Parenting Behaviors and Nutrition in Children with Leukemia
The aim of this study was to examine whether parenting behaviors are associated with child nutrition amongst pre-school children receiving treatment for acute lymphoblastic leukemia (ALL), and to determine whether this association differs from that observed amongst a healthy population. Participants were 73 parents of children aged 2–6 years. The children were either a) receiving treatment for ALL (n = 43), or b) had no major medical history (n = 30). Participants completed psychometrically validated questionnaires that assessed parenting behaviors and child diet. Increased parental overprotection was associated with higher fruit and vegetable consumption for the control group but lower fruit and vegetable consumption for the ALL group. Parental overprotection, inconsistent discipline and emotional feeding were positively associated with non-core (“junk”) food consumption for the ALL group, particularly those who had recently received steroid treatment. To the best of our knowledge, this is the first study to show that certain parenting behaviors may be associated with poor nutrition during treatment for ALL. In light of these results, parenting interventions, specifically targeting parenting behaviors such as assertive discipline, may be a mechanism for nutrition promotion amongst this vulnerable group.
KeywordsParenting Diet Psycho-oncology Cancer Pediatric oncology
This study was funded by the Ponting Foundation and the Victorian Government Department of Human Services and the Victorian Government’s Operational Infrastructure Support Program. KE Lamb was supported under a National Health and Medical Research Council Centre of Research Excellence grant, ID#1035261, to the Victorian Centre for Biostatistics (ViCBiostat). We gratefully acknowledge the parents who participated in the study, Madeleine Bowden, the project research assistant who assisted with participant recruitment and Jessica Bastiani, a Masters in Clinical Psychology student who assisted with recruitment and data entry.
Conflict of interest
Lauren Kendrea Williams, Karen Lamb and Maria McCarthy declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
- Brouwer, C. A., Gietema, J. A., Kamps, W. A., de Vries, E. G., & Postma, A. (2007). Changes in body composition after childhood cancer treatment: Impact on future health status—a review. Critical Reviews in Oncology and Hematology, 63, 32–46. doi: 10.1016/j.critrevonc.2007.01.007.CrossRefGoogle Scholar
- Colletti, C. J., Wolfe-Christensen, C., Carpentier, M. Y., Gawthorne, R., Tapsell, L. C., & Cohn, R. J. (2008). The relationship of parental overprotection, perceived vulnerability, and parenting stress to behavioral, emotional, and social adjustment in children with cancer. Pediatric Blood & Cancer, 51, 269–274. doi: 10.1002/pbc.23280.CrossRefGoogle Scholar
- Davies, W. H., Noll, R. B., DeStefano, L., Bukowski, W. M., & Kulkarni, R. (1991). Differences in the child-rearing practices of parents of children with cancer and controls: the perspectives of parents and professionals. Journal of Pediatric Psychology, 16, 295–306. doi: 10.1093/jpepsy/16.3.295.CrossRefPubMedGoogle Scholar
- de Lauzon-Guillain, B., Oliveira, A., Charles, M. A., Grammatikaki, E., Jones, L., Rigal, N., & Monnery-Patris, S. (2012). A review of methods to assess parental feeding practices and preschool children’s eating behavior: The need for further development of tools. Journal of the Academy of Nutrition and Dietetics, 112, 1578–1602. doi: 10.1016/j.jand.2012.06.356.CrossRefPubMedGoogle Scholar
- Fedele, D. A., Mullins, L. L., Wolfe-Christensen, C., & Carpentier, M. Y. (2011). Longitudinal assessment of maternal parenting capacity variables and child adjustment outcomes in pediatric cancer. Journal of Pediatric Hematology/oncology, 33, 199–202. doi: 10.1097/MPH.0b013e3182025221.CrossRefPubMedGoogle Scholar
- Forsythe, A., Breland, T., Majumdar, S., Elkin, T. D., Johnson, D., & Megason, G. (2010). Gender differences in incidence rates of childhood B-precursor acute lymphocytic leukemia in Mississippi. Journal of Pediatric Oncology Nursing, 27, 164–167. doi: 10.1177/1043454209357919.CrossRefPubMedGoogle Scholar
- Hoffbrand, A. V., & Moss, P. A. H. (2011). Essential haematology (6th ed.). Malden, MA: Blackwell.Google Scholar
- Hunger, S. P., Lu, X., Devidas, M., Camitta, B.M., Gavnon, P.S., Winisk, N. J., … Carroll, W. L. (2012). Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005: A report from the Children’s Oncology Group. Journal of Clinical Oncology, 30, 1663–1669. doi: 10.1200/JCO.2011.37.8018.
- Magarey, A., Golley, R., Spurrier, N., Goodwin, E., & Ong, F. (2009). Reliability and validity of the Children’s Dietary Questionnaire; A new tool to measure children’s dietary patterns. International Journal of Pediatric Obesity, 4, 257–265. doi: 10.3109/17477160902846161.CrossRefPubMedGoogle Scholar
- Oeffinger, K. C., Adams-Huet, B., Victor, R. G., Church, T. S., Snell, P. G., Dunn, A. L., & Vega, G. L. (2009). Insulin resistance and risk factors for cardiovascular disease in young adult survivors of childhood acute lymphoblastic leukemia. Journal of Clinical Oncology, 27, 3698–3704. doi: 10.1200/JCO.2008.19.7251.PubMedCentralCrossRefPubMedGoogle Scholar
- Steffens, M., Beauloye, V., Brichard, B., Robert, A., Alexopoulou, O., Vermylen, Ch., & Maiter, D. (2008). Endocrine and metabolic disorders in young adult survivors of childhood acute lymphoblastic leukaemia (ALL) or non-Hodgkin lymphoma (NHL). Clinical Endocrinology, 69, 819–827. doi: 10.1111/j.1365-2265.2008.03283.x.CrossRefPubMedGoogle Scholar
- Thomasgard, M., Metz, W. P., Edelbrock, C., & Shonkoff, J. P. (1995). Parent-child relationship disorders. Part I. Parental overprotection and the development of the Parent Protection Scale. Journal of Developmental and Behavioral Pediatrics, 16, 244–250. doi: 10.1097/00004703-199508000-00006.PubMedGoogle Scholar
- Williams, L. K., McCarthy, M., Eyles, D., & Drew, S. (2013). Parenting a child with cancer: Perceptions of adolescents and parents of adolescents and younger children following completion of childhood cancer treatment. Journal of Family Studies, 19, 80–89. doi: 10.5172/jfs.2013.3186.CrossRefGoogle Scholar
- Youlden, D., Baade, P., Ward, L., Velery, P., Hassall, T., Green, A., & Aitken, J. F. (2009). Childhood cancer incidence in Australia, 1983-2006. Brisbane: Viertel Centre for Research in Cancer Control, Cancer Council Queensland and the Australian Pediatric Cancer Registry.Google Scholar