"It makes sense that children who have difficulty breathing might be anxious and prefer to keep their parents, who can help them in an emergency, close by," said Barbara H. Fiese, a University of Illinois professor of human and community development and director of the university's Family Resiliency Center.
Fiese and her colleagues had two guiding questions going into the study. First, is asthma severity, as measured by pulmonary testing and by reported asthma symptoms, related to the development of separation anxiety symptoms in children? Second, can family interaction patterns mediate this relationship? This study reports that the answer to both questions is yes.
"In this study, we identified one important practice that makes a difference. Supportive interaction during family mealtimes helps increase a child's sense of security and eases separation anxiety symptoms. And, when children are less anxious, their lung function improves," she said.
According to Fiese, family members play an important role in helping children emotionally manage their asthma symptoms, adding that a supportive, organized environment during mealtime puts a child at ease whereas a chaotic, unresponsive atmosphere fosters worry and anxiety.
"Children need regularity and predictability," she said. "When families are overwhelmed or lack the skills to keep routines in place, there are often physical and psychological costs to their children. Left untreated, separation anxiety can lead to adult panic disorder."
In the six-week study, 63 9- to 12-year-old children with persistent asthma completed questionnaires and were interviewed about their physical and mental health, including an assessment for separation anxiety. Within one week of the lab visit, a family meal was recorded on video camera. The children's medication use was monitored electronically throughout the study.
The researchers found a relatively strong relationship between compromised lung function and separation anxiety symptoms.
"But, interestingly, we could also see that these intense feelings of concern were related to how the family interacted at mealtime. When children had separation anxiety, their mealtimes were characterized by withdrawal, a lack of engagement, and low levels of communication," she said.
Conversely, family mealtimes that were organized, featured assigned roles, and generated involvement among participants were a protective factor for children.
Why are shared family mealtimes so important? "Few other family activities are repeated with such regularity, allowing children to build up expectations about how their parents and siblings will react from day to day. As a result, kids develop a sense of security. They know someone's there for them. That's important for a child who feels vulnerable," she said.
Fiese recommends that health care providers "prescribe" family mealtimes as a tool for building trust and an opportunity for parents to check in and find out how their children are doing.
The repetitive nature of mealtimes allows parents of children with a chronic health condition to regularly check on their symptoms, quickly remind them to take medications, and plan ahead for the next day's events, she said.
"Unobtrusively, you can ask: are your meds filled up, do you have a doctor's visit this week, is your inhaler in your backpack?
"In this way, family management becomes part of the child's expected environment and reduces the anxious feelings associated with unpredictability and the feeling that things are not in control," she said.
What are the important components of family mealtimes? "Regularity and predictability," she said, "but that doesn't mean dinner always happens at 5:30 or 6 every night because no one's life is like that. We like to shoot for at least four times a week.
"It's also important that parents and other family members show genuine concern about the activities each child is involved in, that marital and other problems aren't discussed at the table, and, finally, that there's an element of planning ahead so that children know an adult is on top of their situation," she said.
When all this occurs, children with asthma may begin to see their symptoms as less threatening, their sense of security in their family relationships will likely be reinforced, and their lung function may improve as a result, she added.
The study, published in the February 2010 issue of the Journal of Child Psychology and Psychiatry, was co-authored by Marcia A. Winter of Syracuse University; Frederick S. Wamboldt of National Jewish Health; Ran D. Anbar of Upstate Medical University in Syracuse; and Marianne Z. Wamboldt of the University of Colorado, Denver, School of Medicine. It was funded by the National Institute of Mental Health.
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