Not All Daycares are the Same: How Low-Quality Childcare Can Affect Emotional Development

 

Original Post|Amelia Arman

 

Do you really know what your child is experiencing in daycare?

For many American families, daycare is a trusted option for childcare while both parents of the household work to provide for the needs of the family.  These families feel as though their children are being properly cared for and nurtured by the daycare staff. However, these daycares can cause physical or emotional stress in their child. A child’s perceived stress is best defined as either an actual or imagined threat that is personal and overwhelming to the point that emotional, psychological, developmental, and/or physiological changes are observed in the child’s behavior (Davis, 2023). Sadly, there are many low-quality daycares that cause stress in children under the age of six. These low-quality daycares lack caregiver response and can damage the emotional well-being of the child or infant in their care through abuse and/or neglect. In a 2023 study of mostly American children, results revealed that the quality of early childhood education and quality of care impacts children’s early childhood development (Suchodoletz, 2023).

Harms of Low-Quality Daycare Centers

Low-quality daycare centers are usually run by harsh or neglectful employees who either lack the experience of caring for the child’s emotional wellbeing, or who do not show signs of caring for one reason or another. These daycare workers are often underpaid, overworked, burnt out and desensitized to children’s cries. They tend to not feel compelled to attentively care for the needs of the children in their care, which can lead to neglect, causing stress in the child. There are also cases in which young children are preyed upon by caregivers, who purposely insert themselves into an environment to be able to target young children. Many of these children become victims of sexual and physical abuse. Children are an easy target for these predators because they are impressionable and vulnerable to manipulation. Specifically, infants are non-verbal and unable to vocalize their trauma. To a predator, these young children are the perfect targets.

How do you know what to look for when attempting to choose a high-quality daycare for your child?

Researching the daycare center and reviewing their licensing information is important before deciding to enroll your child in a specific daycare. Some daycare options, such as in-home daycares, give you the option to place your child in the home of a caregiver who is not licensed. A licensed daycare is one in which the state has inspected and approved the home and has completed a background check on the caregiver. Licensing for childcare is also based on certain health and safety standards. This does not ensure that the child will be in a stress-free environment but knowing that your chosen daycare is licensed at least provides some comfort in that the child will be in an environment that has been through inspection and that the staff has been properly screened. Speaking with parents who have either enrolled their children in daycare or currently have a child enrolled is also important as they can provide insight into their experience and insight into the type of care their children received or are receiving in that particular daycare center. Parents can also ask the daycare center that they are considering if its workers have been through screening and what type of screening the daycare center uses. For example, modern times have provided a machine learning approach to identifying non-parental caregivers’ risk for harsh caregiving towards infants in daycare centers. A 2023 study was able to identify a set of indicators and predictive rules that could accurately predict women’s risk for harsh caregiving behavior in daycare environments. This machine learning approach can be used as a screening tool to predict harsh caregiver behavior in women from 100% chance to report low levels of harsh caregiving behavior with a 95.2% accuracy. This allows the daycare center to decline employment to anyone who scores low in the chance of not exemplifying harsh caregiving behavior (Sharon, 2024).

What are the long-term psychological effects of low-quality daycare abuse on children?

An alarming finding is that, for most children, the parent and caregiver relationships are interchangeable in terms of attachment figures. Therefore, daycare abuse or neglect should be considered a subsidiary attachment trauma, which is a form of relational trauma involving impairments in the healthy bonding between the child and their secondary caregivers. These abuses within the daycare setting have been implicated in emotional posttraumatic manifestations, such as difficulty in processing emotional depression and anxiety and tendencies towards aggressive behavior. In addition, children who were victims of sexual abuse exhibited symptoms of post traumatic stress disorder (PTSD) with 30% of the children having sexual behavior problems, 25% internalizing problems, 17% attachment insecurity, and 18% other psychiatric disorders. These children also showed problems concerning emotions and toilet training. The long-term effects of this abuse were found to be that 5-10 years after the abuse, over one-third of the children remained clinically symptomatic (Talmon, 2023).

What are the alternatives?

Infants and toddlers who are placed in high-quality daycare settings have shown improved psychosocial skills and cognitive development. In a study that included sixty-eight infants and toddlers in daycare and sixty-eight infants and toddlers not in daycare with an almost equal male to female ratio, it was found that the infants and toddlers who attended high-quality daycare with caring, attentive caregivers had increased levels of psychosocial, cognitive, motor, and language development compared to those who did not attend high-quality daycare. Of the infants and toddlers who attended high quality daycare, 100% showed normal levels of psychosocial, cognitive, motor, and language development while only 77.9% of those not attending a high-quality daycare showed normal levels of psychosocial development, 69.1% showed normal levels of cognitive development, 75% showed normal levels of motor development, and 79.4% showed normal levels of language development (Villarreal-Ríos, 2021). 

Conclusion

All of these findings suggest that high-quality daycares can be beneficial to the growth and development of children. Not all daycares produce negative effects on children. Parents just need to be vigilant about their research of daycares and find care that improves their child’s development rather than causing stress, which can hinder their emotional development over a long period of time.  Take the time to get to know the center and the people who will be caring for your child. Know what is happening in your child’s daycare class and the other parents will also aid you in making sure that, long-term, you made the right choice for the emotional wellbeing of your child.

 

Author

My name is Amelia Arman and I am a Psychology major at Franciscan Missionaries of Our Lady University with the goal to become a child and family counselor. I am very interested in the way that children emotionally develop and the long term effects that childhood experiences can have on their development. I chose this topic because, as a long-term babysitter, I have seen the negative effects that low-quality daycare can have on the emotional development of young children, and would like to help guide parents in choosing whether or not daycare is the best option for them and in choosing the best daycare setting for their individual child.

 

 

References

Davis, S. L., & Soistmann, H. C. (2022). Child’s perceived stress: A concept analysis. Journal of pediatric nursing. https://pmc.ncbi.nlm.nih.gov/articles/PMC10167593/. dio not found

Sharon, C., & Rousseau, S. (2024). A machine learning approach to identifying non-parental caregivers' risk for harsh caregiving towards infants in daycare centers. Early Childhood Research Quarterly, 67, 128-138. dio not found https://www.sciencedirect.com/science/article/abs/pii/S0885200623001692

Talmon, A., Ditzer, J., Talmon, A., & Tsur, N. (2024, January). Maltreatment in daycare settings: A review of empirical studies in the field. Trauma, violence & abuse. https://pmc.ncbi.nlm.nih.gov/articles/PMC10666466/. doi not found

Villarreal-Ríos, E., Cruz-Hernández, C., Morales-Morales, K., Vargas-Daza, E. R., Galicia-Rodríguez, L., Isassi-González, D. M., & Guzmán-Padilla, E. (2021). Comparison of growth and psychomotor development in daycare centers attended by professionals. Boletín Médico del Hospital Infantil de México. https://www.bmhim.com/frame_esp.php?id=277. doi: 10.24875/BMHIM.21000068

von Suchodoletz A;Lee DS;Henry J;Tamang S;Premachandra B;Yoshikawa H;, A., Lee, S. D., Henry, J., Tamang , S., Premachandra, B., & Yoshikawa, H. (n.d.). Early childhood education and care quality and associations with child outcomes: A meta-analysis. PloS one. https://pubmed.ncbi.nlm.nih.gov/37228090/.  doi: 10.1371/journal.pone.0285985  

 

ADHD Is Often Missed in Girls: A Hidden Struggle

 ADHD Is Often Missed in Girls: A Hidden Struggle

Introduction: More Than Just Daydreaming

Why are so many young girls with ADHD labeled as “emotional,” “chatty,” or “spacey” instead of getting the support they truly need?

When people think of ADHD, they picture a young boy bouncing off the walls, blurting out answers, or getting in trouble. ADHD doesn’t always look like that, especially in girls. Girls with ADHD often get misdiagnosed and misunderstood for years, which can have serious long-term effects on their mental health and academic success.

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What Is ADHD and How Does It Work?

ADHD (Attention-Deficit/Hyperactivity Disorder) is a neurodevelopmental condition that affects brain functioning, especially in areas related to attention, impulse control, and executive functioning. According to the DSM-5, there are three types:

• Inattentive Type: Trouble focusing, forgetfulness, disorganization.
• Hyperactive-Impulsive Type: Fidgeting, restlessness, impulsive behavior.
• Combined Type: A mix of both sets of symptoms.

The problem is, these categories are based mostly on how ADHD appears in boys.

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How ADHD Presents Differently in Girls

Girls with ADHD are more likely to show inattentive symptoms rather than hyperactivity (Hinshaw et al., 2019). This can look like:

• Daydreaming in class
• Being overly talkative or "too sensitive"
• Frequently losing items or forgetting instructions
• Trouble staying focused, even when they are interested
• Being labeled as lazy or unmotivated

These behaviors are less disruptive so they’re often written off as personality quirks or emotional issues rather than ADHD.

In the article She Rocks the Spectrum (n.d.), many women look back and realize they had ADHD all along but were never taken seriously because their symptoms didn't match the stereotype. Girls are more likely to internalize their struggles, which can cause anxiety, low self-esteem, and depression before they receive a diagnosis (Eleos Clinic, 2023).

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Why Are Girls Being Overlooked?

The easy answer is bias. Both in the way ADHD is studied and how its diagnosed. Most ADHD research was initially done on young boys because they were so disruptive, so the diagnostic criteria was developed around how the disorder manifests in them. This led to parents and teachers not recognizing ADHD in girls who didn’t show hyperactive behaviors (Quinn & Madhoo, 2014).

A study by Mowlem et al. (2019) found that parents often rated boys' symptoms as more severe, even when girls had similar difficulties. This bias can delay girls from getting the help they need.

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Real-Life Consequences of Late Diagnosis

When ADHD goes unnoticed, it doesn’t go away, it just gets harder to manage.

Undiagnosed girls often experience:

• Academic issues from disorganization or difficulty focusing
• Social challenges from interrupting conversations or being overly talkative
• Emotional struggles like anxiety, depression, or feeling “broken”

These effects can snowball, especially during adolescence when academic and social demands increase. Girls may blame themselves or feel like they're just not trying hard enough. According to Dr. Michael Ingram (2022), many women are diagnosed only after their own children are screened for ADHD, realizing that they’ve had the same struggles their whole lives.

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The Mental Load and Masking

Girls are also more likely to "mask" their symptoms because they are always being told that they are just emotional or to talkative. That means they work hard to hide their difficulties to fit in socially or meet expectations. Masking can be exhausting and increases the risk of burnout and emotional breakdowns. Leading to even more of a misdiagnosis. As described by Eleos Clinic (2023), these girls may appear organized on the outside but feel like they're falling apart on the inside.

Masking may work sometimes, but it delays the diagnosis and prevents proper support.

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New Research and Changing the Narrative

It’s becoming clearer that ADHD is not a “one-size-fits-all” diagnosis.

In their review of gender differences in ADHD, Hinshaw et al. (2019) emphasized that girls are more likely to be diagnosed only if they have severe symptoms or other psychological disorders like anxiety. A lot of the time girls are diagnosed with anxiety or depression first and when the issues are still happening they then decide to diagnose with ADHD. This further proves that current diagnostic tools miss many girls whose struggles are still very real.

Quinn and Madhoo (2014) argues that it's not just that ADHD looks different in girls, but it’s that our systems aren’t designed to recognize those differences.

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Addressing the Concerns: Is Overdiagnosis a Problem?

Some critics argue that with increased awareness, we may start to overdiagnose ADHD. But the evidence still strongly supports the underdiagnosis of girls. While it's important to avoid labeling kids unnecessarily, it’s even more important not to overlook those who are suffering in silence.

Proper screening and evaluation by trained professionals using gender-informed approaches can help strike the right balance.

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What Can Parents and Teachers Do?

Awareness is the first step. Here’s how adults can help:

• Look beyond behavior. A quiet, daydreamy girl may be struggling just as much as a loud, impulsive boy.
• Listen without judgment. If a child says they’re overwhelmed, believe them.
• Use updated screening tools. Ensure they account for gender differences.
• Push for professional evaluation. Don’t rely on surface-level observations.
• Advocate in school settings. Request support services or accommodations like extra time or quiet workspaces.

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Conclusion: Changing the Outcome for Girls

ADHD is real, and it affects girls just as much as boys, but it is often easier to overlook.

The longer a child goes without proper diagnosis and support, the more likely they are to face academic, social, and emotional challenges. By recognizing that ADHD doesn’t always fit the “hyperactive boy” mold, we open the door to better outcomes for all children.

We must update the way we recognize ADHD, especially in quieter or more emotionally sensitive kids because these may be the ones who are struggling the most on the inside.. Early support can mean the difference between years of silent struggle and a future where these kids thrive.

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About the Author

By: Genevieve Prejean

I'm a first-year nursing student who wasn’t diagnosed with ADHD until college. It was a struggle all my life, and I want to make sure other girls don’t have to go through the same experience. Through this blog, I hope to help parents and educators understand how ADHD can look different and why early recognition matters.

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References 

Eleos Clinic. (2023, January 9). ADHD: How it may present differently in girls and boys. https://www.eleosclinic.com/post/adhd-how-it-may-present-differently-in-girls-and-boys

Ingram, M. T. (2022, January 22). All about ADHD. https://michaeltingram.com/2022/01/22/all-about-adhd

Mowlem, F., Agnew-Blais, J., Taylor, E., & Asherson, P. (2019). Do different factors influence whether girls versus boys meet ADHD diagnostic criteria? Sex differences among children with high ADHD symptoms. Psychiatry Research, 272, 765–773. https://doi.org/10.1016/j.psychres.2018.12.128

Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: Uncovering this hidden diagnosis. The Primary Care Companion for CNS Disorders, 16(3). https://pubmed.ncbi.nlm.nih.gov/25317366/

She Rocks the Spectrum. (n.d.). ADHD in women. https://www.sherocksthespectrum.com/adhd-women

 

Too Much Control, Too Little Confidence: How Strict Parenting Hurts Kids’ Confidence

By: Madison Gilbert

“Why doesn’t my child believe in themselves?”

This is a question many parents ask when their child struggles with confidence. It’s common to blame social media, peer pressure, or school stress. While those things can play a role, one of the most important—and often overlooked—factors is how a child is raised. Parenting shapes the way children view themselves, the world, and their place in it. A very strict style of parenting, known as authoritarian parenting, may seem helpful at first. After all, it involves structure, rules, and discipline. But research shows that this style can lower a child’s self-confidence over time. When kids grow up in homes filled with rules but lacking emotional warmth and support, they may begin to see themselves in a negative light. As future nurses and healthcare professionals, it’s important that we understand how parenting affects a child’s emotional well-being. We are often the ones who spot early warning signs of emotional distress, especially in children and teens. When we understand how home life impacts mental health, we can offer better support to the children and families we care for.

Let’s start by explaining some key terms.

Authoritarian parenting is a strict way of raising children. Parents who use this method expect their kids to follow rules without question. These parents are often quick to punish and slow to explain. They may believe that being too kind or understanding will make their child “soft” or undisciplined. They may not show much affection or allow their child to express their feelings freely. Self-confidence, also called self-esteem, is how much someone believes in their own abilities and self-worth. Children with healthy self-confidence feel good about who they are. They’re more likely to try new things, take healthy risks, and learn from failure instead of being crushed by it. Another important term is emotional control. This happens when a parent uses guilt, fear, or shame to get their child to behave. Instead of calmly explaining what the child did wrong, the parent might make the child feel like a disappointment. Over time, this can hurt the child’s ability to trust themselves or others.

Why is this so important?

Because when kids don’t feel good about themselves, it affects every part of their lives. A child with low self-confidence might struggle in school, have trouble making friends, or avoid trying new things. They may act out, become very quiet, or seem anxious or sad all the time. As nurses, we often see these behaviors, but we also need to think about what’s causing them. What’s happening at home? Do the child’s caregivers listen to them? Do they feel safe expressing their emotions? A 2024 study by Tang and colleagues, published in Child and Adolescent Psychiatry and Mental Health, looked at children aged 7 to 12. The researchers found that when parents used emotional control—like guilt, shaming, or limiting the child’s ability to make choices—those children’s confidence dropped over time. Even worse, the less confident the children felt, the more their parents tried to control them. It became a harmful cycle. This study showed that the emotional side of parenting—how rules are given and how children are treated—matters just as much as the rules themselves. Other research supports this. A study in the Journal of Education, Humanities and Social Sciences found that teenagers raised by very strict parents were more likely to have low self-confidence. These teens often avoided trying new things because they were afraid of failing. They didn’t feel safe making mistakes or asking for help. Instead of seeing failure as a learning opportunity, they saw it as something to be ashamed of. Another study from Frontiers in Psychology showed that strict parenting also affects how children get along with others. Children raised this way had a harder time making friends and working well with classmates. Without emotional support from their parents, these kids struggled to speak up, set boundaries, or express their feelings. As a result, many became isolated or anxious, leading to other mental health challenges. The Nursing and Health Sciences Journal also found a strong link between strict parenting and low confidence. In this study, kids raised by very strict parents were five times more likely to struggle with self-confidence than kids raised in homes with more warmth and understanding. These children were afraid to speak up or try new things. They worried about being punished or judged harshly. Instead of feeling safe, they often felt anxious and alone. This research shows that discipline without love and support can do more harm than good. Sadly, the effects of strict parenting don’t stop when childhood ends. A 2023 study in Frontiers in Psychology found that teens who grew up with this parenting style often carried emotional pain into adulthood. They were more likely to deal with depression, low self-worth, and trouble forming healthy relationships. These kids didn’t learn how to express themselves or ask for help. Many didn’t believe they were good enough, no matter how hard they tried. This long-lasting emotional damage can affect everything from school and work to friendships and romantic relationships.

So, what’s the big takeaway?

When kids grow up in homes with a lot of control but not enough love, their confidence suffers. They start to believe they’re not good enough. They become afraid to speak up or try new things. They may even stop believing in themselves altogether. This is a serious issue that we can’t ignore. As nursing students and healthcare workers, we need to look beyond surface-level behaviors and consider what’s going on at home. Is the child supported? Do they feel safe and heard? If not, we can be part of the solution by encouraging better communication and healthier parenting.

Why should you care?

Because raising emotionally strong, confident kids takes more than rules and discipline—it takes love, trust, and connection. Parents need to set boundaries, yes, but those boundaries should come with kindness and understanding. Children need to know they are loved, even when they make mistakes. They need to know their voices matter. If we want the next generation to grow up healthy and happy, we need to help families create homes that are not just structured—but also safe, loving, and supportive. Every child deserves to feel heard. Every child deserves to feel valued. And every child deserves to grow up knowing they are more than their mistakes—they are worthy of love and confidence.

 

References

 

The ICU: Where Family Being Present Can Help Adolescent Recovery

The ICU: Where Family Being Present Can Help Adolescent Recovery

By: Caroline Gilbert

Caroline Gilbert is a Nursing major, double minoring in Psychology and Theology at Fran U. Her ultimate goal throughout her career is to focus on severely ill people in the ICU, not only helping them with their physical needs, but also with their emotional and mental needs. She chose to write about her blog topic because Lil’ Rudy, his family, and especially his sister and sister-in-law, have been such an inspiration, and have shown her what true grit, determination, faith, and love can do. 

Pictured above is the inspiration for this blog, Lil’ Rudy. Here, he is doing what he does best: enjoying company, making people laugh, and smiling!

Have you ever wondered what it would be like to be stuck in the ICU without being able to move, yet hearing everything around you? Lil’ Rudy, a quiet young man, sat on the floor for hours and hours without being able to call out for help. Time went on as he lay on the floor; blood pressure rising, body weakening, brain bleeding, yet no help had arrived. Only by the full grace of God, his boss found him nearly eight hours later, and he was rushed to the hospital.  This is the true story of a family friend who had his family's support through it all.  There he sat, unable to move and see, yet able to hear everything. Throughout his stay in the ICU, he experienced burr holes, and a craniectomy to relieve his brain swelling due to a blood clot. It was later known that this was caused by a severe stroke. Day upon day, night upon night, his sister, sister-in-law, parents, family members and friends stayed with him and talked to him. I, in fact, was able to witness his sister and sister-in-law rub his feet, provide him care, ask him questions as he started improving, ask his nurses and doctors questions, and relay messages to the rest of his family with unwavering support. This was in fact encouraged by his nurses and doctors, which leads me to my ultimate question: Are family members also encouraged to be with their beloved adolescent child if they are in the ICU?

Family Presence

A parent is a child’s safe place, home, guide, and so much more. Children rely on their parents to be a crucial place of comfort, so when a child is in the Intensive Care Unit fighting for their life, a parent being by their child’s side is the best thing they can do at that moment. While digging into some research, a peer reviewed article showed that parents offered a safe and catering environment for their child to lean on throughout their stay in the ICU. While their child lay there resting, holding their hand was the best emotional support they could ever give to their child (Crump et al., 2025). 

Furthermore, children in the PICU fighting cancer also had parents struggling emotionally. Parents had to compose themselves in order to make decisions on treatment and care for their child, just as Lil Rudy’s family did. Since fighting cancer is a tough and enduring battle, some parents chose to talk to chaplains and priests, which in turn helped them cope significantly (Charleston et al., 2022). Emotional well-being can be defined as someone being able to understand and express a wide variety of their own emotions in a safe and comforting way. After all, parent’s are humans too, and being able to talk to someone will ultimately help them continue to support their child. 

The Need For Involvement

The need for parent involvement is particularly special to children. As anyone can tell, the ICU is scary for anyone; especially a young child. The need for parent involvement is critical for everyone’s emotions during a difficult time, nonetheless a time where a child is fighting for their life in the ICU. Research was done in South Africa proving that if a child’s caregiver was involved with certain decisions with their child, while their child was sick, then the parent's emotional status ended up being detrimental and not supportive to their child. Certain decisions that were made by parents, left them overthinking, and unable to provide proper care for their child. Such proper care may be holding their hand or providing them water, just as Lil’ Rudy’s sister and sister-in-law did. . Sometimes, nurses and doctors have to intervene on life supporting care, though. With the brain fog of making life supporting decisions, a parent’s emotional status could get in the way, therefore, a parent should maintain the emotional role of care, while doctors and nurses should maintain life supporting care (Chasweka et al., 2023). Though parents tend to have a desire to help nurses take care of their children, it is also very common for parents and caregivers to let out a plea for assistance, especially through a long hospital stay. 

Nurse Intervention 

To begin the tough part of the conversation, family presence in the ICU is amazing, but some drastic measures need to be talked about. Families should be aware that the resuscitation process is common in the ICU. When and if the resuscitation process occurs, it has been found that nurses actually tend to want the presence of the family in the room with them. Though this is not a common practice among hospitals, it actually helps the nurses gain confidence during the resuscitation process. Nurses are able to ask any last minute questions and gain knowledge. One nurse might be with the family to help support them, explain what is happening, and ask them any questions about the patient, while the other nurses and doctors may be working on the patient (Bush and Woodley, 2022). 

Cost Prevention

Throughout significant hospital stays, the cost of medical intervention is extremely high, which can lead to high stress on families as bills come in. No family wants to deal with the cost of significant medical intervention while trying to be emotionally supportive for their loved one. Many people may be asking if there is a way hospitals can reduce this price? Well, the simple answer is yes! Studies have been shown to prove that the cost of ICU stays can certainly be lowered. Some of the features that help lower medical intervention costs include the communication of nurses with the child and the family, and emotional family support for the child instead of extensive hospice support (Anderson et al., 2024). To further this point, IV medications may be inhibiting the child from going home, which will add to the stack of hospital bills. To allow the patient to go home safely, nurses may communicate to the family about how and when to provide such medications. 

Conclusion

Connecting children in the ICU and Lil’ Rudy’s story is about how God, family, and friends truly do matter in a person’s life. Without this, a family has absolutely nothing. It reminds people that everyone needs to be kind in this dark world, just as Lil’ Rudy is and continues to be. It is not about the clothes people wear, or what people have been through.  It is about family, faith, and kindness. It reminds people to put a smile on their face before they walk out the door each day. 

  Families are their child's comfort. Children are very vulnerable, especially when going through traumatic experiences. Feeling the love of others helps children especially with their mental and emotional status while recovering. Just as Lil' Rudy takes on every day with courage, parents of children in the ICU also need to do this. Though it can be a hard time for everyone, courage is very important for parents as they care for their child. It helps them be supportive to their child in a positive aspect. After all, people are never fully dressed without throwing a smile on their face, and putting kindness and hope in their hearts. 

Reflection Prompt

I really liked blogger! It helped my organize my blog in a simple and easy way with no complaints!

References

Andersen, S. K., Chang, C.-C. H., Arnold, R. M., Pidro, C., Darby, J. M., Angus, D. C., & White, D. B. (2024). Impact of a family support intervention on hospitalization costs and hospital readmissions among ICU patients at high risk of death or severe functional impairment. Annals of Intensive Care, 14(1), 1–9. https://doi-org.ezproxy.franu.edu/10.1186/s13613-024-01344-9 

Bush, R. N., & Woodley, L. (2022). Increasing Nurses’ Knowledge of and Self-confidence With Family Presence During Pediatric Resuscitation. Critical Care Nurse, 42(4), 27–37. https://doi-org.ezproxy.franu.edu/10.4037/ccn2022898 

Chasweka, G., Majamanda, M. D., & Namathanga, A. (2023). The Cry to Be Involved: Experiences of Caregivers on Participation in Decision Making and Care Provision at Mercy James PICU in Blantyre, Malawi. Comprehensive Child & Adolescent Nursing, 46(1), 20–32. https://doi-org.ezproxy.franu.edu/10.1080/24694193.2022.2085821 

Michelson, K. N., Arenson, M., Charleston, E., Clayman, M. L., Brazg, T., Rychlik, K., Rosenberg, A. R., & Frader, J. (2022). Parental Views of Social Worker and Chaplain Involvement in Care and Decision Making for Critically Ill Children with Cancer. Children, 9(9), N.PAG. https://doi-org.ezproxy.franu.edu/10.3390/children9091287

Ryan, M. J., Lee, L. A., Carnevale, F. A., Crump, L., Garros, D., O’Hearn, K., Curran, J. A., Fiest, K. M., Fontela, P., Moghadam, N., Slumkoski, C., Walls, M., & Foster, J. R. (2025). Parental and family presence are essential: A qualitative study of children’s lived experiences with family presence in pediatric intensive care. Journal of Pediatric Nursing, 80, e228–e235. https://doi-org.ezproxy.franu.edu/10.1016/j.pedn.2024.12.017