Needs Assessment Toddler Parenting Resource

Publication

Needs Assessment Toddler Parenting Resource

1. Introduction

In 2002 HEBS (now NHS Health Scotland), commissioned a piece of research to evaluate Ready Steady Baby and explore its relevance amongst its target audience (expectant parents, parents and health professionals). Findings indicated demand for a more detailed resource targeted at parents of toddlers, with content addressing the practical and psycho-social/emotional issues specific to toddler parenting.

Scott Porter Research and Marketing Ltd was commissioned in January 2003 by HEBS, to conduct a research study with the overall aim of identifying exactly what issues should be included as part of a new resource.

This document discusses the outcome of the research and provides recommendations as to the priority topics for inclusion in such a new resource.

1.1 Aims and objectives

Specific objectives were defined as being to:

• ascertain the broad views of health and other professionals about the relevant priority issues for a toddler parenting resource;

• identify the practical toddler parenting issues that need to be addressed;

• explore a range of psycho-social/emotional issues experienced by mothers and fathers of toddlers;

• establish professionals’ training needs relating to their ability to provide support to parents of toddlers.

1.2 Methodology and sample

A two-stage approach was adopted, employing both qualitative and quantitative methodologies. Four NHS Area Health Boards were sampled:

• Greater Glasgow selected for size, spread of socio-economic variables, and a range of initiatives including Starting Well;

• Lothian represented another large Area Health Board, but also covered some semi-rural areas;

• Dumfries & Galloway is a rural area, in which the Area Health Board has a dedicated Child Health Services Directorate;

• Highlands covers a large and dispersed area, some parts of which are very remote.

1.2.1 Qualitative element

Initially, individual and group interviews were conducted with key health professionals and parents of toddlers, with a view to gaining insight into the priority issues for inclusion in a toddler parenting resource. The findings from this stage of the research also provided direction for the development of the subsequent questionnaire.

A combination of individual depth interviews and mini focus groups were conducted with professionals across four Area Health Boards:

Table 2.1 Composition of Professional interview and group respondents

Mini Group	Profession	Location
1	Nursery Nurses and Nursery Managers	Glasgow
2	Voluntary and Community Professionals	Edinburgh
3	Health Visitors and GP’s	Dumfries

Depth	Profession	Location
1	Health Promotion Officer	Dumfries
2	Health Promotion Officer	Edinburgh
3	Health Promotion Officer	Inverness
4	Health Promotion Officer	Edinburgh

Depth interviews were also conducted amongst parents with a range of toddler parenting experience. Across the sample, a mix of age (20-50 years), social class (ABC1C2DE), single parents and those in couples, first time and more experienced parents were interviewed:

Table 2.2 Composition of Parent interview and group respondents

Depth	Location	Gender	Social Class	Age	Parental Type	Marital Status
1	Glasgow	Male	C2DE	36-50	Experienced	Couple
2	Glasgow	Male	ABC1	20-35	Experienced	Couple
3	Glasgow	Female	ABC1	36-50	Experienced	Couple
4	Edinburgh	Male	ABC1	20-35	First Time	Single Parent
5	Edinburgh	Male	C2DE	36-50	Experienced	Single Parent
6	Edinburgh	Female	ABC1	36-50	First Time	Couple
7	Edinburgh	Female	C2DE	20-35	First Time	Single Parent
8	Edinburgh	Female	C2DE	36-50	Experienced	Couple
9	Lothian (Rural)	Male	ABC1	36-50	Experienced	Couple
10	Lothian (Rural)	Male	C2DE	20-35	First Time	Single Parent
11	Lothian (Rural)	Female	ABC1	20-35	First Time	Single Parent
12	Dumfries & Galloway	Male	ABC1	36-50	Firest Time	Couple
13	Dumfries & Galloway	Female	C2DE	36-50	First Time	Single Parent
14	Dumfries & Galloway	Female	C2DE	20-35	Experienced	Couple
15	Highlands	Female	C2DE	20-35	Experienced	Couple
16	Highlands	Male	C2DE	20-25	Experienced	Couple

1.2.2 Quantitative element

This stage of the project enabled assessment of the views of professionals with regards priority parenting issues. In order to ensure that the opinions of all relevant professionals involved in this area of work were sought, an initial phase of desk research was undertaken to build the database of relevant health and other professionals from public, private and voluntary sector organisations.

A self-completion questionnaire was mailed to all relevant professionals in the four selected Area Health Boards:

• GPs;

• Community Paediatricians;

• Health Visitors;

• Health Promotion Officers;

• Sure Start staff;

• Nursery Nurses (private and public sectors);

• Staff from other Voluntary/Community organisations.

A copy of the questionnaire is provided in Appendix 1

A total of 3371 questionnaires were mailed out, with 1001 returned – a response rate of 30%. This response, broken down into the four Area Health Boards, was as follows:

Table 2.3 Total Number of Survey Respondents by Health Board Area

Table 2.3

The profile of those professionals who returned completed questionnaires is shown in the following tables.

Figure 2.1 Profile of Sample By Location

Figure 2.1: Profile of professionals

Figure 2.2 Profile of Sample By Professional Group

Figure 2.2

The higher response rate for Lothian and Greater Glasgow can be attributed to a greater number of potential respondents in these Area Health Boards. Similarly, the relatively large number of returns from health visitors and nursery nurses reflected the greater proportion of these professionals with experience of working with toddlers.

Table 2.4 Profile of Professional Group By Health Board Area

Table 2.4

1. The figures in the column below this symbol indicate the percentage of the total sample in each professional group, e.g. 14% of the total sample were GPs

2. The figures to the right of these symbols indicate the percentage of each professional group based in each of the AHBs, eg. 44% of community paediatricians were from Greater Glasgow

Figure 2.3 Professionals’ Length Of Time Working With Parents of Toddlers

Figure 2.3

Almost half of our sample had over 10 years experience working with parents of toddlers, with a further 25% with 5-10 years experience. This applied across most of the professions sampled, with the exception of those replying from the voluntary sector, who tended in the main to have under 10 years experience in this area. Nonetheless, the sample as a whole had considerable experience of working with toddlers, indicating that the opinions expressed in this survey are knowledgeable and expert.

Table 2.5 Professionals’ Length Of Time Working With (Parents Of) Toddlers

Table 2.5

1 The Figures in the column below this symbol indicate the percentage of the total sample falling into each experience bracket (ie: number of years experience) shown. e.g. 27% of the total sample had < 5 years experience.

2 The figures to the right of these symbols indicate the percentage of each experience bracket by professional group, e.g. 2% of those with >10 years experience were Sure Start workers.

2. Main findings

Given the different focus of the qualitative and quantitative research, this section will firstly consider the issues explored in the interview discussions. It is intended that this will set the scene, particularly with regard to the nature of parental concerns and will provide a context within which to examine the priority topics which emerged from the survey data.

2.1 Parents

Respondents were interviewed on a one to one basis and encouraged in the first instance to speak about the toddler parenting issues, which were uppermost in their minds. They were subsequently prompted to discuss these specific topics more fully with a view to establishing the extent to which these were perceived as important issues for them. This gradual approach enabled the moderator to build rapport and trust with the respondent, thereby facilitating discussion of some of the more sensitive issues.

2.1.1 Broad issues

In overall terms, the needs and issues raised by parents fell into two broad areas: emotional and practical. The overwhelming requirement at both levels related to straightforward, manageable strategies, which could be implemented in individual situations. This section highlights the key issues that were raised – these will be developed and discussed in more detail in the subsequent sections of the report.

Spontaneous comments about parenting issues invariably focused on practical matters. These revolved primarily around managing toddler behaviour, which was viewed as either unacceptable or disruptive, and therefore as creating discomfort for adults, other children and/or the toddler himself:

“… if I don’t give him a piece of chocolate or whatever, he’ll throw a tantrum and sometimes he goes as far as to hit me.”

Equally important however, was the strongly felt need for tactics to help parents cope on a day-to-day level. This referred to dealing both with the needs of the toddler, and with their own reactions and other regular commitments. Most parents acknowledged that part of this learning process involved being able to recognise the issues as they arose, to enable them to adopt the most effective strategy for addressing them. The other expressed practical need referred to the recognition and management of childhood illness.

Parents found it more difficult to talk openly about the emotional issues that emerged. This stemmed both from sensitivity about exposing what some parents perceived as weakness or failure and from a feeling of guilt about some of the emotions that they had experienced in the course of raising their toddler.

It was evident that many of the issues raised stemmed from a lack of understanding of toddler behaviour per se and as a consequence, an inability to manage both their own and others’ expectations in this regard. Many expressed a need for strategies to help build confidence in their own parenting skills, and thus to enable them to support their toddler’s developing sense of confidence.

Additionally, parents wanted to feel in control (both of their situation with their toddler and themselves), which would enable them to relax and enjoy the experience of toddler parenting. Ultimately, parents expressed the desire to develop their emotional intelligence in this area.

First time parents

Not surprisingly, many of these issues loomed larger for first time parents and those without a close support network. With little experience and knowledge, first time parents had no frame of reference, and felt unable to gauge what constituted ‘normal’ or expected toddler behaviour. Nonetheless, these parents had high expectations of themselves about managing such toddler parenting issues. The general belief that ‘all children are different’ at this stage as they were developing their own personalities, led many to assume that they had to work out independent strategies for their toddler’s particular issues. As a result, first time parents were less likely to seek professional advice unless they perceived a ‘real’ problem to be emerging. This was particularly true amongst the ABC1 parents, who were anxious not to convey a sense of being unable to cope:

“We have asked our health visitor for advice and whatever, but only when there was something really wrong.”

The consequence for many was a strong sense of living from one moment to the next, relying on impulse and intuition, with little control over events.

Whilst the issues raised spontaneously by parents, invariably related to practical parenting concerns, they stemmed from two key areas: lack of understanding of toddler behaviour and lack of confidence:

“… sometimes you need tips, because I often think ‘oh, I’m a rubbish parent and I’m clueless’.”

Gaps in understanding of toddler behaviour revolved around the various stages in development (both physical and emotional). Parents wished to know about the causes of certain behaviours, (and whether anything could be done to avoid their occurrence), and the ways in which toddlers interacted with parents and other adults and children.

Lack of parental confidence in many cases stemmed from lack of knowledge, giving rise to a constant self-questioning: ‘Am I doing this right?’ In an attempt to establish a sense of ‘the norm’, parents often resorted to comparing their toddler with other toddlers.

Many had experienced conflicting advice – both from family and friends, and from more ‘formal’ written sources. Whilst some reacted against advice to ‘stay calm and positive’, perceived as being unrealistic, for many this simply served to further undermine their confidence by reinforcing the fact that they had been unable to do so. This was sometimes further compounded by a lack of ease/sense of guilt about the emotions they were personally experiencing (frustration, anger, irritation), and their inability to reconcile their own needs with those of their toddler:

“To reassure you that everything your toddler is going through is normal. I just like to have someone to bounce things off.”

“Some books tell you to ‘count to ten before you do anything’. But sometimes, you can be counting to ten and you’ve got this toddler pulling on your legs and screaming in the supermarket, and I’m just about to burst!”

At the early toddler stages, many first-time parents experienced a void in terms of parenting advice and a concomitant mix of emotions. The extent to which parents felt supported through parenting advice and information for babies 0-1 years served to highlight the lack of advice and information at the toddler stage. In the first year of their child’s life, these parents felt that they had been offered a lot of advice and support by professionals, particularly because of regular contact with their health visitor. This was often seen as a form of both emotional and practical support for parents, especially mothers. There seemed to be an endless flow of literature made available to parents about a wide range of issues pertaining to this early stage. Additionally, parents found that they were proactively sourcing additional information both prior to the birth and in the early months.

As the child entered the toddler stage, many parents found themselves “thrown in at the deep end” as their contact with health professionals became much more limited (and in some cases, ceased altogether). Whilst some found themselves provided with or able to access problem-specific literature, there appeared to be little time (or indeed, appetite) to proactively seek their own more general parenting guides. ABC1 parents were more likely to search out this type of resource, with Christopher Green’s ‘Toddler Taming’ emerging as a favourite:

“I used Dr Green’s Toddler Taming. He has another one out for 5-11 years, I’m going to invest in that.”

Overall then, first time parents were seeking a framework for understanding and coping with toddler parenting issues, from the point of view of both practical advice and emotional support. However, the tone adopted by any resource aiming to address these needs is crucial, and should be empathetic, reassuring and above all, grounded in reality.

Experienced parents

Experienced parents were generally more relaxed and accepting of the ups and downs of raising a toddler. However, some found the issues re-emerging as a result of the impact of different personalities and behaviours exhibited by siblings. Many experienced the additional pressure imposed by having to manage the different needs of siblings. This engendered feelings of guilt as they tried to balance each individual child’s needs but found themselves favouring the ‘easier’ child or baby in family. These emotions and any sense of resentment were further heightened by increased time pressures, (especially for working parents), and associated stresses:

“I’m looking forward to a time when I can take them both out without having to worry about the wee one… it’s awful isn’t it; I feel like I’m wishing her life away.”

These parents were less likely to seek professional advice for behaviour related issues, preferring to rely on either their own or other people’s experience. There was a strong sense amongst this group that they could rely on their own instinctive handling of situations when dealing with the more routine aspects of parenting. However, they also recognised the importance of building and using their personal support network as a means of providing advice, reassurance and increased confidence.

Interestingly, some parents were comfortable with consulting nursery staff about such concerns and whom they considered as part of their support network. This stemmed from the fact that nursery staff were considered “distant” from parents’ dealings with ‘health professionals’ – and were therefore viewed as being more approachable and perhaps less judgmental about their parenting skills. Additionally, parents felt that the nursery staff knew their toddler as an individual and were also more familiar in dealing with similar situations in a practical sense and on a daily basis. Parents believed that a more empathetic rapport could be established with the nursery staff when discussing ‘problems’ with behaviour etc., particularly given the less formal context and impromptu nature of such discussion:

“Kay (the nursery nurse) know Jack’s traits. She’ll come to me at the end of the day and tell me what he’s done and how it was dealt with in the nursery. I really value that.”

Parents tended to consult Health Visitors and GP’s only to be about health topics, unless other concerns were perceived as having become a “serious” problem.

Experienced parents consistently preferred to discuss problems in a more informal/conversational manner, as opposed to seeking advice through written references on general parenting issues.

2.1.2 Practical parenting issues

The following sections detail the key toddler parenting topics that were raised in the course of the discussions with parents.

Behaviour Management

The area of behaviour management was uppermost in most parents’ minds, but tended to be viewed in terms of dealing with specific issues rather than in the broader context of discipline. However, the key thread that ran through most of the practical issues raised was that of how to handle an undesirable situation, and instances of anti-sociable behaviour.

Parents wished for advice on coping with an existing situation, whilst at the same time establishing boundaries. They were keen to learn about acceptable and effective strategies with examples based on ‘real’ scenarios being favoured as more likely to be appealing and trusted. It was felt that this would provide the reassurance of a method which had been ‘tried and tested’ and therefore more likely to be effective.

Some parents requested a discussion of the benefits and drawbacks of alternative approaches to managing behaviour for example, a strict versus a more democratic approach, positive versus negative reinforcement. Parents placed importance on achieving consistency in approach, particularly between both parents and between home and day care, and sought strategies as to how to achieve this.

Practical coping strategies were requested in the form of guidance, tips and reassurance. Key topics raised within the area of behaviour management were:

• tantrums

• biting, hitting, shouting

• whingeing, complaining

• ignoring parents’ requests/instructions

• learning to share

• altering habits learned as baby e.g. use of dummy

• establishing and maintaining routines

However, these topics raised emotional issues for parents about their own behaviour and feelings towards the toddler and the stresses he/she may cause.

Feeding

The elements within this topic that were prioritised varied from parent to parent and depended on the issues that they had experienced. Key concerns related to nutrition: what and how much is a ‘good’ meal, what constituted a healthy, balanced diet, and advice on which foods (if any) were not recommended. This was often linked to requests of suggestions for quick, appealing meal ideas, how to deal with fussy eaters and encourage healthy eating. Other topics raised were:

• dealing with external influences (Grandma/Auntie providing sweets etc)

• oral health (when to start dental visits, how to limit sugar intake etc)

• food safety (e.g. potential sources of danger, choking, allergies).

Sleep

Sleep was often a cause of concern and frustration for many parents. The issues raised related primarily to refusal to go to bed/sleep, inability to go down unaccompanied, and waking up in the night. Other topics were;

• not staying in bed/bedroom

• coming into the parents’ bed

• fear of the dark

• night terrors/bad dreams/the need for night lights

• moving from cot to bed

• establishing different sleep times/patterns for older siblings.

Toilet Training

Whilst acknowledging that toilet training will become established, this topic still created anxiety among many parents, particularly with respect to when and how to start toilet training, what to expect and when to become concerned. Specific topics included;

• training bladder vs. bowels (techniques to use and encourage)

• potty vs. toilet

• pants vs. nappies

• problems: refusal, lack of interest (whether to leave or address the problem and if so, how?)

• night time/bed wetting

• outside the home.

Physical Development and Health

This covered both general development and specific areas of concern. More guidance was sought on developmental milestones. However, it was considered vital that discussion in this area be non-prescriptive and couched in broad terms, since comparisons made about the ‘achievements’ of individual toddlers could potentially become a source of anxiety.

Physical activity is an area which is heavily focussed upon throughout health promotion. As such, parents were aware of physical activity as an integral part of child development. However, they sought advice about the type of activity to pursue with their child and clarity about how much was considered appropriate and the advantages to be gained.

2.2 Professionals

This section reports the views expressed by the professionals in our sample. Whilst the focus is on the findings of the survey, the insights gained from the interviews with professionals are also incorporated in order to provide both the context for the statistics and greater depth to understanding the issues raised. Details of the interview and survey respondents are provided earlier in section 2 of this report.

In presenting the survey data, the analysis is based in the first instance on the total sample answering the specific question. The description of the composition of this sample base (both in terms of number of respondents and who were), is indicated as the ‘base’ in the bottom left of each figure. Where there are significant differences between the professional groups, these are highlighted in the narrative accompanying the figure. However, given the small number of respondents from some professional groups who participated in the survey, these statistically significant differences can only be shown for GPs, health visitors, nursery nurses, and in some cases for those from voluntary organisations. Our analysis of statistical significance is at the 95% confidence level. Where other comparisons are made, but for which statistical significance could not be established because of small base sizes, these are indicated by an asterisk (*).

2.2.1 Perceptions of needs and focus

The professionals consulted widely reported that a gap existed in the absence of a parenting resource for parents of toddlers. Despite the availability of various topic-specific leaflets and the fact that certain Area Health Boards (eg Fife and Highland) had developed their own resources focussed on play development, social interaction and behaviour etc., professionals believed there was a real requirement for a broader and more balanced resource. Health professionals expressed the clear opinion that parents’ preferred approach to parenting issues/problems was on a more personal level. Thus these professionals viewed a written resource as a starting point or focus for discussing issues with parents. Additionally, there was recognition of the value of providing parents with ‘anonymous’ access to information, advice and sources of support. Nonetheless, professionals acknowledged that that some parents - typically ABC1C2s (professional and other middle classes) - were more receptive to written literature than others.

The general consensus was that the focus should be on the development of support for parenting skills by providing practical advice that was easy to incorporate into different lifestyles.

Primary concerns expressed by professionals were related to positively facilitating the development of the child. There was strong acknowledgement that this could best be achieved within the framework of providing support and reassurance to parents, focusing on encouraging positive interaction and addressing the emotional needs of both parents and their toddler. Therefore, whilst the overt focus of a resource on toddler parenting should be on the toddler, it was felt that the underlying emphasis should be on building parental confidence and skills.

Some professionals also felt strongly that a resource of this nature might well open up new avenues for support and advice (e.g. through nurseries, playgroups). This stemmed from their observation that many parents viewed professionals in these organisations as being less ‘official’/formal, and more in touch with individual toddlers than health professionals.

The survey opened by asking professionals to assess the value that would be bought to a potential new resource on toddler parenting by a number of broad topic areas. Across the sample as a whole, the four areas that were rated as most valuable were ‘positive parenting’ (83% of the total sample rating this as being very valuable), ‘behaviour management’ (82%), ‘emotional development’ (81%) and ‘physical/social development’ (78%). This reinforced the views expressed in the qualitative stage.

Figure 3.1 Professionals’ Perceived Value of Topics For Inclusion

Figure 3.1

Overall, greater proportions of health visitors and nursery nurses were likely to rate topics as ‘very valuable’, compared with GPs. In the case of ‘positive parenting’ for example, 90% of health visitors rated the topic in this way, compared with 84% of nursery nurses and 75% of GPs. ‘Behaviour management’ showed a similar pattern of response.

Respondents were subsequently asked to rank which of these broad topics they perceived to be the 5 most important ones for inclusion in a potential new resource. Overall, the same four topics (‘emotional development’, ‘positive parenting’, ‘physical/social development’ and ‘behaviour management’) were most likely to be prioritised within professionals’ top three choices. However, there were significant differences with respect to the proportion of respondents who selected each topic area. This was partly a reflection of the emphasis placed on the topic by each of the professional groups, coupled with the degree to which they had contact with parents.

The figures below show the proportion of the sample who ranked each topic amongst their top 3 for inclusion in a new resource. A larger proportion of nursery nurses/managers (78%) and voluntary organisation staff (82%) rated ‘emotional development’ in their top 3, with a significantly lower proportion of GPs (47%) attributing high value to this area. Likewise, health visitors (70%), health promotion officers (78%*) and Sure Start staff (73%*) were more likely to prioritise ‘positive parenting’ as a topic, while a higher percentage of the GP sample selected ‘behaviour management’.

Figure 3.2 Professionals’ Priority Topics For Inclusion

Figure 3.2

Professionals’ Priority Topics For Inclusion (cont)

Figure 3.2 contd

The figures above illustrate that although the most commonly raised issues by parents were of a practical nature, overall the professionals’ responses indicated that they prioritised the more emotional areas of parenting and child development. As a result the priorities highlighted by professionals were emotional development (67%) and positive parenting (57%) rather than the purely practical issues of feeding (13%) and toilet training (3%).

As such the prioritisation of ‘emotional development’ and ‘positive parenting’ as topics for inclusion reflected professionals’ belief that these areas played a key role in developing parents’ understanding of the issues that were relevant to toddler raising, and consequently the quality of their interaction with their child. Whilst these might be more difficult topic areas (from a parental perspective), professionals felt that they impacted on all aspects of toddler development. This view clearly reflects the concerns raised by the parents interviewed.

Linked with this, was the importance attributed by professionals to ‘social development’ (including communication), and the perceived potential of active play in helping to develop skills in this area. Some felt that the importance of play was underestimated by many parents; possibly due to a gap in parents’ own experience and knowledge.

Professionals believed that ‘behaviour management’ topped the list of most parents’ concerns, and felt that skills in this area would help to ease parental stress. However, they were anxious that guidance should be considered in the context of the entire relationship/interaction, and should draw on clear principles (e.g. ‘positive parenting’).

The figure above indicating ‘priority topics for inclusion’ shows that ‘coping with parenthood’ was considered as a priority area by a significantly smaller proportion of the sample. The reason for this low prioritisation was indicated by the respondents interviewed in the qualitative part the study. These respondents conveyed a strong sense that since coping with parenthood was such an important area in its own right, that it would be difficult to do justice to it in this context. Given the necessarily broad coverage envisaged for the proposed new resource, there were fears that the topic coverage may be superficial. Furthermore, it was felt that some of the aspects of parental coping would be covered under other areas (e.g. ‘behaviour management). Overall however, there was a strong sense that this was an important issue in its own right and that parents were in need of additional focused communication and advice.

2.2.2 Issues that should be addressed

The main part of the survey was designed to provide professionals with the opportunity to share their experience in relation to the detail concerning the topics that they felt should be prioritised in a new toddler parenting resource.

All professionals who selected a particular topic in their top 5 priority areas were asked to list all the practical parenting issues, which they felt should be covered. This produced a wealth of data, and the figures and tables in this section provide listings of all the issues raised. In each case, the figure illustrates those issues cited most often, whilst the list below shows points highlighted by much smaller numbers of individuals (in many cases these were refinements or nuances of the broader issues reflected in the figure). However, this additional level of detail supplied by professionals is valuable as it provides greater clarity about the focus of priority topics. These supplementary comments have been grouped during the data analysis stage to reflect the key themes that emerged, and to provide an indication of the extent to which the issues raised under a specific topic were closely linked to other related themes. For example, issues relating to ‘relationships’ emerged under a range of topic areas: ‘emotional development’, ‘positive parenting’, ‘behaviour management’ and ‘coping with parenting’.

Therefore the survey data very much complements the qualitative findings: the issues emerging from interviews with parents are clearly reflected, albeit with a greater level of detail, in the priority topics raised by professionals.

The following sections examine the responses under each priority topic area, highlighting the key issues that were raised across the professional sample as a whole, and where relevant, indicating any significant differences in priority between the professional groups. As stated before, it has only been possible to analyse these differences in instances where the base sizes for each of the professional groups has been large enough to allow such conclusions to be drawn. Thus in each of the following sections, significant differences can only be indicated for GPs, Health Visitors, nursery nurses, and in some cases, workers in voluntary organisations.

2.2.3 Emotional Development

This topic was raised as a priority area by 804 of the 1001 respondents in the sample (80%). The key issues raised in this context were communication and interaction, confidence building, and relationships with adults and other children, with over 90% of the sample indicating each of these as key parenting issues that needed to be addressed under this topic heading. This was consistent across all professional groups. The other key issues highlighted under this topic related to developing the toddlers’ independence (mentioned by 79% of the total sample) and addressing toddlers’ fears (mentioned by 63%). The issue of encouraging independence was most strongly highlighted by nursery nurses (85%) and those in voluntary organisations (87%).

Figure 3.3 Issues that should be addressed - Emotional Development

Figure 3.3

The other issues raised under this topic are listed below. Each was mentioned by a very small proportion of the sample (1% or less), but together they serve to indicate the perceived importance of the two sub areas under which they have been categorised: social/relationships and emotional/feelings.

Social/Relationships

Emotional/Feelings

• Play/attachment

• Separation/attachment

• Socialisation

• Developing imagination

• Sharing

• Become aware of differences:

- cultural/gender/physical

• Positive relationships

• Understanding of age

• How to encourage/improve parent/child bonding

• Tying in with parents own experience of parenting

• Security

• Love

• Self-esteem

• Frustration

• Response to discipline

• Emotional needs

• Nurturing

• Feeling valued

• Coping with loss/change/stress

• Identifying emotions – exploring and expressing

• Coping with emotions

2.2.4 Positive parenting (parent/child interaction)

Key issues raised under this priority area related to providing encouragement/support to toddlers (mentioned by 96% of total sample), active play (mentioned by 93%), special needs (mentioned by 73%) and dealing with gender issues (mentioned by 61%). This was consistent across the professional groups, with the exception of dealing with gender issues, which received a greater response from nursery nurses (69%) and health visitors (60%) compared to GPs (47%).

Figure 3.4 Issues that should be addressed – Positive Parenting

Figure 3.4

The other issues raised (each by 1% or less of the total sample) in the context of this topic can be categorised as follows:

Behaviour Management

Parental Confidence and Support

• Discipline

• Setting boundaries

• Consistency in approach

• Ineffective punishment

• Escalation traps

• Accidental rewards for misbehaviour

• Not using physical punishment

• Effects of negative attitude

• Sense of right and wrong

• Supervision and letting go

• Understanding child development

• Confidence-building for parents/self-esteem

• Parenting courses – how to cope

• Importance of help and support to parents

• Time-management – quality time

• Coping strategies

• Chill time – time out

• Parents looking after themselves

• Praise for parent

• Where to go for help

Providing Positive Learning Environment

Relationships

• Reading stories/rhymes to build language skills

• Praise

• Security

• Promote ‘play at home’

• Language development

• Suitability of toys and books

• Story-time

• Realistic expectations

• Enjoyment of child

• Bonding

• Communication

• Role models

• Family relationships

• Positive attachment with significant adults

• Both parents input

• Praise for child’s personality and self-esteem

• Sibling issues

• Sharing

• Way a parent

• Relationship difficulties

• Feelings

• Different cultures

2.2.5 Physical/social development of child

Around 90% of the sample highlighted three key areas for inclusion: socialisation, language development and active play. There were no significant differences between the key professional groups.

Figure 3.5 Issues that should be addressed – Physical/Social Development

Figure 3.5

Other issues related primarily to the development of motor and social skills. Each was mentioned by 1% or less of the sample.

Social Interaction	Motor Skills/Hand-Eye Co-ordination
• Sharing • Co-operating with others • Interactive play • Turn-taking • Parent/child playtime • Interaction with other adults • Interaction with peers • Boundary setting • Management of different behaviour • Hurting others/aggression • Eating as a family	• Gross-motor skills • Fine-motor skills • Co-ordination • Balance – co-ordination • Confidence building in physical development • Develop and encourage child’s ability
Physical Development	Personal Expression Development
• Milestones of development • Expectations of development/stages • Average growth/physical growth • Becoming aware of personal health and hygiene • Value of regular exercise/minimum recommended levels	• Imaginative play (drawing/intelligence) • Expressive movement to music • Quiet play • Self-help skills • New challenges – music, swim • Communication • Speech development • Concentration skills

2.2.6 Behaviour management

The top three areas indicated (mentioned by approximately 90% of the total sample) related to dealing with ‘unacceptable’ behaviour and the whole issue of discipline. This was consistent across the professional groups. The issue of tantrums came a close third among the sample as a whole, with 88% raising it as a key area that needed to be addressed in a new resource. The topic of tantrums was mentioned most frequently by health visitors (94%) and GPs (89%), compared to 85% of nursery nurses.

The need to cover issues related to crying was prioritised by 83% of GPs and 78% of health visitors but only 61% of nursery nurses. While the greater proportion of nursery nurses (87%) emphasised the importance of “sharing”, only 59% of this professional group prioritised dealing with bad habits compared to 68% of GPs and 77% health visitors.

Figure 3.6 Issues that should be addressed – Behaviour Management

Figure 3.6

The following noted issues indicate the importance attributed by professionals to the issues of parental knowledge and confidence when dealing with behavioural matters.

Parents Understanding & Attitude	Interaction & Relationships
• Understanding underlying basics • Parents positive role modelling • Positive parenting • Promotion of positive handling • Encouragement of good behaviour • Ignore negative behaviour • Positive behaviour management • Parental consistency/messages to child • Accepting ways of dealing with behaviour • Coping strategies for mums • Response to attention seeking behaviour • Respect for child/allowing assertiveness • Parental attitude and effect on child • Loss of parenting confidence • Setting and enforcing consistent boundaries • Positive/negative reinforcement • Use of reward systems • Consistency with discipline	• Playing with child to improve relationship • Learning to compromise (child & parent) • Listening to child • Tips to build trust • Siblings • Thinking of others • Sulking • Shyness • Poor concentration • Separation • Attachment and bonding
	Routines/Problems
	• Bedtime • Mealtime • Refusal to toilet out with home • Soiling and bed-wetting • Staying in bed
	Expectations
	• Understanding of normal age-specific behaviour • Stages of development

2.2.7 Coping with parenthood

The key priority topics in this area concerned the addressing of emotional issues: ie. parental understanding and coping with their own emotions (mentioned by 94% of those highlighting this as a priority area), practical and emotional support needs (mentioned by 91%), relationships (mentioned by 88%), depression (mentioned by 87%) and making time for self and chores (mentioned by 86%). Whilst there were no significant differences between the professional groups in relation to the first two topics, GPs were more likely to mention relationships (95%) compared to health visitors (92%) or nursery nurses (82%). While similar proportions of GPs and health visitors mentioned depression, (92%), this was prioritised to a lesser extent by nursery nurses, (82%). This clearly reflects their experience with parents as a result of their different professional roles.

Figure 3.7 Issues that should be addressed – Coping with Parenthood

Figure 3.7

As with the other priority topics, a range of other issues were raised by individuals, which can be grouped as follows.

Pressures/Planning & Strategies	Support Networks
• Time management • Self-esteem/confidence building • Returning to work/juggling • Finances/budgeting • Dealing with stress • Exhaustion • Relaxation techniques/anger management • Media coverage of parenthood • Physical fitness • Single parent • Impact on emotional health • Isolation	• Sources of help/support • Assertiveness training • Teenage parents • Parents with learning difficulties • Adults education
	Ability to Adapt to Changes
	• Awareness of responsibility • Changing family/changing needs • Transition for adults • Lifestyle changes
	Dysfunctional Situations
	• Domestic abuse • Violence against toddler • Alcohol/drug misuse
Relationships
• Including father/partner • Coping with grandparents • New partners • Meeting/sharing with other parents

2.2.8 Physical health

The key issues here related to immunisation (mentioned by 88%), childhood illness (mentioned by 85%) and basic child health (mentioned by 81%). Whilst there were no significant differences between the professional groups in response to immunisation, health visitors were more likely to prioritise childhood illnesses (95%) compared to nursery nurses (86%) and GPs (85%). A greater proportion of GPs mentioned basic health (92%) compared to health visitors (89%) and nursery nurses (78%). This would appear to reflect their view on what could best be dealt with at home without necessarily having to seek professional advice. A significantly higher proportion of nursery nurses mentioned the need to cover issues relating to special needs (85%), compared to health visitors (66%) and GPs (62%).

Figure 3.8 Issues that should be addressed – Physical Health

Figure 3.8

Base: those highlighting as a priority area – Physical Health (n=387)

The following health related issues were also raised.

Knowledge/Awareness of General Illness	Well-being and Nutrition
• Emergencies/recognition of serious illness • When to seek medical advice • Minor illness or infections • Parental management of minor illness • Antibiotics and overuse of • How to cope with ill child • Continuous illness – monitoring • Speech development	• Healthy eating/diet • Rest/sleep • How much milk/food/sleep information • Fresh air • Water • Impact of smoking • Exercise
	Hygiene
	• Hygiene/cleanliness • Oral health • Dental checks • Tooth brushing • Dummy care

2.2.9 Safety

The main issues raised here were accident prevention, personal safety and first aid. No significant differences were evident between the professional groups.

Figure 3.9 Issues that should be addressed – Safety

Figure 3.9

The following specific issues were mentioned in this context.

Generic Issues	Adult Influence/Impact
• Car travel • Road safety • Water safety • Hazards in garden • Hazards at home • Safety equipment to buy • Child proof home • Use of baby walkers • Medical storage • Contact information regarding safety • Play areas	• Protection from adult emotional and physical abuse • Adult awareness of dangers • Setting appropriate boundaries • Parents involvement in safety training • Stranger danger
	Illness/First Aid
	• Illness management • CPR • Choking

2.2.10 Feeding

Two key issues emerged: nutrition (mentioned by 93%) and feeding problems such as fussiness (mentioned by 91%). No significant differences were observed between the professional groups (although this may in part be due to the small base sizes), however, nursery nurses (82%) and health visitors (79%) were most likely to mention the need to include meal suggestions in a resource of this kind.

Figure 3.10 Issues that should be addressed – Feeding

Figure 3.10

Base: those highlighting as a priority area – Feeding (n=283)

The following specific issues were also raised under this topic.

Establishing Routine

Mealtimes

• Weaning advice

• What and how much

• Moving onto different textured feeds

• Changing to cows milk

• Breastfeeding to bottle

• Establishing routine

• Preparing nutritious meals

• Appropriate drinks

• Vegetarianism

• Allergies/pseudo food allergies

• Additives

• Deficiencies

• Importance of nutrition

• Information on iron/vitamins/calcium

• Choking

• Vomiting/regurgitating

• Colic

• Diabetes

• Cooking with child

• Recipes for parent/child activities

• Junk food

• Establish healthy eating habits

• Establish good habits at mealtimes

• Make feeding a social occasion

• Sitting at the table

• Use for cups and bottles

• Knife and fork

2.2.11 Sleep

The issues receiving the highest level of mentions under this topic related to establishing and maintaining a routine (mentioned by 95%) and dealing with sleep problems (mentioned by 92%). Nursery nurses were less likely to mention the need to include dealing with sleep problems (88%), compared to 96% of both GPs and health visitors.

Figure 3.11 Issues that should be addressed – Sleep

Figure 3.11

The following additional comments serve to provide detail about some of the specific issues that were raised under this topic.

Habits/Routine

Importance of Sleep

• How to establish good patterns/routine

• Consistent approach

• Staying in child’s bed

• Sleep triggers

• Issues of sleeping with parents

• Moving from parents to bed to cot

• Day-time naps

• Sleep patterns in childhood

• Stopping breastfeed/bottle feed through night

• Reducing drinks

• Bed wetting

• Sleep walking

• Night wakening

• Routines broken by illness

• Emotional development – links to sleep

• How much sleep a child needs

• Purpose/value of sleep to growing child

• Sleep deprivation

• Consistency

• Effect of tiredness on parent

• Where to get help

2.2.12 Toilet training

Only 106 respondents raised this as a priority area for coverage in a new resource. The key issue under this heading emerged as being advice on how and when to get started (mentioned by 96%). The small base sizes did not permit any analysis of differences between professional groups.

Figure 3.12 Issues that should be addressed – Toilet Training

Figure 3.12

A small number of additional issues were raised.

Parental Approach

Hygiene & Illness

• Positive attitude to accidents

• Stress/keeping calm

• Hygiene

• Constipation

• Encopresis

• Highlight when to see GP when signs of UTI and constipation

2.2.13 Siblings

Very few respondents (34 out of the total sample) selected this as a priority area, and there was a spread of opinion as to issues to be addressed.

Figure 3.13 Issues that should be addressed – Siblings

Figure 3.13

2.3 Reactions to the development of a toddler parenting resource

There was a strong view expressed by professionals that a toddler parenting resource would prove valuable to both parents (to use directly) and to professionals (for use in supporting parents). However, given the level of experience amongst a large proportion of the sample, it is not surprising that whilst 80% of professionals viewed this as very valuable for parents, only 53% anticipated that it would be very valuable for professionals, (with a further 37% indicating it would be quite valuable).

Figure 3.14 The Value of a Toddler Parenting Resource

Figure 3.14

The perceived value for parents was highest amongst health visitors and nursery nurses/managers. A significantly higher proportion of health visitors (70%) than other professionals (51% of nursery nurses and 27% of GPs) felt that it would be ‘very valuable’ to professionals. We believe that this reflects the fact that 25% of health visitors had less than 5 years experience. Furthermore, the interview data indicated that they were more likely to envisage using it as part of their interaction with parents and not just as a resource for themselves.

The figures below shows the value that each of the professional groups felt a new toddler parenting resource would bring to a) parents, and b) professionals.

Figure 3.15 The Value of Toddler Resource to Parents & Professionals

Figure 3.15

2.4 Suggested format for a toddler parenting resource

When asked what they felt would be the most appropriate format for such a toddler parenting resource, the majority of professionals (84%) indicated a preference for a printed booklet. A further 43% (comprised mainly of health visitors, nursery nurses and voluntary organisation staff) suggested that printed leaflets would be an appropriate format. Only 25% (comprised mainly of health visitors) saw value in a web-based resource.

Figure 3.16 Ideal Format for Toddler Parenting Resource

Figure 3.16

In relation to the internal format, it was suggested that it be colourful, well broken up (photos, boxes) and employing realistic case studies and Q & A sections. The use of clear, jargon free language was thought to be essential.

There was a general consensus that the tone of the resource was crucial to its uptake. There was strong feeling that this should be non-judgemental and not patronising or authoritative in any way. The ideal tone suggested was one that was empathetic and reassuring, with an approach that utilised suggestion rather than instruction. It was considered vital that in terms of both the tone and stylistic approach adopted, the resource communicated that the guidance within was intended to be of practical benefit.

Crucially, it must also be inclusive in its coverage, addressing the requirements of parents whose first language is not English and whose toddlers have special needs.

2.5 Training requirements

37% of professionals who participated in the survey felt that they needed training in some area relating to providing support to parents of toddlers.

Figure 3.17 Professionals’ Requirement for Training

Figure 3.17

The need for training was expressed mostly by health visitors (42%) and nursery nurses (39%), Sure Start staff (36%) and voluntary organisation staff (35%) – see figure overleaf. Almost half the requests for training came from those with under 5 years experience, but a third of those with greater levels of experience also felt they had some need for training.

Figure 3.18 Requirement for Training By Professional Group

Figure 3.18

Base: All those in each segment

Of those who felt they required training, almost ¾ requested this in the area of providing practical parenting advice (73%), while over half sought training in providing emotional support for parents (57%).

The tables below indicate the specific training needs that were raised. With regard to practical parenting advice, the key requirements were for training relating to behaviour management (mentioned by 23%) and updates on current practice (mentioned by 11%). Fourteen percent of professionals wished for training in counselling skills to enable them to provide emotional support to parents.

Table 3.1 Areas in Which Training Was Required

PRACTICAL PARENTING ADVICE
Behaviour management	23%
Practical parenting advice (unspecified)	16%
Updates on current practice	11%
Sleep problems	7%
Positive parenting	7%
Toilet training	4%
Child development	3%
Feeding problems	3%
Active play	2%
Safety/first aid	2%
Communication	2%
Physical health	2%
Special needs	2%
Awareness of resources	2%

Base: Those who feel the need for training in practical parenting advice (n=267)

EMOTIONAL SUPPORT FOR PARENTS
Emotional support for parents (unspecified)	32%
Counselling	14%
Knowledge of resources/support access	8%
Post natal depression	7%
Updates on current practice	6%
Children with special needs	2%
Communication skills	2%
Understanding/coping with stress	2%

Base: Those who feel the need for training in emotional support for parents (n=210)

3. Overview

This section aims to draw together the toddler parenting issues raised by both parents and professionals working in this area, with a view to illustrating the areas of similarity and difference.

The diagram below illustrates the perceived interconnections of the practical and emotional issues raised by both parents and professionals. Whilst it was acknowledged that the use of such a toddler parenting resource may be topic driven, with users dipping in and out, there appeared to be a strong need (from both parents and professionals) for these topics to be presented within a consistent framework. It was envisaged that this would provide a foundation of key principles from which other advice would naturally emerge. This would have the advantage of providing parents in particular with some fundamental tenets of toddler parenting from which they might be able to develop their own specific solutions once their confidence, stemming from such knowledge had been established.

Positive Parenting

From the perspective of experienced professionals, this framework is one of promoting positive parenting.

Whilst some priority areas fell primarily into the categories of either practical (eg toilet training) or emotional (eg emotional development) issues, others quite clearly incorporated both of these elements (eg behaviour management and social development). In the case of the latter, it was felt that the two aspects of the topic area were equally important and so closely inter-related that their coverage in the resource should reflect this.

The priority issues raised by both parents and professionals were identical, with the key differences lying in the way in which ‘priority’ was interpreted. For parents this tended to start with the practical issues with which they were dealing on a day-to-day basis. However, whilst these were foremost in their minds, many were also concerned about (but often less ready to voice) more emotional issues. However, more in-depth discussion with respondents indicated not only the presence of these issues, but also the extent to which they were troubled by them. As discussed in the body of this report, it was often because of embarrassment or a lack of willingness to “expose” what was perceived as failure, that led to these emotional issues not being raised early on in the interviews.

Professionals, on the other hand, immediately acknowledged the central importance of the emotional topics, emphasising the extent to which many of the aspects of toddler parenting are linked to the issues which arise in this “emotional” area.

As such, whilst the overt priorities of parents were generally the mirror image of those highlighted by professionals, they do in fact reflect the same concerns which have been simply expressed from different perspectives. Thus parents might tend to approach a resource with a specific (practical) issue or problem in mind and absorb/evaluate the related emotional information in this context. Professionals, with the benefit of their experience, were able to identify the extent to which emotional and practical issues within certain topic areas were closely interlinked.

4. Conclusions

There is clearly an identified need for a resource targeted at parents of toddlers, with both professionals and parents recognising the value that it could bring.

From a parental perspective, the requirement is for a resource which provides a context for understanding and coping with toddler behaviour:

• providing clear, realistic practical advice, offering a number of alternative strategies for dealing with problems;

• viewing the range of situations from a parent’s perspective and providing emotional support and reassurance with regard to their experiences.

In terms of the practical parenting issues identified, there was a great deal of consistency between parents and professionals. However, professionals emphasised the need to provide guidance about the emotional issues involved in parenting and child development (e.g. positive parenting and emotional development).

Practical parenting issues were uppermost in parents’ minds, and it was evident that these stemmed from a lack of knowledge of/confidence in the most appropriate approaches to adopt. Whilst facilitating the emotional and social development of their child also emerged as a key priority for respondents, most were unable to speak of this in terms of specific needs. Equally, there was an identified need for support for parents themselves, particularly with respect to managing the range of emotions they find themselves experiencing.

Overall, the key priority areas for inclusion in a toddler parenting resource emerged as being;

• Emotional development of child;

• Physical/social development of child;

• Behaviour management;

• Positive parenting;

• Coping with parenthood.

The majority of respondents felt that a printed booklet would be the most appropriate format for the resource, with the internal layout well broken up with photos and boxes.

The appropriateness of the tone of the text was considered crucial. It was suggested that this should be:

• empathetic;

• reassuring;

• inclusive;

• with examples/advice grounded in reality.

About a third of the professional sample felt that they would benefit from training in relation to providing support to parents of toddlers. This training would help them offer better practical advice and emotional support to parents.