were assessed. Results: Multilevel regression analyses revealed that trait attachment-anxiety moderated the effect of spousal presence on sAA. Specifically, mothers with high attachment-anxiety showed reduced sAA when their spouse was present, which indicates that spousal support is effective for mothers with high attachment-anxiety. Conclusions: Findings from this study translate to promising clinical applications for the management of parenting stress from infant cry.  相似文献   

17.
ABSTRACT

Children with Autism Spectrum Disorder (ASD) and other developmental disabilities can face challenges during typical daily routines. Assistive technology can be used to address the problems encountered during typical routines, yet the competence of caregivers of children with these disabilities in using assistive technology varies. This study was designed to explore Saudi Arabian caregivers’ perceptions about problematic typical daily routines. Caregivers of children with these disabilities were surveyed about the problems they encountered with typical routines, the solutions they found to the problems, the assistive technology they used in the solutions, and their training in and feelings of competence about using assistive technology. Caregivers experienced problems in playing, bathing, and mealtime routines and some found solutions using assistive technology. Over one-third of the caregivers did not feel at all competent in using assistive technology. Suggestions for future research as well as training and development for caregivers are provided.  相似文献   

18.
Reading aloud to infants continues to be the focus of controversy between educators, researchers, and health care professionals. This article will provide insight into what research says about reading aloud to infants as well as the results of a case study of a six-month-old infant who has been read aloud to in utero to the present time. The results of this case study confirm that parents and caregivers reading aloud to infants is necessary in developing literacy skills that are paramount to book awareness, print awareness, vocabulary development, fluency, and comprehension, all of which are stepping stones to learning to read and write.  相似文献   

19.
SYNOPSIS

Objective. Working parents of young children often face work–family conflict, but little is known about the impact of this stressor on distress tolerance in the parenting role. We examined whether work–family conflict is associated with heightened work–family guilt and reduced infant distress tolerance, and we tested whether these effects are strongest among parents high in attachment anxiety. Design. In an experimental study of 233 parents of children ages 1–3 years, parents first reported their attachment anxiety, then were randomly assigned to read a vignette depicting a subtype of work–family conflict—work-interfering-with-family (WIF) conflict—or to an attention control condition. Finally, parents reported their feelings of WIF-guilt and completed an infant distress tolerance paradigm. Results. Attachment anxiety predicted greater WIF-guilt and less distress tolerance cry task persistence and moderated associations between experimental condition and outcomes: Parents with low attachment anxiety reported less WIF-guilt when primed with WIF-conflict than parents with average or high attachment anxiety, and parents with high attachment anxiety displayed less distress tolerance when primed compared to parents with low or average attachment anxiety. Conclusions. Working parents with low attachment anxiety may fare better emotionally in the face of WIF-conflict than their peers with higher attachment anxiety. High attachment anxiety may represent a risk factor for the negative effects of WIF-conflict on distress tolerance in response to infant crying. Future work should explore interventions to support working parents with high attachment anxiety.  相似文献   

20.
SYNOPSIS

This study showed that prenatal quality of caregiving behavior toward a crying simulator infant predicted the postnatal quality of caregiving behavior of both mothers and fathers.  相似文献   

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