Co-Construction of a Dance Class Adapted for Adolescents with Cerebral Palsy.

AIM: To co-construct a dance class adapted for adolescents with cerebral palsy (CP). METHOD: A three phase co-construction process with study collaborators was used to (1) define the objectives and the obstacles and opportunities related to offering a dance class in the community through three focus groups with adolescents, their parents and study partners; (2) co-create the dance class based on the results of step 1, the expertise of the research team and the logic model of the dance class; and (3) test the dance class to evaluate its effects in relation to the defined objectives. RESULTS: Three objectives were identified: to have fun, promote movement, and social interaction. A weekly dance class (60 min./10 wk) was continuously tested on the adolescents and adapted by the dance facilitators. CONCLUSION: To improve practices and support the implementation of dance classes for young people with CP, eight recommendations are proposed relating to the creation of adapted classes and the evaluation of their desired effects.

Knowledge and practices of youth awareness on death and dying in school settings: a systematic scoping review protocol.

BACKGROUND: Awareness-raising and education have been identified as strategies to counter the taboo surrounding death and dying. As the favoured venue for youth education, schools have an essential role to play in informing future decision-makers. However, school workers are not comfortable addressing the subjects of death and dying, which, unlike other social issues, have no guidelines to influence awareness of these subjects in youth. OBJECTIVES: To systematically explore the knowledge and practices on raising awareness about death and dying in schools, the viewpoints of the people involved (young people, school workers; parents), and the factors that either promote or hinder awareness practices. METHOD: The scoping review method of Levac and Colquhoun (Implement Sci 5(1):69, 2010) will be used. Using a combination of keywords and descriptors, a body of literature will be identified through 15 databases and through grey literature searches, manual searches, consultation of key collaborators, and the list of relevant literature. Publications since 2009 will be selected if they relate directly to awareness-raising about death and dying in schools. Writings will be selected and extracted by two independent people, and conflicts resolved by consensus. The extracted data will be synthesized using a thematic analysis method. Experts from a variety of disciplines (health sciences, humanities, social sciences, and education) will be consulted to enhance the interpretation of the preliminary results. Results will be presented in narrative form and will include tables and diagrams. CONCLUSION: The results of this scoping review will contribute to the development of educational practices adapted to young people and to the identification of future avenues of research on awareness of death and dying.

Understanding musculoskeletal disorders in dancers: The role of lumbopelvic muscles and movement competency.

OBJECTIVE: To investigate whether transversus abdominis activation (TrA), hip strength, and movement competency are associated with the incidence of musculoskeletal disorder episodes (MDEs) in dancers when controlling for confounding variables. The secondary objectives were to determine if there were differences between professional and preprofessional dancers for the aforementioned factors, as well as to determine if there were differences in TrA activation and hip strength between the dominant and non-dominant sides. DESIGN: Prospective cohort study. METHODS: 118 dancers were recruited. The independent variables were collected at the beginning of the dance season: 1) TrA activation, 2) hip strength, and 3) movement competency. To assess the development of MDEs, a weekly electronic diary was used over a 38-week period. MDEs were compiled for each dancer's whole body and subdivided into total musculoskeletal disorder episodes (all body parts) and lower quadrant musculoskeletal disorder episodes (lower limb and lower back). RESULTS: Lower TrA, as well as higher hip abductor and external rotator strength, were associated with a lower incidence of MDEs. TrA activation (ß = 0.260, p = 0.023) and hip external rotator strength (ß = -0.537, p = 0.002) could significantly explain 25.4% of the variance of total MDEs, as well as 20.9% of the variance of lower quadrant musculoskeletal disorder episodes (ß = 0.272, p = 0.016; ß = -0.459, p = 0.011). No significant associations were found between movement competency and MDEs. CONCLUSIONS: Higher hip strength could be a protective factor for MDEs among dancers. Further studies are needed to better understand the involvement of the transversus abdominis in MDEs.

Diversity and Access to Palliative Care and Medical Assistance in Dying in an Urban Setting.

This article focuses on the end-of-life experiences of migrants and non-migrants from young to old, who died in a Canadian cosmopolitan city in the years preceding the COVID-19 pandemic. Based on interviews with over one hundred relatives of as many deceased, the authors discuss end of life issues, namely access to palliative care and medical assistance in dying. The data indicate unequal access to care at the intersection of several factors, including type of disease, patient's age, uncertainty of their prognosis, and migrant/non-migrant status. While being young and having cancer were undeniably associated with the provision of care (curative and palliative), those who did not benefit from palliative care tended to be social minorities in the local society and suffered from diseases with ambiguous prognosis. The right to "Die with dignity" is fundamental, with or without palliative care and regardless of where the end of life takes place.

Passion and performance anxiety: How it affects the incidence of musculoskeletal disorders in dancers.

OBJECTIVES: This study aimed to examine the association between the incidence of musculoskeletal disorder episodes (MDEs) and obsessive and harmonious passion as well as performance anxiety throughout a dance season, which lasted 38 weeks. DESIGN: Prospective cohort study. METHODS: A total of 118 professional and preprofessional dancers were recruited and assessed at baseline, while 88 completed the follow-up. Their levels of passion and performance anxiety were assessed at the beginning of a dance season using the Passion Scale and the Kenny Music Performance Anxiety Inventory, respectively. To monitor the incidence of MDEs throughout a dance season, dancers were asked to complete a weekly electronic diary. RESULTS: A higher level of obsessive passion was associated with a higher incidence of MDEs causing an interruption of dance activities (ß = 0.264, p = 0.022). Harmonious passion and performance anxiety were not associated with MDEs throughout the season. CONCLUSIONS: Findings of this study support the role of obsessive passion in the development of MDEs in dancers.

Adapting Dance to Complex Clinical Contexts: A Methodology Model.

BACKGROUND: While the content of health-related dance interventions is still relatively undocumented in the literature, the processes of adapting dance to specific situations are even less so, and rarely seem to be based on theoretical or practical guidelines. Yet the description of these processes could guide the adaptation of other interventions. PURPOSE: This study aimed to document the process of adapting a dance intervention in a complex clinical setting, in order to propose a methodology that could inspire the development of other interventions in specific clinical contexts. METHODS: The adaptation methodology described in this article is part of an embedded single-case study, where the case unit was the adaptation process of a dance group intervention and the subunits of analysis were the intervention's clinical and theoretical premises, content, and pedagogy. Participants were rehabilitation therapists (n=21), patients (n=6), relatives (n=4), and rehabilitation assistants (n=4). Data were collected through various techniques (focus groups, situational observation, pilot dance sessions, interviews, critical incidents, research journals, template for intervention description and replication/TIDieR checklist, and video recordings) to allow an iterative adaptation process. Data were analyzed using inductive qualitative analysis. RESULTS: Adaptations were made prior to and throughout the intervention, taking into account relevant scientific and disciplinary knowledge, as well as the different actors' implicit and explicit experiences. The intervention pedagogy focused on adapting the dance content to meet the participants' needs while inviting them to self-adapt this content. The resulting methodology model includes four stages: preliminary design, validation with rehabilitation therapists, specific tailoring, and ongoing tailoring. Conclusion: Optimizing the adaptation of dance and ensuring its complementarity within a complex clinical context requires collaboration with the different disciplinary clinicians in order to offer synergistic coherence and ensure dance's contribution to therapeutic objectives.

Movement Competency Screen: Rethinking the Rating.

Background: Dancers are at high risk of musculoskeletal disorders. There has been a growing interest in the last few years in pre-season screening using tools to evaluate movement competency, among which is the Movement Competency Screen (MCS). It is currently scored using a categorical 3-level rating system, but this method does not seem to take into account the load level of movements. A 5-level scoring system could potentially alleviate this problem. Hypothesis/Purpose: For each scoring system, to investigate (1) the internal consistency, and (2) the association with transversus abdominis activation (TrA), hip muscle strength and with Functional Movement screen (FMSTM) total score. Study design: Secondary analyses of a prospective cohort study. Methods: One hundred and eighteen professional and preprofessional dancers evolving in ballet or contemporary dance were recruited. The MCS was performed and was scored according to the 3- and 5-level scoring systems. The key variables for movement competency that were considered for convergent validity were the activation ratio of the TrA evaluated with ultrasound imaging and hip strength assessed with a handheld dynamometer. Movement competency was also measured with the FMSTM. Results: Internal consistency was higher for the 5-level scoring of the MCS items ($*$\alpha$*$=0.548) compared to the 3-level scoring system ($*$\alpha$*$=0.494). Multiple linear regressions showed that TrA activation, hip adductor strength, and FMSTM could significantly explain 24.0% of the variance for the 5-level scoring system of the MCS whereas hip internal rotator strength and FMSTM could explain only 16.4% of the variance for the 3-level scoring system. Conclusion: The 5-level scoring system showed better metrologic properties in terms of internal consistency and concurrent validity and therefore, should be preferred over the 3-level scoring system in future research. Level of Evidence: Level III.

Use of Adapted Dance to Intensify Subacute Rehabilitation Post-Stroke: A Qualitative Study on the Participation Experience and Active Participation Time.

Background: Strategies are still needed to intensify stroke rehabilitation. As an alternative therapy, dance warrants examination since its multimodal nature appears to offer an enjoyable means of engaging in a rehabilitation activity. Objectives: (1) To describe the participation experience in an adapted-dance group intervention, and (2) to study the patients' active participation time. Methods: In this embedded single-case study, the experience of participating patients, relatives and rehabilitation assistants was examined through semi-structured interviews. The verbatim transcripts underwent thematic analysis (qualitative method), while the patients' active participation time was examined through audiovisual recordings analyzed by type and length of engagement time (quasi-qualitative method). Setting: The study was conducted in the neurology department of a rehabilitation hospital. Participants: The study included patients doing intensive functional rehabilitation post-stroke (≤25 days) (n = 6), relatives (n=4) and rehabilitation assistants (n = 4). Patients were recruited irrespective of their neurologic impairments. Their mean age was 71.0 years ± 9.9 years (range 59 to 86 years). Intervention: An adapted-dance group intervention ranging from moderate to somewhat hard/hard intensity was added to their rehabilitation program in the form of biweekly sessions of 55 minutes each, for up to 10 weeks. Carried out mainly on chairs, the intervention borrowed from dance approaches, rehabilitation practices, and movement-based educational approaches. Results: Observed adherence reached 82%. The participation experience involved 3 types of participation incentives (what motivated, fostered and facilitated their participation) and 4 types of perceived effort (unconscious, self-regulated, feasible and appropriate) conducive to participation. Mean motor engagement time of 50 minutes 4 seconds/session ± 2.53 minutes was observed in patients. Conclusion: The use of an adapted-dance group intervention can contribute to the intensification of stroke rehabilitation and have a positive impact on motivation and perceived effort.

Decision-making and Poor Prognosis: When Death is Silenced by Action.

In the hospital milieu, daily questions relate to highly invested areas such as quality of life and death issues, choices to continue or stop active treatment, and the legitimacy of those who take part in such decisions. Stemming from an ethnographic study carried out in a hematology-oncology transplant unit in a Montreal pediatric hospital, we discuss the decision-making process (or lack thereof) when a patient faces poor prognosis and the change of trajectory from a curative/disease directed to a palliative perspective. The intricate relationship between science, caregiver, and care receiver sustains action even when (near) death is the probable outcome.

Does the Movement Competency Screen Correlate with Deep Abdominals Activation and Hip Strength for Professional and Pre-professional Dancers?

BACKGROUND: Dancers are a unique category of athletes who are frequently injured and experience pain. The primary cause of dance injuries is overuse, which could potentially be prevented. However, literature is scarce regarding validated methods of evaluating the risk of injury in dancers. The Movement Competency Screen (MCS) could potentially fill this gap. HYPOTHESIS/PURPOSE: To investigate the validity of the Movement Competency Screen (MCS) for dancers by 1) examining the correlation between scores on this functional test and the activation of deep abdominals and hip strength; 2) investigating the correlation between MCS scores and those of the Functional Movement Screen (FMS™). STUDY DESIGN: Cross-sectional study. METHODS: A total of 77 pre-professional and professional dancers from ballet and contemporary backgrounds were evaluated. The activation of deep abdominals was evaluated using ultrasound imaging and the hip strength was evaluated using a handheld dynamometer. The FMS™, another tool evaluating fundamental movement competency, was also administered. RESULTS: The dancers' MCS score was correlated with the activation of the transversus abdominis (r=0.239, p=0.036) and the strength of hip abductors (r=0.293, p=0.010), adductors (r=0.267, p=0.019) and external rotators (r=0.249, p=0.029). The MCS score was also correlated with the FMS™ score (r=0.489, p<0.001). CONCLUSION: This study shows that the MCS score is correlated with deep abdominal activation and hip strength in dancers, as well as with the FMS™ score. These findings provide evidence toward the validation of the MCS in dancers. LEVELS OF EVIDENCE: Level 2B.

Decision-Making in the Era of New Medical Technologies in Pediatric Hematology-Oncology: The Death of Palliative Care?

BACKGROUND: Recent advances in immunology, genomics, and cellular therapy have opened numerous therapeutic possibilities in pediatric hematology-oncology, generating new hope in poor prognosis situations. How decisions are made when it comes to treatments and aims needs to be explored in this new technologic context. In particular, their impact on the gold standard of early referral to palliative care must be assessed. MATERIALS AND METHODS: Stemming from an ethnographic study combining semistructured interviews and observations carried out in a hematopoietic stem cell transplant unit in a Montréal Pediatric Hospital, we discuss the decision-making process when a patient faces poor prognosis. RESULTS AND DISCUSSION: Although health care providers individually envisioned that palliative care may be the best course of action for patients receiving emergent therapy, they remained collectively in the curative mode. The intricate relationship between science, hope, caregiver, and care receiver sustains this perspective even when (near) death is the probable outcome. When proven treatment fails, emerging therapeutic possibilities offer new hope that can delay the referral to the palliative care team.

Exploring the impact of a clinical dance therapy program on the mobility of adults with a neurological condition using a single-case experimental design.

BACKGROUND: This study built upon previous quasi-experimental design research studying the effectiveness of a 12-week dance therapy program for persons with a physical disability (DTPD) aiming to improve mobility. METHODS: We conducted a single-case experimental design (SCED), including pre- and post-interventions measures, with seven participants with repeated measures during pre-dance (A1), dance program (B) and post-dance phases (A2). RESULTS: Five participants completed the study and significantly (p < 0.05) improved their scores on the MiniBESTest; 2/5 and 4/5 improved scores for the 4 Square Step Test and the Multidirectional Reach Test-Behind, respectively, with very large effect size (ES). Aggregated ES (A1-A2) went from moderate to very large. CONCLUSIONS: Results support the effectiveness of the DTPD program for adults with neurological conditions, and for the use of SCED to explore effectiveness of dance interventions for heterogeneous cohorts.

An adapted dance program for children with Charcot-Marie-Tooth disease: An exploratory study.

BACKGROUND: Charcot-Marie-Tooth disease (CMT) is a rare hereditary peripheral neuropathy. Its sensorimotor clinical manifestations are heterogeneous, and it might also influence cognitive functions. Physical activity is recommended for adults with CMT, however there is a lack of studies focusing on the effects of physical activity in children with CMT. Dance practice is beneficial for motor and cognitive functions. Adapted dance is interesting for children with CMT because it could address the functional deficits. OBJECTIVES: To evaluate the feasibility of an adapted dance program and to explore its effects on motor and cognitive functions in children with CMT. METHODS: Five children with CMT followed a 10-week dance program added to regular care, while four others received only regular care. Feasibility of the program was assessed by participation and retention rates. Motor (CMT clinical characteristics, muscular force and power, postural control, pain) and cognitive (rhythm task, sustained attention, short term memory) abilities were evaluated before and after the program. RESULTS: The high participation and retention rates (89% and 100%) suggest that a dance program is feasible in children with CMT. Significant benefits were noted for both motor (CMT clinical characteristics, strength of leg muscle groups, pain during physical activity) and cognitive (rhythm task, attention) functions for the dance group. CONCLUSION: The results suggest that an adapted dance program is feasible and can have beneficial effects on motor and cognitive functions of children with CMT. Dance appears as a new approach adapted for these children. Further research is needed to confirm these results.

Adapted dance used in subacute rehabilitation post-stroke: impacts perceived by patients, relatives and rehabilitation therapists.

Purpose: To examine the perceived impacts of an adapted-dance group intervention when added to intensive functional rehabilitation post-stroke.Method: In this exploratory qualitative case study, semi-structured interviews were analyzed using a deliberative inductive logic and referring to the International Classification of Functioning, Disability and Health. Participants were patients in rehabilitation post-stroke (≤25 days) (n = 6), relatives (n = 4) and rehabilitation therapists (n = 12). Selection was on a voluntary basis. The intervention added to the patients' rehabilitation program consisted of 55-minute bi-weekly sessions for 10 weeks.Results: Three categories of perceived positive impacts emerged from the data: (1) mobility, (2) mental functions and personal factors (emotional functions, motivation and self-efficacy) and (3) interpersonal interactions and social life. A fourth category of perceived impacts involving exercise tolerance was both positive, in terms of general physical endurance, and negative, in terms of a feeling of increased fatigue.Conclusion: Such an adapted-dance intervention holds promise in subacute rehabilitation post-stroke. Its main strength lies in its perceived positive impact on mental functions, personal factors, and interpersonal and social interactions.Implications for rehabilitationAn adapted-dance group intervention could offer an innovative means of contributing to intensive functional rehabilitation post-stroke by potentially generating positive perceived impacts on emotional functions, motivation and self-efficacy, as well as on interpersonal and social interactions.Adapted dance could be added to inpatients' rehabilitation with only minor impacts on fatigue.

Survey highlights the need for specific interventions to reduce frequent conflicts between healthcare professionals providing paediatric end-of-life care.

AIMS: This study explored how paediatric healthcare professionals experienced and coped with end-of-life conflicts and identified how to improve coping strategies. METHODS: A questionnaire was distributed to all 2300 professionals at a paediatric university hospital, covering the frequency of end-of-life conflicts, participants, contributing factors, resolution strategies, outcomes and the usefulness of specific institutional coping strategies. RESULTS: Of the 946 professionals (41%) who responded, 466 had witnessed or participated in paediatric end-of-life discussions: 73% said these had led to conflict, more frequently between professionals (58%) than between professionals and parents (33%). Frequent factors included professionals' rotations, unprepared parents, emotional load, unrealistic parental expectations, differences in values and beliefs, parents' fear of hastening death, precipitated situations and uncertain prognosis. Discussions with patients and parents and between professionals were the most frequently used coping strategies. Conflicts were frequently resolved by the time of death. Professionals mainly supported designating one principal physician and nurse for each patient, two-step interdisciplinary meetings - between professionals then with parents - postdeath ethics meetings, bereavement follow-up protocols and early consultations with paediatric palliative care and clinical ethics services. CONCLUSION: End-of-life conflicts were frequent and predominantly occurred between healthcare professionals. Specific interventions could target most of the contributing factors.

Diversity, Conflict, and Recognition in Hospital Medical Practice.

The hospital is a place of encounter between health care providers, patients and family members, the healthy and the suffering, migrants and non-migrants, as well as social and cultural minorities, and majorities of various backgrounds. It is also a space where multiple conceptions of care, life, quality of life, and death are enacted, sometimes inhibiting mutual understanding between caregivers and the cared for, a scenario that in turn may provoke conflict. Through the lens of conflict, we explore in this article the theme of Otherness within the clinic, basing analysis on an ethnographic study conducted in recent years in three cosmopolitan Canadian cities. Daily practices and-on a larger scale-the social space of the clinic become material here for reflecting on recognition (and non-recognition) of the Other as actors in the clinical encounter. The examination of structural and situational conditions that contribute to the emergence of conflict offers an understanding of the diversity of values that pervade the clinic. By way of conclusion, we argue that recognition of diversity, at least on the part of practitioners, is a key condition for the emergence of a pluralist normativity in the social space of the clinic.

Blood transfusion in acute and chronic pediatric settings: beliefs and practices.

BACKGROUND: Blood has been imbued with powerful connotations through history and across cultures. Currently bestowed with scientific meaning, blood nevertheless carries symbolic resonance. This study examines these representations among practitioners and sheds light on the clinical and nonclinical factors that guide blood transfusion (BT) decision-making in Quebec, Canada. STUDY DESIGN AND METHODS: With a qualitative exploratory study design, data were collected in the pediatric intensive care unit and the hematology-oncology unit of Sainte-Justine Hospital in 2009. A total of fifteen 1-hour-long semistructured interviews were conducted with physicians. RESULTS: Physicians affirm that the symbolic connotations of blood found in the lay population do not influence their transfusion decisions. However, there are other "social" and "cultural' aspects that influence these practices. Also, BT strategies remain diverse across units. Practitioners perceive these situations as resulting from insufficient training and by the existence of an "oral tradition" and a professional culture that are resistant to change. CONCLUSION: BT practices differ within and across units. Many dimensions intervene in the decision to transfuse, from individual clinical appreciation and local unit "culture" to formal and ad hoc training. Consistent change in BT can only occur with the implementation of norms and guidelines that are endorsed by key influential figures. An extensive multicentered study is necessary to better understand how social and cultural factors affect BT practices. This knowledge will sustain an enlightened clinical practice and lead to the recognition that peer practices are also embedded in professional cultures.

BETWEEN REASON, SCIENCE AND CULTURE: BIOMEDICAL DECISION-MAKING.

Over the last decade, we have extensively examined clinical practice in the context of sociocultural, religious and ethnic diversity. Stemming mainly from data collected amongst physicians we reflect, in this paper, upon the norms and values which guide decision-making processes in tertiary pediatric hospital contexts. Clinical ethics is portrayed a neutral guide between competing choices and obligations of hospital units, healthcare professionals, and families, when there is a conflict or divergence in the perspectives concerning the progression of the clinical trajectory. We will chart the sharing/non-sharing of different voices in critical decision-making pathways of maternal-child hospital care. How do "universal" ethical principles accommodate the diversity of perspectives anchored within the ensemble of cultural, social, and religious institutions? Similarly to the image of cosmopolitan urban communities, health care settings are defined by a multiplicity of values brought forth by families and health care professionals from diverse backgrounds. Attempting to seize these logics entails a better grasp of the delicate relationship between the individual and the collective, between personal values and instituted norms, between majorities and minorities.

Diverse pathways to care for children with stomach pain in a Canadian cosmopolitan city.

In Montreal, Quebec, 31% of the population is born outside Canada. Yet, only 9% of patient consultations for symptoms associated with functional gastrointestinal disorders (FGIDs) are from immigrants at the Paediatric Gastroenterology Clinic at Sainte-Justine's University Hospital Centre. This discrepancy inspired a multidisciplinary exploratory study (anthropological and paediatric) to examine the sociological, interpretative and pragmatic aspects of immigrant and non-immigrant patients and family life with FGIDs. This paper examines the discrepancy between immigrant and non-immigrant paediatric patients with FGIDs and presents the different pathways to care utilised by families. Semi-structured interviews were carried out between November 2008 and June 2009, with children and their parents. In total, 38 families were recruited: with 27 families (including a child experiencing abdominal pain, his/her siblings, mother and/or father as well as any other significant individual living in the family home) from the community and 11 from the paediatric gastroenterology clinic. A comparative analysis between the immigrant and non-immigrant groups focused on perceptions, meanings and actions taken to relieve/alleviate symptoms. Immigrant and non-immigrant families alternate and combine different therapeutic environments: home, alternative healing therapies and medical paths to care. Our analysis suggests that culture (as a set of values, beliefs and ways of being), as well as social interactions within family life and the clinic, shape pathways to care. The analysis highlights the centrality of receptiveness--and more widely the social dimensions--of all medical encounters. Treatment disparities between immigrant and non-immigrant families in pathways to care help us to understand these patients' social world and the intricate relationships between values and social milieux, between culture, practices of symptom management and rationales guiding diverse therapeutic actions.

Uncertainty, culture and pathways to care in paediatric functional gastrointestinal disorders.

This paper examines how children and families of diverse ethnic backgrounds perceive, understand and treat symptoms related to functional gastrointestinal disorders (FGIDs). It is questioned how different ways of dealing with medical uncertainty (symptoms, diagnosis) may influence treatment pathways. Semi-structured interviews were conducted with 43 children of 38 family groups of immigrant and non-immigrant backgrounds. The analysis takes into account (a) the perceived symptoms; (b) the meaning attributed to them; and (c) the actions taken to relieve them. The social and cultural contexts that permeate these symptoms, meanings and actions were also examined. It is found that, in light of diagnostic and therapeutic uncertainty, non-immigrant families are more likely to consult health professionals. Immigrant families more readily rely upon home remedies, family support and, for some, religious beliefs to temper the uncertainty linked to abdominal pain. Furthermore, non-immigrant children lead a greater quest for legitimacy of their pain at home while most immigrant families place stomach aches in the range of normality. Intracultural variations nuance these findings, as well as family dynamics. It is concluded that different courses of action and family dynamics reveal that uncertainty is dealt with in multiple ways. Family support, the network, and trust in a child's expression of distress are key elements in order to tolerate uncertainty. Lastly, the medical encounter is described as a space permeated with relational uncertainty given the different registers of expression inherent within a cosmopolitan milieu. Narrative practices being an essential dynamic of this encounter, it is questioned whether families' voices are equally heard in these clinical spaces.