Category Archives: Psychology

Parenting and constipation

Common, General paediatrics, OPD, Psychology

Parental child-rearing attitudes (as assessed by the Amsterdam version of the Parental Attitude Research Instrument, A-PARI), are associated with constipation in children in Dutch study.

More specifically, both higher and lower scores on the autonomy attitude scale were associated with decreased defecation frequency and increased faecal incontinence. High scores on the overprotection and self-pity attitude scales were associated with increased faecal incontinence.

“Autonomy” reflects emphasis on encouraging independence.  “Overprotection” refers to concern about child with respect to prevention of disappointment and problems for the child, and need to know what’s going on inside child.  “Self pity” refers to irritability and frustration with respect to upbringing, which implies rejection.

More and stronger associations were found for children aged ≥6 years than for younger children.

Authors recommend addressing parenting issues during treatment and even referral to mental health services when parenting difficulties hinder treatment or when the parent–child relationship is at risk.  [Arch Dis Child 2015;100:329-333 doi:10.1136/archdischild-2014-305941]]

 

Psychosocial interventions

General paediatrics, Psychology

Flashpoints are transition eg from nursery to primary, to secondary, to adult services.

At diagnosis, constantly try to normalise.

Other triggers are new or difficult situations: staff changes esp specialist nurses. Effect on parent’s work, parent’s role in family, child’s fears.

Past experience of medical condition, procedure, hospital/doctors will colour.

Parenting in chronic illness – limit setting vs laxity (love!) in face of illness.

Behaviour as communication of fear, displeasure!

Signs and symptoms – changes in appearance, mood, behaviour, thoughts.

Support at diagnosis: names, phone numbers! Normalise experience and feelings. Signpost peer support, online or other. Written. Practical eg financial, family routines. Joint working for consistent info. Deciding what chats are appropriate with child present. Reiteration.

“Other people in your situation have tried x, y and z. Do any of those sound good?”

Pre-5: encourage play and exploration, avoid interfering with parental proximity.

5-7 May develop magical thinking (I think, and it comes true). Guilt, punishment, contagion? Accept what other children say as true! Imitate parental behaviour. Death as reversible.

Drawing! Check understanding of bodily functions.

Sue Robinson, hospital passport (Janie donnan). For primary school age, app for teens to follow.

Concrete reminder of achievements and rewards.

Alphabet. Backwards!

Hand on tummy, feel rise and fall.

Guidance for parents!

Sucrose. Video for juniors, showing expected techniques.

Functional analysis (ABC) – immediate antecedent (context as much as events), consequences (esp people’s actions, any difference in attention (anything given or taken away)?  What would usually happen otherwise?) use diary again. Bedside table! 5-7 days max, can be repeated. Review within 2 weeks.

Pacing – beware boom/bust cycles. Rest before exhausted but maintains daily activity.

Activity record: enjoyment vs pain impact.

Smart goal. Low hanging fruit first! Goal diary – did you achieve it? Rate pain. How did you feel?

If/then plan – beware abandoning at first set back. If you can’t get to school one day, then what will you do? Phone to update? Try harder next day?

How confident? What benefits, what difficulties?

Visualisation – can child describe a scene easily? Else unlikely to work.  Personally relevant dream place. Safe and happy. Real or imagined. Describe it in as much detail as you can – all senses. As long as possible; but 5 mins is plenty.

Record positive achievements.

Positivity – but listen empathetically.

Negative beliefs.

 

[NES study day – Liz Hunter, Ashley Sikoura]

Obesity prevention

General paediatrics, Nutrition, Psychology

Childhood obesity can be prevented – Cochrane updated evidence 2011!

Most effective interventions change social and physical environments and norms, not just individual behaviour.  Policies for healthy eating and physical activity in schools and early childcare settings, support for teachers to do health promotion, parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities.  Esp 6-12yrs but heterogeneous.

Fast food patronage is a frequent reality for many children and their parents. Although there are increasingly healthier alternatives for popular menu items (apple slices instead of French fries), they are infrequently selected.

Lifestyle factors cluster of course.  Boys’ adherence to a healthy lifestyle pattern (combining a nutrient‐dense diet and limited screen time) at 5 years was positively associated with prosocial behaviours (β = 0.14; 95% confidence interval [CI] 0.01, 0.26) and inversely related to hyperactivity‐inattention symptoms (β = −0.12; 95% CI −0.23, −0.01) at 8 years. But in the EDEN cohort, there was no association with BMI, and for girls, a mixed lifestyle pattern (sugar or artificially sweetened beverages, high screen, physical activity and low sleep times) was still associated with prosocial behaviours (β = 0.12; 95% CI 0.01, 0.23). [DOI:10.1111/ppe.12926]

What would Batman eat? Priming

Study of 22 children presented with 12 photos of 6 admirable and 6 less admirable models incl Batmand and Superman.  Asked, ‘Would this person order apple fries or French fries?’ In the health prime condition, the same children were shown 12 photos of 6 healthy foods and 6 less healthy foods and asked to indicate if each food was healthy or unhealthy.

Results

When children were asked what various admirable people – such as Batman or Spiderman – would eat, 45% then chose apple slices over French fries (cf 9% in control group).  Incidentally, knowing which foods were healthy or not made no sigificant difference to food choice.  [Wansink et al,  Pediatric Obesity, 7: 121–123. doi: 10.1111/j.2047-6310.2011.00003.x]

Weight talk in the home—parents talking to their children about their weight, shape or size— is associated with many negative health outcomes in children and adolescents, although the majority of research has been with adolescents.   Most psychological (e.g., emotional problems) and social (e.g., peer problems) outcomes differed significantly by race/ethnicity!

  • no significant associations between weight talk and biopsychosocial outcomes were found for Hmong and Latino children;
  • negative association (e.g., less healthy functioning) was found for African American and Somali children;
  • a positive association (e.g., healthier functioning) was found for Native American children. [DOI:10.1007/s10826-022-02351-9]