Yeme Sorunu Tanısı Alan Çocukların Ailelerinin Damgalanmışlık (Stigma) Algısı

Yıl 2019, Cilt: 13 Sayı: 2, 101 - 106, 26.03.2019

Bahar Bingöller Pekcici

Öz

 Amaç: Bebeklik ve erken çocukluk döneminde yeme sorunu olan çocukların ailelerinin damgalanmışlık algısı (stigma) hissedip hissetmedikleri alanyazında bilinmemektedir. 

Araştırmada bebeklik ve erken çocukluk döneminde yeme sorunu tanısı alan çocukların ailelerinin kendilerini ne oranda damgalanmış hissettiğinin ve ailelerin damgalanma algılarının risk etmenleri ve sosyodemografik özellikler ilişkisinin belirlenmesi incelenmiştir. 

Gereç ve Yöntemler: Kesitsel ve gözlemsel bir desenle yapılan araştırmada yeme sorunu tanısı alan 0-42 aylık çocukların ailelerinin damgalanma algısı Genişletilmiş Gelişimi İzleme Destekleme Rehberi (G-GİDR) ile değerlendirilmiştir. İlişkili etmenlerin belirlenmesi amacıyla Student- t testi, Pearson Ki-Kare ya da Fisher-exact testi kullanılmış, anlamlı ilişki saptanan etmenlerin damgalanma algısına olan etkilerini araştırmak için çoklu lojistik regresyon analizi kullanılmıştır. 

Bulgular: Örneklemi oluşturan 67 çocuğun ailelerinin 22’si (%33) G-GİDR’de damgalanma algısı bildirmişlerdir. Ailenin damgalanma algısı ile çocuğun kız olması (OR:3.3, %95 GA:1.1-10, p=0.029), ailenin annede yılgınlık-bitkinlik-depresyon bildirmesi (OR:3.2, %95GA:1-10, p=0.041), baba eğitim düzeyinin lisenin altında olması (OR:5.2, %95 GA:1.1-23.5, p=0.05) arasında istatistiksel olarak anlamlı ilişki bulunmuştur. Çoklu lojistik regresyon analizinde ailelerin damgalanma algısının babanın eğitim düzeyi lise ve altında (OR:7.6, %95 GA:1.4-4) ve çocuğun kız olması (OR:4.4, %95 GA:1.2-15.4) ile ilişkisi bulunmuştur. 

Sonuç: Araştırma, yeme sorunu tanısı alan çocukların ailelerinin üçte birinin damgalanma algısı bildirdiğini göstermektedir. Araştırmamızın yeme sorunu tanısı alan çocukların değerlendirmelerinde ailenin damgalanma algısının sorgulanması ve tedavide bu algı konusunda aileler ile çalışılması konusundaki yaklaşımlara ışık tutması umulmaktadır. 

Anahtar Kelimeler

Damgalanma

Perceived Stigmatization of Families of Children with Feeding Disorders

Öz

 Objective: Feelings of perceived stigmatization of families of children with feeding disorders in infancy and early childhood is not known according to the existing literature. The objective of this study was to determine the perceived stigmatization of families and which risk factors and sociodemografic characteristics are related to perceived stigmatization. 

Material and Methods: In this cross-sectional study, the families of children diagnosed with feeding disorders aged 0-42 months were evaluated for perceived stigmatization with the Expanded Guide for Monitoring Child Development (Exp-GMCD). The Student t, Pearson Chi-square and Fisher-exact tests were used to determine the related factors and logistic regression anaysis was used to find out the effects of related factors on perceived stigmatization 

Results: Of the 67 caregivers of children with feeding disorders used as the sample, 22 families (33%) expressed perceived stigmatization on the Exp-GMCD. Female gender of the child (OR:3.3, 95% CI:1.1-10, p= 0,029), mother’s feelings of depression (OR:3.2, 95% CI:1-10, p=0.041) and paternal education under high school (OR:5.2, 95% CI:1.1- 23.5, p=0.05) were found to be statistically significantly related to perceived stigmatization of the families. In multiple logistic regression analysis, paternal education (OR:7.6, 95% CI:1.4-4) and female gender of the child (OR:4.4, 95% CI:1.2-15.4) were found to be related to perceived stigmatization of the families. 

Conclusion: This study shows that one third of the families of children with feeding disorders express perceived stigmatization. We believe this study will stimulate asking the families about perceived stigmatization while evaluating feeding disorders and the provide guidance for the treatment approach when working with families for perceived stigmatization. 

Anahtar Kelimeler

Stigma

Kaynakça

• 1. Kerzner B, Milano K, MacLean WC Jr, Berall G, Stuart S, Chatoor I. A practical approach to classifying and managing feeding difficulties. Pediatrics 2015;135:344-53.
• 2. Doğan DG, Ertem İÖ. Bebeklik ve erken çocukluk döneminde yeme sorunları. Ertem İ (ed). Gelişimsel Pediatri, Ankara: Antıp, 2005: 227-46.
• 3. Chatoor I. Feeding disorders in infants and toddlers: Diagnosis and treatment. Child Adolesc Psychiatr Clin N Am 2002;11:163-83.
• 4. American Psychiatric Publishing. Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington, VA: American Psychiatric Publishing, 2013.
• 5. Zero to Three. DC:0-3R: Diagnostic classification of mental health and developmental disorders of infancy and early childhood. Washington, D.C: Zero To Three Press, 2005.
• 6. Manikam R, Perman JA. Pediatric feeding disorders. J Clin Gastroenterol 2000;30:34-46.
• 7. Phalen JA. Managing feeding problems and feeding disorders. Pediatr Rev 2013;34:549-57.
• 8. Borowitz KC, Borowitz SM. Feeding problems in ınfants and children: Assessment and etiology. Pediatr Clin North Am 2018;65:59-72.
• 9. O’Brien LM, Heycock EG, Hanna M, Jones PW, Cox JL. Postnatal depression and faltering growth: A community study. Pediatrics 2004;113:1242-7.
• 10. Haycraft E, Farrow C, Blissett J. Maternal symptoms of depression are related to observations of controlling feeding practices in mothers of young children. J Fam Psychol 2013;27:159-64.
• 11. Patel V, Rahman A, Jacob KS, Hughes M. Effect of maternal mental health on infant growth in low income countries: New evidence from South Asia. BMJ 2004;328:820-3.
• 12. Bronfenbrenner U. Ecological models of human development. In: International Encyclopedia of Education, Vol: 3, 2nd ed. Oxford: Elsevier. Reprinted in: Gauvain, M & Cole M (eds) Readings on the development of children. 2nd ed. New York: Freeman, 1993:37- 43.
• 13. Goffman E. Stigma: Notes on the management of spoiled identity. New York, NY: Simon & Schuster, 1963: 5-37.
• 14. Ali A, Hassiotis A, Strydom A, King M. Self stigma in people with intellectual disabilities and courtesy stigma in family caregivers: A systematic review. Res Dev Disabil 2012;33:2122-40.
• 15. Werner S, Shulman C. Subjective well-being among family caregivers of individuals with developmental disabilities: The role of affiliate stigma and psychosocial moderating variables. Res Dev Disabil 2013; 34:4103–14.
• 16. Caslini M, Crocamo C, Dakanalis A, Tremolada M, Clerici M, Carrà G. Stigmatizing Attitudes and Beliefs About Anorexia and Bulimia Nervosa Among Italian Undergraduates. J Nerv Ment Dis 2016;204:916-24.
• 17. Yu J, Fei K, Fox A, Negron R, Horowitz C. Stress eating and sleep disturbance as mediators in the relationship between depression and obesity in low-income, minority women. Obes Res Clin Pract 2016;10:283-90.
• 18. Craig GM, Scambler G. Negotiating mothering against the odds: Gastrostomy tube feeding, stigma, governmentality and disabled children. Soc Sci Med 2006;62:1115-25.
• 19. Burklow KA, Mc Grath AM, Valerius KS, Rudolph C. Relationship between feeding difficulties, medical complexity, gestational age. Nutr Clin Pract 2002;17:373-8.
• 20. Francis A. Stigma in an era of medicalisation and anxious parenting: How proximity and culpability shape middle-class parents’ experiences of disgrace. Sociol Health Illn 2012;34:927- 42.
• 21. Benson A, O’Toole S, Lambert V, Gallagher P, Shahwan A, Austin JK. The stigma experiences and perceptions of families living with epilepsy: Implications for epilepsy-related communication within and external to the family unit. Patient Educ Couns 2016;99:1473- 81.
• 22. Galip N. Gelişimi İzleme ve Destekleme Rehberi”nin “Dünya Sağlık Örgütü (DSÖ) İşlevsellik, Yetiyitimi ve Sağlığın Uluslararası Sınıflandırması (ICF-CY)”na Uyarlanması ve 0–5 Yaş Arası Kronik Hastalığı Olan Çocukların Değerlendirilmesinde Geçerliliği. Yayınlanmamış Uzmanlık Tezi, Ankara Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Ankara, 2009.
• 23. Ertem IO, Krishnamurthy V, Mulaudzi MC, Sguassero Y, Balta H, Gulumser O, et al. Similarities and differences in child development from birth to age 3 years by sex and across four countries: A crosssectional, observational study. Lancet Glob Health 2018;6:e279- 91.
• 24. Bayley N. Bayley Scales of Infant and Toddler Development. Administration Manual. 3rd ed. San Antonio: Psychological Corporation, 2006.
• 25. World Health Organization. The International Classification of Functioning, Disability and Health (ICF). Geneva: WHO, 2001. 26. SPSS IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.
• 27. Pont SJ, Puhl R, Cook SR, Slusser W; Section On Obesity; Obesity Society. Stigma experienced by children and adolescents with obesity. Pediatrics 2017;140: e20173034.
• 28. Griffiths S, Mond JM, Murray SB, Touyz S. The prevalence and adverse associations of stigmatization in people with eating disorders. Int J Eat Disord 2015;48:767-74.
• 29. Puhl R, Suh Y. Stigma and eating and weight disorders. Curr Psychiatry Rep 2015;17:552.
• 30. Baybas S, Yıldırım Z, Ertem DH, Dirican A, Dirican A. Development and validation of the stigma scale for epilepsy in Turkey. Epilepsy Behav 2017;67:84-90.
• 31. Chiu MYL, Yang X, Wong F HT, Li J H, Li J. Caregiving of children with intellectual disabilities in China-an examination of affiliate stigma and the cultural thesis. J Intellect Disabil Res 2013;57:1117- 29.
• 32. Farrugia D. Exploring stigma: Medical knowledge and the stigmatisation of parents of children diagnosed with autism spectrum disorder. Sociol Health Illn 2009;31:1011–27.
• 33. Stern M, Karraker K, MCIntosh B, Moritzen S, Olexa M. Prematurity stereotyping and mothers’ interactions with their premature and fullterm infants during the first year. J Pediatr Psychol 2006;31:597- 607.
• 34. Migraine A, Nicklaus S, Parnet P, Lange C, Monnery-Patris S, Des Robert C, et al. Effect of preterm birth and birth weight on eating behavior at 2 y of age. Am J Clin Nutr 2013;97:1270-7.
• 35. Golik T, Avni H, Nehama H, Greenfeld M, Sivan Y, Tauman R. Maternal cognitions and depression in childhood behavioral insomnia and feding disturbances. Sleep Med 2013;14:261-5.
• 36. de Barse LM, Cardona Cano S, Jansen PW, Jaddoe VV, Verhulst FC, Franco OH, et al. Are parents’ anxiety and depression related to child fussy eating? Arch Dis Child 2016;101:533-8.
• 37. Leaffer EB, Hesdorffer DC, Begley C. Psychosocial and sociodemographic associates of felt stigma in epilepsy. Epilepsy Behav 2014;37:104-9.
• 38. Mickelson KD. Perceivde stigma, social support and depression. PSPB 2001;27:1046-56.