BackgroundArmed conflicts affect more than one in 10 children globally. While there is a large literature on mental health, the effects of armed conflict on children’s physical health and development are not well understood. This systematic review summarizes the current and past knowledge on the effects of armed conflict on child health and development.MethodsA systematic review was performed with searches in major and regional databases for papers published 1 January 1945 to 25 April 2017. Included studies provided data on physical and/or developmental outcomes associated with armed conflict in children under 18 years. Data were extracted on health outcomes, displacement, social isolation, experience of violence, orphan status, and access to basic needs. The review is registered with PROSPERO: CRD42017036425.FindingsAmong 17,679 publications screened, 155 were eligible for inclusion. Nearly half of the 131 quantitative studies were case reports, chart or registry reviews, and one-third were cross-sectional studies. Additionally, 18 qualitative and 6 mixed-methods studies were included. The papers describe mortality, injuries, illnesses, environmental exposures, limitations in access to health care and education, and the experience of violence, including torture and sexual violence. Studies also described conflict-related social changes affecting child health. The geographical coverage of the literature is limited. Data on the effects of conflict on child development are scarce.InterpretationThe available data document the pervasive effect of conflict as a form of violence against children and a negative social determinant of child health. There is an urgent need for research on the mechanisms by which conflict affects child health and development and the relationship between physical health, mental health, and social conditions. Particular priority should be given to studies on child development, the long term effects of exposure to conflict, and protective and mitigating factors against the harmful effects of armed conflict on children.

More than 1 in 10 children worldwide are affected by armed conflict. The effects are both direct and indirect and are associated with immediate and long-term harm. The direct effects of conflict include death, physical and psychological trauma, and displacement. Indirect effects are related to a large number of factors, including inadequate and unsafe living conditions, environmental hazards, caregiver mental health, separation from family, displacement-related health risks, and the destruction of health, public health, education, and economic infrastructure. Children and health workers are targeted by combatants during attacks, and children are recruited or forced to take part in combat in a variety of ways. Armed conflict is both a toxic stress and a significant social determinant of child health. In this Technical Report, we review the available knowledge on the effects of armed conflict on children and support the recommendations in the accompanying Policy Statement on children and armed conflict.

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Children are increasingly exposed to armed conflict and targeted by governmental and nongovernmental combatants. Armed conflict directly and indirectly affects children's physical, mental, and behavioral health. It can affect every organ system, and its impact can persist throughout the life course. In addition, children are disproportionately impacted by morbidity and mortality associated with armed conflict. A children's rights-based approach provides a framework for collaboration by the American Academy of Pediatrics, child health professionals, and national and international partners to respond in the domains of clinical care, systems development, and policy formulation. The American Academy of Pediatrics and child health professionals have critical and synergistic roles to play in the global response to the impact of armed conflict on children.abstract If we are to reach real peace in this world, and if we are to carry on a real war against war, we shall have to begin with the children. Mahatma GandhiThe guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

Pharyngeal hairy polyps are rare lesions that present as a pedunculated mass that may arise from the oropharyngeal or nasopharyngeal regions of the pharynx. The mass has the potential to partially or completely obstruct pathways towards the trachea and/or esophagus resulting in respiratory distress and/or feeding difficulties respectively. They have a predilection for female infants of 6:1 with the vast majority of the cases occurring in the infantile period. We report 5 cases of the hairy polyp in female infants, one of which showed unusual presentation since it was diagnosed at ten months of age.

This article offers a child rights theory in pediatric bioethics, applying the principles, standards, and norms of child rights, health equity, and social justice to medical and ethical decision-making. We argue that a child rights theory in pediatric bioethics will help pediatricians and pediatric bioethicists analyze and address the complex interplay of biomedical and social determinants of child health. These core principles, standards and norms, grounded in the U.N. Convention on the Rights of the Child (CRC), provide the foundational elements for the theory and a means for better understanding the complex determinants of children's health and well-being. Rights-based approaches to medical and ethical decision-making provide strategies for applying and translating these elements into the practice of pediatrics and pediatric bioethics by establishing a coherent, consistent, and contextual theory that is relevant to contemporary practice. The proposed child rights theory extends evolving perspectives on the relationship between human rights and bioethics to both child rights and pediatric bioethics.

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We are really tired of these wars… I'm speaking up for peace. Malala Yousafzai, Nobel Peace Prize laureate and child rights activist Multiple armed conflicts throughout the world are profoundly impacting the physical and mental health of children. The conflict in Gaza, Syria's civil war, the targeting of children in Iraq, the kidnapping and murder of schoolchildren in Nigeria, the recruitment of child soldiers by ISIS, and the street violence in inner-city America are among the reasons UNICEF identified 2014 as the most dangerous year in recent history for children.1 In past conflicts, children were collateral damage; now, they are targeted victims of war.In the shadow of this carnage, it is incumbent upon pediatricians as child advocates to respond to these gross violations of children's rights. We know that we owe children our voices and protection, but it is not always clear how we can advocate for and protect them. This dilemma is especially true with regard to advocacy and support for children affected by wars and violent conflicts distant from the United States. To date, no American Academy of Pediatrics policy has been established regarding the impact of armed conflict on children.In these circumstances, the principles, standards, and norms of child rights, equity, and social justice provide pediatricians with the capacity to advocate for affected children with the strength of a unified global voice and the power of legal precedent. The United Nations Convention on the Rights of the Child (CRC) 2 provides clear guidelines, through the explicit articulation of 40 substantive child rights, for the protection of children affected by humanitarian crises, as well as the promotion of their well-being and participation in decisions that are being made on their behalf. The CRC establishes the legal basis and precedent for these rights, in addition to mechanisms to advocate for their implementation in the international arena. Because all rights are interdependent and indivisible, the CRC also underscores the necessity of conducting child rights impact analyses to ensure that all rights due to children as rights-holders (ie, humans with inherent rights) are fulfilled. Particular attention is given to the rights of children affected by armed conflict.With respect to children in Gaza, for example, the CRC defines the duties of States Parties to protect children from armed conflict (Articles 19 and 38) and exploitation . Similarly, with regard to the .1 million displaced Syrian children, the CRC defines the rights of displaced and