Commitment to Breastfeeding in the Context of Phenylketonuria

Objective: To describe the meaning and importance of breastfeeding to mothers of infants with phenylketonuria (PKU). Design: Qualitative description. Setting: Mothers from the United States and Canada were recruited from the PKU Listserv and interviewed by telephone. Participants: Ten breastfeeding mothers with infants who had PKU and were younger than age 36 months. Methods: Mothers’ thoughts, decisions, and experiences of breastfeeding their infants with PKU were collected through telephone interviews. Interviews were transcribed verbatim, and data were analyzed using thematic descriptive analysis in the context of PKU. Results: Participants felt that that breastfeeding an infant with PKU was the healthiest choice and was therefore worth the labor. These women believed that this was what a loving mother would choose. As they continued to breastfeed their infants after diagnosis, the views of the participants changed. Initially they saw PKU as a disorder and felt that their infants were ill; later they felt that their infants were healthy in spite of PKU. Normal could mean a breastfeeding infant with PKU. Conclusion: Findings demonstrate the importance mothers attribute to breastfeeding and their willingness to invest considerable effort to breastfeed. Health care providers working with these mothers should help them strategize for success

Breastfeeding Success among Infants with Phenylketonuria

Breast milk is the nutrition of choice for human infants (American Academy of Pediatrics, 2005; American Association of Family Physicians, 2008; Association of Women’s Health Obstetric and Neonatal Nurses, 2005; Canadian Paediatric Society, 2005; U.S. Preventive Services Task Force, 2008; World Health Organization, 2009). The literature on the benefits of breast milk and breastfeeding for infants and mothers has established multiple positive outcomes for infants (Hoddinott, Tappin, & Wright, 2008; Horta, Bahl, Martines, & Victora, 2007; Ip et al., 2007). Breast milk has advantages for infants that distinguish it from standard commercial infant formulas. These advantages include growth factors, hormones, immunological factors, and long-chain polyunsaturated fatty acids. For infants with phenylketonuria (PKU), breast milk has additional advantages over any standard commercial infant formula, such as a lower concentration of protein and a lower content of the amino acid, phenylalanine. Despite these benefits, some clinics encourage mothers of infants with PKU to breastfeed whereas others present breastfeeding as an unacceptable option. Although the possible risks and benefits of breastfeeding infants with PKU have been discussed, there is limited research and practice describing breastfeeding infants with PKU. As a result, breastfeeding infants with PKU is based more upon limited clinical experiences rather than upon evidence based practice that aims to apply the best scientific evidence gained from research to clinical decision making

The Long-Lived Disks in the Eta Chamaeleontis Cluster

We present IRS spectra and revised MIPS photometry for the 18 members of the Eta Chamaeleontis cluster. Aged 8 Myr, the Eta Cha cluster is one of the few nearby regions within the 5-10 Myr age range, during which the disk fraction decreases dramatically and giant planet formation must come to an end. For the 15 low-mass members, we measure a disk fraction ~50%, high for their 8 Myr age, and 4 of the 8 disks lack near-IR excesses, consistent with the empirical definition of "transition'' disks. Most of the disks are comparable to geometrically flat disks. The comparison with regions of different ages suggests that at least some of the "transition" disks may represent the normal type of disk around low-mass stars. Therefore, their flattened structure and inner holes may be related to other factors (initial masses of the disk and the star, environment, binarity), rather than to pure time evolution. We analyze the silicate dust in the disk atmosphere, finding moderate crystalline fractions (~10-30%) and typical grain sizes ~1-3 micron, without any characteristic trend in the composition. These results are common to other regions of different ages, suggesting that the initial grain processing occurs very early in the disk lifetime (<1 Myr). Large grain sizes in the disk atmosphere cannot be used as a proxy for age, but are likely related to higher disk turbulence. The dust mineralogy varies between the 8-12micron and the 20-30 micron features, suggesting high temperature dust processing and little radial mixing. Finally, the analysis of IR and optical data on the B9 star Eta Cha reveals that it is probably surrounded by a young debris disk with a large inner hole, instead of being a classical Be star.Comment: 35 pages, 6 tables, 8 figures; Accepted by Ap

Work-Life Integration Issues for Parents Raising Children with ADHD. Community, Work and Family

PDF version of a presentation given at Community, Work and Family: IV International Conference Actors, Structures, and Theories. Tampere, Finland, May 2011

Factors Predicting Difficulty Combining Work and Family Responsibilities for Mothers Raising Children with ADHD

PDF version of presentation given at the Work and Family Researchers Network Conference in New York, NY, June 16, 2012

Finding Fit Between Work and Family Responsibilities When Caring for Children with ADHD Diagnoses

Finding fit between work and family responsibilities is challenging for parents, especially when raising a child with mental health difficulties. The purpose of this study was to investigate the relationship of children’s problematic behaviors to maternal employment and difficulty combining work and family obligations. Data were analyzed from 174 mothers parenting a child with a diagnosis of attention deficit hyperactivity disorder who completed child problem behavior (child behavior checklist), family functioning, and employment measures at baseline and 12 months later. Results from logistic regression analysis indicated that children’s problematic behaviors predicted maternal employment. Structural equation modeling showed that children’s higher baseline scores on the child behavior checklist internalizing scale were related to difficulty combining work and family at 12 months, even after controlling for difficulty of combining work and family at baseline. Children’s externalizing scores were not found to predict difficulty combining work and family responsibilities. Further analysis did not confirm mediation between children’s externalizing and internalizing behaviors, family conflict, and difficulty combining work and family. Given these results, service providers need to more comprehensively address the intersection of children’s mental health difficulties and work–family fit in order to better support caregivers as parents and employees

Longitudinal Impact of a Randomized Clinical Trial to Improve Family Function, Reduce Maternal Stress and Improve Child Outcomes in Families of Children with ADHD

Objective Evaluate the efficacy of a 12 month nursing case-management intervention over a period of 18 months, 6 months after the end of intervention, for families of children attention deficit hyperactivity disorder (ADHD). Methods Mother and child dyads were enrolled to participate in a randomized controlled clinical trial. Children were 4–18 years old. Data were collected at baseline, 6, 12, and 18 months or 6 months after the termination of direct intervention. Longitudinal analyses, using generalized estimating equations, were conducted to assess change in study outcomes relating to family function, maternal stress, and child behavior over the 18 month period. Results Compared to control families, some family function outcomes were moderately improved in the intervention group. In particular, intervention families demonstrated substantial improvement in implementing family behavior controls (p value = 0.038) and improvement in family satisfaction (not statistically significant p = 0.062). Although there was improvement in the overall family function measure there was not a statistically significant difference between groups. Maternal stress and child behavior outcomes were not significantly different between control and intervention groups by the end of the intervention. Conclusions for Practice Addressing ADHD is complex and requires the assessment of comorbidities that might exacerbate negative behavior. Our findings support the latest American Academy of Pediatrics guidelines to use behavioral therapy as the first line of treatment in young children. Nursing case-management interventions that provide direct family education and improve family function, especially with respect to providing structure and behavior control, may complement and facilitate behavioral therapy for treatment of ADHD and improving child behavior