the correlation between parenting style and child stunting

STUDENT RESEARCH PAPER

THE CORRELATION BETWEEN PARENTING STYLE AND CHILD

STUNTING IN GRADE 5 ELEMENTARY STUDENTS OF WEST

JAKARTA

Monica Raharjo

030.09.157

Faculty of Medicine, Trisakti University

Jakarta, Indonesia – 2012

ABSTRACTThe incidence of child stunting is still high in Indonesia despite general improvements

in food availability and health services. One of the environmental influences thought to play a role in child stunting is parenting style. The objective of this study is to find out if there is a correlation between parenting style and child stunting and whether democratic parenting style is associated with lower risk of child stunting. A cross-sectional study was conducted at SDN Duri Kepa 07 and 08 Pagi, West Jakarta with 71 grade 5 elementary students recruited as study samples. Assessment of parenting style (democratic, authoritarian, or permissive) is done using a Parental Authority Questionnaire and anthropometric measurement of height is interpreted as normal, stunting, or severely stunting. Data was analyzed with the analysis of variance test and the Pearson correlation test using the SPSS version 17.0 program. The correlation test done showed that there is no significant correlation between parenting style and child stunting (p >0.05). Further, the ANOVA test done showed that there is no statistical difference between the three parenting styles for the indicator height-for-age (p >0.05).

Keywords: Parenting style, child stunting, height, West Jakarta

INTRODUCTION

Stunting is an indicator of chronic malnutrition which represents linear growth failure

due to poor nutrition and infections both before and after birth. The National Health Survey

(RISKESDAS) done by the Ministry of Health Republic of Indonesia showed that the

incidence of stunting in school-children aged 6-12 years old was still high and the decline in

stunting is not very significant despite general improvements in food availability and also

health and social services.(1,2) The incidence of stunting in 2007 was 36.8% and in 2010 it was

35.6% (20.5% stunting and 15.1% severe stunting). The highest incidence of stunting was in

Nusa Tenggara Timur which was 58.5%, whereas in Jakarta, the capital of Indonesia,

incidence of child stunting was 23.9%. Stunting was more common in male than female

children, more common in children living in rural areas, and decreased in children with

parents of higher educational status.(3) A study done in families in Indonesia and Bangladesh

confirmed that both maternal and paternal education are strong determinants of child

stunting.(4)

Child stunting in Indonesia should be a concern, because children who are healthy

both physically and mentally are assets for the growth and development of this developing

country. Stunting in childhood is associated with poor cognitive, motor, and emotional

development. It is also associated with increased mortality. Further, stunted children don’t

reach their full growth potential and will grow to be stunted adults. Stunted adults have

reduced work capacity and stunted adult women have increased risk of mortality during

childbirth.(4) In short, stunting in childhood may cause undesirable consequences.

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Child stunting is the result of long-term consumption of low-quality diet combined

with morbidity, infectious disease, and also environmental influence. One of the

environmental influences thought to play a role in child stunting is a child’s caregiver

(including parents). It is stated previously that formal education of both mother and father are

determinants of child stunting. Also, according to Kartono, a child living with caregivers that

do not provide concern and affection in terms of healthcare will experience a state of

psychological emptiness which hinders physical growth. This is confirmed by a study done in

North Jakarta which shows that the incidence of stunting in children living in pesantren since

preschool (37.5%) is higher than children living in homes (10%). This study suggests that

nutritional status indicated by height-for-age is affected by interaction of child and caregiver,

parenting practices, stimulation of child, and living environment.(5) Parenting practices are

related to and influenced by parenting style. This means that parenting style also influences

child development.

Parenting style is a characteristic of the parent that is stable over time and forms the

environmental and emotional context for raising up a child. A widely accepted theory of

parenting style has been developed by Diana Baumrind using two different dimensions of

parenting which are parental demandingness/ control and parental responsiveness/

nurturance. Demandingness refers to “claims that parents make on children by behavior

regulation, direct confrontation, maturity demands, and supervision of children’s activities”,

while responsiveness refers to how parents support and listen to their children’s requests,

needs, and demands. Crossing these two dimensions of parenting, three different parenting

styles are formulated. Parents with high demandingness and responsiveness have an

authoritative style/ democratic style: they encourage their child to be independent and are

willing to listen to their needs and demands but set clear rules and guidelines that their

children are expected to follow. Parents with high demandingness but low responsiveness

have an authoritarian style: they expect their child to strictly obey rules and regulations with

little regard for their child’s needs and little communication with the child. Lastly, parents

with high responsiveness but low demandingness have a permissive style: these parents are

nurturing and communicative with their children but do not set limits and allow children to

set their own rules, schedules, and activities.(6-7) Many studies have shown that parenting style

affects a child’s growth and development in multiple domains, in which democratic parenting

style as the ideal parenting style is associated with positive child health outcomes. One

example is that democratic parenting style is associated with lower risk of childhood

overweight (8-9). Sadly, no studies have been done to assess the relationship between parenting

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style and stunting. For this reason, this research was done to find out if there is a correlation

between parenting style and child stunting and whether democratic parenting style is

associated with lower risk of child stunting compared to the two other parenting styles.

METHODS

Research Design

This research has a cross-sectional design and was carried out at SDN Duri Kepa 07,

08 Pagi in Kebon Jeruk, West Jakarta starting from June 2012 until mid-July 2012.

Population and Sample

The study population was elementary school students of Grade 5 studying in SDN

Duri Kepa 07, 08 Pagi throughout the school year 2011-2012. The study samples were

students who meet both the criteria of inclusion and the criteria of exclusion. They were

collected through consecutive sampling, in which all subjects who meet the sample criteria

are included in the research until the size of sample is met. The criteria of inclusion are

students aged 10-13 years old and students who agreed to take part in the research by filling

in the questionnaire given to them. The criteria of exclusion are students with physical and

mental disabilities, students suffering from acute or chronic illness (assessed using

questionnaire), students without both parents alive, and students not living or staying with

their parents. The sample size needed for this research is calculated using two different

equations, as follows:

1. Infinite population equation:

No=Zα 2 PQd2

No = required sample size

Zα = degree of confidence at 95% (standard value of 1.96)

P = estimated prevalence of stunting in Jakarta 23.9% (Riskesdas 2010)

Q = 1 – P (1-0.239 = 0.761)

d = margin of error at 5% (standard value of 0.05)

Calculation:

No=1.962 ×0.239 ×0.7610.052 =3.8416 × 0.239× 0.761

0.0025=0.6987

0.0025=279,5

2. Finite population equation:

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n= No

1+NoN

n = sample size for research

No = required sample size (279.5)

N = size of accessible population (90)

Calculation:

n= 279.5

1+279.5

90

= 279.51+3.106

=279.54.106

=68,07 ≈ 69

This means that sample size for this research should be 69 students or more.

Data Collection

Data collection was conducted for one whole day in the two different elementary

schools by using a questionnaire. Identity of students (including full name, date of birth, age,

gender, and address), questions regarding the criteria of exclusion, and questions to assess the

parenting style of these students were asked. Anthropometric measurement of height was

done after students finish filling up the questionnaire given. The questionnaire used in this

research is included in the appendix.

Assessment of Parenting Style

The existing Parental Authority Questionnaire (PAQ) developed by Buri in 1991 is

chosen for this study and translated to simple Indonesian language before it is given to study

samples.

The PAQ was designed as a measure of Baumrind’s three parenting styles which has

been described earlier. It is a self report measure which measures parenting style by looking

at the perspective of the child on how their parents acted towards them. This measure consists

of 30 questions, 10 questions for each of the three different parenting styles. Answers to these

questions ranges from 1 to 5 points ranging from strongly agree to strongly disagree. There

are actually two separate sets of questions one for mother and one for father, but in this study

the researchers are only going to use one set of questions to represent the parenting style of

both mother and father. Items 4, 5, 8, 11, 15, 20, 22, 23, 27, and 30 are questions for

authoritative/ democratic parenting style; items 2, 3, 7, 9, 12, 16, 18, 25, 26, and 29 are

questions for authoritarian parenting style; and items 1, 6, 10, 13, 14, 17, 19, 21, and 24 are

questions for permissive parenting style. To determine the parenting style that a child

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receives, the score (1-5) for each individual items of the parenting styles are summed and the

highest score obtained reflects the parenting style of a child’s parent. The reliability of the

PAQ was found to be 77-92%, while the validity of the PAQ was found to be 74-87%. (10)

Height Measurement

Height measurement was done according to the guidelines made by the Ministry of

Health in 1999. The instruments used were one measuring tape which measures in

centimeters (cm) and one right triangle ruler. The measuring tape is taped on a wall which is

perpendicular to the floor beneath with the point 0 cm exactly on the floor. The student is

asked to remove all footwear and head-cover/accessories and is asked to stand straight in

front of the measuring tape with his head, shoulder, hips, and heels touching the wall. The

right triangle ruler is then placed above the student’s head with one side touching the wall.

The point where the scale touches the tip of the ruler is the student’s height in cm. (11)

Assessment of Stunting

To assess whether a child is stunted or not, the indicator height-for-age is used. Z-

scores for the indicator height-for-age are calculated using a program developed by WHO

which is compatible with SPSS version 17.0. This program consists of a syntax file and the

SPSS data set containing the WHO reference 2007 for the indicator height-for-age. After

obtaining z-scores for each study samples, it is interpreted as shown in Table 1. (11)

Table 1. Interpretation of Z-Score Height-for-Age (WHO)

Z-Scores Height-for-Age Interpretation

> -2 SD Normal

≤ -2 SD – -3 SD Stunting

< -3 SD Severe stunting

Statistical Analysis

Data processing and analysis will be done using the SPSS Statistics version 17.0

program. Statistical analysis was done using the analysis of variance test (ANOVA) and

Pearson correlation test with 95% degree of confidence and p < 0.05.

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Ethical Clearance

Informed consent was obtained from the principals of SDN Duri Kepa 07 Pagi and

SDN Duri Kepa 08 Pagi to conduct this research on their students. Students are also

explained about the research, its procedure, and its purpose before the questionnaire is

distributed to them. Students who are willing to fill in the questionnaire given to them are

considered willing to take part in the research.

RESULTS

A total of 90 children participated in the research; however 19 children were excluded

because they match the criteria of exclusion. This means that only 71 children were included

in the research as study samples, 34 male students and 37 female students. Of the study

samples, 57 children had normal linear growth, 11 children were stunted (z-scores height-for-

age ≤ -2 SD), and 3 children were severely stunted (z-scores height-for-age < -3 SD). The

characteristic of parenting style are as follows: 48 children had a democratic parenting style,

13 children had an authoritarian parenting style, and 10 children had a permissive parenting

style. Other characteristic of samples are presented in Table 2.

Table 2. Characteristics of Samples (n=71)

Characteristics Mean (Range) / Frequency

Age (months) 137.15 ± 8 (122-158)

Height (cm) 140.03 ± 8.5 (119.5-160.5)

Height-for-age (N/stunted/severly stunted) 57/ 11/ 3

Gender (M/F) 34/ 37

Parenting style (democratic/ authoritarian/ permissive) 48/ 13/ 10

The ANOVA test is done to determine whether there is a difference between each

parenting styles (democratic, authoritarian, and permissive) in regards to height-for-age of

study samples. Using SPSS tests of normality and test of homogeneity of variances, it is

found that the data has a normal distribution and that data variance is the same; this means

that the ANOVA test can be done. Result of the ANOVA test (Table 3) shows that there is no

significant difference between the three parenting styles in regards to height-for-age because

p > 0.05 (see Table 3 Sig.=0.122).

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Table 3. Result of ANOVA Test

height-for-age

Sum of Squares df Mean Square F Sig.

Between Groups .026 2 .013 2.169 .122

Within Groups .408 68 .006

Total .434 70

The Pearson correlation test is done to determine whether there is a correlation

between parenting style and child stunting. Result of the Pearson correlation test (Table 4)

shows that there is no statistically significant correlation between parenting style and child

stunting because p > 0.05 (see Table 4 Sig.(2-tailed)=0.733).

Table 4. Result of Pearson Correlation Test

dominant parenting

stylenormal or stunting

dominant parenting style

Pearson Correlation 1 .041

Sig. (2-tailed) .733

N 71 71

normal or stunting Pearson Correlation .041 1

Sig. (2-tailed) .733

N 71 71

DISCUSSION

The correlation test done showed that there is no significant correlation between

parenting style and child stunting. Further, the ANOVA test done showed that there is no

statistical difference between the three parenting styles for the indicator height-for-age. This

means that parenting style is not a determinant of child stunting. It also means that the

research hypothesis that democratic parenting style is associated with better health outcomes

compared to the other two parenting styles cannot be proven.

The reason for these results may be because child stunting is not only influenced by

parenting style alone but also by other environmental factors such as socioeconomic status

and other caregivers, nutritional factors such as availability of food, and morbidity which is

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not assessed in this research. A child raised in a democratic home may be stunted because of

poor socioeconomic status and low availability of nutritious food. On the other hand, a child

raised in an authoritarian or permissive home may have normal linear growth (not stunted)

because there is another caregiver at home who teaches him about healthy eating practices.

Also in this research, morbidity is only assessed using a questionnaire and therefore the

researcher can’t be sure that the samples are not suffering from any chronic illness which can

hinder linear growth.

CONCLUSION

There is no correlation between parenting style and height-for-age. There is also no

correlation between parenting style and child stunting. Further study in a broader scope

should be done as an effort to lower the rates of child stunting in Indonesia.

ACKNOWLEDGEMENTS

The author wishes to thank Prof. dr. H. Widagdo, SpA, MBA for supervising this

research. The author also wishes to thank the principals of SDN Duri Kepa 07 and 08 Pagi for

allowing this study to be conducted at their school. Also, the author extends utmost

appreciation for Michelle Jansye, M. Rifki Maulana, M. Fachri Ibrahim, Muhamad Rosaldy,

and Muthi Melatiara for their cooperation and assistance in sample recruitment and data

collection. The author is especially grateful for the children who participated in this study.

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REFERENCES

1. Hadi H. One-third of School Age Children in Indonesia Experiences Stunted [updated

2010 April 10; cited 2012 July 07]. Available from: http://www.ugm.ac.id/en/?

q=news/one-third-school-age-children-indonesia-experiences-stunted.

2. Atmarita. Nutrition Problems in Indonesia. Article for an Integrated International

Seminar and Workshop of Lifestyle – Related Diseases, Gajah Mada University, 19-

20 March, 2005.

3. Badan Penelitian dan Pengembangan Kesehatan Kementrian Kesehatan RI. Riset

Kesehatan Dasar: RISKESDAS 2010. Jakarta: Departemen Kesehatan RI; 2010.

4. Semba RD, Pee SD, Sun K, Sari M, Akhter N, Bloem MW. Effect of Parental Formal

Education on Risk of Child Stunting in Indonesia and Bangladesh: a Cross-sectional

Study. Lancet 2008; 371: 322-28.

5. Rahayu L, Megawangi R, Martianto D. Pola Pengasuhan, Status Gizi dan

Kemampuan Kognitif Anak Usia Sekolah di Lingkungan Pesantren dan Keluarga

Serta Faktor-faktor yang Mempengaruhinya. Media Gizi & Keluarga 2003; 27(2): 25-

33.

6. Cross DR. Parenting Styles [updated 2009 January 22; cited 2012 May 31]. Available

from: http://www.davidcross.us/classes/child/ParentingStyle.pdf.

7. Lao J. Parenting Styles [updated 2011 July 25; cited 2012 May 31]. Available from:

http://parentingliteracy.com/parenting-a-z/44-overview/47-parenting-styles.

8. Sleddens EFC, Gerards SMPL, Thijs C, De Vries NK, Kremers SPJ. General

Parenting, Childhood Overweight and Obesity-inducing Behaviors: a Review.

International Journal of Pediatric Obesity 2011; 6: e12-e27.

9. Rhee KE, Lumeng JC, Appuglise DP, Kaciroti N, Bradley RH. Parenting Styles and

Overweight Status in First Grade. Pediatrics 2006; 117(6): 2047-54.

10. Riberio LL. Construction and Validation of a Four Parenting Styles Scale

[dissertation]. Arizona: Humboldt State University; 2009.

11. Supariasa IDN, Bakri B, Fajar I. Penilaian Status Gizi. In: Ester M; editor. Jakarta:

EGC; 2001.

APPENDIX

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http://parentingliteracy.com/parenting-a-z/44-overview/47-parenting-styles

http://www.davidcross.us/classes/child/ParentingStyle.pdf

http://www.ugm.ac.id/en/?q=news/one-third-school-age-children-indonesia-experiences-stunted

http://www.ugm.ac.id/en/?q=news/one-third-school-age-children-indonesia-experiences-stunted

LEMBAR KUESIONER

IDENTITAS DIRI

Nama Lengkap

Tanggal Lahir

Umur

Jenis Kelamin a) Laki-laki

b) Perempuan

Alamat

Nama Sekolah

PERTANYAAN A

Apakah kedua orang tua anda masih ada? a) Ya

b) Tidak

Apakah anda tinggal dengan kedua orang tua anda? a) Ya

b) Tidak

Apakah anda sedang sakit?

Bila jawaban “Ya” sebutkan sakit apa

a) Ya

b) Tidak

Saya sedang sakit ……………….

PERTANYAAN B: PARENTAL AUTHORITY QUESTIONNARE (PAQ)

Instruksi. Untuk setiap pernyataan di bawah ini, lingkarilah salah satu dari 5 nomor (1 = sangat tidak setuju – 5

= sangat setuju) yang paling menggambarkan hubungan anda dan orangtua anda. Tidak ada jawaban yang benar

atau salah dalam menanggapi pernyataan-pernyataan tersebut. Pastikan jangan sampai ada pernyataan yang

terlewat!

1. Orangtua saya menganggap bahwa dalam keluarga yang baik, anak-anak seharusnya dapat menentukan

apa yang ia mau dalam keluarga sama seperti kedua orangtuanya.

1) Sangat tidak setuju 3) Tidak keduanya 5) Sangat setuju

2) Tidak setuju 4) Setuju

2. Walaupun saya tidak setuju dengan kedua orangtua, orangtua saya akan memaksa saya untuk

mengikuti pendapat yang mereka anggap benar karena itu demi kebaikan saya.



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3. Kapanpun orangtua menyuruh saya untuk mengerjakan sesuatu, mereka mengharapkan saya segera

melakukannya tanpa bertanya apapun.



4. Apabila ada peraturan yang diterapkan di dalam keluarga, orangtua saya menjelaskan alasan dan

kepentingan peraturan tersebut kepada anak-anaknya.



5. Orangtua saya selalu menjelaskan dan mendengarkan saya setiap kali saya merasa ada peraturan atau

larangan dalam keluarga yang tidak masuk akal.



6. Orangtua saya merasa bahwa saya bebas berpendapat dan melakukan apapun yang saya inginkan,

walaupun pendapat dan keinginan tersebut tidak sesuai dengan apa yang orangtua saya inginkan.



7. Orangtua saya tidak memperkenankan saya untuk bertanya apapun mengenai keputusan yang telah

mereka buat.



8. Orangtua saya mengatur segala kegiatan dan keputusan anak-anaknya dengan pertimbangan dan

disiplin.



9. Orangtua saya selalu beranggapan bahwa, paksaan pada anak-anaknya diperlukan untuk membuat

anak-anaknya berperilaku sesuai dengan apa yang seharusnya anak-anak lakukan.



10. Orangtua saya tidak beranggapan bahwa saya perlu menaati peraturan hanya karena seorang yang lebih

tua telah menetapkannya.



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11. Saya tahu apa yang diharapkan kedua orangtua terhadap saya dalam keluarga, tetapi saya juga bebas

berdiskusi mengenai harapan tersebut dengan mereka apabila saya merasa hal tersebut tidak masuk

akal.



12. Orangtua saya beranggapan bahwa orangtua yang bijaksana adalah orang tua yang menunjukkan siapa

‘bos’ (yang mempunyai kuasa) di dalam keluarga.



13. Orangtua saya jarang memberikan saya harapan dan panduan dalam bertingkah laku.



14. Orangtua saya melakukan apa yang diinginkan oleh anak-anaknya saat membuat keputusan keluarga.



15. Orangtua saya terus-menerus memberikan arahan dan panduan yang masuk akal dan objektif kepada

saya.



16. Orangtua saya akan sangat marah apabila saya tidak setuju dengan mereka.



17. Orangtua saya merasa bahwa kebanyakan masalah dalam masyarakat dapat diselesaikan apabila

orangtua tidak melarang aktivitas, keputusan, dan keinginan anak-anaknya.



18. Orangtua saya memberitahukan harapan mereka mengenai bagaimana saya harus bersikap dan

berperilaku, dan apabila saya tidak memenuhinya, saya akan dihukum.



13

19. Orangtua saya memperbolehkan saya untuk memutuskan hal-hal untuk diri saya sendiri tanpa ada

banyak arahan dari mereka.



20. Orangtua saya mendengarkan pendapat saya sebagai pertimbangan untuk mengambil suatu keputusan

keluarga. Namun, mereka tidak segampang itu memutuskan sesuatu hanya apabila saya menginginkan

hal tersebut.



21. Orangtua saya tidak memandang dirinya sebagai orang yang bertanggungjawab untuk membimbing

dan mengarahkan tingkahlaku saya selama saya tumbuh dewasa.



22. Orangtua saya memiliki patokan yang jelas mengenai bagaimana anak-anaknya harus berperilaku

dalam keluarga, namun mereka tetap menyesuaikan patokan tersebut dengan kebutuhan dari masing-

masing anak mereka.



23. Orangtua saya memberikan arahan terhadap tingkah-laku dan aktivitas saya dan mereka mengharapkan

saya mengikuti arahannya. Tetapi, mereka juga selalu bersedia untuk mendengarkan pendapat saya dan

mendiskusikan arahan tersebut dengan saya.



24. Orangtua saya memperbolehkan saya untuk membentuk pandangan saya sendiri terhadap hal-hal dalam

keluarga, dan mereka juga memperbolehkan saya untuk memutuskan sendiri hal yang saya ingin

lakukan.



25. Orangtua saya merasa bahwa kebanyakan masalah di masyarakat akan terselesaikan apabila orangtua

dapat membatasi dengan keras atau memaksa anaknya ketika anak-anaknya tidak melakukan apa yang

seharusnya dilakukan.



14

26. Orangtua saya seringkali mengatakan secara langsung apa yang mereka ingin saya lakukan dan

bagaimana harapan mereka agar saya melakukan hal tersebut.



27. Orangtua saya memberikan arahan yang jelas terhadap tingkah-laku dan aktivitas saya, namun mereka

juga mengerti ketika saya tidak sependapat dengan mereka.



28. Orangtua saya tidak mengatur perilaku, aktivitas, dan keinginan saya.



29. Saya tahu harapan orangtua terhadap saya dalam keluarga dan mereka menuntut saya untuk

memenuhinya demi menghormati kekuasan mereka.



30. Apabila orangtua saya membuat keputusan keluarga yang menyakiti saya, mereka bersedia untuk

membicarakan hal tersebut dengan saya dan mengakui bahwa mereka telah melakukan kesalahan.



15

the correlation between parenting style and child stunting

Documents

environmental influences thought

normal linear growth

pearson correlation test

democratic parenting style

permissive parenting style

authoritarian parenting style

parenting practices

parenting style