ABSTRACT. Objectives. Identify pediatrician (faculty and resident) beliefs about spirituality and religion (SR) in medicine and the relationship of those beliefs to SR behavior and experiences in clinical practice.Methods. A self-report questionnaire was administered to full-time pediatric faculty (N ‫؍‬ 65) and residents (N ‫؍‬ 56) of an urban children's hospital affiliated with a school of medicine. The response rate was 70.8% among faculty (n ‫؍‬ 46) and 78.6% among residents (n ‫؍‬ 44). Respondents indicated the extent of their SR inquiry and the frequency of their SR experiences (requests by patients or families to discuss SR or pray), routinely and during health crisis, and rated 19 belief statements about SR in pediatrics.Results. Few pediatricians routinely ask about SR issues. Faculty were more likely than residents to ask about religious affiliation, whereas residents were more likely to be asked to pray during health crises, to believe that SR has health relevance, and to perceive pediatrician-initiated prayer as appropriate. Composite scores indicated that physicians who did not expect negative patient reactions to SR inquiry and prayer, who believed more strongly that SR is relevant to pediatric outcomes, and who felt more capable with SR inquiry were more likely to engage in SR inquiry and to experience SR requests.Conclusions. Pediatrician beliefs with respect to health relevance of SR, patient reactions to SR inquiry, and physician capabilities regarding SR in the clinic are strongly related to their clinical practice concerning SR inquiry and experiences. Correction of physician misperceptions about SR issues and incorporation of religious sensitivity into physician training may remove barriers to both patient and physician SR inquiry. Pediatrics 2003;111:e227-e235. URL: http://www.pediatrics.org/cgi/ content/full/111/3/e227; pediatrics, religion in medicine, physician's role, attitude of health personnel, internship and residency, medical education.ABBREVIATIONS. SR, "spiritual and religious" or "spirituality and religion"; SD, standard deviation.

Most childhood deaths that occur in the hospital happen in the pediatric intensive care unit. Providing pediatric palliative care in the intensive care unit comes with unique challenges due to the acute care, curative and often medically aggressive focus of these settings. In this study, 190 PICU health care professionals reported on their comfort and confidence in providing palliative care. Findings indicate that professionals report only a moderate level of comfort and confidence in this type of care in the pediatric ICU. For physicians and nurses, comfort and confidence was significantly higher for those who had practiced 8 years or more. Practitioners reported less comfort in providing psychosocial care. Implications for the social work role on the interdisciplinary team and suggestions for future research are discussed.

When children are dying in a hospital setting, healthcare providers need to help families make important end-of-life care decisions. Most providers use the term do not resuscitate (DNR) when suggesting a course of action that involves not using extraordinary lifesaving measures. Some healthcare providers use the term allow natural death (AND) to discuss this same approach. This study investigated pediatric healthcare providers' beliefs about using AND as opposed to DNR. Results revealed that providers believe the term AND is somewhat ambiguous but may be more family centered.

I n the past year an article in this journal discussed the role of the child life professional in the palliative care setting. 1 I write to support the authors' recommendations and also share a most poignant experience. I began a palliative fellowship 20 years into my work life, never having collaborated with these invaluable professionals. My interaction with them during fellowship engendered a deep respect for their work, making me a strong advocate for their inclusion on interdisciplinary teams providing hospice and palliative care to adults or children.It was my good fortune to shadow a very seasoned child life practitioner. This particular experience occurred early in our time together and stands firmly in that select group of formative experiences which shapes both our practice and our person. In my mind, its power to do so lay in the mystical quality which seemed to suffuse it. I had the sense I had entered an altered, almost enchanted world and was witness to an ancient art, so fluid in its execution that it seemed choreographed. This memory has stayed with me through the years, consistently evoking a kind of grounded and energized state upon its recall.Our patient was a nine-year-old Laotian boy with a terminal brain tumor. He was ambulatory, with good functional status, but he had become withdrawn and essentially mute in the preceding weeks. The parents were anxious to find someone who could help him communicate his feelings. His mother worried that his behavior might represent depression and disappointment in her and his father. As the only child of his immigrant parents, he had been very vocal about his desire to have a brother, his comments becoming more frequent as his disease progressed. Thus far, the parents had been unsuccessful in becoming pregnant again, which weighed heavily upon his mother.I followed my colleague and our patient into an empty playroom. After introducing myself to the child, I sat quietly in a corner, watching from afar. A conversation ensued (she talking, he not) which involved a decision to make a picture. Every step of the process seemed intentioned and each flowed into the next. What size picture would he like to make?-and various sizes of paper were offered. Would white paper or colored paper be best?-and various colors were offered. Which way should the paper lay, vertically or horizontally? Should we cut the paper with scissors and have a clean edge or tear it so it is jagged but appears softer? What material would he like to use?-and colored pencils, markers, paint, crayons, and chalk were offered. For each of these decisions he would point or nod and she would continue on seamlessly asking questions and offering choices. When the conversation was complete, he sat in front of a 20 by 30 inch, clean-edged, white piece of paper with a set of colored markers. ''I can tell that you have something to say,'' she said, ''and maybe it's hard to find words right now. Making a picture sometimes helps us to tell a story. Start by drawing the first thought that comes to you, you d...