Good Child Care Research Articles

Caregiving and the experience of health and illness in children living with HIV/AIDS in Gulu District Northern Uganda: An ethnographic research narrative

In this paper we discuss the experience of caregiving for children living with HIV in a resource poor environment in Gulu municipality in northern Uganda; the main research questions of the study were: what are the perceptions of caregivers on the care of children with HIV, and what barriers and enablers exist that undermine or promote better care for children respectively? The experience of caregivers and their perceptions on managing HIV in children is believed to shape the health seeking behaviour towards treatment and efforts to cope with its negative impact on the body. Women and children are the greatest bearer of the burden of the HIV scourge to date. While more and more children are undergoing treatment as a way of controlling HIV/AIDS, it is still crucial to understand the perceptions of their parents and/or caregivers on the AIDS pandemic and the impact of antiretroviral therapy on the quality of life of their children. In this paper the socio-medical views of these clients, based on an ethnographic study are discussed to give a holistic understanding of the ‘crisis’ of HIV/AIDS as well as their ‘imagined’ hopes, fears and expectations on antiretroviral therapy as HIV/AIDS become a chronic disease. Five themes emerged from analysing the experiences and perceptions of caregivers of children living with HIV: beliefs in the antiretroviral therapy, psychological counselling, family breakdown, positive living with HIV and social stigma. These were central in their perception of caring for the affected children and other family members.

Mothers' caregiving resources and practices for children under 5 years in the slums of Hyderabad, India: a cross-sectional study.

The extended care model of the United Nations Children's Fund (UNICEF) identifies knowledge/beliefs, nutritional status, mental health, control of resources/autonomy, workload/time constraints and social support as important caregiver resources for childcare. The aim of this paper is to examine the role of mothers' caregiving resources in child-care practices in slums. A cross-sectional study was conducted in 10 slums of Hyderabad, to appraise the caregiving practices and health status of children under 5 years. Data were collected from 506 households, selected through multistage stratified random sampling, and data relating to 451 children aged 6-59 months were analysed. Four caregiving practices were studied: psychosocial stimulation, as assessed by the Home Observation Measurement of the Environment inventory; hygienic care rated by spot-check observation; and meal frequency and dietary diversity based on maternal recall. The role of the mother's caregiving resources was examined using bivariate and multivariate logistic regression analyses. More than 50% of the children received good psychosocial stimulation and close to 60% had good hygienic care. About 75% of the children aged 6-23 months had the recommended minimum meal frequency and 13% had the recommended dietary diversity. Mother's media exposure (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.35-3.77), participation in household budgeting (OR 2.19, CI 1.25-3.83) and husband's support (OR 2.04, CI 1.28-3.24) were predictors of psychosocial stimulation. Mother's younger age (OR 1.11, CI 1.04-1.18), poor media exposure (OR 1.95, CI 1.15-3.29), dissatisfaction with life (OR 1.84, CI 1.05-3.24), workload (OR 1.79, CI 1-3.18) and having no money for their own use (OR 1.52, CI 0.95-2.45) placed children at higher odds for receiving poor hygienic care. Leisure time (OR 2.75, CI 1.25-6.06) and participation in budgeting (OR 1.97, CI 1-3.86) were predictors of meal frequency. Mother's workload, poor media exposure, dissatisfaction with life, lack of husband's support and absence of economic autonomy are constraints to good child care in slums.

Child diet and healthy growth in the context of rural poverty in the Peruvian Andes: What influences primary caregivers’ opportunities and choices?

This study explored opportunities and choices related to child feeding among women living in a remote and low-income district in the Andean highlands. Data were collected through in-depth interviews with mothers (N = 7) with reputations for providing good child care, and who participated in an NGO-run social and health programme. The aim of this study was to learn about women's positive experience with child feeding, in the context of living in low-income communities. Such knowledge could be of substantial practical value to health promotion practitioners, in illuminating existing local circumstances and practices that produce good child nutrition. The women who were most knowledgeable about child health and diet were better educated and had relatively higher social positions in the community. Regarding contextual factors related to child feeding, numerous references were made to the extensive use of own crops and food stuffs, seen to provide a better diet than that available in cities where people buy their food. In discussing food and meal preparation habits, there were clear references to child welfare and health as motivating factors in the choices that were made. The NGO programme was not mentioned by the interviewer, to avoid prompting, yet the respondents referred to it explicitly, and attributed improved health-related knowledge and skills to the NGO education interventions (e.g. education about nutritious meal preparation, child care skills, and sanitation practices). It is concluded that the women were concerned about providing a good diet to their children, they were aware of the impact of feeding practices on child health, and that education about health and diet helped them to improved feeding practices.

Handling power-asymmetry in interactions with infants

Interaction between adults and infants by nature constitutes a strong powerasymmetry relationship. Based on the assumption that communicative practices with infants are inseparably intertwined with broader cultural ideologies of good child care, this paper will contrast how parents in two distinct socio-cultural communities deal with power asymmetry in interactions with 3-months old infants. The study consists of a microanalysis of videotaped free play mother-infant interactions from 20 middle class families in Muenster, Germany and 20 traditional farming Nso families in Kikaikelaki, Cameroon. Analysis followed a discursive psychology approach. The focus of analysis is on how mothers handle and negotiate power-distance in these interactions and what discursive strategies they draw on. Mothers in both groups used various forms of directives and control strategies. The Muenster mothers, however, mainly used mitigated directives that can be seen as strategies to reduce the competence gap between mother and child, while the Nso mothers mainly used upgraded directives to stress the hierarchical discrepancy between mother and child. The different strategies are discussed in light of the prevailing broader cultural ideologies and the normative orientations that they reflect. Finally, the findings are discussed with regard to possible developmental consequences of these distinct cultural practices for the child. Keywords: power-asymmetry; mother-infant interaction; discursive psychology; culture; Nso farmers; Muenster middle class families

Care and Support for Vulnerable Children in Schools: The Case of Child-headed Families

A vulnerable child refers to a person who is under 18 years of age. The South African law expects educators to take responsibility for caring for the learner. The common law regarding duty of care is imposed on the educator in loco parentis. This article aims to explore ways and means through which child-headed households can be cared for and supported in schools. Reference is made to the seven roles of the teacher, with special focus on the pastoral role in the context of these children. The questions addressed are: How can schools better care for children in child-headed households? Are practising educators empowered to deal with challenges facing learners both at home and at school? The main method of data collection is document analysis. Initial findings indicate that children in child-headed households need support and protection in dealing with their unfortunate circumstances.

Will health visiting survive?

W hen I met district nurses and health visitors last week in Edinburgh, there was much discussion about our plans for the integration of acute and community health services and social care. There were questions and comments about the pace of change, the implications of such fundamental change for frontline staff and, most importantly, what it will mean for patients—how will it really improve services and outcomes of care? How will we ensure robust clinical governance and professional accountability? There were also questions about money and how health budgets would be ‘protected’ against the need to subsidise the rising demand for social care. It was a very interesting and stimulating session. I did my best of course to share our thinking and our progress in terms of agreeing how we will deal with such issues and to share my hopes about such a fundamental shift in the way we deliver our services, but one question stood out for me: ‘Will health visiting survive?’ This was as much a general question as one linked to health and social care integration. It certainly was not a question I was expecting, but the answer was easy: ‘Yes it must.’ Health visiting celebrated its 150th birthday last year and has as much to do now as it did when the profession was born, in terms of helping to improve the health of the population. The need for significant support for mothers and babies, as well as the more general public health agenda, means there is plenty for health visitors to do. We know so much more now about the importance of nurturing and good health care in the early years of life (as well as pre–birth) and we need to be applying it in practice for every child. Attempts not so long ago at national change in Scotland to review community nursing instigated more upset and concern among frontline practitioners than successful progress towards developing a confident community nursing workforce ready to face such challenges as integration. I hope that is well behind us and we can all move on. The policy context in Scotland does clearly hold a place for health visitors. This is evident in Modernising Nursing in the Community (www.mnic.nes.scot.nhs.uk), Health for All Children (‘Hall 4’) (Scottish Government, 2005 and 2011), Getting it Right for Every Child (GIRFEC) (2008) and The Early Years Framework (2009). The introduction of models of care developed and tested elsewhere, such as the Family Nurse Partnership (FNP), provides excellent evidence-based care and support to a specific group of clients—but not to all. Such programmes as FNP were not meant for all women and their families. The strength of health visiting is that it was and is meant for all women and their families, as part of the provision of universal services that underpins the NHS. Our current challenge across the UK is that, to Melanie Hornett Nurse Director NHS Lothian Health Board continue to provide a health visiting service to all, we do need to find different ways to deliver and sustain it. The demands placed on the service by health inequalities, the needs of vulnerable children and child protection issues, as well as the impact of parental substance misuse, to name but a few, continue to rise. Added to this, across Lothian we have a growing population. Routine work around parental support, developmental checks and immunisation is also considerable. The demands of the workload, especially around child protection, are often cited to me as reasons why it is hard to recruit and retain health visitors in certain areas. We know that the best care for children and their families comes from child-focused teams working together across professional and organisational boundaries and this brings me back to where I started—integration.

Socializing Infants Toward a Cultural Understanding of Expressing Negative Affect: A Bakhtinian Informed Discursive Psychology Approach

This article addresses the socialization of emotion expression in infancy. It argues that in order to adequately understand emotion development we need to consider the appraisal of emotion expression through caregivers in mundane, everyday interactions. Drawing on sociocultural and Bakhtinian theorizing, it claims that caregivers' appraisals of infants' emotion expression are dialogically intertwined with broader speech genres or “communicative genres” of a community and the emotional-volitional tone and normative orientations embedded in them. It aims to investigate how communicative genres become visible in early caregiver–infant interactions. In a comparative study with 20 farming Cameroonian Nso mothers from Kikaikelaki and 20 German middle-class mothers from Muenster and their 3-month-old infants, we investigated discursive practices used by the mothers in reaction to the infants' expression of negative affect. We found distinct patterns of coconstructing the interaction that point to different normative orientations and communicative genres that can be considered to be specific to the two sociocultural contexts. These communicative genres were found to be in line with broader cultural ethnotheories on good child care in these two communities found in previous studies and by other researchers.

Pediatric movement disorders

There is increasing need for both consensus definitions and continued research into the causes, clinical spectrum, and treatment of pediatric movement disorders. Treatment has been largely based on experience rather than evidence because clinical trials are limited. With development of consensus definitions, identification of causative genes, understanding of the clinical spectrum of disease, and clinical trials, we can provide overall better care for children with movement disorders. This review highlights 5 areas where progress is being made to achieve these goals in pediatric movement disorders.

Do integrated health and social care services deliver better care for children with intellectual disabilities?

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Paediatric Research Before and after the EU Regulation 1901/2006: Surveys Conducted by the Europan Federation of Cros (EUCROF)

The European Community Regulation governing clinical research in paediatrics, which came into force in January 2007, is aimed at ensuring a better care for children and setting quality and scientific standards for evidence-based use of medicines in Paediatrics. The related obligation system, affecting the medical community and even more the pharmaceutical industry, is expected to increase the number of controlled trials, in order to have more drugs approved in Paediatrics and less off label use. Two surveys in 16 countries on the pre-Regulation period (2005-2007) were conducted to better understand the status of paediatric research at the start of the new era. The experience of paediatrc trials is mostly in Phase III, and the major hardles were found in preparing an appropriate protocol and in practical issues (to be intended as submission document preparation and logistic issues). Thus, it is assumed that many trials before the Regulation are investigator's initiated and that the support by industrial sponsors has been poor when compared to other developmental projects. The ranking by therapeutic area (respiratory>endocrinology>infectious diseases>oncology) does not fit with the needs for controlled trials identified by EMA in a survey on the off label use of non-authorised medicines for children. All together these data on years 2005-2007 support the need expressed by the Regulation for a higher qualitative and quantitative commitment in Clinical Research in Paediatrics. A third questionnaire (results expected October 2011) is aimed at monitoring the first years of the Regulation (2007-2010), in order to understand its initial impact.

A new age for child protection – General comment 13: Why it is important, how it was constructed, and what it intends?

Children continue to be subjected to high levels of violence (i.e., physical, psychological and sexual maltreatment) throughout the world. International concern about violence against children has increased significantly during the last decade. A Study on Violence Against Children, encouraged by the UN Committee on the Rights of the Child, conducted under the auspices of the United Nations Secretary General and reported in 2006, has become a rallying call to improve child protection. Child protection practices and systems have been judged to be generally inadequate and, in some cases, destructive. It is widely recognized that business as usual—more of the same—will not do. A General Comment (guide to fulfilling obligations) for Article 19, the central conceptualization of child protection of the UN Convention on the Rights of the Child, has the potential to promote a worldwide reformulation of child protection priorities, policies, and practices by virtue of the infusion of a child rights approach. It can be a mechanism for framing and promoting the transformational change needed – for a genuine paradigm shift. Here, explication is given for the historical context, rationale, centrality of child rights, process of development, holistic nature, and primary elements of General Comment 13 (GC13): The child's right to freedom from all forms of violence. GC13 embodies and champions a child rights approach to child protection entailing strong support for proactive primary prevention, promotion of good child care, and a commitment to secure the rights and well-being of all children. A child rights-based, comprehensive coordinating framework is recommended for the implementation of GC13.

Postoperative pain assessment in special patient groups

Postoperative pain assessment in children with cognitive impairment poses major challenges to healthcare professionals.Children with moderate to severe cognitive impairment are generally unable to communicate effectively and to self-report the level of pain. Difficulties assessing pain have led to their exclusion from clinical trials and rendered them vulnerable to insufficient treatment of pain.The realization of pain is a particularly important step forward for a better care of children with cognitive impairment.Scales based on a child's own perception of pain and its severity play a limited role in this vulnerable population and pain assessment tools which rely on observing pain behavior are essential. The r-FLACC, which is reliable and valid, includes specific behavioral descriptors and can be used simply and effectively postoperatively in clinical practice. Our task has to be assessing pain as a routine procedure in cognitively impaired children as a keystone for an improved and successful pain management in this very sensitive patient population.

Improving Services for Children and Young People: From Gatekeeper to Navigator – The GP at the Helm?

The Kennedy report,1 commissioned to look at the cultural barriers to good care for children and young people in the NHS, was recently described in The Back Pages as being ‘prejudiced and ill-informed’.2 Indeed there is scant evidence of consultation with GPs in preparing the report but I would suggest there are other interpretations of Kennedy's conclusions which might be read as a recognition of the ‘extraordinary potential’ of GPs as a catalyst in improving services. The report is premised on the finding that children and young people are ill-served by the existing structures. It would be hard to deny this given the conclusions drawn from the inquiries into the tragic deaths of children including Victoria Climbie, Tiffany Wright, and more recently ‘baby Peter’; all of whom were known to their local health …

A Framework for Providing Quality Pediatric Palliative Care

This Oxford Specialist Handbook is designed for inpatient or community pediatric teams, as well as other non-palliative care professionals, to “equip them to provide good palliative medicine to children in their care, despite lack of training.” It is authored by a pediatric palliative care specialist and a general practitioner. The first three chapters include the basics of pediatric palliative care—identifying which children need palliative care, balancing the burdens and benefits of every intervention, the range of life-limiting conditions seen in pediatric palliative care, disease trajectories, basic ethical principles, and withholding and withdrawal of treatment. There is a description of the different palliative care settings for children in the United Kingdom, from the children’s hospice to the inpatient adult palliative medicine service. All topics are presented concisely and in outline form. Five chapters are devoted to the topic of pain, which is the strength of the handbook. Diagnosis, assessment, and evaluation of pain are addressed. A helpful table of common errors in opioid prescribing for children is provided. A chapter on pain evaluation includes a list of self-report pain scales, objective and behavioral measures of pain, and their strengths and weaknesses. Three remaining chapters address opioids, adjuvants, and an analysis of each step in the World Health Organization analgesic ladder. The next seven chapters address common symptoms such as gastrointestinal, neurological and psychological symptoms, feeding and hydration, dyspnea, and skin symptoms. Pathophysiology, etiology, and management are discussed in practical terms, with helpful tables and management algorithms. The chapters on nausea/vomiting and dyspnea are remarkably practical; the former includes a flow chart outlining “a rational approach to antiemesis”. After the chapter on pediatric palliative emergencies, the next several chapters cover specific diseases commonly seen in pediatric palliative care. There is a general overview of malignant diseases, and more in-depth coverage of the most common pediatric malignancies, along with a general discussion on management of cancer-related symptoms. Specific nonmalignant diseases are outlined in more detail, including clinical features and management strategies. The concluding chapters provide a worthwhile practical overview of the clinical issues surrounding death, the major religious issues related to death, funeral practices, bereavement, coping and communication skills, education, and training. As with many pediatric books, a pediatric formulary is included, with recommended dose ranges based on the child’s weight, and notes pertinent to each drug. Each chapter is primarily presented in outline form, with several current references provided at the end. This makes the handbook easy to read and understand. On the other hand, the descriptions of palliative care services for children refer exclusively to services in the United Kingdom and could be less relevant to readers from other countries. In addition, the formulary includes several medications that are unavailable in the United States. As the authors point out in the preface of this book, most children with life-limiting conditions will be cared for not by pediatric palliative medicine specialists but by general pediatric or subspecialist teams. Hospice teams, medical students, pediatric residents, pediatricians, and oncology fellows will appreciate this practical introduction to pediatric palliative medicine. The handbook also will benefit adult palliative care fellows who are rotating through their pediatric palliative training. The authors have succeeded in producing a handbook that provides basic concepts and information for the professional without specialty training in pediatric palliative medicine. The handbook can serve as a framework for those professionals endeavoring to provide good palliative care for children. Katherine Leonard, MD, is an Attending Physician in the Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, USA.

Back to the Not-So-Basics: The Pharmacology of Pain

chapter on pain evaluation includes a list of selfreport pain scales, objective and behavioral measures of pain, and their strengths and weaknesses. Three remaining chapters address opioids, adjuvants, and an analysis of each step in the World Health Organization analgesic ladder. The next seven chapters address common symptoms such as gastrointestinal, neurological and psychological symptoms, feeding and hydration, dyspnea, and skin symptoms. Pathophysiology, etiology, and management are discussed in practical terms, with helpful tables and management algorithms. The chapters on nausea/vomiting and dyspnea are remarkably practical; the former includes a flow chart outlining ‘‘a rational approach to antiemesis’’. After the chapter on pediatric palliative emergencies, the next several chapters cover specific diseases commonly seen in pediatric palliative care. There is a general overview of malignant diseases, and more in-depth coverage of the most common pediatric malignancies, along with a general discussion on management of cancer-related symptoms. Specific nonmalignantdiseases areoutlined inmoredetail, including clinical features andmanagement strategies. The concluding chapters provide a worthwhile practical overview of the clinical issues surrounding death, the major religious issues related to death, funeral practices, bereavement, coping and communication skills, education, and training. As with many pediatric books, a pediatric formulary is included, with recommended dose ranges based on the child’s weight, and notes pertinent to each drug. Each chapter is primarily presented in outline form, with several current references provided at the end. This makes the handbook easy to read and understand. On the other hand, the descriptions of palliative care services for children refer exclusively to services in the United Kingdom and could be less relevant to readers from other countries. In addition, the formulary includes several medications that are unavailable in the United States. As the authors point out in the preface of this book,most children with life-limiting conditions will be cared for not by pediatric palliative medicine specialists but by general pediatric or subspecialist teams. Hospice teams, medical students, pediatric residents, pediatricians, and oncology fellows will appreciate this practical introduction to pediatric palliative medicine. The handbook also will benefit adult palliative care fellows who are rotating through their pediatric palliative training. The authors have succeeded in producing a handbook that provides basic concepts and information for the professional without specialty training in pediatric palliative medicine. The handbook can serve as a framework for those professionals endeavoring to provide good palliative care for children.

Reducing child mortality in Indonesia

Reducing child mortality in Indonesia

Determining the benefits and objectives of a child health residency program for Canadian rural family physicians: An international qualitative research study

To clarify the need for an advanced child health training program for Canadian rural family physicians, and to determine the key learning objectives to enable graduates to become community leaders in child and youth health care. Qualitative educational research study. Canada and Australia. To gather data, the authors carried out semistructured interviews and focus groups with child care consultants, Canadian rural family physicians, child patients and parents, family medicine residents and Australian rural family physicians. Standards of qualitative methodology were applied to identify themes and subthemes. IT WAS DETERMINED THAT A FAMILY MEDICINE CHILD HEALTH PROGRAM WOULD PROVIDE THE FOLLOWING BENEFITS: enhanced care by family physicians, improved access to child care, increased attractiveness of family medicine as a career and reduced 'specialty burden'. FIVE KEY LEARNING OBJECTIVES FOR GRADUATES WERE IDENTIFIED: the ability to provide child-centred care, to care for acutely or critically ill children, to care for children with complex needs, to recognize and act on 'red flags', and to provide behavioural and mental health care. The Australian general practitioners confirmed that their training provided most of these benefits, and enabled them to achieve the objectives identified. The present study showed that multiple stakeholders believed that advanced training in child health for rural family physicians would provide better care for children. The study also identified key learning objectives for the program. The present research led to the establishment of a Family Medicine Child Health Residency Program (www.familymedicineuwo.ca/PostGrad/PGY3/ChildHealth.aspx) at The University of Western Ontario (London, Ontario).

Significant Effects of Fatwa-Based Perception on Contraceptive Practice Among Muslim Women in South Jordan Under the Early Stage of Fertility Transition

An interview survey of 450 Muslim women in a rural village of south Jordan under the early stage of fertility transition was conducted to explore major causes of contraceptive use, taking both their sociodemographic attributes and fatwa (Islamic jurisprudence)–based perception into account. Discriminant analysis, which was performed for the subject women divided into 15- to 29-, 30- to 39-, and 40- to 49-year age groups, revealed that “the number of living children” in the former and “to do contraception for good care of children” in the latter played significant roles in discrimination into contraceptive user and nonuser groups for any age groups. To cope with demographically and socioeconmically vulnerable situations, contraceptive prevalence rate should be increased by means of government-led family planning programs in cooperation with the imam (Muslim religious leaders and priests) through fatwa, in which special attention is paid to traditional norms, represented by good childcare.

Using the ACEI Global Guidelines Assessment to Evaluate the Quality of Early Child Care in Greek Settings

In recent years, there has been a significant growth of interest in ensuring that child care provision for children is of a high quality. This interest has been stimulated by research evidence according to which good quality child care has a positive influence on children’s overall development. The global quality in Greek preschool and infant/toddler classrooms was assessed with ACEI Global Guidelines Assessment (GGA), Early Childhood Environment Rating Scale-Revised (ECERS-R) and Infant Toddler Environment Rating Scale (ITERS). Our research data, confirm previous research results from Greece, and suggest that Greek child care centers provide low quality care and education. Comparisons between the tools employed revealed great similarity between the ACEI GGA and ECERS-R ratings on issues relating to environment and physical space, program evaluation, communication with families, opportunities for family and community participation, recognition of diversity, curriculum and activities, etc. On the other hand the ACEI GGA and ITERS seem to measure different aspects of process quality, as far as infant care and education are concerned. Research results indicate the need for immediate improvement and revision of the policies employed by Greek state, as far as young children’s education and care are concerned.

What a difference a decade makes: Counting the benefits of investment in early childhood development in Quebec

What a difference a decade makes: Counting the benefits of investment in early childhood development in Quebec