Protocolo de atención en salud integral de niñas y niños en situación de maltrato infantil / Comprehensive health care protocol for girls and boys in situations of child abuse

A partir de la premisa, que el maltrato infantil se está convirtiendo en un problema cada vez más serio a nivel nacional, situación que es avalada por la Organización Panamericana de la Salud (OPS) que considera que la violencia y sus diferentes manifestaciones son un problema que afectan a la salud y al desarrollo social y económico de amplios sectores de la población. Este protocolo considera que es importante que los proveedores de salud desarrollen habilidades y competencias que ayuden a detectar los casos de niños maltratados, así como conocer las mejores estrategias de intervención. El objetivo de este protocolo es proponer una herramienta que proporcione los elementos básicos a proveedores y proveedoras de salud para brindar atención de calidad en salud integral y realizar la notificación oportuna de los casos de maltrato infantil. Para ello han seleccionado un modelo basado en el triage del AIEPI (Atención Integral a las Enfermedades Prevalentes de la Infancia). Es una estrategia elaborada por la Organización Mundial de la Salud (OMS) y el Fondo de las Naciones Unidas para la Infancia (Unicef) presentada en 1996 como principal método para mejorar la salud en la niñez. La metodología del modelo se lleva a cabo por medio de tres componentes. El primero está dirigido a mejorar el desempeño del personal de salud para la prevención de enfermedades en la niñez y su tratamiento. El segundo se dirige a mejorar la organización y funcionamiento de los servicios de salud para que brinden atención de calidad apropiada; y el tercer componente está dirigido a mejorar las prácticas familiares y comunitarias de cuidado y atención de la niñez. Contiene un marco teórico, marco legal, así como una serie de anexos dirigidos a apoyar tanto el diagnóstico, como el seguimiento dado a las víctimas.

[Selected legal aspects of the protection of the unborn child in the light of the draft amendment to the Polish Penal Code]. / Wybrane aspekty prawne ochrony dziecka poczetego w swietle projektu nowelizacji Kodeksu Karnego.

Criminal Law Codification Commission, acting at the Ministry of Justice prepared proposals for amendments in the Polish Penal Code, related to offenses against life and health that were presented to the public in 2013. The draft provides for the protection of the child in the prenatal stage, introducing a new category of the entity to be protected, which is "unborn child" and "unborn child able to live outside the mother's body". These regulations provide for mothers criminal liability and responsibility of the medical staff (a doctor), as well as the child's father to the extent in which he is obliged to take steps aimed at rescuing the fetus. It is doctor's responsibility to show particular care for human health and life since a doctor has special medical knowledge and that is regulated by art. 30 of the act on professions of doctor and dentist. The proposed rule changes were not brought before the legislature in the current term of the Sejm (2011-2015), but due to the development of medicine, including obstetrical ultrasound, which enables visualization of a child that moves in the womb and is treated as a separate entity with distinct personal features the grounds are given for the opinion that the issue of the legal status of the unborn child, particularly in the context of causing death of a child in the last phase before birth as a result of medical malpractice or other external factors will be back in the public discussion.

Companion piece: Needs, rights, and the human family: a bio-psycho-social-spiritual perspective.

This article sets forth a bio-psycho-social-spiritual perspective on the needs and rights of children. Consideration is first given to the philosophical nature of need. The nature of rights is then examined in relation to need as a basis for social justice claims. Various need paradigms, such as human development needs, socially constructed needs, and needs hierarchies, are considered and compared to the rights paradigm presented in the Convention on the Rights of the Child. Rationale for ratification is then presented.

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.

La convención sobre los derechos del Niño y su aplicación en la práctica pediátrica / The convention on the Rights of Children and its application in the pediatric practice

Los Derechos de los Niños no son un tema científico, no se encuentran en los libros de Pediatría, y sin embargo, lo que ocurre con los derechos de los niños es algo que atañe a los pediatras. Revisar algunos artículos de la Convención a la luz de la práctica pediátrica puede ayudarnos a encontrar formas más adecuadas de defensa de los derechos de los niños desde el ejercicio profesional. Los pediatras, desde su ámbito profesional, pueden contribuir a la mejora de los servicios sanitarios de atención a niños y adolescentes y así trabajar por la defensa de los derechos de los niños. Preparándose y manteniéndose actualizados en la pediatría; brindando un servicio de calidad; luchando por una adecuada financiación médica, investigando sobre los problemas de salud; enseñando a los colegas; predicando con el ejemplo; trabajando por los derechos de los niños en las instituciones científicas y tratando de comprender los fenómenos sociales y políticos para tener una visión más holística de las problemáticas de los derecho de los niños y niñas (AU)

Children´s Rights are not a scientific subject. They are not found in books on Paediatrics. And yet what happens with their rights concerns Paediatricians. The review of some articles of the Convention from a paediatrician’s point of view can help us find the most suitable ways of defending children´s rights through the profession. In their professional field, paediatricians can contribute to improving the attention of health services to children and adolescents and in doing so, work in defense of their rights. Being well prepared and up to date in paediatrics will contribute quality service: paediatricians can insist on adequate medical financing, research health problems, teach colleagues, set an example, work for children´s rights in scientific institutions and try to understand the social and political phenomena in order to gain a or HOLISTIC vision of Children’s Rights (AU)

Child consent and the law: an insight and discussion into the law relating to consent and competence.

BACKGROUND: The law governing consent for children is not very clear. A child can consent to treatment but usually in practice is unable to refuse it. Even if both the child and parents refuse treatment, courts are reluctant to accept this, particularly if it is in the best interest of the child. DISCUSSION: In order to consent to treatment, a child must be competent enough to do so, and this competence is judged usually by a doctor. Children can even consent to contraceptives and abortion if 'competent' to do so. This concept perfectly lacks moral, ethical and emotional competence, and judgement of competence is carried out usually purely scientifically by pure science-orientated objective professionals like doctors. A broad discussion about the issues of children refusing treatment is conducted from the legal, ethical and philosophical point of view. Life-saving treatment and various other cases are also discussed. CONCLUSION: There is no right answer to the question. A more holistic approach is needed, and not only doctors but also sociologists, care specialists and even clergymen should be asked to judge competence in a multidisciplinary environment, particularly for contraceptives and abortion. This multidisciplinary working can be extended to other areas in medical law as well particularly in light of changes in medicine. Experience in life should be valued in a decision-making environment for judging competence. The law in relation to child consent is unclear and requires changes in order to clarify what is perceived as the child's best interest.

Living with disability: part 1.

This is the first of three articles which consider the holistic care required by children with a disability and their families. Although the articles mainly address care of children with disabilities in the acute hospital setting, the concepts and knowledge can be transferred to care in other settings. The articles aim to provide a summary of the main subject areas while prompting readers to revisit their own opinions and experiences. This article provides an overview of: commonly used terminolgy; receiving the news that your child has a disability; impact on family members; and relevant social policy. The second and third articles cover: the therapeutic use of self; the value of communication; meeting complex needs on a paediatric ward and multi-diciplinary working.

Pediatric use of complementary therapies: ethical and policy choices.

OBJECTIVE: Many pediatricians and parents are beginning to integrate use of complementary and alternative medical (CAM) therapies with conventional care. This article addresses ethical and policy issues involving parental choices of CAM therapies for their children. METHODS: We conducted a literature search to assess existing law involving parental choice of CAM therapies for their children. We also selected a convenience sample of 18 states of varying sizes and geographic locations. In each state, we inquired within the Department of Health and Human Services whether staff were aware of (1) any internal policies concerning these issues or (2) any cases in the previous 5 years in which either (a) the state initiated proceedings against parents for using CAM therapies for their children or (b) the department received telephone calls or other information reporting abuse and neglect in this domain. We asked the American Academy of Pediatrics and the leading CAM professional organizations concerning any relevant, reported cases. RESULTS: Of the 18 state Departments of Health and Human Services departments surveyed, 6 reported being aware of cases in the previous 5 years. Of 9 reported cases in these 6 states, 3 involved restrictive dietary practices (eg, limiting children variously to a watermelon or raw foods diet), 1 involved dietary supplements, 3 involved children with terminal cancer, and 2 involved religious practices rather than CAM per se. None of the professional organizations surveyed had initiated proceedings or received telephone calls regarding abuse or neglect concerning parental use of CAM therapies. CONCLUSIONS: Pediatric use of CAM therapies raises complex issues. Clinicians, hospitals, state agencies, courts, and professional organizations may benefit from a policy framework to help guide decision making.

Pediatric resuscitation: questioning DNAR legitimacy and offering an alternative decision-making model.

The views expressed in this paper are those of the author and do not necessarily represent those of the American Medical Association.

Parents' refusal of medical treatment based on religious and/or cultural beliefs: the law, ethical principles, and clinical implications.

When parents apply religious or cultural beliefs concerning spiritual healing, faith healing, or preference for prayer over traditional health care for children, concerns develop. Medical care is considered one of the most basic of all human needs, and yet parents may elect to apply religious or cultural beliefs in place of traditional Western medical care for their children. Because memberships in religious groups that have beliefs concerning prayer and health care for children are increasing, the topic is of great importance for pediatric health professionals. This article describes parental refusal of medical care, and it discusses the legal, ethical, and clinical implications.

Legal outcomes for children who have been sexually abused: the impact of child abuse assessment center evaluations.

Fifty children who were seen at a Child Abuse Assessment Center (CAAC) were matched on age and relationship to perpetrator with 51 children not evaluated at a CAAC to determine whether the groups differed in legal outcomes in cases of sexual abuse. CAAC children were significantly more likely to have cases filed rather than no-actioned, to have more overall counts charged in filed cases, to have more counts charged against biological fathers and stepfathers who were alleged perpetrators, and to have a greater number of defendants pleading or being found guilty compared to cases involving children not seen at the CAAC. There were also significantly more cases filed for 4- to 6-year-olds and children at least 12 years old if they were seen at the CAAC. The implications of the results are discussed in light of the use of CAACs.

The cutaneous manifestations and common mimickers of physical child abuse.

The cutaneous manifestations of physical child abuse are some of the most common and easily recognized forms of injury. To make an accurate assessment and diagnosis, it is important to differentiate between inflicted cutaneous injuries and mimickers of physical abuse. Likewise, an understanding of reporting guidelines helps guide practitioners in their decision making.

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.

[The feasibility of preoperative autologous blood donation in children]. / Möglichkeit der präoperativen Eigenblutspende im Kindesalter.

According to the experience to date, autologous blood donation is feasible in children and is not accompanied by an increased risk as compared to adult patients. If indicated, autologous blood donation should therefore be offered to pediatric patients using the same criteria as in adults. Problems specific to blood donation in children may arise from limited compliance of the children. In addition, the amount of the blood drawn and the amount of the anticoagulant has to be adjusted according to the weight of the child. This may present difficulties especially in smaller facilities, since there are no blood donation systems available to date that specifically suit the pediatric patient. The necessary manipulations to adjust the blood donation system to the weight of the child might enhance the risk of bacterial contamination.