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A secondary study was conducted within a broader National Institutes of Health (NIH)-funded longitudinal study on resilience in South African mothers and children affected by HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome). The aim of this study was to evaluate the effect of a 24-week support group intervention programme, which was designed to enhance adaptive behaviour of latent-phase children affected by maternal HIV/AIDS as reported by the mother participants. The study was embedded in a concurrent nested mixed-method design, with a quasi-experimental and a nested multiple case study approach. The mother and child dyads (n = 139) were purposefully selected from amongst previously identified HIV-positive women (n = 220), with children between the ages of 6 and 10 years at clinics in the Tshwane region, South Africa. Data were collected over a period of five years in multiple waves of intervention implementation. The data collection strategies comprised of mother psychological questionnaires and quality assurance questionnaires. The quantitative data were analysed by means of a paired-sample t-test for within-group comparisons. The qualitative text was analysed for themes to establish defined categories. The findings of the study showed that the mothers reported that the child support group intervention sessions decreased the children's withdrawal-, social-, attention-, rule-breaking- and aggressive behavioural problems. The findings suggest that the use of support groups should be incorporated into intervention programmes dealing with latent-phase children affected by HIV/AIDS to enhance adaptive behaviour.

This paper describes the process of developing a parallel intervention for HIV-positive mothers and their young children (6-10 years) with a view to strengthening the relationship between them. Strong mother-child relationships can contribute to enhanced psychological resilience in children. The intervention was developed through action research, involving a situation analysis based on focus group discussions; intervention planning, piloting the intervention and a formative evaluation of the intervention. Participants supplied feedback regarding the value of the intervention in mother-child relationships. The findings obtained from the formative evaluation were used to refine the intervention. Two parallel programmes for mothers and children (15 sessions each) were followed by 10 joint sessions. The intervention for mothers focused on maternal mental health and the strengthening of their capacity to protect and care for their young children. The intervention for children addressed the development of their self-esteem, interpersonal relationships and survival skills. The formative evaluation provided evidence of good participation, support and group cohesion. Qualitative feedback indicated that the activities stimulated mother-child interaction. A similar intervention can easily be applied elsewhere using the detailed manual. The insights gained and lessons learnt related to mother and child interaction within an HIV-context that emerged from this research, can be valuable in other settings, both in Sub-Saharan Africa and elsewhere. (Contains 1 figure and 1 table.)

To provide understanding of social and psychological factors that affect disclosure of HIV status among women diagnosed HIV-positive in pregnancy, 438 HIV positive women attending antenatal al clinics in Pretoria, South Africa were invited to participate in a longitudinal study. A total of 293 (62%) women were enrolled from June 2003 to December 2004. Questionnaires assessing sociodemographics and psychological measures were administered during pregnancy and at 3 months postdelivery. At enrollment, 59% had disclosed to their partners and 42% to others. This rose to 67% and 59%, respectively, by follow-up. Logistic regression analysis identified being married (adjusted odds Ratio [AOR] 2.32; 95% confidence interval [CI] 1.20-4.47), prior discussion about testing (AOR 4.19; CI 2.34-7.49), having a partner with tertiary education (AOR 2.76; CI 1.29-5.88) and less experience of violence (AOR 0.48; CI 0.24-0.97) as factors associated with having disclosed to partners prior to enrollment. Better housing (AOR 1.26; CI 1.06-1.49), less financial dependence on partners (AOR 0.46; CI 0.25-0.85), and knowing someone with HIV (AOR 2.13; CI 1.20-3.76) were associated with prior disclosure to others. Increased levels of stigma at baseline decreased the likelihood of disclosure to partners postenrollment (AOR 0.91; CI 0.84-0.98) and increased levels of avoidant coping decreased subsequent disclosure to others (AOR 0.84; CI 0.72-0.97). These results provide understanding of disclosure for women diagnosed as HIV positive in pregnancy, and identify variables that could be used to screen for women who require help.

Medical complications during pregnancy may increase the risk of postpartum depression and influence the way mothers perceive their children's health. Of 1,095 mothers of children aged four to eight, 212 (12%) reported severe medical complications during pregnancy. The most common complications were premature delivery, toxemia and diabetes in pregnancy. Overall, 227 of the women (13%) reported a history of postpartum depression. Women who reported severe medical complications during pregnancy were 2.5 times more likely to have reported postpartum depression. Women who were white, who were not married and who had the least education were the most likely to report a history of postpartum depression. Altogether, 179 of the mothers (10%) perceived their children as vulnerable to illness. Women with severe complications during pregnancy were almost twice as likely to view their children as vulnerable., To determine whether mothers with complicated pregnancies are at increased risk of postpartum depression and whether their children are at increased risk of being perceived as vulnerable, the investigators conducted an interview survey of mothers of 1095 children aged 4 to 8 in a community-based sample of primary care pediatric practices. The offspring were viewed as vulnerable by 17% of the women with severe pregnancy complications and 9% of the women without pregnancy complications (relative risk = 1.88; 95% confidence interval = 1.11, 2.63). Women with a severe complication of pregnancy were significantly more likely to report postpartum depression than those without a complication (27% vs 11%; relative risk = 2.45; 95% confidence interval = 1.55, 3.01). These relationships persisted after adjustment for prematurity, neonatal hospitalization, and demographic factors. It is concluded that pregnancy complications may place a woman at increased risk of postpartum depression and may have important effects on a mother's long-term perceptions of her child's vulnerability to illness. Pediatrics 1993; 91:566-571; pregnancy complications, depression, vulnerability.

The importance of psychological and social issues for children's well-being has long been recognized and their importance in the practice of pediatrics is well documented. However, many of the studies looking at this issue have emphasized psychiatric problems rather than issues commonly referred to as the new morbidity The goal of this research was to refocus interest on the problems of the new morbidity. This study examined the rates and predictors of psychological problems in 19 of 23 randomly chosen pediatric practices in the greater New Haven area. Families of all 4- to 8-year-old children were invited to participate and to complete the Child Behavior Checklist prior to seeing a clinician. Clinicians completed a 13-category checklist of psychological and developmental problems based on a World Health Organization-sponsored primary care, child-oriented classification system. Of the 2006 eligible families, 1886 (94%) participated. Clinicians identified at least one psychosocial or developmental problem in 515 children (27.3%). Thirty-one percent of the children with problems received no active intervention, 40% received intervention by the clinician, and 16% were referred to specialty services. Not surprisingly, children whose problems were rated as moderate or severe were twice as likely to be referred compared with children with mild problems. Recognition of a problem was related to four characteristics: if the visit was for well child rather than acute care; if the clinician felt he or she knew a child well; if the child was male; and if the child had unmarried parents (all P [less than or equal to] .05). The data suggest that, when asked to use a taxonomy appropriate for primary care, clinicians recognize problems in many 4- to 8-year-old children (515/1886; 27.3%). This rate is considerably higher than the rates previously reported. Further, many children with identified problems (56%) were reported by their clinicians to receive some form of active intervention. Characteristics of the visit (type of visit, clinician's knowledge of a child) that influence the recognition of problems were also identified. These results suggest that investigators must define what types of problems they are interested in and under what circumstances to determine accurately what pediatric practitioners know about psychosocial and developmental problems in their young patients and families. Pediatrics 1992;89:480-485; primary care, psychopathology.

Acute infectious illnesses are common in children under age three. It is often difficult for parents to evaluate the illnesses and to decide whether to report these to the physician. Parents' clinical judgment was not well researched until recently. One study found that parents tended to have poor overall judgment of children's well-being, often overestimating the severity of illness. However, the use of the Acute Illness Observation Scales (AIOS) helped improve parental judgment. This article discusses a second aspect of this study, in which the influence of demographic factors on the reliability of parental judgment were assessed. At one site, of 317 parents were asked to participate, and 225 agreed to do so, while 172 of 219 parents at a second site participated. A final group of 369 mothers were studied; their average age was 22 years. Of these women, 183 used the AIOS. Mothers made one-to-three visits to clinics with their children, and their reliability was assessed for each visit. During the first two visits, mothers using the AIOS were fairly reliable, but this faded with the first visit. Maternal anxiety about the baby were strongly correlated with unreliably. Other variables such as previous child with serious illness, pregnancy complications, and location of clinic (inner city or suburban) had small-to-medium effects on reliability. Other important influences included maternal age and maternal worry about pregnancy. Reliability of maternal judgment decreased with an increase in the number of previous children, possibly due to lack of attentiveness in learning about illnesses. Marital status, level of education, and method of payment did not significantly affect the mother's medical judgment. The report suggests that worry, anxiety, and other unidentified maternal characteristics are more important than some demographic factors in influencing maternal judgement of children's illnesses. (Consumer Summary produced by Reliance Medical Information, Inc.)

Although feeding and crying problems often occur in infants, the way in which such problems are managed may affect a child's psychological development. Overconcern with an increased sensitivity of an infant to milk in early infancy may result in a persistent concern of parents about allergy in later life. Events occurring during the first few months of a child's life influence how parents perceive their child. Feeding and crying problems and their management may influence a parent's perception of a child's vulnerability. Parents who perceive their child as vulnerable may be overprotective, which can adversely affect the child's psychological development. A previous study has shown that mothers of first-born children and mothers with less education tended to report feeding and crying problems more often. Furthermore, mothers who changed their infant's formula tended to view their child as having a physical problem such as allergy. The perceptions of parents regarding feeding and crying problems during infancy were assessed. The long-term effects of parents' perceptions of their infant's vulnerability on behavior in later childhood were also examined. Of 379 infants studied over the first four months of life, 36 percent had feeding and crying problems, and formula had been changed during infancy for 17 percent of children. Children with feeding and crying problems during infancy tended to be perceived as vulnerable and had more behavior problems and allergies at three and a half years of age than children without such problems during infancy. Change of formula was also associated with perceptions of vulnerability. However, there were no differences in personality or prevalence of asthma or eczema, a chronic inflammatory skin disease. The findings suggest that the development of feeding and crying problems during infancy and how they are handled have long-term effects on a child's psychological development. (Consumer Summary produced by Reliance Medical Information, Inc.)

Vulnerable child syndrome refers to a condition that arises when a family considers their child to have had a 'close call' and thus believes him to be prone to serious injury. This condition is well known to occur following problems relating to newborns. Neonatal jaundice is a common condition in newborns and results from excess bilirubin in the blood; it is treated with phototherapy (exposure to sunlight or artificial blue light). A previously reported portion of this study reported that most mothers of babies with neonatal jaundice considered it a serious condition. They were more likely to have their breastfeeding interrupted in the hospital and to stop breastfeeding completely after one month. They were also less willing to leave their babies with another person, and sought medical attention more frequently than did mothers of babies without jaundice. These maternal actions were consistent with the signs of vulnerable child syndrome. The study was continued for an additional six months to determine if these maternal behaviors continued. At six months of age it was found that the jaundiced babies experienced more feeding problems than did nonjaundiced babies. Although a similar number of health problems existed among both jaundiced and nonjaundiced babies, the jaundiced babies were brought for medical attention more frequently. Surprisingly, the mothers of jaundiced babies dramatically changed their attitudes about separation from their babies. When the jaundiced babies reached about one month old, their mothers were less likely than other mothers to leave them with someone else, yet at 6 months old they were more likely to do so. The authors suggest that the benefits derived from treating mild neonatal jaundice in otherwise healthy babies be weighed against the risk of developing vulnerable child syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aim: It is of critical importance to have internationally constructed tools to address early childhood development. The aim of this second phase of a two-phase study was to examine the sensitivity and specificity of the Guide for Monitoring Child Development (GMCD) in identifying developmental delay in four diverse countries.Methods: The first phase of this 2011-2015 back-to-back study included 4949 children up to 42 months of age from primary healthcare centres in Argentina, India, South Africa and Turkey. Distribution curves were generated to show the ages when the children attained GMCD milestones and those that could be used across sexes and countries were placed in age ranges corresponding to the 85th and 97th percentile point estimates. Phase two examined a separately recruited sample of children in those countries to determine sensitivity and specificity of the GMCD.Results: The validation phase of the 85 milestones in the GMCD identified delayed development in 30% of the 1731 children in the four countries. The sensitivity and specificity ranged from 0.71-0.94 and 0.69-0.82, respectively, for the total sample and the different age groups.Conclusion: The GMCD standardised in four diverse countries has appropriate accuracy for identification of children with developmental delay. [ABSTRACT FROM AUTHOR]

When a child's illness or injury is perceived by the parents as life-threatening or serious, the vulnerable child syndrome develops and the parents become overly concerned with benign medical problems. Children with the vulnerable child syndrome are underachievers in school, have problems with separation and discipline, and are overly concerned with bodily functions. Neonatal jaundice, or yellowing of the skin, is a common problem in infancy; it is due to high levels of bilirubin (a by-product of red blood cell destruction) which develop because the liver is immature. Neonatal jaundice is generally a benign condition that is treated with phototherapy, the use of florescent lights to rid the body of excess bilirubin. Although this condition is safely and effectively treated, many mothers perceive the continuous blood testing and prolonged hospitalization of their infants as a serious problem. Additionally, mothers may have to temporarily stop breast feeding when the newborn's bilirubin level is elevated. This interrupts essential mother-infant bonding. The impact of neonatal jaundice therapy on maternal behaviors and the development of the vulnerable child syndrome was studied in 85 jaundiced and 124 nonjaundiced infants and their mothers. One month later, 42 percent of the mothers of jaundiced infants and 19 percent of mothers of nonjaundiced infants stopped breast-feeding. The mothers of jaundiced babies were less likely to leave the baby with someone else; if they did leave the baby it was rarely for greater than one hour. They reported more infant health problems and made more well-child visits to their pediatricians. The care and treatment of neonatal jaundice increases the chance of the vulnerable child syndrome and early termination of breast-feeding. More problems may develop from the effects of treatment than from not treating this generally benign condition. (Consumer Summary produced by Reliance Medical Information, Inc.)

The authors tested the validity of the theory that aspirin use causes Reye's syndrome, a rare and devastating childhood disease often occurring after a viral infection of the upper respiratory system that causes vomiting, liver changes, brain swelling and, sometimes, death. Eight-eight percent of case subjects and only 17 percent of controls took aspirin before the onset of Reye's syndrome. The study confirms that there is a strong association between Reye's syndrome and exposure to aspirin. Parents should be warned against giving aspirin to children with viral ilness.

ABSTRACT: Stimulated by reports that some children who are seropositive for human immunodeficiency virus (HIV+) have been abandoned in the hospital, we studied the extent of, and reasons for, medically unnecessary hospital use at Yale-New Haven (Conn) Hospital among HIV+ children. We reviewed inpatient stays for all HIV+ children hospitalized through Oct 31, 1987. Hospital days were judged to be unnecessary if they failed to meet any of the criteria on the Pediatric Appropriateness Evaluation Protocol. Among 34 children eligible for the study, 54% of their hospital days were judged medically unnecessary; 59% of the children had at least one such day. Unnecessary use was 100% for one-day stays (all for gamma-globulin infusions) and 58% for stays longer than three weeks, with 94% of those unnecessary days being secondary to placement problems. The rate of unnecessary days has declined from 64% of all hospital days in 1983 and 1984 to 30% in 1987 as a result of improved outpatient services and access to foster care. Improved medical and social services could substantially reduce the cost of medically unnecessary hospital care in HIV+ children.

A secondary study was conducted within a broader National Institutes of Health (NIH)-funded longitudinal study on resilience in South African mothers and children affected by HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome). The aim of this study was to evaluate the effect of a 24-week support group intervention programme, which was designed to enhance adaptive behaviour of latent-phase children affected by maternal HIV/AIDS as reported by the mother participants. The study was embedded in a concurrent nested mixed-method design, with a quasiexperimental and a nested multiple case study approach. The mother and child dyads (n = 139) were purposefully selected from amongst previously identified HIV-positive women (n = 220), with children between the ages of 6 and 10 years at clinics in the Tshwane region, South Africa. Data were collected over a period of five years in multiple waves of intervention implementation. The data collection strategies comprised of mother psychological questionnaires and quality assurance questionnaires. The quantitative data were analysed by means of a paired-sample t-test for within-group comparisons. The qualitative text was analysed for themes to establish defined categories. The findings of the study showed that the mothers reported that the child support group intervention sessions decreased the children's withdrawal-, social-, attention-, rule-breaking- and aggressive behavioural problems. The findings suggest that the use of support groups should be incorporated into intervention programmes dealing with latent-phase children affected by HIV/AIDS to enhance adaptive behaviour. [ABSTRACT FROM AUTHOR]