Child Health Care Professionals Research Articles

Familiar in the Unfamiliar – Children's, Parents', and Healthcare Professionals' Experiences of Procedure-Related Anesthesia in the Pediatric Oncological Ward

PurposeTo explore children's, parents', and healthcare professionals', experiences of anesthesia related to pediatric oncological treatment performed at the pediatric oncology ward. Design and methodsThe study was a qualitative study. 11 children and 12 parents were recruited for individual or dyadic interviews and two focus groups with a total of 12 healthcare professionals were recruited through purposeful and convenience sampling procedures. ResultsThematic analysis generated one main theme, the familiar in the unfamiliar, and two subthemes, the room creates an atmosphere and relational continuity. ConclusionsChanging the physical environment and composition of the team positively influenced the experience of anesthesia in pediatric cancer treatment for both children, parents, and healthcare professionals. Familiarity was important for all involved and familiarity was associated with continuity related to the physical environment, as well as the relational and procedural professional continuity. Parents expressed that they never felt good about anesthesia as there were feelings of leaving your child's life into the hands of others. However, familiarity in trusting relationships with healthcare professionals helped to moderate these aspects. Practice implicationsFamiliarity should be considered important with continuity in trusting relations and collaborations between nurses and families, as well as between healthcare staff. Pediatric oncology ward is a preferred safe familiar setting for procedure-related anesthesia. Parents and children value individualized flexible nursing care, that takes the child's and parents habits and preferences into account during procedure-related anesthesia in pediatric oncological treatment.

Evaluation of a New Personalized Health Dashboard in Preventive Child Health Care: Protocol for a Mixed Methods Feasibility Randomized Controlled Trial.

BackgroundA new dashboard, the 360ºCHILD-profile, was developed to adopt personalized health care within preventive child health care. On this profile, holistic health data are visualized in a single image to provide parents, adolescents, and caregivers direct access to a manageable résumé of a child’s medical record. Theoretical ordering, conforming to “International Classification of Functioning, Disability and Health for Children and Youth”, guides clinical reasoning toward the biopsychosocial concept of health. It is yet unknown if and how this promising tool functions in practice, and a variety of feasibility questions must be addressed.ObjectiveThis paper describes the design and methods of a feasibility randomized controlled trial (RCT), with the aim of evaluating the RCT’s feasibility (recruitment, response, measure completion, and intervention allocation) and 360ºCHILD-profile’s feasibility (usability and potential effectiveness).MethodsA pragmatic mixed methods study design was chosen, starting with an RCT to measure feasibility and health literacy in 2 parallel groups (1:1). Qualitative research will then be used to understand and explain quantitative findings and to explore the stakeholders' perspectives on the potential of the 360ºCHILD-profile. Participants will include child health care professionals (n≥30), parents (n≥30), and caregivers (n≥10) of children who experience developmental problems (age 0-16 years). Children will only be able to participate if they are older than 11 years (adolescents, n≥10). The 2 groups included in the study will receive standard care. The experimental group will additionally receive personalized 360ºCHILD-profiles.ResultsAfter an intervention period of 6 months, quantitative outcomes will be measured, analyzed (descriptive feasibility statistics and preliminary between-group differences) and used to purposively sample for semistructured interviews.ConclusionsStudy results will provide knowledge for building theory on the 360ºCHILD-profile and designing future (effect) studies.Trial RegistrationNetherlands Trial Register NTR6909; https://www.trialregister.nl/trial/6731International Registered Report Identifier (IRRID)DERR1-10.2196/21942

Issue highlights

Several papers in this issue explore growth in children. Van Dommelen et al8 have developed a guideline to help preventive child healthcare professionals improve early detection of pathological disorders associated with short or tall stature. Meanwhile, Gomula et al9 explored secular trends and social variations in the height of Polish schoolchildren between 1966 and 2012, while Kvist et al10 studied factors that influenced growth plate closure in adolescents and young adults.

Designing a Personalized Health Dashboard: Interdisciplinary and Participatory Approach.

BackgroundWithin the Dutch Child Health Care (CHC), an online tool (360° CHILD-profile) is designed to enhance prevention and transformation toward personalized health care. From a personalized preventive perspective, it is of fundamental importance to timely identify children with emerging health problems interrelated to multiple health determinants. While digitalization of children’s health data is now realized, the accessibility of data remains a major challenge for CHC professionals, let alone for parents/youth. Therefore, the idea was initiated from CHC practice to develop a novel approach to make relevant information accessible at a glance.ObjectiveThis paper describes the stepwise development of a dashboard, as an example of using a design model to achieve visualization of a comprehensive overview of theoretically structured health data.MethodsDevelopmental process is based on the nested design model with involvement of relevant stakeholders in a real-life context. This model considers immediate upstream validation within 4 cascading design levels: Domain Problem and Data Characterization, Operation and Data Type ion, Visual Encoding and Interaction Design, and Algorithm Design. This model also includes impact-oriented downstream validation, which can be initiated after delivering the prototype.ResultsA comprehensible 360° CHILD-profile is developed: an online accessible visualization of CHC data based on the theoretical concept of the International Classification of Functioning, Disability and Health. This dashboard provides caregivers and parents/youth with a holistic view on children’s health and “entry points” for preventive, individualized health plans.ConclusionsDescribing this developmental process offers guidance on how to utilize the nested design model within a health care context.

6 voces en 10 minutos: Herramientas para educación en niños

6 voces en 10 minutos: Experiencias en educación en ArgentinaHerramientas para educación en niñosLos profesionales de la salud requieren una formación especializada adecuada en los principios de la práctica de la enseñanza/aprendizaje para implementar con éxito educación diabetológica tanto a niños/as, adolescentes y sus cuidadores. La misma debe ser diseñada para la promoción de la autonomía de las personas con diabetes.Las intervenciones educativas que demostraron ser eficaces incluyen como estrategias: en primer lugar, considerar al niño/a y la familia como paciente, la edad de la persona con diabetes, si se está frente a un/a bebé, niño/a o púber, su contexto, su modalidad de aprendizaje, y de esa manera integrarla en la atención clínica de rutina como un proceso continuo de prestación de servicio. Las intervenciones deben estar enfocadas en los factores psicosociales, implicando la responsabilidad continua de los padres/madres o cuidadores, tanto en la niñez como en la adolescencia. Es fundamental hacer uso de técnicas que posibiliten el ejercicio en la resolución de situaciones de la vida cotidiana, establecimiento de metas terapéuticas construidas de manera conjunta entre la familia y el equipo de salud, habilidades de comunicación, capacidad de resolución de conflictos familiares, siempre vehiculizadas a través de actividades lúdicas y recreativas, de manera grupal o individual.

Guideline for referring short or tall children in preventive child health care.

To develop a guideline for preventive child healthcare professionals in orderto improve early detection of pathological disorders associated with short stature (or growth faltering) or tall stature (or accelerated growth). We updated the previous Dutch guideline for short stature in children aged 0-9years and extended it to adolescents (10-17years), and added a guideline for tall stature, based on literature and input from an expert committee. Specificities were calculated in a cohort of healthy Dutch children aged 0-9years (n=970). We investigated the impact of a late onset of puberty on height standard deviation score based on the Dutch growth charts. Growth parameters of the guideline include height, the distance between height and target height and change of height over time. Other parameters include diagnostic clues from medical history and physical examination, for example behavioural problems, precocious or delayed puberty, body disproportion and dysmorphic features. Preventive child healthcare professionals now have an updated guideline for referring short or tall children to specialist care. Further research is needed on the diagnostic yield after referral and specificity at field level.

A Presentation of Collaborative and Innovative Training Programs for Early Child Care Providers and Healthcare Professionals on the Impact of the Opioid Crisis on Children

A Presentation of Collaborative and Innovative Training Programs for Early Child Care Providers and Healthcare Professionals on the Impact of the Opioid Crisis on Children

Child and adolescent immunisation in the UK: current issues

Abstract The childhood immunisation programme in UK is highly successful and constantly under review. Changes are frequent with new vaccines introduced or alterations to the timing or number of doses of existing vaccines. It is important for child healthcare professionals to keep up to date with the programme, as parents will often turn to them for advice. In this article we outline recent changes to the vaccine programme and the impact of recently introduced vaccines on disease. Current issues, including increases in measles cases and addressing parents’ concerns about vaccines, are discussed.

Precautionary Principle: Cancer Prevention Efforts During Critical Periods of Growth and Development.

Although the mechanisms of action for all cancer types are not fully known, best practice recommends promoting a healthy lifestyle while avoiding certain substances. Based on environmental science, the precautionary principle is a guideline that suggests that preventive action should be taken when the effects of a substance are unknown or disputed. Oncology nurses and maternal child healthcare professionals can improve cancer prevention through efforts during pregnancy, childhood, adolescence, and adulthood. This article reviews the application of the precautionary principle during critical periods of growth and development and provides recommendations that may prevent epigenetic changes and reduce the risk for cancer.

BUILDING NETWORKS OF PROFESSIONALS TO SUPPORT KINSHIP CARE FAMILIES

Numbers of American children being raised by relatives continue to rise. Over 7.8 million children, representing 10.5% of American children under age 18, lived in a relative-headed home. Of these, 2.5 million have no parent present in their home (Generations United, 2016). Kinship families’ needs are typically complex, needing prompt and sensitive responses. Varied professionals often serve kinship families but the majority report receiving little information or training related to kinship families. (Smith 2017 This pilot project surveyed professionals (n = 63) representing varied disciplines in a pre/post-test format to determine change in knowledge and strategies for working with kinship care family members. All respondents were enrolled in graduate courses specifically focused on kinship families. Respondents represented diverse fields including family therapists (n = 9), family service workers (n = 23), teachers (n = 16), school administrators (n = 4), child care providers (n = 2) and health care professionals (n = 7 ). Respondents completed a 17 question pre/post survey. Results demonstrated the majority (n = 59; 93%) had experience with kinship families but most (n = 47; 74%) had received little/no targeted professional training. Post-test results strongly indicated that completing any amount of kinship-related coursework positively impacted professionals’ knowledge, confidence, and readiness to utilize learned strategies in their work with kinship families. Additionally, post-test results of students completing the entire series of classes (9 credits) revealed significantly greater changes, demonstrating the importance of providing comprehensive information to enhance professional practices for working with kinship families.

Effects of a computerised guideline support tool on child healthcare professionals\u2019 response to suspicions of child abuse and neglect: a community-based intervention trial

BackgroundHealthcare professionals’ adherence to guidelines on child protection is not self-evident. This study assessed the effects of a computerised support tool on child healthcare professionals’ adherence to the seven recommended guideline activities, and on time spent seeking information presented in this guideline.MethodsA community-based intervention trial design was applied, comparing access to a paper-based guideline (control) with access to a paper-based guideline supplemented with a computerised guideline support tool (intervention). A total of 168 child healthcare doctors and nurses working in one large Dutch organisation were allocated to an intervention or control group. Outcomes were professionals’ performance of seven recommended guideline activities and the amount of time spent seeking information presented in the guideline. Professionals’ adherence was measured using two methods: health record analysis and a self-report questionnaire. The questionnaire was also used to collect data on the amount of time spent seeking guideline information.ResultsIn total, 152 health records (102 in the intervention group and 50 in the control group) were available for analysis. The tool was registered in 14% of the records in the intervention group. Performance of activities, corrected for intentional non-adherence, was except for one activity, high (range 80–100%); no differences were found between the control and intervention groups. Forty-nine questionnaires (24 in the intervention group and 25 in the control group) were analysed. Sixty-three percent of the questionnaire respondents (15/24) claimed to have used the tool. No differences in guideline adherence were found between the two groups. Respondents in the intervention and control groups spent, on average, 115 and 153 min respectively seeking relevant information presented in the guideline.ConclusionsThe results regarding use of the tool were inconclusive as the outcomes differed per method. In contrast to expectations, performance of guideline activities was high in both groups. The support tool may decrease the amount of time spent on seeking guideline information. However, given the high adherence scores and small number of questionnaire respondents, the outcomes failed to reach statistical significance. Future research should focus on studying the effects of the tool after a longer period of availability.

Handover of care and of information by community midwives, maternity care assistants and Preventive Child Healthcare professionals, a qualitative study

IntroductionHandover of care has been internationally acknowledged as an important aspect in patient safety. Families who are vulnerable due to low socio-economic status, a language barrier or poor health skills, benefit especially from a decent handover of care from one healthcare professional to another. The handover from primary midwifery care and maternity care to Preventive Child Healthcare (PCHC) is not always successful, especially not in case of vulnerable families. AimObtaining insight in and providing recommendations for the proces of handover of information by primary midwifery care, maternity care and PCHC in the Netherlands. MethodsA qualitative research through semi-structured interviews was conducted. Community midwives, maternity care nurses and PCHC nurses from three municipalities in the Netherlands were invited for interviews with two researchers. The interviews took place from February to April 2017. The qualitative data was analyzed using NVivo11 software (QSR International). ResultsA total of 18 interviews took place in three different municipalities with representatives of the three professions involved with the handover of care and of information concerning antenatal, postnatal and child healthcare: six community midwives, six maternity care assistants and six PCHC nurses. All those interviewed emphasized the importance of good information transfer in order to provide optimum care, especially when problems within the family ar present. In order to improve care, a large number of healthcare professionals prefered a fully digitized handover of information, providing the privacy of the client is warrented and the system works efficiently. To provide high quality care, it is considered desirable that healthcare workers get to know each other and more peer agreements are prepared. The ‘obstetric collaborative network’ or another structured meeting was considered most suitable for this exchange. ConclusionThis study shows that the handover of care and of information between professionals in the fields of antenatal, postnatal and child healthcare is gaining awareness, but a more rigorous chain of care and collaboration between these disciplines is desired. Digitizing seems important to improve the handover of information.

We Have All Been Working in Our Own Little Silos Forever: Exploring a Cross-Sector Response to Child Maltreatment

ObjectiveA child protective services (CPS) investigation for maltreatment signals risk for childhood toxic stress and poor health outcomes. Despite this, communication between child welfare and health care professionals is rare. We present a qualitative exploration of experiences with, barriers to, and hopes for cross-sector collaboration for children with suspected maltreatment. MethodsWe conducted focus groups with child welfare and health care professionals participating in a cross-sector learning collaborative to improve care for children at high risk for toxic stress. Participants were asked to describe 2 phenomena: identifying and responding to childhood adversities in their professional settings and cross-sector collaboration in cases of suspected maltreatment. Analysis included an iterative process of reading, coding and comparing themes across groups. ResultsHealth care professionals shared positive experiences in screening for social risks in clinic, while child welfare professionals expressed mixed attitudes toward social risk screening during CPS investigations. Consistent with prior research, health care professionals reported limited communication with CPS caseworkers about patients but suggested that relationships with child welfare professionals might reduce these barriers. Child welfare professionals described the poor quality of information provided in referrals from medical settings. Caseworkers also recognized that improved communication could support better understanding of maltreatment concerns and sharing of outcomes of CPS investigation. ConclusionsOur project extends previously published research by describing potential benefits of child welfare and child health care collaboration in cases of suspected maltreatment. Lack of effective cross-sector communication and concerns about confidentiality present significant barriers to uptake of these collaborative practices.

Psychotropic Medication Use and Perceptions of Medication Effects Among Transition-Age Foster Youth

The prevalence of psychotropic medication use among children and adolescents in foster care has received increasing attention from policymakers and scholars and led to responses from government. Most research has focused on school-age foster children; less is known about psychotropic medication use among foster youth transitioning to adulthood from care. Using data from a longitudinal study of transition-age foster youth (n = 611), this study examines the prevalence of psychotropic medication use over time, evaluates youths’ perceptions of the benefits of medication, and assesses associations between medication use and behavioral health problems. The overall rate of psychotropic medication use dropped from age 17 to age 19. Among youth with at least one behavioral health problem, rates of psychotropic medication use also declined over time. Decreases in psychotropic medication use between age 17 and 19 were found among youth with the following disorders: mania, an alcohol use disorder, and a non-alcohol drug use disorder. Behavioral health status and youths’ living arrangements were associated with the likelihood of psychotropic medication use at age 17, whereas only behavioral health status was associated with the likelihood of psychotropic medication use at age 19. Most youth reported either a positive or neutral view of the relative benefits of using medications. Among youths who had used medications, those in relative foster homes were less likely than those in non-relative foster homes to report negative views of their medications. The findings have implications for child welfare and health care professionals and policymakers.

Neurodevelopmental problems should be considered in children with febrile seizures.

Clinical developmental phenotyping of four- to five-year-old children with febrile seizures (FSs). Children with FS (n=157, corresponding to 3.7% of the targeted general population of four-five-year-olds) had been identified at child healthcare centres in Gothenburg. Parents of 73 children (41 boys, 32 girls) accepted participation in the present study. The assessments included a neuropaediatric assessment, Movement ABC, Wechsler Preschool and Primary Scale of Intelligence-III and parent questionnaires (Five-to-Fifteen (FTF) and Strengths and Difficulties Questionnaire (SDQ)). Hospital records were reviewed, when applicable. One-third of the children had at least one DSM-5 neurodevelopmental disorder diagnosis or marked developmental problems within areas of attention, activity regulation, behaviour, speech and language, general cognition or motor functioning. No differences were found between children with single vs recurrent or simple vs complex FS. Febrile seizure are relatively often associated with Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCEs). We found no indications that ESSENCE might be caused by FS per se. However, the results suggest that child healthcare professionals should consider the possibility of ESSENCE in children with a history of FS.

Differences in attitudes and knowledge about vaccination in preschool children parents and health care professionals

Differences in attitudes and knowledge about vaccination in preschool children parents and health care professionals

Health Care Utilisation by Bullying Victims: A Cross-Sectional Study of A 9-Year-Old Cohort in Ireland.

Children frequently refrain from disclosing being bullied. Early identification of bullying by healthcare professionals in children may prevent adverse health consequences. The aim of our study was to determine whether Health Care Utilisation (HCU) is higher in 9-year-olds who report being bullied and factors influencing type of HCU. The study consists of cross-sectional surveys of Child Cohort of Irish National Longitudinal Study of Children (Wave 1), 8,568 9-year-olds, and their carers. Being bullied was assessed by a self-reported questionnaire completed by children at home. HCU outcomes consisted of the following: visits to GP, Mental Health Practitioner (MHP), Emergency Department (ED), and nights in hospital by parent interview. Bivariate logistic regression and gender-stratified Poisson models were used to determine association. Victimisation by bullying independently increased visits to GP (OR 1.13, 95% confidence interval (CI): 1.03 to 1.25; p = 0.02), MHP (OR 1.31, 95% CI: 1.05 to 1.63; p = 0.02), though not ED visits (OR 0.99, 95% CI: 0.87 to 1.13; p = 0.8) or nights in hospital (OR 1.07 95% CI: 0.97 to 1.18; p = 0.2), adjusting for underlying chronic condition(s) and socio-demographic confounders. Victimised girls made higher GP visits (RR 1.14, 95% CI: 1.06 to 1.23; p < 0.001) and spent more nights in hospital (RR 1.10, 95% CI: 1.04 to 1.15; p < 0.001). Victimised boys were more likely to contact MHPs (RR 1.21, 95% CI: 1.02 to 1.44; p = 0.03). 9-year-old bullied subjects were more likely to utilise primary care services than non-bullied 9-year-olds. Different HCU patterns were observed according to gender and gender differences in the presentation of victimisation. Our findings may lead to the development of clinical practice guidelines for early detection and appropriate management of bullied children.

Parent–infant interactions looking for instances of volitional social gaze versus reflexive gaze – an observational study

ABSTRACTVery early precursors of disrupted social behaviours are significant to understanding the possibility of mitigating or changing behaviours through interventions. Spontaneous play situations between infant and parent in two groups of infants aged 8.5–9 months were observed. First, a large number of videos were analysed to develop an observational schedule of play behaviour. Second, 135 videos were used in the comparison of atypical (AT; n = 23) and typically developed (TD; n = 22) infants. Frequency and duration of infants’ orientation towards the parent’s eye zone was significantly higher among TD infants than AT, indicating a stronger social gaze behaviour. Both groups were as competent at screening the surroundings, grabbing, and looking at toys. Finding may indicate an equal competence at reacting to reflexive stimuli. The quality of gaze behaviour provides important information for child healthcare professionals and parents when deciding whether to start supportive intervention or diagnostic investigation.

Parental conceptions of the rotavirus vaccine during implementation in Stockholm: A phenomenographic study.

In 2014, Stockholm became the first Swedish county to introduce the rotavirus vaccine, which is given from as early as six weeks of age. The aim of this study was to describe parental conceptions of rotavirus infection and vaccination during its implementation as part of the child immunization program, as their support is vital for any new vaccine. The study followed a descriptive, qualitative design with a phenomenographic approach. Ten in-depth interviews with parents were conducted in Stockholm County, transcribed and analyzed to describe qualitatively different conceptions of rotavirus infection and vaccination. Four main categories were identified: to vaccinate without doubt, hesitant to vaccinate, risky to vaccinate, and unnecessary to vaccinate. All the parents had in common the desire to protect their children from suffering, either by vaccinating their child in order to avoid rotavirus infection or by not vaccinating their child because of concerns about the side effects. It is important that child health-care professionals understand the variations of conceptions that influence the parents' decisions and that these conceptions may differ considerably. Individualized parental information about rotavirus infection and vaccination would help to achieve a successful implementation of the vaccination program.

Variation in prevention of child maltreatment by Dutch child healthcare professionals

Child maltreatment (CM) is a common condition with a large impact on the victim and society. In the Netherlands, the preventive child healthcare (CHC) aims to protect children against such threats. However, several studies indicate that the efficacy in this area may be suboptimal for many CHC professionals. Therefore, this study aims to map the practice variation in the primary and secondary prevention of CM, by CHC physicians and nurses. This mixed-methods study used interviews to identify relevant topics and develop an online questionnaire. All CHC organizations in the Netherlands (n=45) were asked to forward this questionnaire to their professionals. Practice variation was described with domain scores and item response distributions. Multi-level analysis was used to assess case mix-corrected variance between organizations. Interview participants (n=11) expected suboptimal care in 35 topics which they considered important for prevention of CM, resulting in a 15min questionnaire. Nearly two-thirds of the organizations (n=29) agreed to forward the questionnaire to their employees. The response rate was 42% (n=1104). Suboptimal care and practice variation was found in all domains (i.e. communication, medical expertise, collaboration, involvement in prevention of CM, and improvement opportunities), mostly caused by intra-organization variance. Significant inter-organization variance was found for collaboration (variance partition coefficient 6–7%) and involvement (2–3%). Furthermore, the majority of the respondents (96%) reported fear in acting upon suspicions of CM. Substantial suboptimal care and practice variation in prevention of CM warrant action from authorities, CHC training institutes, CHC organizations, and professionals.