Search

The Bioethics of Children's Rights are not only embedded in child development knowledge and in the laws of a particular nation or society, but also in the values, customs and practices of the culture in which they are formulated and practiced. The Bioethics of Children's Rights reflect the changing values assigned to children by adults in our society and are determined by the parents or parental adults responsible for the care and safety of children. The Bioethics of Children's Rights reflect the role of children of different ages in a particular society and community. It is difficult to conceptualize and define. It is fundamental to realize that you cannot refer to children's rights without taking into account the adults who provide them with the continuity of their affectionate, safe-guarding care. It is the parent(s) or their surrogates who have the capacity, authority and responsibility for defining those rights, and for asserting and assuring they are in the service of their children's needs and priorities. This paper, using case vignettes, is intended to heighten our consciousness that by and large children are unable to speak effectively for their rights alone. Through the voices of their parents, care-providers and the society in which they live, we can examine the voice of the child, with the child's needs and potentialities being paramount.

Knowledge and services for children do not fare well when they are subordinate to either general or adult organizations. The history of the American Academy of Pediatrics and its publication, Pediatrics, and of the American Academy of Child and Adolescent psychiatry and the Journal of the American Academy of Child and Adolescent Psychiatry provides eloquent evidence of how independence and autonomy foster organization and productivity for forging ahead in the service of a richer collaboration with adult psychiatry departments. Independence in acquiring and disseminating clinical and scientific knowledge based on child and adolescent perspectives enriches in breadth and depth our capacity to improve priorities for children and youth as part of the continuum of the life cycle in human development. It is long overdue that child psychiatry should follow the inspiration and support of the Academy in establishing independent, autonomous clinical and academic departments of child psychiatry. I believe the department of child psychiatry can be replicated nationally and internationally, but not without conviction, medical center commitment, and major independent fund-raising.

Recovery and adaptation go hand in hand. The potential for recovery and adaptation is present in each child and adult. It is through psychoanalytic understanding that the strategies for reaching these potentials can be activated, coordinated, and understood.

In this article, the authors illustrate a model of an effective ongoing and active collaboration among a group of pediatricians and child and adolescent psychiatrists. They demonstrate how regular meetings and active collaborative interventions broadened each other's understanding and treatment of children. The close relationship, trust, and understanding that developed as a result of this project had a marked impact on the treatment provided by both types of specialist. The concept of the developmentally informed pediatrician is the basic tenet of this project, which continues to have important implications for the training and practice of today's pediatricians.

For children who require placement, individual assessment can reveal whether return to the parents, termination of parental rights and adoption, relative placement, transfer of guardianship, or innovative placement and open adoption arrangements, such as the neighborhood program of the Center for Family Life, represents the least harmful option for the child. Nevertheless, certain guiding principles should prevail: psychological continuity of at least one significant nurturing protective adult and decisions based on the least detrimental alternative, according to the child's sense of time.

Evelyn K. Oremland, Ph.D., founded the first college-based Child Life Program on the West Coast. A pioneer in child life, in her twenty years at Mills College, Oakland, California, she developed a graduate curriculum to create the child life profession. Through her tireless activities in the international organization, Association for the Care of Children's Health (ACCH), and her co-chairing the Educational Committee of the Child Life Council, she helped establish standards for the child life specialist certification. Around the world, her teaching, research, and writing have helped protect the emotional development of sick children. She is best remembered as a devoted and beloved teacher. Graduates from her program now occupy many senior administrative positions in child life in the United States and in Europe.

Throughout childhood and adolescence, psychological growth proceeds in a sequence of progressive hierarchical organizations. Consequently, children are continuously consolidating existing positions or are in transition from one to another. When analytic treatment is proposed, analysts often find themselves in the position of being required to technically coordinate the requirements of the analytic process with those of the ongoing developmental process. While it is the patient who will ultimately bring the needs of both processes together, the approach the analyst assumes to recognizing and addressing these needs can have a facilitating influence on the treatment. Play, for example, is a window on old conflicts and impaired object relationships from the past, but it is also a way in which children consolidate existing organizational hierarchies. Similarly, the analytic interaction provides a pathway to the past, but it is also used by children to provide the building blocks for newly emerging structures. To facilitate further clinical research, a conceptual outline of the relationship between the two processes is provided.

The evolution of play to playfulness over time establishes developmental foundations that are of central importance throughout life. Freud believed that play is at its richest and most adaptive during the oedipal phase; others have taken issue with Freud's view that play has its place mainly in childhood and is given up in adulthood. This paper emphasizes the central importance of playfulness throughout life. In formulating the boundaries of play, it utilizes the observations and comments of experts in the field.

A clinical assessment of the Mental Health Services Program for Youth, a national initiative to integrate systems and coordinate care for severely emotionally disturbed children, was designed to augment and enrich the larger evaluation of program structure. Case conferences were used as a method of examining the effects of collaborative systems of care on vulnerable individuals and of generating clinical insight and understanding. Case vignettes are presented and discussed in terms of the contributions and shortcomings of current system-of-care efforts.

Anna Freud's genius encompassed the study and understanding of children and adults, spanning the gap between theory and practice. She pioneered the method and theory of child psychoanalysis, and demonstrated that the applications of psychoanalytic theory could make a crucial difference to children at high risk of having their physical, emotional and intellectual well-being blighted by poverty, war, biological handicaps, and family breakdown.

Pediatricians play a large role in social-legal efforts to assure children of appropriate priorities in a democratic society. Pediatricians must be aware of the social, legal, and medical ramifications of divorce, physical or sexual abuse, and medical/pediatric problems and how to serve the best interests of the child.

Children in clinical psychoanalysis are able to resolve conflicts and move ahead developmentally. This therapeutic process is facilitated by the psychoanalyst's understanding of the child, reflected in multi-faceted and thoughtful clinical technique. We review aspects of the analyses of four developmentally deviant children who were engaged in child psychoanalysis because of ego disturbances that impaired their ability to learn. These clinical analyses are used to exemplify three intertwined processes related to the therapeutic action of child psychoanalysis: therapeutic alliance, transference, and the role of the child analyst as a real person. These processes were expressed in and were influenced by the emergence of particular types of play in which the children explored complex issues in their lives. Along with other aspects of psychoanalytic technique, including interpretation, the analyses of these four children illustrate the therapeutic meanings of play in child psychoanalysis.

An emergency evaluation was requested on a 16-week-old infant and her parents. The child's mother had a long history of schizophrenia and mental retardation and was noted to decompensate following the child's birth; the mother was hospitalized and the child placed in foster care. Although the mother was severely impaired, the family had a reasonable and appropriate plan for the infant's care and reunification of the family was recommended. Aspects of custody and placement recommendations, the risk of the child for subsequent disorder, and legal issues involved in the evaluation are discussed.

There is substantial agreement about the basic concepts of vulnerability and at-risk conditions in childhood in the context of what constitutes healthy development. Health is characterized by a progression of maturation and development in mental and emotional as well as in the physical spheres. When there is a failure of developmental progress that is more than transient, the expert observer ideally would detect it before the deviation creates its own complications. If the child and parents start off with the child poorly or incompletely equipped, or with the parents unable to respond with competence and affection to a healthy child, the vulnerability of the child or the at-risk environment created or unrelieved by the parents may set up a deviant or impaired development that has its own momentum and pattern. Thus, vulnerability refers to the weaknesses, deficits or defects of the child, whereas risk refers to the interaction of the environment and the child. Vignettes are presented to illustrate alternate patterns of parent-child interaction and how risk and vulnerability must be viewed together as a dynamic interchange between equipment and environment.