Pediatric palliative care requires a comprehensive approach that addresses psychological, social, and spiritual needs. Effective communication is one of the key tools available to healthcare professionals to meet these needs. This article summarizes the lecture presented at the SCCALP Spring Meeting held on April 17-18, 2026. Practical aspects of communication with families, pediatric patients, and adolescents are reviewed, together with strategies aimed at promoting clear, empathetic, and emotionally tailored communication. The article also discusses the delivery of bad news using the EPICEE protocol and reflects on the emotional impact that these situations may have on healthcare professionals. Training in communication skills and interdisciplinary teamwork are essential tools for providing comprehensive care focused on supporting and accompanying patients and their families throughout the course of illness.
The recent creation of the Child and Adolescent Psychiatry specialty responds to a growing body of knowledge about child and adolescent mental health, as well as a significant increase in the prevalence of various psychiatric disorders and pathologies in this age group. Therefore, the following is a review of basic concepts regarding neurotransmission and the most frequently used psychotropic medications, describing their potential uses, most common adverse effects, considerations, and con-clusions. This text aims to enable pediatricians in both primary care and hospital settings to use these medications, providing solid evidence and greater safety in the care of psychiatric patients.
Introduction/objective. Pediatric palliative care (PPC) is a comprehensive care model for children and adolescents with life-limiting or life-threatening conditions and their families. Despite regulatory and healthcare advances, significant gaps remain in its implementation, alongside a general lack of awareness among pediatric professionals. This review aims to provide an updated overview of the fundamentals, epidemiology, specificities, and essential clinical and ethical aspects of PPC. Development. The definition and conceptual framework of PPC, epidemiology, and classification of eligible conditions according to the Association for Children’s Palliative Care (ACT) groups are reviewed. The unique characteristics distinguishing PPC from adult palliative care, the integrated care model from diagnosis onwards, symptom management with particular focus on pain, communication principles, and advance care planning are analyzed. End-of-life care, bereavement support, and professional self-care are also addressed. Conclusions. PPC is a right for every child with a life-limiting condition. Its early integration improves the quality of life of both the patient and the family. It is essential that every pediatrician understands the basic principles of PPC to ensure adequate care.
Introduction. Phakomatoses comprise a heterogeneous group of genetically determined neurocutaneous disorders that primarily affect the skin and central nervous system. Their importance in pediatrics lies in the early detection of cutaneous signs that act as markers of underlying neurological disease. These conditions show variable progression, with manifestations that may include epilepsy, developmental delay, vascular abnormalities, and an increased risk of neoplasia. Management requires a comprehensive clinical evaluation and multidisciplinary follow-up. Neurocutaneous disorders. Congenital melanosis is characterized by extensive pigmented nevi with possible leptomeningeal involvement, associated with a risk of melanoma and neurological complications. Incontinentia pigmenti, an X-linked dominant disorder, presents with evolving skin lesions and may be accompanied by neurological and ocular abnormalities. Sturge-Weber syndrome features facial angiomas in the trigeminal distribution and leptomeningeal vascular malformations, frequently associated with epilepsy and cognitive impairment. Tuberous sclerosis complex is distinguished by multisystem hamartomas, early-onset epilepsy, and neurodevelopmental disorders. Neurofibromatosis type 1, the most common neurocutaneous disorder, manifests with café-au-lait spots, neurofibromas, learning difficulties, development of nervous system tumors, and osteoarticular abnormalities. Conclusions. Early recognition of phakomatoses allows the implementation of appropriate surveillance and timely treatment, improving prognosis. Detailed clinical evaluation, imaging studies, and genetic testing are essential. Management should be individualized, with emphasis on neuropediatric follow-up and family support.
Introduction. The Ecuadorian healthcare system is divided into levels according to the complexity and reso- lution of cases, which seeks to ensure timely and effective care, although it faces operational limitations due to overdemand on hospitals and limited capacity for resolution in primary care. Objective. To identify the main causes of referral from primary care to pediatric consultation at a general hospital in Ecuador, evaluating its effectiveness and compliance. Methodology. A descriptive, retrospective study was conducted using an anonymized matrix, which included all patients under 15 years of age referred between January 2023 and June 2024. Demographic, clinical, and operational variables were analyzed using descriptive statistics. Results. A total of 1,028 referrals were analyzed, of which 58% were male and 46.7% were children between the ages of 1 and 5; 92% came from urban areas, and 66.6% were referred by general practitioners. The five main reasons for referral were: malnutrition (13.2%), hip dysplasia (10.6%), language disorders (9.4%), phimosis (2.8%), and heart murmur (2.5%). Only 60.7% of those who requested appointments attended the consultation, and the average waiting time was 9.3 days. Conclusion. The system showed high scheduling rates (89.3%) and short waiting times (9.3 days), although only 60.7% completed the consultation. The main causes of referral reflect the epidemiological profile and limitations of primary care. The assessment of appropriateness should be interpreted with caution due to limitations in the registry and lack of standardized criteria.
Introduction. Respiratory syncytial virus (RSV) is one of the main causes of respiratory infections in children, mainly those under two years of age. Furthermore, it´s considered a cause of death in children under one years of age. According to studies, the steps implemented during SARS-CoV-2 pandemic have had an impact in the epidemiology of hospitalizations for this infection. The objective is know the incidence and the characteristics of RSV hospitalizations in children of spanish province. Methods. A retrospective descriptive study was conducted on hospital discharges of patients under 15 years of age belonging to a province over a period of 21 years. Results. Of the 32,957 hospitalizations, 2.8% were diagnosed with RSV infection. 94.6% of hospitalizations were in the province where the patients in the study were located. The median stay was 4.22 days. The average age of hospitalization from 2001 to 2020 was between 5 and 9 months. However, in 2021 the average age of hospitalization was 13 months. There was a non-significant (p= 0.08) annual decline of 2% in the hospitalizations rate in the 21 years. There is a dominant circannual rhythm with acrophase on January 27 (p< 0.01). No deaths were recorded. Conclusion. Change point haven´t been identified between 2001 and 2021, but have been observed marked seasonality with acrophase in January.
Introduction and objectives. Buzzy (Pain Care Labs, Atlanta, Georgia, USA) is a device that applies cold and vibration to the skin, considered a non-pharmacological analgesia strategy. The aim was to evaluate whether Buzzy® is effective for venipuncture, a common invasive procedure in pediatric hospital practice. Patients and methods. A randomized clinical trial was conducted including children aged 3 to 14 years who attended the Pediatric Emergency Department of a tertiary hospital and required venipuncture. Six CE-marked Buzzy devices were available. Anxiety was assessed before the procedure; pain and satisfaction scales were applied after venipuncture. Results. Sixty-one patients were included: Buzzy® group (n = 30) and non-Buzzy group (n = 31). Fifty-nine percent were male. Mean age was 8.49 years (SD 3.5). A significant reduction in pain was observed in the Buzzy® group (p = 0.038). No differences were found in pre-procedure anxiety, satisfaction, or procedure time. Compared with previous venipunctures without Buzzy®, lower pain was observed (p = 0.001). Conclusions. The use of Buzzy modestly reduced pain during venipuncture in our sample. This difference was statistically significant, although of limited clinical relevance. Studies with larger sample sizes are needed to confirm these findings.
Introduction: Electrolyte imbalances in pediatric patients can range from mild to severe. These disorders can be caused by underlying diseases or the inappropriate use of intravenous solutions, particularly in hospitalized patients who are fasting. Methods: A prospective cohort study was conducted from January 2023 to September 2024 at the Nuevo Hospital Civil de Guadalajara Dr. Juan I Menchaca (HCGJIM), Jalisco, México. Patients aged 1 month to 17.9 years who were admitted to the emergency department and fasted were included, with follow-up from admission until 48 hours. A non-probability sampling method was used for consecutive cases. Frequencies and percentages were estimated for qualitative variables, and means and standard deviations were obtained for quantitative variables. Results: 423 patients were included; 56.7% were male. The median age was 4 years (IQR 8). Upon admission, the most common electrolyte imbalances were hyponatremia (19.4%) and hypocalcemia (18.4%). The main cause of admission was infectious disease (34%, n= 144). The most frequently used intravenous maintenance solution was Hartmann's solution (54.6%). After 12 hours of fasting, significant changes in potassium and chloride were observed. At 24 and 48 hours, changes were seen in calcium, potassium, and chloride. Conclusion: In hospitalized patients who are fasting, monitoring serum electrolytes is recommended due to the frequency of electrolyte imbalances. Furthermore, basal electrolyte requirements, according to age, should be added to maintenance solutions.
Introduction: Exclusive breastfeeding (EBF) for the first six months is a public health priority, but rates in Spain are below target and insufficient training of healthcare staff hinders its continuation. Objective: To evaluate breastfeeding (BF) competencies of primary care staff to detect training gaps and prioritize educational actions aligned with IHAN and WHO‑UNICEF standards. Methods: Descriptive cross‑sectional study targeting professionals from 18 health centers (n=579) using convenience sampling and institutional email contact. An adapted version of the ECoLa questionnaire (26 items) was administered and scores (range 0–21) were grouped into four competency levels. Results: The overall mean score was 15.5±3.8 (73.9% correct). Sixty‑seven percent reached “Good” or “Excellent” levels and 33% “Insufficient” or “Very deficient.” Midwives and pediatricians obtained the highest scores, while family physicians (FPs) and nursing assistants (TCAE) showed significant deficiencies (p<0.001). Gaps were identified in assessment of latch (TCAE 68% correct), management of mastitis (FPs 72%) and inappropriate recommendation of supplementation (65%). A discrepancy was observed between self‑perceived competence and objective results, along with persistence of professional myths (perceived insufficient milk 58%; fear of supposedly contraindicated drugs 62%). Conclusions: Significant competency gaps in BF exist, especially among FPs and TCAE. The ECoLa questionnaire is useful to identify deficits and guide training. Practical workshops led by midwives, aligned with IHAN/WHO‑UNICEF, are recommended to strengthen support and promote exclusive breastfeeding during the first six months.
Introduction and objectives: Atrial septal defects (ASDs) account for 6-10% of congenital heart defects. The most prevalent type, with the most variable clinical and therapeutic approach, is the ostium secundum(OS). The objective of this study is to describe the clinical and evolutionary characteristics, as well as the clinical and echocardiographic prognostic factors, of patients requiring closure of the defect. Materials and methods: Retrospective observational study of patients diagnosed with ASD. Variables studied: ASD type, size, age at diagnosis and at closure, and type of closure. Results: Predominance in males(55.4%), with OS being the most frequent(80.3%). 25% presented with heart failure during their follow-up, and 24.2% required nutritional support. At diagnosis, the mean age and size were 17.71 months and 6.5 mm. Spontaneous closure occurred in 15.2%, closure was achieved with a device in 24.2%, surgical closure was required in 30.3%. Ostium primum(OP) and sinus venosus(SV) ASDs required external closure. Age at closure was not a significant factor, but OS and SV were larger. OS ASDs were analyzed, revealing a 2.5-fold increased risk in males and a 7.33-fold increased risk of requiring closure in sizes >5 mm at diagnosis. No factors were found to indicate a preference for surgical or device-assisted closure. Conclusions: The most frequent ASD was type OS, with closure being more frequently in males and in those with a size greater than 5 mm at diagnosis, without finding prognostic factors for the type of closure. All OP and venous sinus ASDs required surgical closure.
Los autores estudiaron 45 lactantes con niveles hematológicos normales, pero cerca de los limites inferiores. Se realizo una prueba oral con 3 mg/k/día de sulfato ferroso. Los enfermos fueron divididos en 3 grupos de acuerdo a su edad. El resultado fue positivo en todos los casos. El aumento medio de los niveles de hemoglobina fue 1 gr/dl. También aumentó la cifra de hematocrito y el valor corpuscular medio. Los autores consideran la prueba terapéutica con hierro muy fácil de realizar y muy útil en el diagnóstico de la ferropenia latente.
La patología infantil y el cuidado del niño constituyen temas que se abordan en los tratados generales de medicina desde los primeros que se conocen en la literatura peninsular; a las noticias sobre atención al recién nacido, incluidas en exposiciones tocológicas, de procedencia romana, hay que incorporar las correspondientes a la etapa medieval, tanto las provenientes de la cultura médica hispanoárabe como las menos valiosas suscritas por profesionales que ejercieron en los reinos cristianos durante la Baja Edad Media.
Introduction. Respiratory syncytial virus (RSV) is one of the main causes of respiratory infections in children, mainly those under two years of age. Furthermore, its considered a cause of death in children under one years of age. According to studies, the steps implemented during SARS-CoV-2 pandemic have had an impact in the epidemiology of hospitalizations for this infection. The objective is know the incidence and the characteristics of RSV hospitalizations in children of spanish province. Methods. A retrospective descriptive study was conducted on hospital discharges of patients under 15 years of age belonging to a province over a period of 21 years. Results. Of the 32,957 hospitalizations, 2.8% were diagnosed with RSV infection. 94.6% of hospitalizations were in the province where the patients in the study were located. The median stay was 4.22 days. The average age of hospitalization from 2001 to 2020 was between 5 and 9 months. However, in 2021 the average age of hospitalization was 13 months. There was a non-significant (p= 0.08) annual decline of 2% in the hospitalizations rate in the 21 years. There is a dominant circannual rhythm with acrophase on January 27 (p< 0.01). No deaths were recorded. Conclusion. Change point haven't been identified between 2001 and 2021, but have been observed marked seasonality with acrophase in January.
Introduction. Electrolyte imbalances in pediatric patients can range from mild to severe. These disorders can be caused by underlying diseases or the inappropriate use of intravenous solutions, particularly in hospitalized patients who are fasting. Methods. A prospective cohort study was conducted from January 2023 to September 2024 to evaluate the frequency of electrolyte imbalances in patients admitted to the pediatric emergency department at the Nuevo Hospital Civil de Guadalajara Dr. Juan I. Menchaca (HCGJIM), Jalisco, Mexico. Patients aged 1 month to 17.9 years who were admitted to the emergency department and fasted were included and followed from admission until 48 hours. A non-probabilistic, consecutive case sampling method was used. For the quantitative variables, mean or median values and standard deviation or interquartile range were obtained, according to their type of distribution. Results. 423 patients were included; 56.7% were male. The median age was 4 years (IQR 8). Upon admission, the most common imbalances were hyponatremia (19.4%) and hypocalcemia (18.4%). The main cause of admission was infectious disease (34%; n= 144). The most frequently used intravenous maintenance solution was Hartmann's solution (54.6%). Significant changes in potassium and chloride were observed after 12 hours of fasting. At 24 and 48 hours, changes were observed in calcium, potassium, and chloride levels. Conclusion. In hospitalized patients who are fasting, monitoring of serum electrolytes is recommended due to the frequency of electrolyte imbalances; in addition, basal electrolyte requirements according to age should be added to maintenance solutions.
Introduction. Exclusive breastfeeding (EBF) for the first six months is a public health priority, but rates in Spain are below target and insufficient training of healthcare staff hinders its continuation. Objective. To evaluate breastfeeding (BF) competencies of primary care staff to detect training gaps and prioritize educational actions aligned with IHAN and WHO-UNICEF standards. Methods. Descriptive cross-sectional study targeting professionals from 18 health centers (n= 579) using convenience sampling and institutional email contact. An adapted version of the ECoLa questionnaire (26 items) was administered and scores (range 0-21) were grouped into four competency levels. Results. The overall mean score was 15.5 +/- 3.8 (73.9% correct). Sixty-seven percent reached "Good" or "Excel-lent" levels and 33% "Insufficient" or "Very deficient." Midwives and pediatricians obtained the highest scores, while family physicians (FPs) and nursing assistants (TCAE) showed significant deficiencies (p< 0.001). Gaps were identified in assessment of latch (TCAE 68% correct), management of mastitis (FPs 72%) and inappropriate recommendation of supplementation (65%). A discrepan-cy was observed between self-perceived competence and objective results, along with persistence of professional myths (perceived insufficient milk 58%; fear of supposedly contraindicated drugs 62%). Conclusions. Significant competency gaps in BF exist, especially among FPs and TCAE. The ECoLa question-naire is useful to identify deficits and guide training. Practical workshops led by midwives, aligned with IHAN/ WHO-UNICEF, are recommended to strengthen support and promote exclusive breastfeeding during the first six months.
Introduction. The Ecuadorian healthcare system is divided into levels according to the complexity and resolution of cases, which seeks to ensure timely and effective care, although it faces operational limitations due to over-demand on hospitals and limited capacity for resolution in primary care. Objective. To identify the main causes of referral from primary care to pediatric consultation at a general hospital in Ecuador, evaluating its effectiveness and compliance. Methodology. A descriptive, retrospective study was conducted using an anonymized matrix, which included all patients under 15 years of age referred between January 2023 and June 2024. Demographic, clinical, and operational variables were analyzed using descriptive statistics. Results. A total of 1,028 referrals were analyzed, of which 58% were male and 46.7% were children between the ages of 1 and 5; 92% came from urban areas, and 66.6% were referred by general practitioners. The five main reasons for referral were: malnutrition (13.2%), hip dysplasia (10.6%), language disorders (9.4%), phimosis (2.8%), and heart murmur (2.5%). Only 60.7% of those who requested appointments attended the consultation, and the average waiting time was 9.3 days. Conclusion. The system showed high scheduling rates (89.3%) and short waiting times (9.3 days), although only 60.7% completed the consultation. The main causes of referral reflect the epidemiological profile and limitations of primary care. The assessment of appropriateness should be interpreted with caution due to limitations in the registry and lack of standardized criteria.
Introduction and objectives. Buzzy (R) (Pain Care Labs, Atlanta, Georgia, USA) is a device that applies cold and vibration to the skin, considered a non-pharmacological analgesia strategy. The aim was to evaluate whether Buzzy (R) is effective for venipuncture, a common invasive procedure in pediatric hospital practice. Patients and methods. A randomized clinical trial was conducted including children aged 3 to 14 years who attended the Pediatric Emergency Department of a tertiary hospital and required venipuncture. Six CE-marked Buzzy (R) devices were available. Anxiety was assessed before the procedure; pain and satisfaction scales were applied after venipuncture. Results. Sixty-one patients were included: Buzzy (R) group (n = 30) and non-Buzzy (R) group (n = 31). Fifty-nine percent were male. Mean age was 8.49 years (SD 3.5). A significant reduction in pain was observed in the Buzzy (R) group (p = 0.038). No differences were found in pre-procedure anxiety, satisfaction, or procedure time. Compared with previous venipunctures without Buzzy (R), lower pain was observed (p = 0.001). Conclusions. The use of Buzzy (R) modestly reduced pain during venipuncture in our sample. This difference was statistically significant, although of limited clinical relevance. Studies with larger sample sizes are needed to confirm these findings.
Introduction and objectives. Atrial septal defects (ASDs) account for 6-10% of congenital heart defects. The most prevalent type, with the most variable clinical and therapeutic approach, is the ostium secundum (OS). The objective of this study is to describe the clinical and evolutionary characteristics, as well as the clinical and echocardiographic prognostic factors, of patients requiring closure of the defect. Materials and methods. Retrospective observational study of patients diagnosed with ASD. Variables studied: ASD type, size, age at diagnosis and at closure, and type of closure. Results. Predominance in males (55.4%), with OS being the most frequent (80.3%). 25% presented with heart failure during their follow-up, and 24.2% required nutritional support. At diagnosis, the mean age and size were 17.71 months and 6.5 mm, respectively. Spontaneous closure occurred in 15.2% of cases, closure was achieved with a device in 24.2%, surgical closure was required in 30.3%, and the remainder were in the process of closure at diagnosis. Ostium primum (OP) and sinus venosus (SV) ASDs required external closure. Age at closure was not a significant factor, but OS and SV were larger. OS ASDs were analyzed, revealing a 2.5-fold increased risk in males and a 7.33-fold increased risk of requiring closure in sizes > 5 mm at diagnosis. No factors were found to indicate a preference for surgical or device-assisted closure. Conclusions. The most frequent ASD was type OS, with closure being more frequently required in this series in males and in those with a size greater than 5 mm at diagnosis, without finding prognostic factors for the type of closure. All OP and venous sinus ASDs required surgical closure.
Introducción: La expansión de la actividad científica en la era digital ha generado importantes retos en la gestión, identificación y acceso a la producción académica. En este contexto, los identificadores persistentes han surgido como herramientas fundamentales para garantizar la recuperación, trazabilidad y atribución inequívoca de publicaciones, personas, instituciones y proyectos de investigación. Su desarrollo se alinea con los principios que promueven la reutilización y transparencia de los datos científicos. Desarrollo: Se describen cuatro identificadores persistentes que abordan necesidades específicas: el DOI (Digital Object Identifier) para objetos digitales y publicaciones, el ORCID (Open Researcher and Contributor ID) para la autoría individual, el ROR (Research Organization Registry) para instituciones y el emergente RAiD (Research Activity Identifier) para proyectos de investigación. Su empleo aporta ventajas como la cita precisa, la integración automatizada de información y la mejora de la visibilidad y seguimiento de la producción científica. Estos sistemas están gestionados por consorcios internacionales y están siendo adoptados de manera creciente por editoriales, universidades, repositorios y agencias financiadoras, demostrando su rentabilidad y utilidad para la comunidad científica. Conclusiones: La implantación y uso extendido de identificadores persistentes fortalece la interoperabilidad y la sinergia entre los agentes del ecosistema científico. Para los profesionales sanitarios, utilizar estos identificadores favorecerá el correcto seguimiento y valoración de su labor en el ámbito académico y de la investigación.
Introducción: La trombosis de senos venosos cerebrales (TSV) como complicación de una otitis media aguda (OMA) tiene una incidencia muy baja, siendo una causa infrecuente de hipertensión intracraneal (HTIC). Caso clínico: Niño de 3 años, que tras diez días del diagnóstico de OMA derecha, presenta de forma aguda cefalea intensa y parálisis del VI par derecho. La sospecha clínica de HTIC se confirmó al objetivar papiledema bilateral e incremento de presión de apertura de líquido cefalorraquídeo (24 cmH2O), tras realizar una tomografía computarizada craneal normal. Se completaron los estudios con una angioresonancia magnética (ARM) craneal con trombosis de senos transverso y sigmoide derechos hasta vena yugular interna y mastoiditis derecha. Se inicia antibioterapia intravenosa y enoxaparina. Ante la persistencia de HTIC, se inició tratamiento con acetazolamida, que se mantuvo durante tres meses hasta resolución completa de la clínica y repermeabilización confirmada en ARM de control. Comentarios: Ante sospecha de HTIC debe realizarse estudio oftalmoscópico, neuroimagen y, si normalidad, punción lumbar con medición de presión de apertura. Una causa infrecuente de HTIC es la TSV secundaria a una OMA y requiere de un tratamiento precoz y de un manejo multidisciplinar.
