Aims and objectives The aim was to explore and describe the child's active participation in daily healthcare practice at children's hospital units in Sweden. Objectives (a) Identify everyday situations in medical and nursing care that illustrate children's active participation in decision‐making, (b) identify various ways of active participation, actual and optimal in situations involving decision‐making and (c) explore factors in nursing and medical care that influence children's active participation in decision‐making. Background Despite active participation being a fundamental right for children, they are not always involved in decision‐making processes during their health care. There still remains uncertainty on how to support children to actively participate in decisions concerning their health care. Design A qualitative study with overt, nonparticipant observations fulfilling the COREQ checklist criteria. Methods Observations of interactions between children aged 2 and 17 years with both acute and chronic conditions, their parents, and healthcare professionals were conducted at three paediatric hospitals in Sweden. The Scale of Degrees of Self Determination was used to grade identified situations. The scale describes five levels of active participation, with level one being the least and level five being the most active level of participation. Normative judgements were also made. Results Children's active participation was assessed as being generally at levels four and five. Children demonstrated both verbal and nonverbal ways of communication during decision‐making. Findings indicated that children's, parents' and healthcare professional's actions influenced children's active participation in decision‐making processes involving healthcare. Conclusions Healthcare professionals specialised in paediatrics need to embrace both a child perspective and a child's perspective, plan care incorporating key elements of a child‐centred care approach, to ensure children's active participation at a level of their choosing. Relevance to clinical practice There is a need for awareness creation to help healthcare professionals facilitate children's active participation in their care and decision‐making.

Overweight and obesity in childhood are highly preventable and parents are key role models in the establishment of healthy behaviours. The aim of this study was to assess the effectiveness of family-based interventions for prevention of overweight and obesity in children aged 2-6 years. A systematic literature search was performed in the databases such as Medline, PsycInfo, Family Study Abstracts, Embase, and CINAHL, published between 2010 and May 2019. The eligible studies were preventive randomised controlled interventions targeting the child or the child's caregivers. The primary outcome was body mass index (BMI). Twelve trials were included with a total of 3506 participants. The overall follow-up rate in the intervention groups was 83% as compared to 82% in the control groups. Nine trials had a high or unclear risk of bias. The children were followed for between 6 weeks and 3 years. Four of the interventions showed significant intervention effects on BMI. Significant effects on children's food intake were reported in one (of five) study, whereas no significant changes in physical activity were found (six studies). Two studies (of six) measuring sedentary behaviours and one (of three) measuring sleep showed significant differences between groups favouring the intervention group. The current evidence for the effects of preventive family interventions is limited. The four trials showing positive effects on BMI were multicomponent interventions, lasting for a minimum of 12 weekly sessions.

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The COVID-19 pandemic created new challenges for children including access to education and limiting social and emotional connections to extended family, friends, and the community. Globally, opportunities for sharing children's self-reported experiences during lockdown were limited. The primary aim of this project was to create an art-E-Book that reflects children's experiences of life during the COVID-19 pandemic that could be shared with other children around the world. Secondly, we wanted to reflect on the consultation undertaken within the International Network of Child and Family Centered Care (INCFCC) using Gibbs (1988) reflective cycle framework. Children from around the world were invited to submit a piece of artwork that reflected their experience during the COVID-19 pandemic via a Qualtrics-survey in May 2020. The children's artwork and written pieces were transcribed verbatim into an E-Book and the artwork was further placed into groups based on similarity of meaning. Fifty-five children from 17 countries submitted an artwork piece. Four groups were evident within the children's artwork including infection control measures, positive experiences and emotions (connection to family, fun activities), negative experiences and emotions (social impact, emotional impact), and uniting children globally. The E-Book is available to download free of charge via the INCFCC website. The E-Book illustrates how children of all ages can provide meaningful insightful commentary and valuable information on their experiences during an unprecedented pandemic.

Aims and objectives: To describe ways in which children's best interests were observed to be expressed in paediatric settings during their hospital visit. Background:The best interests of the child are embodied in national and international legal systems, although the definition remains problematic. The child's limited autonomy mandates duty bearers to have both a child perspective and the child's perspective when considering what the best interest of the child entails in care situations.Design: A qualitative descriptive study with overt, non-participant observations fulfilling the COREQ criteria.Methods: Thirty-two observations of interactions between children aged 2 to 17 years with both acute and chronic conditions, their parents and healthcare professionals were conducted at three paediatric hospitals in Sweden. Inductive and abductive reasoning were used in the content analysis of data, which followed the identification, coding, categorising and abstraction of observed patterns of the best interest of the child.Results: Findings reveal facilitating and obstructing factors for the child's best interests to be safeguarded in healthcare situations. Children were guided in or hindered from exercising their competence. The observations showed a variation in actions taken by both parents and healthcare professionals to safeguard the best interests of the child. Conclusions: Determining the best interest of the child requires a case-by-case basis, as it is context-dependent, situational, flexible and dependent on all actors involved and actual decisions made. Relevance to clinical practice: Healthcare professionals' actions can facilitate or obstruct observed expressions of the child's best interest. It is essential to enhance healthcare professionals' communication skills, knowledge awareness and continuing education about the rights of children receiving healthcare services. Reflections and discussions on how to protect the best interests of children may help healthcare professionals to uphold children's best interest in daily clinical practice.

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