Care Planning in Children and Young Peoples Nursing

Care Planning in Children and Young People's Nursing addresses a selection of the most common concerns that arise when planning care for infants, children and young people within the hospital and community setting. Clear and detailed, this text reflects both the uniqueness and diversity of contemporary children's nursing and utilizes images and case studies to provide a holistic insight into the practice of care planning through the reporting of best available evidence and current research, policy and education.

Divided into sections for ease of reference, Care Planning in Children and Young People’s Nursing explores both the theory and practice of care planning. Chapters on the principles of care planning include issues such as managing risk, safeguarding children, ethical and legal implications, integrated care pathways, interprofessional assessment, and invaluable parent perspectives. Additional chapters on the application of planning care examine the practical aspects of a wide range of specific conditions including cystic fibrosis, obesity, cardiac/renal failure and HIV/AIDS. Each chapter is interactive, with questions, learning activities and points for discussion creating an engaging and enquiry-based learning approach.

Care Planning in Children and Young People’s Nursing is a definitive resource, reflecting innovative practice which is suitable for undergraduate and postgraduate nurse education.

Primary airway epithelial cell culture and asthma in children-lessons learnt and yet to come

Until recently the airway epithelial cell (AEC) was considered a simple barrier that prevented entry of inhaled matter into the lung parenchyma. The AEC is now recognized as having an important role in the inflammatory response of the respiratory system to inhaled exposures, and abnormalities of these responses are thought to be important to asthma pathogenesis. This review first explores how the challenges of studying nasal and bronchial AECs in children have been addressed and then summarizes the results of studies of primary AEC function in children with and without asthma. There is good evidence that nasal AECs may be a suitable surrogate for the study of certain aspects of bronchial AEC function, although bronchial AECs remain the gold standard for asthma research. There are consistent differences between children with and without asthma for nasal and bronchial AEC mediator release following exposure to a range of pro-inflammatory stimulants including interleukins (IL)-1β, IL-4, and IL-13. However, there are inconsistencies between studies, e.g., release of IL-6, an important pro-inflammatory cytokine, is not increased in children with asthma relative to controls in all studies. Future work should expand current understanding of the "upstream" signalling pathways in AEC, study AEC from children before the onset of asthma symptoms and in vitro models should be developed that replicate the in vivo status more completely, e.g., co-culture with dendritic cells. AECs are difficult to obtain from children and collaboration between centers is expected to yield meaningful advances in asthma understanding and ultimately help deliver novel therapies. 

Cross-readings and ecoliteracy in children's pop-up books

The purpose of this text is to analyse two recently been published pop-up books aimed at children, by Anouck Boisrobert e Louis Rigaud, Popville (2009) and Dans la forêt du paresseux [Wake up, Sloth!, En el bosque del perezoso] (first published in 2009 and 2012, accompanied with texts by Joy Sorman and Sophie Strady, respectively). These books were published originally in France by Hélium Editions, but they can now be found in several western countries and in many languages (Catalan, French, Dutch, English, German, Italian, Portuguese and Spanish, at least). The objective is to analyse their verbal text and their visual aspects produced by a sophisticated paper engineered to question how they achieve what seems to be one of their goals, the promotion of the readers' ecoliteracy (Orr, 1992) by his involvement in the reading process. This issue seems to be one of the main trends on children's literature in western societies nowadays, transcending the traditional and almost omnipresent role of scenario that nature plays in many children's narratives.

The cardiovascular hemodynamic responses to various levels of orthostatic stress in children

The ability of the cardiovascular system to quickly and efficiently adapt to an orthostatic stress is vital for the human body to function on earth. The way in which the various aspects of the cardiovascular system work together to counteract an orthostatic stress has been previously quantified in the adult population. However, there are still many unknowns surrounding the topic of how the cardiovascular system functions to cope with this same stress in children. The purpose of this study was to describe the cardiovascular hemodynamic adaptations to various levels of orthostatic stress induced using a lower body negative pressure (LBNP) chamber in pre-pubertal boys. A secondary purpose was to determine indices of baroreceptor sensitivity (BRS) at both rest and during low levels of LBNP in this same pediatric sample. Finally, this study aimed to compare the relative responses to LBNP between the children and adults. To complete the study 20 healthy pre-pubertal boys and adult males (9.3 ± 1.1 and 23 ± 1.8 years of age respectively) were recruited and randomly exposed to three levels of LBNP (15, 20 and 25 mmHg). At rest and during the application of the LBNP heart rate (HR), manual and bcat-by-beat systolic (SBP), diastolic (DBP) and mean arterial blood pressure (MAP) were monitored continuously. Aortic diameter was measured at rest and peak aortic blood velocity (PV) was recorded continuously for at least I minute during each baseline and LBNP condition. From the raw data HR, stroke volume (SV), cardiac output (Q), total peripheral resistance (TPR), low frequency baroreceptor sensitivity (LF BRS), high frequency baroreceptor sensitivity (HF BRS) and LFIIIF ratio were calculated. At rest, llR wa'i higher and SBP, SV, Q and LF/HF ratio were lower in the children compared to the adult males (pgJ.05). In response to the increasing LEN!> IIR and TPR increased, and LF BRS. SV and Q decreased in the adult group (pSf).05). while the same levels of LBNP caused an increase in TPR and a decrease in SBP, SV and Q in the children (pSf).05). Although not significant, the LF/HF ratio in the adult group showed an increasing trend in response to increased negative pressure (p=O.088). As for resting BRS, there were no significant differences in LF or HF BRS between the children and the adults despite a tendency for both measures to be 18% lower in the children. Also the LF/HF ratio was almost significantly greater in the adults compared to the children (p=O.057). In addition, a comparison between the relative adult and child responses to LBNP yielded no significant group by level interactions. This result should be taken with caution though, as the low sample size and high measurement variability generated very low statistical power for this analysis. In conclusion, the results of this study suggest that the hemodynamic adaptations to an orthostatic stress were less pronounced in the prepubertal males, most likely due to an underdeveloped autonomic system. These results need to be strengthened by further research before any implications can be derived for health care purposes.

Canadian Society for Exercise Physiology Position Paper: Resistance Training in Children and Adolescents

Many position stands and review papers have refuted the myths associated with resistance training (RT) in children and adolescents. With proper training methods, RT for children and adolescents can be relatively safe and improve overall health. The objective of this position paper and review is to highlight research and provide recommendations in aspects of RT that have not been extensively reported in the pediatric literature. In addition to the well-documented increases in muscular strength and endurance, RT has been used to improve function in pediatric patients with cystic fibrosis, cerebral palsy and burn victims. Increases in children’s muscular strength have been attributed primarily to neurological adaptations due to the disproportionately higher increase in muscle strength than in muscle size. Although most studies using anthropometric measures have not shown significant muscle hypertrophy in children, more sensitive measures such as magnetic resonance imaging and ultrasound have suggested hypertrophy may occur. There is no minimum age for RT for children. However the training and instruction must be appropriate for children and adolescents involving a proper warm-up, cool-down and an appropriate choice of exercises. It is recommended that low-to-moderate intensity resistance should be utilized 2-3 times per week on non-consecutive days, with 1-2 sets initially, progressing to 4 sets of 8-15 repetitions for 8-12 exercises. These exercises can include more advanced movements such as Olympic style lifting, plyometrics and balance training, which can enhance strength, power, co-ordination and balance. However specific guidelines for these more advanced techniques need to be established for youth. In conclusion, a RT program that is within a child’s or adolescent’s capacity, involves gradual progression under qualified instruction and supervision with appropriately sized equipment can involve more advanced or intense RT exercises which can lead to functional (i.e. muscular strength, endurance, power, balance and co-ordination) and health benefits.

Genes involved in the metabolism of fatty acids and risk for Crohn's disease in children: a candidate gene study

Contexte - La prévalence de la maladie de Crohn (MC), une maladie inflammatoire chronique du tube digestif, chez les enfants canadiens se situe parmi les plus élevées au monde. Les interactions entre les réponses immunes innées et acquises aux microbes de l'hôte pourraient être à la base de la transition de l’inflammation physiologique à une inflammation pathologique. Le leucotriène B4 (LTB4) est un modulateur clé de l'inflammation et a été associé à la MC. Nous avons postulé que les principaux gènes impliqués dans la voie métabolique du LTB4 pourrait conférer une susceptibilité accrue à l'apparition précoce de la MC. Dans cette étude, nous avons exploré les associations potentielles entre les variantes de l'ADN des gènes ALOX5 et CYP4F2 et la survenue précoce de la MC. Nous avons également examiné si les gènes sélectionnés montraient des effets parent-d'origine, influençaient les phénotypes cliniques de la MC et s'il existait des interactions gène-gène qui modifieraient la susceptibilité à développer la MC chez l’enfant. Méthodes – Dans le cadre d’une étude de cas-parents et de cas-témoins, des cas confirmés, leurs parents et des contrôles ont été recrutés à partir de trois cliniques de gastro-entérologie à travers le Canada. Les associations entre les polymorphismes de remplacement d'un nucléotide simple (SNP) dans les gènes CYP4F2 et ALOX5 ont été examinées. Les associations allélique et génotypiques ont été examinées à partir d’une analyse du génotype conditionnel à la parenté (CPG) pour le résultats cas-parents et à l’aide de table de contingence et de régression logistique pour les données de cas-contrôles. Les interactions gène-gène ont été explorées à l'aide de méthodes de réduction multi-factorielles de dimensionnalité (MDR). Résultats – L’étude de cas-parents a été menée sur 160 trios. L’analyse CPG pour 14 tag-SNP (10 dans la CYP4F2 et 4 dans le gène ALOX5) a révélé la présence d’associations alléliques ou génotypique significatives entre 3 tag-SNP dans le gène CYP4F2 (rs1272, p = 0,04, rs3093158, p = 0.00003, et rs3093145, p = 0,02). Aucune association avec les SNPs de ALOX5 n’a pu être démontrée. L’analyse de l’haplotype de CYP4F2 a montré d'importantes associations avec la MC (test omnibus p = 0,035). Deux haplotypes (GAGTTCGTAA, p = 0,05; GGCCTCGTCG, p = 0,001) montraient des signes d'association avec la MC. Aucun effet parent-d'origine n’a été observé. Les tentatives de réplication pour trois SNPs du gene CYP4F2 dans l'étude cas-témoins comportant 225 cas de MC et 330 contrôles suggèrent l’association dans un de ceux-ci (rs3093158, valeur non-corrigée de p du test unilatéral = 0,03 ; valeur corrigée de p = 0.09). La combinaison des ces deux études a révélé des interactions significatives entre les gènes CYP4F2, ALOX et NOD2. Nous n’avons pu mettre en évidence aucune interaction gène-sexe, de même qu’aucun gène associé aux phénotypes cliniques de la MC n’a pu être identifié. Conclusions - Notre étude suggère que la CYP4F2, un membre clé de la voie métabolique LTB4 est un gène candidat potentiel pour MC. Nous avons également pu mettre en évidence que les interactions entre les gènes de l'immunité adaptative (CYP4F2 et ALOX5) et les gènes de l'immunité innée (NOD2) modifient les risques de MC chez les enfants. D'autres études sur des cohortes plus importantes sont nécessaires pour confirmer ces conclusions.

Sleep spindle activity in children with ADHD

Le trouble du déficit de l’attention/hyperactivité (TDA/H) est le désordre du comportement le plus commun chez les enfants. Les études suggèrent qu'un pourcentage élevé d'enfants atteints de TDA/H souffre de problèmes de sommeil et de somnolence diurne. Le mécanisme sous-jacent à ces difficultés demeure inconnu. Plusieurs études ont suggéré que les fuseaux de sommeil jouent un rôle dans les mécanismes de protection du sommeil. L'objectif de cette étude est de comparer les fuseaux lents (11-13 Hz) et rapides (14-15 Hz) chez des enfants atteints du TDA/H et des sujets contrôles. Nous prévoyons que comparativement aux enfants contrôles, les enfants atteints du TDA/H montreront une plus faible densité des fuseaux lents et rapides, et auront des fuseaux plus courts (sec), moins amples (uV) et plus rapides (cycle/sec). Enfin, nous prévoyons que ces effets seront plus prononcés dans les dérivations cérébrales antérieures que dans les dérivations plus postérieures du cerveau. Les enregistrements polysomnographiques (PSG) du sommeil de nuit ont été menés chez 18 enfants diagnostiqués avec le TDA/H et chez 26 sujets témoins âgés entre 7 et 11 ans. Un algorithme automatique a permis de détecter les fuseaux lents et rapides sur les dérivations frontales, centrales, pariétales et occipitales. Les résultats ont montré que, les caractéristiques PSG du sommeil ne différaient pas significativement entre les deux groupes. On ne note aucune différence significative entre les groupes sur nombre/densité des fuseaux lents et rapides ainsi que sur leurs caractéristiques respectives. Cette étude suggère que les mécanismes de synchronisation du l'EEG en sommeil lent, tel que mesuré par la densité et les caractéristiques des fuseaux lents et rapides en sommeil lent ne différent pas chez les enfants atteints du TDA/H.

Understanding and production of prosody in children with Williams syndrome: A developmental trajectory approach

This study investigated the development of three aspects of linguistic prosody in a group of children with Williams syndrome compared to typically developing children. The prosodic abilities investigated were: (1) the ability to understand and use prosody to make specific words or syllables stand out in an utterance (focus); (2) the ability to understand and use prosody to disambiguate complex noun phrases (chunking); (3) the ability to understand and use prosody to regulate conversational behaviour (turn-end). The data were analysed using a cross-sectional developmental trajectory approach. The results showed that, relative to chronological age, there was a delayed onset in the development of the ability of children with WS to use prosody to signal the most important word in an utterance (the focus function). Delayed rate of development was found for all the other aspects of expressive and receptive prosody under investigation. However, when non-verbal mental age was taken into consideration, there were no differences between the children with WS and the controls neither with the onset nor with the rate of development for any of the prosodic skills under investigation apart from the ability to use prosody in order to regulate conversational behaviour. We conclude that prosody is not a ‘preserved’ cognitive skill in WS. The genetic factors, development in other cognitive domains and environmental influences affect developmental pathways and as a result, development proceeds along an atypical trajectory.

Maternal antenatal anxiety, postnatal stroking and emotional problems in children: outcomes predicted from pre and postnatal programming hypotheses

Background Mothers' self-reported stroking of their infants over the first weeks of life modifies the association between prenatal depression and physiological and emotional reactivity at 7 months, consistent with animal studies of the effects of tactile stimulation. We now investigate whether the effects of maternal stroking persist to 2.5 years. Given animal and human evidence for sex differences in the effects of prenatal stress we compare associations in boys and girls. Method From a general population sample of 1233 first-time mothers recruited at 20 weeks gestation we drew a random sample of 316 for assessment at 32 weeks, stratified by reported inter-partner psychological abuse, a risk indicator for child development. Of these mothers, 243 reported at 5 and 9 weeks how often they stroked their infants, and completed the Child Behavior Checklist (CBCL) at 2.5 years post-delivery. Results There was a significant interaction between prenatal anxiety and maternal stroking in the prediction of CBCL internalizing (p = 0.001) and anxious/depressed scores (p < 0.001). The effects were stronger in females than males, and the three-way interaction prenatal anxiety × maternal stroking × sex of infant was significant for internalizing symptoms (p = 0.003). The interactions arose from an association between prenatal anxiety and internalizing symptoms only in the presence of low maternal stroking. Conclusions The findings are consistent with stable epigenetic effects, many sex specific, reported in animal studies. While epigenetic mechanisms may be underlying the associations, it remains to be established whether stroking affects gene expression in humans.

Photographic assessment of nasal morphology following rapid maxillary expansion in children

Objective: The aim of the present study was to use facial analysis to determine the effects of rapid maxillary expansion (RME) on nasal morphology in children in the stages of primary and mixed dentition, with posterior cross-bite. Material and Methods: Facial photographs (front view and profile) of 60 patients in the pre-expansion period, immediate post-expansion period and one year following rapid maxillary expansion with a Haas appliance were evaluated on 2 occasions by 3 experienced orthodontists independently, with a 2-week interval between evaluations. The examiners were instructed to assess nasal morphology and had no knowledge regarding the content of the study. Intraexanniner and interexanniner agreement (assessed using the Kappa statistic) was acceptable. Results: From the analysis of the mode of the examiners' findings, no alterations in nasal morphology occurred regarding the following aspects: dorsunn of nose, alar base, nasal width of middle third and nasal base. Alterations were only detected in the nasolabial angle in 1.64% of the patients between the pre-expansion and immediate post-expansion photographs. In 4.92% of the patients between the immediate post-expansion period and 1 year following expansion; and in 6.56% of the patients between the pre-expansion period and one year following expansion. Conclusion: RME performed on children in stages of primary and mixed dentition did not have any impact on nasal morphology, as assessed using facial analysis.

Auditory processing in children and adolescents in situations of risk and vulnerability

CONTEXTO E OBJETIVO: Crianças e adolescentes que vivem em situação de vulnerabilidade social apresentam uma série de problemas de saúde. Apesar disso, ainda é controversa a afirmação sobre a existência de alterações cognitivas e/ou sensoriais. O objetivo deste estudo foi investigar aspectos relacionados ao processamento auditivo, através da aplicação de testes de potencial evocado auditivo de tronco encefálico (PEATE) e avaliação comportamental do processamento auditivo em crianças em situação de rua, comparando a um grupo controle. TIPO DE ESTUDO E LOCAL: Estudo transversal no Laboratório de Processamento Auditivo, Faculdade de Medicina da Universidade de São Paulo. MÉTODOS: Os testes de processamento auditivo foram aplicados em um grupo de 27 indivíduos, subdivididos em grupos de 11 crianças (7 a 10 anos) e 16 adolescentes (11 a 16 anos) de ambos os sexos, em situação de vulnerabilidade social, e comparado a um grupo controle, formado por 21 crianças, subdivididas em grupos de 10 crianças e 11 adolescentes, pareados por idade, sem queixas. Também se aplicou os PEATE para investigação da integridade da via auditiva. RESULTADOS: Para ambas as faixas etárias, foram encontradas diferenças significantes entre grupos estudo e controle para a maioria dos testes aplicados, sendo que o grupo estudo apresentou desempenho estatisticamente pior do que o controle para todos os testes, exceto para o teste pediatric speech intelligibility. Apenas uma criança apresentou resultado alterado para os PEATE. CONCLUSÕES: Os resultados demonstraram pior desempenho do grupo estudo (crianças e adolescentes) para os testes comportamentais de processamento auditivo, apesar de estes apresentarem integridade da via auditiva em nível de tronco encefálico, demonstrada pela normalidade nos resultados do PEATE.

Eco-physiological aspects of melaleuca seed germination

The invasive behavior of melaleuca (Melaleuca quinquenervia) plants in wetlands is due to its aggressive regeneration strategy, which is based on its seeds germination performance. Understanding of the eco-physiological aspects of the seed germination in melaleuca plants may significantly contribute for the development of management strategies. The objective of this research was to learn how the germination of M. quinquenervia seeds are affected by light and temperature. Melaleuca seeds were placed on filter paper moistened with 12 ml of distilled water at temperatures between 10 and 45°C. Germination was evaluated in dark and light conditions. Seed germination, first count of seed germination (seven days), germination speed index and germination mean time were determined up to 40 days after seeding, when germination had ceased in most of the treatments. After that period, the seeds were transferred to conditions of 30°C and light, which was found to be ideal in the previous phase. Seed germination was daily evaluated up to 63 days when it was again observed no longer to occur. The treatment repetitions were distributed in the growth-chamber according to a completely randomized design in a factorial scheme (eight temperatures x two light conditions) and four repetitions. The data were submitted to analysis of variance with the F test and the means were adjusted to polynomial and non linear regression models. The highest seed germination performance was observed to take place under conditions of 27.3°C with light. The temperatures of 35 and 40°C in the dark induced thermal inhibition of seed germination. The temperature of 45°C was lethal to the seeds.

Bioethics and medical/legal considerations on cochlear implants in children

Cochlear implants are the best treatment for congenital profound deafness. Pediatric candidates to implantation are seen as vulnerable citizens, and the decision of implanting cochlear devices is ultimately in the hands of their parents/guardians. The Brazilian Penal Code dictates that deaf people may enjoy diminished criminal capacity. Many are the bioethical controversies around cochlear implants, as representatives from the deaf community have seen in them a means of decimating their culture and intrinsic values. Objective: This paper aims to discuss, in bioethical terms, the validity of implanting cochlear hearing aids in children by analyzing their vulnerability and the social/cultural implications of the procedure itself, aside from looking into the medical/legal aspects connected to their criminal capacity. Materials and Methods: The topic was searched on databases Medline and Lilacs; ethical analysis was done based on principialist bioethics. Results: Cochlear implants are the best therapeutic option for people with profound deafness and are morally justified. The level of criminal capacity attributed to deaf people requires careful analysis of the subject's degree of understanding and determination when carrying out the acts for which he/she has been charged. Conclusion: Cochlear implants are morally valid. Implantations must be analyzed on an each case basis. ENT physicians bear the ethical responsibility for indicating cochlear implants and must properly inform the child's parents/guardians and get their written consent before performing the procedure.

Voice disorders in children and its relationship with auditory, acoustic and vocal behavior parameters

Objective: Parameters to distinguish normal from deviant voices in early childhood have not been established. The current study sought to auditorily and acoustically characterize voices of children, and to study the relationship between vocal behavior reported by teachers and the presence of vocal aberrations. Methods: One hundred children between four and 6 years and 11 months, who attended early childhood educational institutions, were included. The sample comprised 50 children with normal voices (NVG) and 50 with deviant voices (DVG) matched by gender and age. All participants were submitted to auditory and acoustic analysis of vocal quality and had their vocal behaviors assessed by teachers through a specific protocol. Results: DVG had a higher incidence of breathiness (p < 0.001) and roughness (p < 0.001), but not vocal strain (p = 0.546), which was similar in both groups. The average F-0 was lower in the DVG and a higher noise component was observed in this group as well. Regarding the protocol used "Aspects Related to Phonotrauma - Children's Protocol", higher means were observed for children from DVG in all analyzed aspects and also on the overall means (DVG = 2.15; NVG = 1.12, p < 0.001). In NVG, a higher incidence of vocal behavior without alterations or with discrete alterations was observed, whereas a higher incidence of moderate, severe or extreme alterations of vocal behavior was observed in DVG. Conclusions: Perceptual assessment of voice, vocal acoustic parameters (F-0, noise and GNE), and aspects related to vocal trauma and vocal behavior differentiated the groups of children with normal voice and deviant voice. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

Measures of quality of life in children with cochlear implant: systematic review

The use of cochlear implant (CI) in children enables the development of listening and communication skills, allowing the child's progress in school and to be able to obtain, maintain and carry out an occupation. However, the progress after the CI has different results in some children, because many children are able to interact and participate in society, while others develop limited ability to communicate verbally. The need for a better understanding of CI outcomes, besides hearing and language benefits, has spurred the inclusion of quality of life measurements (QOL) to assess the impact of this technology. OBJECTIVE: Identify the key aspects of quality of life assessed in children with cochlear implant. METHOD: Through a systematic literature review, we considered publications from the period of 2000 to 2011. CONCLUSION: We concluded that QOL measurements in children include several concepts and methodologies. When referring to children using CI, results showed the challenges in broadly conceptualizing which quality of life domains are important to the child and how these areas can evolve during development, considering the wide variety of instruments and aspects evaluated.