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Australian Journalof Child and Family Health Nursing

Volume 8 Issue 3 December 2011

• Managingimmunisationpainininfants

• Beyondthebabyblues

• MumMoodBooster–Internetbasedtreatmentforpostnataldepression

• CHoRUSstudyupdate

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Australian Journal of Child and Family Health Nursing 1

Contents

President’s report .......................................................................................................... 2

Editorial ............................................................................................................................. 3

Articles

Managing immunisation pain in infants ........................................................ 4

News and Reviews

Beyond the baby blues: perinatal mental health .....................................10

MumMoodBooster – Internet-Based treatment

for postnatal depression ....................................................................................13

CHoRUS study update ........................................................................................14

Book Review ..................................................................................................................16

State and Territory Reports

Australian Capital Territory ...............................................................................17

New South Wales ..................................................................................................17

Northern Territory ................................................................................................18

Queensland ............................................................................................................19

South Australia ......................................................................................................19

Victoria .....................................................................................................................20

Western Australia .................................................................................................20

Australian Journal of Child and Family Health NursingThe Official Journal of the Australian Association of Maternal, Child and Family Health Nurses Inc.

Volume 8 Issue 3December 2011

ISBN 9780646516059

Published twice a year by

a division of Cambridge Media10 Walters Drive, Osborne Park WA 6017 www.cambridgemedia.com.au

Copy Editor Rachel HoareGraphic Designer Sarah HortonAdvertising enquiries toSimon Henriques, Cambridge PublishingTel (08) 6314 5231 Fax (08) 6314 5299 [email protected]

Copyright ©2011 by the Australian Association of Maternal, Child and Family Health Nurses Inc

Australian Association of Maternal Child and Family Health Nurses (Inc.)

Board members

President: Julian Grant (SA)Vice-President: Joanne Fittock (Vic)Secretary: Carolyn Briggs (NSW)Treasurer: Virginia Hunter (NSW)Alice Blake (WA)Christine Burrows (ACT)Gail Clee (NT)Libby Dawson (Tas)Jan Finlayson (QldWendy Jones (Vic)Christine Long (Tas)Karine Miller (WA)Creina Mitchell (Qld)Pam Murphy (SA)Lesley Nuttall (NT)

State and territory member groups

Australian Capital Territory Child and Family Health Nurses AssociationPresident: Christine Burrows

Child and Family Health Nurses Association (NSW)President: Julia Maddox

Northern Territory Child and Family Health Nurses AssociationPresident: Chris McGill

Queensland Child and Family Health Nurses Association

President: Sue Kruske

South Australian Child and Family Health Nurses AssociationPresident: Pam Murphy

Tasmanian College of Child and Family Health NursesPresident: Vacant

Victorian Association of Maternal, Child and Family Health NursesPresident: Joanne Fittock

Community Health Nurses Western AustraliaPresident: Margaret Abernethy

ADVERTISINGAdvertising that appears in the Australian Journal of Child and Family Health Nursing conforms to the standards required by the Australian Association of Maternal, Child and Family Health Nurses Inc., but endorsement is in no way implied by the publishing of said material. All advertising enquiries should be directed to the publisher, Cambridge Publishing.

DISclAImERThe views and opinions expressed in the Australian Journal of Child and Family Health Nursing are those of the authors and not necessarily those of the Australian Association of Maternal, Child and Family Health Nurses or the Editor and must not be quoted as such. While every care is taken to reproduce articles as accurately as possible, the publisher accepts no responsibility for errors, omissions or inaccuracies.

2 Volume 8 Issue 3 December 2011

President’s reportCarolyn BriggsRetiring President

Julian GrantPresident

The AGM of the AAMCFHN was held on 26 October 2011 and marked the completion of another cycle for the Association. It has been a busy year for the Board, with much accomplished. The report below gives a summary of the year’s activities.

To promote the aim of the Association to provide a voice for maternal child and family health nurses, the Association has:

· Become a member of the National Primary Health Care Partnership, that provides an opportunity for the Association to contribute to national primary health care policy.

· Continued representation on the national Baby-friendly Hospital Committee.

· Submitted a written response to the Productivity Commission on the Early Childhood Development Workforce Report and held a teleconference with Commissioners.

· Attended the meetings of the National Council for Community Child Health in April and November of this year.

· Accepted an invitation for the President to present at the Royal College of Nursing Australia Community and Primary Health Care Conference in October 2011 on maternal child and family health nursing.

Members of the Board have been working on drafts of position papers that will express the views of the Association on important issues for maternal, child and family health nurses. A major interest was in supporting and promoting breastfeeding. At present, the Association has an informal policy to refuse advertising to manufacturers of infant formulas. The Board resolved to clearly express the Association’s position supporting breastfeeding and to define the Association’s position regarding the advertising of infant formulas in our publications and at the national conference.

During the past three years the Board has supported a review of postgraduate education programmes that prepare registered nurses for employment in maternal, child and family health nursing services. An outcome of the review conducted by Associate Professor Sue Kruske and Dr Julian Grant was the submission of a paper submitted for publication to an education journal. The findings of the review will support the development of a position statement on the need for nationally accepted core content in education programmes that prepare nurses for practice in maternal, child and family health.

The Association is an industry partner in the Chorus research project headed by Professor Virginia Schmied and her team. Thanks

are extended to Cecelia Randles for her continuing representation of the Association with the research study.

The biennial national conference was held in May 2011 and proved to be a great success, with over 700 maternal child and family health nurses attending. Congratulations are extended to Sue Kruske, Conference chairperson, and to all members of the conference committees, who worked so hard to ensure the conference went smoothly and achieved a fantastic outcome.

At the face-to-face meeting of the Board in Brisbane, July 2011, a range of issues and proposals to further the aims of the Association were discussed. These included exploring the feasibility of setting up a credentialling scheme for maternal, child and family health nurses, and the employment of a professional officer to assist the Board. Also discussed was the instigation of a research group to promote research into maternal, child and family health nursing.

A matter of interest for all members is progress with the review of the Constitution, which is currently under way. The Board has proposed changes to the Constitution to improve direct connection of individual nurses to the Association, and each state and territory group has been asked to discuss the proposals with their nurse members. The revision of the Constitution is an ongoing matter.

The Editor of the Association’s journal for the past six years has been Chris Brenton. Earlier this year, Chris advised that she would be stepping down from the position and the Board extends to Chris sincere thanks for her hard work in producing the journal. Following a review of the journal production process, an important decision made by the Board was to contract the production of the Australian Journal of Child and Family Health Nursing to a publishing house, Cambridge Media. The contract was signed in September 2011 and this issue of the journal is the first produced in conjunction with Cambridge Publishing.

Karine Miller is the website coordinator for the Association and our thanks go to Karine Miller for her support of the Association in this role.

The new Board was declared at the AGM and membership for 2012 is listed in this issue of the journal. As the retiring President, I would like to thank all Board members for their time, energy and commitment to the Association during the year: much has been achieved to further the aims of the Association. The 2012 Board under the guidance of the new President will now continue to promote the interests of the Association and its members.


Nursing journals are an important source of information for nurses, allowing them to quickly and easily update their knowledge and be informed about improvements in practice and service delivery. Nursing scholarship advances the profession of nursing by making available the ideas, thoughts and experiences of fellow clinicians and expands nursing knowledge through publication of new research. Journals should not only inform, but also foster debate about issues and problems.

For the past eight years, the Association has published a journal as a service for its members. During that time the format of the journal has remained mostly the same, but this issue of the Australian Journal of Child and Family Health Nursing heralds a new direction with a redesigned interior layout.

The new-look journal will also have new features. Following the President’s report, the journal opens with an editorial page. The purpose of the editorial will be to prompt awareness of and thinking about contemporary developments and issues in health care that have an impact on maternal, child and family health nursing. Editorials are expected to inform, to interpret and to critique ideas and issues, as well as stimulate and persuade. Mostly editorial copy is written by the journal’s Editor, but it is also customary to invite well-known nurses or other persons with relevant expertise or a fresh point of view to contribute a guest editorial. Controversial topics often prompt letters to the Editor, so we will be introducing this new feature as well.

Another new feature is the introduction of an Editorial Board. Articles published in peer-reviewed journals usually undergo a stringent process of scrutiny by peers where the aim, scope and content of the article are evaluated. Journals that have a peer-review process are more valued because of the credibility that peer review endows. Reviewers for the AJCFHN will be nurses

Editorial

Changes to the journal

experienced in maternal, child and family health nursing, who will assess submitted papers, advise the Editor on the suitability of the article for publication and provide helpful comments to the author/s to further refine the article. If a submitting author elects to have her/his article peer-reviewed, this will be identified in the journal. We do not, however, expect that every author will want to be peer-reviewed.

A major aim of the journal has always been to encourage maternal, child and family health nurses to contribute to nursing scholarship by publishing their work. One of the roles of the Editor is to mentor less experienced authors. We will support maternal, child and family health nurses to write about their clinical work, as sharing experiences and new developments is an important way to keep peers informed.

To assist writers, the submission process has been made more accessible. All submissions to the journal are now electronic via the manuscript system available on the Cambridge Media website. Instructions for accessing the manuscript system are in the detailed Information for journal contributors, located on the inside back cover of every issue of the journal or from the AAMCFHN home page. The manuscript system may be used for all items for inclusion in the journal, including state and territory reports.

We believe the journal is an important service for the Association members. A viable journal raises awareness of maternal, child and family health nursing, thus furthering the aims of the Association, and attracts new members. The introduction of new features and the redesign of the format are intended to ensure that the AJCFHN continues to service the needs of members into the future and make a real contribution to the developing literature in maternal, child and family health.

EditorDr Carolyn Briggs Faculty of Nursing, Midwifery and Health, University of Technology, Sydney

Editorial BoardAssistant Professor Manal Kassab Maternal and Child Health Department, Faculty of Nursing, Jordan University of Science and Technology

Associate Professor Sue Kruske Director, Queensland Centre for Mothers and Babies, University of Queensland

Professor Cathrine Fowler Faculty of Nursing, Midwifery and Health, University of Technology, Sydney

Professor Virginia Schmied School of Nursing and Midwifery and the Family and Community Health Research Group, University of Western Sydney

Marie Shepherd Child and Family Health Nurse, Tasmania

AJCFHN EDItorIAl BoArD


AbstractThere exists an ethical imperative to ensure the wellbeing of infants undergoing painful procedures, even procedures of short duration. The use of suitable, non-pharmacological pain-relieving measures such as sweet-tasting solutions (for example, sucrose or glucose) should be considered. The calming effect of sweet-tasting solutions during routinely applied painful procedures is supported in several randomised controlled trials, with the large majority showing profound calming, reduced crying incidence and duration and reduced facial pain expression scores, compared to water or no treatment. Although such methods could be considered as low-cost, widely available, convenient and safe, non-pharmacological pain relief is still not readily applied in most clinical settings. Many factors contribute to the lack of effective management of an infant’s pain including insufficient knowledge among caregivers and inadequate application of knowledge. The aim of this paper is to emphasise the need to eliminate or assuage procedural pain and suffering in infants during short procedures such as routine primary immunisation.

Keywords: infant pain, immunisation, child and family health nursing.

IntroductionUnderstanding an infant’s experience of pain is a complex process. It “… involves not only the transduction of noxious … stimuli, but also cognitive and emotional processing by the brain…” (Julius & Basbaum 2001, p. 203). This means that infants are able to feel and remember pain.

Managing immunisation pain in infants

Acute pain “… is one of the most common adverse stimuli experienced by children, occurring as a result of injury, illness and necessary medical procedures” (American Academy of Pediatrics 2006a, p. 793). Infants are regularly required to undergo routine procedures and experience the pain associated with these procedures. Procedural pain is described as “… an acute, short lived pain that comes as a result of diagnostic, surgery, preventive measurements, and/or necessary treatment” (American Academy of Pediatrics & American Pain Society 2001, p. 793). Accordingly, procedural pain is identified as an outcome from mildly invasive procedures such as injections (Finley & McGrath 2001). Crucially acute procedural pain has the potential for undesirable effects on preverbal infants under the age of three years (Derbyshire 1999; Stevens & Koren 1998; Young 2005). Although it was commonly thought that infants could not feel pain because they have an immature nervous system (Twycross, Dowden & Bruce 2009), research has confirmed that infants do feel and remember pain (Andrews & Fitzgerald 1999; Fitzgerald & Howard 2003). We now know that unmanaged procedural pain during infancy can have negative long-term effects (Andrews & Fitzgerald 1994; Bellieni & Buonocore 2005; Boyd 2002; Finely & McGrath 2001; Fitzgerald & Howard 2003; Harrison, Loughnan & Johnston 2006; Young 2005). For instance, some infants could develop needle phobia in childhood as an avoidance strategy response to previous painful experience (Finely & McGrath 2001; Pate, Blount & Cohen 1996). Moreover, it has been shown that up to 25% of adults experience significant fear of needles, hospital and dental care and have an avoidant attitude to health care because of painful experiences in the first 10 years of life (Noel, McMurtry, Chambers & McGrath 2009; Pate et al. 1996; Walco 2008).

Pain relief is now more widely used to alleviate routine procedural pain. This is often administered orally in the form of glucose or sucrose solution. The positive outcomes of a reduction in an infant’s pain experience after the use of sucrose and glucose are now starting to be acknowledged.

In this review, an overview of the relationship between the pain experience in infants and young children and the potential impact of unmanaged pain on early brain development is explored. Also, the mechanism of procedural pain is described and the effect of unmanaged pain and an infant’s memory of painful experiences are highlighted. Finally, the potential effect of pain related to receiving immunisation injections is illustrated.

Pain in infantsAn infant experiences pain in a similar way to older children and adults. A crucial difference is demonstrated by research findings that show the psychopathological effects of pain are even more intense the younger the infant is at the time of the painful event (Evans 2001; Jorgensen 1999; Rennick, Johnston &

Manal Kassab*Assistant Professor, Maternal and Child Health Department, Faculty of Nursing, Jordan University of Science and Technology, [email protected], [email protected]

Cathrine FowlerProfessor, Tresillian Chair in Child and Family Health, Centre for Midwifery, Child and Family Health, University of Technology, Sydney, NSW

Maralyn FoureurProfessor of Midwifery, Centre for Midwifery, Child and Family Health, University of Technology, Sydney, NSW

* Corresponding author

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Dougherty 2002; Schellinck, Stanford & Darrah 2003; Young 2005). Supporting this further, are clinicians’ reports that newborns and infants are particularly vulnerable to the harmful effects of untreated pain when compared to older children and adults (Anand & The International Evidence-Based Group for Neonatal Pain 2001; Evans 2001; Gibbins & Stevens 2003; Schelinck et al. 2003). It is well documented that unmanaged, repetitive, painful experiences result in hyperinnervation, with sprouting of both ‘A’ and ‘C’ pain fibres (Lidow 2002; Mitchell et al. 2004; Reynolds & Fitzgerald 1995; Schmidt & Willis 2007). ‘A’ are myelinated (fast) conducting pain fibres associated with sharp, quick pain whilst ‘C’ are unmyelinated (slow) conducting pain fibres associated with pressure, heat or cold. This sprouting is suggested to be partly as a result of an increase in the supply of nerve growth factor. The increase of the nerve growth factor supply is demonstrated to be more available in young infants than in older children or adults (Gibbins, Stevens & Asztalos 2003; Mitchell et al. 2004). Another suggested explanation for infants’ increased sensitivity to pain is due to the large area of skin that sensory nerve cells are linked to, which may result in infants feeling pain over a greater area of their body (Anand & The International Evidence-Based Group for Neonatal Pain 2001).

Based on neurological research, painful experiences in the early first years of life could result in long-term, structural and physiological changes in the central nervous system (Goldman 1999) and production of abnormal levels of neuro-chemicals (Young 2005) that leads to hyperinnervation and long-lasting sprouting of sensory nerve terminals (Peters et al. 2003; Schmidt & Willis 2007; Simons & Tibboel 2006; Young 2005). Such changes to the structure of the nervous system can lead to effects on an infant’s long-term health and wellbeing (Mitchell & Boss 2002; Porter, Grunau & Anand 1999; Young 2005). This is attributed to the plasticity of the nervous system during the early periods of infant development and to the effects of pain on sensory fibres during this critical period of the neurological maturation of infants (Reynolds & Fitzgerald 1995). These effects occur not only because of changes in baseline nociceptive processing agents, but are also due to changes in the pharmacodynamic responses to analgesic agents (Simons & Tibboel 2006). (A nociceptor is a sensory receptor that reacts to potentially damaging stimuli by sending nerve signals to the spinal cord and brain.) In addition, these changes in the nervous system are dependent on activity within the developing sensory pathways and include the structural and functional reorganisation of synaptic connections occurring in the postnatal period (Anand 2000; Harrison, Loughnan & Johnston 2006; Peters et al. 2003). Consequently, abnormal or excessive pain activity possibly alters normal development (Walker, Tam & George 1995) and has the potential to produce behavioural and structural changes that are not seen when similar injuries occur in adults (Anand & Scalzo 2000; Harrison et al. 2006; Navarroa, Vivóa & Valero-Cabré 2007; Peters et al. 2003; Simons & Tibboel 2006).

As noted earlier, pain in infancy is common as a result of therapeutic medical and preventive procedures. The above discussion has shown that these procedures can have serious negative effects. If infant pain is not managed adequately it can lead to undesirable, short- and long-term consequences that could affect normal nervous system development (American Academy of Pediatrics 2006; American Academy of Pediatrics & Canadian Paediatric

Society 2000; Harrison et al. 2006; Harrison, Loughnan, Manias & Johnston 2009; Kostandy et al. 2008; Simons & Tibboel 2006; Young 2005).

Effects of unmanaged pain and an infant’s memory of painful experienceResearch has shown that infants do feel and remember pain, even if it is for a short time and they can retain pain experiences in their subconscious mind (Finley & McGrath 2001; Peters et al. 2003; Peters et al. 2005; Young 2005; Zonneveld, McGrath & Reid 1997). From the previous discussion, we now know that there is a possibility of both short- and long-term consequences of pain in infants without conscious recall (Grunau, Ananad, Stevens & McGrath 2000; Simons & Tibboel 2006). Although the pain itself might not be consciously remembered, it could affect short-term and long-term perceptions (Anand 2000; Grunau, Whitfield, Petrie & Fryer 1994; Porter, Wolf & Miller 1999; Taddio, Katz, Ilersich & Koren 1997; Young 2005).

Memories for early, painful events are included in the implicit memory that operates at the level of conditioning without awareness. This is a type of memory that is expressed through performance, rather than conscious recall, such as information acquired during skill learning, habit formation, classical conditioning, emotional learning and priming. It is also known as non-declarative memory. The persistence of specific behavioural changes after conducting painful procedures implies the presence of such memory (Simons & Tibboel 2006; Zonneveld et al. 1997). This highlights the extent to which an infant will remember untreated painful experiences and how these experiences could affect the infant’s behaviour later in life (Porter et al. 1999; Taddio, Goldbach, Ipp, Stevens & Koren 1995; Warren 2001; Zonneveld et al. 1997).

Moreover, repeated painful experiences in infants could possibly lead to psychological consequences that extend beyond infancy (Johnston et al. 1999; Porter, Grunau et al. 1999; Porter et al. 1999; Rennick et al. 2002; Stevens & Johnston 1993; Zempsky & Schechter 2003). On the other hand, findings show that the way first exposure to acute pain is managed is often critical in the formation of the infant’s later behaviour in relation to health care (Kennedy, Luhmann & Zempsky 2008; Peters et al. 2003; Taddio & Joel 2005; Taddio, Shah, Gilbert-MacLeod & Katz 2002).

Although the exact mechanism mediating such changes is still relatively unexplored, taking these results into consideration is important to provide evidence for classical associative learning in infants and to promote the possibility that memories of pain may be recorded biologically (Woolf & Mannion 1999; Woolf & Salter 2000; Woolf & Thompson 1991), but are not accessible to conscious recall (Anand, Coskun, Thrivikraman, Nemeroff & Plotsky 1999).

There are few proposed explanations which may relate to the memorisation process of painful experiences. For instance, Anand and Scalzo (2000) related such cognitive and emotional sequelae to the vulnerability of infants to neurological damage during this critical period of neuro-development. This may cause changes in the structure and physiology of the infant’s nervous system and could affect adrenocortical responses (Fitzgerald & Beggs 2001;


Grunau, Holsti, Whitfield & Ling 2000; Ljungman, Gordh, Sorensen & Kreutz 1999; McGrath, Hsu & Cappelli 1990). Grunau (2000) proposed other mechanisms (such as association of pain with attention, emotion and later cognitive and social development) to demonstrate relationships between pain experiences in early life and cognitive and later emotional developmental outcomes. This evidence suggests that a relationship of painful stimuli and a later effect on infants’ behaviour in relation to pain exists.

The next section will focus on the importance of managing pain associated with a routinely applied procedure during the first few years of an infant’s life, that is immunisation.

Immunisation painMost medical procedures have the potential to cause pain, even simple procedures such as immunisation (Boyd 2002). Although immunisation nociceptive responses are short and immunisation is considered to be a protective procedure, like any other type of pain it has been associated with considerable anxiety and distress (American Academy of Pediatrics & American Pain Society 2001; Anand & Scalzo 2000; Andrews & Fitzgerald 1994; Harrison et al. 2009; Mitchell & Boss 2002). Moreover, it has been suggested that unmanaged immunisation pain can lead to some immediate and long-term physiological and behavioural consequences (Anand & Scalzo 2000; Mitchell & Boss 2002; Reis, Roth, Syphan, Tarbell & Holubkov 2003; Reis & Tarbell 1996). In support of this, study findings show that immunisation injections, like any other acute invasive procedure, are associated with changes in physiological, hormonal and behavioural patterns during and/or after the procedure (American Academy of Pediatrics & American Pain Society 2001; Harrison et al. 2009; Ljungman et al. 1999).

Although immunisation is an essential component of primary care for infants, it is also considered to be the most common stressful and painful event for infants (Efe & Özer 2007; Reis et al. 2003; Reis & Tarbell 1996). It has been shown that when infants are undergoing immunisation injections, adverse outcomes have been documented including physiological compromise and altered behaviours (Axia & Bonichini 2005; Bernard & Cohen 2006; Felt, Mollen & Diaz 2000; French, Painter & Coury 1994; McMurtry et al. 2007; Reis & Tarbell 1996; Stein 2004). For instance, an infant’s initial nociceptive response to immunisation is characterised by a strong flexion withdrawal response, a specific facial expression, a strong cry and other autonomic and physiological responses, including increased heart and respiratory rates (American Academy of Pediatrics & American Pain Society 2001; Axia & Bonichini 2005; Bernard & Cohen 2006; Lewindon, Harkness & Lewindon 1998; McMurtry et al. 2007). Moreover, short-term alterations in infant feeding, sleeping and crying behaviours have been reported during or following immunisation injections (Harrington, Woodman & Shannon, 1999; Taddio et al. 1997; The Royal Australasian College of Physicians 2006). As with other procedural pain, immunisation pain can lead to long-term consequences such as altered behaviours and coping skills (Pate et al. 1996; Reis & Holubkov 1997; Reis et al. 2003).

Considering the evidence that confirmed the potential harmful effects of inadequately managed procedural pain in infants, several consensus statements emphasised the need to reduce

pain using currently available strategies. This is regardless of the severity of the health status of an infant (Harrison et al. 2006). Position statements by the American Academy of Pediatrics and the Canadian Pain Society contain recommendations regarding the assessment, prevention and management of procedural pain in infants. Despite these published recommendations and research advances in the management of procedural pain in infants, these have not been matched by the use of prevention and immunisation pain management measures (Anand 2000; Anand & The International Evidence-Based Group for Neonatal Pain 2001; Asprey 1994; De Lima, Lloyd-Thomas, Howard, Summer & Quinn 1996; Johnston, Collinge, Henderson & Anand 1997; Lynam 1995; Sabrine, Wilkinson, Robbins, Cleaver & Williams 2000; Walco 2008; Walco, Cassidy & Schechter 1994). Globally, there are reports of low utilisation of pain reduction strategies for immunisation in clinical settings (Lewindon et al. 1998), and the lack of routine pain relief interventions for infants undergoing immunisation (De Lima et al. 1996; Finley & McGrath 2001; Mitchell & Boss 2002; Walco et al. 1994).

The majority of infants worldwide are exposed to multiple needle injections through regular vaccinations as a health prevention measure (American Academy of Pediatrics & American Pain Society 2001; Lewindon et al. 1998). Childhood immunisation schedules call for up to 20 injections within the first 24 months of life (Schechter et al. 2007; World Health Organization 2005).

Immunisation pain may persist for hours or days after the procedure, leading to the phenomenon of hypersensitivity. Hypersensitivity is related to the neural plasticity in the infant and to the effects of pain on sensory fibres during a critical period of neurological development (Evans 2001; Mitchell & Boss 2002; Reis et al. 2003). This, in turn, can cause changes in the sensitivity of the skin and underlying tissue at the injection site and the immediately surrounding area (Reis & Holubkov 1997; Reis et al. 2003; Taddio et al. 1997). This injection site tissue damage may result in local inflammation, an altered perception of pain in which a noxious stimulus leads to enhanced sensation of pain and a previously non-noxious stimulus provokes an abnormal sensation of pain. It has been stated that when a pain signal is sent, it will influence the nervous system by causing molecular changes and a biological marker is placed as a result (Grunau 2000).

Importantly, immunisation pain could be the first step in the development of chronic pain (Fitzgerald & Beggs 2001; Grunau, Ananad et al. 2000; Ljungman et al. 1999; McGrath et al. 1990) Such repeated pain may evolve into chronic pain because it causes changes in the structure and physiology of the infant’s nervous system and could affect adrenocortical responses (Grunau & Ananad 2000; Ljungman et al. 1999; McGrath et al. 1990). Immunisation, unlike other causes of acute pain, is anticipated pain because immunisation is a frequently applied procedure. As immunisation involves a degree of anticipation and memorisation, it can compound an infant’s distress, especially if they have had a previous distressing painful experience (Finley & McGrath 2001; Winskill & Andrews 2008; Young 2005). In addition, the lack of pain management for needle-related procedures is a barrier to immunisation that contributes to decreasing community compliance with recommended schedules (Szilagyi, Rodewald & Humiston 1994). Because of the distress expressed by

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infants during immunisation, some parents tend not to continue the immunisation schedule and report withholding follow-up immunisation from their infants (Lewindon et al. 1998; Reis & Holubkov 1997; Reis et al. 2003; Szilagyi et al. 1994).

Pain managementUnlike vigorous attempts to manage other types of acute pain (such as postoperative pain), immunisation pain is still not managed adequately (Anand 2000; de Lima et al. 1996; Kassab 2010; Lynam 1995; Sabrine et al. 2000; Walco et al. 1994). Emerging data shows that infants who undergo immunisation are not routinely offered pharmacological, behavioural, environmental or any other pain-relieving interventions (De Lima et al. 1996; Finely & McGrath 2001; Kassab 2010; Mitchell & Boss 2002; Walco et al. 1994).

As previously mentioned in this paper, immunisation may be one procedure that has the potential for cumulative, long-term negative effects on infants’ development. As immunisation injections occur far more frequently than any other painful procedure and because its pain may have cumulative long-lasting effects on infants’ wellbeing, immunisation pain should be acknowledged and treated. The control of pain during these injections has implications for the entire population of infants in both developed and developing countries. It is important then to find a simple, cheap and easy way to manage immunisation pain in healthy term infants.

Recently, increased efforts have been made to suggest possible ways to reduce pain and associated stress of newborns and infants undergoing routine invasive procedures such as injections. Although several attempts have been reported to reduce procedural pain, pharmacological interventions are rarely used to manage procedure-related pain in healthy infants. In the last few years, much of the research attention has been devoted to non-pharmacological analgesia as an alternative approach. More recently, different non-pharmacological techniques such as oral administration of sucrose and/or glucose have been shown to be effective in reducing pain in neonates (Kassab 2010; Stevens & Koren 1998). The administration of oral sucrose, a sweet-tasting solution, before a painful procedure has been the most frequently studied intervention in the area of pain management in neonates. Oral sucrose solution administered before painful procedures such as heel lancing and venepuncture has been found to have a pain-relieving effect both in term and preterm neonates (Barr et al. 1995; Eriksson & Finnstrom 2004; Stevens & Koren 1998).

Although various studies have shown that the administration of oral sucrose is an effective and simple intervention that could reduce procedure pain, sucrose is not routinely used in neonatal care and it is not readily available in the neonatal nursery and primary health care settings (Jatana, Dalal & Wilson 2003). Questions regarding the use of other sweet solutions such as glucose as a substitute for sucrose in older infants were suggested by researchers (Kassab 2010). This is because 25% and other concentrations of glucose solution are already available in a sterile container that is feasible and ready to be used during minor painful procedures in children’s clinical settings (Isik, Ozek, Bilgen & Cebeci 2000; Jatana et al. 2003; Kassab 2010). The use of sucrose or

glucose to reduce pain may be a good option for routinely applied procedures such as immunisation for older infants. Therefore, nurses working in primary health care settings such as child and family health services should consider incorporating this simple preventative measure into their routine discussion with parents of young infants prior to immunisation.

Implication for nursingIn a recent study of Jordanian nurses’ knowledge of infant experiences of pain it was identified that this knowledge base was lacking (Kassab 2010). Yet nurses are in a crucial position to act as an advocate for infants. All nurses working with infants and young children should be aware of the accumulating and convincing evidence about early brain development and the potential for this to be disrupted by painful experiences.

ConclusionToday, pain assessment and treatment should be part of current standard medical care in this vulnerable population. Unrelieved pain at varying points of an infant’s development can have long-term effects, even in healthy infants. This should alert nurses to seriously consider finding a suitable, safe and easy method of pain relief to manage all types of pain, including acute procedural pain, among infants.

referencesAmerican Academy of Pediatrics 2006a, ‘Prevention and management of pain in the neonate’, Pediatrics, vol. 118, no. 5, pp. 2231–2241.

American Academy of Pediatrics 2006b, ‘Prevention and management of pain in the neonate: an update’, Pediatrics, vol. 118, no. 5, pp. 2231–2241.

American Academy of Pediatrics & American Pain Society 2001, ‘The assessment and management of acute pain in infants, children, and adolescents’, Pediatrics, vol. 108, no. 3, pp. 793–797.

American Academy of Pediatrics & American Pain Society 2001 ‘The assessment and management of acute pain in infants, children, and adolescents’, Pediatrics, vol. 108, no. 3, pp. 793–797.

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Anand, S 2000, ‘Effects of perinatal pain and stress’ Brain, vol. 122, no. 6, pp. 117–129.

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REVIEWED PAPER


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REVIEWED PAPER


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Visit our website for product information & stockists www.medela.com.au

Medela’s Breastfeeding Group exists to enhance mother and baby’s health through

the life-giving benefits of breastmilk

REVIEWED PAPER


As part of Australia’s National Perinatal Depression Initiative (NPDI)

(2008–2013) which was established to focus on health promotion,

detection and early intervention of depression and anxiety in

the perinatal period, beyondblue has undertaken significant

developments to equip maternal, child and family health nurses

and other health professionals with the knowledge, training and

skills to undertake their work in this area. This article discusses

three of the major developments to date and highlights their

applicability for maternal, child and family health nurses across

Australia.

Background

Pregnancy, birth and early parenthood are rewarding and exciting

times for new parents, but they are also periods of great change.

During pregnancy and in the first year after the birth of a baby,

known as the perinatal period, women and their partners are at

significantly greater risk of experiencing depression and related

disorders.

beyondblue research indicates that around nine per cent of women

in Australia experience depression antenatally and this increases

to almost 16 per cent postnatally (Buist & Bilszta 2006) and the

prevalence of anxiety is estimated to be even higher.

In response to the high rates of depression and anxiety in the

perinatal period, it is vital that health professionals working

with women and their families in the antenatal and postnatal

periods are well equipped to identify, detect, refer and/or manage

perinatal mental health disorders. This is particularly important

when considering the significant research indicating that

persistent maternal stress, depression and anxiety can result in

detrimental effects on infant development both during pregnancy

and postnatally (Van de Bergh, Mulder, Mennes & Glover 2005).

New perinatal mental health clinical practice guidelines

In response to the high rates of depression and anxiety, and the

need for early detection and intervention in the perinatal period,

Beyond the baby blueslatest developments in perinatal mental health for maternal child and family health nurses working with women and their families in the perinatal period

beyondblue: the national depression initiative has developed Clinical

Practice Guidelines for Depression and Related Disorders – anxiety,

bipolar disorder and puerperal psychosis in the perinatal period

(beyondblue 2011). An Australian first, the Guidelines, which are

endorsed by the National Health and Medical Research Council

(NHMRC), draw on the latest high-quality research evidence to

inform best practice in the detection, treatment and management

of depression, anxiety, bipolar disorder and puerperal psychosis in

the perinatal period.

The Guidelines are aimed at a range of clinicians who have a

primary health care role in detecting mental health conditions

in the perinatal period. This includes general practitioners,

obstetricians, midwives, paediatricians, maternal, child and

family health nurses, and Aboriginal and Torres Strait Islander

health workers. The development of the Guidelines was guided

by an expert advisory committee including representatives from

midwifery and maternal, child and family health nurses and other

NEWS AND REVIEWS

Dr Nicole Highet Deputy CEO, beyondblueMs Carol Purtell, National Program Manager Perinatal Depression Initiative, beyondblue


NEWS AND REVIEWS

key health professional associations in the perinatal area, together

with consumers and carers.

The Guidelines recommend routine, universal screening for

depression and anxiety (antenatal and postnatal) using the

Edinburgh Postnatal Depression Scale (EPDS) (Cox, Holden &

Sagovsky 1987) with designated cut-off scores in the antenatal

and postnatal periods. While there was insufficient research

evidence to recommend any specific psychosocial risk assessment

scale, a series of questions was formulated to assess a woman’s

level of risk (Box 1).

Considering the mother–infant interaction as an integral part of

ongoing assessment and the potential impact of treatments on

the infant is also detailed in the Guidelines.

In addition to assessment and screening, the Guidelines also make

recommendations surrounding the treatment of mild to moderate

postnatal depression with evidence-based psychological

interventions, together with advice on the safety of psychotropic

medications during pregnancy and breastfeeding.

Past or current mental health problems

1 Have you ever had a period of two weeks or more when you felt particularly low or down?

2 Do you sometimes worry so much that it affects your day-to-day life?

3 Have you ever needed treatment for a mental health condition such as depression, anxiety disorder, bipolar disorder or psychosis?

4 Has anyone in your immediate family (for example, grandparents, parents, siblings) experienced severe mental health problems?

Previous or current abuse

5 When you were growing up, did you always feel cared for and protected?

6 If you currently have a partner, do you feel safe in this relationship?

Drugs and alcohol

7 Do you or others think that you (or your partner) may have a problem with drugs or alcohol?

recent life stressors

8 Have you had any major stressors, changes or losses in the last 12 months (for example, moving house, financial worries, relationship problems, loss of someone close to you, illness, pregnancy loss, problems conceiving)?

Practical and emotional support

9 When you were growing up, was your mother emotionally supportive of you?

10 If you found yourself struggling, what practical support would you have available? Who could help provide that?

11 If you found yourself struggling, what emotional support would you have available? Who could help provide that?

Box 1. Psycho-social assessment questions from the beyondblue Perinatal Clinical Practice Guidelines

New accredited online training for perinatal health professionals

To facilitate the implementation and understanding of the

Guidelines and ensure effective integration into routine care,

beyondblue in association with the Parent Infant Research Institute

and ThinkGP, have developed a free and accredited, online training

programme for health professionals.

The programme, called Beyond babyblues: Detecting and

managing perinatal mental health disorders in primary care is

the first of its kind in Australia and provides health professionals


NEWS AND REVIEWS

– including midwives, GPs, obstetricians and maternal, child and

family health nurses, care workers and allied health professionals

– with extra training and skills to detect, treat and manage mental

health conditions in the perinatal period.

the six-hour modules include:

Module one: Overview of perinatal mental health and the need

to screen.

Module two: Screening using the EPDS.

Module three: Further assessment and management.

Module four: Pathways to care – collaborative practice.

Module five: GP mental health treatment plans.

Module six: Management of perinatal depression.

To date, approximately 1300 health professionals have registered

to undertake the six-hour programme, which can be completed

in one-hour modules at the participants’ leisure. While modules

five and six are specifically designed for GPs, all modules can

be completed by all health professionals. Feedback from health

professionals has been overwhelmingly positive, especially

from rural and remote primary health care professionals where

access to training and workforce development is often difficult to

access.

Just Speak Up campaign

beyondblue research with women who had experienced antenatal

and postnatal depression and anxiety highlighted several themes

surrounding the lack of recognition and understanding of early

symptoms, coupled with high levels of stigma which prevented

women from seeking help early. In response to this, beyondblue

developed a campaign called Just Speak Up to increase community

awareness about the prevalence of these symptoms and the

need to speak up and ask for help. The campaign, which includes

television, radio and print advertisements and a dedicated

website, features high-profile beyondblue PND Ambassador,

Jessica Rowe and several other people who talk candidly about

their own experiences and encourage others to speak up and seek

help.

To promote awareness, free posters and postcards have been

produced and can be ordered by services and organisations. There

has been significant take-up of these free resources across the

maternal, child and family health sector with posters prominently

displayed in waiting rooms of clinics in health centres.

Conclusion

The development and application of the perinatal clinical practice

guidelines, online training programme and the Just Speak Up

campaign are all integral parts in the implementation of the NPDI.

The Commonwealth and all state and territory governments are

committed to the $85 million initiative and significant progress

has been made and continues to be made in the implementation

across Australia.

As beyondblue continues to support and advise the NPDI, it

continues to provide free, high-quality resources for health

professionals, consumer and carers.

If you would like to be kept up to date about developments and

resources in relation to perinatal mental health in Australia, please

join our PND Stakeholder email Directory by sending your details

to [email protected].

For further information, please contact Dr Nicole Highet or Ms

Carol Purtell on 03 9810 6100 or [email protected].

au, [email protected].

referencesbeyondblue: the national depression initiative 2011, Clinical Practice

Guidelines for Depression and Related Disorders – anxiety, bipolar

disorder and puerperal psychosis – in the perinatal period. A guideline for

primary care health professionals, beyondblue: the national depression

initiative, Melbourne.

Buist, A & Bilszta, J 2006, The beyondblue National Postnatal Screening

Program, Prevention and Early Intervention 2001–2005, Final Report. Vol

1: National Screening Program, beyondblue: the national depression

initiative, Melbourne, Vic.

Cox, J, Holden, J & Sagovsky, R 1987, Detection of postnatal depression:

development of the 10 item Edinburgh Postnatal Depression Scale.

British Journal of Psychiatry, vol. 150, pp. 782–786.

Van de Bergh, BRH, Mulder, EJH, Mennes M & Glover, V 2005, Antenatal

maternal anxiety and stress and the neurobehavioural development

of the fetus and child: links and possible mechanisms. A review.

Neuroscience and Biobehavioral Reviews, vol. 29, pp. 237–258.


The Parent Infant Research Institute (PIRI) at Austin Health is running a research trial to look at the feasibility of their new internet-based programme MumMoodBooster as a treatment for postnatal depression. The MumMoodBooster programme is based on some of PIRI’s successful treatment programmes for antenatal and postnatal depression and was developed in collaboration with the Oregon Research Institute and the University of Iowa.

In order to be eligible to participate, women must

• beover18yearsofage

• haveababyagedunderninemonths

• speakandreadEnglish

• havebroadbandinternetaccessandemail

• not be currently receiving other treatment for depression(including therapy or medication)

• have a score on the Edinburgh Postnatal Depression Scalebetween 12 and 20 (inclusive)

• notcurrentlyhavesuicidalthoughtsorbeatriskofself-harm

• not be currently experiencing bipolar disorder, psychoticdepression or substance abuse.

The MumMoodBooster programme consists of six sequential interactive sessions available for access one per week, as well as additional information in the form of companion library articles that are available for access at any time. The programme also includes web support forums and participants are phoned once a week by a personal coach for support and encouragement in using the programme.

Participants will be asked to complete questionnaires and phone assessments at three time points over six months and will be reimbursed for their time ($40 for the first assessment and $30 each for the second and third assessments).

We are happy to do a telephone intake with women to determine their eligibility. For more information and referral, please contact us on (03) 9496 4496 or [email protected] or [email protected]

NEWS AND REVIEWS

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GymbaROO and KindyROO working with MCFHN’s: helping parents help their children.GymbaROO and KindyROO provide a unique early childhood development program

for parents, their infants and young children. GymbaROO and KindyROO put the ‘natural’ back into development,

actively engaging parents in their children’s development in a fun learning environment.

Do you know that your local GymbaROO/KindyROO centre has fantastic services that MCFHN’s can access?• Free lunch time talks to local council area groups.• Free baby information and activity sessions at your centre or at the local GymbaROO centre.• A great DVD series: The Importance of Being an Infant, 1, 2, 3, & 4 - special deal for MCFHN's• Our latest publication: ‘Smart Start: how exercise can transform your child’s life.’• A quarterly magazine ‘First Steps’ that can be delivered free to your centre.

Contact your local centre or GymbaROO Head Office to find out more. 1800 gymbaroo or 1800 kindyroo

www.gymbaroo.com.au www.kindyroo.com.au

Internet-based treatment for postnatal depression


NEWS AND REVIEWS

Principal aim of the studyTo investigate the feasibility of implementing a national approach to child and family health services in Australia. In particular, the study is seeking the perspective of those directly involved in service provision (that is, child and family health nurses, general practitioners, practice nurses and midwives) and is also being informed by perspectives and experiences of key stakeholders and consumers.

This study is funded by the Australian Research Council.

BackgroundCurrent health policy in Australia is responding to international research on the importance of the early years in influencing behaviour, learning and health. The Council of Australian Governments has identified early childhood development and education as central to human capital reform and most jurisdictions have, or are developing, whole-of-government strategies for a more integrated response to the needs of children and families.

Australia has a well-accepted system of universal health services based on the principles of primary health care to meet the needs of pregnant women, children and families at multiple contact points. Child and family health nurses (CFHN) provide services for families and children from birth to school entry and in some jurisdictions

Investigating the feasibility of implementing a national approach to universal child and family health services: Study overview and update

will provide services in the antenatal period and beyond school entry to age of 12. General practitioners (GPs) provide significant primary care services for pregnant women, children and families (Nutbeam et al. 2010). Midwives provide care across pregnancy, birth and the postnatal period for up to six weeks after birth in some models of care.

Australia currently has a complex and multi-layered system of funding, service provision regulation and policy development involving a range of government and non-government stakeholders supporting children and their families. While there are examples of high-quality, innovative service provision, inconsistency across jurisdictions and fragmentation of services across professional groups and service sectors means many children and families, particularly those who are most disadvantaged, do not receive the services they need (Britt et al. 2005; Leutz 1999).

Study objectives1 To determine how the draft framework matches with or differs

from the current universal health services provided to children aged zero to eight and their families across jurisdictions.

2 To identify the changes in organisational systems and service provision required to implement a national approach and determine the key facilitators and barriers to implementation.

Chief investigators: Prof Virginia Schmied (UWS); A/Prof Sue Kruske, Charles Darwin University; Prof Caroline Homer (UTS); Prof Lesley Barclay (USyd); Prof Ian Wilson (UWS); Prof Cathrine Fowler (UTS); A/Prof Lynn Kemp (UNSW)

Partner investigators: Dr Michael Fasher (general practitioner); Dr Sharon Goldfeld; Ms Cecelia Randles (AAMCFHN); Northern Territory Department of Health & Families; WA Department of Health; Qld Department of health; Communities Division, NSW Dept of Human Services: Community Services; Victorian Department of Education and Early Child Development; RACGP, AGPN, APNA, ACM, AAMCFHN


3 To examine the changes in professional practice required to implement a national approach including the baseline educational preparation, qualifications and competencies of the health professionals required to meet the needs of children and families.

4 To identify if there are other workers that could assist or support the work of the universal health service providers.

5 To identify local models that can be used as exemplars of service and/or practice innovation to guide a national approach.

By exploring professional practice with professional groups the following questions are being addressed:

• What is the roleofmidwives,CFHNsandGPs inprovidingauniversal health service for families and children and where are the overlaps and gaps in service provision?

• Howdo(orcan)theseservicesarticulatewitheachotherandother professionals and sectors to maximise service efficiency, transition of care or service integration?

Study designThe study is a three-phase, sequential, mixed-methods study. Data is being collected using a combination of qualitative and quantitative methods, including consultative forums, focus groups, interviews and surveys.

Phase one: The purpose of phase one is to facilitate consultation around a national approach and the draft framework from the main professional associations/organisations, consumer groups and the specialist health service providers who form the second-tier referral services for primary care providers (for example, paediatricians and relevant allied health workers).

Phase two: A web-based survey completed by a sample of practitioners engaged in direct health service delivery and who represent each discipline.

Phase three: Focus groups will be conducted with a sample of practitioners. The purpose is to determine the changes in services and professional practice required to implement a national approach including identification of facilitators and barriers. Participants will describe exemplary local service models.

Progress to dateThe data collection for the first phase of this study has been completed. In phase one, consultative forums were held with leaders in each of the four professionals groups who provide universal child and family health services.

• Practicenurses–twoteleconferencesconsultations.

• CFHN/MCFHN– consultative forumheldat twoconferencesand one forum with national leaders (planned for November 2011).

NEWS AND REVIEWS

• Midwives–consultativeforumheldatnationalconference.

• GPs – e-conversations (20 participants) and interviews (23participants).

• Consultativeforumshavealsobeenhealthwithalliedhealth,non-government organisations (NGOs) and consumer group representatives.

The second phase is progressing well. Surveys were developed for CFHNs and midwives. The CFHN survey has just closed with 931 completed surveys. Piloting of the consumer survey will commence in November 2011.

Plan for 2012• CommencedatacollectionforphasethreeinMarch2012.

• Completedataanalysisof surveysandqualitativedata fromphase one.

• Presentpreliminaryfindings.

referencesBritt H, Miller GC, Knox S et al. 2005, General practice activity in Australia 2004–05, Australian Institute of Health and Welfare, Canberra, AIHW Cat. No. GEP 18.

Leutz WN, 1999, ‘Five laws for integrating medical and social services: Lessons from the United States and the United Kingdom’, Milbank Quarterly, vol. 77, no. 1, pp. 77–110.

Nutbeam D, Harris E & Wise M, 2010, Theory in a Nutshell: A Practical Guide to Health Promotion Theories, 3rd edn, McGraw-Hill, Sydney

PartnersVictoria Department of Education and Early Childhood Development

Northern Territory Department of Health and Families

Western Department of Health

Queensland Department of Health

New South Wales Department of Community Services

Royal Australian College of General Practitioners

Australian College of Midwives

Australian Association of Maternal CHFN

Australian Practice Nurse Association

Australian General Practice Network

Project teamProfessor Virginia Schmied

Associate Professor Sue Kruske

Professor Caroline Homer

Professor Lesley Barclay

Professor Ian Wilson

Professor Cathrine Fowler

Dr Lynn Kemp

Associate Professor Michael Fasher


Book review

Baby-led Weaning: the Essential Guide to Introducing Solid FoodsRapley G & Murkett T 2008, Vermilion, USA.

RRP $29.95

Available at Fishpond at a discount price: http://www.fishpond.com.

au/Books/Baby-led-Weaning-Gill-Rapley-Tracey-Murkett/978009192

3808?cf=3&rid=833816557&i=2&keywords=baby-led+weaning

Reviewer: Fran Chavasse, Nurse Educator, Tresillian Family Care

Centres

Baby-Led Weaning: The Essential Guide to Introducing Solid Foods is

all about introducing solid foods to babies in a way that reduces

the pressure of mealtimes for both babies and their parents and

makes eating the enjoyable experience it’s meant to be. The

authors refer to this method as a gentle and commonsense way to

introduce baby to solid foods. Weaning in this book refers to the

introduction of solid foods, not breast to bottle.

The authors of this book are Gill Rapley, a health visitor and

midwife who lives in Kent, the United Kingdom. She developed the

theory of baby-led weaning while studying babies’ developmental

readiness for solids as part of her master degree. Tracey Murkett is

a freelance writer and journalist, who lives in London and tried the

baby-led weaning method and wanted to spread the word about

its effectiveness for stress-free mealtimes.

Baby-led weaning, as opposed to ‘parent-led’ weaning to solid

foods, is when we allow the baby to take the lead in eating solid

foods. One of the good things about this method is that it very

clearly stays with World Health Organization (WHO) guidelines for

infant feeding and recommends that babies not be given solid

feeds until six months and that milk remains the most important

food.

The authors provide a brief overview of the history of introducing

solid foods to babies and give reasons why it became ‘a science’

rather than an innate mothering art. The authors stress the

importance of following baby’s cues rather than the traditional

regimented approach to introducing solids. For me it’s a breath of

fresh air! I like how they discuss the mechanics of spoon-feeding

compared to self-feeding and give explanations that make sense

of why babies so often gag over solids and spit food.

The baby-led weaning approach fits very sensibly into the new

practices maternal, child and family health nurses are embracing

such as “working in partnership”, “relationship-focused” and

“strengths-based” approaches. In this case, rather than looking

to the parents’ strengths, we are focusing on the baby’s strengths

and allowing the baby to take the lead and show us what he or she

is or isn’t ready to do. The authors look at the feeding interaction

from the baby’s point of view and use empathy to discuss what

the baby might be experiencing when being introduced to food

in the traditional way.

The authors challenge conventional beliefs about the introduction

of solids and encourage us to reflect on the long-established

practices that we have been advising parents to follow for many

years and allow the baby to be a true partner in their exploration

of solid foods. They suggest to parents to examine how to let your

baby feed him/herself rather than what to offer to him/her, and

give the baby family food right from the start as long as the family’s

diet is healthy and nutritious. They also provide guidelines on how

to provide a healthy and balanced diet for the whole family so the

baby gets to enjoy healthy meals with the family.

One particular argument the authors make, which I think is

important to highlight is the dictionary meaning for spoon-

feeding, which is “... to provide (someone) with so much help or

information that they do not need to think for themselves” and “to

treat (another) in a way that discourages independent thought or

action”.

I think this definition really made me reflect on the way we do

‘spoon-feed’ infants and discourage them from taking the lead in

an intimate, enjoyable and important developmental process.

Finally, the authors highlight how science and technology have

taken over all the basic instinctual, relational aspects of infant

feeding and made it less enjoyable and more stressful for both

the parent and the baby. Baby-led weaning normalises feeding

and brings it back to being an important aspect of the developing

parent–infant relationship and supports the notion so that the

parent–infant dyad can determine what works best for them and

once again make eating and mealtimes enjoyable for the baby.


State and territory reports

Australian Capital territory

With the thrilling news that the ACT will be hosting the 2013 5th national AAMCFHN conference, CAFNAACT will be focusing its efforts on the planning of this exciting event. A conference committee has been formed and there are three ACT members and representatives from Queensland, Tasmania, New South Wales South Australia and Victoria.

Approaching our second year, two founding members on our committee are stepping down. Julie Yates has been a terrific Treasurer and an amazing source of contacts for speakers, logo and website design and photography. A big thank you Julie for all you have contributed to CAFNAACT. Janine Wolf is also stepping down – again we are losing a fabulous Secretary. Without Janine, we would not have progressed so far so quickly and have such an effective association. Enjoy a well deserved break.

Member nights

We have held two member nights. One was a relaxing evening when one of our members introduced us all to a relaxing yoga programme – particularly soothing after a work day – thank you to Viki Cowsill. Our second member evening was a presentation by Louise Murphy and Carolyn Tozzi on preparing and presenting at the Broadening Horizons conference. Thank you to Louise and Carolyn and I know you have encouraged others to take up the challenge in 18 months time.

CAFNAACt newsletter

A subcommittee has been formed to produce a newsletter three to four times per year. Louise Murphy and Lorraine Evans will be the editors.

Website

Our website construction is well under way and Rosie Riley is going to be our webmaster. We hope to launch the website before the end of the year. Our interim email is [email protected]

Future events

Our Christmas theme AGM is on 30 November and all members are welcome. We plan to have a fun, relaxed evening and refreshments will be provided.

Membership/recruitment

Membership is open to registered nurses with a child and family qualification. Child and family health nurses from the surrounding region are also most welcome to join. Contact us at [email protected] if you are interested in this exciting group.

Christine Burrows, President, Child and Family Nurses Association ACT

New South Wales

This has been another busy year with notable achievements as the Child and Family Health Nurses Association (Inc) NSW has continued to represent the interests of members and our speciality area of nursing.

CAFHNA finished off 2011 with the AGM, which was held at the conclusion of a workshop exploring innovative strategies for evaluating service provision. The CAFHNA Committee members elected at the 2011 AGM were as follows:

President: Julie Maddox

Vice-president: Jenni Jones

Secretary: Sue Witherspoon

Treasurer: Joan Stort

Ordinary Committee members: Carolyn Briggs, Virginia Hunter, Sue Mapletoft, Julie Roberts, Monica Hughes, Lorraine Palmer.

In addition to the General Committee, CAFHNA has a range of subcommittees that focus on various aspects of the work of the association. The CAFHNA subcommittees encompass:

• Education(coordinationofCAFHNAeducationevents).

• Editorial (editorial review and production of the CAFHNAjournal and e-newsletters).

• Events and marketing (including liaison with sponsorsfor events and to enable initiatives such as the CAFHNA Professional Development Grant).

• Standards and practice (development and review ofprofessional documents and resources to support evidence-based child and family health practice).

• Website committee (development,maintenance and reviewof the website including the new discussion forum).

Membership of these subcommittees is open to any CAFHNA member. This is a wonderful opportunity for you to contribute your ideas and any particular skills you have to your colleagues through CAFHNA while also adding to your portfolio of professional development evidence for registration. We look forward to more of our members contributing through the subcommittees in the future. Remember, even if you live some distance from Sydney or are busy with other obligations, you can participate in subcommittee business through teleconference and email as well.

CAFHNA has continued our involvement in advocacy and input into policy relevant to child and family health nursing. In 2011 we were involved in the development of responses to the Australian Productivity Commission Research Draft Report into Early Childhood Workforce. This draft paper did not reflect the complexity and comprehensive nature of the services provided by child and family health services but rather focused on specific tasks. This meant that the role of our services in promoting and addressing health and psychosocial issues impacting on the wellbeing of the

STATE AND TERRITORY REPORTS



child, parents and family as a whole and the importance of our services to the health and wellbeing of children, families and the community was not clear. It was important to provide messages to policy makers regarding the high level of expertise of clinicians in our services when promoting and addressing the health needs of children who are at risk for complex problems, particularly within vulnerable populations.

It was pleasing to be able to refer the writers of the Productivity Commission draft report to the recently released NSW Health Child and Family Health Nursing Professional Practice Framework 2011–2016’ This document was recently released by the NSW Nursing and Midwifery Office and has been the product of many years of work, with CAFHNA involved at all stages of development. The framework contains a description of the ‘Scope of Practice in Child and Family Health Nursing Practice’ and an outline of the ‘Core Knowledge and Skills’ required by nurses working in this speciality area. Congratulations to all those involved in the development of this important document. To access the framework, visit the Nursing and Midwifery Office website at http://www.health.nsw.gov.au/pubs/2011/cfhn_report_web.html

The CAFHNA General Committee would like to thank Ann Simpson for her contribution as she stepped down mid-year as Chair of the Education Subcommittee and ordinary committee member following her decision to take long service leave. We also welcomed Monica Hughes, who filled the casual vacancy left by Ann’s resignation.

We have continued our work on the CAFHNA website and I am pleased to announce that the CAFHNA Discussion Board (also known as Blog) is now operational. This new feature of the website will facilitate communication and enable members to share their thoughts, ideas and concerns about key issues for child and family health nurses. The aim is for the discussion forum to facilitate the sharing of resources and ideas for child and family health nurses across NSW while importantly providing a timely means of two-way communication between Association members and the committee members representing you.

Below is a screen shot of the CAFHNA Discussion Forum with one of the first discussion threads being an invitation for members to comment on the draft NHMRC Infant Feeding Guidelines.

At the 2011 AGM I stepped down from my role as President and as CAFHNA General Committee member. This decision is due to my relocation at the end of this year as I have accepted a new position working for a Victorian health service. It has been my great pleasure and honour to have worked alongside the highly experienced, skilled and talented group of child and family health nurses who make up the CAFHNA General Committee. You have inspired me with your passion and commitment. I wish the CAFHNA Committee and all CAFHNA members the very best as you continue to support families in the many and varied challenges they face during the critical early years of a child’s life.

Deborah Nemeth, Outgoing President, Child and Family Health Nurses Association (Inc) NSW

Northern territory

The Northern Territory (NT) branch has had little time to fully develop its potential as an organisation due to the small numbers this year, with membership remaining steady and everyone really busy, making it difficult to maintain the momentum needed to promote the association and its activities. Members have been studying National Standards for Child Health Nursing used around Australia with the view of adopting a Child Health Assessment Tool that will improve our own services.

Several members and CHNs attended the Inaugural Child Health Conference, Broadening Horizons, on the Gold Coast. It was a privilege to hear some great speakers and a fantastic opportunity to swap stories and network with colleagues from other states. It also provided an opportunity to catch up with ex-staff members now working in other parts of Australia and to hear that in the NT with our Family Partnership model and Case Management system, we are lucky to have the flexibility to provide both a Universal Model of Care as well as give more intensive support to vulnerable families from within the one working agreement.

As with the national trend, the NT continues to battle with shortages of qualified CHNs. However, the Charles Darwin University (CDU) has proved to be successful in ‘growing our own’ with several students finding placements in community health upon completion of their studies. Others have taken on student placements in community child and maternal health under the student mentorship programme. Jenny Donovan is to be applauded for her ongoing commitment to the students and for the inclusion of a clinical intensive as part of the course.

Recruitment activities across the NT includes Gail Clee being appointed to the new position of senior nurse advisor community health; also new leadership at the Palmerston Child and Family Health Team and Flynn Drive centre in Alice Springs plus Nhulunbuy.

The Trachoma Team has expanded to include two nurses conducting screening and treatment in Top End Aboriginal communities. Also the roll-out of the Ear Health Programme has been successful and a small team of nurses is providing screening and treatment for children at high risk of hearing impairment or loss on Aboriginal communities across the NT.


In Central Australia, the Central Australian Aboriginal Congress and Congress Alukura have been successful in running a variety of Culturally Focused Early Childhood programmes dedicated to supporting children in the early years of life. The Well Baby Programme is a clinical service offering support, education, developmental assessment, immunisation and referral. Eligible mothers can also be supported through the Australian Nurse Family Partnership Programme which provides an intensive structured home visiting programme, from 28 weeks’ gestation through to the second birthday of the baby. There is also a Multifunctional Child Care Programme which offers a great variety of activities for babies and children up to school age. CCHEP is a sexual health programme targeting young men and women aged 12 to 20 years.

The AGM saw election of some new committee members: Nichole Vincent as Secretary: Maureen Egan as Public Officer. Thanks to the nominees.

The committee is looking forward to some new initiatives in the new year with possible sponsorship of conference attendance. The sponsoring of related speakers to hold education sessions when in Darwin will also be investigated. Mechanisms are in place to have a website set up in the near future, with a link to a national body for people to access through their site.

The new email address for the Northern Territory Child and Family Health Nurse Association is [email protected]

Best wishes to all,

Chris McGill, President, Northern Territory Child & Family Health Nurses Association

Queensland

It has been a busy year for Queensland Child and Family Health Nurses. We hosted the 2011 Broadening Horizons conference at the Gold Coast in May which was a great success.

We continue to lobby for improvements to services for families across the state. QCAFHNA supported our members in the Queensland Health hotline, 13Health by sending letters of concern to management earlier this year when they attempted to get the child and family health nurses to undertake adult triage calls, a skill that many of our speciality nurses did not feel they had to adequately fulfil the role as well as diluting their ability to provide services to families where they needed it the most – in the expertise of parenting advice and support.

We have attempted to increase our membership across the state and this continues to be a challenge. Many CFHNs in Queensland are unaware of the relatively newly formed QCAFHNA (formed in September 2009) and there is a strong presence of an alternative association, the Australian College of Children and Young People’s

Nurses and many nurses do not know the key differences between these organisations.

We hold monthly teleconferences for all members and plan to provide social and professional development activities to our programme in 2012. Thanks to those small and committed members who continue to wave our banner high. I wish all CFHNs everywhere in Australia a most enjoyable Christmas for 2011 and may we all remind ourselves of the importance of family, both in our personal and professional lives.

Sue Kruske, Queensland Child and Family Health Nurses

South Australia

The South Australian Association of Child and Family Health Nurses has had a productive year. We have worked hard to develop our logo which was the first step on our marketing plan. The logo, designed to work alongside the national logo, was launched at our February members’ meeting and was appreciated by all. Our next step is to use our logo to develop a range of products for promoting our group and to establish a web page.

We have also engaged in an exciting collaboration with Flinders University. This was the development of a collaborative teaching tool. A member of SACAFHNA was nominated to be digitally recorded performing a four-week health check. Sections of this recording have been uploaded for teaching in the Flinders University Graduate Certificate in Nursing, Child and Family Health. Sections of the clip are soon to be uploaded onto YouTube. As the clips are double branded with Flinders University and SACAFHNA logos, we hope to raise awareness through this medium. We would like to thank Ruth Steer for her generous contribution as well as Mayumi Kako and her baby Jun for being so willing to participate.

We have held two well-attended members meetings. The first was held in February where Sara Richardson from the Gowrie Training Centre spoke about “Understanding toddler behaviour from an attachment perspective” and the second was a presentation on “The effects of drugs and alcohol on maternal and infant health” by Anne Frisk from Drug and Alcohol Services, South Australia. In August we held our first half-day seminar which included six presentations by child health nurses around exciting projects that they are involved in their everyday practice. This afternoon was such a success for networking and sharing professional strategies that we plan to build on this idea for coming years.

In December 2010 we made a submission to the Senate Inquiry into the Commonwealth Commissioner for Children and Young People and received a response on 15 June.

In May we put out a media release in response to the reduction of Parent Helpline services in South Australia. This issue was most concerning to members as overnight services were cut due to the availability of a generic federally funded a 24-hour ‘medical’



healthline. Unfortunately the cuts remain.

We had a productive AGM with a wonderful guest speaker Corinna Steeb who spoke on “The use of emotional intelligence in decision making”. We had a number of changes in leadership. I have resigned my position to take on the role of national President. I have really enjoyed working with such an enthusiastic and productive team in South Australia. Thanks to you all. South Australia is very lucky to welcome Alice Steeb to the position of President. Philippa Spooner will remain in the position of Secretary, Ruth Steer as Vice-president and Sharon Teleki as Treasurer. We have had some resignations from the committee. Our many thanks for all your hard work go to Anne Ford and to Lynda McDowall who leave us. We welcome Emily Dwyer-Fjeldstad, Alison Martin and Cathlyn McInnes, who bring a wealth of experience and knowledge to the committee. We are looking forward to continued growth and development in 2012 just like a well-nurtured newborn.

Julian Grant, Outgoing President, South Australian Child & Family Health Nurses Association

Victoria

The Victorian Association of Maternal and Child Health Nurses Committee members elected at the 2011 AGM are:

President: Joanne Fittock

Vice-president: Kim Howland

Secretary: Naomi Brown

Treasurer: Sue Berg

Membership Secretary: Karen Mainwaring

Website Administrator: Lisa Zubcic

General Committee members: Heather Convery, Lael Ridgway

AAMCFHN Board members: Wendy Jones & Joanne Fittock

As a result of the release of the Draft Report from the Productivity Commission on the Early Childhood Development Workforce an extraordinary meeting was held in August with the ANF (Victorian Branch) to discuss a Victorian response. Many passionate Victorian maternal and child health nurses attended the meeting and sent individual responses to the Productivity Commission in addition to the VAMCHN and ANF submissions.

Another lively meeting was held in October for VAMCHN members to discuss possible future changes to the AAMCFHN constitution. We thank all our members for their thoughts and contributions to the discussion.

Our membership numbers this year have improved as our committee has been actively promoting our Association through a number of activities. VAMCHN recently had a table at the state MCH conference to promote our Association and this is one of the activities that have contributed to generating interest in membership.

I am sure it is going to be an interesting and exciting year

ahead and we are looking forward to the challenges that it may

bring. We have commenced planning for our VAMCHN conference

in June 2012 and look forward to seeing many of our members

there.

On behalf of the VAMCHN Executive Committee, I would like to

wish everyone a safe and happy Christmas.

Joanne Fittock, President, Victorian Association of Maternal and Child Health Nurses

Western Australia

The Association held its second strategic planning day in

September, which provided members with an opportunity to

revisit our goals from 2009, ensure we achieved them and set

new ones for the coming years. A key goal over that period was

to increase our profile in Western Australia by increasing our

membership, improve marketing, involve more members in

working groups, for example, responding to several government

inquiries on behalf of the Association.

We have achieved many goals: the membership continues to

increase, our website has been updated and we are continually

adding new relevant material for all our members. A successful

strategy introduced in 2009 was to offer members the opportunity

to join for two years at a slightly reduced cost and we are

continuing this for the coming years. We have put in submissions

to a number of inquiries and lastly the Association has joined

Facebook! (Just type in CHNWA on Facebook to view our page and

comment!)

The political landscape in Western Australia continues to consider

the limited resources in the early childhood sector and the

Association has been asked to speak at the current Education and

Health Standing Committee’s Inquiry into early education and we

have also been approached by the local media to comment on

these issues. In response to these requests, the Executive of the

Association agreed that a media spokesperson was required and

this has now been actioned. To view our responses and comments,

visit our website news section at http://www.chnwa.org.au

Plans are well under way for the next conference, titled From little

things big things grow to be held in Mandurah, which is just outside

Perth city in August 2012. Abstracts are currently open. For more

information, visit our website.

And lastly, the Association’s dinner which is traditionally a fun

night is coming up at the University of Western Australia’s function

centre on 9 December

Margaret Abernethy, President, Community Health Nurses WA


The Australian Journal of Child and Family Health Nursing 21

Aim and scope

The Australian Journal of Child and Family Health Nursing aims to reflect the work and interests of Australian child and family health nurses. We will include articles, book reviews, comments, letters and other material relating to child and family health nursing clinical, management and education practice.

Writing guidelines – presentation of submissions

• Providepaperselectronicallyviathepublisher’swebsite:www.cambridgemedia.com.au

• Provide illustrations and/or photographs with each articlewhere possible. Attach signed permission of the subject to use, where appropriate.

• Papersshouldbenolongerthan3000words.Longerarticlesmay be accepted by negotiation.

• Articles are commissioned on a per issue basis and a totalword-count is provided in each brief. It is important that contributors adhere closely to this word-count.

• Includeanintroductionofnomorethan200words.

• Includeallcontactdetails:name,professionalposition,phonenumbers and email address.

Copyright

• PaperssubmittedtotheAustralian Journal of Child and Family Health Nursing for publication must not have been published or be under consideration elsewhere.

• Authors must obtain written permission to reproduceborrowed materials (for example, quotations in excess of 100 words, tables and illustrations) from the original copyright holder and should submit this permission with the paper.

• Authorsmustacknowledgeborrowedmaterialinthecaptionsas follows: ‘Reproduced by kind permission of (publishers) from (reference).’

• Thejournaldoesnottakeresponsibilityfortheviewsexpressedby authors in the paper. Authors retain responsibility for their views as expressed in their paper

references

The Australian Journal of Child and Family Health Nursing uses the author-date system as adapted from the Style manual for authors, editors and printers, 6th edn, John Wiley Australia, 2002. For further information, visit: www.publications.gov.au/styleManual.html or enquire at your library.

• Authors should use standard referencing conventions.References and quotes within the text should cite the author(s)’ name and date (for example, Briggs 2001) and if a direct quote, include the page number (for example, Briggs 2001, p. 2).

• Provideareferencelistinalphabeticalorderattheendofthepaper.

Australian Association of Maternal, Child and Family Health NursesInformation for journal contributors

Books

Cite the author(s)’ surname and initials, date of publication, title

of book (in italics), edition (edn) when this is not the first edition,

name of publisher and place of publication (city).

For example, Slee, P 2002, Child, adolescent and family development,

2nd edn, University Press, Cambridge.

Journals

Cite the author(s)’ surnames and initials, date of publication, title

of paper, full name of the journal (in italics), volume number, issue

number and the page(s) number(s).

For example, St James-Roberts, I, Sleep, J, Morris, S, Cowen, C &

Gilham, P 2001, ‘Use of a behavioural programme in the first 3

months to prevent infant crying and sleeping problems’, Journal of

Paediatrics and Child Health, vol. 37, no. 3, pp. 289–297.

Edited books

Cite the author(s)’ surname(s) and initial(s), date of publication,

title of chapter, surname(s) and initial(s) book editor(s) (ed.), title of

work (in italics), edition (edn) other than first, place of publication,

and name of publisher.

For example, Parker, J, Johnston, l & Faulkner, R 2000, ‘Evidence-

based nursing: Integrating research into practice’, in Greenwood, J.

(ed.), Nursing theory in Australia: Development and application, 2nd

edn, Sydney, Prentice Hall Health, pp. 396–412.

Government or organisational publications

Cite the name of agency or organisation, date of publication, title

of publication, publisher and place.

For example, Child and Family Health Nurses Association (NSW)

1999, Competency standards for child and family health nurses,

Child and Family Health Nurses Association (NSW), Petersham,

NSW.

Submitting your article

Go to the publisher‘s website: www.cambridgemedia.com.au

• ClickonManuscriptSystem.

• Login.

• Createanaccountiffirsttimeusingthesystem.Thiswillbe

retained for future enquiries and submissions.

• Enteryourpersonaldetails:allfieldsmustbecompleted.

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