|Year : 2006 | Volume
| Issue : 3 | Page : 158-162
Child rearing issues for mothers with epilepsy: A case control study
PP Saramma, SV Thomas, PS Sarma
Departments of Nursing Education and Kerala Registry of Epilepsy and Pregnancy, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram - 695011, India
S V Thomas
Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum - 695011
Source of Support: None, Conflict of Interest: None
Background: Epilepsy can cause additional problems in child rearing to mothers with epilepsy (MWE). We aimed to ascertain the knowledge and practice of child rearing in MWE with a pretested questionnaire and compare it with that of mothers without epilepsy (MWoE). Materials and Methods: A standard questionnaire on knowledge (20 questions) and practice (10 questions) of child rearing was prepared through literature review, consultation with subject experts and interview with patients. The questionnaire was administered to 20 MWE with infants less than one-year age and 20 MWoE (matched for age, parity and education). Results: The knowledge on safety needs of infants was significantly ( P <0.01) lower for MWE than for MWoE but the over all knowledge on child rearing was comparable for both groups (12.45 ± 2.95 for MWE and 13.1 ± 3.13 for MWoE). The mean score on child rearing practice (CRP) was significantly lower ( P <0.05) for MWE (27 ± 2.51) than for MWoE (28 ± 1.6). There were three instances of accidentally dropping the baby for the epilepsy group. There was a trend towards better CRP as the knowledge on CR increased.
Keywords: Child rearing practices, parenting, registry of epilepsy and pregnancy, women with epilepsy
|How to cite this article:|
Saramma P P, Thomas S V, Sarma P S. Child rearing issues for mothers with epilepsy: A case control study. Ann Indian Acad Neurol 2006;9:158-62
Child rearing issues for mothers with epilepsy - a comparative study
Nearly half of the two and half million women with epilepsy (WWE) in India belong to the childbearing age group.  WWE experience several gender specific problems. ,,,,,,,,,,,, With improved treatment and easing of societal barriers more WWE are likely to become mothers. Knowledge of child rearing (CR) pertains to the developmental needs of the infants, their feeding, growth and development, safety and infant stimulation. The mother is the most important person to meet the various needs especially during infancy. Mothers with epilepsy (MWE) may have limitations in achieving these objectives on account of frequent seizures, lethargy and sedative effects of anti epileptic drugs (AEDs) or lack of motivation. Seizures may worsen in the postpartum period in MWE due to sleep deprivation or physiological and hormonal effects. The child care environment and maternal ability of child rearing were the important determinants of psychomotor development of children of MWE. Maternal epilepsy can lead to disturbance in family functioning and parenting. Inadequate breast-feeding was observed among MWE in a north Indian state. There had been few systematic studies in to the knowledge and practice of CR among MWE. The objective of our study was to ascertain the knowledge and practice of CR between MWE and compare them with matched mothers without epilepsy (MWoE).
| Materials and Methods|| |
This study was carried out in the Kerala Registry of Epilepsy and Pregnancy (KREP) at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum. We prepared a questionnaire after review of the literature on child development and nutrition, current breast-feeding practices, interview with several young MWE and discussions with a wide range of health care professionals. The questionnaire was pretested on a five MWE. The child rearing knowledge (CRK) test had 20 questions (feeding 8, growth and development 4, safety 6 and infant stimulation score 2). Child rearing practice (CRP) scale had 10 questions and a score of 30 (feeding 12, safety 10 and infant stimulation 8). Out of the ten maternal behaviors in the CRPS, five were rated on a 4-point scale and the other five were dichotomous Yes/No questions. There was a 10-point Visual Analogue Scale VAS as ladder of self-assessment of child rearing capability wherein the mother could depict her child rearing capability. The bottom step denoted total incapability to look after the baby (score 0) and top step denoted complete ability to look after the baby (score 10). Experts from neurology, nursing, obstetrics and pediatrics confirmed the content validity of the tool.
We enrolled 20 consecutive MWE (baby less than one year of age) attending to the KREP and equal number of age, parity and education matched MWoE (baby less than one year of age) attending to the immunization clinic of the Medical College Hospital located in the same campus. The study had the approval of the Institutional ethics committees. An informed consent was obtained from each subject. The interview took about 30 min. The test was administered in local language and questions were read out if the subjects had difficulty in reading.
The data was transferred to excel spreadsheet and was analysed with SPSS for Windows 14 version. Statistical significance was set at P value <0.05.
| Results|| |
The family and demographic characteristics, age and educational status of the MWE were comparable to those of MWoE [Table - 1]. The epilepsy classification for the MWE was Localization Related epilepsy 11 (55%) and Generalized epilepsy 9 (45%). The seizure types were: Complex Partial Seizures -CPS (20%), CPS with secondary generalization (30%), Simple Partial Seizures (5%) and Generalized Tonic Clonic Seizures (45%). The duration of epilepsy was: >5 years (40%), 6-10 years (20%), 11-15 years (30%) and more than 16 years (10%). Seven women (35%) were seizure free for one or more years prior to pregnancy. Eleven (55%) had 1-6 seizures per year; two (10%) had more than six seizures per year. There were no seizures during index pregnancy for 11 Mothers (55%). Seizures increased during pregnancy for one woman (5%), while it remained unchanged for eight mothers (40%). Folic acid was started in pre-pregnancy period for six (30%) women. All except one were taking folic acid during pregnancy. Thirteen (65%) MWE were on monotherapy, six (30%) on two drugs and one (5%) was not on any AEDs during the index pregnancy. Four (20%) were not compliant with AED therapy due to forgetfulness, fear of harm to the baby or financial difficulties.
Delivery details and the baby characteristics did not differ between the MWE and MWoE [Table - 1]. Congenital malformations were noted in three babies of MWE (congenital heart disease 2, Talipes Equinovarus 1). Infants of MWoE were not investigated for congenital malformations except for externally visible ones. About 85% of MWE and all the MWoE reported a sense of well being in the postnatal period. Sixty five percent of the MWE reported that they got adequate rest during day time and sleep during night time while 85% of MWoE expressed similar opinion.
Knowledge and practice on child rearing
The total CRK score for MWE (12.45 ± 2.95) was comparable to that of MWoE (13.10 ± 3.13). Nevertheless, the knowledge on the sub score for safety needs of infants was significantly lower for the MWE than for MWoE ( P <0.01) [Table - 2]. The mean CRP Score for MWE was significantly lower than that for MWoE ( P <0.05) [Table - 2]. There were three instances of accidentally dropping the babies for MWE while there was none for the MWoE. In the VAS, five out of 20 among each group scored >10. There was a positive association between CRK and CRP for MWE ( P <0.095) [Figure - 1].
| Discussion|| |
Caring for newborns and infants requires appropriate attitude, knowledge and skills on the mothers' side. In this study, we have compared the knowledge and practice of child rearing of MWE with that of MWoE. MWE had significantly poorer knowledge regarding the precautions for safety for their infants when compared to their nonepileptic comparators. The knowledge regarding other components of child rearing was comparable for the two groups. With regard to the CRP both groups fared comparably, except that there were three instances of accidentally dropping the baby for the MWE group (none for the MWoE). More enquiries in to the danger of accidents and injuries may have to be incorporated in the questionnaire, if more details of such events require analysis. It appears that WWE need to be specifically educated about the potential risk of dropping the baby, particularly during a myoclonus or a seizure.
Although there are many articles that deal with epilepsy, pregnancy, teratogenicity and maternal or fetal outcome, little attention is focused on the child rearing problems of MWE. It is widely recognized that early mother-infant interaction facilitates neurological and psychosocial development of infants. Children born to mothers with epilepsy may have higher risk of neurodevelopmental difficulties.
The purpose of this preliminary study was to develop a suitable test to estimate the knowledge and practice of child rearing among MWE. The questionnaire that we had prepared could be administered in about 30 minutes. The questionnaire is easy to respond, but would require reading out for illiterate mothers.
| Conclusion|| |
Issues related to child rearing are often neglected in the counseling of women with epilepsy. This study has shown that MWE may experience several child-rearing problems uniquely related to their disease, when compared to healthy mothers. Educating MWE on these aspects and safer child rearing practices could probably facilitate better infant mother bonding, reduce the risk of accidents to the babies. The long-term effects on neurocognitive development need further evaluation.
| References|| |
|1.||Thomas SV. Epilepsy and pregnancy. Curr Sci 2002;82:720-31. |
|2.||Yerby MS. Contraception, pregnancy and lactation in women with epilepsy. Bailliers Clin Neurol 1996;5:887-908. [PUBMED] |
|3.||Yerby M, Yasser YE. Pregnancy risks for the woman with epilepsy. In : Morrell MJ, Flynn KL, editors. Women with epilepsy: A handbook of health and treatment issues. Cambridge University Press: Cambridge; 2003. p. 203-14. |
|4.||Morrell MJ. Hormones and epilepsy through the lifetime. Epilepsia 1992;33:S49-61. [PUBMED] |
|5.||Morrell MJ, Flynn KL. Women with epilepsy: A handbook of health and treatment issues. Cambridge University Press: Cambridge; 2003. |
|6.||Crawford PM, Philip L. Gender differences in management of epilepsy: What women are hearing? Seizure 1999;8:135-9. |
|7.||Crawford PM. Family planning and contraceptive choice. In : Morrell MJ, Flynn KL, editors. Women with epilepsy: A handbook of health and treatment Issues. Cambridge University Press: Cambridge; 2003. p. 197-202. |
|8.||Crawford PM. Best practice guidelines for the management of women with epilepsy. Epilepsia 2005;46:S117-24. |
|9.||Long L, McAuley JW, Shneker J, Moore JL. The validity and reliability of the knowledge of women's issues and epilepsy (KOWIE) questionnaires I and II. J Neurosci Nurs 2005;37:88-91. |
|10.||Thomas SV, Indrani L, Devi GC, Jacob S, Beegum J, Jacob PP, et al . Pregnancy in women with epilepsy: Preliminary results of Kerala registry of epilepsy and pregnancy. Neurol India 2001;49:60-6. |
|11.||Thomas SV. Problems and Pitfalls in Management of Epilepsy in Women. In : Radhakrishnan Kurupath, editor. Reviews in Indian Neurology. Sree Chitra Tirunal Institute for Medical Sciences and Technology: Trivandrum; 2003. p. 195. |
|12.||Thomas SV. Management of epilepsy and pregnancy. J Postgrad Med 2006;52:57-64. [PUBMED] [FULLTEXT]|
|13.||Pennell PB, White R. Statistical approaches to assessing the effects of neutralizing antibodies: IFNbeta-1b in the pivotal trial of relapsing-remitting multiple sclerosis. Neurology 2003;61:S35-7. |
|14.||Pennell PB. Pregnancy in women who have epilepsy. Neurol Clin 2004;22:799-820. |
|15.||Hirano T, Fujioka K, Okada M, Iwasa H, Kaneko S. Physical and psychomotor development in the offspring born to mothers with epilepsy. Epilepsia 2004;45:53-7. |
|16.||Thiels C, Steinhausen HC. Psychopathology and family functioning in mothers with epilepsy. Acta Psychiatr Scand 1994;89:29-34. |
|17.||Nag D. Gender and epilepsy: A clinician's experience. Neurol India 2000;48:99-104. |
|18.||Yerby MS, Collins SD. Pregnancy and the mother. In : Engel J, Pedley TA, editors. Epilepsy: A Comprehensive textbook. Lippincott-Raven Publishers: Philadelphia; 1997. p. 2027-35. |
|19.||Meador KJ. Neurocognitive Outcome on children of mothers with epilepsy. In : Morrell MJ, Flynn KL, editors. Women with epilepsy-A handbook of health and treatment Issues. Cambridge University Press: Cambridge; 2003. p. 222-7. |
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
[Table - 1], [Table - 2]
|This article has been cited by|
||Effect of a self-instructional module on the child rearing knowledge and practice of women with epilepsy
| ||P.P. Saramma,P.S. Sarma,Sanjeev V. Thomas |
| ||Seizure. 2014; |
|[Pubmed] | [DOI]|
||Women with epilepsy have poorer knowledge and skills in child rearing than women without epilepsy
| ||P.P. Saramma, P.S. Sarma, Sanjeev V. Thomas |
| ||Seizure. 2011; |
|[VIEW] | [DOI]|
|| Child rearing knowledge and practice scales for women with epilepsy
| ||Saramma, P.P., Thomas, S.V. |
| ||Annals of Indian Academy of Neurology. 2010; 13(3): 171-179 |
||Sex and Gender Differences in the Assessment, Treatment, and Management of Epilepsy
| ||Fletcher-Janzen, E. |
| ||The Neuropsychology of Women. 2008; : 145 |
||Reply: Comment on child rearing issues for mothers with epilepsy
| ||Thomas, S. |
| ||Ann Indian Acad Neurol. 2006; 9(4): 251-252 |
||Need for educational program among mothers with epilepsy for safe childcare practice
| ||Pati, S., Nambron, R. |
| ||Ann Indian Acad Neurol. 2006; 9(4): 251 |