Trends and associated factors of bottle-feeding in Turkey: dramatic change over the last three decades under the limited implemented code.

The study aimed to examine the trends and associated factors of bottle-feeding among children aged 0-35 months. Data covering 11,205 mother-child pairs, from six recent Turkey Demographic and Health Surveys (TDHSs) were analyzed by using complex sample crosstabs and logistic regression. Bottle-feeding was on an upward trend from 33.0% to 51.5% from 1993 to 2013 and fell slightly 47.9% in 2018. Increasing trends of bottle-feeding were found in children aged 6-35 months, the East region, lower wealth index, maternal education under 5 years, Kurdish mothers, and the low antenatal care attendance. Multivariate analysis using data from TDHS-2018 showed that young maternal age, low birth weight and being 6-23 months of age were associated with higher rates of bottle-feeding. The prolonged bottle-feeding became widespread, and the bottle-feeding was common even in 35-month-old children. Interventions by the Government and stakeholders to minimize low rates of bottle-feeding should focus on high-risk groups.

Evaluation of breastfeeding and infant feeding attitudes among syrian refugees in Turkey: observations of Syrian healthcare workers.

BACKGROUND: The influx of Syrian refugees into Turkey has highlighted the importance of supporting breastfeeding practices among this vulnerable population. We aimed to evaluate the breastfeeding and infant feeding attitudes of Syrian mothers based on the observations of Syrian healthcare workers (HCWs). METHODS: An online form including 31 questions was prepared in Turkish, Arabic, and English languages and distributed to HCWs, working in refugee health centers via e-mail, WhatsApp, or text message with the help of Ministry of Health in Turkey between January 2020 and March 2020. The questions were about HCWs' characteristics (occupation, region of employment, duration of employment, participation in breastfeeding counseling course) and about HCWs' observations of Syrian mothers' breastfeeding and infant feeding practices. RESULTS: A total of 876 HCWs were included in the study; about 37.3% were physicians. Only 40.0% of HCWs reported that babies were predominantly fed with breast milk in the first three days after birth, 45.2% of HCWs indicated that mothers typically used sugary water as a prelacteal food, and 30.5% believed that breastfeeding was discontinued before 12 months. The main barriers to breastfeeding identified by HCWs included the lack of education, mental and physical health issues in the mother, food insecurity, low income, inadequate housing, lack of family planning, sociocultural environment, and limited access to quality health services. For complementary feeding, 28.0% of HCWs stated early introduction and 7.4% remarked delayed. HCWs believed grains, fruits and vegetables, and dairy products as top three foods for starting complementary food (59.5%, 47.8%, and 30.3% respectively). Healthcare challenges of Syrian pregnant and lactating mothers were reported to be associated primarily with "food, finance, and housing difficulties", low maternal education, and cultural and environmental issues. HCWs recommended various solutions, such as supporting breastfeeding, offering nutrition and health support, promoting family planning, improving healthcare systems through legislation, and addressing cultural barriers. CONCLUSIONS: To address breastfeeding issues among Syrian mothers, it is crucial to provide breastfeeding training to both HCWs and mothers. Expanding interventions that support breastfeeding-friendly practices, including community support and food aid for breastfeeding mothers, should also be considered to address the social determinants of breastfeeding.

Breastfeeding practices among Syrian refugees in Turkey.

BACKGROUND: We evaluated (a) opinion of Syrian and Turkish healthcare workers (HCWs), and perceptions and attitudes of Syrian refugee mothers, pregnant women, fathers and grandmothers on age-appropriate breastfeeding, (b) the effect of cultural characteristics, migration and pandemics on Syrian's infant nutrition, and (c) the suggestions of HCWs and Syrian family members to improve breastfeeding practices in the Syrian refugee society in a qualitative study. METHODS: The qualitative study consisting of structured focus group discussions (FGDs) was held in four provinces in Turkey where Syrian refugees live intensely in September and October 2020. Seven different types of online FGDs were held with Turkish HCWs working in maternity hospitals, Syrian HCWs working in Refugee Health Centers (RHCs), Syrian pregnant women, mothers, fathers, and grandmothers. In total, we carried out 46 FGDs with 335 individuals. Thematic analysis of the transcripts in a deductive-inductive fashion was carried out with MAXQDA 11. RESULTS: Most Syrian HCWs did not get any training on breastfeeding counseling. The short duration of breastfeeding in Syrian refugees was seen to be related to the cultural characteristics, and migration. Some cultural characteristics can be summarized as "believing that breastfeeding harms mother's health", "adolescent marriages", "wanting to have as many children as possible", "giving anise to infants and not breastfeeding at night", "prelacteal feeding", "believing that milk is not enough", "over controlling mother-child interaction by grandmothers, which limits the interaction", "short pregnancy intervals", and "not using modern family planning techniques". We found out that migration increased the tendency for adolescent pregnancies, deepened the poverty, and decreased family social support. We did not observe any change in breastfeeding practices during pandemics. CONCLUSIONS: Breastfeeding counseling programs should be designed in consideration of cultural characteristics of Syrian HCWs and family members. Continuing health education programs for family members with socially appropriate interventions to prevent adolescent marriages are important.

Video game playing among preschoolers: prevalence and home environment in three provinces from Turkey.

We aimed to investigate the video game habits and their relationship with home environment in children 2-5 years in Turkey. A structured questionnaire about the child's demographic, screen, and video gaming characteristics was completed by parents in five health centers from three provinces. One-quarter of 1245 preschoolers were found to play video games. The prevalence of playing video games was higher in older age, male gender, low parental education, families with 3 or more children, having a game console, computers and tablets at home, child's screen time of more than 2 hours per day, child's non-compliance with the parental screen rules, and presence of someone else playing videogame at home. Of the parents, 54.5% did not know the name of the video game the child was playing. Parents should be counseled about supervising on their children's video game playing habits and selection of well-designed games with the right content.

Evaluation of problematic screen exposure in pre-schoolers using a unique tool called "seven-in-seven screen exposure questionnaire": cross-sectional study.

BACKGROUND: Screen media exposure has been increasing in the preschool years. Risky aspects of screen exposure have many potential negative effects on children's health. We aimed to evaluate problematic screen exposure in Turkish preschool children by using a unique tool called the "Seven-in-Seven Screen Exposure Questionnaire" and to investigate factors associated with problematic screen exposure. METHODS: A questionnaire form was designed including general descriptive questions in the first part. In the second part, a questionnaire we designed called the "Seven-in-Seven Screen Exposure Questionnaire" was conducted to evaluate problematic screen exposure characteristics. The questionnaire included seven items: daily screen time, viewing with parent(s), setting screen limits, screen exposure during meals and in the hour before bedtime, age of onset of screen exposure, and viewing low-quality content. The total problematic screen exposure score (range 0-13) was generated by summing scores from the seven items. Total scores are classified into two categories: low (< 7) and high (≥ 7). Logistic regression was performed to search for independent parameters associated with problematic screen exposure. RESULTS: One thousand two hundred forty-five mother-child pairs participated in this study. The median age of the children was 3.9 (IQR: 2.9-4.7) years and 51% were males. Overall, 280 children (22.5%) had a problematic screen exposure score of ≥7 (high). The median problematic screen exposure score was 4 (IQR: 3-6). Maternal age of < 30 years; paternal age of ≥30 years; maternal educational level of ≤12 years; the age of 24-48 months; home-based daycare; postponing eating, toileting, or sleeping while using a screen; and using touchscreen devices were found to be associated with an increased risk of having a high problematic screen exposure score. CONCLUSION: Developing national scales to monitor problematic screen use in children would be more effective than monitoring screen time alone. All of the screen use characteristics not recommended in children would be evaluated using problematic screen exposure scales. The "Seven-in-Seven Screen Exposure Questionnaire" may serve as an example for further studies.

Associations between parenting styles and excessive screen usage in preschool children.

OBJECTIVE: Young children and preschoolers are now growing up in settings filled with a variety of technological devices. Despite the recommendation that parents should limit screen time, many preschoolers are exposed to screens at very early ages and for a long time. This study aimed to investigate the associations between parenting styles and the excessive screen time of preschool-aged children. MATERIAL AND METHODS: This cross-sectional descriptive study included preschool children with low screen exposure (<1 hour; n=176) and excessive screen exposure (>4 hours; n=74). A self-completion-structured survey form and Parent Attitude Scale were filled by the mothers. RESULTS: More than half (52.0%) of them were male children. Increased number of children, increased household sizes, mothers being unemployed, birth order ≥2, and home-based care were found to be statistically significantly higher in the excessive screen exposure group than in the low screen exposure group. Mothers and fathers in the excessive screen exposure group had lower educational levels compared with their counterparts in the low screen exposure group (p<0.001). Multivariate logistic regression analyses showed that mothers' high authoritative (democratic) scores were associated with low screen exposure(adjusted odds ratio (AOR): 0.3; 95% confidence interval (CI): 0.1-0.9). High overprotective and permissive parenting subscale scores were related to excessive screen exposure after adjusting potential confounders (AOR: 2.8, 95% CI: 1.1-6.7; AOR: 4.5, 95% CI: 1.8-11.6). CONCLUSION: Excessive screening time may indicate a problematic parent-child relationship. Establishing a positive parent-child relationship can be an effective way of managing screen time in preschool children.

Effect of enuresis on perceived parental acceptance-rejection in children.

OBJECTIVE: Enuresis is a major problem affecting both the child and his family. This study aimed to investigate the effect of enuresis on mother acceptance-rejection perceived by children. MATERIAL AND METHODS: Fourty-six children and their mothers with the diagnosis of primary enuresis were included in the study. Parental Acceptance-Rejection Scale which consisted of 60 questions and consisted of four subscales: affection, hostility, neglect, and undifferentiated rejection was applied to both mothers and children. A dependent Sample t-test was used to compare the scale results of mothers and children, and an independent sample t-test was used to determine the factors affecting perceived high mother hostility in children. RESULTS: The mean age was 10.12±1.34 years and 58.70% of the children were boys. There was no statistically significant difference between total acceptance-rejection, affection, neglect, and undifferentiated rejection scores of mothers and children's perceptions. The perceived hostility score of the children (25.71±8.05) was higher than the mothers' hostility score (22.52±6.26) (p<0.05). The presence of maternal chronic disease was found to increase the perceived high hostility, while other factors were not statistically significant. Thirteen cases with chronic illnesses were excluded and re-analysis revealed that the difference between perceived and mother hostility persisted (p<0.05). CONCLUSION: Children with enuresis perceive their mother's behavior as more hostile than they are. It should be kept in mind that enuresis may affect the mother and child relationship, the family should be informed about the approach to the child.

Excessive screen time is associated with maternal rejection behaviours in pre-school children.

AIM: Early childhood screen exposure leads to multiple adverse health events and parents have a major influence on their children's screen time. Our aim was to determine the association between maternal acceptance-rejection/control behaviours and excessive screen exposure in pre-school children. METHODS: In this cross-sectional descriptive study, children aged 2-5 years who had daily screen time <1 h (n = 76) and >4 h (n = 62) were enrolled. A structured survey form and Parental Acceptance-Rejection/Control Questionnaire were completed by mothers. RESULTS: Total rejection scores were found to be lower in those with screen time <1 h than cases with >4 h (82.7 ± 13.2, 89.3 ± 17.2; P = 0.015). In addition, higher hostility, neglect and reverse-affection scores were detected in excessive screen-exposed group (P = 0.033, P = 0.003, P = 0.047, respectively). Multivariate logistic regression analyses revealed that mothers' low acceptance of their children and high neglect score were associated with excessive screen exposure after adjusting possible confounding factors. The undifferentiated rejection and control behaviours of the mothers had no association with excessive screen exposure. CONCLUSION: Children with excessive screen time may have a problematic relationship with their mothers. The relationship between parent and child should be examined and corrective actions should be taken.

Chylous ascites after lymphadenectomy in a Wilms` tumor patient.

Yörük MA, Erat-Nergiz M, Timur Ç, Canbolat-Ayhan A, Ergüven M. Chylous ascites after lymphadenectomy in a Wilms` tumor patient. Turk J Pediatr 2018; 60: 436-438. Wilms` tumor is the most common renal malignancy in children and the fourth most common childhood cancer. It accounts 6-7% of all childhood malignancies. Surgical resection is an important therapy option and transabdominal or transperitoneal resection with lymph node sampling is preferred. Development of chylous ascites following intraabdominal or retroperitoneal resection in pediatric age group generally results from extensive lymph node dissection, accidental ligation or interruption of lymphatic ducts. Diseases or conditions affecting abdominal and/or retroperitoneal lymph nodes may cause chylous ascites. Postoperative chylous ascites is associated with significant morbidity and may cause mechanic, nutritional and immunological complications. In the present study, a 16-month-old infant with Stage IV Wilms` tumor who developed chylous ascites after left nephrectomy and lymphadenectomy will be presented; chylous ascites treatment with enteral nutrition and surgical treatment approach for Wilms` tumor will be reviewed.