The Child Friendly Cities Initiative-Minneapolis Model.

PURPOSE: The Child Friendly Cities Initiative (CFCI) is a UNICEF framework based on the UN Convention on the Rights of the Child (CRC). CFCI was launched globally in 1996 to protect children's rights throughout the world. There are child friendly cities in over 44 countries around the globe, but none presently in the United States. The purpose was to establish a Child Friendly City in the United States. DESCRIPTION: Child friendly cities are a child-rights and equity-based approach designed to ensure all children in a community reach their full potential for optimal health, development, and well-being. The paper discusses the development of the guiding principles of the CFCI-Minneapolis Model as well as a community needs assessment. ASSESSMENT: The assessment consisted of a digital survey of 60 questions on the SurveyMonkey platform. The sample included 173 Minneapolis youth 10-18 years of age and 85 parents with children less than five years of age. The participants were drawn from four of the 83 Minneapolis neighborhoods that had the highest concentration of children and youth, communities of color, and immigrant families that have historically been under resourced. CONCLUSION: The results of the community assessment guided the development of four programmatic initiatives. These included child rights learning & awareness, emergency preparedness & planning, community safety, and youth participation in decision making. The paper concludes with the lesson learned to date in the implementation of the CFCI-Minneapolis Model. These include partnership, dedication, leadership, community engagement, coalition building, and celebrating success. CFCI-Minneapolis received full designation from UNICEF USA as a child friendly city in February 2024.

Post-Traumatic Stress Disorder in Unaccompanied Refugee Minors: Prevalence, Contributing and Protective Factors, and Effective Interventions: A Scoping Review.

In 2021, there were close to 37 million children displaced worldwide. There were 13.7 million refugees and an additional 22.8 million internally displaced. In Europe, this included 23,255 unaccompanied minors seeking asylum, up 72% compared with 2020 (13,550). The objective was to review the current literature regarding PTSD in unaccompanied refugee minors (URM). The authors searched Ovid Medline, Embase, and Cochrane Library from 1 January 2008 through 15 January 2019. Thirty full texts were chosen that specifically studied unaccompanied refugee minors (URM). The results showed that URM had a prevalence of post-traumatic stress disorder (PTSD of 17-85% across the studies reviewed. There were numerous factors that contributed to PTSD, including cumulative stress and trauma, guilt, shame, and uncertainty about legal status. Protective factors included resilience, a trusted mentor, belonging to a social network, religion, having an adult mentor, and having a family (even if far away). Immigrant youth can thrive most easily in multiculturally affirming countries. Five interventions demonstrated effectiveness, comprising trauma-focused cognitive behavioral therapy (TF-CBT); "Mein Weg", a TF-CBT combined with a group-processing mixed therapy approach; teaching recovery techniques (TRT), narrative exposure therapy for children (KIDNET), and expressive arts intervention (EXIT). The significant mental health conditions include depression, anxiety, internalizing and externalizing behaviors, and frequently PTSD. It is fair to conclude that the high levels of mental health problems experienced in URM are due to exposure to traumatic experiences, separation from parents, and lack of social support.

Renewing our commitment to protect children experiencing armed conflict.

Civilian casualties from armed conflicts have increased, such that 90% of deaths from armed conflicts in the first decade of the 21st century have been civilians, a significant number of whom are children. The acute and chronic effects of armed conflict on child health and well-being are among the most significant children's rights violations of the 21st century. Children are increasingly exposed to armed conflict and targeted by governmental and non-governmental combatants. Despite International Human Rights and Humanitarian laws and multiple international declarations, conventions, treaties and courts, injury and death of children due to armed conflicts have worsened over the decades. It is critically important that a concerted effort be undertaken to address and rectify this issue. Toward this end, the Internal Society of Social Pediatrics and Chid Health (ISSOP) and others have called for a renewed commitment to children experiencing armed conflict with an immediate call to implement a new UN Humanitarian Response on Child Casualties in Armed Conflict.

The Emergence of Planetary Pediatrics.

Pediatrics has witnessed an evolution from primary care, family-centered care, community pediatrics, social pediatrics and global pediatrics, which has shifted our attention beyond the clinic setting to an appreciation of children in their lived environment. We are witnessing the emergence of planetary pediatrics that further broadens the focus of children's health to include the continued importance of clinical care, but also the impacts of climate change, environmental degradation, child migration, unrelenting war and conflict, social injustice, pandemics and violence against children. If we do not acknowledge the present and ever-increasing adverse planetary changes of what children are experiencing now and in the future, we will have failed to adequately protect them from impending catastrophes. The hope of pediatrics for the future is to improve the health and well-being of all children. This hope remains as relevant today as it was for our predecessors and serves as a beacon for the voyage through the remainder of the twenty-first century.

Violence Against Children: Recognition, Rights, Responses.

All forms of violence against children (VAC) are violations of children's rights. Traditional definitions of child maltreatment do not address the rapidly evolving global spectrum of VAC. In this article, we offer an expanded definition of VAC that integrates the principles of child rights, clinical medicine, and public health. The authors further expand the socioecological model to establish a trans-societal sphere, composed of root-cause determinants of VAC, including climate change, globalization, armed conflict, etc. A child rights-based taxonomy of VAC is also presented. The authors conclude with recommendations to address VAC in the domains of clinical practice, systems development, and policy generation.

Rights, justice, and equity: a global agenda for child health and wellbeing.

Worldwide challenges to child health and wellbeing are rapidly becoming existential threats to children and childhood. Inequities, armed conflict and violence, nuclear proliferation, forced migration, globalisation, and climate change are among the global issues violating children's rights to optimal survival and development. Child rights-based approaches will be required to enhance the response to the civil-political, social, economic, and cultural determinants of these global child health issues. In this Viewpoint, we present a global agenda for child health and wellbeing as a blueprint for the practice of paediatrics and child health in the domains of clinical care, systems development, and policy formulation. This global agenda is grounded in the principles of rights, justice, and equity and can address the root-cause determinants of health. The 30th anniversary of the UN Convention on the Rights of the Child is a relevant moment to recommit to shared goals for children's health and wellbeing.

Gender-Related Challenges in Educational Interventions with Syrian Refugee Parents of Trauma-Affected Children in Turkey.

Since 2012, more than three million Syrian refugees have fled to Turkey. While these refugees vary in socioeconomic background, it is notable that 50% of Syrian refugee children in Turkey display symptoms of post-traumatic stress and that more than 663,138 of these children between the ages of six and seventeen are not enrolled in school. For those children who are in school, high levels of trauma have significant implications for the education system as trauma alters the brain and affects the way children learn. A Global Voice for Autism is an international non-governmental relief and development organization that exists to equip teachers and families in conflict-affected communities. Its intent is to support the development and success of children with autism and trauma-related behavioral challenges in their classrooms, home, and communities. The instabilities inherent in the Syrian refugee experience pose a number of challenges to the organization's effective implementation of programming. The experiences of refugees in Turkey are highly gendered. Therefore, a qualitative gender analysis was conducted to address and better understand the challenges faced when carrying out these educational interventions. The article examines domestic violence, sexual violence, and masculinity as gender-driven constructs that influence how refugees experience trauma. In addition, structural issues in existing support systems all present significant challenges to Syrian refugee parents that impede effective program implementation. It is imperative to assess structural issues in existing support services to address these challenges and to successfully carry out meaningful and impactful programming. This Brief Report provides a series of recommendations in order to ameliorate these challenges and increase the efficacy of educational interventions with Syrian refugee parents of trauma-affected and vulnerable children in Turkey. It concludes with a call for policy changes that protect refugees from deportation when accessing support services and a network of services that do not require residency permits. It calls for increased integration of parent trauma support in educational intervention trainings and the creation of safe spaces where mothers and fathers can discuss their own trauma and challenges in the hope of significantly enhancing program efficacy.

The Arc of Migration and the Impact on Children's Health and Well-Being Forward to the Special Issue-Children on the Move.

Since the start of this millennium the diaspora of families with children has continued unabated. UNICEF estimates that nearly 31 million children have been forcibly displaced from their homes by the end of 2017. This includes 13 million child refugees, an estimated 17 million children internally displaced within their own countries and over 900 thousand children seeking asylum in a different country. Even more staggering is the 75 percent increase in the number of child refugees between 2010 and 2015. This Special Issue, Children on the Move: The Health of Refugee, Immigrant and Displaced Children, examines in detail the health and well-being of our most vulnerable children today. It follows the arc of migration from home country, through transit and finally the challenges experienced in a child's new country. The papers explore a variety of acute and chronic health conditions as well as the mental health of these children and youth. The articles examine the trauma experienced in their home country, the fleeing of war, violence and/or poverty, the travails during their journey, the stress throughout their stay in detention centers and refugee camps, and finally the transition to a new home country.

The Rights of Children on the Move and the Budapest Declaration.

It has been estimated that more than 50,000,000 children and youth have migrated across borders or been forcibly displaced within their own country. They consist of refugees, asylum seekers, internally displaced persons (IDP), economic migrants, and exploited trafficked children. They are virtually "stateless", children deprived of the protective structures of state and family that they need and deserve and unrecognized by either their country of origin or the international community. This opinion piece starts with the personal reflections of its author on his recent work in Middle East refugee camps. It then explores the prevalence and demographics of these children and their plight. It examines the United Nation's Convention on the Rights of the Child (CRC) and other international conventions designed to protect them. It also summarizes the International Society of Social Pediatrics and Child Health (ISSOP) Budapest Declaration on the Rights, Health and Well-Being of Children and Youth on the Move as a vehicle for improved care and vehicle for change.

Health and Self-Regulation among School-Age Children Experiencing Family Homelessness.

Children in homeless families have high levels of adversity and are at risk for behavior problems and chronic health conditions, however little is known about the relationship between cognitive-emotional self-regulation and health among school-aged homeless children. Children (n = 86; mean age 10.5) living in shelters were assessed for health, family stress/adversity, emotional-behavioral regulation, nonverbal intellectual abilities, and executive function. Vision problems were the most prevalent health condition, followed by chronic respiratory conditions. Cumulative risk, child executive function, and self-regulation problems in children were uniquely related to child physical health. Homeless children experience problems with cognitive, emotional, and behavioral regulation as well as physical health, occurring in a context of high psychosocial risk. Several aspects of children's self-regulation predict physical health in 9- to 11-year-old homeless children. Health promotion efforts in homeless families should address individual differences in children's self-regulation as a resilience factor.

Adversity and children experiencing family homelessness: Implications for health.

This study tests links between adversity and health problems among children in family emergency housing. Children who experience family homelessness are at risk to also experience high levels of stress, health problems, and need for pediatric care. Understanding the connection between stress and health holds the potential to reduce persistent health disparities. Analyses tested whether experiencing a greater number of stressful life events during the early years of life was related to worse health conditions, emergency health care utilization, and hospitalizations. Parents noted children's experience of negative stressful life events, health problems, emergency room (ER) use, and hospitalization. Two cohorts of kindergarten-aged children staying in emergency family housing participated in the study in 2006-07 (n = 104) and in 2008-09 (n = 138), with the results examined separately. In both cohorts, more health problems were acknowledged for children exposed to more negative stressful life events. Stressful life events were not related to ER use but did relate to hospitalization for the 2006-07 cohort. Results affirm links between stress in early childhood and health problems among children living in emergency housing. Findings are consistent with the hypothesis that adversity in early childhood contributes to income and racial disparities in health.

Child Health Disparities in the 21st Century.

The topic of persistent child health disparities remains a priority for policymakers and a concern for pediatric clinicians. Health disparities are defined as differences in adverse health outcomes for specific health indicators that exist across sub-groups of the population, frequently between minority and majority populations. This review will highlight the gains that have been made since the 1990s as well as describe disparities that have persisted or have worsened into the 21st century. It will also examine the most potent social determinants and their impact on the major disparities in mortality, preventive care, chronic disease, mental health, educational outcomes, and exposure to selected environmental toxins. Each section concludes with a description of interventions and innovations that have been successful in reducing child health disparities.

Asthma and adaptive functioning among homeless kindergarten-aged children in emergency housing.

BACKGROUND: Children who experience homelessness have elevated rates of asthma, a risk factor for other problems. Purpose. Examine rates of asthma and its relation to health care use and adaptive functioning among young children staying in family emergency shelters. METHODS: Children and caregivers (N = 138) completed assessments in shelters, including measurement of child cognitive functioning, parent report of child health care service utilization and asthma diagnosis, and teacher report of child school functioning. RESULTS: Asthma diagnosis was reported for 21% of 4-to-6-year-old children, about twice the national and state prevalences. Children with asthma used more health care services and had worse peer relationships. Asthma did not relate to cognitive test performance or subsequent academic performance, or to other behavior problems in school. CONCLUSIONS: High rates of asthma remain an important issue for children in emergency family housing, a context with high levels of child risk for toxic stress exposure and developmental problems.

The association between maternal perception of obstetric and pediatric care providers' attitudes and exclusive breastfeeding outcomes.

BACKGROUND: Exclusive breastfeeding is recommended for 6 months. Successful breastfeeding requires support from family members, peers, and health care professionals. OBJECTIVE: This study aimed to determine the association between maternal perception of the attitudes of obstetric and pediatric care providers about infant feeding during the neonatal period and exclusive breastfeeding at 1, 3, and 6 months. METHODS: The study sample consisted of 1602 women from the Infant Feeding Practices Study II (2005-2007), a longitudinal study of women in the United States. Analyses included chi-square and Fisher's exact tests and logistic regression models. RESULTS: Mothers who perceived that the obstetric care provider favored exclusive breastfeeding were significantly more likely to exclusively breastfeed their infants at 1 and 3 months (odds ratio [OR] = 1.73, 95% confidence interval [CI], 1.33-2.24; and OR = 1.41, 95% CI, 1.09-1.80, respectively) as compared to mothers who perceived that the obstetric care provider was neutral about the type of infant feeding. Similarly, mothers who perceived that the pediatric care provider favored exclusive breastfeeding had higher odds of exclusively breastfeeding their infants at 1 and 3 months (OR = 1.53, 95% CI, 1.17-1.99; and OR = 1.51, 95% CI, 1.17-1.95, respectively) as compared to mothers who perceived that the pediatric care provider was neutral about the type of infant feeding. The association was no longer significant at 6 months. CONCLUSION: Maternal perception of obstetric and pediatric care providers' preference for exclusive breastfeeding during the neonatal period is associated with exclusive breastfeeding until 3 months.