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OBJECTIVE: E-parenting is an opportunity to provide parental support as a universal prevention strategy. This study analysed the extent to which the promotion actions improve universal use of the online course 'Positive parenting: Gaining health and wellbeing from birth to three' (GH&W) (http://aulaparentalidad-msssi.com/) at the primary care centers. METHODS: The profile of participants and the adherence to the course in a national sample of families using the GH&W course were compared with another Canarian sample distributed in three groups: only GH&W (level 1), GH&W + face-to-face group activities (level 2), and users who also received individual support in the medical checking (level 3). It was carried out in 20 health centers on the islands of Tenerife and Gran Canaria randomly assigned to one of the three levels. Participants were 175 national parental figures and 160 parental figures users of the Canary Health Service, both with children from 0 to 3 years. The sociodemographic profile and the completion rate of the GH&W were registered, as well as a template of implementation quality indicators for innovative experiences. To compare the sociodemographic profile differences between groups, a Chi-square contingency analysis with standardized residuals was performed. RESULTS: Compared to the national sample mainly of high educational level, primiparous mothers and 14% completion, the Canarian sample attracted different educational levels and multiparous mothers, with a higher completion rate at levels 2 and 3 (62.5% and 67.5%) than at level 1 (38.5%). CONCLUSIONS: The universal use of the course and its adherence improve due to the inclusion of face-to-face activities. The implementation process in the selected health centers satisfactorily meets the quality indicators of an innovative initiative.

OBJETIVO: La educación parental en línea es una oportunidad de proporcionar apoyo parental como estrategia de prevención universal. Se pretendió analizar en qué medida las acciones de dinamización mejoran el uso universal del curso a distancia "Parentalidad positiva: Ganar salud y bienestar de 0 a 3 años" (GSB) (http://aulaparentalidad-msssi.com/) en los centros de Atención Primaria. METODOS: Se comparó el perfil de participantes y la adherencia al curso en una muestra nacional de familias usuarias del curso GSB (175), con otra muestra canaria (160) usuaria de 20 centros de salud de las islas de Tenerife y Gran Canaria asignados aleatoriamente en tres grupos: sólo GSB (nivel 1), GSB + actividades presenciales grupales (nivel 2), y usuarios que además recibían apoyo individual en la consulta (nivel 3). Se analizó el perfil sociodemográfico y el porcentaje de finalización del curso GSB, así como una plantilla de indicadores de calidad de la implementación para iniciativas innovadoras. Se realizó un análisis de contingencia Chi Cuadrado con residuos tipificados para comparar el perfil sociodemográfico entre los grupos. RESULTADOS: Respecto a la muestra nacional, con un nivel educativo más alto y madres primíparas con el 14% de finalización, la muestra canaria estuvo compuesta de distintos niveles educativos y madres multíparas con un porcentaje de finalización mayor en los niveles 2 y 3 (62,5% y 67,5%) que en el nivel 1 (38,5%). CONCLUSIONES: El uso universal del curso y su adherencia mejora por la inclusión de actividades presenciales. El proceso de implementación en los centros de salud seleccionados cumple satisfactoriamente con los indicadores de calidad de una iniciativa innovadora.

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We used quality improvement (QI) methodology in the acute paediatric setting to develop clinical screening tools and local resources for addressing child poverty in practice in a London district general hospital between March and August 2019.

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The COVID-19 pandemic is an unprecedented global crisis, affecting millions globally and in Canada. While efforts to limit the spread of the infection and 'flatten the curve' may buffer children and youth from acute illness, these public health measures may worsen existing inequities for those living on the margins of society. In this commentary, we highlight current and potential long-term impacts of COVID-19 on children and youth centring on the UN Convention of the Rights of the Child (UNCRC), with special attention to the accumulated toxic stress for those in difficult social circumstances. By taking responsive action, providers can promote optimal child and youth health and well-being, now and in the future, through adopting social history screening, flexible care models, a child/youth-centred approach to "essential" services, and continual advocacy for the rights of children and youth.

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In 1998, the Centers for Disease Control and Prevention Adverse Childhood Experiences study established the profound effects of early childhood adversity on life course health. The burden of cumulative adversities can affect gene expression, immune system development and condition stress response. A scientific framework provides explanation for numerous childhood and adult health problems and high-risk behaviours that originate in early life. In our review, we discuss adverse childhood experiences, toxic stress, the neurobiological basis and multigenerational and epigenetic transmission of trauma and recognized health implications. Further, we outline building resilience, screening in the clinical setting, primary care interventions, applying trauma-informed care and future directions. We foresee that enhancing knowledge of the far-reaching effects of adverse childhood events will facilitate mitigation of toxic stress, promote child and family resilience and optimize life course health trajectories.

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BACKGROUND: The main source of knowledge on adverse drug events (ADE) are physicians' reports in controlled clinical trials. In contrast, little is known about the parents' perception of ADE of anticonvulsants their children receive. METHODS: After approval by the local ethics committee, we performed a survey in a neuropediatric outpatient clinic of a university hospital. Based on a structured questionnaire, we interviewed parents of children with current anticonvulsant treatment regarding (i) their fears about potential ADE, (ii) experienced ADE according to parents, and (iii) implications of ADE on the child's life. RESULTS: Parents of 150 patients took part in the interview. (i) 95 (63.3%) parents expressed fears concerning ADE, mostly liver injury/liver failure (33 [22%]). (ii) 129 (86%) parents reported experienced ADE, mostly sedation (65 [43.3%]) and abnormal behavior (54 [36%]). (iii) Parents reported substantial implications of ADE on the child's daily life for 84 (56%) children, and 63 (42%) parents expressed a negative impact on the child's development. CONCLUSION: We recognized a great discrepancy between those ADE that were feared and those that were experienced. Parents feared life-threatening ADE and experienced less severe ADE that nevertheless have a negative impact on the child's daily life.

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Mitigating the harmful effects of adverse social conditions is critical to promoting optimal health and development throughout the life course. Many Canadians worry over food access or struggle with household food insecurity. Public policy positions breastfeeding as a step toward eradicating poverty. Breastfeeding fulfills food security criteria by providing the infant access to sufficient, safe and nutritious food that meets dietary needs and food preferences. Unfortunately, a breastfeeding paradox exists where infants of low-income families who would most gain from the health benefits, are least likely to breastfeed. Solving household food insecurity and breastfeeding rates may be best realized at the public policy level. Notably, the health care provider's competencies as medical expert, professional, communicator and advocate are paramount. Our commentary aims to highlight the critical link between breastfeeding and household food insecurity that may provide opportunities to affect clinical practice, public policy and child health outcomes.

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The 'forgotten years' of middle childhood, from age 6 to 12, represent a critical period in child development. Emotional, social and physical development during this time have a lifelong impact on health and adult contributions to society. Mental health conditions have displaced physical illness as the leading childhood disability. Positive parenting can improve child behaviour, prevent early-onset conduct problems and provide a buffer from adverse childhood events resulting in decreased toxic stress and improved health. Medical homes can play a key role in supporting parents with positive parenting skills that are practical, evidence-based and useful in everyday life. Paediatricians need to explore the domains that promote healthy development, including caring environments, fundamental needs and nurturing relationships. Our objective is to promote high-quality positive parenting through middle childhood by identifying opportunities for paediatricians to frame parenting discussions in the context of development, behaviour and safety and to provide access to valuable parenting resources.

Les « années oubliées ¼ de la phase intermédiaire de l'enfance, entre l'âge de six et 12 ans, sont une période critique du développement de l'enfant. Pendant cette période, le développement émotionnel, social et physique a des conséquences permanentes sur la santé et l'apport de l'adulte à la société. Les troubles de santé mentale ont remplacé les maladies physiques comme principale affection de l'enfance. Des pratiques parentales positives peuvent améliorer le comportement de l'enfant, prévenir les troubles des conduites d'apparition précoce et limiter les événements indésirables de l'enfance, réduisant ainsi le stress toxique et améliorant la santé. Les milieux médicaux peuvent beaucoup contribuer à soutenir les parents afin qu'ils acquièrent des compétences parentales positives pratiques, fondées sur des données probantes et utiles dans la vie quoti- dienne. Les pédiatres doivent explorer les sphères qui favorisent un développement sain, y compris les environnements attentionnés, les besoins fondamentaux et les relations aimantes. Afin de promouvoir des pratiques parentales positives de qualité tout au long de la phase intermédiaire de l'enfance, les auteurs visent à cerner les occasions que peuvent saisir les pédiatres pour structurer les discussions avec les parents sur le développement, le comportement et la sécurité et les orienter vers des ressources intéressantes sur ce type de pratiques.

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Paediatric school-based clinics (PSBCs) were established in Saskatoon (Saskatchewan) in 2007, to provide access to specialized paediatric health care as part of multidisciplinary and interdisciplinary teams, and alongside existing services. In its ninth year, the PSBCs have grown both in number and services offered, and in patient numbers - for both new patients and repeat follow-up visits. Viewing paediatric health consistently through the lens of the social determinants of health has been essential in delivering care, which require consideration and negotiation of these contexts in formulating management plans. The responsive relationships we continue to establish with our patients through the PSBCs have enabled us to work effectively with children and youth, and continue the growth of our successes.

Les cliniques pédiatriques en milieu scolaire (CPMS) ont été mises sur pied à Saskatoon, en Saskatchewan, en 2007, afin de donner accès à des soins pédiatriques spécialisés fournis par des équipes multidisciplinaires et interdisciplinaires, conjointement à des services déjà en place. Les CPMS, qui existent depuis neuf ans, ont pris de l'expansion, tant pour ce qui est des services offerts que du nombre de patients, qu'il s'agisse de nouveaux patients ou de rendez-vous de suivi. Il a été essentiel de toujours concevoir la santé pédiatrique sous l'angle des déterminants sociaux de la santé lors de la prestation des soins, ce qui exige de tenir compte de ces contextes et de les négocier lors de la formulation des plans de prise en charge. Parmi les nombreuses leçons tirées de cette expérience, soulignons que ce sont les liens particuliers que nous entretenons avec nos patients au sein des CPMS qui nous permettent de travailler efficacement auprès des enfants et des adolescents et de cumuler les réussites.

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While poverty is a recognized risk factor for ill health, directly intervening on the effects of poverty has traditionally been considered to fall outside the realm of a physician's daily practice. Yet, to appropriately respond to the health needs of all children, we have the social responsibility to help our trainees become competent health advocates. Experiential learning approaches can be used to aid students in developing identities and competencies as health advocates. Experiencing illness outside the sterility of the clinic, from the patient's point of view, encourages students to seek the knowledge they need to care for patients who are disenfranchised, socially vulnerable and/or marginalized.

La pauvreté est un facteur de risque reconnu de mauvaise santé, mais l'intervention directe sur les effets de la pauvreté a toujours été considérée comme extérieure au champ de pratique quotidien du médecin. Pourtant, pour répondre aux besoins de santé de tous les enfants de manière appropriée, nous avons la responsabilité sociale d'aider nos stagiaires à devenir des promoteurs de la santé compétents. Les approches d'apprentissage expérientiel peuvent aider les étudiants à acquérir des identités et des compétences à titre de promoteurs de la santé. L'expérience de la maladie à l'extérieur d'une clinique stérile, selon le point de vue du patient, incite les étudiants à aller chercher les connaissances nécessaires pour soigner des patients privés de leurs droits, en situation de vulnérabilité sociale ou marginalisés.

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Housing affects the health of children and youth. One-third of households in Canada live in substandard conditions or in housing need. The present statement reviews the literature documenting the impacts of housing on personal health and the health care system. Types of housing need are defined, including unsuitable or crowded housing, unaffordable housing and inadequate housing, or housing in need of major repairs. The health effects of each type of housing need, as well as of unsafe neighbourhoods, infestations and other environmental exposures are outlined. Paediatricians and other physicians caring for children need to understand the housing status of patients to fully determine their health issues and ability to access and engage in health care. Recommendations and sample tools to assess and address housing need at the patient, family, community and policy levels are described. Canada is the only G8 country without a national housing strategy. Recommendations also include advocating for enhanced action at all levels of government and for housing-supportive policies, including a national housing strategy.

Le logement a une incidence sur la santé des enfants et des adolescents. Le tiers des ménages canadiens habite dans des conditions déplorables ou éprouve des besoins en matière de logement. Le présent document contient une analyse bibliographique des répercussions du logement sur la santé personnelle et le système de santé. Les types de besoins en matière de logement sont définis, y compris les logements de taille inadéquate ou surpeuplés, les logements inabordables ou en mauvais état et ceux qui ont besoin de réparations majeures. Les effets de chaque type de besoins en matière de logement sur la santé, de même que les quartiers mal famés, les infestations et les autres expositions environnementales, sont présentés. Les pédiatres et les autres médecins qui s'occupent d'enfants doivent connaître les conditions de logement de leurs patients pour cerner leurs problèmes de santé ainsi que leur capacité d'obtenir des soins et de s'y conformer. Sont présentés des recommandations et des modèles d'outils pour évaluer les besoins en matière de logement et de politiques de la santé pour le patient, la famille et la collectivité, ainsi que pour y répondre. Le Canada est le seul pays du G8 à ne pas être doté d'une stratégie nationale en matière de logement. Les recommandations incluent également la nécessité de préconiser des mesures plus énergiques à tous les ordres de gouvernement et d'adopter des politiques en appui au logement, y compris une stratégie nationale en matière de logement.

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The harmful effects of child poverty are well documented. Despite this, progress in poverty reduction in Canada has been slow. A significant gap exists between what is known about eradicating poverty and its implementation. Paediatricians can play an important role in bridging this gap by understanding and advancing child poverty reduction. Establishment of a comprehensive national poverty reduction plan is essential to improving progress. The present review identifies the key components of an effective poverty reduction strategy. These elements include effective poverty screening, promoting healthy child development and readiness to learn, ensuring food and housing security, providing extended health care coverage for the uninsured and using place-based solutions and team-level interventions. Specific economic interventions are also reviewed. Addressing the social determinants of health in these ways is crucial to narrowing disparities in wealth and health so that all children in Canada reach their full potential.

Les effets néfastes de la pauvreté des enfants sont bien attestés. Pourtant, les progrès sont lents au Canada en matière de réduction de la pauvreté. Il y a un écart important entre ce que l'on sait sur l'éradication de la pauvreté et ce qui est fait. Les pédiatres peuvent jouer un rôle important pour corriger cet écart s'ils comprennent la pauvreté des enfants et font progresser les mesures de réduction. Il est essentiel de créer un plan national détaillé de réduction de la pauvreté pour améliorer ces progrès. La présente analyse présente les principaux éléments d'une stratégie efficace de réduction de la pauvreté. Ces éléments comprennent un dépistage efficace de la pauvreté, la promotion d'un développement sain de l'enfant et de la préparation à apprendre, l'assurance de la sécurité alimentaire et de la sécurité de logement, l'offre d'une couverture étendue d'assurance-maladie aux non-assurés et l'utilisation de solutions territoriales et d'interventions d'équipes. Des interventions économiques précises sont également examinées. Il est essentiel de se pencher sur les déterminants sociaux de la santé pour réduire les disparités sur le plan de la richesse et de la santé, afin que tous les enfants du Canada réalisent leur plein potentiel.

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Canadian children's health is influenced, in large part, by the living circumstances that they experience. These living circumstances - also known as the social determinants of health - are shaped by public policy decisions made by governmental authorities. While public policy should be focused on providing all Canadian children with the living circumstances necessary for health, it appears that Canada is far from achieving this goal. Instead, there are programs directed at Canada's most severely disadvantaged families and children. While vital, these programs appear to achieve less than that which would be achieved if governmental action was designed to strengthen the social determinants of health for all children. Considering the governmental actions that would achieve this goal are well known - with rather little evidence of policy implementation - it is essential to understand the processes by which public policy is made. An important physician role - in addition to providing responsive health care services - is to become forceful advocates for public policy in the service of health. It is in the latter sphere that physician involvement may yield the strongest benefits for promoting children's health.

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The health of Canada's children does not compare well with other wealthy industrialized nations. Significant inequalities in health exist among Canadian children, and many of these inequalities are due to variations in Canadian children's life circumstances - the social determinants of health. The present article describes the social determinants of children's health and explains how the quality of these social determinants is shaped, in large part, by public policy decisions. The specific public policies that shape the quality of Canadian children's health are examined, and Canadian approaches in comparison with other wealthy developed nations are described. Policy directions that would improve the quality of the social determinants of children's health are presented and barriers to their implementation are considered.

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The present article provides models that explain how exposures to differing quality living circumstances result in health inequalities among children. Living circumstances - the social determinants of health - operate through a variety of mechanisms to shape children's health and cognitive, emotional and social development. Specific processes set children off on trajectories such that these exposures - in interaction with their environments - not only shape their health as children but also provide the foundations for their health status as adults. In addition to specifying the mechanisms that mediate the relationship between living circumstances and health outcomes, the article also identifies some of the economic and political factors that shape the quality of the living circumstances to which Canadian children are exposed.

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Canada lags behind other countries when it comes to investing in families with children. Canada, therefore, fails to promote health by not optimizing early development. The authors diagnose the Canadian failure. The problem is not research or fiscal capacity, but rather a sickness in Canadian culture. Four ailments are identified: Canadians are convinced they cannot afford new social investments, tend to treat illness rather than promote health, ignore that good family policy requires gender equality, and discount intergenerational justice. In response, the authors propose four policy solutions. Their pan-Canadian framework would cost $22 billion annually, not even one-half of current elderly and pension benefits. The new investment would reduce child vulnerability from approximately 30% to just 10% of children within 10 years. This reduction in early vulnerability would increase gross domestic product 20% more over 60 years than if Canadians tolerate the status quo.

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It is estimated that nearly 100,000 children are born into poverty each year in Canada. During pregnancy, their mothers are likely to face multiple stressful life events, including lone-mother and teenage pregnancies, unemployment, more crowded or polluted physical environments, and far fewer resources to deal with these exposures. The early child health consequences of poverty and pregnancy are multiple, and often set a newborn child on a life-long course of disparities in health outcomes. Included are greatly increased risks for preterm birth, intrauterine growth restriction, and neonatal or infant death. Poverty has consistently been found to be a powerful determinant of delayed cognitive development and poor school performance. Behaviour problems among young children and adolescents are strongly associated with maternal poverty. Sound evidence in support of policies and programs to reduce these disparities among the poor, including the role of health practitioners, is difficult to find. This is partly because many interventions and programs targeting the poor are not properly evaluated or critically appraised.