Barriers to disclosure to children with HIV

Research suggests that it is healthy for children with chronic illness to discuss their illness, but clinical experience and research indicate that this seldom occurs. The purpose of this study was to identify barriers which prevent primary caregivers from discussing HIV/AIDS with children, and ways in which medical and community services could facilitate this process. Focus groups were performed with seventeen primary caregivers of children with HIV seen for care at Chris Hani Baragwanath Hospital in Soweto, South Africa in 2001. The study revealed that primary caregivers of children with HIV typically do not disclose HIV status to their children, despite the fact that these children often ask questions about their illness. For reasons including stigma, lack of knowledge and skills, and emotional unpreparedness, primary caregivers feel uncomfortable discussing HIV and illness with children. Health care and social service providers could facilitate disclosure of illness to children with HIV.     

Children's competence to consent to medical procedures

Children's competence to consent to medical treatment is discussed in terms of basic principles of child development and central concepts in the consent process. Case examples are presented to highlight current problems relevant to children's consent in medical treatment which pediatricians are likely to encounter.     

When to use drugs to help sleep

Paediatric sleep medicine is a relatively new but important and rapidly growing field. It is increasingly recognised that many "adult" sleep disorders begin in childhood where the consequences of missed diagnoses can be devastating. Adequate training of all health care professionals and careful eliciting of symptoms remains the first step in ensuring accurate and timely diagnoses. Although behavioural approaches play a huge role in paediatric sleep medicine, at times severe sleep disorders also require pharmacological treatments. However, the evidence base for these is weak, and currently treatments of conditions including insomnia, narcolepsy and restless legs syndrome in childhood still rely on hopeful extrapolation from adult data. A growth in randomised controlled trials over the last 5 years is encouraging; trial methodologies are also improving. International working groups and multicentre trials will increasingly be needed to evaluate the new technologies and pharmacological treatments that are emerging.