No abstract

In the last decade, there has been a rapid growth in the presence of clowns in hospitals, particularly in pediatric settings. The proliferation of clowns in health care settings has resulted in varying levels of professionalism and accountability. For this reason, there is a need to examine various forms of clowning, in particular therapeutic clowning in pediatric settings. The purpose of this article is to address what therapeutic clowning is and to describe the extent to which it can provide a complementary form of health care. In an attempt to apply theory to practice, the article will draw upon the experiences of a therapeutic clown within a pediatric setting while providing a historical and theoretical account of how clowns came to be in hospitals. Toward this end, a proposed model of therapeutic clowning will be offered which can be adapted for a variety of settings where children require specialized forms of play in order to enhance their coping, development and adjustment to life changes. Finally, current research on clowning in children's hospitals will be reviewed including a summary of findings from surveys administered at the Hospital for Sick Children.

In this ethnographic study, the authors examined the experiences and perspectives of children hospitalized because of SARS (severe acute respiratory syndrome), their parents, and pediatric health care providers. The sample included 5 children, 10 parents, and 8 health care providers who were directly affected by SARS during the time of the outbreaks and extreme infection control procedures. The data analyses illuminated a range of perceived experiences for this triadic sample. Issues related to social isolation due to infection control precautions were predominant. Themes included emotional upheaval, communication challenges, and changes in parental and professional roles. These findings reveal the cogent effects of SARS on family-centered care. The notion of providing family-centered care within an environment plagued by an infectious outbreak suggests an omniously difficult task. Efforts must be made to optimize family-centered care despite obstacles. The authors suggest effective clinical approaches in the event of future outbreaks.

Children, as major stakeholders in paediatric hospitals, have remained absent from discussions on important healthcare issues. One critical area where children's voices have been minimised is in the planning for future pandemics. This paper presents a subset of data from a programme of research which examined various stakeholder experiences of the severe acute respiratory syndrome (SARS) outbreaks of 2003. These data also generated recommendations for future pandemic planning. Specifically, this paper will examine the perspectives and recommendations of children hospitalised during SARS in a large paediatric hospital in Canada. Twenty-one (n = 21) child and adolescent participants were interviewed from a variety of medical areas including cardiac (n = 2), critical care (n = 2), organ transplant (n = 4), respiratory medicine (n = 8) and infectious diseases (patients diagnosed with suspected or probable SARS; n = 5). Data analyses exposed a range of children's experiences associated with the outbreaks as well as recommendations for future pandemic planning. Key recommendations included specific policies and guidelines concerning psychosocial care, infection control, communication strategies and the management of various resources. This paper is guided by a conceptual framework comprised of theories from child development and literature on children's rights. The authors call for greater youth participation in healthcare decision-making and pandemic planning.

A discussion of how the principles of universal design for learning could be applied in paediatric settings is offered for the purpose of advancing ethical and psychosocial care for all children regardless of their age, developmental capacity or condition.

Social inclusion is a complex and often misunderstood concept. For children with disabilities, research has documented the degree of loneliness, bullying and exclusion they often experience in their social lives. This paper presents the findings of a critical literature review on the social inclusion of children with disabilities. Study methods comprised rigorous criteria for study selection followed by established protocols for evaluating studies. Reputable rating scales were used to examine peer-reviewed research published within the last 10 years. Fifty-four studies were analyzed for essential themes. Findings reflect a broad range of stakeholder perspectives and factors that promote or inhibit social inclusion, including child-specific variables as well as environmental influences. Additional research should focus on the perspectives and experiences of children in inclusive settings, particularly those with disabilities, as a means of safeguarding their future social and emotional well-being. © 2017 John Wiley & Sons Ltd and National Children's Bureau Keywords: children, disabilities, peers, social inclusion, social relationships, stigma. BackgroundEstimates of worldwide child disability rates are speculative and dated; however, UNICEF estimates that approximately 93 million (1 in 20) of people aged 14 or younger live with a moderate or severe disability (UNICEF, 2013). In the USA, 5.2 per cent (2.8 million) of the 53.9 million school-aged children (aged 5-17) were reported to have a disability in 2010 (Disability Characteristics, American Community Survey, 2010). For comparison, Human Resources and Skills Development Canada (2011) indicates that 202 350 children (3.7%, aged 0-14 years) and 96 060 teens (4.6%, aged 15-19 years) in Canada have a disability. The most commonly diagnosed disabilities among children include learning, communication and developmental disabilities, while children are also commonly diagnosed with physical disabilities (US Census Bureau, 2010).'Social inclusion' is a multifaceted and largely subjective construct (Le Boutillier and Croucher, 2010). It is often described in opposition to 'social exclusion', which refers to the stigmatisation or marginalisation of certain groups based on particular characteristics, such as socioeconomic status, race, gender or disability. For children with disabilities, social inclusion requires overcoming significant social, economic and political barriers to achieve meaningful involvement in society (Hill and others, 2004). This can involve the ability to make friends, participate in community activities, engage in leisure and play, and have access to quality inclusive practices in the classroom. Social inclusion, therefore, establishes a basis for overall well-being and is a critical component of becoming a valued and contributing member of the community (Mâsse and others, 2012;Murray and Greenberg, 2006).Although children with disabilities value peer relationships and participation in community activities, they continue to experience low levels of ...

We conducted this qualitative study to explore children's and adolescents' perspectives about diabetes self-care, their knowledge of diabetes, and their emotions associated with having the disease. Drawing on the new sociological approach that acknowledges children's competence in discussing complex issues that concern them, we conducted individual interviews with a cross-sectional sample of 48 patients between the ages of 5 and 18 years. We recruited participants from a diabetes outpatient clinic within a large pediatric hospital in one of Canada's major urban centers. In this article, we present data from the following major themes: self-care, knowledge, and emotions. Through an in-depth analysis of these integrated themes, we offer validation that emotional support, along with disease education, provides supportive conditions for engaging in self-care and a process of acceptance.

Given the continuing threat of current and future airborne viruses with potential for epidemic spread and devastating outcomes, preparedness strategies are certainly needed. Effective strategies in pediatrics include practices that provide family centered care while minimizing disease transmission. Toward this end, lessons learned from previous outbreaks merit consideration and may inform future epidemics.