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Positive Parenting and Support

No force may be more important to a child's development than the family. Many factors contribute to the family's influence, including family structure, functioning, economics, and stress. Parenting provides the foundation to promote healthy child development and to protect against adverse outcomes. The term positive parenting describes an approach to parenting that achieves these goals. The Importance of Parenting Interactions between parents and their children provide…

Developmental and Behavioral Theories

The field of pediatrics is dedicated to optimizing the growth and development of each child. Pediatricians require knowledge of normal growth, development, and behavior in order to effectively monitor children's progress, identify delays or abnormalities in development, help obtain needed services, and counsel parents and caretakers. To alter factors that increase or decrease risk, pediatricians need to understand how biologic and social forces interact within the…

Strategies for Health Behavior Change

To improve the health of children, pediatricians often ask patients and caregivers to make behavioral changes. These may be lifestyle changes to manage a chronic condition (e.g., obesity, asthma), adherence with the recommended timing and frequency of medications, or recommendations to seek assistance from other health providers (e.g., dieticians, mental health providers, physical, occupational, or speech therapists). However, change is difficult and can cause distress, and…

Abused and Neglected Children

The abuse and neglect ( maltreatment ) of children are pervasive problems worldwide, with short- and long-term physical and mental health and social consequences. Child healthcare professionals have an important role in helping address this problem. In addition to their responsibility to identify maltreated children and help ensure their protection and health, child healthcare professionals can also play vital roles related to prevention, treatment, and advocacy.…

Child Trafficking for Sex and Labor

Human trafficking violates the fundamental human rights of child and adult victims and impacts families, communities, and societies. Trafficked persons originate from countries worldwide and may belong to any racial, ethnic, religious, socioeconomic, or cultural group. They may be of any gender. According to the United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons , child trafficking refers to the “recruitment, transportation, transfer, harboring…

Impact of Violence on Children

The reach of violence, whether as the victim, perpetrator, or witness, whether in person or through the media, is far, deep, and long-standing across the globe. In the home, it is estimated that 80–95% of such aggression is witnessed by a child. Exposure to violence disrupts the healthy development of children in a myriad of ways. Pediatric clinicians must be competent to address these issues in…

Injury Control

In all high-income countries of the world, and increasingly in many low- and middle-income countries, injuries are the most common cause of death during childhood and adolescence beyond the 1st few mo of life ( Table 13.1 and Fig. 13.1 ). Injuries represent one of the most important causes of preventable pediatric morbidity and mortality in the United States. Identification of risk factors for injuries has…

Maximizing Children’s Health: Screening, Anticipatory Guidance, and Counseling

Routine, scheduled care of well infants, children, and adolescents is an essential prevention effort for children and youth worldwide. Children's constantly changing development lends added value to regular and periodic encounters between children and their families and practitioners of pediatric healthcare. Health supervision visits from birth to age 21 yr are the platform for a young person's healthcare. The provision of well care in the medical home…

Cultural Issues in Pediatric Care

Pediatricians live and work in a multicultural world. Among the world's 7 billion people residing in over 200 countries, more than 6,000 languages are spoken. As the global population becomes more mobile, population diversity increases in all countries. In the United States, sources of ethnic and cultural diversity come from indigenous cultural groups such as Native Americans and Alaskan and Hawaiian natives, groups from U.S. territories…

Medical Evaluation of the Foreign-Born Child

More than 210,000 foreign-born children (≤16 yr old) enter the United States each year as asylees (asylum seekers), refugees, and immigrants, including international adoptees (see Chapter 8 ). This number does not include undocumented children living and working in the United States, the U.S.-born children of foreign-born parents, or the approximately 2.7 million nonimmigrant visitors ≤16 yr old who legally enter the United States annually with temporary visas.…

Foster and Kinship Care

The placement of children in out-of-home care has served the needs of children in many societies worldwide throughout history. The institution of foster care was developed in the United States as a temporary resource for children during times of family crisis and is rooted in the principle that children fare best when raised in family settings. The mission of foster care is to provide for the…

Domestic and International Adoption

Adoption is a social, emotional, and legal process that provides a new family for a child when the birth family is unable or unwilling to parent. In the United States, about 1 million children <18 yr of age are adopted; 2–4% of all American families have adopted. Annually across the globe, approximately 250,000 children are adopted, with 30,000 of these between nations. In the United States, approximately…

Pediatric Palliative Care

According to the World Health Organization (WHO), “Palliative care for children is the active total care of the child's body, mind and spirit and also involves giving support to the family. Optimally, this care begins when a life-threatening illness or condition is diagnosed and continues regardless of whether or not a child receives treatment directed at the underlying illness.” Provision of palliative care applies to children…

Ethics in Pediatric Care

Pediatric ethics is the branch of bioethics that analyzes moral aspects of decisions made relating to the healthcare of children. In general terms, the autonomy -driven framework of adult medical ethics is replaced by a beneficent paternalism (or parentalism) in pediatrics. Pediatric ethics is distinctive because the pediatric clinician has an independent fiduciary obligation to act in a younger child's best interest that takes moral precedence…

Safety in Healthcare for Children

Children may be harmed by the healthcare that aims to make them better. Such harms include central line–associated bloodstream infections (CLA-BSIs) and medication overdoses. In 1991 the Harvard Medical Practice Study reviewed a large sample of adult medical records from New York State and found that adverse events occurred in an estimated 3.7% of hospitalizations. Most events gave rise to serious disability, and 13.6% led to…

Quality and Value in Healthcare for Children

The Need for Improvement in Quality and Value Adults and children only receive recommended evidence-based care about half the time. The gap between knowledge and practice widens to a chasm in part because of variations in practice and disparities in care from doctor to doctor, institution to institution, geographic region to geographic region, and socioeconomic group to socioeconomic group. Furthermore, it is estimated that it takes…

Global Child Health

Global Burden and Trends in Child Health The under-five mortality rate (U5MR) , also known as the child mortality rate , serves as a reliable gauge of child well-being. It measures the outcome of a country's health system and reflects a nation's social and economic development. The global U5MR fell by 53% between 1990 and 2015. Despite these gains, in 2016 an estimated 5.6 million children…

Child Health Disparities

Health and illness are not distributed equally among all members in most societies. Differences exist in risk factors, prevalence and incidence, manifestations, severity, and outcome of health conditions, as well as in the availability and quality of healthcare. When these differences are modifiable and avoidable, they are referred to as disparities or inequities . The U.S. Department of Health and Human Services (DHHS) Healthy People 2020…

Overview of Pediatrics

Pediatrics is the only discipline dedicated to all aspects of the care and well-being of infants, children, and adolescents, including their health—their physical, mental, social, and psychological growth and development—and their ability to achieve full potential as adults. Pediatricians must be concerned not only with specific organ systems, genetics, and biologic processes, but also with environmental, psychosocial, cultural, and political influences, all of which may have…

Acquired Rashes in the Older Child

Many skin findings in childhood are benign and self-limited conditions. Other dermatologic complaints may be the first manifestation of a systemic disease or associated condition, recognition of which facilitates appropriate evaluation and treatment. History, Physical Examination, and Diagnostic Procedures History A careful and focused history is necessary to diagnose pediatric skin disorders. It may be helpful to examine the patient first and then proceed with a…