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Low-Income Parents’ Perceptions of Pediatrician Advice on Early Childhood Education

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Abstract

The American Academy of Pediatrics recommends that pediatricians promote early childhood education (ECE). However, pediatricians have met resistance from low-income parents when providing anticipatory guidance on some topics outside the realm of physical health. Parents’ views on discussing ECE with the pediatrician have not been studied. We sought to understand low-income parents’ experiences and attitudes with regard to discussing ECE with the pediatrician and to identify opportunities for pediatrician input. We conducted 27 in-depth, semi-structured, qualitative interviews with parents of 3- and 4-year-old patients (100 % Medicaid, 78 % African American) at an urban primary care center. Interviews were audio-recorded, transcribed verbatim, and reviewed for themes by a multidisciplinary team. Most low-income parents in our study reported they primarily sought ECE advice from family and friends but were open to talking about ECE with the pediatrician. They considered their children’s individual behavior and development to be important factors in ECE decisions and appreciated pediatricians’ advice about developmental readiness for ECE. Participants’ decisions about ECE were often driven by fears that their children would be abused or neglected. Many viewed 3 years as the age at which children had sufficient language skills to report mistreatment and could be safely enrolled in ECE. Participants were generally accepting of discussions about ECE during well child visits. There may be opportunity for the pediatrician to frame ECE discussions in the context of development, behavior, and safety and to promote high-quality ECE at an earlier age.

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References

  1. Halfon, N., DuPlessis, H., & Inkelas, M. (2007). Transforming the U.S. child health system. Health Affairs, 26, 315–330.

    Article  PubMed  Google Scholar 

  2. Schor, E. L. (2004). Rethinking well-child care. Pediatrics, 114, 210–216.

    Article  PubMed  Google Scholar 

  3. Shonkoff, J. (2011). Protecting brains, not simply stimulating minds. Science, 333, 982–983.

    Article  PubMed  CAS  Google Scholar 

  4. Garner, A., & Shonkoff, J. (2012). Early childhood adversity, toxic stress, and the role of the pediatrician: Translating developmental science into lifelong health. Pediatrics, 129, e224–e231.

  5. Palfrey, J., Hauser-Cram, P., Bronson, M., Warfield, M., Sirin, S., & Chan, E. (2005). The Brookline Early Education Project: A 25-year follow-up study of family-centered early health and development intervention. Pediatrics, 116, 144–152.

    Article  PubMed  Google Scholar 

  6. Zoritch, B., Roberts, I., & Oakley, A. (2000). Day care for pre‐school children. Cochrane Database of Systematic Reviews, (3), Art. No. CD000564. doi:10.1002/14651858.CD000564.

  7. Gormley, W., Phillips, D., Newmark, K., Welti, K., & Adelstein, S. (2011). Social-emotional effects of early childhood education programs in Tulsa. Child Development, 82, 2095–2109.

    Article  PubMed  Google Scholar 

  8. Campbell, F., Pungello, E., Burchinal, M., et al. (2012). Adult outcomes as a function of an early childhood educational program: An Abecedarian Project follow-up. Developmental Psychology, 16, 16.

    Google Scholar 

  9. Campbell, F., Pungello, E., Miller-Johnson, S., Burchinal, M., & Ramey, C. (2001). The development of cognitive and academic abilities: Growth curves from an early childhood educational experiment. Developmental Psychology, 37, 231–242.

    Article  PubMed  CAS  Google Scholar 

  10. Wrigley, J., & Dreby, J. (2005). Fatalities and the organization of child care in the United States, 1985–2003. American Sociological Review, 70(5), 729–757.

    Google Scholar 

  11. Aronson, S. (1994). The science behind the American Public Health Association/American Academy of Pediatrics health and safety guidelines for child-care programs. Pediatrics, 94, 1101–1104.

    PubMed  CAS  Google Scholar 

  12. Norlin, C., Crawford, M., Bell, C., Sheng, X., & Stein, M. (2011). Delivery of well-child care: A look inside the door. Academic Pediatric, 11, 18–26.

    Article  Google Scholar 

  13. Belamarich, P., Gandica, R., Stein, R., & Racine, A. (2006). Drowning in a sea of advice: Pediatricians and American Academy of Pediatrics policy statements. Pediatrics, 118, e964–e978.

    Article  PubMed  Google Scholar 

  14. Silverstein, M., Mack, C., Reavis, N., Koepsell, T., Gross, G., & Grossman, D. (2004). Effect of a clinic-based referral system to head start: A randomized controlled trial. JAMA: Journal of the American Medical Association, 292, 968–971.

    Article  PubMed  CAS  Google Scholar 

  15. Busey, S., Kinyoun-Webb, C., Martin-McKay, J., Mao, J. (2006). Perceptions of inner city parents about early behavioral and violence prevention counseling. Patient Education and Counseling 64, 191–196. Epub 2006 Feb 20.

    Google Scholar 

  16. Coker, T., Chung, P., Cowgill, B., Chen, L., & Rodriguez, M. (2009). Low-income parents’ views on the redesign of well-child care. Pediatrics, 124, 194–204.

    Article  PubMed  Google Scholar 

  17. Radecki, L., Olson, L., Frintner, M., Tanner, J., & Stein, M. (2009). What do families want from well-child care? Including parents in the rethinking discussion. Pediatrics, 124, 858.

    Article  PubMed  Google Scholar 

  18. Dumont-Mathieu, T., Bernstein, B., Dworkin, P., & Pachter, L. (2006). Role of pediatric health care professionals in the provision of parenting advice: A qualitative study with mothers from 4 minority ethnocultural groups. Pediatrics, 118, e839–e848.

    Article  PubMed  Google Scholar 

  19. VanCleave, J., Heisler, M., Devries, J., Joiner, T., & Davis, M. (2007). Discussion of illness during well-child care visits with parents of children with and without special health care needs. Archives of Pediatrics and Adolescent Medicine, 161, 1170–1175.

    Article  Google Scholar 

  20. Cheng, T., Savageau, J., DeWitt, T., Bigelow, C., & Charney, E. (1996). Expectations, goals, and perceived effectiveness of child health supervision: A study of mothers in a pediatric practice. Clinical Pediatrics, 35, 129–137.

    Article  PubMed  CAS  Google Scholar 

  21. Kohorn, I. V., Corwin, M., Rybin, D., Heeren, T., Lister, G., & Colson, E. (2010). Influence of prior advice and beliefs of mothers on infant sleep position. Archives of Pediatrics and Adolescent Medicine, 164, 363–369.

    Article  Google Scholar 

  22. Grossman, D., Cummings, P., Koepsell, T., et al. (2000). Firearm safety counseling in primary care pediatrics: A randomized, controlled trial. Pediatrics, 106, 22–26.

    Article  PubMed  CAS  Google Scholar 

  23. Moon, R., & Omron, R. (2002). Determinants of infant sleep position in an urban population. Clinical Pediatrics, 41, 569–573.

    Article  PubMed  Google Scholar 

  24. Shaughnessy, A., Cincotta, J., & Adelman, A. (1999). Family practice patients’ attitudes toward firearm safety as a preventive medicine issue: A HARNET Study. Harrisburg Area Research Network. Journal of the American Board of Family Practice, 12, 354–359.

    PubMed  CAS  Google Scholar 

  25. Crocetti, M., Dudas, R., & Krugman, S. (2004). Parental beliefs and practices regarding early introduction of solid foods to their children. Clinical Pediatrics, 43, 541–547.

    Article  PubMed  Google Scholar 

  26. Sege, R., Hatmaker-Flanigan, E., DeVos, E., Levin-Goodman, R., & Spivak, H. (2006). Anticipatory guidance and violence prevention: Results from family and pediatrician focus groups. Pediatrics, 117, 455–463.

    Article  PubMed  Google Scholar 

  27. Fuller, B., Holloway, S., Rambaud, M., & Eggers-Pierola, C. (1996). How do mothers choose child care? Alternative cultural models in poor neighborhoods. Sociology of Education, 69, 83–104.

    Article  Google Scholar 

  28. Fram, M., & Kim, J. (2008). Race/ethnicity and the start of child care: A multi-level analysis of factors influencing first child care experiences. Early Childhood Research Quarterly, 23, 575–590.

    Article  Google Scholar 

  29. Henly, J., & Lyons, S. (2000). The negotiation of child care and employment demands among low-income parents. Journal of Social Issues, 56, 683–706.

    Article  Google Scholar 

  30. Uttal, L. (1999). Using kin for child care: Embedment in the socioeconomic networks of extended families. Journal of Marriage and Family, 61, 845–857.

    Article  Google Scholar 

  31. Patton, M. (2001). Qualitative research & evaluation methods (3rd ed.). Thousand Oaks, CA: Sage Publications, Inc.

    Google Scholar 

  32. Silverstein, M., Grossman, D., Koepsell, T., & Rivara, F. (2003). Pediatricians’ reported practices regarding early education and Head Start referral. Pediatrics, 111, 1351–1357.

    Article  PubMed  Google Scholar 

  33. American Academy of Pediatrics. (2005). Quality early education and child care from birth to kindergarten. Committee on early childhood, adoption, and dependent care. Pediatrics, 115(1), 187–191. doi:10.1542/peds.2004-2213.

    Google Scholar 

  34. National Association of Child Care Resource and Referral Agencies. (2012). Leaving children to chance: Appendix B: State Tables for Criteria Scored. Accessed 05/02/12, at http://www.naccrra.org/sites/default/files/default_site_pages/2012/lcc_state_tables_march_20.pdf.

  35. Hart, B., & Risley, T. (1995). Meaningful differences in the everyday experience of young American children. Baltimore, MD: Paul H Brookes Publishing.

    Google Scholar 

  36. Burchinal, M., Roberts, J., Riggins, R., Zeisel, S., Neebe, E., & Bryant, D. (2000). Relating quality of center-based child care to early cognitive and language development longitudinally. Child Development, 71, 339–357.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This project was supported by funds from the Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS), under a Ruth L. Kirschstein National Research Service Award (T32 HP10027-13-00). Physical space for interviews was provided through an Institutional Clinical and Translational Science Award, NIH/NCRR Grant Number 5UL1RR026314-3. We thank Angela Howald for assistance with participant recruitment.

Conflicts of interest

The authors have no conflicts of interest or corporate sponsors to disclose.

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Authors and Affiliations

  1. Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, ML 2011, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

    Courtney M. Brown, Robert S. Kahn & Kristen A. Copeland

  2. Department of Psychology, University of Miami, Miami, FL, USA

    Erin L. Girio-Herrera

  3. SNS Research, Cincinnati, OH, USA

    Susan N. Sherman

Authors
  1. Courtney M. Brown
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  2. Erin L. Girio-Herrera
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  3. Susan N. Sherman
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  4. Robert S. Kahn
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  5. Kristen A. Copeland
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Correspondence to Courtney M. Brown.

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Brown, C.M., Girio-Herrera, E.L., Sherman, S.N. et al. Low-Income Parents’ Perceptions of Pediatrician Advice on Early Childhood Education. J Community Health 38, 195–204 (2013). https://doi.org/10.1007/s10900-012-9642-0

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