ABSTRACT
Background: Evidence of effective early childhood obesity prevention is scarce and mainly derived from face-to-face interventions. However, the COVID-19 pandemic drastically reduced face-to-face health programmes globally. This study assessed effectiveness of a telephone-based intervention in reducing obesity risk of young children. Method(s): We adapted a study protocol (developed before the pandemic) and conducted a pragmatic randomised controlled trial of 662 women with children aged 2 years (mean age 24.06 months [SD 0.69]) during March, 2019, and October, 2021, extending the original planned intervention of 12 months to 24 months. The adapted intervention comprised five telephone-based support sessions plus text messages over a 24-month period (at child ages 24-26 months, 28-30 months, 32-34 months, 36-38 months, and 42-44 months). The intervention group (n=331) received staged telephone plus SMS support regarding healthy eating, physical activity, and information about COVID-19. The control group (n=331) received four staged mail-outs on information not related to the obesity prevention intervention, such as toilet training, language development, and sibling relationships, as a retention strategy. The intervention effects on BMI (primary outcome) and eating habits (secondary outcome), and perceived co-benefits, were evaluated using surveys and qualitative telephone interviews at 12 months and 24 months after baseline (age 2 years). The trial is registered with the Australian Clinical Trial Registry, ACTRN12618001571268. Finding(s): Of 662 mothers, 537 (81%) completed the follow-up assessments at 3 years, and 491 (74%) completed the follow-up assessment at 4 years. Multiple imputation analysis showed no significant difference in mean BMI between the groups. Among low-income families (ie, annual household income <AU$80 000) at age 3 years, the intervention was significantly associated with a lower mean BMI (16.26 kg/m2 [SD 2.22]) in the intervention group than in the control group (16.84 kg/m2 [2.37];p=0.040), a difference of -0.59 (95% CI -1.15 to -0.03;p=0.040). Children in the intervention group were more likely not to eat in front of the television than the control group, with an adjusted odds ratio (aOR) of 2.00 (95% CI 1.33 to 2.99) at 3 years and an aOR of 2.50 (1.63 to 3.83) at 4 years. Qualitative interviews with 28 mothers revealed that the intervention increased their awareness, confidence, and motivation to implement healthy feeding practices, particularly for families from culturally diverse backgrounds (ie, speaking a language other than English at home). Interpretation(s): A telephone-based intervention was well received by the mothers who participated in the study. The intervention could reduce children's BMI from low-income families. Telephone-based support targeted at low-income families and families from culturally diverse backgrounds could reduce current inequalities in childhood obesity. Funding(s): The trial was funded under the NSW Health Translational Research Grant Scheme 2016 (number TRGS 200) and also by a National Health and Medical Research Council Partnership grant (number 1169823).Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
ABSTRACT
Introduction Children with idiopathic chronic constipation are extremely challenging to manage. Before review by tertiary specialist teams, Children have suffered for years with constipation, which leads to significant behaviour related issues around toileting, despite adequate medical treatment. The involvement of the health play specialist (HPS) in the nurseled constipation clinic is to address behaviours around toileting. Aims To demonstrate involvement of HPS in the clinic led to improved outcomes for children and families. This will be identified through the use of parental satisfaction questionnaires and four case studies. Case Studies We demonstrate four extremely complex constipation cases referred to clinic and successfully managed by HPS with unique individualised approach with support and plans for parents and school. 9-year-old boy with history of sexual abuse, with soiling and wetting accidents. 5 sessions with the HPS, focusing on toileting behaviours. Sessions involved desensitizing play around the body, use of toilet related games/activities, videos and mobile apps. All issues resolved. 5-year-old boy: Stool with-holding, will only pass stools in a nappy and soiling. 8 sessions with HPS - Intense toilet training for 2-4 days with hourly sits. Reward charts to compliment interests, targets adjusted when goal reached, prizes given. Desensitization play around toileting behaviours. Using analogies to improve behaviour, he loved dustbin lorries - body empties the waste (poo) just like the bin men collecting the rubbish to get rid of it from home. No more accidents, independent toileting achieved 5-year-old girl Issues with constipation, soiling and toilet refusal. All bowel movements in knickers. Complete HPS treatment virtually, secondary to COVID restrictions. 6 Video call sessions- individualised plan of regular sits to relax, with no pressure to perform. To do an activity whilst on the toilet. Visual pictures/videos explaining how the body works and the plan was adjusted on the video. Rewards when child reached the target, and prize sent in post. Outcome -no fear of the toilet, bowels open on the toilet, no accidents. 8 year old boy premature 33 + 5 weeks. Constipation with overflow since birth. Referred to surgeons for rectal biopsies and botox injections at the age of 3 but no improvement. Age 4 admitted to the ward for 1 week for observation, transit marker study and toilet training was unsuccessful. Referred to another unit for second opinion at parental request. Started to refuse medications. ACE surgery discussed. Diagnosed with Autism at 7 years. Invited for a week of intense toileting with HPS, hourly sits and desensitization activities on medication taking, toileting, with-holding, signs and signals of body. Reward system in place, when reached expectations, reward given by hospital. Outcome bowels open daily in the toilet, wears pants all the time. Satisfaction questionnaires were given to parents and feedback was extremely positive. Conclusion The health play specialist involvement in the nurse led constipation clinic allows for individualised intervention guided by the child's needs. Pharmacological interventions alone may be unsuccessful without addressing behavioural needs.
ABSTRACT
IntroductionChildren with idiopathic chronic constipation are extremely challenging to manage. Before review by tertiary specialist teams, Children have suffered for years with constipation, which leads to significant behaviour related issues around toileting, despite adequate medical treatment. The involvement of the health play specialist (HPS) in the nurse-led constipation clinic is to address behaviours around toileting.AimsTo demonstrate involvement of HPS in the clinic led to improved outcomes for children and families. This will be identified through the use of parental satisfaction questionnaires and four case studies.Case StudiesWe demonstrate four extremely complex constipation cases referred to clinic and successfully managed by HPS with unique individualised approach with support and plans for parents and school.9-year-old boy with history of sexual abuse, with soiling and wetting accidents.5 sessions with the HPS, focusing on toileting behaviours. Sessions involved desensitizing play around the body, use of toilet related games/activities, videos and mobile apps. All issues resolved.5-year-old boy: Stool with-holding, will only pass stools in a nappy and soiling.8 sessions with HPS - Intense toilet training for 2–4 days with hourly sits. Reward charts to compliment interests, targets adjusted when goal reached, prizes given. Desensitization play around toileting behaviours. Using analogies to improve behaviour, he loved dustbin lorries – body empties the waste (poo) just like the bin men collecting the rubbish to get rid of it from home. No more accidents, independent toileting achieved5-year-old girl Issues with constipation, soiling and toilet refusal. All bowel movements in knickers.Complete HPS treatment virtually, secondary to COVID restrictions. 6 Video call sessions- individualised plan of regular sits to relax, with no pressure to perform. To do an activity whilst on the toilet. Visual pictures/videos explaining how the body works and the plan was adjusted on the video. Rewards when child reached the target, and prize sent in post. Outcome -no fear of the toilet, bowels open on the toilet, no accidents.8 year old boy premature 33 + 5 weeks. Constipation with overflow since birth. Referred to surgeons for rectal biopsies and botox injections at the age of 3 but no improvement. Age 4 admitted to the ward for 1 week for observation, transit marker study and toilet training was unsuccessful. Referred to another unit for second opinion at parental request. Started to refuse medications. ACE surgery discussed. Diagnosed with Autism at 7 years.Invited for a week of intense toileting with HPS, hourly sits and desensitization activities on medication taking, toileting, with-holding, signs and signals of body. Reward system in place, when reached expectations, reward given by hospital. Outcome bowels open daily in the toilet, wears pants all the time.Satisfaction questionnaires were given to parents and feedback was extremely positive.ConclusionThe health play specialist involvement in the nurse led constipation clinic allows for individualised intervention guided by the child’s needs. Pharmacological interventions alone may be unsuccessful without addressing behavioural needs.
ABSTRACT
Toileting skills are a developmental milestone most commonly achieved by age 4 for typically developing children. Children diagnosed with autism or other DD face challenges with toileting often due to delayed teaching and acquisition of the skill. However, delaying toilet training can further exacerbate the challenges related to acquisition. One of the many factors in having a successful and sustainable program is to have the right people involved. Caregiver involvement is one of the many important components in the maintenance and sustainability of this skill yet training for caregivers can be difficult when access to services is limited due to factors such as distance, limited availability of providers, or disruptions such as the current coronavirus pandemic. To address this issue, telehealth was used to teach three caregivers a 27-step toilet training program to implement with their child. Behavior measured included percentage of correct implementation steps of each caregiver, urination and fecal successes, accident frequency of both urine and fecal voids, and child initiations for the bathroom. All caregivers learned the performance of the 27-step procedure between 93% and 100% accuracy. The multicomponent toilet training program using telehealth was effective to teach three children daytime dryness, and two children acquired both urine and fecal voids within 25 to 62 days. Social validity, via caregiver satisfaction in using a telehealth service, was assessed and affirmed. Caregiver implementation and the potential for "drift" in implementation is discussed as well as possible ways to mitigate the occurrence. . (PsycInfo Database Record (c) 2022 APA, all rights reserved)