- Email: [email protected]
Infant Feeding Practices and Weight-for-Age at 12 Months: Results From the Infant Feeding Practices Study II
pilot tested for comprehension and clarity by a group of approximately 15-20 SNs, and revised accordingly. In April 2010, the survey was sent to a sample of approximately 2100 SNs in Massachusetts using a link to an encrypted SurveyMonkey Web site. IRB approval was gained by the Boston College Institutional Review Board and expedited review was granted. Data Analysis: Survey analysis used descriptive/qualitative methods to elaborate on the current asthma management practices in the schools and barriers and facilitators to collaboration between SNs and primary care practices. Findings: Five hundred and ninety-eight SNs responded to this survey with a response rate of 28.5%; of these, 433 usable responses were analyzed. More than half of SNs identified a lack of communication with health care providers as a barrier to effective asthma management. Only 32.3% felt that the communication with primary care providers (PCPs) was good/excellent and even fewer (22.4%) reported this level of communication with allergy specialists. The telephone was also the most popular method of communicating with primary care providers (47.1%), followed by fax (18.5%), written notes (14.8%), and e-mail (2.8%). Only 56.7% of those with Asthma Action Plans (AAPs) had sufficient information on the AAP and lack of this tool was identified by SNs as being the most frequent obstacle to managing asthma in the schools. Further quantitative analyses will be presented on relationships between demographic variables and asthma management practices. Implications: Models are needed that improve collaboration around asthma management for school-aged children between PCPs (PNPs and pediatricians) and SNs in order to truly reflect an interdisciplinary, community-based, and system level intervention.
Family Ability to Provide Medication Information Comparing Pediatric Health Care Settings
complete and accurate medication information. Study of family ability is critical for the development of strategies that facilitate the medication reconciliation process. Purpose: The purpose of this study was to evaluate family ability to provide complete and accurate medication information across pediatric health care settings; gain knowledge of the family’s view of the medication reconciliation process; and solicit suggestions from families on ways to improve the medication reconciliation process. Sample: A total of 240 families were recruited from practice sites that provide entry into the pediatric health care system: 60 families from each site (emergency room, specialty clinic, pre-surgical care center, and primary care) participated in the study. Methodology: This descriptive study was conducted with IRB approval. At each site, families with a child receiving daily medication were invited to participate in the study by completing a 10-question survey consisting of open- and close-ended questions. Families that provided complete medication information (medication name, concentration, dose, frequency, and route) from memory or a list were asked to participate in a follow-up telephone call to confirm the information. Results: Ability to provide complete medication information was similar with about half of the families in the emergency room (51.4%), specialty clinic (50%), and pre-surgical care center (52.9%) and less in primary care (28.5%). Many families were unfamiliar with the term medication reconciliation but did expect to be asked about medications. Families provided many suggestions to improve the process. Conclusion: Family members, clinicians, and health care organizations need to partner and collaborate to provide safe health care to children by improving medication reconciliation.
Kathy Riley-Lawless, PhD, RN, PNP-BC
Infant Feeding Practices and Weight-for-Age at 12 Months: Results From the Infant Feeding Practices Study II
Clinical Research Podium Presentation at the 32nd Annual NAPNAP Conference, March 2011, Baltimore, MD
Kathleen F. Gaffney, PhD, RN, F/PNPBC, Panagiota Kitsantas, PhD, & Jehanzeb Cheema, PhD
Significance: Across practice settings, pediatric nurse practitioners actively participate in the medication reconciliation process in an effort to provide safe care by decreasing medication errors. Successful medication reconciliation depends upon family ability to provide www.jpedhc.org
Clinical Research Podium Presentation at the 32nd Annual NAPNAP Conference, March 2011, Baltimore, MD Background: Early childhood obesity is a growing public health concern. Current infant feeding September/October 2011
e21
practice guidelines call for 1) no bottle-to-bed, 2) minimal juice consumption, 3) exclusive breastfeeding up to 4-6 months with continued breastfeeding up to one year, and 4) introduction of solid foods no earlier than 4-6 months infant age. However, associations between these recommended practices and weight-for-age in late infancy remain to be identified. Study Question: To what extent are bottle-to-bed behavior, late infancy juice consumption intensity, late infancy breastfeeding intensity, and early introduction to solid foods associated with weight-for-age among oneyear-old infants? Methods: Data were obtained from the Infant Feeding Practices Study II, a longitudinal survey administered by the Food and Drug Administration and Centers for Disease Control and Prevention that followed U.S. mother-infant dyads from pregnancy through oneyear postpartum. Multiple regression models were used to examine the association between the selected infant feeding practices and weight-for-age among the 691 infants who met inclusion criteria and for whom 12-month survey data were available. A recognized limitation was self-reported data. The HSRB at George Mason University approved the implementation of this study. Results: Of the four infant feeding practice variables, late infancy juice consumption intensity (p = .003), late infancy breastfeeding intensity (p < .001), and introduction to solid food prior to four months (p < .001) were each associated with late infancy weightfor-age. In a regression model that included the four infant feeding variables and controlled for infant gender and birth weight as well as maternal age, education, race, household income, smoking status, pregravid weight, and weight gain during pregnancy the same infant feeding practices remained significant predictors of baby’s weight-for-age at one year. A limitation to generalizability was a disproportionately low representation of low SES and minority groups in the sample. Implications: Modifiable feeding practices contributed to infant weight-for-age at one year. Future clinical research should examine the relationship between these infant feeding practices and excessive weight gain through the preschool years. To reduce the risk for excessive weight gain that may lead to later childhood overweight/obesity, recommended feeding practices for the second half of infancy should emphasize continued breastfeeding, minimal juice consumption, and delayed introduction of solid foods (after six months). e22
Volume 25 Number 5
A Primary Care Healthy Choices Intervention Program for Overweight and Obese School-age Children and Their Parents Diana Jacobson, PhD, RN, PNP-BC Clinical Research Podium Presentation at the 32nd Annual NAPNAP Conference, March 2011, Baltimore, MD Aims: Childhood overweight and obesity have reached epidemic proportions. Primary care providers can intervene in this health crisis by providing evidencebased interventions but there has been limited research conducted in primary care settings to guide interventions to improve the physical and psychosocial outcomes of overweight in school-age children. Therefore, the aims of this study were to pilot test a comprehensive Cognitive Theory-based Healthy Choices Intervention (HCI) program with overweight and obese 9- to 12-year-old children and their parents in order to evaluate: 1) acceptability and feasibility of the HCI; and 2) the psychosocial and anthropometric outcomes in order to determine preliminary effects. Methods: Overweight and obese 9- to 12-year-old children identified in primary care, and their parents, participated in this 7-week, one-group pretest posttest intervention study. The HCI consisted of four 30-minute face-to-face intervention sessions alternated with three 20-minute telephone intervention sessions. Children and parents were given weekly homework assignments, completed daily food diaries, and recorded pedometer steps taken daily. Outcome measures included: weight and body mass index (BMI), BMI percentile, physical activity and nutrition knowledge, healthy lifestyle beliefs, choices, and behaviors; anxiety and depression symptomology; self-concept; and social competence. Results: Participants found the HCI useful and informative. Significant effects of the HCI for the children included: decreased BMI percentile; increased nutrition and physical activity knowledge; increased healthy lifestyle beliefs, choices and behaviors; and increased selfreported physical activity and self-control. Significant preliminary effects of the HCI for the parents included increased nutrition and physical activity knowledge; increased healthy lifestyle beliefs and behaviors, and decreased anxiety. Conclusions: This study provides evidence to support the feasibility, acceptability, and Journal of Pediatric Health Care
Family Ability to Provide Medication Information Comparing Pediatric Health Care Settings
complete and accurate medication information. Study of family ability is critical for the development of strategies that facilitate the medication reconciliation process. Purpose: The purpose of this study was to evaluate family ability to provide complete and accurate medication information across pediatric health care settings; gain knowledge of the family’s view of the medication reconciliation process; and solicit suggestions from families on ways to improve the medication reconciliation process. Sample: A total of 240 families were recruited from practice sites that provide entry into the pediatric health care system: 60 families from each site (emergency room, specialty clinic, pre-surgical care center, and primary care) participated in the study. Methodology: This descriptive study was conducted with IRB approval. At each site, families with a child receiving daily medication were invited to participate in the study by completing a 10-question survey consisting of open- and close-ended questions. Families that provided complete medication information (medication name, concentration, dose, frequency, and route) from memory or a list were asked to participate in a follow-up telephone call to confirm the information. Results: Ability to provide complete medication information was similar with about half of the families in the emergency room (51.4%), specialty clinic (50%), and pre-surgical care center (52.9%) and less in primary care (28.5%). Many families were unfamiliar with the term medication reconciliation but did expect to be asked about medications. Families provided many suggestions to improve the process. Conclusion: Family members, clinicians, and health care organizations need to partner and collaborate to provide safe health care to children by improving medication reconciliation.
Kathy Riley-Lawless, PhD, RN, PNP-BC
Infant Feeding Practices and Weight-for-Age at 12 Months: Results From the Infant Feeding Practices Study II
Clinical Research Podium Presentation at the 32nd Annual NAPNAP Conference, March 2011, Baltimore, MD
Kathleen F. Gaffney, PhD, RN, F/PNPBC, Panagiota Kitsantas, PhD, & Jehanzeb Cheema, PhD
Significance: Across practice settings, pediatric nurse practitioners actively participate in the medication reconciliation process in an effort to provide safe care by decreasing medication errors. Successful medication reconciliation depends upon family ability to provide www.jpedhc.org
Clinical Research Podium Presentation at the 32nd Annual NAPNAP Conference, March 2011, Baltimore, MD Background: Early childhood obesity is a growing public health concern. Current infant feeding September/October 2011
e21
practice guidelines call for 1) no bottle-to-bed, 2) minimal juice consumption, 3) exclusive breastfeeding up to 4-6 months with continued breastfeeding up to one year, and 4) introduction of solid foods no earlier than 4-6 months infant age. However, associations between these recommended practices and weight-for-age in late infancy remain to be identified. Study Question: To what extent are bottle-to-bed behavior, late infancy juice consumption intensity, late infancy breastfeeding intensity, and early introduction to solid foods associated with weight-for-age among oneyear-old infants? Methods: Data were obtained from the Infant Feeding Practices Study II, a longitudinal survey administered by the Food and Drug Administration and Centers for Disease Control and Prevention that followed U.S. mother-infant dyads from pregnancy through oneyear postpartum. Multiple regression models were used to examine the association between the selected infant feeding practices and weight-for-age among the 691 infants who met inclusion criteria and for whom 12-month survey data were available. A recognized limitation was self-reported data. The HSRB at George Mason University approved the implementation of this study. Results: Of the four infant feeding practice variables, late infancy juice consumption intensity (p = .003), late infancy breastfeeding intensity (p < .001), and introduction to solid food prior to four months (p < .001) were each associated with late infancy weightfor-age. In a regression model that included the four infant feeding variables and controlled for infant gender and birth weight as well as maternal age, education, race, household income, smoking status, pregravid weight, and weight gain during pregnancy the same infant feeding practices remained significant predictors of baby’s weight-for-age at one year. A limitation to generalizability was a disproportionately low representation of low SES and minority groups in the sample. Implications: Modifiable feeding practices contributed to infant weight-for-age at one year. Future clinical research should examine the relationship between these infant feeding practices and excessive weight gain through the preschool years. To reduce the risk for excessive weight gain that may lead to later childhood overweight/obesity, recommended feeding practices for the second half of infancy should emphasize continued breastfeeding, minimal juice consumption, and delayed introduction of solid foods (after six months). e22
Volume 25 Number 5
A Primary Care Healthy Choices Intervention Program for Overweight and Obese School-age Children and Their Parents Diana Jacobson, PhD, RN, PNP-BC Clinical Research Podium Presentation at the 32nd Annual NAPNAP Conference, March 2011, Baltimore, MD Aims: Childhood overweight and obesity have reached epidemic proportions. Primary care providers can intervene in this health crisis by providing evidencebased interventions but there has been limited research conducted in primary care settings to guide interventions to improve the physical and psychosocial outcomes of overweight in school-age children. Therefore, the aims of this study were to pilot test a comprehensive Cognitive Theory-based Healthy Choices Intervention (HCI) program with overweight and obese 9- to 12-year-old children and their parents in order to evaluate: 1) acceptability and feasibility of the HCI; and 2) the psychosocial and anthropometric outcomes in order to determine preliminary effects. Methods: Overweight and obese 9- to 12-year-old children identified in primary care, and their parents, participated in this 7-week, one-group pretest posttest intervention study. The HCI consisted of four 30-minute face-to-face intervention sessions alternated with three 20-minute telephone intervention sessions. Children and parents were given weekly homework assignments, completed daily food diaries, and recorded pedometer steps taken daily. Outcome measures included: weight and body mass index (BMI), BMI percentile, physical activity and nutrition knowledge, healthy lifestyle beliefs, choices, and behaviors; anxiety and depression symptomology; self-concept; and social competence. Results: Participants found the HCI useful and informative. Significant effects of the HCI for the children included: decreased BMI percentile; increased nutrition and physical activity knowledge; increased healthy lifestyle beliefs, choices and behaviors; and increased selfreported physical activity and self-control. Significant preliminary effects of the HCI for the parents included increased nutrition and physical activity knowledge; increased healthy lifestyle beliefs and behaviors, and decreased anxiety. Conclusions: This study provides evidence to support the feasibility, acceptability, and Journal of Pediatric Health Care