The Experts below are selected from a list of 114 Experts worldwide ranked by ideXlab platform
Jack P. Shonkoff - One of the best experts on this subject based on the ideXlab platform.
-
Reactions to the Threatened Loss of a Child: A Vulnerable Child Syndrome, by Morris Green, MD, and Albert A. Solnit, MD, Pediatrics, 1964;34:58–66
Pediatrics, 1998Co-Authors: Jack P. ShonkoffAbstract:This report describes a constellation of clinical features found in 25 Children with a history of an illness or accident from which they recovered, despite their parents9 anticipation of a fatal outcome. The paper proposes the hypothesis that Children who are expected by their parents to die prematurely often react with a disturbance in psychosocial development that is rooted in the parent-Child relationship, which the authors characterize as a Vulnerable Child Syndrome . The essential features of the proposed Syndrome include difficulty with separation, infantile behavior, bodily overconcerns, and school underachievement. The paper provides an overview of predisposing factors and determinants of the presenting symptoms, along with suggestions for both clinical management and primary prevention.
-
Parent-Child relationship disorders. Part II. The Vulnerable Child Syndrome and its relation to parental overprotection.
Journal of developmental and behavioral pediatrics : JDBP, 1995Co-Authors: Michael Thomasgard, Jack P. Shonkoff, Craig EdelbrockAbstract:Parents who are excessively concerned about their Child's health are often characterized as being overprotective. We hypothesized that parental overprotection is independent of parental perception of Child vulnerability to illness or injury despite their presumed interchangeability. A community-based sample of 892 parents (92% white, 84% married, 88% middle-upper socioeconomic status, 90% mothers) completed a three-part protocol (clinical background data, the Child Vulnerability Scale, and the Parent Protection Scale). Correlates of high parental perception of Child vulnerability included a medical condition in the Child, a history of life-threatening illness or injury, and the Child being seen for a sick visit. Correlates of high parental overprotection included younger age of Child and parent. Only 20% of those parents who considered their Child Vulnerable were also considered overprotective.
Michael Thomasgard - One of the best experts on this subject based on the ideXlab platform.
-
Parent-Child relationship disorders. Part II. The Vulnerable Child Syndrome and its relation to parental overprotection.
Journal of developmental and behavioral pediatrics : JDBP, 1995Co-Authors: Michael Thomasgard, Jack P. Shonkoff, Craig EdelbrockAbstract:Parents who are excessively concerned about their Child's health are often characterized as being overprotective. We hypothesized that parental overprotection is independent of parental perception of Child vulnerability to illness or injury despite their presumed interchangeability. A community-based sample of 892 parents (92% white, 84% married, 88% middle-upper socioeconomic status, 90% mothers) completed a three-part protocol (clinical background data, the Child Vulnerability Scale, and the Parent Protection Scale). Correlates of high parental perception of Child vulnerability included a medical condition in the Child, a history of life-threatening illness or injury, and the Child being seen for a sick visit. Correlates of high parental overprotection included younger age of Child and parent. Only 20% of those parents who considered their Child Vulnerable were also considered overprotective.
-
The Vulnerable Child Syndrome revisited.
Journal of developmental and behavioral pediatrics : JDBP, 1995Co-Authors: Michael ThomasgardAbstract:Dimensions of the Vulnerable Child Syndrome are clarified in a critical review of the research and clinical literature. The central construct of the Vulnerable Child Syndrome, an increased parental perception of Child vulnerability to illness or injury, is examined in the context of separation and loss. Measures of perceived Child vulnerability are reviewed. A new conceptual model of parental perception of Child vulnerability is presented that takes into account Child, parent, parent-Child, parent-clinician, and family factors. Directions for future research are suggested. Language: en
Thomas B Newman - One of the best experts on this subject based on the ideXlab platform.
-
Effect of Neonatal Jaundice and Phototherapy on the Frequency of First-Year Outpatient Visits
2015Co-Authors: Danielle Usatin, Michael W Kuzniewicz, Petra Liljestr, J. Escobar, Thomas B NewmanAbstract:Objective—The objective of this study was to determine whether either hyperbilirubinemia or inpatient phototherapy is associated with increased subsequent outpatient visit rates, a possible effect of the “Vulnerable Child Syndrome.” Methods—We compared 3 groups of otherwise well term and late-preterm infants who were born between 1995 and 2004 in Northern California Kaiser hospitals: group 1 never had a documented total serum bilirubin (TSB) level ≥12 mg/dL (n = 128 417); group 2 had a TSB level ≥17 and <23 mg/dL as outpatients between 48 hours and 7 days of age and did not receive inpatient phototherapy (n = 6777); and group 3 met criteria for group 2 but did receive inpatient phototherapy (n = 1765). We compared outpatient visit rates from 15 to 364 days of age adjusting for other predictors of visit rates by using Poisson and linear regression. Results—The mean total number of visits between 15 and 364 days was 9.83. Compared with group 1, adjusted total first-year visit rates were slightly increased in group 2 (adjusted incidenc
-
effect of neonatal jaundice and phototherapy on the frequency of first year outpatient visits
Pediatrics, 2010Co-Authors: Danielle Usatin, Petra Liljestrand, Michael W Kuzniewicz, Gabriel J Escobar, Thomas B NewmanAbstract:Approximately 60% of newborns develop jaundice in the first few days after birth.1 Although in most cases jaundice is harmless, the need to monitor bilirubin levels with repeated visits and blood draws and occasionally to readmit infants to the hospital for phototherapy may cause parental anxiety and adversely affect the parent–infant relationship.2,3 Mothers, including those with previous experience with neonatal jaundice, may feel at fault for having caused the jaundice, worry when total serum bilirubin (TSB) levels increase, and have difficulty bonding with their infants.4 Green and Solnit5 first coined the term “Vulnerable Child Syndrome” in 1964 to refer to a pattern of parental overprotection and excessive medical concerns that followed Children's recovery from life-threatening illness. Subsequent work has found that Children may be perceived as Vulnerable after less serious illnesses or events, even as minor as a febrile illness that led to a negative lumbar puncture,6 sickle cell trait,6,7 or a false-positive result on newborn screening.8–10 Indeed, Shonkoff,11 commenting on Green and Solnit's classic article 34 years later, wrote, “The most important contribution of this report is the extent to which it underscores the critical importance of what physicians say (and don't say) to parents. . . . Anything that a pediatrician conveys to a mother or father, whether it is thought through clearly or not, can have enormous impact on them and their Children. Moreover, the effect may not only be immediate, but it often can be long-lasting.” Previous studies have raised concern that neonatal jaundice may be a cause of the Vulnerable Child Syndrome. Kemper et al2,3 found that mothers of infants with jaundice (TSB ≥12 mg/dL) were less likely than mothers of control infants to leave their infants with another person and more likely to bring them for well-Child, sick, and emergency department (ED) visits. Such disproportionate use of health care resources by Children who are perceived as Vulnerable has been reported by others as well6,12–15 and is 1 of the hallmarks of the Vulnerable Child Syndrome.16 The studies of Kemper et al2,3 included only 85 infants who had jaundice and were born in 1987 and 1988. Our access to an integrated health care delivery system has allowed us to analyze data for a larger and more recent cohort of infants who were born in a setting in which considerable variation in the use of phototherapy has been documented.17 Although this study based on electronically available data cannot assess parental perceptions of vulnerability directly, our very large sample size allows us to quantify precisely and objectively 1 important manifestation of perceived vulnerability: increased use of outpatient services for sick- and well-Child care. Thus, the main goal of this study was to determine, by using a more recent cohort, whether either neonatal hyperbilirubinemia or its treatment with inpatient phototherapy is associated with an increase in subsequent outpatient visit rates.
Danielle Usatin - One of the best experts on this subject based on the ideXlab platform.
-
Effect of Neonatal Jaundice and Phototherapy on the Frequency of First-Year Outpatient Visits
2015Co-Authors: Danielle Usatin, Michael W Kuzniewicz, Petra Liljestr, J. Escobar, Thomas B NewmanAbstract:Objective—The objective of this study was to determine whether either hyperbilirubinemia or inpatient phototherapy is associated with increased subsequent outpatient visit rates, a possible effect of the “Vulnerable Child Syndrome.” Methods—We compared 3 groups of otherwise well term and late-preterm infants who were born between 1995 and 2004 in Northern California Kaiser hospitals: group 1 never had a documented total serum bilirubin (TSB) level ≥12 mg/dL (n = 128 417); group 2 had a TSB level ≥17 and <23 mg/dL as outpatients between 48 hours and 7 days of age and did not receive inpatient phototherapy (n = 6777); and group 3 met criteria for group 2 but did receive inpatient phototherapy (n = 1765). We compared outpatient visit rates from 15 to 364 days of age adjusting for other predictors of visit rates by using Poisson and linear regression. Results—The mean total number of visits between 15 and 364 days was 9.83. Compared with group 1, adjusted total first-year visit rates were slightly increased in group 2 (adjusted incidenc
-
effect of neonatal jaundice and phototherapy on the frequency of first year outpatient visits
Pediatrics, 2010Co-Authors: Danielle Usatin, Petra Liljestrand, Michael W Kuzniewicz, Gabriel J Escobar, Thomas B NewmanAbstract:Approximately 60% of newborns develop jaundice in the first few days after birth.1 Although in most cases jaundice is harmless, the need to monitor bilirubin levels with repeated visits and blood draws and occasionally to readmit infants to the hospital for phototherapy may cause parental anxiety and adversely affect the parent–infant relationship.2,3 Mothers, including those with previous experience with neonatal jaundice, may feel at fault for having caused the jaundice, worry when total serum bilirubin (TSB) levels increase, and have difficulty bonding with their infants.4 Green and Solnit5 first coined the term “Vulnerable Child Syndrome” in 1964 to refer to a pattern of parental overprotection and excessive medical concerns that followed Children's recovery from life-threatening illness. Subsequent work has found that Children may be perceived as Vulnerable after less serious illnesses or events, even as minor as a febrile illness that led to a negative lumbar puncture,6 sickle cell trait,6,7 or a false-positive result on newborn screening.8–10 Indeed, Shonkoff,11 commenting on Green and Solnit's classic article 34 years later, wrote, “The most important contribution of this report is the extent to which it underscores the critical importance of what physicians say (and don't say) to parents. . . . Anything that a pediatrician conveys to a mother or father, whether it is thought through clearly or not, can have enormous impact on them and their Children. Moreover, the effect may not only be immediate, but it often can be long-lasting.” Previous studies have raised concern that neonatal jaundice may be a cause of the Vulnerable Child Syndrome. Kemper et al2,3 found that mothers of infants with jaundice (TSB ≥12 mg/dL) were less likely than mothers of control infants to leave their infants with another person and more likely to bring them for well-Child, sick, and emergency department (ED) visits. Such disproportionate use of health care resources by Children who are perceived as Vulnerable has been reported by others as well6,12–15 and is 1 of the hallmarks of the Vulnerable Child Syndrome.16 The studies of Kemper et al2,3 included only 85 infants who had jaundice and were born in 1987 and 1988. Our access to an integrated health care delivery system has allowed us to analyze data for a larger and more recent cohort of infants who were born in a setting in which considerable variation in the use of phototherapy has been documented.17 Although this study based on electronically available data cannot assess parental perceptions of vulnerability directly, our very large sample size allows us to quantify precisely and objectively 1 important manifestation of perceived vulnerability: increased use of outpatient services for sick- and well-Child care. Thus, the main goal of this study was to determine, by using a more recent cohort, whether either neonatal hyperbilirubinemia or its treatment with inpatient phototherapy is associated with an increase in subsequent outpatient visit rates.
George J. Peckham - One of the best experts on this subject based on the ideXlab platform.
-
Maternal Rating of Child Health at School Age: Does the Vulnerable Child Syndrome Persist?
Pediatrics, 1993Co-Authors: Marie C. Mccormick, Jeanne Brooks-gunn, Kathryn Workman-daniels, George J. PeckhamAbstract:Objectives. To assess the extent to which parental ratings of Child health, including perceived vulnerability to illness, are associated with current and past health events and sociodemographic characteristics of the family and the Child. Design. Prospective cohort study of Children aged 8 to 10 years previously assessed in infancy in two multi-site studies. Setting. Thirteen sites largely in eastern United States. Participants. 1877 Children representing 65% of those originally selected for follow-up from the two previous studies. Participants were specifically selected on the basis of birth weight so that more than two-thirds were low birth weight. Measurement. Parental interviews at school age including measures of several dimensions of Child health and sociodemographic characteristics of the family. The former included a six-item scale assessing parental perceptions of Child health overall, and on subscales assessing Child current health, previous health, and resistance or susceptibility to illness. Data on health problems at birth were derived from previously collected birth certificates, medical records, and interviews. Main results. Although overall parental perceptions of Child health reflected both current and past health events, a clear distinction emerged. Parental rating of current Child health and resistance or susceptibility were associated with current Child health problems, not events in infancy including very low birth weight. Nonwhite race and maternal rating of her own health also influenced maternal rating of Child health. Conclusion. The results do not support the persistence of a Vulnerable Child Syndrome, as health in infancy does not affect maternal rating of current Child health at school-age in the absence of current health problems.
