Journal of Child Health Care最新文献

Children who have been maltreated are at an increased risk of having their pain under-recognized and undertreated by healthcare professionals, and thus, are more susceptible to adverse outcomes associated with undertreated pain. This study's aims were to examine: (1) if healthcare professionals' pediatric pain knowledge is associated with their pain assessment methods, (2) if maltreatment-specific pain knowledge is associated with consideration of child maltreatment when deciding on a pain management strategy, and (3) if pediatric pain knowledge would relate to maltreatment-specific pain knowledge. A sample (N = 108) of healthcare professionals responded to a survey designed to examine their current knowledge and utilization of pediatric pain assessment and management with emphasis on the effects of child maltreatment. Findings revealed healthcare professionals' knowledge of pediatric pain is independent of their pain assessment and management practices. However, general pain knowledge was associated with maltreatment-specific pain knowledge and generally, healthcare professionals were knowledgeable of child maltreatment's impact on pediatric pain. Participants who considered a history of maltreatment were also more likely to employ sensitive questioning strategies when asking children about their pain.

This study aimed to examine how parents develop personal resilience when facing the challenges of caring for a child with tracheostomy. This study employed a longitudinal qualitative design. Unstructured narrative interviews with 12 parents (from nine families) whose child had a new tracheostomy were undertaken at three time points over 12 months. Data were analysed using a socio-narratology method. Findings reveal the journey parents experienced, how their feelings changed and the processes involved in developing resilience over the first 12 months of their child having a tracheostomy. Stories told by parents early in their journey revealed emotional upheaval, negative emotions, stress and shock. Due to medical need, parents had little or no choice for their child to have a tracheostomy. Once their child's life was out of danger, parents started to reframe their experiences and beliefs. Resilience played a major part in how parents perceived and faced their situation, allowing them to deal with what came their way and to move forward with their lives. Different aspects of resilience such as self-awareness, grit, gratitude, internal locus of control and reframing came to the fore at different time points. Parents talked feeling stretched by the challenges they faced and how they reframed their perspectives about their child's tracheostomy. Parents' resilience and reframing is discussed in relation to the ABC-X model. This study identifies a theoretical model that explains this process of change, this results in transferable knowledge, useful for understanding and explaining the experience of other parents and families.

Cystic fibrosis (CF) affects not just patients but also their families, highlighting the need for a comprehensive care approach. This descriptive qualitative study aimed to explore the informational needs of family caregivers of children with CF, focusing on how these needs can be addressed within a Patient and Family-Centered Care (PFCC) framework. The study was conducted at a public hospital in Brazil. Thirteen caregivers were interviewed, and their responses were analyzed using content analysis guided by PFCC principles. Analysis revealed three primary themes: Types of Information for Family Caregivers of Children and Adolescents with CF; sources of Information for Family caregivers of Children and Adolescents with CF; and Beyond Information: the need for emotional support and family-centered care in CF management. Caregivers sought comprehensive information about CF management from healthcare professionals and informal sources like social media. Our findings emphasize the diverse and evolving informational needs of family caregivers. Overall, this study underscores the necessity of incorporating PFCC principles, especially those addressing information sharing, in managing CF, extending beyond medical treatment to include emotional support and active family participation in care and decision-making processes.

Learning to communicate with infants in a neonatal unit setting is challenging. Parents need time and support to feel confident and acquire skills that enable them to care for, be close to, and communicate with their infant. This qualitative, narrative-based study sought to investigate parents' understanding of factors that enhance or prevent the development of early communication and interaction between preterm infants and parents within a neonatal setting. Our study used a narrative interview approach with eight parents of premature infants, to explore the enablers and challenges to communication. Reflexive thematic analysis revealed four main themes: Impact of being in the neonatal unit, different communication strategies, communication barriers and an ongoing need for support at home. Our findings provide parental insight into communication between themselves and their premature infants. Overall, parents spoke highly of communication strategies that they were taught but it was clear they received varying advice and support, in the neonatal unit and post-discharge. There is a need for clear, consistent, and culturally appropriate communication strategies with greater awareness of how to facilitate them. Since failure to enable parent-infant interactions may potentially mean delayed language development, there is an essential need for tailored parent-accessible resources.

Children with chronic illnesses often miss school, leading to negative outcomes like diminished health-related quality of life (HRQoL) and sense of belonging. Telepresence robots are suggested to keep these children connected to peers and education, yet little research has explored their impact. This study assessed effects of a telepresence system on HRQoL and sense of belonging in 29 patients with chronic illnesses aged 6 to 18 years, who were absent from school. Using a one-group pre-posttest design, participants completed questionnaires before and 6 months after receiving the robot. It was expected that HRQoL and sense of belonging would remain stable due to the robot. Wilcoxon tests indicated no decline in HRQoL (Z = -.958, 95% CI [-3.1, 8.3]) or sense of belonging (Z = -1.409, 95% CI [-0.3, 0.8]). Spearman correlations revealed a significant correlation between age and changes in school (rs = 0.621, 95% CI [0.200, 0.848]) and friends' subscales (rs = 0.579, 95% CI [-0.136, 829]), suggesting adolescents benefit particularly from the robot. Consistent with prior research, this study shows no change in psychosocial factors, indicating a stabilizing effect of telepresence robots and contributing to sustainable psychosocial care for pediatric patients.

Using a blended diet as an alternative to commercial formula is becoming more popular amongst parents and carers of children and young people (CYP) requiring long-term enteral tube feeding (ETF). Emerging evidence has demonstrated physiological and social benefits; however, families report feeling unsupported to use a blended diet in settings outside the home. This study aimed to explore the attitudes of health and social care staff towards the use of blended diets for CYP. Health and social care professionals with experience of blended diets were invited to partake in an online semi-structured qualitative interview. Thematic analysis was used to identify themes. Five participants from health, education and social care settings were interviewed. Online interviews worked effectively for data collection to allow flexibility to accommodate participants' care roles and avoid face-to-face contact necessary with Coronavirus disease 2019 restrictions. Three themes were identified in the data:• Change from medicalised enteral tube feeding practice.• Individual, person-centred approach.• Open support networks and responsibility.Findings showed that blended diets can be accommodated; however, barriers to implementation remain. Medicalisation of ETF continues to impair acceptance of blended diets whilst effective multi-disciplinary team communication and support facilitates its use in settings outside the home.

The current systematic literature review aimed to summarize and evaluate existing literature regarding parental relationship functioning during and after childhood cancer, with an exploratory evaluation regarding the impact of national health coverage model (proxy for finances). This review used MEDLINE, PsychInfo, Embase, and CENTRAL search database. Articles were reviewed (N = 3060) against inclusion criteria, with 512 abstracts screened and 87 full-text retrieved and reviewed. Inclusion criteria: (1) childhood cancer, (2) measures parental relationship functioning, (3) English, and (4) new, empirical data. A modified version of the Downs and Black checklist was used to assess risk of bias. Narrative synthesis was used to present and discuss results. Final included articles (N = 36) revealed mostly positive or neutral findings across parental relationship functioning subdomains within 6 months (T1) and after 6 months (T2) of childhood cancer diagnosis. Sexual intimacy was negatively impacted across timepoints. Parental stress was higher than norms at T1. Marital conflict and adjustment were also worse at T1 but returned to previous levels at T2. Some variability in parental relationship functioning was observed among the different health coverage models, but these differences were not significant. Results support systematic screening and systems-based parent support programs for families of children with cancer. Mixed-methods studies examining parental relationships longitudinally and utilizing operational definitions for out-of-pocket spending are needed.

The Care for Child Development (CCD) program may improve child development outcomes in resource-limited settings, but has not yet been adapted to group-based settings to facilitate sustainable dissemination. In this study, we determined the acceptability and feasibility of a group-based CCD program, with evaluation of program outcomes for child development, home environment, and symptoms of maternal depression as secondary outcomes. We evaluated this adapted program using a 2 × 2 crossover-designed pilot study administered over 10 bi-weekly sessions. Acceptability and feasibility were assessed through focus group discussions using qualitative methods. Child development, home observations, and symptoms of maternal depression were evaluated at baseline, 6 months, and 12 months and assessed quantitatively. Twenty-six mother-child dyads participated. Overall, they perceived CCD as acceptable and feasible, and especially beneficial within its group-based format. Although there were no measured improvements in child development, improvements in stimulating home environments (mean difference 2.5, 95% C.I. [0.37, 4.72]) were found. Further scale-up of this intervention is needed to determine effectiveness.

Hirschsprung's disease is a common cause of lower intestinal obstruction in newborns. It has variable postoperative outcomes affecting quality of life. The study was aimed at assessing postoperative bowel function in children with Hirschsprung's disease. It was conducted on 120 children operated for Hirschsprung's disease. A structured questionnaire for bowel function score was used and analyzed using relevant statistical tests. Of the 120 children in the study, 97 (80.8%) were male with 49 (40.8%) diagnosed during neonatal age and others by 2 years of age. Ninety-three (77.5%) of them had the classic type. Diversion colostomy was done in 104 (86.6%), and two-staged endorectal pullthrough was performed in 62 (72.5%) of cases with a 16% rate of retained aganglionosis. Postoperative continence was excellent in 46 (57%) and good in 26 (32%) with an incontinence rate of 11%. None of the outcome predictor showed significant influence. Optimal postoperative bowel function was obtained in the majority of patients with two-stage procedures, and the overall outcome of bowel function in children was not influenced by age, gender, level of aganglionosis, and type of procedure. Longer follow-up periods are required for definitive information.

Practices for promoting a child's best interests in rehabilitation are not sufficiently understood. This study describes the practices from the perspectives of professionals and parents of children with disabilities. We conducted 11 interviews: 5 in focus groups with professionals (n = 27 [69%]), 3 with parents (n = 9 [23%]), and 3 individual interviews of paediatric neurologists (n = 3 [8%]). We used a qualitative approach, which included inductive content analysis, to examine the transcribed interview data. The practices for promoting a child's best interests consisted of collective framing of child-specific rehabilitation, fostering a fulfilling daily life for the child, and ensuring appropriate rehabilitation. This was enhanced by using child-specific practices and comprehensively understanding the child's rehabilitation in everyday life but was hindered by the absence of an established process and guidelines. The results highlighted substantial challenges in collaboration aligned with the child's best interests, enabling the child's active participation, and addressing the individual needs of the child and family. Promoting best interests through family-professional partnerships by using a systemic and ecological approach could guide the rehabilitation process and ensure the child's right to participate.