Pediatric palliative care and pediatric hospice care (PPC-PHC) are often essential aspects of medical care for patients who have life-threatening conditions or need end-of-life care. PPC-PHC aims to relieve suffering, improve quality of life, facilitate informed decision-making, and assist in care coordination between clinicians and across sites of care. Core commitments of PPC-PHC include being patient centered and family engaged; respecting and partnering with patients and families; pursuing care that is high quality, readily accessible, and equitable; providing care across the age spectrum and life span, integrated into the continuum of care; ensuring that all clinicians can provide basic palliative care and consult PPC-PHC specialists in a timely manner; and improving care through research and quality improvement efforts. PPC-PHC guidelines and recommendations include ensuring that all large health care organizations serving children with life-threatening conditions have dedicated interdisciplinary PPC-PHC teams, which should develop collaborative relationships between hospital-and community-based teams; that PPC-PHC be provided as integrated multimodal care and practiced as a cornerstone of patient safety and quality for patients with life-threatening conditions; that PPC-PHC teams should facilitate clear, compassionate, and forthright discussions about medical issues and the goals of care and support families, siblings, and health care staff; that PPC-PHC be part of all pediatric education and training curricula, be an active area of research and quality improvement, and exemplify the highest ethical standards; and that PPC-PHC services be supported by financial and regulatory arrangements to ensure access to high-quality PPC-PHC by all patients with life-threatening and life-shortening diseases. Pediatrics 2013;132:966-972 INTRODUCTIONOver the past two decades, pediatric palliative care has emerged as an established field of medical expertise and practice. [1][2][3] Recognized in 2006 by the American Board of Medical Specialties, hospice and palliative medicine is the field of medical expertise that seeks to improve quality of life and reduce various forms of distress for patients and their families in the face of serious life-threatening or inevitably lifeshortening conditions or when end-of-life care or bereavement services are needed. Pediatric palliative care addresses the needs of infants, children, adolescents, and young adults (subsequently referred to SECTION collectively as "children") with these conditions and the needs of their families, providing treatments that aim to (1) relieve suffering across multiple realms, including the physical (eg, pain or dyspnea), psychological (depression, anxiety, or sense of guilt), social (isolation), practical (home-based services or financial stress), and existential or spiritual (why is this happening?); (2) improve the child' s quality and enjoyment of life while helping families adapt and function during the illness and through bereavement; (3) f...

This study examined both instrumental responses and facial expressions during learning and extinction in a group of cocaine-exposed infants ages 4 to 8 months. Of the 72 infants studied, half were exposed to cocaine in utero and half served as matched controls. The groups were matched on maternal demographic characteristics and maternal use of other substances. Findings indicated that (a) infants exposed to cocaine had a significant decrease in mean birth weight and birth length; (b) cocaine-exposed infants showed less overall arousal throughout the procedure; (c) cocaine-exposed infants expressed less interest and joy during learning and less anger and sadness during extinction; and (d) when control over the learning contingency was reinstated, cocaine-exposed infants did not show the expected increase in instrumental responding.Cocaine use during pregnancy has been related to medical complications both in mothers and neonates. For example, increased rates of spontaneous abortion, abruptio placentae, stillbirths, as well as cerebrovascular accidents and neurological damage have been reported in the cocaine-exposed fetus (Bingol,

No abstract

No abstract

No abstract