Positive Parenting Behaviors and Child Development in Ceará, Brazil: A Population-Based Study

Round 1

Reviewer 1 Report

Review of “Positive parenting behaviors and child development in Ceará, Brazil: A population-based study” for publication consideration in Children.

This is a very nice analysis of a large sample in an understudied population. The findings of relations between positive parenting behaviors and child development are not surprising, yet important to document in this population.  I particularly appreciate the breakdown of findings by child age. 

I have just a couple minor comments/questions

·      Are income and maternal education controlled or just education? If not income as well please state why (too collinear with education?).  It seems as if some of the questions specifically asking about playing with certain types of toys would be more likely if more income and ability to have toys. 

·      Table 2 is hard to read, please re-format

·      The emphasis on toys that “make noises” seems odd to me. We know that object play is very good for development, but we also know that kids don’t need fancy squeeky toys to promote learning. Many household items can serve as toys and it is the interactions around those items that matter most.  There is a bit in the discussion that gets at this, but I feel some more could be said to emphasize that it isn’t special toys that are necessary, but the time together playing. 

Author Response

July 28, 2022

Dear Prof. Dr. Sari A. Acra,

Children Editor-in-Chief,

Hope you are well,

Thank you very much for your carefully and thoughtfully review of our manuscript.

Please find enclosed the response to your reviews made on the paper “Positive parenting behaviors and child development in Ceará, Brazil: A population-based study” for your consideration for publication as a Research Article in Children.

We addressed all reviewer comments with a point by point response and to the best of our interpretation we fully addressed all reviewer comments. All changes to the manuscript are clearly indicated. In this document, our responses are in red and in the manuscript they are highlighted using the track changes feature.

Review of “Positive parenting behaviors and child development in Ceará, Brazil: A population-based study” for publication consideration in Children.

This is a very nice analysis of a large sample in an understudied population. The findings of relations between positive parenting behaviors and child development are not surprising, yet important to document in this population.  I particularly appreciate the breakdown of findings by child age. 

I have just a couple minor comments/questions

RESPONSE – Thank you very much for your insightful review. We tried our best to address all the requested changes.

• Are income and maternal education controlled or just education? If not income as well please state why (too collinear with education?).  It seems as if some of the questions specifically asking about playing with certain types of toys would be more likely if more income and ability to have toys. 

RESPONSE – We included income, is the variable we named as “degree of poverty”, because we used beyond the monthly income some assets the family possessed. We made it clear in the manuscript, thank you for remarking.

• Table 2 is hard to read, please re-format

RESPONSE – Sorry for that, the formatting was not adequate, we reinserted the table in the .docx file with special care to format.

• The emphasis on toys that “make noises” seems odd to me. We know that object play is very good for development, but we also know that kids don’t need fancy squeeky toys to promote learning. Many household items can serve as toys and it is the interactions around those items that matter most.  There is a bit in the discussion that gets at this, but I feel some more could be said to emphasize that it isn’t special toys that are necessary, but the time together playing. 

RESPONSE – We reinforced that aspect in the discussion (…although more important than the type of toy is the interaction between parents and children), thank you for remarking.

Again, thank you very much for your review,

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Reviewer 2 Report

Dear Authors,

Please find enclosed my comments and suggestions.

Best regards.

Comments for author File: Comments.pdf

Author Response

1. Thank you for the opportunity to review this manuscript. Overall, this is an interesting study examining the association of parenting practices with child development in a lowincome state in northeastern Brazil. I have some suggestions and comments below for the authors to consider: General suggestions:

RESPONSE – Thank you very much for your insightful review. We tried our best to address all the requested changes.

2. I suggest that keywords should be different from those included in the title.

RESPONSE – We adjusted the keywords (please see revision marked version attached)

I provide minor comments below for the authors' consideration:

Abstract: 3. Page 1: Please, correct the verbal time of the following sentence “The aim of this study is ‘was’ to evaluate the association of parenting practices…”.

RESPONSE – Adjusted, thank you

Introduction: 4. “Globally, it is estimated that 250 million children under five years of age in low- and middle-income countries are at risk of failing to reach their full developmental potential in 2010. [1]” – Are there updated figures that you can include here? It seems not adequate to predict numbers for 2010 – we are now in 2022.

RESPONSE – We adjusted for a newer reference, thank you for the suggestion

5. I suggest informing the age groups from the studies that have been cited in the introduction. For example “Research on positive parental behaviors has demonstrated that greater parental engagement is strongly associated with better child development outcomes [7, 8]” – In which age group? Please, inform. I would also specify the nationalities of the samples regarding the studies that have been mentioned.

RESPONSE – We included the information

Methods: 6. “Ceará is located in northeastern Brazil and is one of the poorest states in the country, with a population of nine million inhabitants living in a semiarid climate, with high prevalence of food insecurity. Fortaleza is the urban commercial center and capital city of the state and there are also rural areas in Ceará, where subsistence farming is the main economic activity” – Please, add appropriate citations.

RESPONSE – We included the citations

7. Which protocol were used to collect child’s anthropometric measures? How was the staff trained and defined as prepared for data collection?

RESPONSE – We included the information about interviewers training (20h training) and anthropometric measures protocol, thank you for remarking that

8. Please, report the Ethics approval number for this study.

RESPONSE – We included the information

9. “Considering that some parenting practices are essential for all ages (0 to six years old), while others are more important for specific age groups, we developed age-specific items in the questionnaire about parenting, as well as included general items that were asked to all age groups” – Was this tool previously tested in a Brazilian sample? If so, what are the psychometric properties of the tool? Please, provide details.

RESPONSE – No, we used a questionnaire for assessing parenting behaviors that, although based on UNICEF recommendations, was not yet validated. We included this information on limitations now

10. “Supplementary Box” – Why it is composed by yes/no questions? The tool/results could be so much stronger with the use of frequency tables from categories ranging from never to always, for example.

RESPONSE – We based our questionnaire on the “Family and community practices that promote child survival, growth and development: a review of the evidence: World Health Organization; 2004”, which have many PPB that should be observed on children in a yes or not manner by non specialized staff, so in our use we used the question in the same fashion.

11. “Mothers/caregivers were asked to answer about what happened in the last three days of the children’ routine, while for parenting practices, which were asked to all age groups, mother/caregivers were asked to answer about what happened in the last seven days of the child's routine, before the interview” – Why 3 days, and 7 days were chosen? Was this based on previous similar studies? Can you provide references?

RESPONSE – I think it’s the same answer of the previous point: we based our questionnaire on the “Family and community practices that promote child survival, growth and development: a review of the evidence: World Health Organization; 2004”, which have many PPB that should be observed on children in 3 or 7 prior days, by non specialized staff, so in our use we used the question in the same fashion.

Results: 12. Table 2: It is written ‘edian’, but it should be “median” – Please, correct.

RESPONSE – Sorry for that, the formatting of the entire table was not adequate, we reinserted the table in the .docx file with special care to format.

Discussion: 13. It would be interesting to discuss the findings of other studies more specifically, providing details of these studies, such as nationalities of the samples, methods used and results obtained. What are the similarities and differences when compared to your study findings? Why?

RESPONSE – We included more details about the cited studies and tried to improve the discussion of the related aspects of our studies.

Conclusions: 14. The conclusion is clear. I would only state the main results more clearly.

RESPONSE – We tried to improve the results in conclusion.

Again, thank you very much for your review,

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