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To test the 6-month efficacy of an inclusive non-diagnosis-specific, 7-session parent education curriculum on five pre-specified outcomes. A randomized clinical trial with 100 parents having children 2-11 years with a variety of chronic conditions was conducted. The 7-session curriculum, Building on Family Strengths (BFS), was created by an interdisciplinary pediatric team as a derivative of a successful adult chronic disease self-Management program distributed by Stanford University Patient and Education Research Center. Despite no differences at baseline, intervention participants had higher scores on self-efficacy to manage the child's condition (p = 0.049), coping with childhood chronic illness (p < 0.001), parent-child shared management of the condition (p = 0.097), family quality of life (p = 0.010), and, lower scores on a measure of depressive symptoms (p = 0.046) at the 6-month end-point. Average effect-sizes were modest across outcomes (7-11% improvement) with intervention participants having baseline scores in the least favorable quartile improving the most (12-41%). This research provides evidence that the BFS curriculum can yield significant improvements across five important outcomes for parents of children with various chronic conditions. Parent education programs should be offered especially to parents of children with chronic health conditions, regardless of the type of condition, who lack adequate support. These programs can help parents cope with and manage their children's chronic conditions more effectively.

Medium chain acyl-CoA dehydrogenase (MCAD) deficiency, the most common defect in β -oxidation of fatty acids, occurs in approximately 1 in 15 000 live births. With the disorder, intolerance to fasting, impaired ketogenesis, and hypoglycemic coma may lead to metabolic crisis and/or irreversible neurological impairment. Although most states now test newborns for MCAD, few publications address treatment of children with MCAD deficiency or the stress parents may experience in caring for their children. Parents of all children with MCAD deficiency identified by newborn screening and followed by the Biochemical Genetics Clinic in Washington State were surveyed via a questionnaire specific to MCAD to determine treatment and management practices and were given the Parenting Stress Index—Short Form questionnaire. Seventy-eight percent (n = 11) of eligible parents responded. The mean parenting stress score among respondents (60) was significantly lower (P = .01) than were normative levels for the US population (71). Openended survey questions indicated that clear guidelines for management and treatment, as well as personal and professional support, may contribute to the relatively low parenting stress levels recorded in this population, thus providing some insight into what services health care providers should offer to parents of a child with MCAD deficiency.

For more than 30 years, the Maternal and Child Health Bureau (MCHB) has funded specialized professional training in nutrition with an emphasis on the development of leadership skills. A survey was conducted of individuals who received Maternal and Child Health nutrition training at the Center for Human Development and Disability (CHDD) at the University of Washington. Those surveyed were asked to reflect on the impact of the training on their career pathway and to report on their leadership activities. Of the 91 respondents, 83 (92%) indicated that the training supported a career pathway that emphasized maternal and child health or children with special healthcare needs. Eighty-five former trainees (93% of respondents) reported leadership activities at the local level, 61 (67%) reported leadership activities at the state level, and 46 (51%) reported leadership activities at the national level. The results of the survey indicate that specialized, intensive training in the field of nutrition develops and supports leadership skills.

Section I: Basic Principles and Concepts Examining the Relationship between Diet, Nutrition and Disease: Dietary Assessment Methodology. Energy Requirement Methodology. Physical Assessment. Overview of Nutritional Epidemiology. Analysis, Presentation, and Interpretation of Dietary Data. Nutrition Intervention: Current Theoretical Bases for Nutrition Intervention and Their Uses. Nutrition Intervention: Lessons from Clinical Trials. Tools and Techniques to Facilitate Eating Behavior Change. Evaluation of Nutrition Interventions. Biomarkers and Biological Indicators of Change. Genetic Influence on Nutritional Health: Genetic Influences on Blood Lipids and Cardiovascular Disease Risk. Genetics of Human Obesity. Genetic Influence on Cancer Risk. Inborn Errors of Metabolism. Supplements and Food Replacements: Role of Liquid Dietary Supplements. Composite Foods and Formulas, Parenteral and Enteral Nutrition. Herbs and Other Botanical Supplements: Principles and Concepts. Section II: Disease-Specific Intervention: Prevention and Treatment Cardiovascular Disease: Dietary Macronutrients and Cardiovascular Risk. Other Dietary Components and Cardiovascular Risk. Nutrition, Diet & Hypertension. Nutrition and Congestive Heart Failure. Cancer Prevention and Therapy: Nutrition and Breast Cancer. Nutrition and Colon Cancer. Nutrition and Prostate Cancer. Nutrition and Lung Cancer. Nutrition and the Patient with Cancer. Diabetes Melitus: Obesity and the Risk for Diabetes. Nutrition Management for Type 1 Diabetes. Nutritional Management of Type 2 Diabetes. Nutrition Management for Gestational Diabetes. Obesity: Overview of Treatments and Interventions. Role of Physical Activity. Micronutrient Intake and Body Weight. Behavioral Risk Factors for Obesity: Diet and Physical Activity. Role of Taste and Appetite in Body Weight Regulation. Gastrointestinal Diseases: Nutrition in the Prevention and Treatment of Common Gastrointestinal Symptoms. Nutrient Considerations in Lactose Intolerance. Nutrient Considerations in Inflammatory Bowel Disease and Short Bowel Syndrome. Nutrition and Liver Disease. Other Major Diseases: Nutrition and Renal Disease. Nutritional Management of Parkinson's Disease and Other Conditions Like Alzheimer's Disease. Osteoporosis. Eating Disorders: Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder. Nutrition and Food Allergy. Nutrition and Cystic Fibrosis. Osteomalacia. Nutrition and Immunodeficiency Syndromes. Disease Prevention Strategy: Nutrition Guidelines to Maintain Health. Epilogue.

When children have special health care needs, parents assume the roles of care coordinator, medical expert, and systems advocate as well as their typical parenting roles. They face many challenges in managing their child's chronic condition in the context of everyday life. Health care providers are uniquely positioned to assist parents in meeting those challenges and to promote parent competency and confidence in their child's care. The data for this analysis were collected during classes for parents of children with chronic conditions who took part in a randomized controlled study of a curriculum's effectiveness. During facilitated discussions, parents discussed challenges they faced and generated strategies they found helpful. Qualitative data analysis revealed dominant themes across subject areas. Challenges included social isolation, strained relationships and ongoing frustrations with health care and educational systems. Helpful strategies focused on being prepared, connecting with peers, becoming an advocate, developing partnerships and caring for one's self. Implications for health care providers include: understanding common challenges parents face; promoting parent-to-parent connections; and building partnerships with parents and their children with special needs.

Over time, most children with special health needs must become partners in their disorder management. Because most care of chronic conditions takes place in the home, parents assume significant responsibility in starting and supporting the child's role in parent-child shared management over time. This article describes findings from analysis of one attempt to measure this important construct.Cross-sectional descriptive study with 129 parents of children with chronic conditions.Internal consistency of the shared management scale was adequate (Cronbach's Alpha: overall scale, 0.91; and subscales: desire, 0.79; knowledge, 0.76; and current actions, 0.86). Observed relationships were in theoretically expected directions. In unadjusted univariate analyses, there were statistically significant associations between parent-child shared management and each of the following variables: (a) condition grouping and severity, (b) parent self-efficacy and coping, (c) amount and frequency of child's limitation to do things, and (d) emergency visits in the past 6 months (all at p0.01 levels). Adjusted multivariable analysis retained condition severity, parent self-efficacy, and coping as significant factors.The parent-child shared management tool can be used in research to broaden understanding of this important construct and identify precursors and outcomes of high or low shared management in a family. Nurses might use the tool in clinical practice to more accurately gauge parent desire for, knowledge of, and current actions in support of parent-child shared management so interventions can be individualized to the family's unique wishes.

Parents of children with chronic illnesses face many challenges not faced by other parents. A family-centered parent support and education program, Building on Family Strengths (BFS), was designed to help parents meet these challenges by gaining new skills and learning new ways to support their children. BFS researchers involved potential participant families in the refinement of the BFS curriculum to make it truly family centered. The article reports major feedback received from parent focus groups, leaders in several cultural communities, and participants in a pilot class as BFS underwent final refinement. This feedback greatly influences the development of the BFS curriculum, as without it the final product going into a randomized clinical trial would be less attuned to the needs of parents of children with chronic illnesses. Other researchers and family educators may find this feedback useful as they improve their own research and program offerings.

Recent dramatic advances in genetics at the laboratory and clinical levels explore opportunities for understanding and promoting health and decreasing the morbidity and mortality associated with metabolic disorders. The treatment of inborn errors of metabolism is, in fact, fairly new to medicine and nutrition. Although inborn errors of metabolism are individually rare, as a group they have a significant impact on the health care system. The backbone of an effective management program for inborn errors of metabolism is an effective newborn screening program. The most frequently identified disorders are those in which the absent or defective protein serves an enzymatic function. This diverse group of disorders responds to nutritional therapy intervention and is discussed in this chapter. Progress in the diagnosis and treatment of genetic diseases is fast paced. The goal for treatment of all disorders is to provide normal biochemical plasma concentrations. There is hope that further progress in the understanding of genetic disorders can promote earlier and more effective treatment and prevent the symptomatic sequelae of metabolic disorders.

Health promotion in child care encompasses components of environmental health and safety, individual and group preventive health practices, medical care, and health education. Child-care providers, children in child day care, and their families have all been appropriate targets for such efforts. It is not surprising, therefore, that goals for health promotion have been vast, complex, and difficult to reach. The purposes of this session are to outline specific and essential elements of health promotion in child day care and to identify realistic ways to make progress toward achieving them. HEALTH EDUCATION AND CHILD DAY CARE To achieve a healthier environment in child day care, it is essential to raise the sense of awareness about the importance of preventive health practices. This is important for child day-care providers, parents of children attending child care, and children. Packaged health curricula for preschool-age children and toddlers have been designed specifically for child day-care settings. Although their ability to improve child health practices is still under investigation, these curricula serve to intensify awareness among children and providers about the importance of safety and hygiene. Health education for preschoolers can also be taught more informally and without a set curriculum. Child day-care providers can add a health component to other activities during the day. A few extra words added to statements made to preschoolers can transform routine instructions into health-promotion messages. "Let's wash our hands before we eat, so that we don't eat the germs that are on our hands after playing outside" is an example.