Reciprocal influences in children's and families' adaptation to early childhood wheezing.

OBJECTIVE: The objective of the present study was to demonstrate the reciprocal relationships between family adaptation to illness and children's medication use over time among children who presented with wheezing illness in infancy but have varying illness outcomes by age 4. DESIGN: A longitudinal design and latent growth curve models (LGM) were used to predict change in family and caregiver adaptation to illness and children's medication use over three years among 140 infants with wheezing, among families from low socioeconomic, multi-ethnic backgrounds. MAIN OUTCOME MEASURES: One LGM predicted level and change (slope) of family adaptation to illness from children's baseline medication use. The second LGM predicted level and change (slope) of children's medication use from baseline family adjustment to illness. In both models, illness severity, caregivers' psychological resources, and emergency department use were covaried with the independent variable. RESULTS: Two latent growth models were found to adequately fit the data and demonstrate full reciprocal relations between family adaptation to illness and children's medication use while accounting for baseline variables. Baseline measures of caregiver psychological functioning and illness severity were also significant predictors of family adaptation and children's medication use over time. The two models were not statistically different for children with and without active asthma at 4 years of age. CONCLUSION: Findings support the reciprocal effects model of child and family influences on pediatric illness and underscore the importance of early indicators of individual and family functioning.