The impact on child developmental status at 12 months of volunteer home-visiting support

Home-visiting support during pregnancy or soon after the birth of an infant can be advantageous for maternal well being and infant development. The best results have been identified when home-visitors are professionals, especially nurses, and if a theoretically driven curriculum is followed with fidelity. Some suggest that disadvantaged families, who may avoid professional services, respond well to support from community volunteers but there is less evidence about their impact. This study identified potentially vulnerable mothers during pregnancy in randomly allocated neighbourhoods where local volunteer home-visiting schemes agreed to offered proactive volunteer support and control areas where the local home-visiting schemes did not offer this proactive service. Taking demographic, child and family factors into account there were no significant differences in infant cognitive development at 12 months of age between families who had been supported by a volunteer and those who had not. Better cognitive development was predicted by less reported parenting stress when infants were 2 months and a more stimulating and responsive home environment at 12 months. The results suggest that unstructured proactive volunteer support for potentially vulnerable families is not likely to enhance infant development. Limitations of the cluster randomised design are discussed

Providing the family-nurse partnership programme through interpreters in England

This study looks at the delivery of the Family-Nurse Partnership (FNP) in England with interpreters. This home-visiting programme for vulnerable, young first-time mothers is known in the USA as the Nurse-Family Partnership (NFP). FNP is manualised with a number of fidelity targets and stretch objectives. This study covers the first two phases, pregnancy and infancy (up to 12 months). The programme relies on the development of a close nurse-client relationship. Interpreters can be a barrier for therapeutic work with vulnerable groups. The aims are to determine from quantitative and qualitative data whether the FNP programme can be delivered with fidelity in the presence of an interpreter and to explore issues concerned with the impact of interpreters on relationships. Statistical comparisons were made of delivery objectives over 2 years, from April 2007 to February 2009, in the 10 sites in England, spread across all nine Government Office Regions providing FNP. Forty-three clients had an interpreter at some point and 1261 did not. Qualitative interviews were conducted between April and May 2009 with 30 stakeholders (nurses, clients, interpreters). In relation to quantitative indicators, the percentage of planned content covered in visits was lower with interpreters (pregnancy 90% vs. 94%; infancy 88% vs. 93%) and both understanding and involvement of clients, as judged by nurses on 5-point scales, were lower (understanding, pregnancy 4.3 vs. 4.6, infancy 3.8 vs. 4.5; involvement, pregnancy 4.4 vs. 4.7, infancy 3.7 vs. 4.5). The interpreter was not thought by nurses to impede the development of a collaborative client-nurse relationship unless the interpreter and client became too close, but some nurses and clients reported that they would rather manage without an interpreter. Some stress was noted for nurses delivering the programme with an interpreter. More research is needed to determine the extent to which interpreters accurately convey the programme's strength-based approach

Health and development of children born after assisted reproductive technology and sub-fertility compared to naturally conceived children: data from a national study

In a non-matched case-control study using data from two large national cohort studies, we investigated whether indicators of child health and development up to 7 years of age differ between children conceived using assisted reproductive technology (ART), children born after sub-fertility (more than 24 months of trying for conception) and other children. Information on ART use/sub-fertility was available for 23,649 children. There were 227 cases (children conceived through ART) and two control groups: 783 children born to sub-fertile couples, and 22,639 children born to couples with no fertility issues. In models adjusted for social and demographic factors there were significant differences between groups in rate of hospital admissions before the children were 9 months old (P=0.029), with the ART group showing higher rates of hospital admission than the no fertility issues control group, the sub-fertile control group being intermediate between the two. Children born after ART had comparable health and development beyond 9 months of age to their naturally conceived peers. This applied to the whole sample and to a sub-sample of children from deprived neighborhoods

The feasibility of delivering Group Family Nurse Partnership

PURPOSE: To evaluate the feasibility of delivering the Group Family Nurse Partnership (gFNP) programme, combining elements of the Family Nurse Partnership programme and Centering Pregnancy and offered from early pregnancy to 12 months postpartum to mothers under 25. DESIGN/METHODOLOGY: A mixed method descriptive feasibility study. Quantitative data from anonymised forms completed by nurses from November 2009 to May 2011 (pilot 1) and January 2012 to August 2013 (pilot 2) reporting referrals, attendance and client characteristics. Qualitative data collected between March 2010 and April 2011 (pilot 1) and November 2012 and November 2013 (pilot 2) from semi-structured interviews or focus groups with clients and practitioners. FINDINGS: There were challenges to reaching eligible clients. Uptake of gFNP was 57% to 74%, attendance ranged from 39% to 55% of sessions and attrition ranged from 30% to 50%. Clients never employed attended fewest sessions overall compared to those working full time. The group format and the programme’s content were positively received by clients but many struggled to attend regularly. FNP practitioners were positive overall but involving community practitioners (pilot 2) placed more stress on them. RESEARCH IMPLICATIONS: Further feasibility and then cost and effectiveness research is necessary to determine the optimal staffing model. PRACTICAL IMPLICATIONS: The content and style of support of the home-based FNP programme, available only to first time mothers under 20, could be offered to women over 20 and to those who already have a child. Social implications A range of interventions is needed to support potentially vulnerable families. ORIGINALITY/VALUE: This new complex intervention lacks evidence. This paper documents feasibility, the first step in a thorough evaluation process. Keywords: Group support, pregnancy, early infancy, nurses, parent-child relationship

The health and development of children born to older mothers in the United Kingdom: observational study using longitudinal cohort data

Objective: To assess relations between children’s health and development and maternal age. Design: Observational study of longitudinal cohorts. Setting: Millennium Cohort Study (a random sample of UK children) and the National Evaluation of Sure Start study (a random sample of children in deprived areas in England), 2001 to 2007. Participants: 31 257 children at age 9 months, 24 781 children at age 3 years, and 22 504 at age 5 years. Main outcome measures: Childhood unintentional injuries and hospital admissions (aged 9 months, 3 years, and 5 years), immunisations (aged 9 months and 3 years), body mass index, language development, and difficulties with social development (aged 3 and 5 years). Results: Associations were independent of personal and family characteristics and parity. The risk of children having unintentional injuries requiring medical attention or being admitted to hospital both declined with increasing maternal age. For example, at three years the risk of unintentional injuries declined from 36.6% for mothers aged 20 to 28.6% for mothers aged 40 and hospital admissions declined, respectively, from 27.1% to 21.6%. Immunisation rates at nine months increased with maternal age from 94.6% for mothers aged 20 to 98.1% for mothers aged 40. At three years, immunisation rates reached a maximum, at 81.3% for mothers aged 27, being lower for younger and older mothers. This was linked to rates for the combined measles, mumps, and rubella immunisation because excluding these resulted in no significant relation with maternal age. An increase in overweight children at ages 3 and 5 years associated with increasing maternal age was eliminated once maternal body mass index was included as a covariate. Language development was associated with improvements with increasing maternal age, with scores for children of mothers aged 20 being lower than those of children of mothers aged 40 by 0.21 to 0.22 standard deviations at ages 3 and 4 years. There were fewer social and emotional difficulties associated with increasing maternal age. Children of teenage mothers had more difficulties than children of mothers aged 40 (difference 0.28 SD at age 3 and 0.16 SD at age 5). Conclusion: Increasing maternal age was associated with improved health and development for children up to 5 years of age

Patterns of childcare arrangements and cognitive development

Objectives. The current study investigated (a) whether identifiable patterns of childcare arrangements from birth to 51 months exist and (b) whether these patterns moderate cognitive development from 18 months to 51 months in relation to maternal stimulation of language and infant difficult temperament controlling for SES and child gender. Methods. Of the 1201 who participated in the Families, Children Childcare Study, 978 were included in the current study. Data were collected when children were 3, 18, 36 and 51 months old regarding their mother-reported childcare arrangements, mother-reported child temperament and objective tests of cognitive and language abilities. Results. Six prevailing patterns of childcare arrangements were identified. Variations were found across these in predicting cognitive development. For all types, cognitive ability at 18 months influenced language ability at 36 months, which in turn influenced cognitive ability at 51 months. Cognitive scores at 18 months were directly and significantly influential on cognitive ability at 51 months only in the ‘maternal to centre-based care’ and ‘multi types’ patterns of childcare. Early and ongoing centre-based care predicted higher language ability at 36 months but its impact was not evident at 51 months. When girls entered centre-based care after they were 3 years old, their cognitive scores were negatively influenced. Low family SES was a risk factor for language ability at 36 months when children were not introduced to any non-parental care before the age of three years. Conclusion. This study helped to understand that the particular childcare pathway from birth to the start of school interacts with family and child factors to contribute to child cognitive outcomes at 51 months. This information should be relevant to families as they make decisions about when to start or stop different types of child care during infancy and preschool years

Health outcomes of children born to mothers with chronic kidney disease: a pilot study

This study aimed to study the health of children born to mothers with chronic kidney disease. Twenty-four children born to mothers with chronic kidney disease were compared with 39 matched control children born to healthy mothers without kidney disease. The well-being of each child was individually assessed in terms of physical health, neurodevelopment and psychological health. Families participating with renal disease were more likely to be from lower socio-economic backgrounds. Significantly fewer vaginal deliveries were reported for mothers with renal disease and their infants were more likely to experience neonatal morbidity. Study and control children were comparable for growth parameters and neurodevelopment as assessed by the Griffiths scales. There was no evidence of more stress amongst mothers with renal disease or of impaired bonding between mother and child when compared to controls. However, there was evidence of greater externalizing behavioral problems in the group of children born to mothers with renal disease. Engaging families in such studies is challenging. Nonetheless, families who participated appreciated being asked. The children were apparently healthy but there was evidence in this small study of significant antenatal and perinatal morbidity compared to controls. Future larger multi-center studies are required to confirm these early findings

Short-term health and social care benefits of the Family Nurse Partnership lack evidence in the UK context but there is promise for child developmental outcomes

Nurse Family Partnership (NFP) home visiting from pregnancy to 24 months post partum, guided by a manualised curriculum, has been shown in three randomised controlled trials (RCTs) to have multiple beneficial outcomes and to be a cost-effective way to decrease the risk of child abuse for children of young, psychologically vulnerable first-time mothers.1 NFP has also been shown to strengthen families through increased maternal employment and wider spacing of pregnancies, and has demonstrated a range of benefits for children through adolescence.2 The US-developed programme was introduced into England in 2007 (renamed Family Nurse Partnership, FNP) and a pragmatic, non-blinded RCT was launched in 2009