Discrimination against children

Attitudes toward children: Distinguishing affection and stress

BACKGROUND

Adults' views and behaviors toward children can vary from being supportive to shockingly abusive, and there are significant unanswered questions about the psychological factors underpinning this variability.

OBJECTIVE

The present research examined the content of adults' attitudes toward children to address these questions.

METHOD

Ten studies (N = 4702) identified the factor structure of adults' descriptions of babies, toddlers, and school-age children and examined how the resulting factors related to a range of external variables.

RESULTS

Two factors emerged-affection toward children and stress elicited by them-and this factor structure was invariant across the United Kingdom, the United States, and South Africa. Affection uniquely captures emotional approach tendencies, concern for others, and broad positivity in evaluations, experiences, motivations, and donation behavior. Stress relates to emotional instability, emotional avoidance, and concern about disruptions to a self-oriented, structured life. The factors also predict distinct experiences in a challenging situation-home-parenting during COVID-19 lockdown-with affection explaining greater enjoyment and stress explaining greater perceived difficulty. Affection further predicts mentally visualizing children as pleasant and confident, whereas stress predicts mentally visualizing children as less innocent.

CONCLUSIONS

These findings offer fundamental new insights about social cognitive processes in adults that impact adult-child relationships and children's well-being.

The Salience of Children Increases Adult Prosocial Values

Organizations often put children front and center in campaigns to elicit interest and support for prosocial causes. Such initiatives raise a key theoretical and applied question that has yet to be addressed directly: Does the salience of children increase prosocial motivation and behavior in adults? We present findings aggregated across eight experiments involving 2,054 adult participants: Prosocial values became more important after completing tasks that made children salient compared to tasks that made adults (or a mundane event) salient or compared to a no-task baseline. An additional field study showed that adults were more likely to donate money to a child-unrelated cause when children were more salient on a shopping street. The findings suggest broad, reliable interconnections between human mental representations of children and prosocial motives, as the child salience effect was not moderated by participants’ gender, age, attitudes, or contact with children.

Prenatal Nicotine or Cannabis Exposure and Offspring Neurobehavioral Outcomes

OBJECTIVE

To study the association between nicotine or cannabis metabolite presence in maternal urine and child neurodevelopmental outcomes.

METHODS

We conducted a secondary analysis of two parallel multicenter randomized controlled trials of treatment for hypothyroxinemia or subclinical hypothyroidism among pregnant individuals enrolled at 8-20 weeks of gestation. All maternal-child dyads with a maternal urine sample at enrollment and child neurodevelopmental testing were included (N=1,197). Exposure was urine samples positive for nicotine (cotinine) or cannabis 11-nor-9-carboxy-delta-9-tetrahydrocannabinol [THC-COOH]) or both metabolites. Primary outcome was child IQ at 60 months. Secondary outcomes included cognitive, motor and language, attention, behavioral and social competency, and differential skills assessments at 12, 24, 36, and 48 months. Quantile regression analysis was performed with confounder adjustment.

RESULTS

Of 1,197 pregnant individuals, 99 (8.3%) had positive cotinine samples and 47 (3.9%) had positive THC-COOH samples; 33 (2.8%) were positive for both. Groups differed in self-reported race and ethnicity, education, marital status, insurance, and thyroid status. Median IQ was similar between cotinine-exposed and -unexposed children (90 vs 95, adjusted difference in medians -2.47, 95% CI -6.22 to 1.29) and THC-COOH-exposed and -unexposed children (89 vs 95, adjusted difference in medians -1.35, 95% CI -7.76 to 5.05). In secondary outcome analysis, children with THC-COOH exposure compared with those unexposed had higher attention scores at 48 months of age (57 vs 49, adjusted difference in medians 6.0, 95% CI 1.11-10.89).

CONCLUSIONS

Neither prenatal nicotine nor cannabis exposure was associated with a difference in IQ. Cannabis exposure was associated with worse attention scores in early childhood. Longitudinal studies assessing associations between child neurodevelopmental outcomes and prenatal nicotine and cannabis exposure with a focus on timing and quantity of exposure are needed.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT00388297.

Rights, justice, and equity: a global agenda for child health and wellbeing

Worldwide challenges to child health and wellbeing are rapidly becoming existential threats to children and childhood. Inequities, armed conflict and violence, nuclear proliferation, forced migration, globalisation, and climate change are among the global issues violating children's rights to optimal survival and development. Child rights-based approaches will be required to enhance the response to the civil-political, social, economic, and cultural determinants of these global child health issues. In this Viewpoint, we present a global agenda for child health and wellbeing as a blueprint for the practice of paediatrics and child health in the domains of clinical care, systems development, and policy formulation. This global agenda is grounded in the principles of rights, justice, and equity and can address the root-cause determinants of health. The 30th anniversary of the UN Convention on the Rights of the Child is a relevant moment to recommit to shared goals for children's health and wellbeing.

ETHICS AND THE DYNAMIC VULNERABILITY OF CHILDREN

In this paper, we want to examine the particular vulnerability of children from an ethical perspective. We want to defend three claims: Firstly, we will argue that children’s vulnerability is best understood as a dynamic quality, meaning that as children progress through childhood, their vulnerability also undergoes particular changes. To capture this, we want to discriminate among physical, mental, social, and symbolic vulnerability, which vary according to certain features, such as age, maturity, gender, and race. These different traits are furthermore important in order to understand what we owe children from an ethical perspective. In a nutshell, children have moral claims not to be harmed and to be protected against threats to their well-being and well-becoming, and these claims have to be explicated via the dynamic vulnerability of children. Finally, we will argue that one of the main issues is to balance the protection of children and their autonomy claims, which both enhance and diminish their vulnerability.

Pediatric immunization-related safety incidents in primary care: A mixed methods analysis of a national database

Background

Children are scheduled to receive 18–20 immunizations before their 18th birthday in England and Wales; this approximates to 13 million vaccines administered per annum. Each immunization represents a potential opportunity for immunization-related error and effective immunization is imperative to maintain the public health benefit from immunization. Using data from a national reporting system, this study aimed to characterize pediatric immunization-related safety incident reports from primary care in England and Wales between 2002 and 2013.

Methods

A cross-sectional mixed methods study was undertaken. This comprised reading the free-text of incident reports and applying codes to describe incident type, potential contributory factors, harm severity, and incident outcomes. A subsequent thematic analysis was undertaken to interpret the most commonly occurring codes, such as those describing the incident, events leading up to it and reported contributory factors, within the contexts they were described.

Results

We identified 1745 reports and most (n = 1077, 61.7%) described harm outcomes including three deaths, 67 reports of moderate harm and 1007 reports of low harm. Failure of timely vaccination was the potential cause of three child deaths from meningitis and pneumonia, and described in a further 113 reports. Vaccine administration incidents included the wrong number of doses (n = 476, 27.3%), wrong timing (n = 294, 16.8%), and wrong vaccine (n = 249, 14.3%). Documentation failures were frequently implicated. Socially and medically vulnerable children were commonly described.

Conclusion

This is the largest examination of reported contributory factors for immunization-related patient safety incidents in children. Our findings suggest investments in IT infrastructure to support data linkage and identification of risk predictors, development of consultation models that promote the role of parents in mitigating safety incidents, and improvement efforts to adapt and adopt best practices from elsewhere, are needed to mitigate future immunization-related patient safety incidents. These priorities are particularly pressing for vulnerable patient groups.

Pursuing concordance: moving away from paternalism

In the second of two articles exploring the value and application of concordance across nursing practice the discussion is aimed at clinical settings and patient groups where concordance may have been viewed as impractical. The author harnesses Cribb and Entwhistle's broader conception of shared decision making and the notion of decision-making capacity as a continuum to argue that concordance can be pursued effectively in challenging settings such as childcare practice, mental health and the care of older people. As in the first paper ( McKinnon, 2013 ) the discussion is not limited to medicines management but remains engaged with all aspects of nursing practice. Legal and ethical frameworks, social participation theory and research across healthcare practice are sourced to argue for concordant approaches in the care of patients who may at times have compromised decision-making capacity. Ideas of direct and indirect concordance are explored.

Policy statement--health equity and children's rights

Many children in the United States fail to reach their full health and developmental potential. Disparities in their health and well-being result from the complex interplay of multiple social and environmental determinants that are not adequately addressed by current standards of pediatric practice or public policy. Integrating the principles and practice of child health equity-children's rights, social justice, human capital investment, and health equity ethics-into pediatrics will address the root causes of child health disparities. Promoting the principles and practice of equity-based clinical care, child advocacy, and child- and family-centered public policy will help to ensure that social and environmental determinants contribute positively to the health and well-being of children. The American Academy of Pediatrics and pediatricians can move the national focus from documenting child health disparities to advancing the principles and practice of child health equity and, in so doing, influence the worldwide practice of pediatrics and child health. All pediatricians, including primary care practitioners and medical and surgical subspecialists, can incorporate these principles into their practice of pediatrics and child health. Integration of these principles into competency-based training and board certification will secure their assimilation into all levels of pediatric practice.

Muslim patients and health disparities in the UK and the US

This article provides a framework for understanding how Muslim identity, and the current social and political contexts in which it is shaped, affects the health of Muslims in the UK and the US, and the quality of health care they receive. Key medical and public health literature that addresses health concerns related to Muslim communities in the UK and the US is reviewed. Few data exist specific to health disparities for Muslim minorities. However, the article focuses on emerging studies concerning the consequences of "Islamophobia" for the physical and mental health and health care of Muslim families and children. We argue that, despite substantive structural differences in the health care systems of the UK and the US, social structural and political forces play similar roles in the health of Muslim children in both countries. Finally, we call for significant cultural and institutional adjustments in health care settings and further research studies to provide specific data to address health disparities for these growing and diverse populations.

13. Children in Australian society

Although children in Australia generally have good health, some alarming indicators of poor health and wellbeing exist, which are related to major socioeconomic discrepancies. The pathways connecting socioeconomic disadvantage to child health outcomes are complex and poorly understood. Reducing social disadvantage requires strategies beyond the health arena, involving political, moral, cultural and economic initiatives. Developing "social capital"--cohesion in communities, a sense of belonging and involvement in community affairs--may be a key strategy in improving health indicators. Overseas studies of early intervention and home visiting programs in early childhood have shown improvements in child health and development outcomes. Similar programs have been introduced in Australia and face considerable challenges in their widespread roll-out and evaluation. Health professionals need to develop practical ways to interact with community programs and thus improve social capital.