By gaining knowledge and further understanding about valid coping strategies during chemotherapy treatment, health professionals can mobilize personal and material resources from the children, health teams, and institutions aiming to potentiate the use of these strategies to make treatments the least traumatic.

The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents), their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients' pain symptoms during the 24 h preceding data collection, as well as pain assessment and pharmacological/non-pharmacological management of pain. The data were obtained from 100% of the eligible inpatients. Thirty-four children/adolescents (28%) answered the questionnaire and for the other 72% (unable to communicate), the family/health professional caregivers reported pain. Among these 34 persons, 20 children/adolescents reported pain, 68% of whom reported that they received pharmacological intervention for pain relief. Eighty-two family caregivers were available on the day of data collection. Of these, 40 family caregivers (49%) had observed their child's pain response. In addition, 74% reported that the inpatients received pharmacological management. Physicians reported that only 38% of the inpatients exhibited pain signs, which were predominantly acute pain detected during clinical procedures. They reported that 66% of patients received pharmacological intervention. The nurses reported pain signs in 50% of the inpatients, which were detected during clinical procedures. The nurses reported that pain was managed in 78% of inpatients by using pharmacological and/or non-pharmacological interventions. The findings provide evidence of the high prevalence of pain in pediatric inpatients and the under-recognition of pain by health professionals.

Children are considered competent social actors. Although they are able to express their opinions, they may have some difficulties in answering direct verbal questions, requiring researchers and health professionals to enter their world by using auxiliary resources for communication. This study presents the experience of using finger puppets as a playful strategy for improving interaction and communication with hospitalized children with cancer, aged seven to 12. It describes the strategy of making and using puppets as an auxiliary tool to communicate with children with cancer and presents the results and limitations of using puppets in clinical practice. The use of the puppets, creatively and in accordance with the children's motor, cognitive, and emotional development, showed benefits, such as allowing the children to freely express themselves; respecting their autonomy; and minimizing the hierarchical adult-child relationship. The use of puppets is an appropriate strategy to communicate with hospitalized children. This tool can also enrich clinical practice, as it encourages children with cancer to report their experience of being ill and also helps the health team during evaluation and intervention.

-The goal of this study was to assess the relation between gender, age, motor type, topography and gross motor function, based on the Gross Motor Function System of children with cerebral palsy. Trunk control, postural changes and gait of one hundred children between 5 months and 12 years old, were evaluated. There were no significant differences between gender and age groups (p=0.887) or between gender and motor type (p=0.731). In relation to body topography most children (88%) were spastic quadriplegic. Most hemiplegics children were rated in motor level I, children with diplegia were rated in motor level III, and quadriplegic children were rated in motor level V. Functional classification is necessary to understand the differences in cerebral palsy and to have the best therapeutic planning since it is a complex disease which depends on several factors.Key wordS: cerebral palsy, disabled children, motor skills, classification system, gross motor function.Classificação da paralisia cerebral: associação entre gênero, idade, tipo motor, topografia e função Motora Grossa resumo -este estudo teve como objetivo avaliar a relação entre gênero, idade, tipo motor, topografia e Função Motora Grossa, baseado no Sistema de Função Motora Grossa em crianças com paralisia cerebral. Participaram desta pesquisa 100 crianças com idade entre 5 meses a 12 anos que foram observadas em relação ao controle de tronco, trocas posturais e marcha. Não houve diferenças significativas entre gêneros e grupos etários (p=0,887) e entre gênero e tipo motor (p=0,731). em relação à topografia corporal, houve predomínio de crianças com quadriplegia, sendo que a maioria (88%) era do tipo espástico. Quanto ao nível motor, as crianças hemiplégicas pertenciam em sua maioria ao nível I, as diplégicas ao nível III e as quadriplégicas ao nível V. Sendo a paralisia cerebral uma condição complexa que depende de diversos fatores, beneficia-se de classificações funcionais para compreensão da diversidade e melhor planejamento terapêutico. PAlAVrAS-chAVe: paralisia cerebral, criança deficiente, sistema de classificação, habilidade motora, função motora grossa. cerebral palsy (cP) is described as a range of disorders of motor and postural development which causes functional limitations attributed to non-progressive disorders that occur in fetal development or child' s brain 1 . It has traditionally been described based on the kind of damage (spasticity, dyskinesia and ataxia) and its location, or topography (hemiplegia, diplegia and tetraplegia) 2 . Until recently there were not standardized methods to classify cerebral palsy in relation to subtypes and severity of motor impairments 3-5 . The Gross Motor Function System (GMFcS) 6 was developed to classify functional mobility in children diagnosed with cerebral palsy by levels of functional mobility and consists of five levels ranging from I, which includes children with minimal or no dysfunction relative to community mobility to V, which includes children who are totally dependent and need help to mo...

Results of the pretest indicate the Brazilian version of the ChlPPA is potentially useful for Brazilian children. ChlPPA training in Portuguese in Brazil with play observation feedback is recommended to improve inter-rater reliability.

Family members are the caregivers' primary source of social support and caregivers reported being satisfied with the support they received.

No abstract

| Background: Several studies have demonstrated the importance of using the Gross Motor Function Classification System (GMFCS) to classify gross motor function in children with cerebral palsy, but the reliability of the expanded and revised version has not been examined in Brazil (GMFCS E & R). Objective: To determine the intraand inter-rater reliability of the Portuguese-Brazil version of the GMFCS E & R applied by therapists and compare to classification provided by parents of children with cerebral palsy. Method: Data were obtained from 90 children with cerebral palsy, aged 4 to 18 years old, attending the neurology or rehabilitation service of a Brazilian hospital. Therapists classified the children's motor function using the GMFCS E & R and parents used the Brazilian Portuguese version of the GMFCS Family Report Questionnaire. Intra-and inter-rater reliability was obtained through percentage agreement and Cohen's unweighted Kappa statistics (k). The Chi-square test was used to identify significant differences in the classification of parents and therapists. Results: Almost perfect agreement was reached between the therapists [K=0.90 (95% confidence interval 0.83-0.97)] and intra-raters (therapists) with K=1.00 [95% confidence interval (1.00-1.00)], p<0.001. Agreement between therapists and parents was substantial (k=0.716, confidence interval 0.596-0.836), though parents classify gross motor impairment more severely than therapists (p=0.04). Conclusions: The Portuguese version of the GMFCS E & R is reliable for use by parents and therapists. Parents tend to classify their children's limitations more severely, because they know their performance in different environments.