The Association between Overprotective Parenting, Parental Perceptions of Child Vulnerability and the growth and Development of Children with Congenital Heart Disease

Abstract

Background: Congenital Heart Disease (CHD) is the most prevalent childhood birth defect, leading to health concerns in growth and development post-surgery. Parents mostly shoulder the responsibility for post-hospitalization care. The chronic nature of caring for a child with CHD induces significant stress, fostering perceptions of the child as highly vulnerable and resulting in overprotective behaviors. These behaviors could restrict the child's developmental opportunities, affecting their overall growth and development. Purpose: The purpose was to investigate the association between parental perceptions of child vulnerability, overprotective parenting, and growth and development of children with CHD. Methods: The study employed a cross-sectional, comparative design. The total sample included 186 [93 CHD and 93 healthy controls] parents and their child aged 1-5 years. Data on parenting practices were gathered using the Child Vulnerability Scale and Parental Protection Scale. Child development was examined using the Ages and Stages Questionnaire-3. Growth and other clinical variables were gathered from the medical records. Data were analyzed using descriptive statistics, correlational and mediation analyses. Results: CHD parents exhibited higher overprotective parenting (p = 0.008) and perceived their child as more vulnerable (p < 0.001) than healthy controls. In CHD, parental perception of child vulnerability was associated with worse gross motor skills (p = 0.010) and problem-solving development (p = 0.011), while among the controls, overprotective parenting was negatively associated with height (p = 0.027) and weight (p = 0.003). The path analyses revealed direct effects but no mediating or moderating effects of perceived child vulnerability and overprotectiveness on growth and development of the child with CHD. Higher parental perceptions of child vulnerability were associated with lower height (b1= -0.253, 95% CI: -0.397 to -0.087) and weight (a2= -0.098, 95% CI: -0.195 to 0.003). The higher the parental stress, the greater the perceptions of child vulnerability were (d1= 0.108, 95% CI: 0.058 to 0.160) and the worse communication skills of the child (cʹ2= -0.250, 95% CI: -0.422 to 0.091). Higher education level of the parents was associated with less perceptions of child vulnerability (a3= -4.099, 95% CI: -6.426 to -1.854), better fine motor development (cʹ3=0.245, 95% CI: 0.090 to 0.418) and less overprotective parenting (d3=-4.583, 95% CI: -7.726 to -1.341). Higher perceptions of child vulnerability showed a trend with lower personal-social development (b1= -0.378, 95% CI: -0.803 to 0.046). Conclusion: Healthcare providers may need to consider the diverse parental and child factors identified to initiate interventions aimed at parenting practices, realistic perceptions of their child’s condition, and reducing parental stress to optimize growth and development in Lebanese children with CHD.