Association Between Parenting Style, Nutritional Status, and Social-emotional Development in Children With Acyanotic Congenital Heart Disease: A Cross-sectional Study

For many families, a child's early years are a time of rapid growth, not just in height and weight, but in how they learn to connect with others, manage their feelings, and navigate the world. This process, known as social-emotional development, is the foundation for future relationships and mental well-being. When a child is born with a heart defect, the path to this development can become more complicated. While medical advances have made it possible for more children with heart conditions to survive and thrive, doctors and researchers are increasingly concerned with how these children grow and learn. Specifically, they want to know if the way parents raise their children and whether the child is getting enough food play a role in how well they develop emotionally and socially. This question is particularly important for children with acyanotic congenital heart disease, a group of heart defects where the blood still carries enough oxygen to keep the skin looking pink, yet the heart still works harder than normal. These children often face challenges like feeding difficulties and frequent hospital visits, which can strain a family and potentially affect the child's growth and behavior.

A team of researchers at Dr. Hasan Sadikin General Hospital in Bandung, Indonesia, set out to investigate these connections. They focused on 64 children between the ages of 18 months and 6 years who had been diagnosed with acyanotic congenital heart disease. The researchers wanted to see if two specific factors—the style of parenting the child experienced and the child's nutritional status—were linked to their social-emotional development. To measure parenting, they asked the primary caregivers to fill out a questionnaire that categorizes how parents interact with their children, looking for styles that are warm and guiding, strict and controlling, or lenient. To check nutrition, they carefully measured each child's weight and height, comparing these numbers to standard growth charts to see if the children were underweight, stunted (too short for their age), or wasted (too thin for their height). Finally, they used a specialized screening tool to determine if the children were developing social and emotional skills at the expected level or if they were showing signs of delay.

The study revealed a striking picture of the children's current state. More than two-thirds of the children in the group showed signs of impaired social-emotional development, meaning they were struggling with skills like emotional regulation or interacting with others. When the researchers looked at the parents' answers about how they raised their children, they found something unexpected. The vast majority of the families, nearly 97 percent, were using an authoritative parenting style, which is characterized by warmth, clear rules, and responsiveness. Because almost every family fell into this single category, there was very little variation to compare. Consequently, the researchers could not find a statistical link between the specific parenting style and the child's development. The study does not prove that parenting style has no effect; rather, it shows that because so many parents in this group were raising their children in the same supportive way, the researchers could not detect any differences in outcomes based on parenting alone.

The story was different when the researchers looked at the children's physical growth. They found a clear connection between how well a child was growing and how they were developing socially and emotionally. Children who were underweight for their age were significantly more likely to have impaired social-emotional development compared to children with a normal weight. Similarly, children who were stunted, meaning they were shorter than expected for their age, were also much more likely to struggle with social and emotional skills. In fact, nearly 80 percent of the stunted children in the study showed developmental impairment. However, the researchers noted that this link was not found for other measures of nutrition, such as weight relative to height, which reflects more recent changes in diet. This suggests that long-term growth problems, rather than short-term fluctuations in weight, are the ones tied to developmental challenges.

These findings offer a new perspective on how to care for children with heart defects. The study suggests that while the way parents interact with their children is vital, the physical health of the child, specifically their long-term growth, may be a stronger indicator of their social-emotional well-being in this specific group. The researchers emphasize that this does not mean parenting does not matter, but rather that in a group where most parents are already providing high-quality care, the physical toll of the heart condition on the child's growth becomes the more visible factor. The study also highlights the need for doctors to look beyond the heart itself. By monitoring a child's height and weight as carefully as they monitor their heart function, medical teams might be able to identify children who are at risk for developmental delays earlier. This approach could help families and doctors work together to support not just the heart, but the whole child, ensuring they have the best chance to grow into healthy, socially confident adults.