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Uchitel J, Alden E, Bhutta ZA, Goldhagen J, Narayan AP, Raman S, Spencer N, Wertlieb D, Wettach J, Woolfenden S, Mikati MA. The Rights of Children for Optimal Development and Nurturing Care. Pediatrics 2019; 144:peds.2019-0487. [PMID: 31771960 DOI: 10.1542/peds.2019-0487] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 11/24/2022] Open
Abstract
Millions of children are subjected to abuse, neglect, and displacement, and millions more are at risk for not achieving their developmental potential. Although there is a global movement to change this, driven by children's rights, progress is slow and impeded by political considerations. The United Nations Convention on the Rights of the Child, a global comprehensive commitment to children's rights ratified by all countries in the world except the United States (because of concerns about impingement on sovereignty and parental authority), has a special General Comment on "Implementing Child Rights in Early Childhood." More recently, the World Health Organization and United Nations Children's Fund have launched the Nurturing Care Framework for Early Childhood Development (ECD), which calls for public policies that promote nurturing care interventions and addresses 5 interrelated components that are necessary for optimal ECD. This move is also complemented by the Human Capital Project of the World Bank, providing a focus on the need for investments in child health and nutrition and their long-term benefits. In this article, we outline children's rights under international law, the underlying scientific evidence supporting attention to ECD, and the philosophy of nurturing care that ensures that children's rights are respected, protected, and fulfilled. We also provide pediatricians anywhere with the policy and rights-based frameworks that are essential for them to care for and advocate for children and families to ensure optimal developmental, health, and socioemotional outcomes. These recommendations do not necessarily reflect American Academy of Pediatrics policy.
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Affiliation(s)
| | - Errol Alden
- International Pediatric Association and Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Jeffrey Goldhagen
- Division of Community and Societal Pediatrics, Department of Pediatrics, College of Medicine, University of Florida, Jacksonville, Florida
| | | | - Shanti Raman
- International Pediatrics Association Standing Committee, International Society of Social Pediatrics and Child Health, Geneva, Switzerland.,Division of Community Pediatric, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nick Spencer
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Donald Wertlieb
- Eliot-Pearson Department of Child Study and Human Development, School of Arts and Sciences, Tufts University, Medford, Massachusetts
| | - Jane Wettach
- Duke Children's Law Clinic, School of Law, Duke University, Durham, North Carolina; and
| | - Sue Woolfenden
- Discipline of Paediatrics, School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mohamad A Mikati
- Division of Pediatric Neurology and .,Early Childhood Development Standing Advisory Group, International Pediatrics Association, St Louis, Missouri
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Abstract
Denise Spitzer and colleagues argue that improving the health and wellbeing of migrants requires attention to their diverse circumstances and building inclusive healthcare
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Affiliation(s)
| | - Sara Torres
- School of Social Work, Laurentian University, Canada
| | - Anthony B Zwi
- School of Social Sciences, University of New South Wales, Australia
| | - Ernest Nene Khalema
- School of Built Environment and Development Studies, University of Kwa-Zulu Natal, South Africa
| | - Erlinda Palaganas
- College of Social Sciences, Institute of Management, University of the Philippines-Baguio, Philippines
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3
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Shikako-Thomas K, Shevell M. Promoting the Human Rights of Children With Neurologic Conditions. Semin Pediatr Neurol 2018; 27:53-61. [PMID: 30293590 DOI: 10.1016/j.spen.2018.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Children with neurologic conditions benefit from international conventions, and national treaties, policies and regulations that safeguard their human rights. These regulations also exist to serve as guidance in the creation of comprehensive systems of care, inclusive environments, accessible societies and communities that allow these children to thrive and to achieve the best of their capacities. This narrative review of issues related to human rights and advocacy in pediatric neurologic disabilities will provide an overview of the human rights conventions that relate to children with disabilities, and the most current approaches implicating health care providers in rights promotion for these individuals and their families. We also suggest venues for professionals to advocate for their patients, and suggest strategies to consider rights-based approaches as a mean to provide holistic care in a social neurology framework.
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Affiliation(s)
- Keiko Shikako-Thomas
- *Participation and Knowledge Translation in Childhood Disability Lab, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada; ((†))Department of Pediatrics, Montreal Children's Hospital, Centre for Interdisciplinary Research in Rehablitation (CRIR), Montreal, QC, Canada.
| | - Meaghan Shevell
- *Participation and Knowledge Translation in Childhood Disability Lab, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
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Mitchell AG, Belton S, Johnston V, Read C, Scrine C, Ralph AP. Aboriginal children and penicillin injections for rheumatic fever: how much of a problem is injection pain? Aust N Z J Public Health 2017; 42:46-51. [PMID: 29168304 DOI: 10.1111/1753-6405.12737] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/01/2017] [Accepted: 09/01/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore young Aboriginal people's and clinicians' experiences of injection pain for the 10 years of penicillin injections children are prescribed to prevent rheumatic fever recurrences. METHODS Aboriginal children on the penicillin regimen and clinicians were purposively recruited from four remote sites in Australia. Semi-structured interviews and participant observations were conducted. Views were synthesised and thematically analysed. RESULTS A total of 29 Aboriginal children and 59 clinicians were interviewed. Sixteen participants appeared to become accustomed to the injection pain, eight did not find pain an issue, and five found injection pain difficult. A further five believed the injections made them unwell. Patients expressed varying abilities to negotiate with clinicians about the use of pain reduction measures. Clinicians revealed good knowledge of pain reduction measures, but offered them inconsistently. All clinicians found administering the injections distressing. CONCLUSION Repeated painful procedures in children necessitate well-planned and child-focused care. Current practices are not in line with guidance from the Royal Australasian College of Physicians about effects of repeated painful procedures on children. Initiating the long-term injection regimen for rheumatic fever is a special event requiring expert input. A newly reported finding of a subset of young people feeling unwell after receiving the injection requires further investigation. Implications for public health: Improvement of local and jurisdictional guidelines on use of pain reduction measures for children who have been prescribed repeated painful injections for rheumatic fever is needed.
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Affiliation(s)
- Alice G Mitchell
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Suzanne Belton
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | - Vanessa Johnston
- Menzies School of Health Research, Charles Darwin University, Northern Territory
| | | | | | - Anna P Ralph
- Menzies School of Health Research, Charles Darwin University, Northern Territory.,Division of Medicine, Royal Darwin Hospital, Northern Territory
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Raman S, Hotton PR. Audit of child maltreatment medical assessments in a culturally diverse, metropolitan setting. BMJ Paediatr Open 2017; 1:e000125. [PMID: 29637146 PMCID: PMC5862160 DOI: 10.1136/bmjpo-2017-000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/07/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Child maltreatment (CM) is a major public health problem globally. While there is evidence for the value of medical examination in the assessment of CM, little is known about the quality of clinical assessments for CM. South Western Sydney (SWS) has a large metropolitan population with many vulnerable subgroups. We aimed to describe acute presentations of CM in SWS over a 3-year period-with a focus on the quality of the clinical assessments. We wanted to determine whether the cases assessed fulfilled established minimum standards for clinical assessment of CM and whether the assessments were performed in a child-friendly manner. DESIGN We gathered data from the acute child protection database on all children <16 years referred for assessment between 2013 and 2015. We performed simple descriptive analysis on the data. We measured the assessment, report writing and follow-up against criteria for minimum standards for CM assessments, and identified whether assessments were child-friendly from available clinical information. RESULTS There were 304 children referred; 279 seen for acute assessment; most (73%) were for sexual abuse, 75 (27%) were for physical abuse/neglect. Over half the assessments identified other health concerns; joint assessments performed by paediatric and forensic doctors were better at identifying these health concerns than solo assessments. Most assessments were multidisciplinary and used protocols; half were not followed up; a third were performed after-hours and a third had no carer present during assessments. CONCLUSIONS We identified strengths and weaknesses in current CM assessments in our service. Locally relevant standards for CM assessments are achievable in the acute setting, more challenging is addressing appropriate medical and psychosocial follow-up for these children. While we have established baseline domains for measuring a child-friendly approach to CM assessments, more should be done to ensure these vulnerable children are assessed in a timely, child-friendly manner, with appropriate follow-up.
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Affiliation(s)
- Shanti Raman
- Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Paul Rex Hotton
- Community Child Health, Sydney Children's Hospital, Randwick, New South Wales, Australia
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Abstract
Context Health inequalities are systematic differences in health among social groups that are caused by unequal exposure to—and distributions of—the social determinants of health (SDH). They are persistent between and within countries despite action to reduce them. Advocacy is a means of promoting policies that improve health equity, but the literature on how to do so effectively is dispersed. The aim of this review is to synthesize the evidence in the academic and gray literature and to provide a body of knowledge for advocates to draw on to inform their efforts. Methods This article is a systematic review of the academic literature and a fixed-length systematic search of the gray literature. After applying our inclusion criteria, we analyzed our findings according to our predefined dimensions of advocacy for health equity. Last, we synthesized our findings and made a critical appraisal of the literature. Findings The policy world is complex, and scientific evidence is unlikely to be conclusive in making decisions. Timely qualitative, interdisciplinary, and mixed-methods research may be valuable in advocacy efforts. The potential impact of evidence can be increased by “packaging” it as part of knowledge transfer and translation. Increased contact between researchers and policymakers could improve the uptake of research in policy processes. Researchers can play a role in advocacy efforts, although health professionals and disadvantaged people, who have direct contact with or experience of hardship, can be particularly persuasive in advocacy efforts. Different types of advocacy messages can accompany evidence, but messages should be tailored to advocacy target. Several barriers hamper advocacy efforts. The most frequently cited in the academic literature are the current political and economic zeitgeist and related public opinion, which tend to blame disadvantaged people for their ill health, even though biomedical approaches to health and political short-termism also act as barriers. These barriers could be tackled through long-term actions to raise public awareness and understanding of the SDH and through training of health professionals in advocacy. Advocates need to take advantage of “windows of opportunity,” which open and close quickly, and demonstrate expertise and credibility. Conclusions This article brings together for the first time evidence from the academic and the gray literature and provides a building block for efforts to advocate for health equity. Evidence regarding many of the dimensions is scant, and additional research is merited, particularly concerning the applicability of findings outside the English-speaking world. Advocacy organizations have a central role in advocating for health equity, given the challenges bridging the worlds of civil society, research, and policy.
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Woolfenden S, Goldfeld S, Raman S, Eapen V, Kemp L, Williams K. Inequity in child health: the importance of early childhood development. J Paediatr Child Health 2013; 49:E365-9. [PMID: 23551940 DOI: 10.1111/jpc.12171] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Susan Woolfenden
- Community Child Health, Sydney Children's Hospital, Sydney, New South Wales, Australia
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Andrade RD, Mello DF, Silva MAI, Ventura CAA. [Health advocacy in child care: literature review]. Rev Bras Enferm 2012; 64:738-44. [PMID: 22378522 DOI: 10.1590/s0034-71672011000400017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 05/29/2010] [Indexed: 11/22/2022] Open
Abstract
This narrative literature review aimed to identify the publications about health law, in the ambit of child health care. The databases LILACS and MEDLINE were searched, between 2004 and 2009. Thirteen articles were analyzed, and three themes were identified: Emphasis on knowledge, abilities and attitudes for the development of competencies; Partnerships as an imperative; Health and Law: intersectorial relationship. The studies about the practice of health law are relevant to our reality, especially in primary health care, pointing out for the possibilities of its applicability in the role of the nurses acting in the family health strategy, with families and children.
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Affiliation(s)
- Raquel Dully Andrade
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
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Abstract
AIMS Waves of immigration from the latter half of the 20th century have changed the cultural and ethnic mix of major regions of the world. Dynamic multicultural societies now are a reality across the Western world. The relationship and influence of these diverse cultures to the understanding and identification of child abuse and neglect is challenging and complex. Health professionals working with children from culturally and linguistically diverse groups often find themselves with the challenge of exploring and resolving the tension between definitions of harm in child protection practice and various cultural and child-rearing practices. In this paper, we set out ways of thinking about the influence of culture when approaching and dealing with the suspicion of child maltreatment. METHODS We will explore how culture shapes the experiences of childhood, child-rearing practices, and identify common barriers in working with children and families from culturally diverse backgrounds when presenting with child maltreatment. We will use case examples from Europe and Australia to illustrate the real life challenges of working in the area of child maltreatment across cultures. We will review the scientific literature exploring the nexus between culture and child maltreatment, identifying the gaps in the literature and highlight areas for future research. RESULTS We suggest a model for dealing with cultural issues in child maltreatment that is culturally competent and respectful. CONCLUSIONS The model for cultural competency in child health and child protective services incorporates four domains for advocacy and action - individual, professional, organisational and systemic.
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Affiliation(s)
- Shanti Raman
- Department of Community Paediatrics, Sydney and South Western Sydney Local Health Districts, Liverpool, NSW, Australia.
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Streuli JC, Michel M, Vayena E. Children's rights in pediatrics. Eur J Pediatr 2011; 170:9-14. [PMID: 20461530 DOI: 10.1007/s00431-010-1205-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 04/19/2010] [Accepted: 04/20/2010] [Indexed: 11/25/2022]
Abstract
The United Nations Convention of Children's Rights (UNCRC) introduced in 1989 has generated a global movement for the protection of children's rights and has brought about a paradigm change in how children are perceived. Pediatric healthcare professionals are interacting with children and therefore with children's rights on a daily basis. However, although at least 18 of the 54 articles are relevant for pediatric practice, there is limited systematic training on how pediatricians can support children's rights in the clinical setting. This article discusses the principles and aims of the UNCRC and proposes a comprehensive checklist of rights vis-à-vis issues that arise in clinical practice.
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Affiliation(s)
- Jürg C Streuli
- Institute of Biomedical Ethics, University of Zurich, Pestalozzistr. 24, CH-8032, Zürich, Switzerland.
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Woodland L, Burgner D, Paxton G, Zwi K. Health service delivery for newly arrived refugee children: a framework for good practice. J Paediatr Child Health 2010; 46:560-7. [PMID: 20626581 DOI: 10.1111/j.1440-1754.2010.01796.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To propose a framework for good practice to promote improved access, equity and quality of care in service delivery for newly arrived refugee children. METHODS Development of a framework based on national and international literature and current service models in Australian paediatric refugee health. RESULTS Ten elements of a framework for good practice were identified: comprehensive health screening; coordination of initial and ongoing health care; integration of physical, developmental and psychological health care; consumer participation; culturally and linguistically appropriate service provision; intersectoral collaboration; accessible and affordable services and treatments; data collection and evaluation to inform evidence-based practice; capacity building and sustainability; and advocacy. CONCLUSIONS High-quality care can be achieved through a range of service models. The elements identified provide a framework for evaluating current services and for planning future service development. The framework for good practice can be applied to facilitate improvements in refugee health care and to reduce the gap between health needs and currently available services.
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Affiliation(s)
- Lisa Woodland
- South Eastern Sydney Illawarra Area Health Service, Multicultural Health, Sydney, New South Wales.
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