The Power of Parenting: Longitudinal Associations Between Psychosocial Distress, Family Rules, Routines, and Child Emotional and Behavioral Health During Pediatric Cancer Treatment.

Document Type

Article

Publication Date

3-2026

Identifier

DOI: 10.1002/1545-5017.70057

Abstract

BACKGROUND: Family rules and routines are modifiable behaviors that may help children cope with stress, yet their role in pediatric cancer remains understudied. This longitudinal study examined links between psychosocial risk, family rules and routines, and child emotional and behavioral health during the first year of pediatric cancer treatment. We hypothesized that family rules and routines would mediate the impact of psychosocial risk on child internalizing and externalizing symptoms.

METHOD: Eighty (N = 80) primary caregivers of youth ages 2-14 years (M = 7.9 years, SD = 3.9 years) with a new diagnosis of cancer reported demographics, psychosocial risk, frequency of engagement in family rules and routines, and child emotional and behavioral health symptoms across three time points after diagnosis: T1, 1-3 months; T2, 6-7 months; and T3, 12-13 months. Treatment intensity was abstracted from the medical record at T3. Longitudinal mediation models were fit to evaluate the impact of psychosocial risk at T1 on subsequent family rules and routines at T2, and child internalizing and externalizing symptoms at T3.

RESULTS: Family rules and routines partially mediated relations between T1 psychosocial risk and T3 child externalizing symptoms, such that families at higher levels of psychosocial risk also exhibited lower engagement in family rules and routines, leading to more child externalizing symptoms. Family rules and routines did not mediate the association between T1 psychological risk and T3 child internalizing symptoms.

CONCLUSIONS: Psychosocial risk factors may disrupt family behaviors during cancer treatment, leading to more child externalizing concerns. Family based interventions should consider integrating support for family rules and routines during cancer treatment to mitigate behavioral risk.

Journal Title

Pediatric blood & cancer

Volume

73

Issue

3

First Page

70057

Last Page

70057

MeSH Keywords

Humans; Child; Adolescent; Male; Neoplasms; Female; Longitudinal Studies; Child, Preschool; Parenting; Stress, Psychological; Psychological Distress; Follow-Up Studies; Emotions

PubMed ID

41491660

Keywords

behavioral health; family functioning; pediatric cancer; psychosocial risk

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