Abstract Objectives Children often experience distress during needle procedures. CARD (Comfort, Ask, Relax, Distract) is an evidence-based practice model shown to reduce distress during vaccination. This study evaluated CARD for venipuncture and venous cannulation in a paediatric hospital setting. Methods Before-and-after (pre-post implementation) hybrid effectiveness-implementation study in the Nuclear Medicine Division, SickKids, Toronto. Before CARD, technologists completed procedures using usual/standard care. After CARD, staff and families were educated about coping strategies, environments were modified to minimize fear cues, and children were supported after choosing preferred coping strategies. Children, caregivers and technologists completed post-procedure surveys. Effectiveness outcomes included child symptoms (fear, pain, dizziness), use of coping strategies, caregiver satisfaction, and caregiver fear. Implementation outcomes were acceptability, feasibility, and fidelity. Results From August 2022 to November 2023, 118 children (52.5% female) participated. There were no significant differences in mean fear and pain between the Before and After CARD periods. After CARD (vs. Before), dizziness was lower (0.0 vs. 0.7, P = 0.01) and fewer children reported high fear (13.1% vs. 27.8%, P = 0.05). Topical anesthetics and vibrating device use increased; vapocoolant use decreased (P < 0.001 for all analyses). Caregivers reported more positive experiences (64.8% vs. 45.8%, P = 0.05) and less fear (1.5 vs. 2.8, P = 0.01). Children, caregivers and technologists had positive attitudes about CARD. Technologists perceived CARD as feasible; however, fidelity was suboptimal. Conclusion Implementing CARD for hospital-based needle procedures reduced dizziness and high fear in children, increased use of evidence-based coping strategies, improved caregiver satisfaction, and reduced caregiver fear. Findings can guide CARD implementation for hospital settings.
Abstract Introduction Point-of-care ultrasound (POCUS) is an emerging diagnostic and procedural tool in paediatric medicine. POCUS-specific competencies have been incorporated into selected paediatric subspecialty training programs, including paediatric emergency medicine and paediatric critical care. Despite its expanding role in paediatric practice, no national standards exist for POCUS integration into general paediatric residency training in Canada. Variability in residency-level training may contribute to inconsistencies in clinical practice, with implications for patient safety, diagnostic accuracy, and standards of care. This study aimed to evaluate the current integration of POCUS education in Canadian paediatric residency programs and identify system-level barriers to implementation. Methods A national, cross-sectional assessment was conducted using an electronic questionnaire distributed to program directors representing 17 eligible Canadian paediatric residency programs between June and November 2025. The assessment evaluated program characteristics, including formal and informal POCUS inclusion, instructional methods, regional variances, and perceived barriers. Descriptive statistics were used to summarize responses. Results Twelve of 17 (71%) Canadian paediatric program directors responded. Only one program reported a formal POCUS curriculum, while four programs offered elective-based POCUS exposure. The most commonly reported barriers to implementation were lack of national curriculum standardization and limited curricular time (83%), followed by insufficient numbers of trained faculty, limited funding and limited access to equipment (75%). Conclusion Despite evidence for the integration of POCUS into paediatric practice, formal paediatric residency-level POCUS training in Canada remains limited and highly variable. These findings highlight a national gap between clinical expectations and training opportunities.
Abstract Virtual care expanded dramatically during the COVID-19 pandemic, but its role beyond the pandemic continues to evolve. After more than three decades in community paediatrics, I closed my physical office and transitioned to a fully virtual practice focused primarily on children and adolescents with mental health, developmental, behavioural, and educational concerns. Two years later, the experience has challenged many of my assumptions about what is gained and lost when paediatric care moves online. Virtual care can improve access, provide unexpected insight into a child's home environment, and facilitate communication with some adolescents. It also has important limitations, particularly when physical examination is required. Drawing on my experience and the emerging paediatric telemedicine literature, this commentary considers the clinical and practical realities of fully virtual community paediatric practice and suggests that the relevant question is not whether virtual care is better or worse than in-person care, but when it is appropriate.
Résumé Les technologies médicales font progresser les soins chez les enfants et les adolescents ayant des affections complexes et chroniques, à la fois grâce aux applications de pointe (p. ex., ventilation mécanique par trachéostomie, dispositifs d’assistance ventriculaire, alimentation parentérale à long terme, dialyse) et à des mesures de soutien moins complexes (p. ex., sondes d’alimentation, matériel d’aspiration, aides à la mobilité). Il faut toutefois tenir compte de certains enjeux, liés aux décisions éthiques relativement à l’utilisation des technologies médicales, de même qu’aux préoccupations sur l’effet de ces technologies sur l’expérience des enfants et de leur famille, sur les pratiques cliniques et sur les cultures de soins des divers établissements. Le présent document de principes s’inspire des publications scientifiques pour formuler les principales considérations susceptibles d’aider les pédiatres et autres prestataires de soins à privilégier la réflexion au sujet de l’utilisation des technologies médicales chez les enfants atteints d’affections chroniques et complexes. Il explore également l’éclairage que ces considérations peuvent apporter aux recommandations thérapeutiques et aux décisions communes, puisque dans un tel contexte, les difficultés éthiques et culturelles sont tout autant intrinsèques que persistantes.
