Psychotherapy with an adolescent boy who refused medical treatment

In this paper we describe psychotherapeutic work carried out in a paediatric hospital to illustrate the important contribution of a psychoanalytically-oriented approach in a hospital context. The work concerns an adolescent boy who had undergone several surgical operations with the result that some of his natural orifices were obstructed and artificial ones had to be created. He was referred to us because he refused pharmacological and rehabilitative treatment necessary prior to further surgery and his eventual recovery. The boy's experience of loss of control of his life and the more primitive anxieties of not feeling safely contained in his physical and psychic skin emerged and were worked through in the psychotherapeutic relationship. The parallel work with medical staff reduced the risk of splitting and acting out by the patient and professionals. The approach adopted enabled this boy to resume his medical treatment and his developmental process.     

The spiritual care of sick children: reflections from a pilot participation project

The authors are a multi-disciplinary team of chaplains, one with a counselling qualification, and an academic with a research background in spirituality and youth work. A pilot participation project undertaken at Birmingham Children’s Hospital (UK) focused on increasing the understanding of the spiritual needs of sick children and young people and involving children and young people in improving the service and provision of spiritual and religious care to them. Views from children, young people and parents were sought with the intention of developing resources and training that help facilitate the meeting of spiritual and religious needs of children and young people in hospital. Within the wider chaplaincy team are chaplains from the six major world faiths and this project considers spiritual needs of children and young people who perceive themselves as belonging to a faith group or not. Reflections from the pilot include identifying ten principles and practices to inform the spiritual care of sick children and proposing the concept of interpretive spiritual encounters as a tool for spiritual care. The pilot study indicated that being more proactive in offering spiritual care enhanced the quality of service offered by Chaplaincy.     

Early and deep: two independent paradigms?

Did Winnicott replace or transform Freud's metapsychology? The author's aim is to explore more deeply the views developed in a previous paper based solely on Winnicott. Here the author draws on other studies to respond to two questions recently posed by Fulgencio concerning the meaning of the term metapsychology and the existence of a new topography in Winnicott's work. For many authors, Winnicott does not reject Freudian metapsychology and says nothing new in this field; in the field of paediatric anthropology, however, he focuses on dependence, and in the field of the living embodiment of the drives on being and self as different from ego. But Green notes the existence of a third topography, that of self/object, and also examines the vicissitudes of being by isolating the concept in Winnicott's work. For the author, however, being seems in continuity with his whole anthropological and ontological perspective; and when Winnicott introduces environmental factors of which the infant is unaware, he also introduces a heuristic distinction between early and deep: there is thus neither a rejection nor a reformulatation of the metapsychological theorization, but rather a coexistence of two paradigms.     

Power,empowerment and surrender in the context of paediatric spiritual care

The dynamics of ‘surrender’ is here put in dialectic with the dynamics of ‘power’ observed in situation involving children and their caregivers in a paediatric hospital setting. Following a qualitative research method used in practical theology, three case studies are presented and then interpreted in the light of both social sciences and Christian theology/spirituality. In the power/surrender paradox, there will always be a need for discernment for each situation and each encounter if the caregiver wants to better care for the children and continue to acknowledge their contribution to the life experience and wisdom of adults. Power and surrender both need to be embraced in order to grow in a fruitful spiritual life.     

How Do Mothers Help Their Children Sleep at Night? Night‐waking Strategy Use Among Mothers of Preschool‐aged Children

Night‐waking is common among preschool‐aged children. Little is known about night‐time parenting among parents of preschool‐aged children. To explore night‐waking strategy use in a community sample, 203 mothers (M age = 32 years, SD = 5.1; children's M age = 3.4 years, SD = 1.0) completed the Night‐waking Strategy Scale (NSS) and measures of general parenting, agreement with night‐waking strategies, and children's sleep. Children were grouped by age (2‐, 3‐, and 4‐to‐5‐year‐olds). Mothers endorsed using routines most frequently, followed by active comforting and rewards; limit‐setting and punishment were used less often. NSS punishment and routines were significantly associated with parenting (e.g. laxness was correlated with NSS routines, rs = ?.35 to .47, p < .001). Night‐waking strategy use was correlated with agreement with those strategies (e.g. active comforting was correlated with agreement with active comforting rs = .35 to .52, p < .001). Active comforting was correlated with the frequency of children's night‐waking for 2‐ and 3‐year‐olds (rs = .35 and .38, respectively, p < .01). Mothers of preschool‐aged children in the community engage in a range of parenting strategies to manage children's night‐waking. These strategies are largely consistent with general parenting and agreement with night‐waking strategy use. Copyright © 2014 John Wiley & Sons, Ltd.     

The visuospatial functions in children after cerebellar low‐grade astrocytoma surgery: A contribution to the pediatric neuropsychology of the cerebellum

The aim of this study was to specify whether cerebellar lesions cause visuospatial impairments in children. The study sample consisted of 40 children with low‐grade cerebellar astrocytoma, who underwent surgical treatment and 40 healthy controls matched with regard to age and sex. Visuospatial abilities were tested using the spatial WISC‐R subtests (Block Design and Object Assembly), Rey–Osterrieth Complex Figure, Benton Judgment of Line Orientation Test, PEBL Mental Rotation Task, and Benton Visual Retention Test. To exclude general diffuse intellectual dysfunction, the WISC‐R Verbal Intelligence IQ, Performance IQ, and Full‐Scale IQ scores were analysed. Post‐surgical medical consequences were measured with the International Cooperative Ataxia Rating Scale. Compared to controls, the cerebellar group manifested problems with mental rotation of objects, visuospatial organization, planning, and spatial construction processes which could not be explained by medical complications or general intellectual retardation. The intensity of visuospatial syndrome highly depends on cerebellar lesion side. Patients with left‐sided cerebellar lesions display more severe spatial problems than those with right‐sided cerebellar lesions. In conclusion, focal cerebellar lesions in children affect their visuospatial ability. The impairments profile is characterized by deficits in complex spatial processes such as visuospatial organization and mental rotation, requiring reconstruction of visual stimuli using the imagination, while elementary sensory analysis and perception as well as spatial processes requiring direct manipulation of objects are relatively better preserved. This pattern is analogous to the one previously observed in adult population and appears to be typical for cerebellar pathology in general, regardless of age.     

Written prayers and religious coping in a paediatric hospital setting

Hospitalised children represent a threatened future to parents. Such stressors call forth people's coping styles. Some individuals cope religiously or spiritually, and religious coping through prayer may be utilised. A sample of prayers written in a paediatric hospital chapel was coded by styles of religious coping evident within them. Styles associated with coping to gain control of their situation and with coping by seeking comfort from God were present. Seeking to cope for gaining control of a situation was more common than seeking comfort from God during the event. Written prayers did not contain evidence of coping by making meaning. Regression analysis showed that the probability of writing a prayer to gain control decreased over time and a trend towards increasing probability of writing a prayer expressing coping by seeking God's comfort. Clinical implications are discussed. Future research should include a larger sample and cognitive interviews with prayer writers.     

Reflecting on a journey of resilience in children’s blood and cancer nursing

Reflective practice is recognised as an integral part of being a highly skilled and successful health care professional. Many benefits have been identified from being a reflective practitioner including the opportunity for critical thinking, growing self-awareness and supporting individual resilience. There is a growing body of literature recognising the negative emotional impact that caring for children with cancer and blood disorders can have on health professionals. Currently there is an emerging interest in a more strengths-based approach focused on maintaining staff wellbeing. Resilience has been suggested as a framework for coping and maintaining wellbeing in areas, like children’s oncology and has been used as a term to describe the ‘surviving’ health professional. This paper explores the first author’s (GA) experiences of being a children’s oncology nurse and paediatric palliative care nurse specialist in the context of existing empirical and theoretical literature, with a particular focus on how GA developed resilience. Reflective examples of practice are used within the context of themes identified from a recent literature review exploring how resilience is defined within empirical literature.     

A model of caregiver paediatric HIV disclosure decision-making

Many of the over 3 million HIV-positive children will only be told of their status as adolescents. Knowing one’s status may increase treatment adherence, reduce onward HIV transmission, increase trust in caregivers and maximise available support. Yet deciding whether, what, how and when to tell HIV-positive children about their condition is challenging for caregivers. We systematically review HIV disclosure theories before presenting a process model of caregiver paediatric HIV disclosure decision-making. The model, consisting of both a pre-intention and a post-intention stage, integrates individual and contextual determinants. It aims to be situationally specific, broadly applicable and consistent with the empirical literature. Research and practice implications are discussed.     

Investigating social functioning after early mild TBI: the quality of parent–child interactions

The young brain is particularly vulnerable to injury due to inherent physiological and developmental factors, and even mild forms of traumatic brain injury (mTBI) can sometimes result in cognitive and behavioural difficulties. Despite the high prevalence of paediatric mTBI, little is known of its impact on children's social functioning. Parent–child relationships represent the centre of young children's social environments and are therefore ideal contexts for studying the potential effects of mTBI on children's social functioning. The aim of this study was to assess the quality of parent–child interactions after mTBI using observational assessment methods and parental report. The sample included 130 children (18–60 months at recruitment) divided into three groups: children with uncomplicated mTBI (n = 47), children with orthopaedic injury (OI, n = 27), and non‐injured children (NI, n = 56). The quality of parent–child interactions was assessed 6 months post‐injury using the Mutually Responsive Orientation (MRO) scale, an observational measure which focuses on the dyadic nature of parent–child exchanges, and the Parental Stress Index questionnaire (Parent‐Child Dysfunctional Interaction (PCDI) domain). Significant differences with medium effect sizes were found between the mTBI group and the NI group on the MRO, but not between the OI group and the other two groups. PCDI scores did not differ across groups, suggesting that observational measures may be more sensitive to changes in parent–child interactions after TBI. The current findings have implications for children's post‐injury social development and highlight the importance of monitoring social outcomes even after minor head injuries.