Caregiver smoking is a significant risk factor for children with acute and chronic diseases. Hospitalization presents an opportunity to explore caregiver smoking as a modifiable risk factor during a time of crisis when the motivation to change could be heightened. To date, there has not been a published review on inpatient smoking cessation interventions in pediatrics that focus on supporting caregivers of hospitalized children. The goals of this review were to identify and assess the reach and efficacy of tobacco cessation strategies implemented across inpatient units in pediatrics and mother-baby units. This review also proposes clinical and research implications along with program-building recommendations that can help inform future practice in tobacco cessation. A narrative review of the literature identified 14 peer-reviewed studies that described smoking cessation interventions between 2002 and 2021. There were five randomized controlled trials, seven prospective studies, and one retrospective study. The primary kinds of interventions were counseling to heighten caregiver contemplation to quit (n = 12), provision of Nicotine Replacement Therapy (NRT) medications (n = 7), and follow-up with the local Quitline (n = 12). A diverse range of deliverers implemented interventions across studies. Variation in defining quit attempts along with tobacco reduction and cessation outcomes contributed to mixed findings across studies.

Significant disparities continue to exist in access to inpatient pediatric hospice care among children at the end-of-life. Increasingly more children at this stage are dying in the hospital or at home on hospice which is not always an acceptable option to the children and their families. Two clinical case examples illustrate implementation of these options in practice. A missing link exists in healthcare systems across developed and developing countries in pediatric end-of-life care. Currently, the primary options involve selecting between hospital and home-based hospice care. Proposing to increase access to inpatient pediatric hospice services could potentially increase acceptability of this option to honor the child in line with the family’s preferences, goals, wishes, and values. In addition, inpatient pediatric hospice could offset costs from preventable hospitalizations and overall high-cost healthcare utilization. Oftentimes, readmissions impact decision-making among caregivers that include changes in code status from Do Not Resuscitate/Do Not Intubate (DNR/DNI) to full curative care, thereby resulting in medicalization or overmedicalization of the child. It follows that reduced healthcare expenditures will increase cost efficiency across the healthcare system. Achieving health equity in palliative care among adult and pediatric patients at the end-of-life is a longstanding goal of the World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF). Proposing to mitigate disparities in palliative care among children through inpatient hospice as another viable option for their families could contribute to the larger overarching goal of achieving health equity in end-of-life care across the world.

Over the past year, we have seen many migrant pediatric patients with significant resource limitations admitted to the Johns Hopkins Hospital. These patients are medically fragile with challenging psychosocial circumstances. They are ineligible for resources and services given their immigration status yet are in dire need of them. Our United States healthcare infrastructure is poorly designed to serve these patients. Resources are increasingly scarce, and fragmentation exists in continuity of care provided to these patients that compromises their health and safety. This global health crisis is surrounded by immense controversy especially with respect to high-cost healthcare. Experiences from the field provide a descriptive context on the circumstances surrounding migration attributed to suboptimal access to healthcare across many developing countries. We present global health, immigration policy, and human rights implications of migration. We also propose recommendations to build a comprehensive global health network that accounts for ample disparities across healthcare systems.