The coronavirus (COVID-19) pandemic has challenged the dental health profession in an unprecedented manner. Suspension of elective dental care across the United States during the initial phase of the pandemic was necessary to prevent viral transmission. The emergency dental care that was provided had to be tailored to minimize the generation of aerosols. With the suspension of elective care, over time, the proportion of dental emergencies was anticipated to rise. Dentists who care (...) for children have continued to provide emergency dental treatment to this vulnerable population. Treatment decisions for pediatric dental emergencies had to be tailored to principles of public health that best mitigated risk of viral transmission. Decisions needed to balance the benefits of chosen treatment modality for the individual child with the risk of viral transmission to dental professionals and their staff, patients, and community. The paucity of reliable research for dentists to aid in clinical decision making may have left careproviders feeling ethically and morally insecure in shifting from a patient-centered to a community-centered paradigm. We present analysis of four pediatric emergency case scenarios that are representative of those likely to present to a private practice, academic setting, or emergency department during the pandemic. This analysis aims to empower dentists who care for children to implement the American Dental Association’s Principles of Ethics & Code of Professional Conduct within the context of a global health crisis. (shrink)

La formación profesional tiene un carácter contextualizado que responde a las exigencias que la época, la sociedad y el país reclaman a las universidades. La Estomatología en Cuba no se encuentra al margen de estos preceptos por lo que desarrolla un plan de estudio que acentúa la flexibilidad para realizar modificaciones necesarias y pertinentes. El estudiante al culminar la carrera debe brindar una atención estomatológica integral donde las anomalías dentomaxilofaciales constituyen la tercera línea de trabajo. Estas ocasionan afectaciones estéticas que (...) repercuten en la autoestima y adaptación social de niños y adolescentes por lo que se necesita de una orientación sicoeducativa, acción para la cual el profesional deberá estar preparado. A partir de las insuficiencias detectadas en el proceso formativo del estomatólogo, el objetivo del presente trabajo es proponer un curso propio sobre la temática para favorecer la graduación de un profesional capaz de resolver los problemas que afectan el complejo estomatognático con un enfoque biosicosocial. Los métodos empleados fueron el histórico-lógico y análisis-síntesis. Professional training has a contextualized nature which reflects the demands that the time, society and the country require from universities. In Cuba, Stomatology is not out of these precepts and therefore it carries out a syllabus that emphasizes flexibility to make necessary and appropriate changes. When students graduate, they must provide a complete stomatological care where dental maxillofacial anomalies are the third line of work. They cause aesthetic harm that affects children and teenagers' self-esteem and social adaptation which makes psych educational guidance necessary; a situation professional must be prepared for. Starting from the weak points discovered in the training process of stomatologists, a crash course in the subject is suggested in order to favor the graduation of professionals who are able to solve problems that affect the stomatognatic complex with a biopsychosocial approach, through the use of required methods, techniques and procedures. (shrink)

Children in the pediatric intensive care unit are indisputably in a vulnerable position, dependent on nurses to acknowledge their needs. It is assumed that children should be approached from a holistic perspective in the caring situation to meet their caring needs. The aim of the study was to unfold the meaning of nursing care through nurses’ concerns when caring for children in the pediatric intensive care unit. To investigate the qualitative aspects of practice embedded (...) in the caring situation, the interpretive phenomenological approach was adopted for the study. The findings revealed three patterns: medically oriented nursing—here, the nurses attend to just the medical needs, and nursing care is at its minimum, leaving the children’s needs unmet; parent-oriented nursing care—here, the nursing care emphasizes the parents’ needs in the situation, and the children are viewed as a part of the parent and not as an individual child with specific caring needs; and smooth operating nursing care orientation—here, the nursing care is focused on the child as a whole human being, adding value to the nursing care. The conclusion drawn suggests that nursing care does not always respond to the needs of the child, jeopardizing the well-being of the child and leaving them at risk for experiencing pain and suffering. The concerns present in nursing care has been shown to be the divider of the meaning of nursing care and need to become elucidated in order to improve the cultural influence of what can be seen as good nursing care within the pediatric intensive care unit. (shrink)

Comparison of the opinions working with the children of psychologists of Volgograd region concerning the provision of psychological assistance to children with early childhood autism in the 10-year interval showed the ongoing institutionalization of this social practice, although not intensive enough. However, the COVID-19 pandemic, which began in early 2020, made it virtually impossible to provide psychological support to children with the disorder, due to numerous factual and subjective factors. It was concluded that regional medical and social (...) services needed to be particularly proactive in providing support to vulnerable categories of persons. (shrink)

Parkinson, Joseph Passing on Catholic teaching effectively means exercising both the doctrinal and pastoral ministries of a Church which professes to be both Mother and Teacher.

With an estimated 12.1% of children aged 2–5 years already obese, prevention efforts must target our youngest children. One of the best places to reach young children for such efforts is the early care and education setting. More than 11 million U.S. children spend an average of 30 hours per week in ECE facilities. Increased attention at the national, state, and community level on the ECE setting for early obesity prevention efforts has sparked a range (...) of innovative efforts. To assist these efforts, CDC developed a technical assistance and training framework – the Spectrum of Opportunities for Obesity Prevention in the ECE setting – which also served as the organizing framework for the Weight of the Nation ECE track. Participants highlighted their efforts at national, state, and local levels pursuing opportunities on the Spectrum, the standards and best practices that had been the emphasis of their efforts, and common steps for developing, implementing, and evaluating initiatives. Strong leadership and collaboration among a broad group of stakeholders; systematic assessment of needs, opportunities and resources; funding sources; and training and professional development were reported to be integral for successful implementation of standards and best practices, and sustainability. (shrink)

I review three existing arguments in favor of having some childcare done by nonparents and then I advance five arguments, most of them original, to the same conclusion. My arguments rely on the assumption that, no matter who provides it, childcare will inevitably go wrong at times. I discuss the importance of mitigating bad care, of teaching children how to enter caring relationships with people who are initially strangers to them, of addressing children's structural vulnerability to their (...) caregivers, of helping children and parents contain the ambivalent feelings of the child-parent relationship, and of distributing the responsibility of care and the ensuing blame for bad care more widely. I conclude that nonparental childcare should be universal. (shrink)

Dental caries is the main oral health challenge for children in Nigeria. Concern about its negative impact makes screening for caries in children an attractive public health strategy. The ability to detect the preclinical phase of caries, the availability of screening tools with high accuracy, and the possibility of treatment before onset of clinical symptoms with significant cost and health benefits, makes it appropriate for screening. However in Nigeria, the poor availability of highly specific and sensitive screening (...) tools, poor access to oral health care and concerns with pre-screening consent, raise the question of the appropriateness of conducting screening programmes for children. We argue that a number of structural challenges associated with poor uptake of oral health care services need to be addressed before screening for caries can be considered ethically appropriate. These include facilitating access of children to quality oral health care and a systematic national approach to oral health impl... (shrink)

Recent estimates indicate that over 40,000 children die annually in the United States and a majority have life-limiting conditions. Children at end of life require extensive healthcare resources, including multiple hospital readmissions and emergency room visits. Yet, many children still suffer from symptoms at end of life—including fatigue, pain, dyspnea, and anxiety—with less than 10% of these children utilizing hospice care services. A critical barrier to pediatric hospice use was the original federal regulations associated with (...) the hospice care that required a diagnosis of 6 months to live and the discontinuation of all curative treatments. The Concurrent Care Provision of the United States’ Affordable Care Act eliminated the need to forgo curative therapies in order to enroll in hospice for children in Medicaid or Children’s Health Insurance Program. Concurrent care for children can help mitigate the tension families experience in choosing between essential forms of care, as well as contribute to improved end-of-life outcomes for the child and possibly bereavement outcomes for the family. Understanding concurrent care for children from a social justice perspective has important advocacy and research implications for hospice and palliative care clinicians providing care for children and their families. We apply Powers and Faden’s theory of social justice “as the moral foundation of public health and health policy” to the provision of concurrent care to children near end of life and families in the United States. The goals of applying this theory are to explore additional insights and perspectives into concurrent care policy may provide and to assess the usefulness of this theory when applied to end-of-life health policy. We argue that concurrent care policy is socially just since it has potential to promote well-being in vulnerable children and families and can limit the inequity children at end-of-life experience in access to high-quality hospice care. (shrink)

IntroductionThere is a significant disparity in the United States between the health care received by children with special health care needs versus physically healthy children.ObjectiveThe objective of the paper is to show that children with special needs receive less than adequate health care overall. This disparity affects the quality of life for these children and influences their ability to live their lives to their full potential.MethodsResearch was conducted by examining multiple studies with a (...) focus on six major factors that play a role in creating this disparity.ResultsThe findings show an alarming trend in the access and delivery of health care to children with special health care needs.ConclusionsSolutions to correcting the disparities are possible, but it will take a full understanding of the issues, perseverance, dedication, and hard work on the part of families, physicians, legislators, and others genuinely interested in creating an equal health care system for all children. (shrink)

End-of-life care is the only major reference to systematically explore the unique medical, social, legal, political, and ethical issues to consider while providing care to adults and children with intellectual and developmental disabilities who are facing terminal illness or life-limiting conditions.

Parents have the autonomous right to choose or refuse a treatment for their child, even those that are life sustaining, if it is extraordinary or disproportionate and it is within the best interest and well-being of their child. Pediatric health care is practiced with the goal of promoting the best interests of the child to do so. Treatment is generally rendered under a presumption in favor of sustaining life. However, in some circumstances, the balance of benefits and burdens to (...) the child leads to an assessment that forgoing life-sustaining medical treatment (LSMT) is ethically supportable or advisable. Input from specialists in palliative care, ethics, pastoral care, and other disciplines enhances support for families and medical staff when decisions to forgo LSMT are being considered. (shrink)

Not long after matriculation—sometimes even before—medical students begin hearing the question, "So, what are you going into?" It can be heard as a colloquial version of a practical question, "To which type of residency are you planning to apply?" Some will evade the question, claiming, perhaps sincerely, to be fascinated by everything from radiology to geriatrics, open to all possible paths. Others will acknowledge that they enjoy or dread working with children, that they crave long-term relationships or bursts of (...) adrenaline, that they are drawn to the knife or sickened at the sight of blood. A smaller number will confess to having a clear vision of their futures, perhaps a desire to... (shrink)

Neither secular moral theory nor religious ethics have had much place for persons in need of constant physical help and cognitive support, nor for those who provide care for them. Writing as the father of a fourteen-year-old daughter with multiple disabilities, I will explore some of moral issues that arise here, both from the point of view of the disabled child and from that of the child's caretaker(s).

Despite the 1970s middle-class feminist dream that women could have it all—families characterized by equitable distributions of household labor and interesting careers—the decades since have told a different story. In the U.S. context of a neoliberal labor market and privatized systems of family care, mothers still struggle to negotiate the conflicting demands of family and employment, particularly when caring for children with disabilities. Though an extensive literature examines labor market participation for mothers of children with disabilities, few (...) scholars have examined the emotional impact of their altered career plans. Drawing from a sample of 40 single- and two-parent families, the author examines mothers’ accounts of care for children with disabilities, focusing on their emotional experiences of their changed employment trajectories. (shrink)

Little is known about the views of mothers when their children are invited to participate in randomized clinical trials (RCTs) investigating medicines and/or invasive procedures. Our goal was to understand mothers’ perceptions of the processes of informed consent and randomization in a RCT that divided uncooperative children into three intervention groups (physical restraint, sedation, and general anesthesia) for dental rehabilitation.

This essay critiques the fiercely utilitarian allocation scheme of Cameron et al. Children have no hope of recovery if their lives are cut short based on administrative protocols that misrepresent the nature of their conditions. Unilateral futility judgements - especially those based on a false predicate - are discriminatory. When considering the best interests of children, we should see possibility in disability and not advance ill-informed utilitarianism.

Volume 19, Issue 12, December 2019, Page 73-74.

In the history of palliative care, all roads lead back to Dame Cicely Saunders, a remarkable social worker/nurse/physician who promoted the concept of total pain and founded the first modern hospic...

Pediatric critical careCritical care refers to the health care of children with life-threatening illness or following major surgery or severe injury. This care is offered in different contexts across the globe. In well-resourced environments, critical careCritical care may be provided in pediatric intensive care units, which provide highly complex medical care with advanced, potentially expensive technological devices aimed primarily at sustaining life; whereas in poorly resourced regions, only primary care may be available (...) for critically ill or injured childrenInjured children. Even where PICU facilities are available, they are a scarce and expensive resource. The knowledge and ability to sustain a critically ill or injured child’sInjured children life, potentially with effects on the child and family’s quality of lifeQuality of life and at the expense of other children’s health care, leads to frequent ethical challenges. Ethical issues related to how best to ensure optimal quality of lifeQuality of life and the fair distribution of scarce resources are common. In-depth knowledge and understanding of the individual patient’s medical, scientific and psychosocial context, through interdisciplinary discussion and collaboration; as well as familiarity with the overriding, relevant ethico-legal policiesPolicy and principles is essential for appropriate decision-makingDecision-making. Truthful communicationCommunication with the family is essential, using a shared decision-makingDecision-making process, and the child’s best interestBest interest must be central to every decision. This chapter presents an overview of the recommended approach to, and important considerations for, ethical decision-makingDecision-making in the PICU, using a hypothetical case example. (shrink)

This commentary explores Medicaid's role for children with special health care needs today and considers how changes to Medicaid's federal financing structure under a per capita cap or block grant could affect coverage for these children.

This article explores the meeting of two approaches towards philosophy and education: the philosophy for children approach advocated by Lipman and others, and Schmid’s philosophical concept of Lebenskunst. Schmid explores the concept of the beautiful or good life by asking what is necessary for each individual to be able to develop their own art of living and which aspects of life are significant when shaping a good and beautiful life. One element of Schmid’s theory is the practical application of (...) philosophy through the notions of Bildung, reflection, prudence and practical wisdom, as well as the requirement for each individual to take responsibility for actively shaping their life as an artwork. In this sense, each person is the artist responsible for living their own beautiful life. We argue that there are useful parallels between Schmid’s concept of the art of living and P4C, such as the ideal of a holistic philosophy that is “lived.” The pragmatic approach of P4C focuses on the embodied learner who practices critical, caring and creative thinking. Both P4C and Schmid’s theory are reminiscent of the Aristotelian notion of practical wisdom, which allows for an approach to an education for life that prepares students to develop their own art of living. (shrink)

The principles of equality and equity, respectively in the Bill of Rights and the white paper on health, provide the moral and legal foundations for future health care for children in South Africa. However, given extreme health care need and scarce resources, the government faces formidable obstacles if it hopes to achieve a just allocation of public health care resources, especially among children in need of highly specialised health care. In this regard, there is (...) a dearth of moral analysis which is practically useful in the South African situation. We offer a set of moral considerations to guide the macro-allocation of highly specialised public health care services among South Africa's children. We also mention moral considerations which should inform micro-allocation. (shrink)

This article analyses the negative ethical impact of privatisation, alongside the ongoing marketisation of social care and social work provision for children and young people in England. It critically appraises the implications of a market-based formal social care system, which includes the risk-averse and often detached role of social workers within ever more fragmented sectors of care. Analysis begins with a discussion of background policy and context. The tendency towards ‘service user’ objectification and commodification are then (...) detailed, followed by a discussion of the limiting of choice for service users. Service and social fragmentation, and the often severely restricted ‘life chances’ of many children and young people in care, are then deliberated. The concluding discussion reiterates the ethical implications of marketisation in relation to ethical frameworks, including those associated with autonomy, informed choice, social exclusion and social justice. The tendency towards children increasingly being utilised as a means to an end within business-orientated sectors of care is highlighted, alongside moral questions asked about the State’s purpose in providing a community of support. (shrink)

Christians care for orphans and children without parental care in different forms. However, in the Global South, care is primarily provided in orphanages or large residential settings. Despite good intentions, there are limitations to provide a nurturing family environment for the children in such care environment. With current knowledge of alternative child care and in light of the holistic ministry, this article suggests an approach for the church to care for orphans and (...) children at risk by focusing on the family and the local community. Additionally, simple steps to transition to holistic orphan care are offered. (shrink)

When critical thinking occurs in a collective context such as a Philosophy for Children workshop, it cannot be considered simply as an intellectual exercise, insofar as it depends on social interactions in the philosophical dialogue. This is why, in line with the works of Matthew Lipman, critical thinking should be taught and practiced as an exercise based on the development of caring thinking among children. Furthermore, open-mindedness, defined as the ability of the child to welcome intellectually and ethically (...) divergent ideas, may constitute the very fundamental precondition for critical thinking as it permits the meticulous, analytic and authentic discovery of the idea. (shrink)

In the last two decades, some authors in the philosophy for children movement have theorized that the community of philosophical inquiry can be a form of spiritual practice, of the care of the self, or a wisdom practice (De Marzio, 2009; Gregory, 2009, 2013, 2014;Gregory & Laverty, 2009). Yet, it is unclear if philosophy for children is, by itself, a form of spiritual education, or if it requires some sorts of modification to be one. And, if it (...) is or can be a form of spiritual education, we can interrogate in what ways and to what extent is it one. It is these questions that this text aims to explore. To do so, we will first clarify the meaning of spiritual education through the presentation of two authors who have explicitly written on that topic. The first is Parker J. Palmer, who has developed a perspective on what it means to reclaim the spiritual roots of education, derived from his study and practice of Quaker spirituality. The second is Pierre Hadot, who has explored how the practice of philosophy in Western antiquity was a form of spiritual exercise. From our presentation of these two authors will emerge a particular perspective of what spiritual education means. In the last section of the text we will use this presentation to examine in what ways philosophy for children can be a form of spiritual education and if requires adaptations to be one. (shrink)

Rigorous attention has been paid to moral distress among healthcare professionals, largely in high-income settings. More obscure is the presence and impact of moral distress in contexts of chronic poverty and structural violence. Intercultural ethics research and dialogue can help reveal how the long-term presence of morally distressing conditions might influence the moral experience and agency of healthcare providers. This article discusses mixed-methods research at one nongovernmental social support agency and clinic in Rio de Janeiro, Brazil. Chronic levels of moral (...) distress and perceptions of moral harm among clinicians in this setting were both violent, following Nancy Scheper-Hughes’ use of that term, and a source of exceptional and innovative care. Rather than glossing over the moral variables of work in such desperate extremes, ethnography in these settings reveals novel skills and strategies for managing moral distress. (shrink)

Philosophy for Children: In the Historical Perspective of the Progressive Nature of Human Consciousness. This paper will examine the importance of the Critical Thinking Movement and the Philosophy for Children Programme in a larger, more inclusive, and innovative perspective. The paper will explain why the CriticalThinking Movement appeared in our time and then offer a new interpretation of the importance of the Philosophy for Children Program – with both seen in a novel historical perspective as well as (...) in the context of the progressive nature of human consciousness. At this point, it is essential to stress the novel importance andindispensable role of Critical Thinking Programmes in light of the larger historical perspective afforded by both the Graves and McIntosh models of human progressive consciousness. Although all Critical Thinking Programmes play a crucial role in this process, the Philosophy for Children Programme (P4C) will be especially crucial and influential in this endeavour of lifting human consciousness and awareness. First of all, P4C Programme operates with Matthew Lipman’s three dimensional model of thinking, namely with three equal and balanced components of Critical, Creative, and Caring dimensions and not simply a linear, one dimensional focus and concentration on rational and logical reasoning. Humanity is destined and already advancing to the higher levels of Post-Modernist, Integral, and Post-Integral Consciousness. These more advanced levels require full competence in Critical Thinking or the adequate and skillful full employment of logical and rational reasoning but they demand, in addition, increased competence in Caring and Creative Thinking. (shrink)