[What is allowed? - Aesthetic Surgery in Children and Adolescents]. / Was ist erlaubt? - Ästhetische Eingriffe bei Kindern und Jugendlichen.

More and more children, and even more so adolescents, undergo procedures pertaining to the category of aesthetic surgery and mainly aiming to improve the patient's physical appearance. There is a broad spectrum of possible operations ranging from purely cosmetic procedures to operations with a medical indication.

Medicine vs. prayer: the case of Kara Neumann.

Religious beliefs and the use of complementary and alternative medicine can help or hinder health care and the well being of children, who are often unable to make informed decisions for themselves, but instead, depend on their parents or caregivers to make health care decisions for them. Tragically, this can sometimes result in prolonged suffering and death when parents or caregivers refuse treatment due to their own personal beliefs. This two-part article explores the case of Kara Neumann, an 11-year-old girl who died after her parents denied her medical care in lieu of prayer to cure her "spiritual attack," and the role pediatric nurses can play in educating patients and their families.

Factors associated with refusal of childhood vaccines among parents of school-aged children: a case-control study.

BACKGROUND: The rate of nonmedical exemptions to school immunization requirements has been increasing, and children with exemptions have contributed to outbreaks of vaccine-preventable diseases. OBJECTIVES: To determine why parents claim nonmedical exemptions and to explore differences in perceptions of vaccines and vaccine information sources between parents of exempt and fully vaccinated children. DESIGN: Case-control study. SETTING: Colorado, Massachusetts, Missouri, and Washington. PARTICIPANTS: Surveys were mailed to the parents of 815 exempt children (cases) and 1630 fully vaccinated children (controls randomly selected from the same grade and school) recruited from 112 private and public elementary schools. Surveys were completed by 2435 parents (56.1%). MAIN OUTCOME MEASURES: Parental reports. RESULTS: Most children (209 [75.5%] of 277) with nonmedical exemptions received at least some vaccines. The most common vaccine not received was varicella (147 [53.1%] of 277 exempt children). The most common reason stated for requesting exemptions (190 [69%] of 277) was concern that the vaccines might cause harm. Parents of exempt children were significantly more likely than parents of vaccinated children to report low perceived vaccine safety and efficacy, a low level of trust in the government, and low perceived susceptibility to and severity of vaccine-preventable diseases. Parents of exempt children were significantly less likely to report confidence in medical, public health, and government sources for vaccine information and were more likely to report confidence in alternative medicine professionals than parents of vaccinated children. CONCLUSION: Continued efforts must be made to educate parents about the utility and safety of vaccines, especially parents requesting nonmedical exemptions to school immunization requirements.

Child welfare versus parental autonomy: medical ethics, the law, and faith-based healing.

Over the past three decades more than 200 children have died in the U.S. of treatable illnesses as a result of their parents relying on spiritual healing rather than conventional medical treatment. Thirty-nine states have laws that protect parents from criminal prosecution when their children die as a result of not receiving medical care. As physicians and citizens, we must choose between protecting the welfare of children and maintaining respect for the rights of parents to practice the religion of their choice and to make important decisions for their children. In order to make and defend such choices, it is essential that we as health care professionals understand the history and background of such practices and the legal aspects of previous cases, as well as formulate an ethical construct by which to begin a dialogue with the religious communities and others who share similar beliefs about spiritual healing. In this paper, we provide a framework for these requirements.