There is a growing trend in European countries for childbearing to occur later in women’s lives. The recent increase in the use of ART, together with the long-term trend towards later childbearing, raises questions as to the acceptable age of childbearing in contemporary society. ART legislation varies considerably across Europe and age limits for access to fertility treatment are rarely defined. The legislation takes into account the preferences of potential parents; children’s preferences, however, are not ascertained. The (...) article discusses a research method used in a survey of older children and young adults. The objective of the survey was to answer the following questions: What age would children prefer their parents to be if they could choose? What are their reasons? Respondents were asked the following question: “How old would you like your mother and father to be when you are 20 (version for respondents younger than 16) or 25 (version for those older than 16) if you could wave a magic wand?” Furthermore, their reasons for wishing a change were identified through an open question, “Why would you like to change the age of your parents?”. (shrink)

Background: With multiple options available today to become a parent, how does the matter of genetic relatedness factor into adolescent cancer patients’ fertility preservation decision making? This study reports on and normatively analyzes this aspect of FP decision making. Methods: A convenience sample of Israeli adolescent cancer survivors and their parents were invited to participate in individual, semi-structured interviews. Results: In discussing the importance of genetic relatedness to future children or grandchildren, participants repeatedly brought up the interrelated issues of nature, (...) normalcy, and personal identity. Regardless of preference or ambivalence for genetic relatedness, the majority of participants were aware of alternative parenting options and noted both their advantages and disadvantages. However, knowledge of alternative parenting options was not uniform. Conclusions: To ensure that adolescent patients and their parents make informed FP decisions that meet their personal goals and values, it is important for physicians to discuss alternative parenting options with them in a culturally sensitive manner. Greater credence also should be given to those who question the importance of genetic relatedness. (shrink)

BackgroundFor many decades, the debate on children’s competence to give informed consent in medical settings concentrated on ethical and legal aspects, with little empirical underpinnings. Recently, data from empirical research became available to advance the discussion. It was shown that children’s competence to consent to clinical research could be accurately assessed by the modified MacArthur Competence Assessment Tool for Clinical Research. Age limits for children to be deemed competent to decide on research participation have been studied: generally children (...) of 11.2 years and above were decision-making competent, while children of 9.6 years and younger were not. Age was pointed out to be the key determining factor in children’s competence. In this article we reflect on policy implications of these findings, considering legal, ethical, developmental and clinical perspectives.DiscussionAlthough assessment of children’s competence has a normative character, ethics, law and clinical practice can benefit from research data. The findings may help to do justice to the capacities children possess and challenges they may face when deciding about treatment and research options. We discuss advantages and drawbacks of standardized competence assessment in children on a case-by-case basis compared to application of a fixed age limit, and conclude that a selective implementation of case-by-case competence assessment in specific populations is preferable. We recommend the implementation of age limits based on empirical evidence. Furthermore, we elaborate on a suitable model for informed consent involving children and parents that would do justice to developmental aspects of children and the specific characteristics of the parent-child dyad.SummaryPrevious research outcomes showed that children’s medical decision-making capacities could be operationalized into a standardized assessment instrument. Recommendations for policies include a dual consent procedure, including both child as well as parents, for children from the age of 12 until they reach majority. For children between 10 and 12 years of age, and in case of children older than 12 years in special research populations of mentally compromised patients, we suggest a case-by-case assessment of children’s competence to consent. Since such a dual consent procedure is fundamentally different from a procedure of parental permission and child assent, and would imply a considerable shift regarding some current legislations, practical implications are elaborated. (shrink)

When faced with transgressions in their peer groups, children must navigate a series of situational cues (e.g., type of transgression, transgressor gender, transgressor intentionality) to evaluate the moral status of transgressions and to inform their subsequent behavior toward the transgressors. There is little research on which cues children prioritize when presented together, how reliance on these cues may be affected by certain biases (e.g., gender norms), or how the prioritization of these cues may change with age. To explore these questions, (...) 138 5- to 7-year-olds (younger children) and 8- to 10-year-olds (older children) evaluated a series of boy and girl characters who partook in physical or relational aggression with ambiguous or purposeful intent. Children were asked to provide sociomoral evaluations (i.e., acceptability, punishment, and intention attribution judgments) and social preferences. Transgressor gender only impacted children’s social preferences. Conversely, aggression form and transgressor intent shifted children’s sociomoral judgments: they were harsher toward physical transgressors with purposeful intent over those with ambiguous intent but made similar evaluations for relational transgressors regardless of intentionality. The present results suggest that gender is perhaps not uniformly relevant to children across all contexts, as other cues were prioritized for children’s sociomoral judgments. Since children likely have less familiarity with relational aggression compared to physical aggression, it follows that intent would only shift judgments about physical transgressors. This research provides insight about how children simultaneously navigate multiple cues in aggression contexts, which is likely reflective of their real-world experiences. (shrink)

Introduction: Cognitive behavioral therapy for children and adolescents has shown efficacy in treating different psychiatric disorders. It has been added to multiple clinical guidelines as the first-line treatment. However, despite more studies of its efficacy, CBT is underutilized in clinical settings due to a lack of rigorous training programs and qualified CBT therapists. The limited knowledge of parents in this intervention and their negative attitudes toward it have been considered as possible reasons.Methods: This is a cross-sectional survey-based study among 464 (...) Saudi parents living in Riyadh city. We aimed to evaluate the preference, knowledge, and attitudes of Saudi parents toward CBT for their children. We compared the difference in the level of knowledge and attitudes toward CBT in relation to the characteristics of parents. An online questionnaire that included 39 questions was carefully reconstructed from four validated scales, approved by an expert panel, and piloted. Participants were recruited to participate through online social media.Results: Saudi parents had average knowledge about CBT; however, they had positive attitudes toward the therapy itself and its role in treating the behavioral issues of children. Male participants showed better knowledge than female participants. Participants with higher education and those with high income had more favorable attitudes toward CBT than others.Conclusion: The knowledge of parents is considered inadequate and indicated the need for more awareness and perhaps mass education. In contrast, they maintained positive attitudes and were interested in evidence-based treatment, with more preference toward non-psychopharmacological interventions. (shrink)

The goal is to present how shared decision-making in paediatric oncology occurs from the viewpoints of parents and physicians. Eight Swiss Pediatric Oncology Group centres participated in this prospective study. The sample comprised a parent and physician of the minor patient. Surveys were statistically analysed by comparing physicians’ and parents’ perspectives and by evaluating factors associated with children’s actual involvement. Perspectives of ninety-one parents and twenty physicians were obtained for 151 children. Results indicate that for six aspects of information (...) provision examined, parents’ and physicians’ perceptions differed. Moreover, parents felt that the children were more competent to understand diagnosis and prognosis, assessed the disease of the children as worse, and reported higher satisfaction with decision-making on the part of the children. A patient’s age and gender predicted involvement. Older children and girls were more likely to be involved. In the decision-making process, parents held a less active role than they actually wanted. Physicians should take measures to ensure that provided information is understood correctly. Furthermore, they should work towards creating awareness for systematic differences between parents and physicians with respect to the perception of the child, the disease, and shared decision-making. (shrink)

For families all over the world, going through a pandemic has presented a number of challenges. In particular, social distancing measures involving the closure of schools and day care centers, as well as increasing work hours at home, made parents face very demanding situations. However, we know little about whether parents’ burnout levels are influenced by the age of their children. This study sought to determine whether levels of parental burnout are higher in families with at least one child under (...) the age of four than in families with older children. The second goal was to explore whether having children under 4 years of age moderates the relationship between parental cooperation and PB. A cross-sectional study was conducted with a sample of 651 participants since May 18th until August 27th, 2020. The main results showed that child age is a predictor of PB. Besides, having a child aged 0–4 years old moderates the relationship between parental cooperation and PB. Finally, it was found that in cases where there was at least one child under 4 years of age in the family, with one of the partners who worked remotely, the respondent’s PB rose by 7.9 points. The implications of these results with respect to the consideration of children’s ages in the different parental scenarios were discussed. (shrink)

Although social scientists have identified diverse behavioral patterns among children from dissimilarly structured families, marketing scholars have progressed little in relating family structure to consumption-related decisions. In particular, the roles played by members of single-mother families—which may include live-in grandparents, mother’s unmarried partner, and step-father with or without step-sibling(s)—may affect children’s influence on consumption-related decisions. For example, to offset a parental authority dynamic introduced by a new stepfather, the work-related constraints imposed on a breadwinning mother, or the imposition of (...) adult-level household responsibilities on children, single-mother families may attend more to their children’s product preferences. -/- Without a profile that includes socio-economic, behavioral, and psychological aspects, efficient and socially responsible marketing to single-mother households is compromised. Relative to dual-parent families, single-mother families tend to have fewer resources and less buying power, children who consume more materialistic and compulsively, and children who more strongly influence decision making for both own-use and family-use products. Timely research would ensure that these and other tendencies now differentiate single-mother from dual-parent families in ways that marketers should address. Hence, our threefold goal is (1) to consolidate and highlight gaps in existing theory applied to studying children’s influence on consumption-related decision making in single-mother families, and (2) to propose a hybrid framework that merges two theories conducive to such research, and (3) to identify promising research propositions for future research. (shrink)

Children’s exposure to the marketing of energy-dense nutrient-poor (EDNP) foods is a public health concern and marketing investment is known to be shifting to non-broadcast media, such as the Internet. This paper examines the perceptions of parents and children on ethical aspects of food marketing to which children are exposed. The research used qualitative methods with parent-child (aged between 8–13 years), from South Australia. Thirteen parent-child pairs participated in this research. Ethical concerns raised by parents and children included, the (...) marketing of EDNP foods, pester power and family conflict and the use of powerful techniques via the Internet. Their views on rights and responsibilities represented a complex mixture of idealistic and pragmatic positions. They appeared to be caught within the tensions of problematizing unhealthy food marketing to children, both as a social problem and as an individual problem. Their dilemmas are not dissimilar to the broader policy debate in Australia on the matter of food marketing to children. The stale-mate on statutory regulations to protect children from exposure to EDNP food marketing could be advanced by stronger use of ethical arguments to protect children from harmful exploitation and to protect parents from forces that undermine their authority. (shrink)

BackgroundBiobanking biospecimens and consent are common practice in paediatric research. We need to explore children and young people’s (CYP) knowledge and perspectives around the use of and consent to biobanking. This will ensure meaningful informed consent can be obtained and improve current consent procedures.MethodsWe designed a survey, in co-production with CYP, collecting demographic data, views on biobanking, and consent using three scenarios: 1) prospective consent, 2) deferred consent, and 3) reconsent and assent at age of capacity. The survey was disseminated (...) via the Young Person’s Advisory Group North England (YPAGne) and participating CYP’s secondary schools. Data were analysed using a qualitative thematic approach by three independent reviewers (including CYP) to identify common themes. Data triangulation occurred independently by a fourth reviewer.ResultsOne hundred two CYP completed the survey. Most were between 16–18 years (63.7%, N = 65) and female (66.7%, N = 68). 72.3% had no prior knowledge of biobanking (N = 73).Acceptability of prospective consent for biobanking was high (91.2%, N = 93) with common themes: ‘altruism’, ‘potential benefits outweigh individual risk’, 'frugality', and ‘(in)convenience’.Deferred consent was also deemed acceptable in the large majority (84.3%, N = 86), with common themes: ‘altruism’, ‘body integrity’ and ‘sample frugality’. 76.5% preferred to reconsent when cognitively mature enough to give assent (N = 78), even if parental consent was previously in place. 79.2% wanted to be informed if their biobanked biospecimen is reused (N = 80).ConclusionProspective and deferred consent acceptability for biobanking is high among CYP in the UK. Altruism, frugality, body integrity, and privacy are the most important themes. Clear communication and justification are paramount to obtain consent. Any CYP with capacity should be part of the consenting procedure, if possible. (shrink)

The sources, extent and margins of parental obligations in taking decisions regarding their children’s medical care are subjects of ongoing debates. Balancing children’s immediate welfare with keeping their future open is a delicate task. In this paper, we briefly present two examples of situations in which parents may be confronted with the choice of whether to authorise or demand non-therapeutic interventions on their children for the purpose of fertility preservation. The first example is that of children facing cancer (...) treatment, and the second of children with Klinefelter syndrome. We argue that, whereas decisions of whether to preserve fertility may be prima facie within the limits of parental discretion, the right to an open future does not straightforwardly put parents under an obligation to take actions that would detect or relieve future infertility in their children—and indeed in some cases taking such actions is problematic. (shrink)

Viola and Ben, two pediatric oncology patients, need to undergo chemotherapy that might decrease their fertility. Both of them want to participate in the decisions related to their cancer treatment and fertility preservation. Should they be involved, and if so when and how?In many jurisdictions, children are not entitled to provide legally valid consent for medical decisions.1 As a result, others, usually parents, take on the role of surrogate decision-makers who act in their best interest. Still, it is important to (...) keep in mind that the age limit for competence set by legislation does not necessarily coincide with children’s clinical decision-making capacity: some children may be able to make certain health-care... (shrink)

The aim of the present study was to investigate the effect of the “Visual Awareness Education Programme” developed to support the visual literacy skills of preschool children. The study group comprised 40 children (20 children in the experimental group and 20 children in the control group) attending preschool in the 2014–2015 school year. The pre-test post-test experimental model was used in the study. The “Visual Literacy Inventory for Preschool Children” and the “Children’s Visual Literacy Rating Inventory for Parents” were (...) used to determine visual literacy level of children. Study results revealed significant differences in favour of the experimental group children in the sub-dimensions and the post-test scores of the “Visual Literacy Inventory for Preschool Children” and the post-test scores of the “Children’s Visual Literacy Rating Inventory for Parents”. (shrink)

It has been argued that, when there is a probable imminent risk of loss of children’s fertility, their parents should take active steps to preserve their reproductive potential if possible – or even that children have a right to such interventions being undertaken on them on their behalf, as an expression of their right to an open future. In this chapter, I explore these proposals and some of their implications. I place the discussion of fertility preservation for children into (...) the more general context of the choices that parents might have to help keep their children’s future reproductive (and parenting) choices open. I discuss the role of desert and fairness in arguments for fertility preservation and their relevance for framings of infertility in general, as well as the relation between having a (slight) possibility to reproduce and becoming a parent. (shrink)

Background: Pediatric guidelines recommend that children and adolescents participate in a developmentally appropriate way in end-of-life decision making. Shared decision making in pediatrics is unique because of the triadic relationship of patient, parents, and physician. The involvement of the patient may vary on a continuum from no involvement to being the sole decision maker. However, the effects of child participation have not been thoroughly studied. The aims of this literature review are to identify studies on end-of-life decision making in pediatrics, (...) to explore patient participation, and to assess the effects of such participation. Methods: Five databases—PubMed, PsycInfo, Medline, CINAHL, and Sociological Abstract—were searched for empirical studies on end-of-life decision making in pediatrics. Selected articles fulfilling the criteria were assessed for type of decision, participants’ characteristics, reports on participation of the minor patient, and outcome. Results: Fifty-seven articles on end-of-life decision making in pediatrics were identified. The majority of papers (n = 43, 75%) investigated parents’ and clinicians’ perspectives, while only 14 articles (25%) included perspectives of children and adolescents. Twenty-two articles (39%) reported some details on various forms of children's participation (e.g., receive information, plan care details, consulted before or after a decision was made). Positive (e.g., respect for patient's preferences) and negative (e.g., conflict due to diverging opinions) effects of children's participation in end-of-life decision making were reported. Conclusions: This systematic review highlights the need for research to identify factors that contribute to a favorable participation of minors in decision-making processes, as well as strategies to solve possible conflicts. More research should take into account the dynamics in the triadic process of decision making and emphasize children and adolescents’ perspectives. A better understanding of how to meaningfully involve children and adolescents in end-of-life decision making could facilitate the practice of patient participation in pediatrics. (shrink)

Background In Canadian jurisdictions without specific legislation pertaining to research consent, the onus is placed on researchers to determine whether a child is capable of independently consenting to participate in a research study. Little, however, is known about how child health researchers are approaching consent and capacity assessment in practice. The aim of this study was to explore and describe researchers' current practices. Methods The study used a qualitative descriptive design consisting of 14 face-to-face interviews with child health researchers and (...) research assistants in Southern Ontario. Transcribed interviews were analysed for common themes. Results Procedures for assessing capacity varied considerably from the use of age cutoffs to in-depth engagement with each child. Three key issues emerged from the accounts: (1) requirements that consent be provided by a single person thwarted researchers' abilities to support family decision-making; (2) little practical distinction was made between assessing if a child was capable, versus determining if study information had been adequately explained by the researcher; and (3) participants' perceived that review boards' requirements may conflict with what they considered ethical consent practices. Conclusion The results suggest that researchers' consent and capacity knowledge and skills vary considerably. Perceived discrepancies between ethical practice and ethics boards' requirements suggest the need for dialogue, education and possibly ethics board reforms. Furthermore we propose, where appropriate, a ‘family decision-making’ model that allows parents and their children to consent together, thereby shifting the focus from separate assent and consent procedures to approaches that appropriately engage the child and family. (shrink)

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. ‘Fertility preservation’ for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion (...) about whether it is ethical to offer such ‘experimental’ procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents’ decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children’s Hospital in Melbourne, Australia. (shrink)

Cognitive incompetence cannot adequately explain the special character of children's moral status. It is, in fact, because children lack preference structures that are sufficiently stable over time that they are not ’temporally extended agents’. They are best viewed as 'special agents’, and parents have the responsibility of fostering the development of temporally extended agency and other necessary related moral capacities. Parental authority should be exercised with the view to assisting children to acquire the capacities that facilitate their transition from 'special (...) agents’ to full and functioning members of the moral community. (shrink)

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. ‘Fertility preservation’ for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion (...) about whether it is ethical to offer such ‘experimental’ procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents’ decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children’s Hospital in Melbourne, Australia. (shrink)

Kuwait is a high fertility country where the average number of desired children still exceeds 5. However, fertility behaviour is beginning to show a noticeable change and the current TFR is about 4·2 children. In order to understand the decline in fertility, the impact of perceived benefits and costs of children on Kuwaiti womens demographic and socioeconomic characteristics. The sociocultural, economic and political contexts that shape the mother’s perceptions of the benefits and costs of children are analysed and it is (...) concluded that the need for children as social and national capital is currently the most important driving force behind fertility desires and behaviour. (shrink)

The present study investigated the cross-cultural variations in parents' views on the role of play in child development and the primary purpose of preschool education from Ethiopia and Hungary. It also examined the cross-cultural variations in preschoolers' executive functions, the frequency of their engagement in home activities, and the role of these activities in the development of EF skills. Participants included 266 preschoolers with their parents. The independent samples t-test showed that Ethiopian parents view fostering academic skills for preschooler significantly (...) more important than their Hungarian counterparts do. We also found that while Ethiopian parents hold the belief that academic and cognitive development is the major purpose of preschool education, Hungarian prioritize social-emotional development and entertainment. Additionally, preschoolers in Ethiopia were reported to engage in academic and arts and crafts activities after preschool significantly more frequently than their Hungarian counterparts. On the contrary, preschoolers in Hungary were found to engage in fine-motor activities, solitary play, sports and other physical activities significantly more frequently than their Ethiopian counterparts. No significant differences were found in EF skills between preschoolers from Ethiopia and Hungary. Results from hierarchical regression analyses showed that, after accounting for age and SES, preschoolers' frequency of pretend play and their parents' play support beliefs were found to be small to medium-sized predictors of inhibitory control skills in both samples. However, children's frequency of having breakfast at home was another significant predictor in the Ethiopian sample only. The frequency of participation in arts and crafts and other fine-motor activities were found to be important predictors of preschoolers' visual-spatial working memory skills in the Ethiopian and the Hungarian samples, respectively. We also found that, after controlling for SES, parental play support was an important factor associated with preschoolers' shifting skills only in the Hungarian sample. Based on the findings, we made important conclusions. (shrink)

BackgroundWhile fertility preservation is recommended practice for paediatric oncology patients, it is increasingly being considered for transgender children and young people in paediatric care. This raises ethical issues for clinicians, particularly around consent and shared decision-making in this new area of healthcare.MethodsA systematic review of normative literature was conducted across four databases in June 2020 to capture ethical considerations related to fertility counselling and preservation in paediatric transgender healthcare. The text of included publications was analysed inductively, guided by the Qualitative (...) Analysis Guide of Leuven.ResultsTwenty-four publications were identified for inclusion. Four key ethical considerations emerged from this literature: access to fertility preservation, conscientious objection, decision-making capacity of children and young people, and shared decision-making.ConclusionIn the identified literature, there is consensus that transgender children and young people should not be refused access to fertility preservation services solely due to their gender identity, and that clinicians with conscientious objections to fertility preservation for this group have an obligation to refer on to willing providers. Factors that create ethical complexity in this area of paediatric care include the child’s age, mental health, and parents’ views. (shrink)

ABSTRACT The objective of the study was to identify future lawyers’ and physicians’ views on testing children for Huntington’s disease (HD) against parents’ wishes. After receiving general information about HD, patient autonomy and confidentiality, law students and advanced medical students were shown an interview with a mother suffering from HD who is opposed to informing and testing her two children (aged 10 and 16) for HD. Students then filled out questionnaires concerning their agreement with testing. No significant differences were found (...) between medical and law students or between students from different courses concerning the adolescent son. Three quarters of students thought that he should be told about his mother’s disease, and 91% thought the adolescent son should have the opportunity of genetic testing for HD for himself. However, significant differences were found concerning the 10‐year old son, with 44% of law students and 30% of medical students in favour of testing the child for HD. Students raised some important ethical issues in their elective comments. In conclusion, we found highly positive attitudes towards informing a 16‐year old of his mother’s HD and offering to test him. These attitudes were not in tune with guidelines. Students did not consider several practical and ethical issues of genetic testing of children and adolescents. Specific education should ensure that attitudes are based on sufficiently detailed knowledge about all aspects of genetic testing of children to discourage pressures on persons at risk of HD. (shrink)

The treatment decisions of competent adults, especially treatment refusals, are generally respected. In the case of minors something turns on their age, and older minors ought increasingly to make their own decisions. On the other hand, parents decide on behalf of infants and young children. Their right to do so can best be justified in terms of the importance of preserving intimate family relationships, rather than in terms of the child's best interests, although the child's best interests will most often (...) follow from this arrangement. Nevertheless, there are and ought to be legal, ethical, and financial constraints on parental decision making. (shrink)

Is the opposition to circumcision partly driven by cultural prejudices?In this issue of the Journal of Medical Ethics you can read a minisymposium on circumcision, mainly dealing with the circumcision of male children at an age where they cannot consent, but also touching upon issues of female genital mutilation.When reading the papers I found it strange, but of course not really surprising given its symbolic importance, that we are so worried about interventions on the male penis. Why are we not (...) equally worried about other irreversible bodily and mental interventions to which parents subject their children? I will not dwell on the irreversible mental imprinting, apart from mentioning that upon becoming a father I was amused to find that certain Danish lullabies and children’s rhymes had apparently been stored in my mind for the last 40 …. (shrink)

The first years of life mark a time of rapid development and dietary change, as children transition from an exclusive milk diet to a modified adult diet. During these early years, children's learning about food and eating plays a central role in shaping subsequent food choices, diet quality, and weight status. Parents play a powerful role in children's eating behavior, providing both genes and environment for children. For example, they influence children's developing preferences and eating behaviors by making some (...) foods available rather than others, and by acting as models of eating behavior. In addition, parents use feeding practices, which have evolved over thousands of years, to promote patterns of food intake necessary for children's growth and health. However in current eating environments, characterized by too much inexpensive palatable, energy dense food, these traditional feeding practices can promote overeating and weight gain. To meet the challenge of promoting healthy weight in children in the current eating environment, parents need guidance regarding alternatives to traditional feeding practices. (shrink)

The present research examines how children’s time spent online is associated with their perceived life satisfaction accounting for their age, gender, socio-economic status, emotional problems, country, and family environmental factors. This article is based on the data of the large scale cross-sectional EU Kids Online survey from 16 European countries with nationally representative samples of children aged 9–17. The results indicated that the time children spent online appeared to have no considerable negative effect on their self-reported life satisfaction. Comparatively, (...) the positive effects of children’s SES and family environment accounted for 43% of the overall 50% of the variance in children’s SRLS scores. Considering that children’s SES alone accounted for 42% of the variance, children’s emotional problems, country of residence, and enabling parental mediation accounted for the remaining 3, 4, and 1% of the variance, respectively. In line with previous studies that urge caution when discussing the negative influence of time spent online on children’s mental health and overall wellbeing, the current findings suggest that social-ecological characteristics and how children use the Internet, need to be examined further. (shrink)

Communication about diagnosis and medical treatment for children suffering from life-threatening illnesses is complex. It is a primary step in involving underage patients and families in care and lays the foundation for obtaining parental permission and patient assent for treatment. In practice child participation in care is often difficult to obtain due to patients' different and sometimes fluctuating preferences, but also parents' protective strategies. Physicians may be susceptible to parental wishes to limit information and feel uncomfortable discussing issues related (...) to uncertainty of cure with patients. A qualitative study in Romanian paediatric oncology units was conducted to explore children's involvement from the perspectives of parents and oncologists. Interviews with participants discussed 18 patient cases. Data were transcribed and thematic analysis was used to interpret and mine patients' involvement during treatment. Different facets of patient participation were identified: restricting, widening and enhancing involvement. A fourth category, unintentional involvement, occurred for all patients due to children's observations during long-term hospitalisations and access to Internet. Uncertainty overarched parental attitudes regarding the extent to which children should be included. Physicians usually complied with parental wishes to limit involvement, but together with parents involved patients at least in a practical way. Adults' protective attitude may backfire, as adolescents' online searches often expose patients to worse-case scenarios. Further research should acknowledge the hazards of restricted diagnosis disclosure and develop clinician tools to support families in communicating with patients. This should be paralleled by physician efforts to elicit patients' needs regarding participation. (shrink)

This study examined whether parents’ attribution of their child’s emotions (internalizing, externalizing) to dispositional causes is associated with children’s problem behaviour (internalizing, externalizing). The mediating roles of parents’ emotion-dismissing and -coaching reactions and the moderating role of child’s gender was also examined. Participants were 241 US parents with a child (43% girls) between the ages of 5 and 7. Parents were presented with vignettes in which a gender-neutral child displayed internalizing and externalizing emotions and were asked to imagine their (...) own child in the vignettes. Subsequently, parents indicated whether they attributed the child’s emotion to dispositional causes and the likelihood of reacting in an emotion-dismissing and -coaching way in each situation. Child problem behaviour was measured using the CBCL. Results show that parental dispositional attributions were associated with child internalizing and externalizing problems, and this association was consistently mediated by emotion-dismissing reactions. The association between parental dispositional attributions and emotion-dismissing, as well as its indirect effect on child internalizing problems, was stronger for boys than for girls, whereas the indirect effect via emotion-coaching was stronger for girls than for boys. Thus, the parental attribution process seems to be different for boys and girls. (shrink)

Mitochondrial replacement techniques, known in the popular media as 'three-parent' or 'three-person' IVFs, have the potential to enable women with mitochondrial diseases to have children who are genetically related to them but without such diseases. In the debate regarding whether MRTs should be made available, an issue that has garnered considerable attention is whether MRTs affect the characteristics of an existing individual or whether they result in the creation of a new individual, given that MRTs involve the genetic manipulation of (...) the germline. In other words, do MRTs affect the qualitative identity or the numerical identity of the resulting child? For instance, a group of panelists on behalf of the UK Human Fertilisation and Embryology Authority has claimed that MRTs affect only the qualitative identity of the resulting child, while the Working Group of the Nuffield Council on Bioethics has argued that MRTs would create a numerically distinct individual. In this article, I shall argue that MRTs do create a new and numerically distinct individual. Since my explanation is different from the NCOB's explanation, I shall also offer reasons why my explanation is preferable to the NCOB's explanation. (shrink)

How likely is it that traumatic childhood events are misremembered or forgotten? Research on children′s recollections of painful or frightening medical procedures may help answer this question by identifying predictors of accurate versus inaccurate memory. In the present study, 46 3- to 10-year-old children were interviewed after undergoing a stressful medical procedure involving urethral catheterization. Age differences in memory emerged, especially when comparing 3- to 4-year-olds with older children. Children′s understanding of the event, parental communication and emotional support, and children′s (...) own emotional reactions also predicted accuracy. Memory did not reliably vary for children who endured the medical procedure once versus multiple times. Results are discussed in relation to possible precursors of accurate and false memories, and forgetting, of traumatic events experienced in childhood. (shrink)

Many drugs used in paediatric medicine are off-label. There is a rising call for the use of adaptive clinical trial designs in responding to the need for safe and effective drugs given their potential to offer efficiency and cost-effective benefits compared with traditional clinical trials. ADs have a strong appeal in paediatric clinical trials given the small number of available participants, limited understanding of age-related variability and the desire to limit exposure to futile or unsafe interventions. Although the ethical value (...) of adaptive trials has increasingly come under scrutiny, there is a paucity of literature on the ethical dilemmas that may be associated with paediatric adaptive designs. This paper highlights some of these ethical concerns around safety, scientific/social value and caregiver/guardian comprehension of the trial design. Against this background, the paper develops a non-static conceptual lens for understanding PADs. It shows that ADs are epistemically open and reduce some of the knowledge-associated uncertainties inherent in clinical trials as well as fast-track the time to draw conclusions about the value of evaluated drugs/treatments. On this note, the authors argue that PADs are ethically justifiable given they have multiple layers of safety, exposing enrolled children to lesser potential risks, create social/scientific value generally and for paediatric populations in particular, specifically foster the flourishing of paediatric populations and can significantly improve paediatric trial efficiency when properly designed and implemented. However, because PADs are relatively new and their regulatory, ethical and logistical characteristics are yet to be clarified in some jurisdictions, the cooperation of various public and private stakeholders is required to ensure that the interests of children, their caregivers and parents/guardians are best served while exposing paediatric research subjects to the most minimal of risks when they are enrolled in paediatric trials that use ADs. Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable. (shrink)

Background. Decisions to test, enrol and disclose HIV status are among the ethical challenges that may influence adherence to antiretroviral therapy (ART) and HIV care and treatment in adolescents living with HIV. In the Tanzanian setting, how parental perceptions of ethical issues affect adolescents’ adherence to HIV care and treatment is not well known.Objective. To explore parental perceptions of ethical issues in adolescent HIV care and treatment. Methods. The study employed a descriptive qualitative exploratory design and was conducted at Temeke (...) Regional Referral Hospital in Dar es Salaam Care and Treatment Centre (CTC) in the Outpatient Department (OPD). The study population were parents and non-parent caregivers of HIV-infected adolescents 10 - 19 years of age. A total of 16 persons participated in semi-structured interviews after their consent was obtained. All interviews were audiotaped, transcribed verbatim in Swahili and back-translated into English. An inductive content analysis was used, and standards of qualitative rigour applied. Results. Three qualitative themes emerged: balancing adolescents’ autonomy with parents’ desire to protect their children; parental dilemmas regarding disclosure of adolescents’ HIV status; and parental reasons for delayed disclosure.Conclusion. Participants perceived that parental authority should override adolescents’ autonomy in HIV care and treatment. Disclosure of HIV status to adolescents is a challenge to parents. Delays in disclosure often occur because parents feel guilty and because they have fears of rejection by their adolescent children. (shrink)

Health behaviours of preschool children have a considerable impact on the shaping of habits later on in their lives. Parents’ and guardians’ role is to develop positive health patterns and represent exemplary models to be followed by children. The aim of the paper is to present the use of correspondence analysis for the assessment of the relationship between eating habits of parents and children, as well as for the determination of the most common situations in which preschool children consume fast-food (...) products and to find the relationship between the frequency of fast-food consumption and BMI values in preschool children. The tests were carried out with the use of an own survey carried out in kindergartens in Białystok among parents dropping off and picking up children. 149 correctly filled questionnaires were obtained. The statistical analysis employs the chi-squared test and correspondence analysis. Among the tested children, a statistically significant relationship between body weight and sex was obtained. In the group of children and parents consuming fast-foods, a statistically significant relationship between the frequency of children’s and parents’ consumption of the products in question was noticed. A statistically significant relationship between the age of introduction of fast-food products into the child’s diet and their BMI was found. A situation that was statistically significant as far as contribution to frequent consumption of fast-food products by children, i.e. at least once a week, were children and parents shopping together. The relationship between the frequency of fast-food consumption by parents and children was presented in the form of correspondence maps, as well as the relationship between the child’s BMI and the age when the first fast-food product is served, and the relationship between the child’s BMI and the frequency of their consumption of fast-foods. Unfortunately, despite the high awareness among parents of the harmful effects of fast-food products and the widespread health education programmes, a number of the children in kindergartens were overweight or even obese. For this reason, the quality of the educational programmes in kindergartens, as well as in various media outlets, needs to be improved, with emphasis put on their effectiveness, in order to minimise the problem of the occurrence of overweight and obesity in children. It is also important for parents rearing children to pay special attention not only to their children’s menus, but also to foods consumed in the presence of children. (shrink)

The overriding theme of the conference honoring Bob Cooter and his work is the question whether law and policy can change people’s preferences. The conventional “law and economics” answer is “no.” People have preferences that are fixed. What changes in law and policy do is to change how people behave by altering the costs and benefits people face in pursuit of their preferences. Put simply, the assumption of the “law and economics” model is that people respond to (...) financial incentives by changing how they act, not what they want. So, to take a simple example, imagine two people at the same starting point, both wanting to drive separately to visit a mutual friend. Their preference to get there promptly and safely is common to both of them, but how they act in pursuit of that goal may well differ. Moreover, government can alter how they drive to their friend’s by making changes such as putting in a freeway, or adding a new lane to the road, or installing lots of new traffic signals or stop signs along one route. The two people may have driven different routes previously, and they may alter their driving strategy in response to the policy changes government has adopted and may still decide that different routes are better for them. But they do not change their desire to see their friend in a prompt and safe manner. In this Article I offer a counterexample — an instance in which changes in law and policy can not only alter the behavior of some with fixed preferences, but also can impact the preferences of others. My example is about changes in society that can alter parenting style (of those parents with a fixed preference to have their children succeed) and can also change the underlying preferences that those children have as to how their lives should play out. (shrink)

Recent work has shown that preschool-aged children and adults understand freedom of choice regardless of culture, but that adults across cultures differ in perceiving social obligations as constraints on action. To investigate the development of these cultural differences and universalities, we interviewed school-aged children (4–11) in Nepal and the United States regarding beliefs about people's freedom of choice and constraint to follow preferences, perform impossible acts, and break social obligations. Children across cultures and ages universally endorsed the choice to (...) follow preferences but not to perform impossible acts. Age and culture effects also emerged: Young children in both cultures viewed social obligations as constraints on action, but American children did so less as they aged. These findings suggest that while basic notions of free choice are universal, recognitions of social obligations as constraints on action may be culturally learned. (shrink)

ObjectiveThe goal of the study was to explore the relationship between parent–children relationships related to using the internet among kids and potentially associated factors.Materials and MethodsA sample of 1.216 Vietnamese students between the ages of 12 and 18 agreed to participate in the cross-sectional online survey. Data collected included socioeconomic characteristics and internet use status of participants, their perceived changes in relationship and communication between parents and children since using the internet, and parental control toward the child’s internet use. An (...) Ordered Logistic Regression was carried out to determine factors associated with parent–children relationship since using the internet.ResultsThe characteristics of the relationship between children and their parents since using the Internet were divided into three levels: deterioration, stability, and improvement. The topics that children most often communicate with their parents include learning, housework, and future directions. Two-way interactive activities, such as supporting parents to use the Internet, have a positive impact on the parent–child relationship. Stubborn parental control, such as establishing rules about contact or allowing Internet access and setting up global positioning system to track negatively affecting parent–child relationships.ConclusionFindings indicated that changes in the quality of the parent–child relationship were self-assessed by participants regard to kids’ internet use, especially in the COVID-19 epidemic context. Educational campaigns and programs to raise awareness of parents as to the dangers and negative influences that their children may encounter online, psychology of children’s behaviors and effects of different responding strategies are recommended. (shrink)

Background: Today in vitro fertilisation is a widespread and important technique of reproductive medicine. When the technique was first used, it was considered ethically controversial. This is the first study conducted of adult IVF-offspring in order to learn about their ethical opinions and personal attitudes towards this medical technology.Methods: We recruited the participants from the first cases of in vitro fertilisation in Germany at the Gynaecological Clinic of the University Hospital Erlangen. Our qualitative interview study consisted of in-depth, face-to-face interviews (...) with 16 adults who had been conceived by IVF. Our data was analysed with methods of Grounded Theory.Results: For these adults, the most important factor influencing their personal attitudes towards IVF was the knowledge that they were deeply wanted children. The artificiality of their conception seemed irrelevant for their ethical opinion. All participants mentioned that it was important for them to be informed about the circumstances of their conception by their parents.Conclusions: IVF seems to be a medical technique which, although it affects intimate aspects of human existence, can be integrated into the lives of the affected persons without any great difficulties. The findings suggest that parents should inform their children about their fertilisation at an early age and as part of a process over time, not only on a single occasion. Physicians should advise IVF-parents accordingly. (shrink)

The Future of Human Reproduction brings together new work, by an international group of contributors from various fields and perspectives, on ethical, social, and legal issues raised by recent advances in reproductive technology. These advances have put us in a position to choose what kindsof children and parents there should be; the aim of the essays is to illuminate how we should deal with these possibilities for choice. Topics discussed include gender and race selection, genetic engineering, fertility treatment, ovarian tissue (...) transfer, and post-menopausal pregnancy. The centralfocus of the volume is the interface between reproductive choice and public regulation. (shrink)

The aim of our study was to examine the familial risk of dyslexia in Year 1 school beginners, whose parents had been diagnosed as dyslexic or exhibited symptoms of the specific difficulties in reading and writing without a formal opinion issued by a counselling centre. We found that both a dyslexia report and specific reading and writing difficulties with no formal diagnosis manifested by a family member, and parents’ reading preferences, predicted the risk of dyslexia in Year 1 children. (...) Moreover, the children at familiar risk of dyslexia, as compared with their peers at no risk, later began to babble, were less apt at self-help and liked drawing less at the age of 2-3 years, and experienced more problems with drawing a circle at the age of 3. Additionally, during Year 1 of education, they performed poorer in fine motor skills, linguistic perception and sound deletion, visual functions and attention. Such symptoms can be observed by parents and teachers during the child’s play and educational activities. Early intervention can enhance the child’s readiness to school entry, and facilitate effective and satisfactory learning, increasing their further educational opportunities and the quality of life. (shrink)

Objective: The objective of the current study was to maximise the amount of information children and adolescents understand about the risks and benefits associated with participation in a biomedical research study.Design: Participants were presented with one of six hypothetical research protocols describing how to fix a fractured thigh using either a “standard” cast or “new” pins procedure. Risks and benefits associated with each of the treatment options were manipulated so that for each one of the six protocols there was either (...) a correct or ambiguous choice.Participants and setting: Two hundred and fifty one children, ages 6–15 , and 237 adults were interviewed while waiting for a clinic appointment at the Hospital for Sick Children.Results: Using standardised procedures and questionnaires, it was determined that most participants, regardless of age group, were able to understand the basic purpose and procedures involved in the research, and most were able to choose the “correct” operation. The younger children, however, showed an overall preference for a cast operation, whereas the older participants were more likely to choose the pins.Conclusions: By creating age appropriate modules of information, children as young as six years can understand potentially difficult and complex concepts such as the risks and benefits associated with participation in biomedical research. It appears, however, that different criteria were used for treatment preference, regardless of associated risks; older participants tended to opt for mobility whereas younger participants stayed with the more familiar cast operation. (shrink)

A series of studies investigated the capacity of children between the ages of 7 and 12 to give free and informed consent to participation in psychological research. Children were reasonably accurate in describing the purpose of studies, but many did not understand the possible benefits or especially the possible risks of participating. In several studies children's consent was not affected by the knowledge that their parents had given their permission or by the parents saying that they would not be upset (...) if the children refused. In contrast, other studies found that children were much more likely to stop their participation if the experimenter said explicitly that she would not be upset if they stopped. We suggest that experimenters should pay more attention to describing the possible risks and benefits of participation in research, and that they should also make it clearer to children that they are free to stop once they have begun. (shrink)

Ever so often in the UK, there is a flurry of activity around the information requirements of donor-conceived individuals. In April 2013, it was the launch of a report from the Nuffield Council on Bioethics that brought the issue back to public consciousness.1Since 1991, information about treatment with donor gametes or embryos has been collected by the Human Fertilisation and Embryology Authority. Since then, over 35 000 donor-conceived individuals have been born through treatment in licensed clinics. Medical information and information (...) about donors’ appearance are collected by clinics, and donors are encouraged to put together a ‘pen portrait’ giving information about themselves for any resulting children. One focus of the new report is on improving the quality and quantity of information available about donors.Traditionally, gamete and embryo donations were practised on an anonymous basis, so that those born as a result of such donation may receive only non-identifying information about the donor when they reach the age of 18. This changed in 2005 when donor anonymity was removed so that anyone donating after that time could be identified to individuals born as a result of the treatment. Those who have donated in the past are also able to reregister as identifiable donors. Much concern was expressed at the time that this would exacerbate the shortage of donors although the Nuffield Council on Bioethics reports that, 8 years on, those clinics that actively recruit donors appear to be successful in finding sufficient donors. The report recommends that the option of anonymous donation should not be reintroduced.A big issue of debate in the UK has been, and continues to be, whether parents should tell their …. (shrink)

In this article the results of a study of psychological readiness of pregnant women to parenthood are presented. Psychological readiness is defined as a structure consisting of three components: the cognitive, emotional, and behavioral, which is consistent with the single theory of psychological processes L. M. Vekkera. It was found that the main component that determines the high level of psychological readiness for motherhood is a cognitive component. The content of the cognitive component includes an understanding of the child as (...) a value. Some results of the research of value orientations of pregnant women in the structure of psychological readiness for parenthood. To identify the value system of pregnant women, the method of ‘Value Orientations‘ by M. Rokich was applied. The analysis of empirical data was performed using factor analysis and U criterion of Mann-Whitney. Respondents were distributed into two age groups: first group of 21-25 years, second group of 26-30 years. All women are nulliparous. The younger age group of pregnant women is characterized by values that are directed at the outside world. Emotional component dominates in the structure of psychological readiness for motherhood. Values of women in the second group are aimed at children. Cognitive and behavioral components dominate in the structure of their psychological readiness for motherhood. Knowledge of the structure of psychological readiness of women to parenthood will help to diagnose disorders of maternal behavior, to design methods of its correction and prevention. (shrink)

Children's comprehension of the universal quantifiers all and each was explored in a series of experiments using a picture selection task. The first experiment examined children's ability to restrict a quantifier to the noun phrase it modifies. The second and third experiments examined children's ability to associate collective, distributive, and exhaustive representations with sentences containing universal quantifiers. The collective representation corresponds to the "group" meaning (for All the flowers are in a vase all of the flowers are in the same (...) vase). The distributive representation implies a pairing (e.g., each flower paired with a vase for Each flower is in a vase). The exhaustive representation exhausts both sets (e.g., for The flowers are in the vases all the flowers are in vases and all the vases have flowers in them). Four- to 10-year-olds children had little difficulty restricting the quantifier all to the noun it modified in a task which required them to attend to the group feature of all. In contrast, only 9- and 10-year-olds were able to solve the task when the quantifier was each and the pictures showed entities in partial one-to-one correspondence. Children showed a preference for associating collective pictures with sentences containing all and distributive pictures with sentences containing each. The results suggest that between the ages of 5 and 10 years, children's semantic representations undergo less radical changes than others have proposed. Instead, developmental change may occur gradually as children acquire linguistic cues which map onto existing semantic representations. (shrink)

This paper examines the quality and stability of the responsive parenting practices of mothers with infants and the longitudinal links between these practices and children’s self-esteem. Using data presented by the Panel Study on Korean Children, this study identified Korean mothers’ responsive parenting trajectories from birth to age three and examined their associations with children’s self-esteem at first grade. Korean mothers developed one of three responsive parenting patterns from birth to age three: low, moderate, or high. Children’s (...) self-esteem differed according to their mother’s responsive parenting trajectory. First-graders with mothers displaying the low responsive parenting trajectory were more likely to have lower self-esteem than children of mothers with the moderate responsive parenting trajectory and children of mothers with the high responsive parenting trajectory. The longitudinal link between mother-reported responsive parenting patterns during infancy and child-reported self-esteem at first grade was verified. This finding highlights the significance of early responsive parenting from mothers as a predictor of the self-esteem of children in later developmental stages. (shrink)

In El Salvador from 1978 to 1988, contraceptive use among married women 15–44 years of age increased from 34% to 47%, and the total fertility rate declined from 6·3 to 4·6 children per woman. Most of this change took place from 1978 to 1985. Sterilization is the most prevalent method used, but nearly one-half of the women who are sterilized did not use any contraception before their operation. Few young couples use reversible methods of contraception to space births or delay (...) the start of childbearing. On average, women wait 8 years after marriage and have nearly three children before they use contraception. (shrink)

To whom do children look when deciding on their own preferences? To address this question, 3-year-old children were asked to choose between objects or activities that were endorsed by unfamiliar people who differed in gender, race, or age. In Experiment 1, children demonstrated robust preferences for objects and activities endorsed by children of their own gender, but less consistent preferences for objects and activities endorsed by children of their own race. In Experiment 2, children selected objects and (...) activities favored by people of their own gender and age. In neither study did most children acknowledge the influence of these social categories. These findings suggest that gender and age categories are encoded spontaneously and influence children’s preferences and choices. For young children, gender and age may be more powerful guides to preferences than race. (shrink)