Little is known about the importance of culture and language in the emergency care of children. The study goal was to conduct a critical review of published studies on culture and language in pediatric emergency care. We used PubMed to perform a literature search of all articles on culture, language, and the emergency care of children published in English/Spanish from 1966-1999. The >2,000 citations initially identified yielded 117 final articles that revealed the following: certain normative cultural values, such as the Navajo hozhooji, can profoundly affect informed consent/medical risk discussions. For limited English proficient children, trained interpreters frequently aren't available or used, and they face more access barriers and poorer understanding of their diagnosis/treatment. Numerous folk illnesses, such as empacho among Latinos, affect care because symptoms overlap with biomedical conditions, first clinical contacts may be with folk healers, and certain remedies are harmful or fatal. Parent beliefs/practices can cause serious morbidity and fatalities (from lead poisoning, liver failure, and other causes), costly/unnecessary medical evaluations (example: Fenugreek teas), and clinical findings easily confused with child abuse (example: coining). Biased provider attitudes and practices can have profound clinical consequences, including ethnic disparities in prescriptions, analgesia, test ordering, sexual histories, quality of asthma care, and diagnostic evaluations. Failure to appreciate culture and language in pediatric emergencies can have multiple adverse consequences, including informed consent difficulties, miscommunication, inadequate understanding of diagnoses/treatment, dissatisfaction, preventable morbidity/mortality, unnecessary child abuse evaluations, lower quality of care, clinician bias, and ethnic disparities in prescriptions, analgesia, test ordering, and diagnostic evaluations.
Learning Objectives: To appreciate the importance of culture and language in pediatric emergency care
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