Resources for pediatricians. How do I answer questions from parents, patients, teachers, and others?

Most pediatricians do not have special training in pediatric environmental health, but environmental exposures are among parents' top concerns for their children. Parents may come to their pediatricians seeking advice about symptoms that they think may be related to an environmental hazard. They may worry about exposures even if their children have no symptoms. Occasionally, pediatricians may diagnose an illness caused by an environmental exposure but may not be familiar with the illness because it is uncommon.

Centers for disease control and prevention lead guidelines: do pediatricians know them?

American Academy of Pediatrics (AAP) fellows responded to a questionnaire measuring knowledge of 1991 Centers for Disease Control and Prevention (CDC) guidelines. Generalists' scores on a knowledge scale were positively correlated with reporting CDC and AAP documents as knowledge sources, and negatively correlated with private practice, medical school as a knowledge source, and age. However, private practitioners who read AAP documents scored well.

Caring for pregnant teens and their mothers, too.

PIP: The Teenage Mothers-Grandmothers (TAM-GM) program was developed at a hospital in the Bronx, New York, to help the adolescents' mothers understand and communicate with their pregnant daughters. Eligible adolescents were no more than 32 weeks pregnant, had no previous live birth, would be aged 17 or younger at due date, and maintained an ongoing relationship with their mother or mother surrogate (their grandmother or the mother of the adolescent's boyfriend). The TAM-GM program consisted of a series of structured, hour-long sessions coinciding with prenatal visits. During sessions one, two, and four, a social worker met with the adolescent's mother alone; the adolescent joined them for the third session. Additional sessions occurred after the birth. An evaluation was undertaken in 1993 to determine if program participation improved school completion, reduced repeat pregnancy rates, and improved the adolescent-mother relationship. The grandmothers reported that participation in the program helped them deal with the situation and improved their relationships with their daughters. Adolescents and their mothers reported improved communications. Program participants suggested that the program be extended beyond clinic hours, possibly using a hotline approach. The adolescents who participated in the program were less likely to drop out of school and had a lower repeat pregnancy rate and significantly higher self-esteem than those who did not participate. High self-esteem was a significant predictor of staying in school.^ieng

The relationship of partner support to outcomes for teenage mothers and their children: a review.

This article reviews the literature on the relationship of partner support to outcomes for teenage mothers and their children. It discusses the changing alliance over time between men who father their babies and the young mothers and their children. This report considers both adults and adolescents who father children with adolescent women. The discussion focuses on the relationship between partner support and three outcomes for the mothers: educational outcomes, economic outcomes, and psychological well-being. The general association between partner support and the children's development is also examined. In addition, partner support is viewed within the context of the teenager's family system, providing a framework for assessing key features of support for teenage mothers. The article outlines suggestions for future research.

PIP: Each year in the US, 11% of all young women aged 15-19 years become pregnant. 50% of these women carry their pregnancy to term, becoming teenage mothers. Adolescent childbearing has serious ramifications for the teenager and her child. Supportive social relationships can, however, help young women to cope with the stresses of teenage motherhood. The authors review the literature on the relationship of partner support to outcomes for teenage mothers and their children. Both adults and adolescents who father children with female adolescents are considered. Focus is given upon the relationship between partner support and maternal educational and economic outcomes, as well as psychological well-being. The paper also examines the general association between partner support and child development. Partner support is viewed within the context of the teenager's family system, providing a framework for assessing key features of support for teen mothers. Suggestions for future research are offered.

Evaluation of an intergenerational program for pregnant and parenting adolescents.

PROBLEM: Poor life outcomes for teenage mothers SUBJECTS: Young mothers (N = 65) several years after the birth of their first child. Half had mothers (called grandmothers) who attended the Teenage Mothers-Grandmothers program. METHODS: A long-term evaluation study of the effects of the Teenage Mothers-Grandmothers Program on outcomes for the teens. Instruments used: demographic questionnaire, the Rosenberg Self-Esteem Scale, the Arizona Social Support Inventory Schedule, and an open-ended questionnaire. FINDINGS: Teens whose mothers participated in the program were significantly less likely to drop out of school and had significantly better self-esteem. CONCLUSIONS & IMPLICATIONS FOR NURSING: Including the mothers of pregnant and parenting adolescents in programs can be beneficial.

PIP: This study evaluates the Teenage Mothers-Grandmothers (TAM-GM) Program, which operated during 1988-91, at a large inner-city hospital in the Bronx, New York. Pregnant adolescents who received prenatal care were expected to attend classes on labor and delivery, changes in pregnancy, AIDS and sexually transmitted disease prevention, teen concerns, sexuality and family planning, the physical care of the newborn, the emotional needs of the newborn and older infant, and nutrition. Grandmothers attended the classes with their pregnant daughters. Postpartum care in the clinic for the same mothers included check-ups monthly during the first year, bimonthly during the second year, and then every 3-6 months. Children were followed-up until the age of 3 years or until the mother turned age 19. The aim of the TAM-GM was to reduce repeat pregnancy. Grandmothers participated in counseling sessions with a social worker during their daughter's pregnancy and in the first months postpartum. 59 grandmothers, or 39% of those eligible, attended at least one session of the TAM-GM Program; 34 attended 4-12 sessions; and 26 attended 1-3 sessions. Adolescent study participants completed questionnaires (demographic survey, the Moos Family Environment Scale, the Rosenberg Self-Esteem Scale, the Brief Symptoms Inventory, and the Arizona Social Support Interview) at Time 1, at the onset of TAM-GM Program, and at Time 2, when the index children were aged 2-5 years. Of the 65 adolescent participants (38% of the original 171), 32 had mothers who attended at least one TAM-GM session. Open-ended interviews revealed seven categories of concern. Findings indicate that teens whose mothers participated in TAM-GM were significantly less likely to have dropped out of school and had significantly higher self-esteem scores. Teens credited the program with helping them feel better about the pregnancy and with improving relations with their mothers. Findings suggest that all benefitted in numerous ways from TAM-GM.

Pediatricians' attitudes concerning motherhood during residency.

Because half of pediatric residents are women, pregnancy is increasingly common among pediatric house staff. We hypothesized that the heavy work load of pregnant pediatric residents is tolerated because those who have experienced a residency themselves underestimate the strain of residency compared with other work. A questionnaire, designed to survey pediatricians' attitudes concerning the effects of employment on the fetus, mother, and newborn infant, was produced in two formats, which were identical except that one concerned residents, while the other concerned women employed full-time in other jobs. Each type of questionnaire was sent to 1000 randomly selected members of the American Academy of Pediatrics. Respondents in both groups shared many attitudes concerning the effects of maternal employment. Certain subgroups (eg, males, those married to spouses not employed, and those women not pregnant in residency) judged employment as more harmful in general. Contrary to the original hypothesis, however, all subgroups consistently judged residency as more deleterious than other work. Training programs need to adopt humane strategies to integrate motherhood with residency.

Examination of genitalia in children: 'the remaining taboo'.

Trained student observers rated 123 physical examinations by pediatric house staff during health care maintenance visits to assess the frequency of examinations done on male and female genitalia compared with examination of ears, heart, and abdomen. Sixty-five observations were made of 21 male house staff and 58 observations of 18 female house staff. One to five examinations per physician were observed. Whereas physicians examined the ears, heart, and abdomen of pediatric patients greater than or equal to 97% of the time regardless of the sex or age of the child, female genitalia were examined 39% of the time and male genitalia 84% of the time. Female genitalia were examined approximately half as frequently as male genitalia at all ages with a trend to less frequent genital examinations on older children. Both male and female physicians examined female genitalia less frequently than male genitalia. It is concluded that increased emphasis is needed in house staff training programs on the examination of genitalia.