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Associations were evaluated between plasma B12 (low in many Guatemalan infants), development at 12 mo, and responses to 9 mo supplemental B12 or beef. Recruitment criteria were age 12 mo, not waste...

This paper is the third in the Child Development Series. The first paper showed that more than 200 million children under 5 years of age in developing countries do not reach their developmental potential. The second paper identified four well-documented risks: stunting, iodine deficiency, iron deficiency anaemia, and inadequate cognitive stimulation, plus four potential risks based on epidemiological evidence: maternal depression, violence exposure, environmental contamination, and malaria. This paper assesses strategies to promote child development and to prevent or ameliorate the loss of developmental potential. The most effective early child development programmes provide direct learning experiences to children and families, are targeted toward younger and disadvantaged children, are of longer duration, high quality, and high intensity, and are integrated with family support, health, nutrition, or educational systems and services. Despite convincing evidence, programme coverage is low. To achieve the Millennium Development Goals of reducing poverty and ensuring primary school completion for both girls and boys, governments and civil society should consider expanding high quality, cost-effective early child development programmes.

The prevalence of iron deficiency among infants and young children living in developing countries is high. Because of its chemical properties--namely, its oxidative potential--iron functions in several biological systems that are crucial to human health. Iron, which is not easily eliminated from the body, can also cause harm through oxidative stress, interference with the absorption or metabolism of other nutrients, and suppression of critical enzymatic activities. We reviewed 26 randomized controlled trials of preventive, oral iron supplementation in young children (aged 0-59 mo) living in developing countries to ascertain the associated health benefits and risks. The outcomes investigated were anemia, development, growth, morbidity, and mortality. Initial hemoglobin concentrations and iron status were considered as effect modifiers, although few studies included such subgroup analyses. Among iron-deficient or anemic children, hemoglobin concentrations were improved with iron supplementation. Reductions in cognitive and motor development deficits were observed in iron-deficient or anemic children, particularly with longer-duration, lower-dose regimens. With iron supplementation, weight gains were adversely affected in iron-replete children; the effects on height were inconclusive. Most studies found no effect on morbidity, although few had sample sizes or study designs that were adequate for drawing conclusions. In a malaria-endemic population of Zanzibar, significant increases in serious adverse events were associated with iron supplementation, whereas, in Nepal, no effects on mortality in young children were found. More research is needed in populations affected by HIV and tuberculosis. Iron supplementation in preventive programs may need to be targeted through identification of iron-deficient children.

Although the development of overweight is a chronic disease that is influenced by genetic, metabolic, and physiological factors, there are environmental and psychological factors that contribute to overweight and therefore can be the focus of prevention and treatment efforts. The purpose of the Special Issue of the Journal of Pediatric Psychology on pediatric overweight is to focus on the environmental, familial, psychological, and health factors associated with pediatric overweight, with an ultimate goal of informing prevention and treatment.

CONTEXT. Rates of rapid second births among low-income black adolescent mothers range from 20% to 50%. Most efforts to prevent rapid second births have been unsuccessful. OBJECTIVES. There were 4 objectives: (1) to examine whether a home-based mentoring intervention was effective in preventing second births within 2 years of the adolescent mother's first delivery; (2) to examine whether greater intervention participation increased the likelihood of preventing a second birth; (3) to examine whether second births were better predicted from a risk practice perspective or a family formation perspective, based on information collected at delivery; and (4) to examine how risk practices or family formation over the first 2 years of parenthood were related to a second birth. DESIGN. We conducted a randomized, controlled trial of a home-based intervention curriculum, based on social cognitive theory, and focused on interpersonal negotiation skills, adolescent development, and parenting. The curriculum was delivered biweekly until the infant's first birthday by college-educated, black, single mothers who served as mentors, presenting themselves as “big sisters.” The control group received usual care. Follow-up evaluations were conducted in the homes 6, 13, and 24 months after recruitment. METHODS. Participants were recruited from urban hospitals at delivery and were 181 first time, black adolescent mothers ( RESULTS. Intent-to-treat analyses revealed that control mothers were more likely than intervention mothers to have a second infant. The complier average causal effect was used to account for variability in intervention participation. Having ≥2 intervention visits increased the odds of not having a second infant more than threefold. Only 1 mother who completed ≥6 visits had a second infant. At delivery of their first infant, mothers who had a second infant were slightly older (16.7 vs 16.2 years) and were more likely to have been arrested (30% vs 14%). There were no differences in baseline contraceptive use or other measures of risk or family formation. At 24 months, mothers who had a second infant reported high self-esteem, positive life events, and romantic involvement and residence with the first infant's father. At 24 months, there were no differences in marital rates (2%), risk practices, or contraceptive use between mothers who did and did not have a second infant. Mothers who did not have a second infant were marginally more likely to report no plans for contraception in their next sexual contact compared with mothers who had a second infant (22% vs 8%, respectively). CONCLUSIONS. A home-based intervention founded on a mentorship model and targeted toward adolescent development, including negotiation skills, was effective in preventing rapid repeat births among low-income, black adolescent mothers. The effectiveness of the intervention could be seen after only 2 visits and increased over time. There were no second births among mothers who attended ≥8 sessions. There was no evidence that risk behavior or contraceptive use was related to rapid second births. There was some evidence that rapid second births among adolescent mothers were regarded as desirable and as part of a move toward increasing autonomy and family formation, thereby undermining intervention programs that focus on risk avoidance. Findings suggest the merits of a mentoring program for low-income, black adolescent mothers, based on a relatively brief (6–8 sessions) curriculum targeted toward adolescent development and interpersonal negotiation skills.

Objective: To examine how maternal infant feeding practices vary by ethnicity in a low-income statewide sample. Methods: Bilingual interviewers conducted a survey on 795 mothers of infants under 13...

Across all specialties of medicine, there is increasing attention to developing and using benchmarks to evaluate productivity and to establish compensation plans, that is, “pay for performance.” Psychologists have to balance the unique aspects of their professional responsibilities with the need of administrators to have systems that are equitable across faculty members. Thus, psychologists need empirical data to develop equitable benchmarks that are applicable to psychological practice and understandable to physician colleagues and administrators. The article by Opipari-Arrigan and colleagues (in press) provides initial guidelines; however, it does not include benchmarks for mentoring, an important area of professional activity. Measuring productivity may be necessary if mentoring is to be sustained at high levels of excellence.

This study sought to determine how dietary patterns, self-esteem, depressive symptoms, and intention to lose weight were associated with body size among adolescent African-American mothers 1 year after delivery and with changes in body size over the next year.Cross-sectional and longitudinal self-reported measures were collected 1 year after delivery. Weight and height were collected 1 and 2 years after delivery.The subjects were 118 low-income, African-American adolescent mothers recruited after the birth of their first child.Multivariate analysis of covariance and multivariate regression analysis were conducted to examine predictors of body size 1 year after delivery and changes in body size over the next year. Analyses were adjusted for maternal age, education, breastfeeding history, and intervention.One year after delivery, 33.0% of mothers were overweight (body mass index [BMI]or =95th percentile) and 23.7% were at risk for overweight (BMIor =85th and95th percentile). Mothers consumed a daily average of 2,527 kcal and 4.1 high-fat snacks. A total of 11% of normal-weight mothers, 22% of mothers at risk for overweight, and 44% of overweight mothers reported intention to lose weight, chi(2)=10.8, P.01. Average maternal BMI z score increased 0.13 (3.9 kg) between 1 and 2 years after delivery, P.01. Dietary patterns, self-esteem, depressive symptoms, and intention to lose weight were not related to body size or increase in body size.One year after delivery, overweight among adolescent mothers was common and increased over time. Although nearly half of overweight mothers reported an intention to lose weight, their weight gain did not differ from that of other mothers, suggesting that they lack effective weight-loss behaviors, and may be good candidates for intervention. African-American adolescent mothers have high rates of overweight and snack consumption and may benefit from strategies to identify nutritious, palatable, affordable, and accessible alternatives to high-fat snack food.

Context. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is the largest food supplement program in the United States, serving almost 7 500 000 participants in 2002. Because the program is a grant program, rather than an entitlement program, Congress is not mandated to allocate funds to serve all eligible participants. Little is known about the effects of WIC on infant growth, health, and food security.Objective. To examine associations between WIC participation and indicators of underweight, overweight, length, caregiver-perceived health, and household food security among infants ≤12 months of age, at 6 urban hospitals and clinics.Design and Setting. A multisite study with cross-sectional surveys administered at urban medical centers in 5 states and Washington, DC, from August 1998 though December 2001.Participants. A total of 5923 WIC-eligible caregivers of infants ≤12 months of age were interviewed at hospital clinics and emergency departments.Main Outcome Measures. Weight-for-age, length-for-age, weight-for-length, caregiver’s perception of infant’s health, and household food security.Results. Ninety-one percent of WIC-eligible families were receiving WIC assistance. Of the eligible families not receiving WIC assistance, 64% reported access problems and 36% denied a need for WIC. The weight and length of WIC assistance recipients, adjusted for age and gender, were consistent with national normative values. With control for potential confounding family variables (site, housing subsidy, employment status, education, and receipt of food stamps or Temporary Assistance for Needy Families) and infant variables (race/ethnicity, birth weight, months breastfed, and age), infants who did not receive WIC assistance because of access problems were more likely to be underweight (weight-for-age z score = −0.23 vs 0.009), short (length-for-age z score = −0.23 vs −0.02), and perceived as having fair or poor health (adjusted odds ratio: 1.92; 95% confidence interval: 1.29–2.87), compared with WIC assistance recipients. Rates of overweight, based on weight-for-length of >95th percentile, varied from 7% to 9% and did not differ among the 3 groups but were higher than the 5% expected from national growth charts. Rates of food insecurity were consistent with national data for minority households with children. Families that did not receive WIC assistance because of access problems had higher rates of food insecurity (28%) than did WIC participants (23%), although differences were not significant after covariate control. Caregivers who did not perceive a need for WIC services had more economic and personal resources than did WIC participants and were less likely to be food-insecure, but there were no differences in infants’ weight-for-age, perceived health, or overweight between families that did not perceive a need for WIC services and those that received WIC assistance.Conclusions. Infants ≤12 months of age benefit from WIC participation. Health care providers should promote WIC utilization for eligible families and advocate that WIC receive support to reduce waiting lists and eliminate barriers that interfere with access.

Objective Infants who are born small for gestational age (SGA) are at risk for developmental delays, which may be related to deficiencies in zinc, an essential trace metal, or to deficiencies in their ability to elicit caregiver responsiveness (functional isolation hypothesis). The objective of this study was to evaluate at 6 and 10 months of age the impact of a 9-month supplementation trial of 5 mg of zinc on the development and behavior of infants who were born SGA and to evaluate infants’ ability to elicit responsive caregiver behavior.Methods A randomized, controlled trial of zinc supplementation was conducted among 200 infants in a low-income, urban community in Delhi, India. Infants were recruited when they were full term (>36 weeks) and SGA (birth weight Results There were no direct effects of zinc supplementation on the infants’ development or behavior at either 6 or 10 months. In a subgroup analysis among the zinc-supplemented infants, lower birth weight infants were perceived to be more temperamentally difficult than higher weight infants; in the control group, birth weight was not associated with temperament. Heavier birth weight infants had better scores on all measures of development and behavior at 6 months and on changes in mental and motor development from 6 to 10 months, compared with lighter birth weight infants. Boys had better weight gain and higher scores on mental development and emotional regulation than girls. Infants who were from families of higher socioeconomic status (indexed by parental education, house size, and home ownership) had higher scores on mental development and orientation/engagement (exploratory behavior) than infants who were from families of lower socioeconomic status. In keeping with the functional isolation hypothesis, caregiver responsiveness was associated with infant irritability, controlling for socioeconomic status, gender, birth weight, and weight gain. Responsive mothers were more likely to perceive their infants to be temperamentally easy than less responsive mothers.Conclusion Possible explanations for the lack of effects of zinc supplementation on infant development and behavior include 1) subtle effects of zinc supplementation that may not have been detected by the Bayley Scales, 2) interference with other nutritional deficiencies, or 3) no impact of zinc deficiency on infants’ development and behavior. The link between birth weight and irritability among infants in the zinc supplementation group suggests that the response to zinc supplementation may differ by birth weight, with irritability occurring among the most vulnerable infants. Longer term follow-up studies among zinc-supplemented infants are needed to examine whether early supplementation leads to developmental or behavioral changes that have an impact on school-age performance. The relationship between infant irritability and low maternal responsiveness lends support to the functional isolation hypothesis and the importance of asking caregivers about infant temperament.

Objective. To examine the association of positive report on a maternal depression screen (PDS) with loss or reduction of welfare support and foods stamps, household food insecurity, and child health measures among children aged ≤36 months at 6 urban hospitals and clinics.Methods. A convenience sample of 5306 mothers, whose children Results. PDS status was associated with loss or reduction of welfare support and food stamps, household food insecurity, fair/poor child health rating, and history of child hospitalization since birth but not low child growth status measures or admission to the hospital at the time of ED visit. After controlling for study site, maternal race, education, and insurance type as well as child low birth weight status, mothers with PDS were more likely to report fair/poor child health (adjusted odds ratio [AOR]: 1.58; 95% confidence interval [CI]: 1.33–1.88) and hospitalizations during the child’s lifetime (AOR: 1.20; 95% CI: 1.03–1.39), compared with mothers without PDS. Controlling for the same variables, mothers with PDS were more likely to report decreased welfare support (AOR: 1.52; 95% CI: 1.03–2.25), to have lost food stamps (AOR: 1.56; 95% CI: 1.06–2.30), and reported more household food insecurity (AOR: 2.69; 95% CI: 2.33–3.11) than mothers without PDS.Conclusion. Positive maternal depression screen status noted in pediatric clinical samples of infants and toddlers is associated with poorer reported child health status, household food insecurity, and loss of federal financial support and food stamps. Although the direction of effects cannot be determined in this cross-sectional survey, child health providers and policy makers should be aware of the potential impact of maternal depression on child health in the context of welfare reform.

This study examined the cognitive development of children in poverty with normal growth and those with a history of failure to thrive (FTT) prospectively from infancy through age 6.Participants were 226 low-income infants with normal birthweight and no perinatal complications, congenital problems, or chronic illnesses. One hundred and twenty-eight children experienced FTT and were treated in an interdisciplinary clinic, and 98 had normal growth.Cognitive development declined in both groups to 1.0-1.5 SD below the norm. Children with FTT had lower cognitive scores than children with adequate growth through age 4, followed by recovery. By ages 5 and 6, there were no differences in cognitive scores based on the children's growth history. Using hierarchical linear modeling, child-centered home environment and small family size were related to better cognitive performance.The low scores of both groups point to the need for programs promoting a child-centered home environment.

Objective: To use Nath et al.’s (1991) conceptual model of adolescent parenting to examine the relationship between resiliency factors measured shortly after delivery and maternal parenting behavior at 6 months. Method: We recruited 181 first-time, adolescent African American mothers at delivery. Data on resiliency factors (maturity, self-esteem, and mother-grandmother relationships) were collected when infants were 1‐4 weeks of age. Data on parental nurturance and parenting satisfaction were examined through observations and self-report at 6 months. Results: Multiple regression analyses were used to examine the longitudinal impact of resiliency factors on parental nurturance and parenting satisfaction. Maternal maturity, positive self-esteem, and positive adolescent mother-grandmother relationships (characterized by autonomy and mutuality) were associated with better parenting outcomes. Maternal parenting satisfaction was lowest when infants were temperamentally difficult and mothers and grandmothers had a confrontational relationship. Conclusions: Longitudinal associations between mother-grandmother relationships at delivery and parental behavior and satisfaction 6 months later may suggest an intergenerational transmission of parenting style. Recommendations are provided for intervention programs to enhance mother-grandmother relationships in contexts where adolescents are required to live with a guardian to receive government assistance.

To investigate fathers' involvement with their children using an ecological model, multiple respondents, and a comprehensive definition of fathers' involvement. The study's primary objectives were: (a) to describe the characteristics of fathers whose infants are born to low-income, urban, African-American adolescent mothers; (b) to describe the ways in which fathers are involved with their children; and (c) to identify factors associated with fathers' involvement.A total of 181 first-time mothers (aged18 years) living in three-generation households (infant, mother, and grandmother) were recruited from three urban hospitals shortly after delivery and invited to participate in a longitudinal study of parenting. Mothers provided the name of their infant's father; 109 (60%) of the fathers also agreed to participate. Baseline interviews of mothers, fathers, and grandmothers addressed demographic characteristics, relationships, and the father's involvement with his child.Three multivariate regression models were used to identify factors associated with paternal involvement, explaining 35% to 51% of the variability in father involvement. Regardless of the respondent (mother, father, or grandmother), paternal involvement was predicted most strongly by the quality of the parents' romantic relationship. The father's employment status, the maternal grandmother's education, and the father's relationship with the baby's maternal grandmother were also associated with paternal involvement.The study confirmed the value of an ecological perspective that uses multiple informants and a comprehensive definition of father involvement that includes multiple role functions. Efforts to increase paternal involvement should help young parents separate the father's relationship with their child from the romantic relationship between the mother and father, address the roles played by maternal grandmothers, and assist fathers to complete their education, and obtain and keep jobs.

Investigated how maternal depression influenced the relation between mothers' perceptions of the quality of their partner interactions and behavior problems among their preschool children. Participants included 194 low-income families from 4 sites. Approximately three fourths of the mothers (72%, n = 139) identified a male partner and comprised the analysis sample. Mothers were adolescents (< or = age 19) at delivery, and data were gathered when children were 4 to 5 years of age. In this high-risk sample, 42.4% of the children had been maltreated, 36% had externalizing scores in the clinical range, and 10.8% had internalizing scores in the clinical range. Multiple regression analyses revealed (a) maternal perceptions of negative partner interactions were associated with more internalizing behavior problems among the children, adjusting for the effects of maltreatment; (b) maternal depression mediated the relation between the maternal perceptions of the quality of partner interactions and children's internalizing and externalizing behavior problems; and (c) maternal perceptions of positive partner interactions did not protect children from internalizing or externalizing behavior problems associated with maltreatment. Programs for adolescent mothers should provide screening and treatment for depressive symptoms and help partners negotiate caregiving roles and mutually satisfying relationships.

Research suggests that fathers' involvement in their children's lives is associated with enhanced child functioning. The current study examined (a) whether presence of a father was associated with better child functioning, (b) whether children's perceptions of fathers' support was associated with better functioning, and (c) whether the above association was moderated by the father's relationship to the child, the child's race, and the child's gender. Participants included 855 six-year-old children and their caregivers. Father presence was associated with better cognitive development and greater perceived competence by the children. For children with a father figure, those who described greater father support had a stronger sense of social competence and fewer depressive symptoms. The associations did not differ by child's gender, race, or relationship to the father figure. These findings support the value of fathers' presence and support to their children's functioning. Priorities for future research include clarifying what motivates fathers to be positively involved in their children's lives and finding strategies to achieve this.

Objectives.There is mounting concern about how mothers' own victimization experiences affect their children. This study examines the effects of mothers' victimization on their own mental health and parenting and on their children's behavior, development, and health. The effects of both timing and type of victimization are assessed. A related objective was to determine if there was a cumulative risk effect produced by victimization during both childhood and adulthood, or both physical and sexual.Setting.Urban families in an eastern state and urban and rural families in a southern state.Participants.A total of 419 mothers and their children 6 to 7 years old were identified from 2 sites. The eastern sample was recruited in the first 2 years of life from 3 pediatric clinics: 1 for children at high risk for human immunodeficiency virus disease, 1 for children with failure to thrive, and a third providing pediatric primary care. The southern sample was derived from a cohort of children at risk for adverse health or developmental outcomes, plus a systematic sampling of controls, recruited from area hospitals. At age 4, a random sample of children from the original cohort who had been maltreated along with a matched comparison group of nonmaltreated children were selected.Results.In general, mothers victimized during both childhood and adulthood had poorer outcomes than mothers victimized during either childhood/adolescence or adulthood who in turn had worse outcomes than mothers with no history of victimization. This manifested as more maternal depressive symptoms, harsher parenting, and more externalizing and internalizing behavior problems in their children. There were no significant differences in maternal functioning or child outcomes between those abused in childhood and those abused in adulthood. These findings were similar for type of victimization. Mothers' depression and harsh parenting were directly associated with their children's internalizing and externalizing behavior problems.Conclusions.Maternal victimization appears to be a highly prevalent problem in high-risk samples and is associated with harmful implications for mental health and parenting, as well as for the offspring. Pediatricians need to consider past and current victimization of mothers. Routine screening for these problems, followed by appropriate evaluation and intervention may reduce maternal depression, improve parenting, and reduce the incidence of behavior problems in children.

Objective: A cumulative risk model was used to examine the relationship among failure-to-thrive (FTT), maltreatment, and four aspects of children’s development: cognitive performance (standardized testing), adaptive functioning at school, and classroom behavior (teacher report), and behavior at home (maternal report). Method: The sample included 193 6-year-old children and their families, recruited from pediatric clinics serving inner-city, low-income, primarily African-American families, who were part of a longitudinal investigation of child development and maltreatment. Four risk groups were formed based on their growth and maltreatment history: neither FTT nor Maltreatment, FTT Only, Maltreatment Only, and both FTT and Maltreatment. FTT was defined as a deceleration in weight gain (weight-for-age below the 5th percentile) prior to 25 months of age among children born at term with birth weight appropriate for gestational age. Maltreatment was defined as having at least one report to CPS for neglect, physical abuse and/or sexual abuse. Results: Risk status was negatively associated with each of the four developmental outcomes. Children with a history of both FTT and maltreatment had more behavior problems and worse cognitive performance and school functioning than children with neither risk factor. Children with only one risk factor (either FTT or maltreatment) achieved intermediate scores. Conclusions: Findings support a cumulative risk model as being more detrimental to children’s development than the presence of a single risk factor alone, consistent with theories linking the accumulation of environmental risks to negative consequences. These results underscore the importance of interventions to prevent both FTT and maltreatment during children’s early years.

To examine the association between father involvement and child neglect.Cohort study.Participants were recruited from an inner-city pediatric primary care clinic and a clinic for children at risk for human immunodeficiency virus infection in a teaching hospital.Mothers and fathers or father figures, and 244 five-year olds participating in a longitudinal study.Child neglect measured via home observation, a videotaped mother-child interaction, and child protective services reports.A father or father figure was identified for 72% of the children. Rates of neglect ranged between 11% and 30%. Father absence alone was not associated with neglect. However, in families with an identified and interviewed father, a longer duration of involvement (P.01), a greater sense of parenting efficacy (P.01), more involvement with household tasks (P.05), and less involvement with child care (P.05) were associated with less neglect. The overall model explained 26.5% of the variance in neglect.There is substantial involvement of fathers in a subset of this high-risk sample, although more than a quarter of the children lacked a father or father figure. The mere presence of a father did not significantly influence the neglect of the children; rather, the nature of his involvement did. Fathers who felt more effective as parents were less likely to have neglected their children. A greater sense of efficacy may reflect parenting skills and be important in enhancing the contribution of fathers to their children's well-being. Pediatric health care providers can play a valuable role in enhancing the involvement and skills of fathers.

Background: African American adolescents living in high-poverty urban settings are at increased risk for early sexual initiation and sexually transmitted diseases. Objective: To determine whether parental stategies to monitor their children’s social behavior and to communicate with them about sexual risks help to reduce the initiation of risky sexual behavior and prevent the resulting adverse health outcomes. Methods: To assess the viability of these strategies, we surveyed a stratified cross-section of African American children aged 9 to 17 years (N = 355) living in urban public housing. Talking computers were used to increase the confidentiality and comparability of the interviews across the wide age range. Results: Children who reported high levels of parental monitoring were less likely to report initiating sex in preadolescence (aged #10 years) and reported lower rates of sexual initiation as they aged. Children who reported receiving both greater monitoring and communication concerning sexual risks were also less likely to have engaged in anal sex. Communication was also positively related to the initiation of condom use and consistent condom use. The protective correlates of these parenting strategies were independent of the type of guardian (mother vs other family member). Conclusion: Interventions with parents and other guardians to increase monitoring and communication about sexual risks seem to be promising healthpromotion strategies for adolescents in high-risk settings.

teractive process that varies across children and is embedded in multiple social levels, extending from the family through cultural factors. The ecological model is based on systems theory, in which changes in any one component of the model affect all other components. Children are conceptualized as active contributors within their primary context-the family. At a broader level, feeding is influenced by the ethnotheories that families hold about feeding and by cultural norms for the timing, type, and amount of food that children should eat (Dettwyler, 1989). From a child’s perspective, feeding requires the integration of multiple systems, including temperament, physical development, and psychosocial development. For example, children are unable to eat solids before they have achieved the oral motor control necessary to move food to the back of their mouths in preparation for swallowing. When solid food is introduced too early, while feeding is still dominated by sucking, food is often pushed forward and out of the mouth, as though the child were rejecting it. Caregivers may misinterpret this action as a signal that the child is rejecting the food or rejecting the caregiver, rather than a sign that the child is not ready for the feeding challenges required of solid foods. If the caregiver responds to the perceived rejection with anger or by intensifying the pressure on the child to eat, mealtime can become stressful and unsuccessful to both the child and the caregiver. Thus, feeding problems may be avoided when clinicians strive to understand caregiver interpretations of their children’s behavior and address their perceptions through anticipatory guidance. Journal of Pediatric Psychology, Vol. 24, No. 3, 1999, pp. 217–219

Relationships among neglect and child and family characteristics were examined in a sample of 121 urban, low-income families with a child under 30 months. Maternal reports of more difficult child temperament predicted emotional neglect; family context was indirectly related, as mothers in well functioning families with more support reported their children as being less difficult. Neither child temperament nor family context was related to physical neglect.

Objective : To identify perinatal factors that are predictive of disruption in primary caregiving among infants of substance abusing women. Method : A randomized longitudinal cohort study. One hundred and fifty two mother/infant dyads were assessed for evidence of disruption of primary caregiving or neglect during the first 18 months of life, defined by mother's inability to provide care. Data analyzed included neonatal characteristics, urine toxicology at delivery, maternal history of drug use, maternal depression, social support, and social and health history. Results : Sixty-six infants (43.4%) had disruption in their primary care during the first 18 months of their life, 86 infants (56.6%) remained in the care of their mothers. Women who were younger, were heroin users, had two or more children, had other children in foster care, and reported depressive symptoms were least likely to provide ongoing primary care for their infant. Conclusions : Although all infants born to substance abusing women are at a high risk for disruption in the continuity of their primary caregiving, maternal demographic and psychosocial factors present at delivery can predict which infants are likely to experience an early disruption in their primary caregiving. Identifying these families can enable health care providers to monitor them more closely and, when appropriate, encourage support from the extended family.

Objective. To use social learning theory to develop and examine the effectiveness of a 15-minute, culturally sensitive videotape in altering mealtime communication and attitudes among African-American adolescent mothers. Design. Randomized clinical trial with baseline and follow-up evaluations. Setting. High schools, WIC (Women, Infants, and Children) Clinics, and Family Support Centers serving low-income families. Participants. Fifty-nine first-time, African-American adolescent mothers of infants. Intervention. Intervention group viewed and received a copy of a videotape titled “Feeding Your Baby With Love.” The messages, title, music, and setting were designed by an advisory group of six African-American adolescent mothers who were filmed feeding their infants in their homes. Measurements and Results. During baseline and follow-up evaluations, mothers were videotaped feeding their baby and completed a questionnaire on attitudes toward mealtime behavior. Analysis of covariance with repeated measures indicated changes in both behavior and attitudes. At follow-up, intervention mothers were more involved with their infant and reported more favorable attitudes toward feeding and communication than control mothers. Conclusions. Brief culturally sensitive videotapes may be effective strategies to promote parenting skills and to prevent social and health problems among adolescents.

Purpose: To examine the relationships among grandmother co-residence, parenting, and early child development among low income, urban families with teen mothers whose children vary in growth (adequate versus failure to thrive [FTT]). Methods: Seventy-nine adolescent mothers of infants and toddlers (42 with adequate growth and 37 with FTT) recruited from a primary care clinic. Data collected during a laboratory evaluation included a videotaped session of mother and child during feeding, developmental assessment (Bayley Scales), and questionnaires on family support, perceived parenting stress, and maternal perception of child's temperament. Analysis: Multivariate analyses of covariance. Independent variables were growth (adequate/FTT) and grandmother co-residence (present/absent). Dependent variables were maternal warmth during feeding, maternal perception of child's temperament, child's mealtime behavior, and child's cognitive and motor development. Covariates were child's age, maternal age, maternal education, parity, family support, and perceived stress. Results: Teen mothers living with grandmothers were younger (mean age=17.4 versus 18.6, p = .03) and had fewer children (mean parity=1.2 versus 1.7, p = .001). Mothers displayed more warmth when not living with grandmothers ( p = .01). Among adequately growing children, grandmother co-residence was associated with better motor skills (106 versus 98, p = .039). In contrast, among children with FTT, grandmother co-residence was associated with lower motor skills (90 versus 100, p = .017). Conclusions: Although multigenerational families may be protective for some teen parents and their young children, grandmother co-residence was not associated with maternal warmth. With the added stress of a poorly growing child, grandmother co-residence was associated with less optimal motor development.

To assess the stability and predictability of perceptions, intentions, and behaviors regarding intended sexual intercourse and condom use.One hundred and nineteen African-American youth aged 9-15 years living in urban public housing provided information at baseline and 6 months later using a theory-based and culturally- and developmentally-tailored instrument assessing perceptions, intentions, and sexual behaviors.Over the 6-month study interval, individual behaviors, intentions, and perceptions demonstrated considerable stability. Intentions regarding sexual intercourse in the next half-year were predictive of subsequent coitus among the entire cohort and among the subset who were virgins at baseline. Youth who thought it likely that they would be sexually-active in the next 6 months were at significantly elevated risk of doing so, compared to youth who were uncertain or thought coitus unlikely. However, intentions regarding future coitus among the subset of youth who were sexually-experienced at baseline were not predictive of future coital behavior.These data suggest that social cognitive behavioral models that incorporate intentions and perceptions are appropriate as the theoretical basis for interventions targeting these young adolescents.A longitudinal study conducted among low-income African-American early adolescents identified the salience of intentions and perceptions regarding sexual intercourse to subsequent behavior. The 119 boys and girls 9-15 years of age were recruited from public housing project recreation centers in Baltimore, Maryland, in 1993. Each youth completed the Youth Health Risk Behavioral Inventory; the instrument was re-administered 6 months later. At baseline, 71 respondents (60%) were virgins; 6 (9%) became sexually active during the 6-month study period. 27 (56%) of the 48 subjects who were sexually experienced at baseline engaged in intercourse during the ensuing 6 months. Overall, the predictiveness of intention to have sex in the next 6 months and actual behavior was very strong, especially among younger youth; nearly half of young people who thought it likely they would have sex did so, while only one-fifth of those who were uncertain and one-seventh of those who considered it unlikely had sex. Condom intention, on the other hand, was not predictive of subsequent use. Youth who engaged in sexual intercourse during the study period had more perceived peer support and internal rewards for sexual activity and perceived the sequelae of intercourse as less severe than their abstinent counterparts. Overall, these findings suggest that social cognitive behavioral models that incorporate intentions and perceptions should form the theoretical basis for interventions aimed at young adolescents.

Examined differences in several developmental indices of competence among 102 low-income, inner-city, predominantly African American children with non-organic failure to thrive (NOFTT) and a comparison group of 67 children with adequate growth matched on age, gender, race, and socioeconomic status. Parents were categorized into one of three groups (nurturant, authoritarian, and neglecting) based on observations during feeding. Parents of children with NOFTT were less nurturant and more neglecting than parents of comparison children. Associations between parenting style and children's social-cognitive development were similar across groups. Children of nurturant parents consistently demonstrated better social-cognitive development. Results support the importance of considering heterogeneity among high-risk families and the need to examine the relationships linking parenting style and child development.

Developmental differences in behavior and self-perception were examined in a group of 44 preschool and school-age children referred for evaluation of sexual abuse and 41 comparison children with no history of sexual abuse, matched on age and gender, and from a similar socioeconomic background. Children suspected of having been sexually abused were rated by their parents as having more internalizing and externalizing problems than comparison children. When children rated their self-competence and social acceptance, there were no group differences between children based on their abuse status; however, there was significant within-group variation among the children suspected of having been sexually abused. Preschool children had elevated scores of perceived competence and social acceptance, and school-age children had depressed scores. There were no age differences among the children in the comparison group. The results suggest that among children suspected of abuse, not only does their self-perception vary by their developmental level, but preschool children may respond with elevated perceptions of themselves. Focusing on individual differences in children's response to suspicions of sexual abuse enables us to identify risk and protective factors that contribute to the psychological outcomes of child sexual abuse.

Deviations in infant/toddler growth patterns can lead to both under- and overweight and are global public health concerns that can have long-lasting impacts on children’s growth, health, and development (1, 2). Although access to food plays a central role in children’s postnatal growth, variability in the feeding context also influences children’s eating behavior and growth (3). The epidemiology of under- and overweight highlights the importance of incorporating parental feeding practices into nutritional recommendations early in life. In some low- and middle-income countries, stunting begins before or shortly after birth (4) and approaches 45% among children under 5 y of age (2). Many stunted children retain their shortened stature throughout life (5) and are at risk for poor cognition and academic performance during childhood and low productivity and human capital during adulthood (6). Recommendations are to initiate programs to prevent stunting early in life (5). In high-income countries, childhood overweight/obesity is a serious public health problem that is increasing in prevalence, particularly among minority and/or low-income children (7). Data from the 2007–2008 NHANES-IV show that the prevalence of obesity among children and adolescents has reached 17.7%, a 3-fold increase over the past 3 decades (7). Not only does childhood obesity track to adult obesity, but it can lead to long-lasting negative health and developmental consequences (8), emphasizing the need to intervene early in life. The goal of this supplement is to examine the association between parental feeding practices and children’s growth from a global perspective. Responsive feeding is embedded in anthropological and psychological constructs that require multidisciplinary investigation and intervention. A diverse group of authors representing psychology, nutrition, anthropology, and child development present issues related to responsive feeding among infants and toddlers from multiple countries. The first paper reviews the theoretical foundation linking responsive parenting to children’s psychosocial, cognitive, and language competence, thereby laying the theoretical foundation for applying responsive parenting to the feeding context as responsive feeding (9). The second paper reviews studies that have applied responsive and nonresponsive feeding to issues of overweight/obesity in high-income countries (10). The third paper reviews the application of responsive and nonresponsive feeding to children’s growth in low- and middle-income countries, focusing on prevention of underweight (11). The final paper examines the programmatic and policy implications of responsive feeding from a global perspective (12).

The objectives of this study were to examine: (a) behavior in children evaluated for sexual abuse, (b) the stability of their behavior over 4 months, and (c) the relationship between aspects of the abuse and the children's behavior. The Child Behavior Checklist (CBCL) was completed by parents of 93 prepubertal children evaluated for sexual abuse and 80 nonabused children matched on age, gender, and race. A follow-up CBCL was completed after 4 months by 45% of parents of abused children. Sexually abused children had significantly more behavior problems than comparison children, including depression, aggression, sleep and somatic complaints, hyperactivity, and sexual problems. At follow-up, only those children who initially had externalizing behavior in the clinical range improved significantly. During the initial evaluation, behavior problems were associated with the child's disclosure of abuse and during follow-up, behavior problems were associated with abnormal physical findings. However, behavior problems were not related to characteristics of the abuse or perpetrator, likelihood of abuse, or therapeutic services. The persistence of behavior problems suggests that children suspected of having been sexually abused should receive an assessment of their psychological status and careful follow-up. Language: en

The recent report by Melchior et al1 on food insecurity raised concerns about the effectiveness of nutritional-assistance programs and highlighted the role played by maternal mental health and domestic violence. Evidence from Children's HealthWatch (www.childrenshealthwatch.org) provides additional information on the link between nutritional-assistance programs and children's health and well-being. …

Objective To examine how body composition and physical activity are related to insulin sensitivity and secretion in adolescents. Design Cross-sectional. Setting Baltimore, Maryland. Participants Fifty-six healthy adolescents (34 boys and 22 girls; mean [SD] age, 13.3 [1.3] years; 95% were African American) who had been recruited at infancy from a health care clinic serving a low-income, urban community. Main Exposures Physical activity was measured for 5 to 7 days by a uniaxial accelerometer placed on the right ankle. Proportion of time spent in play-equivalent physical activity (PEPA) was defined as 1800 or more counts per minute. Body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) was converted to an age- and sex-specific z score. Main Outcome Measures Insulin sensitivity, insulin secretion, and disposition index calculated from a fasting oral glucose tolerance test. Results Thirty-nine percent of the adolescents had a BMI in the 85th percentile or higher; half of those were overweight (BMI ≥ 95th percentile). Play-equivalent physical activity and BMI z score were not correlated. In multivariate analyses, BMI z score and time spent in PEPA together explained 21% of the variance in insulin sensitivity and 18% in insulin secretion. Independent of each other, high BMI z score and low proportion of PEPA were significantly associated with low insulin sensitivity (partial r 2 = 0.14 and 0.10, respectively) and high insulin secretion (partial r 2 = 0.10 and 0.10, respectively), but not with disposition index. Conclusions In a cohort of urban, predominantly African American adolescents, both body composition and physical activity were independently associated with insulin sensitivity. At this point, insulin secretion is appropriately regulated.

Objective: To examine how maternal depressive symptoms are related to infant development among low-income infants in rural Bangladesh and to examine how the relationship is affected by maternal perceptions of infant irritability and observations of caregiving practices. Methods: Development was measured among 221 infants at 6 and 12 months with the Bayley Scales II. Mothers reported on their depressive symptoms and on perceptions of their infant's temperament, and a home visit was made to complete the HOME Inventory. Results: Half (52%) the mothers reported depressive symptoms. In bivariate analyses, maternal depressive symptoms were related to low scores on the Bayley Scales. Infants whose mothers reported depressive symptoms and perceived their infants to be irritable acquired fewer cognitive, motor, and Orientation/Engagement skills between 6–12 months than infants whose mothers reported neither or only one condition. The relationship linking maternal depressive symptoms and perceived infant irritability with infant cognitive skills was partially mediated by parental responsiveness and opportunities for play in the home. Conclusions: The intergenerational risks of maternal depressive symptoms on infant development extend to rural Bangladesh and are accentuated when mothers perceive their infants as irritable. Mothers who report depressive symptoms and infant irritability may lack the capacity to provide responsive, developmentally-oriented caregiving environments.

Objective To examine the effect of child abuse and other household dysfunction on child health outcomes. Design Data from the Longitudinal Studies of Child Abuse and Neglect collected through interviews and questionnaires administered when target children were 4 years old and 6 years old. Setting Children in the South, East, Midwest, Northwest, and Southwest United States. Participants One thousand forty-one children at high risk for child abuse and neglect (3 cohorts derived primarily from among children recruited through social service mechanisms, 1 cohort recruited at birth from among high-risk infants, and 1 cohort recruited from a medical setting). Main Outcome Measures (1) Association of 7 adverse exposures (3 categories of child abuse [physical abuse, sexual abuse, and psychological maltreatment] and 4 categories of household dysfunction [caregiver problem drinking, caregiver depression, caregiver treated violently, and criminal behavior in the household]) derived from data collected when the child was 4 years old. (2) Indexes of child physical health at age 6 years (caregiver overall assessment of child health and reports of illness requiring medical attention). Results Two thirds of the sample had experienced at least 1 adverse exposure. One adverse exposure almost doubled the risk of overall poor health (odds ratio, 1.89; 95% confidence interval, 1.02-3.48), and 4 adverse exposures or more almost tripled the risk of illness requiring medical attention (odds ratio, 2.83; 95% confidence interval, 1.10-7.31). Conclusion Adverse environmental exposures, including child abuse and other household dysfunction, are associated with poor child health even at an early age, although our data do not support a dose-response relationship.

display slow growth, decreased mitochondrial membrane potential, and impaired respiratory capacity. These defects are reversed upon restoration of fusion capability. The importance of mitochondrial fusion is further underscored by the fact that two neurodegenerative diseases, Charcot– Marie–Tooth disease type 2A (CMT) and autosomal dominant optic atrophy (DOA), are caused by mutations in Mfn2 and OPA1, respectively.To further explore the physiological requirements for mitochondrial fusion, we have created conditional knockout mice for both Mfn1 and Mfn2. Interestingly, Mfn2 is required for proper cerebellar development. When cerebellar primordia is targeted embryonically, pups display severe problems in balance and motility, resulting in feeding problems and death by about two weeks of age. When Purkinje cells, the only efferent processes of the cerebellum, are targeted upon maturity, they actually degenerate, causing the mice to develop tremors and wobble while walking. Thus, mitochondrial fusion is required in the central nervous system along with the peripheral motor neurons and optic nerve affected in CMT and DOA.Disruption of both Mfn1 and Mfn2 in skeletal muscle results in severely runted mice, which die at around two months of age. Muscle mass is greatly reduced in these mice, and cross-sectional analysis reveals significantly decreased muscle fiber widths. A modified Gomori-trichrome stain results in predominantly red fibers. In addition, a succinate-dehydrogenase (SDH) enzymatic assay reveals greatly increased activity in all fibers. The combination of red fibers and increased SDH activity is a hallmark of many mitochondrial diseases, suggesting a common link between deficiencies in mitochondrial fusion and traditional mitochondrial diseases.

A critical shortage of affordable housing for low-income families continues in the United States. Children in households that are food insecure are at high risk for adverse nutritional and health outcomes and thus may be more vulnerable to the economic pressures exerted by high housing costs. Only about one fourth of eligible families receive a federally financed housing subsidy. Few studies have examined the effects of such housing subsidies on the health and nutritional status of low-income children.To examine the relationship between receiving housing subsidies and nutritional and health status among young children in low-income families, especially those that are food insecure.Cross-sectional observational study.From August 1998 to June 2003, the Children's Sentinel Nutrition Assessment Program interviewed caregivers of children younger than 3 years in pediatric clinics and emergency departments in 6 sites (Arkansas, California, Maryland, Massachusetts, Minnesota, and Washington, DC). Interviews included demographics, perceived child health, the US Household Food Security Scale, and public assistance program participation. Children's weight at the time of the visit was documented. The study sample consisted of all renter households identified as low income by their participation in at least 1 means-tested program.Weight for age, self-reported child health status, and history of hospitalization.Data were available for 11 723 low-income renter families; 27% were receiving a public housing subsidy, and 24% were food insecure. In multivariable analyses, stratified by household food security status and adjusted for potential confounding variables, children of food-insecure families not receiving housing subsidies had lower weight for age (adjusted mean z score, -0.025 vs 0.205; P.001) compared with children of food-insecure families receiving housing subsidies. Compared with children in food-insecure, subsidized families, the adjusted odds ratio (95% confidence interval) for weight-for-age z score more than 2 SDs below the mean was 2.11 (1.34-3.32) for children in food-insecure, nonsubsidized families.In a large convenience sentinel sample, the children of low-income renter families who receive public housing subsidies are less likely to have anthropometric indications of undernutrition than those of comparable families not receiving housing subsidies, especially if the family is not only low income but also food insecure.