Page 424 - Encyclopedia of Nursing Research

PeDIATRIC PRIMARY CARe n 391

of immunizations. By 1994, the rate had risen such as family stresses, socioeconomic sta-
to 73%, and now it is above the 90% goal. tus, and family life were found not to be sig-
Although these are excellent numbers, there nificant predictors. P
still remain pockets primarily in large cities Faulkner (2002) studied 18 mothers
where immunizations rates are much lower. of preschool children enrolled in a nutri-
Data from the CDC National Immunization tion clinic for mothers and children in
Survey suggest that minority children, pri- low-income households. Mothers were ques-
marily African American and Hispanic, chil- tioned in a 1-hour focus group as to how
dren living below the poverty level, children they defined overweight, how they thought
of teen mothers, children in large families, their children became overweight, and what
children of parents who lack education, fam- barriers existed in preventing and man-
ilies with transportation problems, and chil- aging obesity. Interestingly, the mothers
dren of mothers who lack social support have described their children as strong or solid
lower rates of receiving immunizations by and did not think that standardized growth
age 2 years than the national average. charts reflected a healthy weight. As long
Obesity is another health issue commonly as children were active, the mothers did not
seen in primary care. It is a complex issue consider them overweight but if they were
and not fully understood. The number of lazy or lay around then they were consid-
obese children has increased substantially ered overweight. The mothers thought that
in the last 20 years, putting them at risk for heredity and the environment determined
serious health problems as adults including the child’s weight. In their attempts to man-
cardiovascular disease and stroke, diabetes, age their children’s weight, the mothers had
hypertension, arthritis, and psychological lots of difficulty. Food was used as a reward
problems. Obesity during infancy and child- by some, others did not want to deny their
hood increases the risk of obesity in adoles- children food, and with others, family mem-
cence and adulthood. Children with a body bers did not want the mother restricting the
mass index equal to or more than the 95th child’s diet. Mothers also thought that their
percentile are more likely to become obese own obesity affected their management of
adults. Obesity is considered to be multifac- their child’s weight.
torial with both genetic and environmental Prevention of obesity and development
components. Family lifestyle, stress, socio- of effective programs for those who are over-
economic status, and maternal characteristics weight are critical to reversing the devastat-
are some of the environmental components. ing long term effects. Unfortunately, there
Sowan and Stember (2000) studied infants are not many effective programs available
until 15 months of age to identify parental for children. Dietary management, increas-
characteristics and to see whether obesity ing physical activity, and parental behavior
was linked to any of these characteristics. management are critical ingredients in any
Age of the mother at the time of the infant’s program. Primary care providers need to
birth was predictive of obesity in the infant include appropriate eating patterns, types
at 10 months of age. The chances of obesity of foods, and amounts when talking with
increased in the infant with every 5 years parents during well-child visits. Parents
of age increase in the mother. For every 25 have a crucial role in how children’s eating
pound increase in the mother’s usual weight, habits develop and how that affects their
the chances of the infant being obese at 7 overall health and psychological well-being.
months of age increased. Maternal smoking Providers also need to discuss the amount of
increased the chances of infant obesity at 1 physical activity children receive. Children
and 7 months of age. The usual stressors one should receive 60 minutes of physical activity
might think could cause childhood obesity per day, but where a family lives influences