Hearing the Child's Voice: Their Lived Experience in the Pediatric Intensive Care Unit

Background: More than 200,000 children are admitted annually to Pediatric Intensive Care Units (PICUs) in the US. Research has shown young children can provide insight into their hospitalization experiences; child reports rather than parental reports are critical to understanding the child’s experience. Information relating to children’s perceptions while still in the PICU is scarce. Aims: The purpose of this qualitative study was to investigate school age children’s and adolescents’ perceptions of PICU while in the PICU; changes in perceptions after transfer to the General Care Unit (GCU); differences in perceptions of school age children/adolescents and those with more invasive procedures. Methods: Interviews were conducted in PICU within 24-48 hours of admission and 24-48 hours after transfer to GCU. Data on demographics, clinical care and number/types of procedures were obtained. Results: Participants were 7 school age children, 13 adolescents; 10 Hispanic; 13 males. Five overarching themes: Coping Strategies, Environmental Factors, Stressors, Procedures/Medications, and Information. Children emphasized the importance of peer support and visitation; adolescents relied strongly on social media and texting. Parent visits sometimes were more stressful than peer visits. Video games, TV, visitors, and eating were diversional activities. In the PICU, they wanted windows to see outside and interesting things to see on the ceiling above them. Children expressed anticipatory fear of shots and procedures, frustration with lab work, and overwhelming PICU equipment. Number of child responses was higher in PICU (927) than GCU (593); the largest difference was in Environmental Factors. Variations between school age children and adolescents were primarily in Coping Strategies, especially in social support. Number of GCU procedures were the same (8 children) or greater (2 children) than PICU procedures. Discussion: Admission to PICU is a very stressful event. Perceptions from children while still in PICU found information not previously found in the literature. Longitudinal studies to identify children’s perceptions regarding PICU hospitalization and post-discharge outcomes are needed.

Estilos Educativos Parentais (EMBU-A), Sintomatologia Depressiva/Ansiosa, Stress e Autoestima, numa Amostra de Adolescentes

Introdução. Os estilos educativos parentais enquanto clima educativo geral apresentam um forte impacto em diferentes resultados desenvolvimentais (e.g., sintomatologia depressiva/ansiosa e auto estima) da criança/jovem. Podem ser estudados de um ponto de vista dimensional, considerando, por exemplo, as dimensões Controlo/Sobreproteção e Suporte, ou categorial, seguindo, por exemplo, a abordagem de Baumrind, e Maccoby e Martin. Neste estudo pretendemos: verificar se existem diferenças por género e idade, nas dimensões Suporte Emocional, Sobreproteção e Rejeição (EMBU-A) (cada progenitor separadamente), na sintomatologia depressiva/ansiosa e na auto estima; avaliar se existem diferenças nas dimensões do EMBU-A, entre progenitores, na amostra total e por género; explorar associações entre as variáveis centrais do estudo (estilos educativos, sintomatologias e auto estima) e variáveis sociodemográficas, também nas três amostras; explorar diferenças entre quatro grupos criados (Pai-Filho, Pai-Filha; Mãe-Filho e Mãe-Filha) nas dimensões do EMBU-A; combinando a Sobreproteção e o Suporte Emocional (EMBU-A), e definindo os estilos educativos parentais autoritário, autoritativo, permissivo e negligente, calcular a prevalência dos mesmos na nossa amostra (por Pai e por Mãe) e explorar as suas associações com as sintomatologias e com a auto estima (separadamente, por progenitor). Metodologia. A nossa amostra é constituída por 284 adolescentes (idade média = 14,5; DP = 1,68; raparigas, n = 171, 60,2%). Todos preencheram um protocolo composto por um questionário sociodemográfico, pela Rosenberg Self- Esteem Scale (RSES), pelo DASS-21 e pelo Parental Rearing Style Questionnaire for use with Adolescents (EMBU-A/A). Resultados. De salientar o facto de os adolescentes percecionarem a mãe como apresentando valores mais elevados em todas as dimensões do EMBU-A, por comparação com o pai. Da mesma forma, ainda que com diferentes padrões de associação conforme o género, é de salientar a associação entre níveis maiores de Suporte emocional e níveis mais baixos de sintomatologia depressiva/ansiosa e stress, e a associação entre as dimensões Sobreproteção e Rejeição e níveis superiores desses resultados. Uma mais baixa escolaridade do pai associa-se a menor Suporte emocional e uma maior escolaridade da mãe a maior Sobreproteção. Uma díade constituída por progenitor e adolescente do género masculino apresenta resultados inferiores em todas as dimensões do EMBU-A, por comparação com díades formadas por mãe-filho/filha. O estilo Autoritativo é o mais prevalente na nossa amostra (em ambos os progenitores) e o estilo Autoritário é aquele que se associa a pontuações mais elevadas de psicopatologia e a uma menor auto estima. Discussão. De uma forma, genérica os resultados seguem de perto a literatura e revelam a associação entre valores mais elevados na dimensão Suporte emocional e níveis mais baixos de psicopatologia e stress, e a associação entre as dimensões Sobreproteção e Rejeição e níveis superiores desses resultados. Igualmente, o estilo educativo Autoritário está claramente associado a piores resultados nessas mesmas variáveis. São discutidas algumas implicações, no que toca a programas psicoeducativos/educação parental. / Introduction. As a general educational environment, parental rearing styles have a strong impact in different outcomes of development of the child or teenager (e.g. symptoms of depression/ anxiety and self-esteem). These can be studied from a dimensional point of view considering for example the dimensions Control/Overprotection and Support or from a categorical point of view following for example the approach of Baumrind and Maccoby and Martin. This study aims at checking whether there are differences of gender and age in the dimensions of Emotional Support, Overprotection and Rejection (EMBU-A) (each parent separately) in depressive symptoms/anxiety and self esteem; assessing whether there are differences in the dimensions of the EMBU-A, between parents in the total sample and by gender; exploring associations between the study’s main variables (rearing styles, symptomatology and self esteem) and sociodemographic variables, also in the three samples; exploring differences between the four groups created (Father-Son, Father-Daughter, Mother-Son and Mother-Daughter) in the dimensions of the EMBU-A, combining Overprotection and Emotional Support(EMBU-A) and defining the authoritarian, authoritative, indulgent, and neglectful parental rearing styles. The aim is also to estimate the prevalence of these in our sample (by Father and Mother) and explore their associations to the symptomatology and self esteem (separately, per parent). Methodology. Our sample is composed of 284 teenagers (average age = 14,5; DP = 1,68; girls, n = 171, 60,2%). All participants filled in a protocol of questionnaires consisting of a set of socio demographic questions by Rosenberg Self- Esteem Scale (RSES), by DASS-21 and by Parental Rearing Style Questionnaire for use with Adolescents (EMBU-A/A). Outcomes. It is important to emphasize the fact that teenagers perceive their mother as having higher values in all the EMBU-A dimensions compared to their father. In the same way, though with different patterns of association according to gender, it is important to emphasize the association of higher levels of Emotional Support and lower levels of depressive/anxious symptomathology and stress and the association of Overprotection and Rejection and higher levels of those outcomes. A father’s lower level of education is associated to a lower Emotional Support while a mother’s higher level of education is associated to a greater Overprotection. A dyad composed of male parent and male teenager presents lower outcomes in all EMBU-A dimensions if compared to dyads composed of mother-son/daughter. The authoritative style is the most prevalent in our sample (in both parents) and the authoritarian style is the one associated to higher scores of psychopathology and lower levels of self esteem. Debate. In general, the outcomes closely follow the literature review and reveal the association of higher values in the Emotional Support dimension and lower levels of psychopathology and stress and also the association of the dimensions of Overprotection and Rejection and higher levels of those outcomes. Equally, the authoritarian rearing style is clearly associated to the worst outcomes in those same variables. Some implications are discussed as far as psychoeducational programmes and parental rearing are concerned.

A Comparison of Audio Recordings and Therapist's Process Notes in Child and Adolescent Psychoanalytic Psychotherapy

Therapistsʼ process notes - written descriptions of a session produced shortly afterwards from memory - hold a significant role in child and adolescent psychoanalytic psychotherapy. They are central in training, in supervision, and in developing oneʼs understanding through selfsupervision and forms of psychotherapy research. This thesis examines such process notes through a comparison with audio recordings of the same sessions. In so doing, it aims to generate theory that might illuminate the causes of significantly patterned discrepancies between the notes and recordings, in order to understand more about the processes at work in psychoanalytic psychotherapy and to explore the nature of process notes, their values and limitations. The literature searches conducted revealed limited relevant studies. All identified studies that compare process notes with recordings of sessions seek to quantify the differences between the two forms of recording. Unlike these, this thesis explores the meaning of the differences between process notes and recordings through qualitative data analysis. Using psychoanalytically informed grounded theory, in total nine sets of process notes and recordings from three different psychoanalytic psychotherapists are analysed. The analysis identifies eight core categories of findings. Initial theories are developed from these categories, most significantly concerning the role and influence of a ʻcore transference dynamicʼ between therapist and patient. Further theory is developed on the nature and function of process notes as a means for the therapistʼs conscious and unconscious processing of the session, as well as on the nature of the influence of the relationships – both internal and external – within which they are written. In the light of the findings, a proposal is made for a new approach for learning about the patient and clinical work, ʻthe comparison methodʼ (supervision involving a comparison of process notes and recordings), and, in particular, for its inclusion within the training of psychoanalytic psychotherapists. Further recommendations for research are also made.

Preschoolers’ Executive Control and Diurnal Cortisol as Mediators of the Relations of Prenatal Stress to Child Adjustment

Thesis (Ph.D.)--University of Washington, 2016-08

Delayed presentation of blunt duodenal injuries in children. Case report and review of literature

Background. Duodenal injuries are rare in children and classically present following a fall over the handle bar. Retroperitoneal location of the duodenum may lead to delay in diagnosis, and missed injuries are associated with increased morbidity and mortality. Case report. A 5-year-old child was admitted to the National Trauma Center, in Tirana (Albania), 28 hours after a Motor Vehicle Crash (MVC), complaining of mild abdominal pain. He was febrile (39°C) and had a white blood cells count of 18,000 mm3. On physical exam he had mild tenderness. Plain abdominal X-rays and Focused Abdominal Sonography for Trauma (FAST) were negative for free air or free fluid. The CT scan of the abdomen demonstrated free air and fluid in the retroperitoneal space. At laparatomy, a perforation of the second portion of the duodenum was found. A single layer suture repair of the duodenum with wide drainage was performed. The patient was discharged from the hospital tolerating oral feeding 8 days later. Conclusion. Duodenal injuries in children are rare. Most duodenal hematomas are managed non-operatively. This is a case of MCV with delayed presentation that was treated surgically for perforation successfully.

Child anxiety, resiliency, and the FRIENDS for Life program

Anxiety disorders are the most commonly diagnosed group of mental disorders in children (Kessler et al., 2012). Resiliency, defined as a child’s ability to successfully overcome an adverse event (Newland, 2014) is believed to be comprised of protective factors such as self-esteem and positive coping strategies (Rutter, 1987). These protective factors are related to child anxiety in that their presence or absence may augment or hinder a child’s resiliency towards anxiety-provoking events and situations (Lo Casico, Guzzo, & Pace, 2013; Thorne, Andrews, & Nordstokke, 2013). The FRIENDS for Life (FFL) program is a school-based anxiety prevention program which aims to decrease anxiety and increase resiliency in 8- to 11-year-old children (Barrett & Sonderegger, 2003). Previous studies have shown FFL to be an effective tool in decreasing anxiety and increasing resiliency; however, not all previous studies have utilized control or comparison groups (Brownlee et al., 2013; Neil & Christensen 2007; Stopa, Barrett, & Golingi, 2011). Moreover, existing FRIENDS literature has not previously considered the potential role of parent anxiety in child outcomes. The present study aimed to evaluate child anxiety, resiliency, and parent anxiety in relation to the FFL program while including a no-treatment control group. It was hypothesized that child anxiety would decrease and child resiliency would increase following FFL. Results obtained from a non-identified school-based sample were not entirely consistent with predictions, such that decreases in anxiety and increases in resiliency were observed in both the experimental and control groups.

First-episode psychosis in a 15 year-old female with clinical presentation of anti-NMDA receptor encephalitis: a case report and review of the literature

BACKGROUND: Anti-NMDA receptor encephalitis is an autoimmune disease that was identified in 2007, and manifests in a stepwise manner with psychiatric, neurological and autonomic symptoms. The disease is caused by autoantibodies against NMDA receptors. It can have a paraneoplastic origin, mainly secondary to ovarian teratomas, but it can also be unrelated to the tumor. This disease can affect both sexes and all ages. CASE PRESENTATION: Here, we present a case of a 15 year-old female adolescent with first-episode psychosis with anti-NMDA receptor encephalitis not related to tumor, which manifested with delusion, hallucinations, panic attacks, agitation, and neurological symptoms, and later with autonomic instability. She was treated with immunotherapy and psychiatric medication resulting in improvement of her main psychiatric and neurological symptoms. CONCLUSION: Our main objective in presenting this case is to alert clinicians to this challenging and recent disease that has a clinical presentation that might resemble a functional psychiatric condition and can be underdiagnosed in the context of child and adolescent psychiatry

Analysis of maternal and child health policies in Malawi: The methodological perspective

The question of why most health policies do not achieve their intended results continues to receive a considerable attention in the literature. This is in the light of the recognized gap between policy as intent and policy as practice, which calls for substantial research work to understand the factors that improve policy implementation. Although there is substantial work that explains the reasons why policies achieve or fail to achieve their intended outcomes, there are limited case studies that illustrate how to analyze policies from the methodological perspective. In this article, we report and discuss how a mixed qualitative research method was applied for analyzing maternal and child health policies in Malawi. For the purposes of this article, we do not report research findings; instead we focus our dicussion on the methodology of the study and draw lessons for policy analysis research work. We base our disusssion on our experiences from a study in which we analyzed maternal and child health policies in Malawi over the period from 1964 to 2008. Noting the multifaceted nature of maternal and child health policies, we adopted a mixed qualitative research method, whereby a number of data collection methods were employed. This approach allowed for the capturing of different perspectives of maternal and child health policies in Malawi and for strengthening of the weaknesses of each method, especially in terms of data validity. This research suggested that the multidimensional nature of maternal and child health policies, like other health policies, calls for a combination of research designs as well as a variety of methods of data collection and analysis. In addition, we suggest that, as an emerging research field, health policy analysis will benefit more from case study designs because they provide rich experiences in the actual policy context.

READY FOR KINDERGARTEN: A TRAINING PROGRAM DESIGNED TO ENCOURAGE PARENT-CHILD CONVERSATION DURING THE PRESCHOOL YEARS

Many children in the United States begin kindergarten unprepared to converse in the academic language surrounding instruction, putting them at greater risk for later language and reading difficulties. Importantly, correlational research has shown there are certain experiences prior to kindergarten that foster the oral language skills needed to understand and produce academic language. The focus of this dissertation was on increasing one of these experiences: parent-child conversations about abstract and non-present concepts, known as decontextualized language (DL). Decontextualized language involves talking about non-present concepts such as events that happened in the past or future, or abstract discussions such as providing explanations or defining unknown words. As caregivers’ decontextualized language input to children aged three to five is consistently correlated with kindergarten oral language skills and later reading achievement, it is surprising no experimental research has been done to establish this relation causally. The study described in this dissertation filled this literature gap by designing, implementing, and evaluating a decontextualized language training program for parents of 4-year-old children (N=30). After obtaining an initial measure of decontextualized language, parents were randomly assigned to a control condition or training condition, the latter of which educated parents about decontextualized language and why it is important. All parents then audio-recorded four mealtime conversations over the next month, which were transcribed and reliably coded for decontextualized language. Results indicated that trained parents boosted their DL from roughly 17 percent of their total utterances at baseline to approximately 50 percent by the mid-point of the study, and remained at these boosted levels throughout the duration of the study. Children’s DL was also boosted by similar margins, but no improvement in children’s oral language skills was observed, measured prior to, and one month following training. Further, exploratory analyses pointed to parents’ initial use of DL and their theories of the malleability of intelligence (i.e., growth mindsets) as moderators of training gains. Altogether, these findings are a first step in establishing DL as a viable strategy for giving children the oral language skills needed to begin kindergarten ready to succeed in the classroom.

Injuries of non-lethal child physical abuse to the crania and orofacial regions: a scientific review

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

The healing power of grandparents who parent

This paper explores the changing role of contemporary grandparents with many demonstrating a willingness and ability to take on parental responsibilities for their grandchildren, where they may face challenges and opportunities in difficult times. Three main forms of grand parenting are identified in the literature, those who hâve primary responsibility and are raising their grand children as their main carers perhaps in response to crisis situations, those who live in extended families and participate in care, and those who provide day care while the child's parents work. The rôle of Grandparents encompasses ail three areas in the United Kingdom. This has occurred as a resuit of the increased récognition of children living in abusive families, of the increasing frequency of divorce, single parenting, children and families living in poverty, socio-economic deprivation and the lack of available or subsidised child care in the United Kingdom when parents hâve to work to support the family. Ail of this against the backdrop the Every Child Matters change for children Agenda. When grandparents step into a troubled situation and attempt to offer stability and security for their grandchildren they may hâve to manage the combined responsibilities of family caregivers and parental figures. Grandparenthood is atenuous rôle, lacking clear agreement on behaviour norms. In the current culture of advice and parenting support, while care must be taken not to undermine parenting skills or make judgements about the ability to cope with the demands of childcare, an exploration of the impact on grandparents, and children in the context of families must be undertaken. Due to the complex web of interrelated factors the process and outcomes of care giving by grandparents is not well known in the literature. It is proposed therefore that it is timely to explore the impact of this on the health of children and their families in the current climate of change when there has been dissolution of the nuclear family and grandparents are playing increasingly significant rôles in healing and supporting their families.

The fact of metafiction in nineteenth-century children's literature : Nathaniel Hawthorne's A Wonder Book and Elizabeth Stoddard's Lolly Dinks's Doings

This article examines two American books for children: Nathaniel Hawthorne’s A Wonder Book for Girls and Boys (1851) and Elizabeth Stoddard’s Lolly Dinks’s Doings (1874). In both books, fairy tales or myths are framed by a contemporary American setting in which the stories is told. It is in these realistic frames with an adult storyteller and child listeners that metafictional features are found. The article shows that Hawthorne and Stoddard use a variety of metafictional elements. So, although metafiction has been regarded as a postmodernist development in children’s literature, there are in fact instances of metafiction in nineteenth-century American children’s literature.

Complicaciones perioperatorias en el manejo de corrección de escoliosis en un hospital de tercer nivel en la ciudad de Bogotá entre el 2010-2014

Introducción: la escoliosis, definida como una deformidad de la columna vertebral en más de 10 grados, se agrupa en 4 orígenes distintos: idiopática, congénita, neuromuscular y sindromática. Cada una de ellas con diferente riesgo de progresión en severidad, lo que determina la necesidad de corrección quirúrgica para cada caso en su tratamiento. Conocer las probabilidades de complicación en la etapa peri operatoria, abre la posibilidad de dar asesoría integral que mida la relación riesgo - beneficio de la medida terapéutica. Métodos: se realiza un estudio retrospectivo de corte transversal. La información se obtiene de los registros de las historias clínicas desde el año 2010 al 2014, de pacientes intervenidos quirúrgicamente para la corrección de escoliosis. Resultados: Se obtuvieron 318 registros de procedimientos en 230 pacientes. El tipo de escoliosis presentado con mayor frecuencia es de origen idiopático 108 (47%); en los 4 tipos de escoliosis se observa mayor número de mujeres 169 (73,4%). La edad donde se concentran la mayor cantidad de cirugías para corrección de escoliosis está entre 10 - 14 años. De 13 complicaciones seleccionadas, aquellas de origen respiratorio son las de mayor probabilidad de ocurrencia (OR 30 - sig 0,000). La característica sociodemográfica “edad” logra predecir el 46% de las complicaciones perioperatorias. Discusión: La corrección de escoliosis va acompañada de comorbilidades, datos sociodemográficos y diagnósticos que en conjunto determinan el grado de complicación peri operatoria. Se necesitan registros clínicos muy completos para poder determinar la asociación entre la etiología de la escoliosis con las complicaciones más comunes. Este trabajo propone y evidencia los datos de los registros clínicos como predictores de complicaciones quirúrgicas de escoliosis. Esto exige un trabajo institucional interno que garantice la calidad en los registros de datos clínicos.

Holocaust postmemory in contemporary anglophone children's literature

This dissertation discusses contemporary Anglophone children’s literature representing the Holocaust and it claims that, through the reading of historical novels, children can acquire a specific kind of postmemory, which I call ‘attitudinal postmemory’. The works analyzed have been written by ‘non-related’ authors, meaning writers who are not witnesses nor their descendants. Attitudinal postmemory is based on the readers’ establishment of a personal-emotional link with the Holocaust by means of narrative empathy towards the characters; it is an ‘active’ kind of memory because it will hopefully convert into an informed, respectful attitude towards peers that opposes the Nazi ideology. The dissertation is structured into two main parts. Part One provides an overview of the origins and development of Holocaust memory in Western countries. Chapter 1 introduces two major historiographical-literary debates and the following chapter discusses three main issues concerning the representation of the Holocaust (naming, the need to represent, and the ‘right to’ represent) while considering the forms and genres traditionally used and considered ‘appropriate’. Focusing on the scope of literary narratives, Chapter 3 explains how the presence of a personal-emotional link is essential to acquire Holocaust postmemory and, in particular, attitudinal postmemory. The criteria adopted with regard to the case studies are described in Chapter 4. Part Two discusses the process of interweaving historical truth with fiction and how historical fiction helps child readers acquire attitudinal postmemory. After a brief overview of the genre in Chapter 5, Chapter 6 probes how it is possible to meet the two main expectations of historical fiction while avoiding a disrespectful stance towards the Holocaust. Chapter 7 discusses the idea of empathy and some issues in the representation of Nazi evil, while Chapter 8 offers a comparative analysis of the case studies proposed, including authors from the UK, Ireland, Australia, and the USA.

Pedagogy of healthcare interactions. A study on pediatric well-child visits as culture-oriented and culture-making sites

This study investigates interactions between parents and pediatricians during pediatric well-child visits. Despite constituting a pivotal moment for monitoring and evaluating children’s development during the critical ‘first thousand days of life’ and for family support, no study has so far empirically investigated the in vivo realization of pediatrician-parent interactions in the Italian context, especially not from a pedagogical perspective. Filling this gap, the present study draws on a corpus of 23 videorecorded well-child visits involving two pediatricians and twenty-two families with children aged between 0 and 18 months. Combining an ethnographic perspective and conversation analysis theoretical-analytical constructs, the micro-analysis of interactions reveals how well-child visits unfold as culture-oriented and culture-making sites. By zooming into what actually happens during these visits, the analysis shows that there is much more than the “mere” accomplishment of institutionally relevant activities like assessing children’s health or giving parents advice on baby care. Rather, through the interactional ways these institutional tasks are carried out, parents and pediatricians presuppose, ratify, and transmit culturally-informed models of “normal” growth, “healthy” development, “good” caring practices, and “competent” parenting, thereby enacting a pervasive yet unnoticed educational and moral work. Inaugurating a new promising line of inquiry within Italian pedagogical research, this study illuminates how a) pediatricians work as a “social antenna”, bridging families’ private “small cultures” and broader socio-cultural models of children’s well-being and caregiving practices, and b) parents act as agentive, knowledgeable, (communicatively) competent, and caring parents, while also sensitive to the pediatrician’s ultimate epistemic and deontic authority. I argue that a video-based, micro-analysis of interactions represents a heuristically powerful instrument for raising pediatricians’ and parents’ awareness of the educational and moral density of well-child visits. Insights from this study can constitute a valuable empirical resource for underpinning medical and parental training programs aimed at fostering pediatricians’ and parents’ reflexivity.