Characteristics of Correctly Identified Pediatric Obesity and Overweight Status and Management in an Academic General Pediatric Clinic

Objective: The goals of this study were to identify and characterize the rates of documentation and guideline-based management of overweight and obese children within an academic pediatric clinic. Population/Methods: Overweight, obese, and severely obese children were identified from 7,422 well child visits in 2016 within a primary care clinic that cares for a primarily urban, minority (80% African American), and Medicaid (85%) population until the age of 12. During this 1-year study, there were 79 pediatric residents, 19 attending pediatricians, and 5 nurse practitioners who treated patients. Through a retrospective electronic medical record review, diagnosis and treatment including counseling, referral to a dietician, or referral to a pediatric weight management clinic, were analyzed by the patient’s weight diagnosis, sex, age, and provider training level. Orders for laboratory testing as well as follow up visits were also reviewed. χ 2 analyses were performed to identify whether independent variables such as age of patient, sex, provider level of training, or weight diagnosis affected provider behavior in diagnosis and weight management. Logistic regression was utilized to calculate odds ratio estimates of likelihood of treatment by provider training level, age of patient, weight diagnosis, sex, laboratory testing and follow up. Results. As expected, older and heavier patients were more likely to be diagnosed and to receive weight management. Surprisingly, nurse practitioners and faculty demonstrated lower adherence to pediatric obesity guidelines. The percentages of correctly identified severely obese (90.2%), obese (77.0%), and overweight (42.0%) children were much higher than in previous retrospective chart reviews; however, less than 30% of children were referred for more intensive weight management to a dietician or pediatric obesity weight management program and less than 60% received counseling. Conclusions: Despite progress in the rates of identification of weight status at primary care visits, significant improvement in adherence to intensive pediatric weight management guidelines is needed. Strategic modifications to electronic medical records that automatically offer BMI associated weight diagnoses with a link to treatment pathways and resources are needed to facilitate improved compliance with current pediatric obesity guidelines in the primary care setting. Acknowledgements: The W.T.Gill Fellowship Program funded the research efforts for this study

Caregivers’ perceived emotional and feeding responsiveness toward preschool children: Associations and paths of influence

Although there is a large body of research connecting emotion to eating behaviors, little is known about the role of caregivers’ responses to children’s emotions in the context of child feeding. The purpose of this study was to analyze the relation between caregivers’ emotional responsiveness and feeding responsiveness. The mothers of 137 children between 2 and 6 years of age reported on their responses to children’s negative emotions using the Coping with Children’s Negative Emotions Scale and on their feeding practices using the Comprehensive Feeding Practices Questionnaire. The results showed that mothers’ supportive emotion responses (e.g., problem-focused, emotion-focused, and expressive encouragement reactions) tend to be positively associated with responsive feeding practices (e.g., encouraging, modelling, and teaching healthy food-related behaviors). Instead, mothers’ unsupportive responses (e.g., distress, punitive and minimization reactions) tend to be positively associated with nonresponsive feeding practices (e.g., food as reward or to regulate emotions, and pressure to eat) and negatively associated with responsive feeding practices. Our results suggest that emotional and feeding responsiveness may be intertwined and that differences in parent’s emotional responsiveness may translate into differences in their feeding styles, setting the stage for parents’ use of positive vs. negative feeding practices.Fundação para a Ciência e Tecnologia - FCTinfo:eu-repo/semantics/publishedVersio

Specifying social structures in preschool classrooms: descriptive and functional distinctions between affiliative subgroups

Preschool children attending Head Start programs (N=586, 296 boys and 290 girls, between 3 and 5 years of age, over 95% African–American) were observed to determine physical proximity to peers as well as rates of visual attention given and received. Sociometric data were used to derive peer acceptance scores, peer friendships, and sociometric status classifications. Three subgroup types (high mutual proximity (HMP), lower mutual proximity (LMP), and ungrouped children) were identified through complete linkage hierarchical clustering and chi-square procedures from the proximity data. HMP subgroups tended to be larger, to have higher sociometric acceptance scores, and children in these subgroups had more reciprocated friendships than was true for the other subgroup types. Significant within-group preferences and out-group biases were observed for both HMP and LMP subgroups using measures of visual attention and sociometric choice data, but these were more marked for HMP subgroups. Results are consistent with previous ethological studies of affiliative structures in preschool classrooms and also show that methods of data collection and analysis from social ethology and child psychology research traditions are mutually informing

A concordância entre o comportamento de base segura com a mãe nos primeiros anos de vida e os modelos internos dinâmicos no pré-escolar

Estuda-se, numa amostra que contempla dois países – Portugal e Estados Unidos da América –, a estabilidade da qualidade da vinculação, na relação mãe criança, analisando-se o comportamento de base segura na relação mãe-criança nos primeiros anos de vida e as representações mentais da criança acerca desta relação, no pré-escolar. Os participantes são 25 díades mãe-criança portuguesas e 47 díades mãe-criança americanas. Utiliza-se o Attachment Behaviour Q-Set (AQS) (Waters, 1995) para avaliar os comportamentos de base segura e, três anos mais tarde, aplica-se às crianças o Attachment Story Completion Task (ASCT) (Bretherton & Ridgeway, 1990) que avalia a qualidade e a segurança das representações internas da relação de vinculação. Os resultados mostram que, nesta amostra, há uma estabilidade da vinculação entre os 2-3 anos de idade e os 5-6 anos de idade. O valor de segurança do AQS está correlacionado positiva e significativamente com a dimensão de segurança do ASCT. Nesta amostra, os modelos internos dinâmicos parecem permanecer relativamente estáveis ao longo de um período significativo de tempo

A concordância entre o comportamento de base segura com a mãe nos primeiros anos de vida e os modelos internos dinâmicos no pré-escolar

Estuda-se, numa amostra que contempla dois países – Portugal e Estados Unidos da América –, a estabilidade da qualidade da vinculação, na relação mãe criança, analisando-se o comportamento de base segura na relação mãe-criança nos primeiros anos de vida e as representações mentais da criança acerca desta relação, no pré-escolar. Os participantes são 25 díades mãe-criança portuguesas e 47 díades mãe-criança americanas. Utiliza-se o Attachment Behaviour Q-Set (AQS) (Waters, 1995) para avaliar os comportamentos de base segura e, três anos mais tarde, aplica-se às crianças o Attachment Story Completion Task (ASCT) (Bretherton & Ridgeway, 1990) que avalia a qualidade e a segurança das representações internas da relação de vinculação. Os resultados mostram que, nesta amostra, há uma estabilidade da vinculação entre os 2-3 anos de idade e os 5-6 anos de idade. O valor de segurança do AQS está correlacionado positiva e significativamente com a dimensão de segurança do ASCT. Nesta amostra, os modelos internos dinâmicos parecem permanecer relativamente estáveis ao longo de um período significativo de tempo

Concordância entre dados antropométricos reportados vs. medidos e relação com as práticas parentais alimentares em idade pré-escolar

The present study aimed to analyze the agreement between the parent-reported and measured children’s anthropometric data (weight, height, respective BMI and BMI z-score calculated), as well as their relationship with parental feeding practices. Seventy-one families with children between 2 and 6 years of age participated in the study. There was a discrepancy between parent-reported and measured data for 45,5% of the children. Bidirectional effects were found between the practice restriction for weight and parent-reported height and weight, as well as between the practice pressure to eat and parent-reported weight, BMI and BMI z-score. Results suggest that incorrect parents’ perceptions of the child’s weight status may lead to higher levels of negative parental feeding practices, with an impact on children’s weight. On the other hand, parents and children influence each other, therefore parents are reactive to the children’s weight, but they also influence it.O presente estudo teve como objetivo analisar a concordância entre os dados antropométricos das crianças (peso, altura, respetivos IMC e z-score de IMC calculados) reportados pelos pais e medidos objetivamente pelos investigadores, bem como a sua relação com as práticas parentais alimentares. Participaram no estudo 71 famílias, com crianças entre os 2 e os 6 anos. Verificou-se uma discordância entre os dados reportados pelos pais e os dados medidos para 45,5% das crianças. Foram encontrados efeitos bidirecionais entre a prática restrição por controlo de peso e a altura e peso reportados, bem como entre a prática pressão e o peso, IMC e z-score de IMC reportados. Os resultados sugerem que perceções parentais incorretas sobre o estado ponderal da criança poderão levar a maiores níveis de práticas parentais alimentares negativas, com impacto no peso das crianças. Por outro lado, pais e filhos, influenciam-se mutuamente, pelo que os pais são reativos ao peso das crianças, mas também o influenciam

Secure base representations for both fathers and mothers predict children’s secure base behavior in a sample of portuguese families

Relations between fathers’ and mothers’ representations of attachment (independently assessed using an attachment script representation task) and children’s secure base behavior (assessed using the Attachment Q-sort; AQS) were studied in 56 Portuguese families (mean age of child ¼ 31.9 months). Each parent’s secure base script representation score predicted AQS security scores for the child with that parent at approximately equivalent degrees of association. However, both parental secure base script scores and AQS security scores were positively correlated across parents. A hierarchical regression predicting AQS security with father from both parent’s scriptedness scores and from the AQS score with mother showed a unique, significant influence of father’s scriptedness score and the AQS score with mother, but mother’s scriptedness score did not uniquely add to the prediction. Difficult temperament was ruled out as a mediator of the cross-parent association for AQS security scores

A relação entre a qualidade de vinculação à mãe e o desenvolvimento da competência social em crianças de idade pré-escolar

O presente estudo de natureza longitudinal tem como objectivo estudar a relação entre a qualidade da vinculação da criança à mãe (em média aos 32 meses) e a sua competência social em idade pré-escolar, avaliada dois anos mais tarde. No total participaram 48 díades mãe-criança de nacionalidade portuguesa e americana. Em ambos os contextos sócio culturais constatou-se que a qualidade da vinculação está positiva e significativamente correlacionada com a competência social. Estes resultados sugerem que as relações de vinculação mãe-criança são facilitadoras da adaptação da criança ao grupo pré-escolar, na medida em que promovem o envolvimento positivo com os pares, potenciado uma variedade de competências que contribuem para a aceitação no grupo de pares. ------ ABSTRACT ------ In this study, we attempted to map early attachment security to the development of social competence in preschool years. Participants were 48 mother dyads from two different countries (Portugal and the United States of America). Positive and significant correlations were found between the AQS security score and the social competence. The results suggest that the parent-child attachment relationships contribute to children’s adaptation in the preschool peer group by promoting positive engagement with peers and by supporting a range of skills that underlie peer acceptance

The quality of maternal secure-base scripts predicts children's secure-base behavior at home in three sociocultural groups

The secure-base phenomenon is central to the Bowlby/Ainsworth theory of attachment and is also central to the assessment of attachment across the lifespan. The present study tested whether mothers’ knowledge about the secure-base phenomenon, as assessed using a recently designed wordlist prompt measure for eliciting attachment-relevant stories, would predict their children’s securebase behavior, as assessed by observers in the home and summarized with the Attachment Q-set (AQS). In each of three sociocultural groups (from Colombia, Portugal, and the US), scores characterizing the quality of maternal secure-base narratives elicited using the word-list prompt procedure were internally consistent, as indicated by tests of cross-story reliability, and they were positively and significantly associated with the child’s security score from the AQS for each subsample. The correlation in the combined sample was r(129) = .33, p < .001. Subsequent analyses with the combined sample evaluated the AQS item-correlates of the secure-base script score. These analyses showed that mothers whose stories indicate that they have access to and use a positive secure-base script in their story production have children who treat them as a “secure base” at home. These results suggest that a core feature of adult attachment models, in each of the three sociocultural groups studied, is access to a secure-base script. Additional results from the study indicate that cross-language translations of the maternal narratives can receive valid, reliable scores even when evaluated by non-native speakers