Care Of Sick Children Research Articles

Interrupting pathways to sepsis: Effectiveness of an intervention to reduce delays in timely care for sick children in rural Bangladesh

RationaleThe time it takes for a child with suspected sepsis to receive care is critical. ObjectiveWe evaluated care-seeking practices for sick children under 5 years in rural Bangladesh, following interpersonal communication to inform households of newly introduced supports for quality care. Based on the Delays Framework, we assessed length and source of care-seeking delays, use of formal providers, and autonomous decision-making among mothers. MethodUsing two cross-sectional rounds before and after the 3-year intervention (August 2012 and August 2015), we surveyed 400 mothers of recently sick children in 26 randomly sampled villages from 2 intervention and 2 control subdistricts, using structured questions about delays. Six to ten times during the 18-month intervention period, local workers communicated four key messages to most intervention households in 292 villages: serious symptoms of suspected sepsis in children, a call-in center number for referral advice, a reliable transport hub, and upgrades to the local hospital. ResultsCompared to baseline, endline results demonstrated a significant difference in the total delay between the onset of child's illness and seeking external care, with intervention families having shorter delays. Over 90% of mothers informed someone in the family, mainly the husband, about the sick child before acting to seek care. Delays due to transportation and receiving provider care were short and not different. Using a benchmark of seeking external care within 24 h of onset, only 14.14% of intervention households and 13.40% of control households were “timely” in seeking care. Approximately 78% of parents, similar for the two groups, sought care from a non-formal practitioner (the village doctor). ConclusionThe results demonstrate that the delay in deciding to seek external care is most serious, and that communication strategies at the community level are necessary to increase the uptake of improved health services.

The Benefits and Issues Regarding Sick Child Care Services in Double Income Nuclear Families with Children

Purpose: As the benefits of sick child care services are usually evaluated based on parents’ work-related views, very few studies have reported those on health recovery or parenting of sick children. This study investigated the usage and evaluation of sick child care services in double-income nuclear families, in order to clarify their benefits and issues. Methods: This study used a qualitative and descriptive approach. Semi-structured interviews were conducted involving 27 mothers of double-income nuclear families after obtaining their written consent.The survey consisted of: the age and number of children, child-raising status, strategies to cope with children’s illness, and usage and needs of sick child care services and pediatric emergency medical care services. Results: The mothers of double-income nuclear families worked with hope of self-realization. They used sick child care services to balance their child-raising and career in a situation where there is no one to rely on. By experiencing positive reactions and early recovery of their children, the mothers developed a sense of security and trust towards high quality medical, nursing, and child nursery care of the service and childcare education provided to mothers. On the other hand, they desired improvement with regard to expensive care fees, short-hours of service, and the capacity to accept children, as well as the operation of transportation service from nursery school to the sick child care facility Conclusions: The results of this study demonstrated that sick child care services were beneficial in promoting healthy recovery of children and for improving childcare skills of mothers of doubleincome nuclear families. The results also suggest the need to develop measures based on the needs of sick child care users.

The current status of pediatric radiology in India: A conference-based survey.

Introduction:Like most other developing countries, India has a large proportion of children among its population. However, the facilities for adequate treatment of this large population is inadequate. The development of pediatric radiology as a subspecialty is still at an infant stage in India. The goal of our study was to assess the awareness about the current status of pediatric radiology in India.Materials and Methods:A questionnaire was handed over to all attendees of a pediatric radiology conference to assess their opinion regarding the adequacy of pediatric training and practice in India. The questionnaire consisted of 10 multiple-choice and two descriptive questions. Descriptive statistical methods were used for analyzing the results.Results:Eighty-one out of 400 delegates responded to the questionnaire. Among these 81 respondents, 50 (61.7%) felt that exposure to pediatric cases during postgraduate course was inadequate. Sixty-three out of 81 (77.7%) respondents thought that specialized training is required for practicing pediatric radiology, and 79 respondents (97%) felt that the number of such training programmes should increase. Forty-five out of 81 respondents (55.5%) were interested in pursuing pediatric radiology as a career.Conclusion:According to the opinion of the respondents of our survey, pediatric radiology remains an underdeveloped speciality in India. Considering the proportion of the population in the pediatric age and the poor health indicators in this age group, elaborate measures, as suggested, need to be implemented to improve pediatric radiology training and the care of sick children in India.

RISK FACTORS FOR HAND-FOOT-AND-MOUTH DISEASE

Background: HFMD is an infectious disease caused by enterovirus. The disease is benign and self-limiting within 7-10 days. However, in some cases, the disease progresses to severe neurological, cardiovascular complications and can be fatal if not detected and treated in time. Identifying some risk factors of severe HFMD is very important. Based on these risk factors, doctors at grassroots health system can quickly classify HFMD patients and adopt appropriate handling approaches: either transfer HFMD patients at high risk complications to the hospital early to closely monitor for subsequent treatment, while those with low risk can be given outpatient care after counseling patients’ parents. Methodology: a case-control study based on hospital was conducted on 150 cases of severe HFMD patients (from level 2b or higher) and 150 cases of mild HFMD patients (level 1, 2a), matching by age, gender, ethnicity and area of residence. Both cases and controls were hospitalized at the same hospital and were positive for EV or EV71 (PCR). Cases and controls were compared in terms of factors which can affect the severity of HFMD. Results: Logistic regression showed that the risk factors before patients’ hospitalization include: malnutrition, not exclusive breastfeeding in the first 6 months, low maternal education, and poor care for sick children. The risk factors after patients’ hospitalization include: peak temperature ≥ 39oC, with no signs of mouth ulcers, startling history, increase of leukocytosis, and EV71 as pathogen. Conclusion: Factors increasing the risk of severe HFMD include stunting malnutrition (OR = 1.84 - 95% CI: 1.05 to 3.22); not be exclusively breastfed for the first 6 months (OR = 2.03 - 95% CI: 1.08 to 3.84); Low maternal education (OR = 2.77 - 95% CI: 1.06 to 7.28); poor maternal care for patients (OR = 3.93 - 95% CI: 2.40 to 6.44); peak temperature ≥ 39oC (OR = 3.63 95% CI-: 1.91 to 6.90); No signs of oral ulcers (OR = 2.45 95% CI-: 1.28 to 4.69); Startling history (OR = 9.93 95% CI-: 4.89 to 20.14); increase of leukocytosis ≥ 11.0 (K/µl) (OR = 2.52 95% CI-: 1.36 to 4.69); EV71-infected patients (OR = 2.46 95% CI-: 1.29 to 4.69). Key words: risk factors, severer hand-foot-mouth disease

Caregiver mental health and HIV-infected child wellness: perspectives from Ugandan caregivers

ABSTRACTPrior studies indicate a substantial link between maternal depression and early child health but give limited consideration to the direction of this relationship or the context in which it occurs. We sought to create a contextually informed conceptual framework of this relationship through semi-structured interviews with women that had lived experience of caring for an HIV-infected child while coping with depression and anxiety symptoms. Caregivers explained their role in raising healthy children as complex and complicated by poverty, stigma, and isolation. Caregivers discussed the effects of their own mental health on child well-being as primarily emotional and behavioral, and explained how looking after a child could bring distress, particularly when unable to provide desired care for sick children. Our findings suggest the need for investigation of the reciprocal effects of child sickness on caregiver wellness and for integrated programs that holistically address the needs of HIV-affected families.

Assessment of the impact of quality improvement interventions on the quality of sick child care provided by Health Extension Workers in Ethiopia.

BackgroundEthiopia has scaled up integrated community case management of childhood illness (iCCM), including several interventions to improve the performance of Health Extension Workers (HEWs). We assessed associations between interventions to improve iCCM quality of care and the observed quality of care among HEWs.MethodsWe assessed iCCM implementation strength and quality of care provided by HEWs in Ethiopia. Multivariate logistic regression analyses were performed to assess associations between interventions to improve iCCM quality of care and correct management of iCCM illnesses.FindingsChildren who were managed by an HEW who had attended a performance review and clinical mentoring meeting (PRCMM) had 8.3 (95% confidence interval (CI) 2.34–29.51) times the odds of being correctly managed, compared to children managed by an HEW who did not attend a PRCMM. Management by an HEW who received follow–up training also significantly increased the odds of correct management (odds ratio (OR) = 2.09, 95% CI 1.05–4.18). Supervision on iCCM (OR = 0.63, 95% CI 0.23–1.72) did not significantly affect the odds of receiving correct care.ConclusionsThese results suggest PRCMM and follow–up training were effective interventions, while implementation of supportive supervision needs to be reviewed to improve impact.

Quality of child healthcare at primary healthcare facilities: a national assessment of the Integrated Management of Childhood Illnesses in Afghanistan.

To assess quality of the national Integrated Management of Childhood Illness (IMCI) program services provided for sick children at primary health facilities in Afghanistan. Mixed methods including cross-sectional study. Thirteen (of thirty-four) provinces in Afghanistan. Observation of case management and re-examination of 177 sick children, exit interviews with caretakers and review of equipment/supplies at 44 health facilities. Introduction and scale up of Integrated Management of Childhood Illnesses at primary health care facilities. Care of sick children according to IMCI guidelines, health worker skills and essential health system elements. Thirty-two (71%) of the health workers were trained in IMCI and five (11%) received supervision in clinical case management during the past 6 months. On average, 5.4 out of 10 main assessment tasks were performed during cases observed, the index being higher in children seen by trained providers than untrained (6.3 vs 3.5, 95% CI 5.8-6.8 vs 2.9-4.1). In all, 74% of the 104 children who needed oral antibiotics received prescriptions, while 30% received complete and correct advice and 30% were overprescribed, and more so by untrained providers. Home care counseling was associated with provider training status (41.3% by trained and 24.5% by untrained). Essential oral and pre-referral injectable medicine and equipment/supplies were available in 66%, 23%, and 45% of health facilities, respectively. IMCI training improved assessment, rational use of antibiotics and counseling; further investment in IMCI in Afghanistan, continuing provider capacity building and supportive supervision for improved quality of care and counseling for sick children is needed, especially given high burden treatable childhood illness.

Puppets in an acute paediatric unit: Nurse’s experiences

Puppets have been used for play and in education with children in a variety of contexts, including health care. There is however a dearth of literature that explains nurses’ experiences when using puppets in a paediatric health care context nor any process to guide how they use puppets. In 2007 an educational framework called the Pup-Ed (KRS Simulation) was developed to assist nurses and educators in using puppets. In 2012 nurses (n=13) from a regional paediatric acute care setting, who had been educated in the Pup-Ed (KRS Simulation) framework, described their experiences using puppets when caring for sick children. Participants reported that the principles of the Pup-Ed (KRS Simulation) framework including the users’ knowledge/hidden nurse, a consistent history and silent voice all contributed to the central theme called connecting to optimise care. The puppets were a means to educate the children and were a source of distraction from unpleasant procedures. Additionally the puppets were a strategy to reduce fear and break down barriers for the child especially when undergoing procedures. When using the puppets participants identified that infection transfer was something to be considered and not all nurses felt comfortable using the puppets. A lack of confidence and time were identified as barriers to using the puppets. The findings from this study have been valuable in establishing recommendations for future puppet use.

Benefits of and Issues Regarding Sick Child Care for Children and Their Parents

Aim: We surveyed users of sick child care services about the benefits of and issues regarding such care, in order to obtain an insight into its practice. Methods: The study subjects comprised a total of 144 parents whose children had used any of the 15 sick child care facilities in Prefecture A in 2015. These parents consented to participate in the study. Using a quantitative and qualitative method, we surveyed them about their usage of sick child care, care-related requests, as well as perceived benefits and difficulties. Results: Sick child care was used mainly by children from either double-income nuclear families (n=123) or single-mother households (n=12) because of infectious diseases. The systems for reducing care fees were utilized by 58% of the single mothers. Subjects viewed the following factors as the benefits of sick child care: 1) a sense of ease achieved through appropriate and professional childcare, 2) being able to work free from anxiety, 3) a reduced burden on children and their normal development, and 4) child raising support for parents. On the basis of difficulties in utilizing sick child care, parents desired improvement in care services, such as an increase in the number of both care facilities and days such care is available, and the capacity to accept children. Conclusions: The results of this study suggest that, to facilitate sick child care based on the needs of care service users, there is a need to increase the number of care facilities, and expand the capacity to accept children

Training And Supervision Did Not Meaningfully Improve Quality Of Care For Pregnant Women Or Sick Children In Sub-Saharan Africa.

In-service training courses and supportive supervision of health workers are among the most common interventions to improve the quality of health care in low- and middle-income countries. Despite extensive investment from donors, evaluations of the long-term effect of these two interventions are scarce. We used nationally representative surveys of health systems in seven countries in sub-Saharan Africa to examine the association of in-service training and supervision with provider quality in antenatal and sick child care. The results of our analysis showed that observed quality of care was poor, with fewer than half of evidence-based actions completed by health workers, on average. In-service training and supervision were associated with quality of sick child care; they were associated with quality of antenatal care only when provided jointly. All associations were modest-at most, improvements related to interventions were equivalent to 2 additional provider actions out of the 18-40 actions expected per visit. In-service training and supportive supervision as delivered were not sufficient to meaningfully improve the quality of care in these countries. Greater attention to the quality of health professional education and national health system performance will be required to provide the standard of health care that patients deserve.

Sick Child Care-related Needs According to the Type of Household -Single-Mother Households and Double-income Nuclear Families

Background: Sick child care is a form of nursing care provided temporarily by nursery staff and nurses for sick children when they cannot be cared for by their parents, for reasons such as having to work. To facilitate sick child care according to the type of household, we investigated single-mother households and double-income nuclear families, and clarified their usage of such care and relevant needs. Methods: The study subjects comprised 14 single mothers, and 131 individuals from double-income nuclear families. We investigated their usage of sick child care, perceived benefits of such care, and carerelated requests. Results: For both types of family, the mean age of care service users was less than 3 years, and most of them had infectious diseases. In the single-mother group, more than 50% of the subjects were non-regular employees. Compared with the double-income group, the single-mother group showed significantly higher percentages of people with a low income and those using the systems for reducing care fees (P<0.0001, P<0.0243). The latter group also exhibited a higher percentage of individuals with anxiety due to the possibility of their dismissal from work caused by taking time off (P=0.0238).Furthermore, a higher percentage of single mothers than those from double-income households considered sick child care-related guidance to be beneficial (P<0.021).

Benefit of Using Sick Child Care Facilities to the Children and Their Parents

Introduction: Sick child care is a form of nursing care provided temporarily for sick children when they cannot be cared for by their parents at home. To clarify the benefits of using sick child care facilities for children and their parents, we surveyed these parents about the benefits of such care and their needs. Method: Study design: Descriptive research. We studied parents whose children had used one of the 11 sick child care facilities for sick children in Hiroshima City in 2014. A total of 156 parents consented to participate in the study. We investigated their usage situation of sick child care, perceived benefits of such care, and care-related requests in a quantitative and qualitative manner. Results: Both nuclear families consisting of the dual income parents and their children and single-mother households reported that their children (mean age: 2.46 years [SD: 1.77 years]) had used sick child care because of infectious diseases. Approximately 10% of the parents were using the fee reduction systems of sick child care intended for people with a low income. Parents viewed sick child care as beneficial both in early the health recovery of children, and as support for child raising and working. On the other hand, some parents left their children at home alone when sick child care was not available due to the limited number of sick child care facilities and an insufficient capacity to accept children. Some parents desired an increased number of care facilities, as well as a reduction in or subsidies for care fees. Conclusion: The results of this study suggest that, to ensure children’s health and safety, and support their parents for working and child raising, there is a need to increase the number of sick child care facilities along with expanding care services.

Simulation in acute care pediatrics: New paradigms in care

Simulation offers tremendous promise to improve health care delivery especially in acute care areas. It can be an efficient mode to learn, probe and improve crisis resource management, unit risk assessment, establish an environment for discussing error without punishment, investigating human performance, assessing situation readiness, implement new protocols, test run new instruments, improve interdepartmental coordination, learn new concepts or procedural skills and also in establishing systems and usability of a new unit. Simulation based learning relies heavily on reflective practice, a key foundational concept of adult learning. PediSTARS India is actively working towards addressing the challenges of implementing simulation based interventions to better the care of sick children in India.

Working Conditions and Lifestyle of Female Surgeons Affiliated to the Japan Neurosurgical Society: Findings of Individual and Institutional Surveys.

To investigate the working conditions of female neurosurgeons in Japan, two surveys were conducted by The Japan Neurosurgical Society: one involving female neurosurgeons themselves and the other involving the chiefs of neurosurgical departments. The responses were received from 224 (43.8%) female neurosurgeons and 496 (61.2%) departmental chiefs. About half (50.2%) of the female neurosurgeons were married and 39.2% had children (average number of children, 1.27). Their work was full-time in 80.6% of cases; on average, they worked 51.9 h per week, had night duty 2.8 times per month, and had 5.7 days off per month. Many of them stated that they were satisfied with their job status, but about half of them reported difficulty in maintaining a correct work–life balance. Among the institutions surveyed, 29% had female neurosurgeons. The survey of departmental chiefs revealed that the proxies for maternity leave were not available at most institutions, and that there was only limited availability of night child care (41%) or sick child care (39%); female neurosurgeons did not appear to be well-informed of these support systems. These findings suggest that apart from systematic approaches already in place, female neurosurgeons would prefer to have more understanding from their peers and chiefs.

Assessing the Quality of Sick Child Care Provided by Community Health Workers.

BackgroundAs community case management of childhood illness expands in low-income countries, there is a need to assess the quality of care provided by community health workers. This study had the following objectives: 1) examine methods of recruitment of sick children for assessment of quality of care, 2) assess the validity of register review (RR) and direct observation only (DO) compared to direct observation with re-examination (DO+RE), and 3) assess the effect of observation on community health worker performance.MethodsWe conducted a survey to assess the quality of care provided by Ethiopian Health Extension Workers (HEWs). The sample of children was obtained through spontaneous consultation, HEW mobilization, or recruitment by the survey team. We assessed patient characteristics by recruitment method. Estimates of indicators of quality of care obtained using RR and DO were compared to gold standard estimates obtained through DO+RE. Sensitivity, specificity, and the area under receiver operator characteristic curve (AUC) were calculated to assess the validity of RR and DO. To assess the Hawthorne effect, we compared estimates from RR for children who were observed by the survey team to estimates from RR for children who were not observed by the survey team.ResultsParticipants included 137 HEWs and 257 sick children in 103 health posts, plus 544 children from patient registers. Children mobilized by HEWs had the highest proportion of severe illness (27%). Indicators of quality of care from RR and DO had high sensitivity for most indicators, but specificity was low. The AUC for different indicators from RR ranged from 0.47 to 0.76, with only one indicator above 0.75. The AUC of indicators from DO ranged from 0.54 to 1.0, with three indicators above 0.75. The differences between estimates of correct care for observed versus not observed children were small.ConclusionsMobilization by HEWs and recruitment by the survey teams were feasible, but potentially biased, methods of obtaining sick children. Register review and DO underestimated performance errors. Our data suggest that being observed had only a small positive effect on the performance of HEWs.

Calgary Family Assessment Model (CFAM) Keluarga tentang Penanganan Pertama Food Borne Disease Anak

Food borne disease (FBD) is a disease through consumption of contaminated food. The problem is that, school children are vulnerable to FBD because of household food contamination. This indicates the family as a food handler hygiene mainly the mother who prepare the food needed to be improved. Most common FBD is diarrhea, one of the danger is that the child’s body fluids are expelled out through the stool this can cause dehydration or even death. Family plays very important role in the handling of FBD first before being taken to the health service. This can be known through family studies approach CFAM (Calgary Family assessment model). The design of this study was descriptive eksplorative with a sample of 35 respondents; the 4th graders and their parents (17 persons) and 5th graders and their parents (18) in Jatirejoyoso Kepanjen Elemetary School through purposive sampling technique. The data taken were demographic and CFAM consists of the structural assessment components, development as well as family function. The family in first handling of food borne disease largely was not routine (71.4%). Ways of solving the problems mostly by the head of the family (74.3%). Responsible care for sick children mostly (57.2%) by only one parent (father / mother). Follow up during sick mostly made an effort (curative) as much as 85.7%. Family belief the majority (80%) considered that the first treatment at home was not needed because it could be taken directly to the health service. Health workers are expected to provide guidance for families through health volunteers on first handling practices of FBD. While schools are expected to perform optimization of UKS (School Health Unit) program to provide health education about the prevention and first treatment of FBD toward the school community.

Nursing care of children in general practice settings: roles and responsibilities.

To examine roles and responsibilities of Practice Nurses in the area of child health and development and in advising parents about child health issues. As the focus of Australia's health care system shifts further towards the primary health care sector, governmental initiatives require that Practice Nurses are knowledgeable, confident and competent in providing care in the area of child health and development. Little is known about roles and responsibilities of Practice Nurses in this area. Cross-sectional survey design. Practice Nurses completed a national online survey examining the roles and responsibilities in child health and development, professional development needs and role satisfaction. Data were collected from June 2010-April 2011. Respondents (N=159) reported having a significant role in well and sick child care and were interested in extending their role. Frequent activities included immunization, phone triage/advice, child health/development advice, wound care and Healthy Kids Checks. However, few had paediatric/child nursing backgrounds or postgraduate qualifications in paediatric nursing and they reported limited preparation for the role. Practice Nurses reported difficulties with keeping up-to-date with child health information and advising parents confidently. Satisfaction was relatively low regarding opportunities and encouragement to undertake professional development and expand scope of practice. Practice Nurses are largely unprepared to meet the demands of their child health role and need support to develop and maintain the skills and knowledge base necessary for high-quality, evidence-based practice. Both financial and time support is needed to enable Practice Nurses to access child health professional development.

New kid on the block? Community nurses' experiences of caring for sick children at home.

To investigate the experiences of Swedish community nurses in caring for sick children at home, as this is a growing population of patients in community care. There is international consensus that sick children should receive care in their homes as far as possible. Home health care allows the family to stay together while the child is undergoing treatment and thus reduces strain on the family. However, it can also be demanding for parents to take on increased responsibilities for their sick child. Children as a patient group is a relatively new phenomenon in community home health care in Sweden and represents a small part of the community nurse responsibilities, making it difficult to accumulate experience. A qualitative descriptive design. In-depth interviews with twelve nurses in community health care. Qualitative content analysis was used. 'Feeling confident in order to instil confidence' was key in nurses' experiences. Two main themes emerged: 'Building a trusting relationship with the family' and 'Feeling confident in the role as caregiver'. Nurses aimed at creating a trusting nursing relationship and working closely with parents. The nurses' feeling of confidence in their role as caregivers depended on the support they received and the knowledge they had. Many community nurses felt unconfident about caring for children at home but experienced it as manageable when peer support and a distinct collaboration with the paediatric clinic/hospital were present. The ongoing shift from hospital to home care urges paediatric clinics/hospitals and community health care to develop formal policies of transmural collaboration to train and support home nurses to deliver adequate care to sick children and their families at home and safeguard good outcomes. The implication of the study may contribute to efforts being made to extend and improve cooperation between paediatric clinics/hospitals and community health care.

Ghana's National Health insurance scheme and maternal and child health: a mixed methods study.

BackgroundGhana is attracting global attention for efforts to provide health insurance to all citizens through the National Health Insurance Scheme (NHIS). With the program’s strong emphasis on maternal and child health, an expectation of the program is that members will have increased use of relevant services.MethodsThis paper uses qualitative and quantitative data from a baseline assessment for the Maternal and Newborn errals Evaluation from the Northern and Central Regions to describe women’s experiences with the NHIS and to study associations between insurance and skilled facility delivery, antenatal care and early care-seeking for sick children. The assessment included a quantitative household survey (n = 1267 women), a quantitative community leader survey (n = 62), qualitative birth narratives with mothers (n = 20) and fathers (n = 18), key informant interviews with health care workers (n = 5) and focus groups (n = 3) with community leaders and stakeholders. The key independent variables for the quantitative analyses were health insurance coverage during the past three years (categorized as all three years, 1–2 years or no coverage) and health insurance during the exact time of pregnancy.ResultsQuantitative findings indicate that insurance coverage during the past three years and insurance during pregnancy were associated with greater use of facility delivery but not ANC. Respondents with insurance were also significantly more likely to indicate that an illness need not be severe for them to take a sick child for care. The NHIS does appear to enable pregnant women to access services and allow caregivers to seek care early for sick children, but both the quantitative and qualitative assessments also indicated that the poor and least educated were less likely to have insurance than their wealthier and more educated counterparts. Findings from the qualitative interviews uncovered specific challenges women faced regarding registration for the NHIS and other barriers such lack of understanding of who and what services were covered for free.ConclusionEfforts should be undertaken so all individuals understand the NHIS policy including who is eligible for free services and what services are covered. Increasing access to health insurance will enable Ghana to further improve maternal and child health outcomes.

Growing Pains: Childhood Illness in Ireland, 1750–1950 ed. by Anne Mac Lellan and Alice Mauger (review)

Reviewed by: Growing Pains: Childhood Illness in Ireland, 1750–1950 ed. by Anne Mac Lellan and Alice Mauger Maria Luddy Anne Mac Lellan and Alice Mauger, eds. Growing Pains: Childhood Illness in Ireland, 1750–1950. Kildare: Irish Academic Press, 2013. xix + 254 pp. Ill. $85.00 (978-0-7165-3160-9). This is the first collection to deal with the history of childhood illness in Ireland and is thus groundbreaking in its extent and concerns. The volume is structured [End Page 126] around four main themes: the sites of care for sick children, child patient experiences, those who played a key role in their treatment, and the eventual emergence of pediatrics as a discrete medical sphere in Ireland. Consisting of ten chapters, it explores infectious and noninfectious diseases such as rickets, smallpox, tuberculosis, Spanish flu, epilepsy, and ophthalmia among children. It reveals, for instance, that in 1750 one in every three children died of small pox; by 1800, 20 percent of infants still died in their first year, and it was not until the 1950s that real inroads were made into reducing the levels of infant mortality in the country. Rather than having a systematic network of pediatric care in Ireland, this volume shows that Irish institutions, such as workhouses and industrial and reformatory schools, became accidental sites of medical care. The first hospital dedicated to children in Ireland was the Dublin Institution for the Diseases in Children, founded in 1822. At first it provided an outpatient service only, but its existence predated the establishment of children’s hospitals in Britain by almost thirty years. Pediatrics as a clinical specialism was slow to develop, with only a handful of such specialists in Britain by 1900. The British Journal of Diseases of Children was first published in 1904 and was followed by the establishment of the British Paediatric Association in 928, with the formation of the Irish Paediatric Club in 1933. This volume is full of information and insights into a range of childhood illnesses and their treatment over two hundred years. The significance of maternal care for ill children is a major feature of eighteenth- and nineteenth-century health provision. Ashford argues convincingly that it was the introduction of compulsory small pox vaccination in Ireland in 1863 that turned the rural poor away from itinerant smallpox inoculators, to whom they had previously remained firmly committed. Ward explores the range of children’s clinics, wards, and hospitals established in Dublin in the nineteenth century and uncovers the debates that arose concerning the increasing specialization of institutional medical provision for Irish children. Walker examines the treatment of syphilitic children in Dublin’s Westmoreland Lock Hospital, a specialist hospital treating venereal diseases from the late eighteenth century. Further chapters deal with the epidemic of ophthalmia among children in Irish workhouses between 1849 and 1861, when children had been weakened by the impact of the Great Famine. Another examines the treatment of epileptic children confined to Richmond District Lunatic Asylum, an institution where such children probably received a greater level of medical assistance than if they had remained at home or as was more usual for such children, in the workhouse. While there is a strong history of tuberculosis in Ireland two chapters in this present volume are the first to deal historically with the disease in children. One reveals how the neglect of testing children for tuberculosis or the misdiagnosis of tubercular children affected treatment, while also revealing how the focus on tubercular children allowed for both the visibility and the continuing development of pediatrics as a clinical specialism. A second chapter uses oral histories to access childhood patient experiences of tuberculosis. Milne’s chapter also utilizes oral histories to shed light on childhood memories and experiences of the Spanish flu. Kelly’s chapter looks at Irish children with rickets and the establishment [End Page 127] of the Children’s Sunshine Home by Dr. Ella Webb. She shows how Webb’s work can be viewed as part of a system of welfare work carried through by Irish women doctors in Dublin in the twentieth century. Such work in itself revealed the extent to which the diseases of children were the result of Irish...