To be or not to be three: a clinical narrative, an unanswered question

The psychoanalytic literature deals with parenthood as a developmental stage but barely addresses the couple's preconception of fertility intentions. The author reviews the available literature from social research and psychoanalytic writing. Working with a couple over family of origin conflicts, she uncovers the hidden conflict over the wish to have or not have a child, reveals unconscious fantasies about the potential child, and deals with conflict in the otherwise compatible couple relationship itself. The author offers this clinical vignette to extend psychoanalytic understanding of the unconscious fantasies involved. She concludes with a discussion of transference towards the couple therapist as an infection to be avoided, an annoying parent to speed away from, and a disturbing child about whom the couple was ambivalent.

Responsive caregiving, opportunities for early learning, and children’s safety and security during COVID-19: A rapid review

ABSTRACTIntroductionDuring the COVID-19 pandemic, there have been drastic changes in family life and programs and services that promote and protect early childhood development. Global stakeholders have raised concerns that the pandemic is putting enormous strain on parents and other caregivers, compromising capabilities and enabling environments for nurturing care of young children and therefore likely impacting children’s development.MethodologyThis rapid review takes stock of emerging research on nurturing care for young children during the COVID-19 crisis. Two databases were searched in addition to an extensive search for grey literature, drawing on 112 scholarly and scientific studies from more than 30 countries that have examined components of nurturing care during the pandemic, namely: responsive caregiving, early learning and play, and children’s safety and security.ResultsThere are some reports of unexpected positive benefits of the pandemic on families, including increased father involvement in caregiving. But more commonly, the studies’ findings reveal numerous issues of concern, including parental and caregiver mental health difficulties and less responsive parent-child relationships, increased screen time among children, limited opportunities for outdoor play, and fractured systems for responding to potential child neglect and maltreatment. Evidence suggests limited access and challenges in the provision of remote learning for the youngest learners, such as those in early childhood education.ConclusionThe findings can inform global stakeholders, who have advocated for increased support and funding to ensure young children and other caregivers are supported and protected during the COVID-19 pandemic. There is an urgent need for action-oriented implementation studies – those that go beyond identifying trends and begin to pinpoint “what works” to effectively promote and protect nurturing care during emergencies such as the COVID-19 pandemic.Key questionsWhat is already known?The most fundamental promotive experiences in the early years of life to reach optimal development come from nurturing care and protection received from parents, family, and community, which have lifelong benefits including improved health and wellbeing. Health and other emergencies are detrimental to the provision of nurturing care.What are the new findings?Findings from this rapid review reveal numerous areas of concern, including families reporting mental health difficulties and less responsive parent-child relationships, increased screen time among children, limited opportunities for outdoor play, and fractured systems for responding to potential child neglect and maltreatment. As with other features of this pandemic, not all families are affected equally: financially vulnerable families are much more likely to experience negative ramifications. The pandemic is also disproportionately affecting parents and other caregivers with young children, particularly mothers, those with pre-existing mental health difficulties, and those caring for children with disabilities.What do the new findings imply?Findings highlight the need for action by governments, civil society, international and community-based organizations to improve support for families so that the pandemic does not break the provision of nurturing care and wipe out decades of progress, especially for vulnerable families and children.

The Role of Nursing in the School Setting to Lead Efforts to Impact Child Trafficking: An Integrative Review

Registered professional and advanced practice nurses in the school setting, as a specialized practice entity, are leaders in implementation of evidence-based practice, skilled coordinators of care, advocates for students, and experts in designing systems assisting individuals and communities to reach full potential. Child trafficking (CT) is an emerging public health threat impacting safety and well-being of students present in the school setting. This literature review identified four themes in five studies: (1) training impacts nurses’ knowledge, awareness, and attitudes; (2) school nursing is underrepresented in training, education, prevention, response, and research; (3) lack of collaboration exists between school staff and school nurses; and (4) formal education and length of experience impact levels of interventions school nurses are able to provide. School nurses are opportunely situated to intervene as advocates for vulnerable children to develop a coordinated, effective response to CT risk factors, mitigating risk and fostering resiliency with systems-based change.

Examining Factors of Accelerometer-Measured Sedentary Time in a Sample of Rural Canadian Children

The aim of this study was to examine potential child-level and day-level factors of accelerometer-measured sedentary time in a sample of rural Canadian children. Children (n = 86) from rural Northwestern Ontario participated in this study. Children’s sedentary times were identified and logged using an accelerometer. Child-level data (socio-demographic, household, and environment) came from surveys of children and their parents and a passively logging global positioning unit. Day-level data on day type (weekday/weekend) and weather (temperature, precipitation) were based on the dates of data collection and meteorological data came from the closest Environment Canada weather station. Cross-classified regression models were used to assess the relationship between child-level and day-level correlates of sedentary time. Boys were less sedentary than girls (b = −30.53 p = 0.01). For each one-year age increase, children’s sedentary time increased (b = 12.79 p < 0.01). This study indicates a difference in sedentary time based on a child’s age and gender. However, family, environmental, and weather characteristics did not influence sedentary time in this sample. Health practitioners who deliver care for northern rural youth can provide targeted health advice regarding sedentary time and consider gender and age to be risk factors for these behaviors.

Child Abuse

Child maltreatment is an important clinical condition. The emergency department (ED) is frequently the site of initial evaluation when a child is the victim of an acute inflicted injury. Abused children may present to the ED for vague complaints that could be attributed to a more benign illness such as a viral infection, but have evidence of abusive injuries. This evidence is sometimes overt but often subtle. Recognition of these injuries may save the child’s life, spare them from years of psychological and physical suffering, and prevent long-term morbidity such as intellectual disability and need for chronic medical care. In this way, emergency providers are at the front line of child abuse detection. This chapter details important diagnostic tools for evaluation of potential child maltreatment.