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Previous studies have analyzed the characteristics and prevalence of sleep disturbances among Italian children. Less attention has been paid, however, to the factors involved in sleep disturbances in the first two years of life. The goals of the present study were, therefore: 1) to provide a developmental trajectory of Italian infants' night awakenings and duration during the first two years of life and 2) to analyze which factors affect night awakenings the most over time. Data for this study were collected in the NASCITA cohort. During the well-child visits conducted at 6, 12, and 24 months, pediatricians asked parents to report if the child had any sleep disturbances, especially frequent night awakenings. Univariate and multivariable analyses were performed to test the association between child and family variables and the likelihood of frequent awakenings. 2973 toddlers, out of 5054 initially enrolled newborns, were included in this study; 875 (29.4 %) of whom presented frequent awakenings in at least one visit (peak of prevalence of 19.8 % at 12 months). Bed-sharing (adjusted OR 2.53; 95%CI:2.05–3.12) and living in the northern Italy (aOR 2.25; 95%CI:1.80–2.81) were the variables more strongly associated with an increased likelihood of frequent awakenings in the binomial logistic regression, while sleeping alone was associated with a decreased chance (aOR 0.62; 95%CI 0.45–0.89). A short sleep duration (<11 h/day) was reported for 801 (26.9 %) at 12 months, for 743 (25.0 %) at 24 months of age; in 383 cases, the short sleep duration was reported at both time points. An association was observed between frequent awakenings at 12 or 24 months and short sleep duration (OR 1.23; 95%CI 1.05–1.44 -ꭓ2 6.25, p = 0.012). The current study identified some early predictors of frequent awakenings during the first two years of life. Since optimal sleep practices in children are essential for their development, effective, early interventions must be defined and integrated into pediatric care practices. • Many studies describe the characteristics and prevalence of sleep disturbances among Italian children. • The factors involved in sleep problems in the first two years of life have not been investigated. • Frequent awakenings are reported in at least one visit during the first two years of life for nearly 30 % of the children. • Bed-sharing and living in northern Italy increased the odds of problematic sleep patterns. • Environment, cultural contexts, and parental attitudes need to be considered when analyzing sleep disturbances. [ABSTRACT FROM AUTHOR]

To investigate and compare the attitudes of parents who initiated their daughters' HPV vaccination with parents who did not. Data were collected through telephone interviews with a close-end questionnaire on parents' knowledge, attitudes towards the vaccine, and the reasons for vaccinating or not their daughters against HPV. The sample was random, stratified by geographic region and urbanization level, national, and representative of the general population of parents of girls aged 11-18 in Greece. Statistical analysis consisted of descriptives, an inferential analysis with hypothesis testing, and a logistic regression model. Overall, 996 parents were included in the analysis, 99.0% of which were women. Forty-seven percent of them initiated their daughters' HPV vaccination, with physician recommendation stated as the most important reason for this decision (50.2%). For those who had not initiated their daughters' HPV vaccination (53%), lack of information was the most important reason (25.6%). In the hypothesis testing, parents with unvaccinated daughters agreed more with the statements "I do not have enough information for the HPV vaccine to decide," and "My child is very young to be vaccinated for an STD" (P <.05), but no significant difference found for the statement "It's more possible for a vaccinated girl to begin sexual activities" (P >.05). Lack of information, young age of the daughter, and perceived effectiveness of the vaccine are the most important hesitation factors. Physician recommendation is the most important reason to initiate vaccination. [ABSTRACT FROM AUTHOR]

Determine self-reported parental feeding behavior changes and perspectives on parental feeding intervention at 12-month follow-up. Telephone focus groups using a 2 × 2 design (English/Spanish × in-class or online) with Expanded Food and Nutrition Education Program participants (n = 37) with children 2–8 years and high exposure to the Food, Feeding, and Your Family intervention (7 lessons). Researchers (n = 3) independently identified themes. Parental behavior changes that (1) positively influenced children's diets, (2) involved children in food-related activities, (3) eased stressful situations around food, (4) led to healthier food choices, and (5) saved money when food shopping. Commonly implemented practices included establishing structured mealtime routines, introducing new foods multiple times, and encouraging children's eating competence. Online participants noted materials were easily accessible via text messages. Incorporating parental feeding content (in-class or online) into nutrition education interventions, such as the Expanded Food and Nutrition Education Program , supports developing positive parental feeding behaviors in families with low income. [ABSTRACT FROM AUTHOR]

• Positive association between parental expectation and home numeracy activities. • Positive association between operational home activities and children's SFON. • Operational activities mediated the relation between parental expectation and SFON. Home numeracy environment encompasses both home provision of numeracy activities for preschool children as well as parental attitudes toward mathematics. The present study investigated the mediating role of home numeracy activities in the relationship between parental academic expectations for their children and children's spontaneous focusing on numerosity (SFON). A total of 176 parent-child dyads from Hong Kong participated in the study where children were tested on their SFON tendency, while parents completed a questionnaire on home numeracy environment which included measures on both home numeracy activities and parental expectations for their children on numeracy performance. Our results revealed, for the first time, a mediating role of home numeracy activities—specifically operational activities—in the relationship between parental expectations for their children on numeracy performance and their children's SFON tendency. The present findings highlight the importance of a nurturing home numeracy environment on preschoolers' SFON tendency, which has potentially far-reaching significance on children's math achievement in later years. [ABSTRACT FROM AUTHOR]

This study evaluated the receptive vocabulary of girls diagnosed with Rett Syndrome (RS) by employing eye-tracking technology and examined how these objective measures compared with parents' perceptions of their daughters' language abilities. Fourteen girls with RS and eleven typically developing peers participated. Instruments included the Kerr Scale, a parental questionnaire on communication skills, the Peabody Picture Vocabulary Test - PPVT-4, and eye-tracking equipment. The PPVT-4's initial 12 cards, each displaying four images, were presented on screen for 5 s for the child's initial inspection. Subsequently, the same card was shown for 5 s with instructions to identify the picture matching the word, repeated three times in a randomized order. Eye-tracking assessments revealed that girls with RS with less severe symptoms, performed below typically developing peers with aged 3–4 years. The number of eye fixations emerged as a reliable metric for assessing their performance. A positive correlation was found between parental reports of their daughters' vocabulary knowledge and their ability to identify the correct stimulus, suggesting comprehension and active engagement in the testing process. This study presents a pioneering approach by combining parental perceptions with eye-tracking measures to assess receptive vocabulary in girls diagnosed with Rett Syndrome. Despite showing lower performance levels compared to significantly younger peers, the findings suggest that these individuals use less effectively eye contact as a mode of communication. • A positive correlation was found between parental reports of their daughters' vocabulary knowledge and their ability to identify the correct stimulus. • The number of eye fixations emerged as a reliable metric for assessing their performance. • Girls with Rett Syndrome, even those with less severe symptoms, performed below typically developing peers who were aged 3 to 4 years. [ABSTRACT FROM AUTHOR]

There are insufficient data and measuring tools for parental perception of defecation and constipation in Thai children. The primary objective of this study was to develop a tool to measure parental perceptions towards defecation and constipation in children. The secondary objective was to identify parental understanding and misconceptions about these issues. The authors developed a questionnaire in three domains: knowledge, attitude, and practice. Content validity was evaluated using the item-objective congruence index (IOC) by five experts. The reliability of the measure was assessed based on both internal consistency and test-retest reliability. Then, a descriptive cross-sectional survey was conducted on Thai parents at pediatric outpatient clinics and wards in Bhumibol Adulyadej Hospital. The authors developed a first draft questionnaire consisting of 31 items, which were categorized into three domains of knowledge, attitude, and practice. During expert validation, five items were disqualified. To assess the questionnaire's reliability, Cronbach's alpha value was calculated and found to be 0.229 for the original questionnaire. However, after removing irrelevant questions, Cronbach's alpha value increased to 0.511 for an 18-item questionnaire. The adjusted questionnaire demonstrated excellent test-retest reliability (Intraclass correlation coefficient, ICC = 0.91). The survey with 306 parents revealed parental misconceptions about the pathophysiology of stool withholding, stool soiling indicating constipation, toilet training after meals, and monitoring bowel movements. The developed questionnaire helps to assess parental perception regarding defecation and constipation in Thai children. Based on the survey results, the authors suggest that parental education on these issues is still necessary. [Display omitted] [ABSTRACT FROM AUTHOR]

Previous studies have examined the perspectives of both affected children/adolescents and their parents on family functioning impacts of obsessive-compulsive disorder (OCD). While siblings play an integral role within the family system, their perspectives have been largely overlooked in the literature. This study examined sibling, parent, and child perspectives of family functioning in pediatric OCD and assessed demographic and clinical factors associated with family functioning. Participating families were identified from a larger research registry of 398 patients referred between 2012 and 2020 to the Provincial OCD Program. A total of 185 families who provided data on family functioning from the perspectives of OCD-affected children, siblings and parents were included for study. All family members completed the OCD Family Functioning scale. The extent of perceived impairment differed by family member type, with parents reporting the greatest impacts, followed by OCD-affected children, and then siblings. Predictors of OCD-imposed family dysfunction included family accommodation from all perspectives, clinician-reported child OCD severity, and family blame from parent perspectives. Data are cross-sectional, and we cannot conclude that the observed associations reflect causal effects. Missing data were evident and differed by variable item and family member type. By providing sibling perspectives within the same family unit, this study expands upon previous findings that accommodation predicts family impairment from parent and child perspectives. Our study highlights factors relevant to family-based interventions in the treatment of pediatric OCD. Clinicians should be aware of the ongoing impacts OCD has on all family members. • Disruptions on family functioning by pediatric OCD were noticeable by all family member types. • Siblings perceived a significant, albeit lower, degree of impairment compared to other family members. • Parents perceived the greatest family impairment, possibly due to caregiver responsibilities. • A nuanced breakdown of family impairment may provide insight into family accommodation and, in turn, treatment outcomes. [ABSTRACT FROM AUTHOR]

Families are vital providers and recipients of pediatric palliative care (PPC) services. Understanding the scope and nature of evidence at the intersection of family science and PPC research is necessary to develop family-focused interventions that enhance child and family health. Explore and describe the family-level impact of pediatric serious illness. We conducted a librarian-assisted scoping review using Arskey and O'Malley's approach. We searched PubMed, Scopus, CINAHL, and EMBASE databases for empirical publications from 2016 to 2021 that focused on families navigating serious pediatric illness published in English. Two reviewers assessed eligibility, with discrepancies resolved by a third. We used Covidence and REDCap for data management and extraction. We screened 10,983 abstracts; 309 abstracts were included in full text screening. The final group of 52 citations was analyzed by the entire team. Most research was conducted in Western Europe and North America. The perspectives of parents of children with cancer were most frequently described; voices of seriously ill youth and their siblings were less often presented. Most of the research was descriptive qualitative, followed by descriptive quantitative. Few studies were mixed methods, inferential, or interpretive. Studies most often described parent, youth, and family experience with illness and less often explored family processes and relationships. Irrespective of the approach (i.e., qualitative, quantitative), few studies focused on families as the analytic unit or used family-level analysis techniques. Study participants were usually from local dominant populations and less often from historically marginalized communities. The robust, descriptive, and individual-level evidence describing family impact of serious pediatric illness provides a solid foundation for future research priorities. Stronger integration of family techniques and diverse family voices in pediatric palliative care research can clarify family processes, illuminate structural barriers, and inform interventions that are responsive to family needs. These steps will enhance the education, policy, and clinical provision of PPC to all who would benefit, thereby advancing health equity for children living with serious illness and their families. [ABSTRACT FROM AUTHOR]

This study investigates the association between parental attitudes towards mandatory and recommended vaccines in the National Immunization Plan (NIP) of Italy and their acceptance of the COVID-19 vaccine in children aged 5–11 years. Using data from approximately 42,000 children in Southern Italy, parental attitudes towards previous vaccinations were examined. Mandatory and recommended vaccinations were considered for the analysis, with the first shot of each schedule being considered relevant, regardless of when it was administered or whether the recommended number of doses was administered. A multivariate logistic regression was performed to analyze associations between the covariates of age, sex, adherence to mandatory vaccinations, number of recommended vaccinations, and COVID-19 vaccination. The COVID-19 vaccine acceptance rate was 50.7% in our sample. We revealed a strong association between parental attitudes towards previous vaccinations and the acceptance of the COVID-19 vaccine. Mandatory vaccinations under the NIP showed the highest acceptance rates, and among non-mandatory vaccines, the pneumococcal conjugate vaccine had the highest acceptance rate, potentially due to its co-administration with the hexavalent vaccine. The study identified a trend of lower COVID-19 vaccine coverage in younger children. The study underscores the importance of co-administration approaches and well-planned vaccination schedules in enhancing vaccine coverage. It suggests that integrating newer vaccines, like the COVID-19 vaccine, into established vaccination schedules could potentially increase acceptance and coverage. The findings highlight the urgency of addressing vaccine hesitancy, particularly in the pediatric population, to ensure high vaccination coverage and effective disease control. Further research is needed to explore the potential strategies to increase vaccine acceptance. [ABSTRACT FROM AUTHOR]

There is minimal research eliciting teen reproductive desires and parenting attitudes. Behavioral, educational, and public health interventions to prevent teen pregnancy often highlight the negative consequences of teen pregnancy or benefits of delaying parenting. However, limited empirical information is available regarding what factors teens perceive to influence the desire to delay pregnancy. In this study, we sought to identify teen perspectives regarding factors that influence their desire to delay parenting. A consensual qualitative research approach was used to identify reproductive desires, parenting attitudes, and any factors that influence the desire to delay parenting expressed by at risk teens. Forty participants were randomly selected from a larger clinical trial testing the efficacy of a brief, motivational interviewing-based intervention. During the brief intervention, participants were asked about their parenting attitudes and reproductive desires and factors that influence decisions to avoid teen pregnancy. These recorded segments were extracted, transcribed, and thematically analyzed. The study collected qualitative data on overarching key themes regarding teen parenting attitudes and reproductive desires, as well as factors that influence the desire to delay pregnancy, including education, financial stability, partnership, maturity/responsibility, friendships, and family. Many participants indicated that they wanted to delay parenting due to wanting to pursue future goals and/or not feeling ready for the responsibility of children. Overall, teens have a variety of reasons for delaying parenting that may not be explicitly captured by the general gain/loss messaging of current interventions. Allowing teens to explore their own beliefs and values around factors that they perceive to influence their desire to delay parenting creates autonomy and places the focus on the teens themselves and not perceived future losses or gains. This study analyzed the parenting attitudes and reproductive desires of teens undergoing a parenting prevention motivational interviewing intervention. Through a qualitative assessment, this article identifies themes of teen perspectives regarding factors that influence their desire to delay parenting. [ABSTRACT FROM AUTHOR]

• Incomplete transfer of responsibilities from parent to AYA is a barrier of transition;. • The desired roles of parents are ambiguous;. • A latent sense of responsibility was identified as an important motive in parents;. • The attitude of AYAs and parents are greatly intertwined, promoting the onset of a vicious or virtuous circle of undesired and desired behaviour, respectively. Inadequate participation of Adolescents and Young Adults (AYAs) and parents are well-established barriers of transition. Shifts in roles are mandatory with increasing responsibilities for AYAs and decreasing involvement of parents in care. This study explores the shifts in roles of AYAs and their parents and its association with the subjective experience of transition. We conducted in-depth semi-structured interviews with AYAs living with Cystic Fibrosis and parents. Participants were recruited through patient organizations via convenience sampling and questioned on which roles they assumed during transition. Three authors performed an interpretative phenomenological analysis, establishing separate code trees for AYAs and parents. Data saturation was achieved. 18 AYAs (age 21y±2.9) and 14 parents (age 50y±2.0) were included. We identified five common themes: (1) the reciprocal reliance between AYAs and parents, (2) the policies of physicians and hospitals, (3) the AYAs' changing appeal and need for support, (4) the identification of parents as co-patients, and (5) the enforced changes in the roles of parents. AYAs primarily addressed roles related to self-management, while parents discussed family functioning. This study identified motives underlying the assumption of roles by AYAs and parents. Both AYAs and parents addressed similar themes, highlighting their mutual challenges and needs. In contrast to AYAs, parents' desired roles were undefined and a latent sense of responsibility was identified as an important motive. Healthcare providers should acknowledge parents' challenging position and communicate transparently about changing roles. Additionally, healthcare providers should recognize that imposing restrictive roles may result in parental resistance, but can also foster AYAs' skill development. Future research should examine the short- and long-term impact of role-management interventions in AYAs and their parents. [ABSTRACT FROM AUTHOR]

To evaluate if parent perceptions of school meals influence student participation. In May 2022, an online survey was used to evaluate parents' perceptions of school meals and their children's participation. A total of 1,110 California parents of kindergarten through 12th-grade students. Student participation in school lunch and breakfast. Principal component analysis and Poisson regression models. Three groups of parental perceptions were identified: (1) positive perceptions (eg, liking school meals and thinking that they are tasty and healthy), (2) perceived benefits to families (eg, school meals save families money, time, and stress), and (3) negative (eg, concerns about the amount of sugar in school meals and stigma). More positive parental perceptions about school meals and their benefits to families were associated with greater student meal participation. In contrast, more negative parental perceptions were associated with reduced student participation in school meals (P < 0.05). Parent perceptions of school meals may affect student participation in school meal programs. Working to ensure parents are familiar with the healthfulness and quality of school meals and the efforts schools are making to provide high-quality, appealing meals may be critical for increasing school meal participation rates. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic changed the setting of education for many children in the U.S. Understanding COVID-19 vaccination coverage by educational setting is important for developing targeted messages, increasing parents' confidence in COVID-19 vaccines, and protecting all children from severe effects of COVID-19 infection. Using data from the Household Pulse Survey (n = 25,173) collected from December 9–19, 2022, January 4–16, 2023, and February 1–13, 2023, this study assessed factors associated with COVID-19 vaccination and reasons for non-vaccination among school-aged children 5–11 and adolescents 12–17 by educational setting. Among children 5–11 years, COVID-19 vaccination coverage was higher among those who received in-person instruction (53.7%) compared to those who were homeschooled (32.5%). Furthermore, among adolescents 12–17 years, COVID-19 vaccination coverage was higher among those who received in-person instruction (73.5%) or virtual/online instruction (70.1%) compared to those who were homeschooled (51.0%). Children and adolescents were more likely to be vaccinated if the parental respondent had been vaccinated compared to those who had not. Among children and adolescents who were homeschooled, main reasons for non-vaccination were concern about side effects (45.4–51.6%), lack of trust in COVID-19 vaccines (45.0–50.9%), and lack of trust in the government (32.7–39.2%). Children and adolescents who were home-schooled during the pandemic had lower vaccination coverage than those who attended school in person, and adolescents who were home-schooled had lower vaccination coverage than those who received virtual instruction. Based on the reasons for non-vaccination identified in this study, increasing parental confidence in vaccines, and reducing barriers to access are important for supporting COVID-19 vaccination for school-age children. [ABSTRACT FROM AUTHOR]

In the U.S., uptake of the HPV vaccine remains below coverage goals. There is concern that negative reactions to emergency initiatives during the COVID-19 pandemic, including vaccination, may have increased some parents' hesitancy towards all vaccines, including HPV. Understanding how different parent populations view routine vaccination post-pandemic is key to strategic efforts to maintaining and increasing uptake of HPV vaccine. In early 2022, we recruited an online panel of English-speaking U.S. parents and caregivers, who used the social media platform Twitter and had HPV vaccine-eligible but unvaccinated children age 9–14 years. Respondents completed a 20-minute survey measuring knowledge, attitudes and intentions regarding HPV vaccination for their child, as well as background socio-demographics and health information-seeking practices. Questions regarding experiences during the COVID-19 pandemic included changes in access to preventive care, and perceptions of whether pandemic experiences had positively or negatively affected their attitudes about routine vaccination, with open text capturing reasons for this change. Among 557 respondents, 81 % were definitely or likely to vaccinate their child against HPV, with 12 % being uncertain, and 7 % unlikely to vaccinate. Regarding routine vaccination, most (70 %) felt their attitudes had not changed, while 26 % felt more positively, and only 4 % felt more negatively. Reasons for positive attitude change included increased appreciation for vaccines overall, and motivation to proactively seek preventive care for their child. Negative attitude changes stemmed from distrust of COVID-19 public health efforts including vaccine development, and disillusionment with vaccines' ability to prevent disease. In multivariable models, intention to vaccinate was greater among parents reporting greater education, Democratic affiliation, greater religiosity, and urban residence. Negative attitude change due to the pandemic independently predicted reduced HPV vaccination intention, while positive attitude change predicted positive intention. Post-pandemic, most U.S. parents remain committed to vaccinating their children against HPV. However, addressing residual COVID-19 concerns could improve uptake among vaccine-hesitant parents. [ABSTRACT FROM AUTHOR]

• In a multi-site cohort, we examine how parents' KAPs related to COVID-19 vaccination translate to vaccine uptake in children. • COVID-19 vaccination rates remain low in kids. More research is needed on COVID-19 vaccine hesitancy among parents. • Parents' KAPs changed throughout the pandemic. Policies to increase vaccine uptake should focus on safety and effectiveness. Pediatric COVID-19 vaccine hesitancy and uptake is not well understood. Among parents of a prospective cohort of children aged 6 months–17 years, we assessed COVID-19 vaccine knowledge, attitudes, and practices (KAP), and uptake over 15 months. The PROTECT study collected sociodemographic characteristics of children at enrollment and COVID-19 vaccination data and parental KAPs quarterly. Univariable and multivariable logistic regression models were used to test the effect of KAPs on vaccine uptake; McNemar's test for paired samples was used to evaluate KAP change over time. A total of 2,837 children were enrolled, with more than half (61 %) vaccinated by October 2022. Positive parental beliefs about vaccine safety and effectiveness strongly predicted vaccine uptake among children aged 5–11 years (aOR 13.1, 95 % CI 8.5–20.4 and aOR 6.4, 95 % CI 4.3–9.6, respectively) and children aged 12+ years (aOR 7.0, 95 % CI 3.8–13.0 and aOR 8.9, 95 % CI 4.4–18.0). Compared to enrollment, at follow-up parents (of vaccinated and unvaccinated children) reported higher self-assessed vaccine knowledge, but more negative beliefs towards vaccine safety, effectiveness, and trust in government. Parents unlikely to vaccinate their children at enrollment reported more positive beliefs on vaccine knowledge, safety, and effectiveness at follow-up. The PROTECT cohort allows for an examination of factors driving vaccine uptake and how beliefs about COVID-19 and the COVID-19 vaccines change over time. Findings of the current analysis suggest that these beliefs change over time and policies aiming to increase vaccine uptake should focus on vaccine safety and effectiveness. [ABSTRACT FROM AUTHOR]

Parenting apps have become increasingly used in parents' everyday life. This growth offers the possibility for simple, low-cost parenting interventions to a wide range of populations. These apps may contribute to a decrease in social inequality as they promote access to information and health. The content provided by these apps varies from prevention messages and parenting tips to more specific parental guidance and activity suggestions. However, few studies have examined their effect on parenting competence and attitudes. The French Gazouyi app aims to promote parenting skills and to provide parents with the means to play in a positive way with their child. The aim of this study was to examine, over a period of 3 months, the acceptability, the relevance, and the impact of the use of a digital application by parents of young children aged from birth to 2 years of age. The app proposes developmentally appropriate play activities developed by professionals. In all, 137 participants were recruited and randomly assigned to an intervention group (n = 60) and a control group (n = 77). Both groups completed the EPAQ, the QAECEP and the KIDI questionnaires at the beginning of the study (T1) and again three months later (T2). EPAQ is designed to evaluate parental awaremess and attitudes about parenthood and child development. The QAECEP measures the parenting sense of competence. The KIDI assesses practical knowledge of parenting styles, early development processes, and behavioral milestones. The intervention group was asked to perform four activities per week on Gazouyi. The app offers different types of play activities in four aspects of child development: language, motor, sensory and social. Overall, no significant differences between the two groups were found. Between T1 and T2, both the intervention and the control group had a significant increase in the QAECEP score. At both assessment points, the number of correct responses to the KIDI and the EPAQ score was high in both groups. However, significant links between scores of parenting competence and some sociodemographic factors were observed. Regression analyses showed that, for frequent users, high scores on the EPAQ were positively predicted for at-term delivery and female children. For infrequent users, high scores on the QAECEP were positively predicted for at-term delivery, infants' growth, and the level of the fathers' education. Correct answers on the KIDI were positively predicted for low household incomes, female children, at-term delivery, and nursery childcare. As the first French study to assess the impact of a parenting app and despite its several shortcomings, this study demonstrated that French parents have a strong interest in apps and digital sources of information that may potentially help them in their role as parents. However, further studies should be conducted to improve these apps, to know how parents use them, what effects this type of device can produce, and what improvements could be made. [ABSTRACT FROM AUTHOR]

Many babies cared for on a neonatal unit are at risk of adverse neurodevelopmental outcomes. The aim of early intervention (EI), therefore, is to support a child and their family to achieve the best outcome possible. Notably, EI is not one specific thing. The term encompasses a wide range of approaches and interventions that can vary in a number of ways, including who undertakes them, where they happen and when they start. There is debate as to the most effective approach, but the evidence supports the implementation of EI from soon after birth, continuing post-discharge. Furthermore, involving the parents in EI is critical, not only to ensure sustained effects throughout childhood, but also because of the beneficial impact on parental wellbeing. All in all, the evidence shows improved neurodevelopmental outcomes for children exposed to EI, particularly in the short-term. This review will explore what EI means in practice, considering the variations in application, as well as the evidence of benefit. It will also consider the limitations of current research. [ABSTRACT FROM AUTHOR]

The role of parents in decision-making concerning their child's end-of-life care is not clearly defined. Their participation is encouraged by ethical reflection, in particular by the CCNE (French National Ethics Advisory Committee), but laws are limited to imposing a duty to provide information to doctors. Decisions are taken at the end of a collegial meeting (CM) intended to better inform the child's referring physician (RP) who is in charge of the final decision following the French law. The aim of this study was to describe the support provided to bereaved families after they had been invited to attend a CM concerning their child, if they so wished. Additional aims were to determine the differences resulting from their acceptance or their refusal to participate as regards their perception of their child's history and as regards their grieving process. We conducted a retrospective study of all CMs held between November 2016 and May 2021, drawing a distinction between proposals made or not made to parents and their decision to accept or refuse. In total, 49 CMs concerning 46 children were held during the study period. The proposal was not made to the parents in three cases; the parents chose to be present in 28 cases. The psychological follow-up (15/28 parents attending, 10/16 parents absent) illustrated that their presence enabled them to reflect on their child's death after having listened to and understood the reasons why it happened. They did not dispute the team's approach or decisions taken. It is possible to include parents in CMs if they so wish. It would appear more beneficial than merely providing them with the information required. Studies must be carried out to ensure potential long-term benefit. [ABSTRACT FROM AUTHOR]

Parents may experience challenges implementing their child's therapeutic treatment following burn. A mixed methods study was conducted to explore the parent experience of intensive splinting following palmar burns in young children (median age 16 months [IQR 14]). Thirteen parents were interviewed after cessation of their child's splinting (mean 12 months [SD 2] following burn). Parent interviews were semi-structured with open-ended questions and conducted one-to-one. Inductive thematic analysis was completed by two researchers with consensus achieved through discussion and agreement from third researcher. Themes were triangulated with quantitative data, including range of motion (ROM), scar, developmental and quality of life outcomes. Children used the splint intensively (>12–24 h/day) for median 179 days (IQR 74) with all splinting ceased by median 275 days (IQR 105). All children had full ROM at scar maturation. Thematic analysis revealed two main themes: parents perceive the impact of splinting to be greater on them than their child and parents perceive outcomes to be more important than burden. Parents described the importance of routine and therapeutic relationships in ongoing engagement with intervention. Parents consider intensive splinting to impact them more than their child with burden of care manageable considering overall outcomes. • Parents perceive intensive splinting to have greater impact on them than child. • Intensive splinting has minimal impact on child's daily activities. • Parents report practical and emotional challenges implementing child's treatment. • Parents perceive outcomes to be more important than burden. [ABSTRACT FROM AUTHOR]

Recognizing what is normal constitutes a key skill for medical practitioners, especially paediatricians. It is a necessary requisite to providing reassurance and avoiding unnecessary referrals, investigations and treatment. Normal variants are atypical or uncommon findings in a given population which are of no clinical or pathological significance yet fall within the spectrum of what is considered the normal range. The list of conditions discussed in this article is by no means complete or comprehensive but merely a reflection of frequently encountered issues in primary care, paediatric outpatients and the paediatric emergency department; they include infantile dyschezia, 'catch down' growth, familial macrocephaly, positional plagiocephaly, asymmetrical thigh creases, sacral dimples, physiological anisocoria, PURPLE screaming episodes, gastro-oesophageal reflux and infant gratification and also provide guidance on what not to miss. This short article provides essential guidance for those new to paediatric outpatients or those less familiar with providing advice and guidance to worried parents. [ABSTRACT FROM AUTHOR]

[Display omitted] • Chickenpox is a common childhood illness with a safe effective vaccine. • First qualitative systematic review of parental perceptions of varicella vaccination. • The varicella vaccine has been recommended for inclusion in the UK vaccine schedule. • Many parents exhibit complacency towards chickenpox and varicella vaccine hesitancy. • Public health messaging should consider these findings to ensure high vaccine uptake. In countries where varicella vaccination is not on the routine childhood immunisation schedule, such as those in the United Kingdom (UK), chickenpox is an almost universal disease of childhood. Chickenpox can cause serious complications, particularly in infants, pregnant women, and the immunocompromised. In November 2023 the varicella vaccine was recommended for inclusion in the UK routine childhood immunisation schedule. Successful rollout of the vaccine may be hindered by parental concerns about vaccine safety and efficacy, and perceptions of chickenpox as a mild illness. To examine parental perceptions of chickenpox and varicella vaccination, which may be crucial to effective vaccination campaigns. Qualitative systematic review and thematic analysis. Six electronic databases were systematically searched for studies published between 2016 and 2023: CINAHL, EMBASE, MEDLINE, PsycInfo, PubMed, and Web of Science. The included studies were appraised against the Critical Appraisal Skills Program checklist for qualitative studies. Thematic analysis was used to analyse qualitative data, through the development of themes. 22 articles were included in this review, and five themes identified: perceptions that chickenpox is a mild illness, that parents have concerns about varicella vaccine efficacy and safety, a notion of natural immunity as superior, social determinants of health influence vaccine decision making, and vaccination is overwhelming perceived as a parental decision. Whilst some parents displayed an acceptance and willingness to vaccinate against chickenpox, many expressed concerns, and perceived chickenpox as a routine unworrying childhood illness. Analysis demonstrated a knowledge gap in understanding UK parental opinions regarding chickenpox and varicella vaccination, highlighting the need for research in this area, particularly given ongoing reconsideration for inclusion in the UK vaccination schedule. The review was registered on PROSPERO, registration ID CRD42021236120. [ABSTRACT FROM AUTHOR]

Parental vaccine hesitancy (VH) is a major barrier to childhood vaccination. We aimed to identify the determinants of parental VH towards routine childhood immunization in 12 Sub-Saharan African countries. A cross-sectional study was conducted from November 1 to December 15, 2022. Parents of children aged 19 months to 6 years and residing in the Sub-Saharan Africa were included. An anonymous online survey and face-to-face interviews were conducted. The Parent Attitude about Childhood Vaccine Scale was used to identify vaccine-hesitant parents. Multivariate regression and mediating analysis were performed. Across the 5032 participants, 21.2% were hesitant towards routine childhood immunization. Urban residents (adjusted odds ratio [AOR] = 1.32, 95% confidence interval [CI]: 1.10–1.58), non-first-born children (AOR = 1.54, 95% CI: 1.19–1.98), and chronically ill children (AOR = 2.00, 95% CI: 1.69–2.37) increased the likelihood of parental VH. Mothers with higher education, attending at least one antenatal care (ANC) visit (AOR = 0.25, 95% CI: 0.19–0.32), and had a healthcare facility–based delivery (AOR = 0.55, 95% CI: 0.44–0.70) decreased the odds of parental VH. Parental VH mediated the effect of ANC and mothers' age on vaccination uptake. ANC increased the odds of vaccination uptake (odds ratio [OR] = 12.49, 95% CI: 9.68–16.13). Parental VH mediated the association between ANC and vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.12, 95% CI: 0.10–0.14). Each additional year of the mother's age decreased the odds of vaccination uptake (OR = 0.95, 95% CI: 0.95–0.96). The indirect effect of mother's age on vaccination through parental VH decreased the odds of vaccination uptake (OR = 0.45, 95% CI: 0.44–0.45). Parental VH continued to be a mediator of the combined effect of mother's age and ANC on vaccination uptake, decreasing the likelihood of vaccination uptake (OR = 0.0017, 95% CI: 0.00166–0.00168). Context-specific interventions are needed to address parental VH and improve vaccine acceptance and coverage. [ABSTRACT FROM AUTHOR]

OBJECTIVE: While a number asthma questionnaires have been validated, most have not been used in an emergency department (ED) setting, nor evaluated patient feedback or clinical benefit. We sought to evaluate parent feedback on an asthma questionnaire used in an ED setting. METHODS: We recruited parents of children 2-17 years old presenting to a tertiary pediatric ED for asthma care. Parents first completed then rated the Pediatric Asthma Control and Communication Instrument (PACCI-ED). RESULTS: One hundred seventy-four parents (84%) completed surveys. Approximately two-thirds were Latinx, and 82% completed high school. Ninety-three percent of children had uncontrolled asthma. Parents endorsed the PACCI-ED: as easy to answer (94%); useful in understanding their child's asthma (83%); used the right words to describe their child's condition (95%); and would help the ED physician (93%) and primary care provider (PCP) (89%) better understand their child's asthma. Eleven percent reported that the PACCI-ED interfered with ED care. Parents with lower health literacy were more likely to agree the PACCI-ED asked more complete questions about their child's asthma than the ED physician (64% vs 45%, P = .02). Parents of children with uncontrolled asthma were more likely to agree that the PACCI-ED should become part of regular ED care (88% vs 62%, P = .02). Parents were more likely to agree that the PACCI-ED would help their PCP understand their child's asthma if they had a lower income (92% vs 50%, P < .001), less education (100% vs 88%, P = .004), were Latinx (94% vs 83%, P = .006), or were not using controller medication (93% vs 83%, P = .03). CONCLUSIONS: Parents endorse an asthma questionnaire as valuable during an ED encounter. Because it is endorsed to be valuable to parents, this questionnaire could be used to facilitate patient-centered asthma care. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Although national asthma guidelines recommend use of validated questionnaires to improve asthma care, little is known about the extent to which these questionnaires are patient-centered. This qualitative study evaluated parent perceptions of a validated asthma questionnaire. METHODS: We administered the Pediatric Asthma Control and Communication Instrument for the Emergency Department (PACCI-ED) to parents of children 2 to 17 years old presenting to a large urban pediatric ED for asthma care and assessed their perceptions of the tool's utility and acceptability via a structured interview. Responses were recorded, transcribed, and analyzed using a phenomenological approach. RESULTS: Eighty-three parents participated. Qualitative analysis revealed 2 major themes (with 5 subthemes). The first major theme (and 3 subthemes) was that the PACCI-ED facilitated communication with the health care team and caregivers: improving communication 1) with ED providers, 2) in other settings such as schools, and 3) in the primary care setting where the relationship with primary care providers was felt to be variable. The second major theme (and 2 subthemes) was that the PACCI-ED increased parents' capacity to manage their child's asthma: by helping parents understand 1) what symptoms were related to asthma and 2) how those symptoms might change over time. CONCLUSIONS: Parents perceive that the PACCI-ED is acceptable and useful for facilitating communication in the ED and other health care settings, and for building parent capacity to track and manage their child's asthma. A validated structured asthma questionnaire in the ED may facilitate patient-centered asthma care. [ABSTRACT FROM AUTHOR]

• "Deliberators" concerned about vaccine effectiveness and risk outweighing benefits. • "Rejecters" tended to refuse vaccination and distrust all vaccines. • Young parents with low educational attainment tended to be "rejectors" and "deliberators". • Promotion strategies were similarly preferred. • Results may aid in identifying and addressing vaccine hesitancy. The COVID-19 vaccine coverage among children in countries where COVID-19 vaccines are recommended has been suboptimal. Conflicting information in the media leads to parental anxiety and confusion around COVID-19 vaccination in children. The scepticism expressed by certain experts regarding the importance of COVID-19 vaccines in children has also had a negative impact on parental attitudes towards COVID-19 vaccination. This study aimed to understand parental concerns and preferences for paediatric COVID-19 vaccination, and identify potential vaccination promotion ("nudge") interventions to optimise paediatric COVID-19 vaccine uptake. Mixed methods including Focus Group Discussions and a Discrete Choice Experiment survey were used. The Discrete Choice Experiment survey design was based on a literature review and the findings of Focus Group Discussions. The study was conducted on a nationally representative sample of parents in Australia. In total, 1039 parents participated in the study. Parents showed strong preferences for a COVID-19 vaccine with lower risk of serious side effects and longer protection duration, followed by higher vaccine effectiveness and delivery via oral tablets. Promotion strategies were similarly preferred by parents. Latent class logit analysis identified three groups, interpretable as COVID-19 vaccine "accepters (35.3%)", "deliberators (31.7%)", and "rejecters (33.1%)". The "deliberators" composed of more parents, residing in metropolitan areas, having concerns about vaccine effectiveness, and believing that disease risks outweigh vaccine benefits than the "accepters". The "rejecters" were more likely to not be vaccinated themselves, and generally have less trust in vaccines than the "accepters". The "deliberators" and "rejecters" were less likely to be parents aged ≥25 years and complete final year of high school than the "accepters". Parents' sociodemographic factors and vaccine perceptions were associated with different levels of acceptance toward paediatric COVID-19 vaccination, which may help to better understand how to "nudge" vaccine hesitancy. [ABSTRACT FROM AUTHOR]

Latino youths in the United States experience disproportionately high rates of teen pregnancy. The aim of this study was to obtain expecting and parenting Latino adolescents' perspectives regarding factors contributing to teen pregnancy and pregnancy prevention. Expecting/parenting Latino adolescents were recruited from high schools with high proportions of Latino youths and teen pregnancy. Participants completed a questionnaire on sociodemographic and background characteristics. Focus groups were stratified by age and gender and audio recorded. Grounded theory was used to identify themes from the transcribed audio recordings. Thirty-two expecting/parenting Latino adolescents (20 females, 12 males) 14-19 years old participated in four focus groups. Quantitative results revealed that two-thirds of participants at birth had adolescent mothers. Over three-quarters of participants reported that their pregnancies had occurred too soon. Qualitative themes for factors contributing to teen pregnancy included lack of contraceptive knowledge/access, belief of invincibility, influence within relationships, male decisions on contraceptive use, desire to belong among peers, lack of parental support for contraceptive use, lack of parental attention, rebellion, normalization of adolescent parenthood in Latino culture, and media. Themes for pregnancy prevention included time alone with physicians, parenting teens as mentors, reproductive health education, and community pregnancy-prevention programs. Multiple factors contribute to teen pregnancy in Latino youth, including influences from Latino culture, family, peers, partners, and social determinants of health. Pregnancy prevention should incorporate interventions to address these aspects, including disseminating culturally sensitive education materials, providing parenting teens as peer mentors, encouraging time alone with health care providers, and addressing various social determinants of health. [ABSTRACT FROM AUTHOR]

Investigating the completion rate of 12-month vaccinations and parental perspectives on vaccine services during COVID-19. Service evaluation including parental questionnaire. Uptake of 12-month vaccinations in three London general practices during three periods: pre-COVID (1/3/2018–28/2/2019, n = 826), during COVID (1/3/2019–28/2/2020, n = 775) and post-COVID first wave (1/8/2020–31/1/2021, n = 419). Questionnaire of parents whose children were registered at the practices (1/4/2019–1/22/2021, n = 1350). Comparing pre-COVID and both COVID cohorts, the completion rates of 12-month vaccines were lower. Haemophilus influenzae type B/meningococcal group C (Hib/MenC) vaccination uptake was 5.6% lower (89.0% vs 83.4%, P =<0.001), meningococcal group B (MenB) booster uptake was 4.4% lower (87.3% vs 82.9%, P = 0.006), pneumococcal conjugate vaccine (PCV) booster uptake was 6% lower (88.0% vs 82.0%, P < 0.001) and measles, mumps and rubella (MMR) vaccine uptake was 5.2% lower (89.1% vs 83.9%, P = 0.003). Black/Black-British ethnicity children had increased odds of missing their 12-month vaccinations compared to White ethnicity children (adjusted odds ratio 0.43 [95% confidence interval 0.24–0.79, P = 0.005; 0.36 [0.20–0.65], P < 0.001; 0.48 [0.27–0.87], P = 0.01; 0.40 [0.22–0.73], P = 0.002; for Hib/MenC, MenB booster, PCV booster and MMR. Comparing pre-COVID and COVID periods, vaccinations coded as not booked increased for MMR (10%), MenB (7%) and PCV booster (8%). Parents reported changes to vaccination services during COVID-19, including difficulties booking and attending appointments and lack of vaccination reminders. A sustained decrease in 12-month childhood vaccination uptake disproportionally affected Black/Black British ethnicity infants during the first wave of the pandemic. Vaccination reminders and availability of healthcare professionals to discuss parental vaccine queries are vital to maintaining uptake. [ABSTRACT FROM AUTHOR]

La recherche vise à établir un état des lieux du soutien social apporté par l'entourage adulte à un enfant endeuillé. Pour un enfant, le décès d'un membre de sa fratrie est une terrible épreuve. Le soutien social constitue un facteur de protection efficace face au risque élevé de détresse psychologique. Pourtant, les adultes hésitent à s'impliquer car beaucoup ne savent pas comment accompagner un enfant endeuillé. À ce jour, peu d'études se sont penchées sur la manière de donner aux proches les moyens de s'engager auprès de l'enfant. Nous avons réalisé une étude exploratoire qualitative inductive. Sept adultes ayant accompagné un enfant confronté à la perte d'un frère ou d'une sœur ont participé à un cycle de 3 ateliers de groupe. Une analyse qualitative reprenant les 3 premières étapes de la théorisation ancrée (codification, catégorisation et mise en relation) de l'ensemble de données a été menée. Les résultats ont mis en évidence 4 phénomènes amenant les proches à ne pas aborder le deuil de l'enfant. Il s'agit de l'anxiété de deuil, les cognitions liées au deuil, le sentiment de légitimité et la tendance à l'évitement. Le fonctionnement des parents et de l'enfant contribue également aux freins mentionnés par les participants dans leur engagement auprès de l'enfant endeuillé. La catégorisation et la mise en relation des phénomènes amènent à une meilleure compréhension et une connaissance nouvelle des difficultés rencontrées par l'entourage d'un enfant endeuillé. Des perspectives cliniques et de recherche émergent de nos résultats, notamment l'identification d'une personne de référence, la conception d'un inventaire de besoins de l'enfant endeuillé et un travail de collaboration entre les parents, l'enfant et l'entourage, pour favoriser l'engagement des adultes et prévenir les risques psychosociaux chez l'enfant. The purpose of this research was to establish an overview of the social support provided by the adults to a bereaved child. The death of a sibling is a terrible experience for a child. Social support is an effective protective factor against the high risk of psychological distress. However, adults are reluctant to get involved because many do not know how to support a bereaved child. To date, few studies have looked at how to empower relatives to engage with the child. We conducted an exploratory inductive qualitative study. Seven adults who had been involved with a child experiencing the loss of a sibling participated in a cycle of three group workshops. An analysis by coding, categorizing, and relating the data set was conducted. The results identified four phenomena that lead adults to avoid dealing with the child's grief. These are grief anxiety, grief cognitions, feeling of legitimacy, and tendency to avoid. The way parents and child function also contributes to the barriers participants identified to engaging with the bereaved child. Categorizing and relating the phenomena led to a better understanding and a new knowledge of the difficulties encountered by the adults around a bereaved child. Clinical and research perspectives emerged from our results, notably the identification of a reference person, the design of an inventory of the bereaved child's needs, and collaborative work between parents, child, and their relatives, in order to promote adult involvement and prevent psychosocial risks for the bereaved child. [ABSTRACT FROM AUTHOR]

Introduction : While previous studies on childhood injury focused mainly on the relationship between parents' preventive behavior and its determinants, knowledge about parental risk perception that can help to develop, implement, and evaluate successful interventions to prevent childhood unintentional home injuries is still limited. The aim of this study was to gain a deeper understanding of parental risk perception regarding unintentional home injuries of children under six years of age. Method: A convenience sample of 469 parents, residing in Germany, completed a web-based questionnaire assessing factors potentially associated with parental risk perception on the child, parental, and environmental level. Descriptive statistics, p for trend, and Spearman's Rho correlation coefficients were calculated. Results: Key factors influencing parental risk perception included children's sex, age, migrant status, emotionality, and injury risk as well as parents' parenting style and external locus of control. While parental risk perception was positively associated with children's injury risk, the analyses showed no associations between parental risk perception and parents' preventive behavior. Conclusions: Our findings add to a better understanding of parental risk perception, provide practical implications for injury prevention, and indicate that the relationship between parental risk perception and parents' preventive behavior is based on a complex mechanism which is possibly moderated by parents' locus of control. Practical Applications: The identified key factors help to assess parental risk perception more accurately. Therefore, they should be considered in the development of tailored interventions to prevent unintentional home injuries of children, for instance, by targeting specific groups of parental risk perception. [ABSTRACT FROM AUTHOR]

Postural tachycardia syndrome (POTS) is associated with complaints of cognitive and emotional difficulties that may contribute to severe functional disability. For high-achieving adolescents, these symptoms can result in decreased participation in school and extracurricular activities. There are very limited data comparing subjective symptom reports to neurocognitive profiles in adolescents presenting with POTS, "brain fog," and cognitive difficulties. A review of medical records and neuropsychological data was conducted for six adolescents diagnosed with POTS at a pediatric neurology clinic. All patients had frequent symptoms of orthostatic intolerance for more than three months. There was heart rate increase of ≥40 beats per minute (bpm) within 10 minutes of active standing or head-up tilt test in five patients and 36 bpm in one patient, who was diagnosed with probable POTS. All were referred for neuropsychological evaluations due to reported debilitating cognitive problems and an inability to function in a regular academic setting. Patients underwent a six-hour neuropsychological evaluation utilizing standardized measures of cognitive and emotional functioning. Clinically reported symptoms included fatigue, poor concentration, and memory impairment as well as "brain fog." Subjective complaints differed from patients' performance on standardized neuropsychological measures. Patients performed in the average to superior range across measures of general intelligence, verbal and working memory, processing speed, and sustained attention. Further research is needed to elucidate the basis for perceived "brain fog" and cognitive impairment in POTS, such as better understanding of patient and parental perceptions of initial medical symptoms and diagnosis as well as symptom amplification due to biopsychosocial processes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe the process of identifying and reporting inpatient safety concerns from the perspective of parents of children with medical complexity (CMC). METHODS: We conducted a secondary analysis of qualitative data from semi-structured interviews with 31 English and Spanish-speaking parents of CMC at two tertiary children's hospitals. Interviews lasted 45--60 minutes and were audio-recorded, translated, and transcribed. Three researchers inductively and deductively coded transcripts using an iteratively refined codebook with validation by a fourth researcher. Thematic analysis was used to develop a conceptual model of the process of inpatient parent safety reporting. RESULTS: We identified four steps illustrating the process of inpatient parent safety concern reporting 1) parent recognizing concern, 2) parent reporting concern, 3) staff/hospital response continuum, and 4) parent feelings of validation/invalidation. Many parents endorsed that they were the first to catch a safety concern and were identified as unique reporters of safety information. Parents typically described reporting their concerns verbally and in real-time to the person they felt could quickly remedy the situation. There was a spectrum of validation. Some parents reported their concerns were not acknowledged and addressed, which led them to feel overlooked, disregarded, or judged. Others reported their concerns were acknowledged and addressed, resulting in parents feeling heard and seen and often leading to changes in clinical care. CONCLUSIONS: Parents described a multi-step process of reporting safety concerns during hospitalization and a spectrum of staff response and validation. These findings can inform family-centered interventions that support safety concern reporting in the inpatient setting. [ABSTRACT FROM AUTHOR]

• Vaccine refusal and hesitancy toward childhood and COVID-19 vaccines hinder the achievement of adequate immunization coverage worldwide. • The prevalence of parents who previously rejected childhood vaccines due to personal beliefs accounted for 7.8%, and parental COVID-19 hesitancy was 85.6%. • Parental attitudes and beliefs toward vaccines were significantly associated with their behavior regarding the vaccination of their children. • Many parents who did not refuse childhood vaccines were found to have negative attitudes toward vaccines and distrust health authorities. • Significant changes in parental attitudes toward childhood vaccines after the onset of the COVID-19 pandemic are possible. Vaccination rates worldwide have declined in recent years. This decrease is primarily driven by vaccine hesitancy, which remains understudied in Central Asia, including Kazakhstan. Furthermore, there is great concern about parental hesitancy toward COVID-19 vaccines, as previous studies have focused on adult vaccine hesitancy. The current study was conducted by UNICEF and funded by USAID to explore the drivers of routine and COVID-19 immunization behaviors among parents and caregivers in Kazakhstan. Using a cross-sectional methodology, researchers conducted 3081 face-to-face interviews with parents and caregivers of children aged 0–17 years across cities and villages in Kazakhstan. A tablet-based questionnaire (CAPI) was utilized, collecting participants' data on sociodemographic characteristics, childhood and COVID-19 vaccination behaviors, and potential drivers. Total of 239 participants (7.8%) were found to previously refuse vaccination due to their own beliefs. Stronger belief that vaccines are efficacious (AdjOR = 0.47), stronger belief that childhood vaccines are safe and danger of vaccine-preventable diseases is high (AdjOR = 0.73), firmer trust in societal factors (AdjOR = 0.77) and positive attitudes of family members toward immunization (AdjOR = 0.6) were significantly associated with parental refusal of childhood vaccines. The large proportion of respondents (N = 2,634, 85.6%) missed the COVID-19 vaccination of their child or were unwilling to get vaccinated. Stronger belief that COVID-19 vaccines are safe and efficacious (AdjsOR = 0.18), lacking important information about COVID-19 vaccines (AdjOR = 1.25) and parents being unvaccinated against COVID-19 (AdjOR = 2.3) were significant predictors of vaccine hesitancy. This study revealed numerous socio-demographic and behavioral factors significantly associated with parental refusal of childhood vaccines and hesitancy toward COVID-19 vaccines. Many parents not refusing vaccination possessed negative attitudes towards vaccines. Potential changes in their attitudes and beliefs of parents were observed compared to findings from pre-COVID era. Continuous monitoring of parental hesitancy, proper interventions and education of healthcare workers are suggested to reduce parental vaccine hesitancy. [ABSTRACT FROM AUTHOR]

To explore weight talk in the homes of racially/ethnically diverse immigrant/refugee children and their families. Qualitative interviews were conducted with parents of young children. Twin Cities, Minnesota. Parents from 150 families (25 families each from White, Black, Latino, Hmong, Native American, and Somali households) were recruited from primary care clinics. Eligibility criteria included: participating parent lived with a child aged 5–7 years, shared a meal with this child at least daily, and had another child living in the home. Weight talk (ie, weight-related conversations, teasing), intergenerational transmission of weight talk. Qualitative content analysis using Nvivo software. Themes were found for each of our 4 research questions. Themes included: (1) parents experienced weight talk in their own homes growing up; (2) parents believed their community or culture influenced weight talk in their home; (3) parents described different ways of approaching weight talk, including not discussing weight, being direct about weight, and playful teasing; and (4) parents described various strategies for addressing concerns about their children's weight. Results suggested weight and health were salient issues for racially/ethnically diverse parents. Further research is needed to investigate why some parents engage in weight teasing, what prompts weight teasing, and the differences between weight- and health-focused conversations to identify potential targets for intervention. Recommendations for health providers working with families with young children, such as training using nonstigmatizing language, are discussed. [ABSTRACT FROM AUTHOR]

School lunch programs are mandated by the US Code of Federal Regulations to serve pasteurized milk that is skim or 1% fat and fortified with vitamins A and D. In recent years, proposals have been made to alter nutritional requirements for school lunches and school lunch milk, including changes to the milk fat and flavor options available. The objective of this study was to evaluate parental understanding and perception of school lunch milk to better understand how changes to school lunch milk are perceived by parents. Four focus groups (n = 34) were conducted with parents of school-aged children (5–13 yr) who purchased milk as part of a lunch at school. Participants were asked about school lunch milk, including nutritional content, packaging, and flavoring. Focus groups included a build-your-own milk activity and discussion of children's milk products currently available on the market. Two subsequent online surveys were conducted with parents of school-aged children (survey 1, n = 216; survey 2, n = 133). Maximum difference scaling was used to evaluate what beverages parents would prefer their child to drink at school (survey 1) and which attributes of chocolate milk for children were most important to parents (survey 2). An adaptive choice-based conjoint activity (survey 1) included flavor, milk fat, heat treatment, label claims, and packaging type. Both surveys included questions to evaluate knowledge of milk nutrition and attitudes regarding milk and flavored milk. Agree/disagree questions were used in both surveys to assess parental opinions of school lunch milk. Survey 2 also included semantic differential (sliding scale) questions to assess parental opinions of chocolate milk and their acceptance of sugar alternatives in chocolate milk served in schools. Parents were familiar with the flavor options and packaging of school lunch milk, but expressed limited familiarity with school lunch milk fat content. Parents perceived milk to be healthy and a good source of vitamin D and calcium. From survey results, parents placed the highest importance on school lunch milk packaging, followed by milk fat percentage and flavoring over label claims and heat treatment. The ideal school lunch milk for parents was unflavored (white milk) or chocolate, 2% fat, and packaged in a cardboard gabletop carton. For school lunch chocolate milk, 3 distinct clusters of parents with differing opinions for children's chocolate milk were identified. Parents are largely unfamiliar with the specific attributes and nutritional profile of milk served in schools but believe that schools should offer milk to their children as part of breakfast and lunch. Parents in both surveys also displayed a preference for 2% fat milk over low-fat options, which provides actionable insight for both governmental bodies determining educational and nutritional policies for school meals and fluid milk producers seeking to optimize their products intended for schools. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the anxiety, depression, obsessive-compulsive disorder symptoms, and quality of life of children whose parents were healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic period. The participants completed a sociodemographic questionnaire, the depression inventory for children (CDI), the screening for anxiety disorders in children (SCARED), the Maudsley obsessive compulsive question list (MOCQL), and the pediatric quality of life inventory (PedsQL) using online applications. A total of 153 children and adolescents whose parents were healthcare workers and 356 children and adolescents whose parents were not healthcare workers were included in the study. One tenth of all children participating in our study had a high level of depression, and nearly half of them had a high level of anxiety. There was no significant difference in CDI (p = 0.306), SCARED (p = 0.841), and PedsQL (p = 0.863) scale scores between the two groups. The MOCQL scale scores were higher in the group whose parents were not health professionals for cleanliness (p <0.001), slowness (p = 0.001), and total score (p <0.001). It was found that all participants were affected by anxiety, depression, and quality of life decline; moreover, obsessive-compulsive symptoms were more common in children whose parents were healthcare workers. In this context, our findings could help determine possible mental health problems of children and adolescents whose parents are or are not healthcare workers. [ABSTRACT FROM AUTHOR]

In France, national guidelines recommend early detection and management of overweight and obesity in children, with multi-year systematic generation of children's body mass index (BMI) curves in primary care. It is important for the parents to understand the BMI curves displayed in the child's health notebook and to become involved in the care with health professionals. The aim of the current study was to compare parents' understanding of a BMI curve displayed using color coding versus their understanding of the same curve displayed without color coding. An observational, cross-sectional, comparative study was performed between February 1, 2021 and November 15, 2021. Adult parents with at least one child attending primary school were included. Two questionnaires testing parents' understanding were completed: one showing BMI curves without color coding (five questions) and one showing BMI curve with color coding (five questions). The primary endpoint was the proportion of parents achieving fully correct answers. Comparisons of endpoints between the color-coded and non-color-coded curve were performed using the McNemar test. Factors associated with the primary endpoint were investigated by mixed logistic regression models with the subject as a random effect. The 109 participants (45.4% response rate) had an average age of 39.4 ± 6.6 years; 81.7% were women. A total of 214 complete questionnaires were compared: The proportion of participants with fully correct responses was significantly higher using the BMI curve with color coding compared to the curve without color coding (86.0% vs. 54.2%, p <0.0001). In multivariate analysis, the use of color coding was significantly associated with a higher likelihood of achieving fully correct responses (odds ratio: 5.9, 95% CI: 3.0–11.2, p <0.0001). The use of color coding improved parents' understanding of BMI curves. Further research should explore equally the benefits and risks associated with weight loss and mental health when using a colored BMI curve for the detection and management of overweight and obese children. [ABSTRACT FROM AUTHOR]

To investigate the prevalence of sleep disturbances (SDs), their related comorbidities, interventions and the impact on the family for individuals with current SDs and those who had SDs in the past. Members of the Italian national association of parents of persons with autism (ANGSA) completed an anonymous online survey collecting demographic data, the presence of comorbidities and specific information on sleep arrangement and sleep disorders using a modified version of the of the Sleep Disturbance Scale for Children (SDSC). The final sample consisted of 143 participants, 90 patients presented current SDs (C_SDs) and 53 reported previous SDs (P_SDs). In the C_SDs group, the most prevalent sleep disorders were related to insomnia and, especially, difficulty falling asleep; a high number of individuals presented with restless sleep. Also, the parents in the P_SDs group retrospectively reported a high prevalence of insomnia with difficulty falling asleep, night awakenings and restless sleep. Parents reported that sleep hygiene practice were effective in less than one third of cases in both groups and the most used compound was immediate-release melatonin, followed by antihistamines and then benzodiazepines, antipsychotics, and antidepressants, with approximately 60–70% reported efficacy. Parents of both groups reported that insomnia negatively affected their children behavior and caused stress, mood changes or physical fatigue in their daily life. Our study shows that insomnia is most prevalent in individuals with autism with several consequences on children and family behavior and quality of life. As reported by parents, melatonin might be helpful for sleep disturbances in these children and the causes of restless sleep need further investigations. • We studied two groups of autistic subjects with current sleep disturbances (SDs) and previous SDs. • In both groups, the most prevalent sleep disorders were insomnia and restless sleep. • Sleep hygiene practice were effective in less than one third of cases in both groups. • Most used drugs were melatonin, antihistamines, benzodiazepines, antipsychotics, and antidepressants. • Insomnia negatively affected child behavior and stress, mood changes and fatigue in parents. [ABSTRACT FROM AUTHOR]

The US Latino/a population disproportionately lives in poverty and experiences household food insecurity, especially households with children. The Household Food Security Survey Module (FSSM) was originally developed among rural White women. Despite wide use in English and Spanish, how well the FSSM captures the food insecurity experiences of Latino/a households is not well known. This study explored how Latino/a caregivers understood, interpreted, and perceived FSSM items and responses, and how well quantitative FSSM responses captured their reported food insecurity experiences. Trained researchers conducted in-depth cognitive interviews in a qualitative study. Interviews were conducted between October 2021 and August 2022 with Latino/a adults (N = 62) experiencing food insecurity while caring for a child (aged 18 years or younger) in the same household, and living in California, New York, or Texas. Qualitative analysis using iterative summaries for data reduction focused on item interpretation, response patterns, and cross-cutting themes. Participants generally understood FSSM items as intended. The most salient findings were themes that applied across multiple FSSM items rather than wording issues with specific items. Underreporting of food insecurity was linked to nonaffirmative ("never") responses to items referencing not having enough money for food while describing reliance on nonmonetary resources (eg, food assistance or food pantries); emotional sensitivity to discussing food insecurity, particularly as it related to children; stigma and emotions related to skipping meals; and limited response options that participants believed did not reflect their experiences. These issues influenced multiple items, impeding ease of responding and leading to inaccurate responses in English- and Spanish-language versions. Assessing coping strategies and providing more acceptable response options could enhance FSSM validity. Considering emic perspectives of Latino/a caregivers and how food access experiences differ from quantitative survey measures of food security could strengthen policy and programs. [ABSTRACT FROM AUTHOR]

Radiographs provide critical information on developmental and eruption problems, detection of interface caries, pulpal and periapical pathologies in clinical examination. This study aimed to evaluate parents' knowledge, attitudes and behaviors towards dental radiographs. A cross-sectional study was conducted on the parents of 396 children who visited to the Pediatric Dentistry clinics. All participants were asked to answer a total of 26 questions. A questionnaire was developed to assess participants' attitudue, behavior and knowledge toward pediatric dental radiographies and provided information on their demographic characteristics. The number of positive attitudes and correct answers was scored based on items asked to the participants. In order to analyze the effect of demographic data on the obtained scores, a multivariate linear regression model was created. The significance level was accepted as 0.05 in all analyzes. Children's dental radiography experience affects parents' attitude score towards dental radiographs (t = 4.375, P < 0.001). Parents' level of knowledge about dental radiography has a positive effect on their attitudes (t = 5.510, P = 0.005). The education level of the parents and the frequency of visits to the dentist have a significant effect on the knowledge level of the parents about dental radiography (P < 0.05). When the correlation between knowledge and attitude scores is analyzed, it is observed that there is a statistically significant, weak and positive correlation between the two variables (r = 0.34, P < 0.001). In conclusion, parents who did not had dental radiographs before have a more negative attitude towards dental radiographs than those who have had dental radiographs. [ABSTRACT FROM AUTHOR]

To examine cooking practices, online information-seeking habits, and intervention preferences among parents with low income to inform the development of a digital cooking intervention on the basis of the Healthy Cooking Index. This formative research study included a brief survey followed by in-depth interviews (from February to April, 2021) with parents of a child aged 6–11 years with low income (n = 20; 100% female, 70% African American or Hispanic White). Interview transcripts were analyzed using a semistructured hybrid coding approach. Three main themes were identified to inform the development of the intervention: (1) current Healthy Cooking Index behaviors, (2) preferences for digital cooking intervention content, and (3) design and delivery preferences. A 7-step process was used to develop the intervention and integrate qualitative findings. Online culinary programs targeting parents with low income may consider short, mobile-friendly video formats and focus on easy-to-prepare recipes adaptable to family preferences. [ABSTRACT FROM AUTHOR]

Examine how experiencing the coronavirus disease 2019 (COVID-19) pandemic influenced adolescent independent eating occasions (iEOs) and iEO-related parenting practices from the perspective of parents and adolescents Cross-sectional remote interviews were conducted for this basic qualitative research study. Participants were a purposive sample of multiracial/ethnic adolescents aged 11–14 years and their parents from households with low income (n = 12 dyads) representing 9 US states. The main outcome measures were iEOs and iEO-related parenting practices. Data were analyzed using directed content analysis. About half of the parents indicated that their adolescents had more iEOs during the COVID-19 pandemic and that there were changes in the types of foods consumed during iEOs. In contrast, most adolescents indicated their iEOs had not changed remarkably in frequency or foods consumed since the onset of the pandemic. Most parents reported no change in how they taught their adolescents about healthy food, the rules for foods/beverages permitted during iEOs, or how they monitored what their adolescents ate during iEOs; adolescent reports were in general agreement. Most parents indicated that family members were home together more often during the pandemic, which increased cooking frequency. The effect of the COVID-19 pandemic on adolescents' iEOs varied, and the parenting practices used to influence iEOs remained stable during the pandemic. Families experienced having more time together and cooking at home more often. [ABSTRACT FROM AUTHOR]

To investigate the knowledge and attitudes of mothers living in Denmark on the storage and usage of their children's biological material. The Danish Neonatal Screening Biobank contains blood from the Phenylketonuria-screening test. Legal, ethical, and moral concerns have been raised in several countries of how consent is obtained best in pediatric biobank governance. Research on knowledge and attitudes of Danish parents on the usage of their children's biological material is scarce. A coproduced study between a mother and 2 researchers. We analyzed 5 online focus group interviews using Ricoeur's hermeneutical narrative analysis. Mothers have very little knowledge on the storage and usage of their children's biological material. They consider the Phenylketonuria-screening test to be part of a birth package, which leaves very little option of choice. They accept donating the material as a token of appreciation in an act of altruism toward the wider society but are only comfortable supporting Danish research. An exploration of the communal narrative build in the interviews reveal an overall feeling of duty to help benefit society, an overwhelming trust toward the health system, and epistemic unjust storage information practices. • Medical research increasingly depends on the coupling of biological data. Pediatric biobanking governance causes special concerns because of proxy parental consent practices. • Danish mothers have very low knowledge on the usage of their children's biological material for research but have unlimited trust in the Danish system to use the material benevolently. • Policy makers who claim focus on transparency and informed decisions should consider changing information practices of Neonatal Screening Biobanks. [ABSTRACT FROM AUTHOR]

Early integration of palliative care (PC) in hematopoietic cell transplantation (HCT) has demonstrated benefits, yet barriers remain, including perceived lack of patient/caregiver receptivity despite no data on attitudes toward PC and limited patient/caregiver reported outcomes in pediatric HCT. This study aimed to evaluate perceived symptom burden and patient/parent attitudes toward early PC integration in pediatric HCT. Following IRB approval, consent/assent, eligible participants were surveyed at St. Jude Children's Research Hospital including English-speaking patients aged 10–17, 1-month to 1-year from HCT, and their parents/primary-caregivers, as well as parent/primary-caregivers of living HCT recipients

Electronic patient-reported outcomes (e-PROs) in pediatric oncology may be useful to track patients' symptoms and quality of life (QoL). However, implementation in the clinical setting is limited and few studies have examined child and parent perspectives on e-PRO usage. This brief report aims to explore child and parent perspectives on the benefits of using e-PROs to routinely report on symptoms and QoL. We analyzed qualitative data embedded within the PediQUEST Response trial, a randomized controlled trial aimed at early palliative care integration for children with advanced cancer and their parents. Study dyads, made up of a child and their parent, completed weekly surveys assessing symptoms and QoL for 18 weeks, and were invited to participate in an audio-recorded exit interview to share study feedback. Interview transcripts were analyzed with a thematic analysis approach, with emergent themes centered on the benefits of e-PRO usage reported here. Of 154 total randomized participants, we collected 147 exit interviews representing 105 child participants. Interviewed children (n=47) and parents (n=104) were mostly White and non-Hispanic. Two predominant themes emerged regarding e-PRO benefits:1) raised reflection and awareness of self and others' experiences, and 2) increased communication and connection between parents and children or between study dyads and care teams through survey prompted discussion. Advanced pediatric cancer patients and their parents found benefit in completing routine e-PROs as they promoted greater reflection and awareness and increased communication. These results may inform further integration of e-PROs in routine pediatric oncology care. [ABSTRACT FROM AUTHOR]

Understanding the long-term consequences of the COVID-19 pandemic on children's mental health is needed to deal with it successfully. Our study focuses on the pandemic's impact on children's mental health in the middle of its second year in Lithuania. To assess the impact of the pandemic and related restrictions on the mental health of 11–17-year-old children in the second year of the pandemic from the perspectives of children and parents. 389 11–17-year-old children and 392 parents/guardians participated in the study. Data were collected from March 9, 2021, to April 30, 2021. A cross-sectional study was conducted with two online questionnaires. Children provided information about changes in emotions and behavior during quarantine, and the influence this had on interpersonal relationships. Parents/guardians answered questions on their children's emotional state, behavior, relationships, and daily life. Anxiety was the most frequent children's complaint. Girls reported the experience of getting angry more easily, anxiety, stress and tensions, profound tiredness, overall negative changes, and they were more worried about family and friends being infected, while boys were unable to participate in daily activities and were less worried about being infected. Children more frequently than parents reported severe loneliness, sadness, fatigue, impaired concentration, increased sleeping time, improved interpersonal relationships with friends and impaired ones with siblings, and feeling severely worried about family members or friends being infected. Parents more frequently reported children's inability to participate in daily activities, improved children-parent relations, and severe children's anxiety about being infected. In its second year, the pandemic continues to have an extensive negative impact on children's mental health. Significant discrepancies were found between children and parents' perceptions of quarantine consequences on children's mental health, as parents tend to underestimate it. Such undervaluation can be an obstacle to getting mental health services for those children in need of them. [ABSTRACT FROM AUTHOR]

The assessment of attention-deficit/hyperactivity disorder (ADHD) typically relies on subjective observer reports from parents, teachers, or the young person, combined with clinical observation and history. Children and young people can often experience lengthy delays to assessment and medication initiation resulting from conflicting or missing observer reports and diagnostic uncertainty. However, more recently, a computerised test of attention, impulsivity and activity (QbTest) has been implemented as an adjunct to standard clinical practice, with the aim to provide a more objective measure of ADHD symptoms. Here, we discuss the evidence for the clinical utility of QbTest to aid in the assessment and monitoring of ADHD. Drawing on key literature and real-world case studies, we show the potential benefits that QbTest may have in creating service efficiencies for ADHD care, but also note limitations in diagnostic accuracy, importantly demonstrating that QbTest should supplement and not replace standard care. We review key barriers and facilitators to implementation, to aid decision making and planning in how to integrate QbTest in paediatric services. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Infant well-child visits are increasingly being explored as opportunities to address parental postpartum health needs, including those related to reproductive health. To inform potential pediatric clinic-based interventions, this study assessed postpartum contraceptive needs and health services preferences. METHODS: We surveyed postpartum individuals attending 2 to 6-month well-child visits at three Northern California pediatric clinics (2019--20). We examined unmet contraceptive needs; the acceptability of contraceptive education, counseling, and provision at well-child visits; and sociodemographic and clinical correlates. We conducted univariate and multivariable regression modeling to assess associations between sociodemographic and clinical variables, the status of contraceptive needs, and acceptability measures. RESULTS: Study participants (n = 263) were diverse in terms of race and ethnicity (13% Asian, 9% Black, 37% Latinx, 12% Multi-racial or Other, 29% White), and socioeconomic status. Overall, 25% had unmet contraceptive needs. Unmet need was more common among participants who had delivered more recently, were multiparous, or reported ≥ 1 barrier to obtaining contraception; postpartum visit attendance, education, race, and ethnicity were not associated with unmet need. Most participants deemed the following acceptable in the pediatric clinic: receiving contraceptive information (85%), discussing contraception (86%), and obtaining a contraceptive method (81%). Acceptability of these services was greater among participants with unmet contraceptive needs, better self-rated health, and private insurance (all P < .05). CONCLUSIONS: A quarter of participants had unmet contraceptive needs beyond the early postpartum period. Most considered the pediatric clinic an acceptable place to address contraception, suggesting the pediatric clinic may be a suitable setting for interventions aiming to prevent undesired pregnancies and their sequelae. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Social needs interventions in clinical settings can improve child health outcomes; however, they are not routinely delivered in routine pediatric care. The electronic health record (EHR) can support these interventions, but parent engagement in the development of EHR-based social needs interventions is lacking. The aim of this study was to assess parent perspectives on EHR-based social needs screening and documentation and identify family-centered approaches for screening design and implementation. METHODS: We enrolled 20 parents from four pediatric primary care clinics. Parents completed a social risk questionnaire from an existing EHR module and participated in qualitative interviews. Parents were asked about the acceptability of EHR-based social needs screening and documentation and preferences for screening administration. A hybrid deductive-inductive approach was used to analyze qualitative data. RESULTS: Parents identified the benefits of social needs screening and documentation but expressed concerns related to privacy, fear of negative outcomes, and use of outdated documentation. Some felt self-administered electronic questionnaires would mitigate parent discomfort and encourage disclosure of social needs, while others felt face-to-face screening would be more effective. Parents stressed the importance of transparency on the purpose of social needs screening and the use of data. CONCLUSIONS: This work can inform the design and implementation of EHR-based social needs interventions that are acceptable and feasible for parents. Findings suggest strategies such as clear communication and multi-modal delivery methods may enhance intervention uptake. Future work should integrate feedback from multiple stakeholders to design and evaluate interventions that are family-centered and feasible to implement in clinical settings. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine climate change concerns among parents in Chicago, a large and diverse urban setting that experiences climate change-related weather events and rising water levels which have the potential to affect more than 1 million children living in the city. METHODS: We collected data through the Voices of Child Health in Chicago Parent Panel Survey from May to July 2021. Parents indicated their personal level of worry about climate change, concern about the impact of climate change on themselves and their families, and how well they understood the issue of climate change. Parents also provided demographic information. RESULTS: Parents reported high levels of concern about climate change in general and specifically about the impact on their families. Logistic regression indicated that parents who were Latine/Hispanic (vs White) and those who felt they understood climate change well (vs less well) had higher odds of reporting high levels of concern. Parents with some college (vs high school education or below) had lower odds of high concern. CONCLUSIONS: Parents indicated high levels of concern about climate change and its potential impact on their families. These results can help inform pediatricians' discussions with families about child health in the context of a changing climate. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess if 100% fruit juice intake prior to 6 months is associated with juice and sugar-sweetened beverage (SSB) intake at 24 months and whether this differs by sociodemographic factors. METHODS: We used longitudinal data from infants enrolled in the control (no obesity intervention) arm of Greenlight, a cluster randomized trial to prevent childhood obesity which included parent-reported child 100% fruit juice intake at all well child checks between 2 and 24 months. We studied the relationship between the age of juice introduction (before vs after 6 months) and juice and SSB intake at 24 months using negative binomial regression while controlling for baseline sociodemographic factors. RESULTS: We report results for 187 participants (43% Hispanic, 39% non-Hispanic Black), more than half (54%) of whom had reported 100% fruit juice intake before 6 months. Average 100% fruit juice intake at 24 months was greater than the recommended amount (of 4 oz) and was 8.2 oz and 5.3 oz for those who had and had not, respectively, been introduced to juice before 6 months. In adjusted models, early introduction of juice was associated with a 43% (95% confidence interval: 5%--96%) increase in juice intake at 24 months. CONCLUSIONS: 100% fruit juice intake exceeding recommended levels at 6 and 24 months in this diverse cohort was prevalent. Introducing 100% fruit juice prior to 6 months may put children at greater risk for more juice intake as they age. Further research is necessary to determine if early guidance can reduce juice intake. [ABSTRACT FROM AUTHOR]