You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

Child Health

Safeguarding Looked after Children- Does Looked After mean safe?

17 Sep, 17 | by josmith

Lin Graham-Ray Designated Nurse Looked After Children


This weeks EBN Twitter chat Wednesday 20th September 2017 between 8 pm and 9 pm (UK time) on ‘Safeguarding Looked after children- Does Looked After mean safe’ will focus on the concept of safeguarding vulnerable children in the care system and challenge the conception that once in care safeguarding ends. The Twitter chat will be hosted by Lin Graham-Ray who commenced her Professional Doctorate studies in October 2015 at The Tavistock and Portman NHS Foundation Trust and is currently the Designated Nurse for Looked After Children and Care Leavers in Merton and Wandsworth CCGs.

To participate in the Twitter chat, you will need a  Twitter account. If you do not have an account, you can create one easily at Once you have an account, it is easy to get started. You can follow the discussion on Twitter by searching for #ebnjc – this is the EBN Twitter chat hashtag and by searching for this in Twitter, you’ll only see the relevant tweets related to the Twitter chat. Include #ebnjc in every tweet you send, to ensure that everyone participating in the Twitter chat can see your tweet. But remember, each tweet is limited to 140 characters of text, so make your tweets informative and concise.

Once accommodated into care children (under the age of 18) become ‘Looked After Children’ and subject to legal orders which give full, or partial legal responsibilities (depending on the type or order) to the state for their parenting. Much has been written about the poor outcomes and life chances for children in care (DfE 2015) and for the lack of support for children who stay in the care system and then progress to be care leavers. Among the main themes around poor outcomes mental health, offending and poverty feature.

The national trajectory is that we are accommodating older ‘Looked after Children’ throughout their adolescence who have experienced a range of challenges and traumas, with this in mind the chat will focus on the following questions:

  • Is it time to refocus our safeguarding thinking and challenge the concept of safe care?
  • Being ‘Looked After’ removes the child from an unsafe environment but the experience of being unsafe stays with them and their vulnerability continues, how can these children / young people be best supported?
  • Should Looked after children and care leavers who remain vulnerable despite being in the care system have more regard from health professionals?
  • Rather than defining them as hard to reach, difficult to engage or challenging, should we be challenging ourselves to see how we can deliver services to them rather than how they don’t fit into the services offered?


Department of Education (2015) Promoting the Health and wellbeing of Looked After Children, DfE


Family Nursing: Transforming Health for Families

9 Jul, 17 | by josmith


Dr Joanna Smith, Lecturer Children’s Nursing, School of Healthcare, University of Leeds, UK

I have had a busy few months – conference season always seems to coincide with a busy period of student assessments & juggling commitments, with a never again often following a frenetic few months. Then I reflect on what I have learned, exciting new contacts & a feeling of enthusiasm about nursing follows. The opportunity to attending presentations & seminars is a great way of keeping updated & debating nursing issues is always of value.

The empathise of the 2017 bi-annual International Family Nursing Conference held in Pamplona, Spain focus was ‘Improving The Art & Science of Family Nursing: Transforming Health for Families’, with an emphasise on global issues related to family health was an ideal opportunity to consider the meaning of family across the globe and share research that is aiming to transform the lives of families. The sits well with the International Family Nursing Association (IFNA) conference IFNA’s mission is to transform family health globally.


In addition to undertaking two presentations (an expert qualitative methods lecture with my colleague Dr Linda M
ilnes, & concurrent session on collaborating with families with Dr Sarah Kendal), the posters I co-presented won awards.

The networking was great with lots to learn.

Pain in children with cancer: myths, management, and the family context

4 Jun, 17 | by atwycross

This week’s EBN Twitter Chat on Wednesday 7th June 2017 between 8-9 pm (UK time) will focus on pain in children with cancer and is being hosted by Roses Parker (, PhD student in Children’s Nursing, London South Bank University @Roses_Parker and Perri Tutelman (, PhD student in Clinical Psychology, Dalhousie University Twitter @PerriTutelman.

Participating in the chat requires a Twitter account. If you do not have one you can create an account at Once you have an account, contributing is straightforward. You can follow the discussion by searching links to #ebnjc. You can contribute by sending a tweet (tweets are text messages limited to 140 characters) and adding #ebnjc (the EBN Twitter chat hash tag) to your tweet.

Each year, over 300,000 children are diagnosed with cancer worldwide (Steliarova-Foucher, 2017). With an increasing amount of research on pediatric cancer, greater consideration is now being given to the symptoms and side effects associated with the disease, in addition to the cancer itself. Pain is one of the most common and burdensome symptoms of pediatric cancer according to both children and their parents (Miller, Jacob & Hockenberry, 2011; Poder, Ljungman & Essen, 2010). Evidence suggests pain affects children with cancer regardless of their age, gender or diagnosis and continues throughout the cancer journey (Twycross et al., 2015). Children with cancer experience pain from three main sources. Firstly, cancer itself causes pain when tumour affects bones or soft tissue (Oakes, 2011). Secondly, children with cancer undergo many painful procedures such as lumbar punctures, bone marrow aspirates and surgery (Cline et al., 2006; Walco et al., 2005). Finally, increasingly aggressive treatments, such as chemotherapy and radiotherapy, have painful side-effects such as mucositis, peripheral neuropathy, and burns (World Health Organisation, 2012). Evidence suggests pain affects children with cancer regardless of their age, gender or diagnosis throughout the cancer journey (Twycross et al., 2015), and can have a significant impact on the lives of children and their families. Unfortunately, while various pain management strategies exist to manage children’s cancer-related pain (e.g. medications, psychological and physical pain management techniques), pain continues to be a problem for the majority of children with cancer.


International Council of Nurses Congress – Using Social Media to Engage with Nurses

21 May, 17 | by josmith

Roberta Heale (@robertaheale) & Joanna Smith (@josmith175) Associate Editors, EBN

We are presenting how Evidence Based Nursing (EBN) is using social media to engage with nurses at the International Council of Nurses (ICN) Congress, being help at the end of May 2017 in Barcelona, Spain. Nurses across the globe will be exploring nurses’ roles in leading the transformation of care, & is an opportunity for nurses to build networks, share & disseminate nursing practices across specialties, cultures & countries,

The ICN ams to

Demonstrate & advance the nursing contribution to informed & sustainable health policies;

Support nursing’s contribution to evidence-based healthcare & encourage problem-solving approaches to health priority needs:

Provide opportunities for an in-depth exchange of experience & expertise within & beyond the international nursing community.

We are excited to be representing the work of EBN at the ICN Congress, and networking with peers. Although the journal’s main purpose is to publish expert commentaries on current research that is relevant to nursing, over the last few years EBN editors have implemented a social media strategy to increase engagement with our readers, their access to evidence for practice & awareness of important health issues. We will be sharing our social media strategies that include:

  • Posting regularly on our Facebook @BMJNursing & Twitter account @EBNursingBMJ;
  • Hosting fortnightly Twitter Chats which are linked to a new Opinions article series relating to discussing participants’ key messages during the Twitter chat;
  • Publishing weekly blogs (;
  • Recording podcasts with authors of commentaries to expand & debate in more depth issues raised in the commentary.

Treating pain during pregnancy and breast feeding

16 Apr, 17 | by josmith

This week’s EBN Twitter Chat on Weds 19th April at 8-9pm UK time will focus on pain during pregnancy, how important and difficult is to treat pain during pregnancy and breast feeding.

The Twitter Chat will be hosted by Dr Massimo Allegri, Assistant Professor in Anesthesia Intensive Care and Pain Medicine at the University of Parma (Italy),@allegri_massimo. Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at Once you have an account contributing is straightforward, You can follow the discussion by searching links to #ebnjc, or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

The Pain Department of University Hospital of Parma is one of the biggest pain clinic in Italy and it is the most important research centre about acute ad chronic pain in Italy and one of the most important in Europe.

Furthermore, next year a new PhD Position in Pain will be settled up together with Alborg University and Prof Lars Arendt Nielsen about chronic pain and central sensitization. Furthermore, University of Parma organizes one of the most important translational pain meeting in the world: SIMPAR (

Pain affects 20% of adult population worsening not only quality of life, but also outcome of patients who refer it. Unfortunately, pain continues to being undertreated and under-recognized. Chronic pain is not just a symptom but it is a real disease that needs an accurate diagnosis and appropriate therapy against the pain generator pathophysiology.

This problem is even more important during pregnancy and breastfeeding. The fear to give drugs that can hurt foetus/neonate can drive the physician to a “wait and see” approach that cannot solve the problem to the mother. Furthermore, during pregnancy there are several physiological changes that can worsen previous pain or generate new one. Finally, all the drugs are obviously off label and it is difficult to know exactly their real toxicity.

On Wednesday 19th April during the twitter chat we will continue the conversation to consider how to drive the therapy for patients during pregnancy and breastfeeding. We will discuss all together which multidisciplinary approach could be useful and how important is to diagnose the right pathophysiological mechanism that triggers the acute or chronic pain:

  • Which are the classifications of the drugs that could drive clinicians to use the drugs to alleviate pain?
  • When is more harmful to use some specific drugs?
  • Which concerns do we have to consider when we give a drug to a breastfeeding mother?
  • How to perform the right pathophysiological diagnosis?
  • Do we have to stop some drugs if the women would like to become pregnant

Please join us to discuss this important medical, nursing and public health challenge.


1 Coluzzi F, Valensise H, Sacco M, Allegri M Chronic pain management in pregnancy and lactation. Minerva Anestesiol. 2014 Feb;80(2):211-24.

2  Narayan B, Nelson-Piercy C. Medical problems in pregnancy. Clin Med (Lond). 2016 Dec;16(Suppl 6):s110-s116.

3 Tepper D. Pregnancy and lactation–migraine management. Headache. 2015 Apr;55(4):607-8.

Desert Island Discs and the role of the health care professional in addressing child health inequalities….

12 Mar, 17 | by atwycross

Blog written by Kath Evans 

This week’s EBN Twitter Chat on Wednesday 15th March between 8-9 pm (UK time) will focus on the role of the health care professional in addressing child health inequalities. The Twitter Chat will be hosted by Kath Evans (@kathevans2) a children’s nurse who works at NHS England and leads on improving experiences of care in maternity, infant, children and young people’s services and Professor Alison Twycross (@alitwy) – editor of Evidence Based Nursing. This Blog provides some context for the Chat.

Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at Once you have an account contributing is straightforward, You can follow the discussion by searching links to #ebnjc, or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

I love listening to Desert Island discs as I run (admittedly at a pretty slow pace) around my local park, it was Dame Carol Black and her desert island discs that got me running again back in February 2016. She’s still running in her 70s, and as I’m in my 40s I didn’t think I had any excuse not to lace up my running shoes and get plodding!

However it was Sir Michael Marmott’s  desert island discs podcast (who published ‘Fair Society, Healthy Lives’  ‘The Marmot Review’  )  that got me thinking that we now know so much about child health inequalities and the reasons for them, and yet they continue to exist.

As health care professionals we also see child health inequalities day in day out on our wards, in schools, A&E or Urgent Care centres in fact anywhere where healthcare is delivered. The infant brought in dead having suffocated after co-sleeping, the 4 year old drinking cola from a bottle whilst being admitted for dental extractions due to tooth decay, the obese five year old, the 8 year old awaiting a child protection medical so malnourished and with hair so matted and infested that the play specialist and nurse spend hours bathing and treating her with such kindness that shines a light on compassion in practice and exemplifies the non-judgemental attitude of health care professionals, whilst knowing the social deprivation many of the children are facing. more…

Living with paediatric chronic illness: What are the developmental challenges?

12 Feb, 17 | by atwycross


Abbie Jordan (@drabbiejordan), University of Bath and Line Caes (@LineCaes5), University of Stirling will be leading this week’s EBN Twitter Chat (#ebnjc) on Wednesday 15th February between 8-9pm UK time focusing on the developmental challenges of living with a paediatric chronic illness.




Participating in the Twitter Chat requires a Twitter account; if you do not already have one you can create an account at Once you have an account contributing is straightforward:

  • Go to your Twitter account
  • Follow the discussion by searching for #ebnjc once linked to the discussion, click “all tweets” to keep up-to-date with recent tweets
  • Add the EBN chat hash tag (#ebnjc) to your tweets to join in, this allows everyone taking part to view your contribution

Chronic illness in childhood is common, with figures estimating as many as one in four families in the US reporting caring for a child or adolescent with an ongoing health condition (Compas et al., 2012).  As noted by Christie and Katun (2012), receiving a diagnosis of a chronic condition marks the start of a long and challenging journey for children and their families. This journey may change along the way as children grow up and develop new skills. To explore this, research has focused on exploring what it is actually like for children and their families to live and grow up with a chronic condition (Compas et al., 2012; Palermo et al., 2014).  In addition to the challenges associated with managing a chronic illness (e.g. repeated hospital appointments, daily treatment requirements), a substantial number of children who live with a chronic illness experience emotional and social difficulties. Not only the child, but their entire family is affected, with some parents and siblings reporting emotional distress and poor relationship functioning (Knecht et al., 2015; Palermo and Eccleston, 2009).


‘Losing the child’s voice’ and ‘the captive mother’- an inevitable legacy of family-centred care?

2 Jan, 17 | by josmith

This week’s EBN Twitter Chat on Wednesday 4th January between 8-9 pm (UK time) in conjunction with @WeCYPnurses will focus on child & family cunknown-3unknownentred care.

The chat wll be lead by Professor Linda Shields (@lshields50), Charles Stuart University, Australia; Professor Philip Darbyshire (@PDarbyshire), global healthcare consultant; Sarah Neil (@SarahNeill7) University of Northampton, UK; and Dr Joanna Smith
IMG_0206(@josmith175) theUniversity of Leeds, UK.unknown-2

Participating in the Twitter chat requires a Twitter account; if you do not have one you can create an account at Once you have an account, contributing is straightforward. You can follow the discussion by searching links to #ebnjc, or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ adding #ebnjc (the EBN Twitter chat hash tag) to your tweet, this allows everyone taking part to view your tweets.

Professor Linda Shield’s recent publication (Shields Linda (2016) (Family-centred care: the ‘captive mother’ revisited, Journal of the Royal Society of Medicine; 109; 4: 137-140 ( revisited Roy Meadow’s acclaimed article ‘The captive mother’ (Arch Dis Child 1969; 44: 362–367), where he eloquently described the “captive mother” who was forced to accompany her school aged child to hospital when in reality they would spend little time together. Family-centered care has evolved since that time is espoused as the dominant philosophy underpinning care in children’s hospitals around the world. We postulate that that although family-centered care is embedded within most health services policies for children, it is largely untested. Evidence suggests problems with the implementation of family-centred care, with some parents feeling resentful that they have to undertake some of their child’s care. We postulate that Meadow may have been right & that expecting a mother (or other carer) should stay with a hospitalized school aged child, we are not operating within the ethos of family-centred care, potentially compromising the care given.



The article is already generating debate: with suggestions that concepts such as the ‘captive patient’ and ‘family-centred care’ are no longer relevant in today’s world of personalised care and offering care delivery choices ( The child must be treated as an individual, with rights & choices having a voice in their cared.

This Twitter chat provides a chance for nurses to discuss their experiences of working with children & families, & identify some of the common challenges of embedding child & family-centred care into practice such as:

  1. Is family-centred care relevant within contemporary healthcare contexts?
  2. Does family-centred care marginalise the voice of the child?
  3. Given that evidence of its effectiveness is not available, is it ethical to continue pushing for family-centred care?

Mission Possible – Putting Neonatal Pain Knowledge into Action

14 Aug, 16 | by josmith

Dr Denise Harrison (RN, PhD), Associate Professor, Chair in Nursing Care of Children, Youth and Families, University of Ottawa &  Children’s Hospital of Eastern Ontario (CHEO) Research Institute OR

This week’s EBN Twitter Chat is being held on Tuesday August 16th from 1100-1200 (Pacific Daylight Time), between 1900-2000 (British Summer Time) and is a joint venture with the Council of International Neonatal Nurse (COINN) conference 2016 being lead by Dr Densie Harrison. Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at Once you have an account, contributing is straightforward. You can follow the discussion by searching links to #ebnjc, or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN Twitter chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

We have the knowledge how to reduce pain in sick and healthy newborns during routine, frequently occurring painful procedures – breastfeeding,1 skin-to-skin care2 or very small volumes of sweet solutions, either sucrose3 or glucose.4 Evidence from randomized controlled triaAlice Englishls – synthesized into systematic reviews – further distilled into clinical practice guidelines and finally concentrated into usable evidence; YouTube videos showing these strategies during bloodwork (BSweet2Babies & Power of Parent’s touch) give us ample knowledge and tools to inform our practice and help us translate the knowledge into action. Yet, studies of newborn pain practices around the world continue to show that neonatal pain in under-treated We do not consistently facilitate parents to breastfeed or hold their babies skin-to-skin during procedures, and sweet solutions are not always made available.5 Ultimately, the babies we care for in our Neonatal Intensive Care Units, Special Care Units, other hospital wards and even our healthy newborn babies suffer from pain that is easily preventable.

In our COINN pain panel titled Mission Possible – Putting Neonatal Pain Knowledge into Action, ( and live Twitter Chat (HashTag #ebnjc), to be held Tuesday August 16th from 1100-1200 (Pacific Daylight Time), we will work together as neonatal pain champions in our organizations, to work at best ways to put our neonatal pain knowledge into action. Our panel includes our audience @COINN2016, as well as Dr Linda Franck, Dr Bonnie Stevens, Dr Marsha Campbell-Yeo (‏@DrMCampbellYeo),and myself, as the Session Chair (@dharrisonCHEO). Our discussion will include myths surrounding recommended pain care; effectiveness of maternal-led interventions to reduce procedural pain; ways we can support and empower parents and facilitate their role as partners in pain care, and improving practices at the organizational level.

I really look forward to our session, our speakers and, from our audience, ways to move forward to embed our knowledge into normalized pain management practices.

1         Shah PS, Herbozo C, Aliwalas LI, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev 2012. DOI:10.1002/14651858.CD004950.pub3.

2         Johnston C, Campbell-Yeo M, Fernandes A, Inglis D, Streiner D, Zee R. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev 2014. DOI:10.1002/14651858.CD008435.pub2.

3         Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 2013 2016; DOI:10.1002/14651858.CD001069.pub5.

4         Bueno M, Yamada J, Harrison D, et al. A systematic review and meta-analyses of non-sucrose sweet solutions for pain relief in neonates. Pain Res Manag 2013; 18: 153–61.

5         Harrison D, Reszel J, Wilding J, et al. Neuroprotective Core Measure 5: Neonatal Pain Management Practices during heel lance and venipuncture in Ontario, Canada. Newborn Infant Nurs Rev 2015; 15: 116–23.

The Power of a Parent’s Touch on Newborn Procedural Pain

14 Aug, 16 | by josmith

Dr Marsha Campbell-Yeo PhD RN, Neonatal Nurse Practitioner, Associate Professor and Clinician Scientist, School of Nursing, Departments of Pediatrics, Psychology and Neuroscience, Dalhousie University and IWK Health Centre

No parent wants toBaby SSC image for ebnjc see his or her child experience pain. Sadly, for parents of sick or preterm babies requiring hospital care, it’s a common event with preterm and sick babies ofte
n undergoing on average 12 painful procedures every day with the majority receiving little or no pain relief. In addition to the immediate pain and stress babies experience during these procedures, the
se babies may develop learning and motor delays, behavior problems, and lower academic achievement later in life. This has to change.

As a neonatal nurse practitioner and a researcher who has cared for mothers and babies for over 25 years, I decided to explore ways to minimize these negative outcomes. Historically, mothers have always been crucial to infant survival and wellbeing but they are not always involved in critical care settings. Over my time at the bedside, I noticed that the power of touch could have a positive impact on infants and mothers. So I decided to study this. We found that Skin-to-Skin Contact (SSC), sometimes called kangaroo care, where an infant lies directly on a mothers’ chest, between moms and infants has powerful benefits and can even significantly decrease pain responses in preterm and full term infants undergoing a single painful procedure such as blood collections and needle pokes. However, it is not just mothers that can provide pain relief – fathers, alternative care providers and co-bedding twins have been found to effectively reduce pain during procedures as well!

Despite these positive findings related to pain management in newborns, pain is still associated with regular procedures and continues to be undermanaged for these infants during their hospital stay. A significant challenge remains related to practice change in the NICU. We found that while nurses reported fewer concerns over time related to helping mothers provide SSC as a pain-relieving strategy in the NICU, the amount of the time SSC was actually used did not change.tumblr_maq3vwaULq1rog5d1o1_500

Knowing the positive impact that families can have on minimizing pain during painful procedures by simply asking for it is something that I felt I had to get into the hands of parents. Therefore, I created a parent friendly video titled “Power of a Parent’s Touch” that is meant to empower parents to help minimize neonatal pain in the NICU. Launched on December 2, 2014, it has received over 156,000 views so far in over 150 countries around the world!

It’s not just the one in ten babies that are born preterm worldwide that are adversely affected by untreated pain. Untreated pain is an issue for every baby, even those that are born healthy. Every baby in the world undergoes painful procedures in the first few hours and days after birth and many can receive up to 20 injections in their first years! Parents are one of our most underutilized resources to help relive this pain.

We need to change that. Parents can make a difference.

Join COINN live Twitter Chat – Mission Possible – Putting Neonatal Pain Knowledge into Action, ( and (HashTag #ebnjc), to be held Tuesday August 16th from 1100-1200 (Pacific Daylight Time), 1900-2000 (Bristsh Summer Time)

Analysis and discussion of developments in Evidence-Based Nursing

Evidence-Based Nursing blog

Analysis and discussion of developments in Evidence-Based Nursing. Visit site

Creative Comms logo

Latest from EBN

Latest from EBN