Children may experience pediatric medical traumatic stress as a consequence of exposure to medical procedures, illness, or injury that are perceived as distressing, threatening, or otherwise aversive. In order to address the traumatic stress, trauma-informed care practices are warranted. The application of trauma-informed care practices has been widely used in healthcare for over 25 years; however, its integration into behavior-analytic practice has emerged more recently. Although trauma-informed care principles have informed practice across multiple areas of behavior analysis, relatively few studies have addressed their application to the treatment of pediatric feeding problems. Rajaraman et al. proposed four tenets of trauma-informed care that complement behavior-analytic practice as a whole: (1) acknowledge trauma and its potential impact, (2) ensure safety and trust, (3) promote choice and shared governance, and (4) emphasize skill building. In this paper, we describe a novel framework of the application of these tenets into behavioral feeding treatment. Specifically, we examine a balanced progression in which trauma-informed care and evidence-based interventions are integrated and implemented in tandem.
A prenatal diagnosis of Turner syndrome (TS) presents expectant parents with complex and emotionally demanding decisions under conditions of uncertainty. However, there is limited insight into how parents interpret and integrate medical information, personal experiences, and values during this process. This qualitative study explores how parents who chose to continue a pregnancy following a prenatal TS diagnosis experienced and navigated decision-making. The study was conducted within the Danish healthcare system between September 2024 and October 2025. During this period, we conducted 12 semi-structured interviews with 19 parents of girls diagnosed prenatally with TS (seven joint interviews with both parents and five interviews with the mother only). Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Across interviews, parents repeatedly returned to the question, "How serious is this?", and our analysis showed that decision-making unfolded as a dynamic, evolving process rather than a single point of choice. This process was captured through five interrelated themes: The crisis of diagnosis; What parents bring into decision-making; Contrasting images of Turner syndrome; What kind of life is possible?; and The turning point. These themes illustrate how assessments of seriousness were shaped through an interplay of prior experiences, emerging attachment to the fetus, ultrasound findings, counseling encounters, and social responses. Over time, parents developed a more coherent understanding of the diagnosis, culminating in the decision to continue the pregnancy. In this way, decision-making following a prenatal TS diagnosis extended beyond the evaluation of medical information and involved substantial interpretative and emotional work. Clinical encounters were most meaningful when information was contextualized and aligned with parents' concerns about everyday life and future possibilities. These findings reinforce the importance of prenatal counseling that integrates medical information with support for the interpretative and emotional work through which parents make sense of the diagnosis and navigate uncertainty.
Paternal engagement has been described as a relational process that redistributes caregiving responsibilities and strengthens family resilience and function. This study investigated the association between fathers' childcare success and maternal parenting stress by comparing families raising children with neurodevelopmental disabilities (ND) with those raising typically developing (TD) children. Fifty-three fathers of children with ND and 206 fathers of TD children completed online surveys on parenting self-efficacy, childcare knowledge, involvement, communication with their spouse, and perceived social support. In paired surveys, spouses reported on parenting stress. Structural equation modeling indicated that in both groups, higher paternal childcare success was significantly associated with lower maternal stress (ND: β = -0.42, p < 0.05; TD: β = -0.39, p < 0.001). However, the contributing factors differed; in TD families, paternal role awareness, father-child relationship, and spousal relationship were most strongly related to fathers' childcare success, whereas these associations were less prominent in ND families. These findings highlight the importance of interventions that address fathers' psychological traits as well as the specialized skills and knowledge required for parenting children with ND to enhance family functioning and parental well-being.
Giving birth to a child in exile and then raising that child in a transcultural setting - that is, in a context different from the one in which one grew up - is a situation that requires parents and professionals alike to draw on a wide range of resources. The well-being of migrant parents and their children depends on this collaboration. It is therefore essential to have a clear understanding of one another in order to best support the development of these children of migrant parents.
This exploratory cross-sectional study examined whether pandemic-related family well-being responses differed across North Carolina's 2021 county economic tiers among 178 Black parents. Survey responses were linked to county tier and included reported stress, emotional symptoms, food hardship, self-rated health, sleep change, work and parenting disruption, and parent-child interaction items. Primary analyses used the Kruskal-Wallis and chi-square tests; within-tier correlations and tier-stratified linear probability models were used for supplementary and descriptive purposes. Respondents across all tiers reported pandemic-related burdens, but most cross-tier comparisons were not statistically significant. One food-hardship item (p = 0.050) and one parent-child interaction item (p = 0.042) met the nominal 0.05 threshold, while one emotional symptom item approached significance (p = 0.074); these isolated findings did not form a consistent cross-domain pattern. The findings indicate that the county-tier classification was useful for organizing place-based comparisons but did not consistently differentiate response patterns in this sample. Larger, longitudinal studies using neighborhood- and household-level measures are needed before tier-specific or causal conclusions can be drawn.
Background Healthy eating is essential throughout childhood and adolescence, and has been associated with better health-related quality of life (HRQoL). Healthy eating results from complex interactions, including the transmission of eating habits within families. Although parental feeding practices may influence children's HRQoL through several plausible behavioral pathways, empirical evidence examining this association remains limited. Therefore, the objective of this study was to investigate the association between parental feeding practices-monitoring, pressure-to-eat, and restriction-and children's HRQoL. Methods This cross-sectional study included 1,535 children (819 boys and 716 girls) aged 3 to 11 years recruited from 19 schools in Catalonia between 2022 and 2024. Parental feeding practices and children's HRQoL were assessed by the same parent using the Child Feeding Questionnaire and the KIDSCREEN-10 parent-proxy instrument, respectively. Results Restrictive and pressure-to-eat feeding practices were associated with lower HRQoL in children (p < 0.001 and p = 0.03, respectively), whereas monitoring showed a significant non-linear association with HRQoL (p < 0.001), with higher HRQoL observed only at the highest levels of monitoring, after adjustment for children's age, gender, body mass index, adherence to the Mediterranean diet, physical activity level and parental education level. Conclusion Based on reports of both parental feeding practices and children's HRQoL provided by the same parent, our findings were broadly consistent with our hypothesis; however, future longitudinal studies incorporating multiple informants are needed to clarify the directionality of these associations and minimize potential reporting bias.
Background Geography and socioeconomic disadvantage impede access to appropriate services for rural and remote-dwelling children with complex developmental and mental health needs. Telehealth offers opportunities to increase access to essential health and well-being services for people with complex needs who live in rural and remote areas, whose experiences of mental ill-health are frequently compounded by social marginalization and economic disadvantage. Objective This study aimed to describe caregivers' and service providers' perspectives on the challenges and value of telehealth services for rural and remote children by drawing on experiences within a specialist service (Royal Far West; RFW) that provides mental and developmental health services to rural and remote-dwelling children and families in Australia. Methods Participants included a convenience sample of caregivers of children who use RFW services (n=11) and service providers from RFW (n=21). Deidentified interview transcript data were analyzed thematically using framework analysis. Results Caregivers were generally enthusiastic about telehealth but acknowledged potential technological limitations and challenges to effectively engaging some children. While acknowledging its value and importance, RFW service providers identified additional challenges with providing telehealth, such as limited capacity for some detailed clinical assessments and potential child and family risk and safety issues. Conclusions Telehealth remains a vital option within multidisciplinary services to improve access and outcomes for children in rural and remote communities who present with complex mental and developmental health needs. Despite challenges, rural and remote caregivers and RFW service providers identified telehealth as a beneficial, accessible, and effective component of multidisciplinary care for children with complex mental and developmental health needs. These caregiver and service provider perspectives will inform ongoing service development, research, and advocacy.
Background Achondroplasia, although rare, is the most common genetic form of skeletal dysplasia and is associated with a wide range of clinical manifestations and complications throughout the body. This study evaluated the psychometric measurement properties of the Achondroplasia Child Experience Measures (ACEMs), which were previously conceptually developed as condition-specific, observer-reported outcome measures to assess the signs (ACEM-OSM) and impacts (ACEM-Impact) of achondroplasia in children aged 2 to < 12 years. Methodology Data for the psychometric evaluation were from a non-interventional, observational study (N = 200 (impacts) and N = 148 (signs)) and a phase 2, multicenter, double-blind, randomized, placebo-controlled, dose escalation interventional trial (N = 57) of navepegritide (TransCon CNP) administered once weekly. The larger observational study sample size allowed for evaluation of distributional properties, test-retest reliability, and construct validity. Trial data was analyzed to confirm reliability and validity findings and evaluate responsiveness. Results Factor analysis and qualitative results identified six domains for the ACEM-Impact and one domain for the ACEM-OSM. The psychometric properties of both measures were found to be acceptable for reliability and validity for the intended use. An 8-item ACEM-OSM and a 25-item ACEM-Impact were finalized. Conclusions The ACEMs are reliable and valid measures of the signs and impacts of achondroplasia on children. Incorporation of these measures in clinical and research settings can aid in assessing new treatments and improve our understanding of the experience of those living with achondroplasia. Trial registration National Institutes of Health Clinicaltrials.gov (ID NCT04085523) and European Union Drug Regulating Authorities Clinical Trials database (EudraCT 2019-002754-22).
Background Historically, assessment of child speech has focused on transcription and analysis of speech sound production with no exploration of the child's own perception of his or her speech. This article explores the possibility that whilst children with speech 'difficulties' may be aware that 'talking to people' is problematic, they may not be aware that the reason for their communication difficulty is that their speech is unclear. Similarly, in a therapy context, the child's own appreciation of the purpose and progress of therapy has not been explored. Given the current concern for child well-being, particularly in educational settings, it is timely to examine the premise that all children with speech difficulties are consciously aware that their speech is different, that they want to change the way they talk and that they welcome help to improve their speech. Aims This overview of a child's own perception of his or her 'disordered' speech aims to bring the child's perspective clearly into focus. Long-held assumptions that children are aware of their speech differences and seek to change them are revisited, and consideration is given to the possibility that young children with speech disorders don't perceive the difference between adult pronunciations and their own. An ethical perspective of engaging young children in activities to change the way they talk before they have developed an appreciation that their pronunciation is different from an adult model is presented and considered. Readers will gain new insights into a child's perspective of not being understood and of being confused by efforts to help them to speak more clearly when their own perception is that their speech already matches the adult pronunciation. Clinicians will come to appreciate that strategies to 'help' children with their speech may feel confusing and even distressing to the child. Given the likelihood that children with SSD/D have little or no awareness of their mispronunciations, a case is made for a less corrective, directive style of therapy and for more facilitative, non-corrective therapy. Method Childhood experiences of growing up with speech sound difficulties are considered through child-focused interpretation of clinical video data and relevant literature. Review of a small selection of parent-consented videos originally collected for clinical or audit purposes prompted reflection on the child's perspective of assessment and therapy. In addition, adult reflections on their childhood experiences of speech problems in different contexts and at different ages were considered. Principles of ethical practice provided a framework for conceptualising ways in which well-intentioned therapy might provoke imperceptible emotional harm. Strategies are proposed for ensuring that 'problem-based' therapy is child-focussed, promotes autonomy and positive self-esteem and minimises the risk of imperceptible emotional harm. Main contribution This discussion article highlights a gap in clinicians' recognition that children in early and middle childhood (2-7 years) may be unaware of their specific speech differences and that they are likely to be confused by therapy activities that require them to change the way they talk. An ethical perspective introduces the possibility that, without some child-focused explanation about the reason for therapy, intervention might cause distress, which children are likely to suppress, and, in some cases, long-term therapy may cause emotional harm. Strategies based on ethical principles are proposed for communicating with children about speech and for introducing 'new ways' to pronounce sounds. Development of a training route for equipping speech and language therapists (SLTs) to adopt a non-directive, collaborative style is recommended. Conclusion From an ethical perspective, this discussion paper introduces the possibility that well-intentioned therapy aimed at changing a child's speech could inadvertently cause emotional harm. It proposes that subtle adjustments to therapy style may elicit new sounds without conscious effort from the child, thereby reducing risks to emotional well-being such as fear of failure and confusion when new productions are deemed to be 'right' but feel wrong to the child. Collaboration between SLT, parents, school and, where possible, ELSA (Emotional Literacy Support Assistant) would reduce the risk of unintended harm that might be caused by practice-based therapy. What this paper adds What is already known on this subject The question as to whether or not children are able to perceive mismatches between their own mispronunciations and their intended production has, to date, been sadly overlooked. This is reflected in the absence of any reference to the child's perspective in routine speech assessments. Existing literature indicates that children have little or no awareness that their speech is distinctive or in what ways it needs to be changed. Hence, it is quite possible that a proportion of children undergoing therapy are confused and could be distressed by therapy which seeks to change the way they talk. What this study adds to existing knowledge By viewing therapy to change and 'improve' a child's speech, from the child's perspective, this article invites clinicians to question their assumptions that children will appreciate 'help' to speak more clearly. Attention is drawn to the risk that therapy might provoke an accumulation of unexpressed negative emotions which could lead to emotional harm. Strategies are suggested for exploring a child's perspective of their speech and for creating opportunities for collaborative therapy planning in the hope that therapy might boost, rather than erode, a child's self-esteem. What are the potential or actual clinical implications of this work? Increased awareness of the risk that children who are compliant with therapy for speech 'differences' may experience emotions such as confusion, anger or general distress during therapy might lead to adjustments in therapy style. It is proposed that shared exploration of a child's speech patterns, with the child, at assessment, followed by collaborative therapy planning and child-focussed progress reviews, might enrich both therapist and child experiences of therapy for speech differences in childhood.
Abstract Parental migration is a widespread phenomenon in developing countries and has important implications for population health. In China, large-scale rural-to-urban migration has resulted in millions of left-behind children, raising concerns about early-life health inequalities. This study uses longitudinal data tracking 800 preschool-aged children in rural China across five survey waves from 2013 to 2017. Socio-emotional health was measured using the Ages and Stages Questionnaire: Social-Emotional (ASQ:SE). Child fixed-effects models and multi-period difference-in-differences approaches were applied. Parental migration is associated with worse socio-emotional health outcomes. Maternal migration has the largest effect (0.478, p < 0.05), followed by joint parental migration (0.406, p < 0.01), while paternal migration has a smaller effect (0.171, p < 0.01). These effects operate through changes in caregiving environments, including reduced caregiving time and lower interaction quality. Parental migration contributes to early-life health inequalities among left-behind children. Policies that improve family environments and access to child health services may help mitigate these disparities.
