Guidelines For Care Of Children Research Articles

Higher paediatric readiness in emergency departments and trauma centres with a paediatrician on-site

Background: Critically ill and injured children are frequently admitted to mixed adult/paediatric emergency departments and trauma centres. Children constitute a smaller proportion of patients in these facilities, thus leading to the risk of poor quality of paediatric emergency care being provided. Studies show that day-to-day readiness for the emergency care of children affect paediatric patient safety and is associated with a reduced risk of mortality among critically ill children. This study aimed to assess the level of paediatric readiness in Danish emergency departments and trauma centres. We hypothesised that trauma centres had a higher paediatric readiness than emergency departments.
 Methods: From November 2020 to January 2021, a nationwide survey was conducted in all 18 Danish emergency departments and four trauma centres. The questionnaire was a Danish translation of the 2013 American assessment of paediatric readiness provided by the National Pediatric Readiness Project. Facility chief physicians were approached by phone and for those willing to participate, the questionnaire was e-mailed for completion by designated healthcare professionals working in the emergency department or trauma centre. Primary outcome was paediatric readiness, which was assessed using the weighted paediatric readiness score based on a scale from 0-100. A score of 100 points indicated full compliance with the 2009 American Guidelines for Care of Children in the Emergency Department. The weighted paediatric readiness score was presented as median with interquartile range (IQR). Our hypothesis was tested using the Mann-Whitney U test, and a P-value of less than 0.05 was considered statistically significant.
 Results: A total of 13 emergency departments and three trauma centres replied resulting in a response rate of 73%. There was no significant difference in weighted paediatric readiness scores between emergency departments, median (IQR) 70.0 (56.1-78.2) and trauma centres 75.6 (70.9-78.4); (P = 0.42). Facilities with a paediatrician on-site 24/7 (n=12) had higher paediatric readiness scores 75.5 (67.7-78.8) than four facilities without an on-site paediatrician 53.8 (44.9-63.1); (P = 0.02).
 Conclusion: Trauma centres did not have a higher paediatric readiness than emergency departments. However, we found a higher paediatric readiness in facilities with a paediatrician on-site.

Bringing Child Buddhist Monks into the Alternative Care Conversation: Reflections on an Under-considered Group of Children

Tens of thousands of children in India, Bhutan, Nepal, Sri Lanka, and other Asian countries are living as child Buddhist monks. Many are in temples and monasteries far from home and do not see their parents for months, even years. Some are as young as 6 years of age. The aim of this article is to engage scholars, practitioners, child rights advocates, and others in a conversation around the rights and vulnerabilities of child Buddhist monks and children susceptible to being entrusted to monasteries to live as child monks. This group of children receives relatively little attention in alternative care conversations despite many parallels and overlaps with children in orphanages and care homes. This article identifies risks and vulnerabilities that child monks can face, including sexual abuse. It reflects on how aspects of entrusting young children to live as child monks do not necessarily fit with principles articulated in the Convention on the Rights of the Child ( UNGA, 1989 ) and the United Nations Guidelines for the Alternative Care of Children ( UNGA, 2009 ).

Deinstitutionalisation and the Best Interest of the Child: The Case of Rwanda and Lessons for South Asia

The ‘deinstitutionalisation’ (DI) movement, also known as ‘care reforms’, is spreading rapidly across the globe, gaining momentum with the growing understanding among both practitioners and policy makers of the harmful effects of institutionalisation on the development and well-being of children as well as the strengthening of the child rights discourse. This has led to a growing international trend towards the development of, and a strong belief in, family-based care options for children deprived of parental care, away from large-scale institutions. This trend is reflected in and supported by international frameworks guiding the care of children, including the United Nations Convention on the Rights of the Child and in particular the United National Guidelines for the Alternative Care of Children, which was hailed in 2009. These instruments recognise that a caring and protective family is central to a child’s development, that governments should fulfil children’s right to quality care in families of origin and in alternative care and that institutionalisation of a child should be discouraged. DI processes are, however, not simple and straightforward as there are many challenges and complexities in their cross-cultural implementation. Even though unequivocally agreed by all stakeholders that the ‘best interest of the child’ should be at the heart of such care reform processes, its actual practice can often contradict such understandings as it gets submerged in numerous other considerations, constraints and challenges. This article analyses some of the dominant DI trends prevailing at present, in particular the primacy of family-based care and the misconceptions associated with the suitability of residential care, illustrated by the experience of SOS Children’s Villages in the DI process and its outcomes in Rwanda. The analysis is premised on the framework of the UN guidelines for the alternative care of children and strives to understand whether DI as it is practiced in Rwanda is aligned with the principles of ‘necessity’, ‘suitability’ and the ‘best interest of the child’ as stipulated in the Guidelines. The attempt is to draw lessons for South Asia from the success as well as the challenges faced in Rwanda, as many governments in South Asia progressively join the DI movement. It is critical for all child-focused international non-governmental organization/ non-governmental organizations (INGOs/NGOs) in Asia to understand the UNGL, learn from different experiences about the challenges of DI and prepare to engage with policy makers. One of the most important lessons from the Rwanda experience is that the ‘quality’ of care should take precedence over the ‘form’ of care, and that quality is not always guaranteed in family-based care. The shift in the positionality of the government of Rwanda and their willingness to rethink their approach to DI particularly in terms of recognising quality residential care is commendable. This needs to be taken as a precedence by other governments across the world including in South Asia—especially by those who are truly interested in ensuring the best interest of children who have lost the care of their parents.

Real-Time Electronic Health Registry Improves Care for Children with Sickle Cell Disease

Objective: Published literature shows low and variable compliance with the recommended guidelines for care of children with sickle cell disease (SCD). Our objective was to use an electronic health record (EHR)-based registry to track and improve compliance with the recommendations for the pediatric population of SCD at our institution, using annual transcranial doppler screening (TCD) as an example. Methods: We developed an in-EPIC real time registry for children with SCD in the year 2016 to enhance point of care and improve quality. Since 2017, we have been conducting plan-do-study-act (PDSA) cycles using the registry to improve TCD compliance. We extract data quarterly to examine TCD rates and share with the clinical team the list of children who have not received a TCD screening in the past 18 months. This allows the clinical team to provide case-management to reduce non-compliance. We recently added Child Life support to increase TCD compliance among children <7 years. We use control charts to examine TCD rates after the aforementioned interventions. We also continually refine the registry to broaden the provision of quality care to the patient population. Results: One year into the registry, which we considered baseline and the start of the first PDSA cycle, 63% of children were compliant with the recommendation of an annual TCD screen. The TCD rates steadily increased to 80% by the third-quarter of 2017. We observed a dip in TCD rates by the second-quarter 2018 (66%), felt to be in part driven by failure of screening young children. Since the initiation of Child Life Support for young children, the overall TCD rates increased to 74% (first-quarter 2019). Our data demonstrate a sustained improvement in TCD rates since 2016 and meet criteria for special cause variation (Figure 1). We have recently added other metrics such as acute care encounters external to our institution, magnetic resonance imaging, and an indicator for active hydroxyurea use to the registry. Conclusion: Use of an EHR-based registry to track and provide feedback on quality of care metrics such as annual TCD screening can result in sustained improvement in compliance with the recommended guidelines. Preliminary evidence indicates that Child Life involvement further improves TCD rates. Future work will determine if audit and feedback for other metrics added to the registry can improve compliance and improve outcomes. Disclosures Panepinto: NIH: Research Funding.

Pediatric Readiness in the Emergency Department.

This is a revision of the previous joint Policy Statement titled "Guidelines for Care of Children in the Emergency Department." Children have unique physical and psychosocial needs that are heightened in the setting of serious or life-threatening emergencies. The majority of children who are ill and injured are brought to community hospital emergency departments (EDs) by virtue of proximity. It is therefore imperative that all EDs have the appropriate resources (medications, equipment, policies, and education) and capable staff to provide effective emergency care for children. In this Policy Statement, we outline the resources necessary for EDs to stand ready to care for children of all ages. These recommendations are consistent with the recommendations of the Institute of Medicine (now called the National Academy of Medicine) in its report "The Future of Emergency Care in the US Health System." Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that ED staff, administrators, and medical directors seek to meet or exceed these recommendations to ensure that high-quality emergency care is available for all children. These updated recommendations are intended to serve as a resource for clinical and administrative leadership in EDs as they strive to improve their readiness for children of all ages.

Aftercare of Children in Alternative Care: An Analysis of the International and National Legal Framework from the Prism of Human Rights

Aftercare is an essential element in the life after institutionalised care for a child. A good aftercare programme ensures that the children are given a chance at living a normal life. Children in institutionalised care are often discriminated and abused for their background. During their time in such institutions, they are generally shielded from such abuse but in the real world, having such a background creates many hurdles for children. Consequently, aftercare forms an integral part of a child in institutionalised care. The United Nations is the nodal body within the international framework working towards preservation and promotion of human rights of all. The General Assembly in 2010 adopted a resolution, titled, Guidelines for the Alternative Care of Children. In the resolution, the UN provides numerous guidelines for aftercare which may be utilised as standards for aftercare. With this background, this study is aimed at studying the concept of aftercare from the prism of human rights and the international framework in context of the Convention on the Rights of the Child and the UN resolution, Guidelines for the Alternative Care of Children. Furthermore, the research is aimed at analysing the legal provisions and standards provided within the Indian legal system and how far it is attuned to the international standards. This study is an endeavour to correlate the international and national provisions to understand the concept of aftercare in a comprehensive manner.

Pediatric Readiness and Facility Verification

We perform a needs assessment of pediatric readiness, using a novel scoring system in California emergency departments (EDs), and determine the effect of pediatric verification processes on pediatric readiness. ED nurse managers from all 335 acute care hospital EDs in California were sent a 60-question Web-based assessment. A weighted pediatric readiness score (WPRS), using a 100-point scale, and gap analysis were calculated for each participating ED. Nurse managers from 90% (300/335) of EDs completed the Web-based assessment, including 51 pediatric verified EDs, 67 designated trauma centers, and 31 EDs assessed for pediatric capabilities. Most pediatric visits (87%) occurred in nonchildren's hospitals. The overall median WPRS was 69 (interquartile ratio [IQR] 57.7, 85.9). Pediatric verified EDs had a higher WPRS (89.6; IQR 84.1, 94.1) compared with nonverified EDs (65.5; IQR 55.5, 76.3) and EDs assessed for pediatric capabilities (70.7; IQR 57.4, 88.9). When verification status and ED volume were controlled for, trauma center designation was not predictive of an increase in the WPRS. Forty-three percent of EDs reported the presence of a quality improvement plan that included pediatric elements, and 53% reported a pediatric emergency care coordinator. When coordinator and quality improvement plan were controlled for, the presence of at least 1 pediatric emergency care coordinator was associated with a higher WPRS (85; IQR 75, 93.1) versus EDs without a coordinator (58; IQR 50.1, 66.9), and the presence of a quality improvement plan was associated with a higher WPRS (88; IQR 76.7, 95) compared with that of hospitals without a plan (62; IQR 51.2, 68.7). Of pediatric verified EDs, 92% had a quality improvement plan for pediatric emergency care and 96% had a pediatric emergency care coordinator. We report on the first comprehensive statewide assessment of "pediatric readiness" in EDs according to the 2009 "Guidelines for Care of Children in the Emergency Department." The presence of a pediatric readiness verification process, pediatric emergency care coordinator, and quality improvement plan for pediatric emergency care was associated with higher levels of pediatric readiness.

Overall State of Pediatric Readiness in U.S. Improved Over the Past 10 Years, but Gaps Remain

Overall pediatric readiness has improved over the last 10 years, but many U.S. EDs lack equipment and pediatric specific training for healthcare providers. OVER THE LAST two decades, U.S. researchers have focused on improving pediatric readiness for children in emergency care settings. Last month researchers from the National Pediatric Readiness Project updated a 2006 report assessing the pediatric readiness of U.S. emergency departments (ED) (Gausche-Hill et al., 2015). The study is important because it provides the most up-to-date and comprehensive evaluation of pediatric readiness of U.S. EDs. The current report found that overall pediatric readiness had improved over the last 10 years, but that many U.S. EDs continue to lack pediatric equipment and pediatric-specific training for healthcare workers. To assess pediatric readiness the researchers used a weighted 55 question Web-based survey based on the guidelines for care of children in EDs issued by the American Academy of Pediatrics, American College of Emergency Physicians, and the Emergency Nurses Association (2009). Previous reports had showed relatively poor, uneven compliance with the guidelines. The investigators assessed pediatric readiness, including physician/nurse training, quality of improvement activities, patient safety initiatives, policies and procedures, availability of equipment and disaster planning. Of the 4,137 assessments completed (83% response rate) in 2013, there was a median score of 69 on the 100-point weighted pediatric readiness score (WPRS) scale, an increase from a median of 55 in 2003. The researchers found a correlation between the WPRS scores and the annual volume of pediatric patients. Hospitals with less than 1,800 pediatric patients a year had a

A national assessment of pediatric readiness of emergency departments.

Previous assessments of readiness of emergency departments (EDs) have not been comprehensive and have shown relatively poor pediatric readiness, with a reported weighted pediatric readiness score (WPRS) of 55. To assess US EDs for pediatric readiness based on compliance with the 2009 guidelines for care of children in EDs; to evaluate the effect of physician/nurse pediatric emergency care coordinators (PECCs) on pediatric readiness; and to identify gaps for future quality initiatives by a national coalition. Web-based assessment of US EDs (excluding specialty hospitals and hospitals without an ED open 24 hours per day, 7 days per week) for pediatric readiness. All 5017 ED nurse managers were sent a 55-question web-based assessment. Assessments were administered from January 1 through August 23, 2013. Data were analyzed from September 12, 2013, through January 11, 2015. A modified Delphi process generated a WPRS. An adjusted WPRS was calculated excluding the points received for the presence of physician and nurse PECCs. Of the 5017 EDs contacted, 4149 (82.7%) responded, representing 24 million annual pediatric ED visits. Among the EDs entered in the analysis, 69.4% had low or medium pediatric volume and treated less than 14 children per day. The median WPRS was 68.9 (interquartile range [IQR] 56.1-83.6). The median WPRS increased by pediatric patient volume, from 61.4 (IQR, 49.5-73.6) for low-pediatric-volume EDs compared with 89.8 (IQR, 74.7-97.2) for high-pediatric-volume EDs (P < .001). The median percentage of recommended pediatric equipment available was 91% (IQR, 81%-98%). The presence of physician and nurse PECCs was associated with a higher adjusted median WPRS (82.2 [IQR, 69.7-92.5]) compared with no PECC (66.5 [IQR, 56.0-76.9]) across all pediatric volume categories (P < .001). The presence of PECCs increased the likelihood of having all the recommended components, including a pediatric quality improvement process (adjusted relative risk, 4.11 [95% CI, 3.37-5.02]). Barriers to guideline implementation were reported by 80.8% of responding EDs. These data demonstrate improvement in pediatric readiness of EDs compared with previous reports. The physician and nurse PECCs play an important role in pediatric readiness of EDs, and their presence is associated with improved compliance with published guidelines. Barriers to implementation of guidelines may be targeted for future initiatives by a national coalition whose goal is to ensure day-to-day pediatric readiness of our nation's EDs.

The Blind Side: A True Story about how Quality Alternative Care Brings Out the Hidden Potentials of Children

A child's right to alternative care in situations where he/she has no family or parents is ensured by international standards. In terms of Articles 20 (1) and 20 (2) of the United Nations Convention of the Rights of the Child (CRC), a child temporarily or permanently deprived of his or her family environment shall be entitled to special protection and assistance provided by the State and that every state has an obligation to ensure alternative care for such a child. In order to further ensure the rights of the children deprived of parental care, the Guidelines for the Alternative Care of Children was adopted by the United Nations General Assembly in February 2010. In terms of the preamble, these guidelines set out desirable orientations for policy and practice required to enhance the implementation of the international standards regarding the protection and the well-being of the children deprived of parental care. Many countries are still in the process of developing their own guidelines in par with the said international standards. In this context, exemplary artistic creations on this subject can be of vital importance in order to sensitise the public as to what quality alternative care is. TheBlind Side, an Academy award winning American movie, is one such example that emphasises on the ideal family-based alternative care. The importance of the movie is that it is based on the real life story of Michael Oher, a renowned football player. The Blind Side can be reviewed in the light of quality alternative care of children in terms of access to education, dignity and self-esteem, legal status, recognition and identity, love and care, best interest concept, etc., aspired by the international standards. The movie is significant in demonstrating how a child is brought up not in the manner desired by the caregivers, but in helping to bring out the hidden potentials of the child in his/her best interest.

Moving Forward: Implementing the ‘Guidelines for the Alternative Care of Children’ International

Moving Forward: Implementing the ‘Guidelines for the Alternative Care of Children’ International

Adherence to Guidelines for Diabetes Care in School: Family and School Nurse Perspectives

To ensure the safe and fair treatment of children with diabetes, the American Diabetes Association (ADA) publishes guidelines for care of children with diabetes in the school setting (1–4). We surveyed 99 families of youth with type 1 diabetes (mean age 12.2 ± 3.2 years; diabetes duration 5.0 ± 3.6 years) and 51 school nurses from corresponding schools in Ohio using structured questionnaires to systematically evaluate reported adherence to these guidelines from the perspectives of key stakeholders. This study has institutional review board approval. Sixteen key ADA recommendations, taking into account guidelines with multiple components, were assessed. For 7 of the 16 ADA recommendations, fewer than half of families reported adherence, defined as providing the service usually or always. Among school nurses, fewer than half reported …

When Mr Yuck Meets Mr Bubble: A Primer on Pediatric Decontamination

It is incumbent on ED pediatric champions to take action to ensure that staff have appropriate equipment, medications, and competency to care for children. The recognition of this fact came in 2009, when Pediatrics, the official journal of the American Academy of Pediatrics, issued a joint policy statement on guidelines for care of children in the emergency department,1 coauthored by the Emergency Nurses Association and the American College of Emergency Physicians. In addition to these prestigious and influential organizations, the work is supported by 22 others, including the Joint Commission and the American Heart Association.

Parents’ discursive resources: Analysis of discourses in Swedish, Danish and Norwegian health care guidelines for children with diabetes type 1

The incidence of diabetes type 1 in children, the most common metabolic disorder in childhood, increases worldwide, with highest incidence in Scandinavia. Having diabetes means demands in everyday life, and the outcome of the child's treatment highly depends on parents' engagement and involvement. The aim of this study was to explore and describe discourses in health care guidelines for children with diabetes type 1, in Sweden, Norway and Denmark during 2007-2010, with a focus on how parents were positioned. As method a Foucauldian approach to discourse analysis was applied, and a six-stage model was used to perform the analysis. The findings shows a Medical, a Pedagogic and a Public Health discourse embedded in the hegemonic Expert discourse. The Expert discourse positioned parents as dependent on expert knowledge, as recipients of education, as valuable and responsible for their child's health through practicing medical skills. This positioning may place parents on a continuum from being deprived of their own initiatives to being invited to take an active part and could result in feelings of guilt and uncertainty, but also of security and significance. From this study we conclude that guidelines rooted in the Expert discourse may reduce opportunities for parents' voices to be heard and may overlook their knowledge. By broadening the selection of authors of the guidelines to include patients and all professionals in the team, new discourses could emerge and the parents' voice might be more prominent.

RE: A Guideline for the Inpatient Care of Children with Pyelonephritis

RE: A Guideline for the Inpatient Care of Children with Pyelonephritis

RE: A guideline for the inpatient care of children with pyelonephritis

RE: A guideline for the inpatient care of children with pyelonephritis

Audit to monitor the uptake of national mouth care guidelines for children and young people being treated for cancer

The aim of this study is to review current oral care practices in children being treated for cancer against audit criteria derived from national guidelines, and to compare findings with data from a baseline survey carried out in 2002 prior to implementation of the national guidelines. A telephone survey was carried out of all 21 haematology-oncology (HO) centres and seven bone marrow transplant (BMT) units within the UK Children's Cancer Study Group focusing on key audit themes of: availability of evidence-based guidelines, oral and dental care prior to and during cancer treatment, oral assessment, prevention and treatment of oral complications. The national guidelines were used in 19/25 (76%) settings that employed written guidelines. There was little variation in advice given to patients/parents on basic oral hygiene, and this advice was commensurate with guideline recommendations. Inconsistencies in oral care assessment, reported at baseline, remained commonplace across the majority of settings. In only 10/21 HO centres, it was usual practice for children to undergo dental assessment prior to commencing cancer treatment, indicating no improvement since baseline survey. Few therapies outside of the guideline recommendations were being used. The routine use of preventive nystatin, not recommended in the guideline, had significantly decreased from baseline (by 40%). Uptake of national guidelines by HO/BMT settings was good however certain oral care practices fell short of the guideline recommendations. Routine dental checks need to be embedded in practice. Further consideration is needed as to how oral assessment might be used more effectively in informing treatment.

1654 ORAL Developing evidence-based mouth care guidelines for children being treated for cancer

1654 ORAL Developing evidence-based mouth care guidelines for children being treated for cancer

Illness and injuries at summer camp.

Children at summer camp are at risk of injury and illness. The American Academy of Pediatrics and the American Camping Association have specific guidelines for the medical care of children in summer residential camps. This report describes the types of illnesses and injuries seen in 730 children attending camp for 2 weeks, use of the infirmary, and difference in the onset of infectious diseases compared with injuries during the camp session. During the month studied, there were 921 infirmary visits. The most common diagnoses were injuries and infectious disease. Girls and boys were equally likely to be seen in the infirmary and had the same distribution of diagnoses. Infectious disease (gastroenteritis) had a later mean day of onset during the camp session than did injuries and was increasing in frequency at the end of each session. Potential common camp medical problems (sunburn, otitis externa) were prevented by simple medical preventive care.

Guidelines for home care of children with chronic respiratory insufficiency.

Guidelines for home care of children with chronic respiratory insufficiency.