Academy Of Pediatrics Research Articles

Social Vulnerability and Pregnancy Option Counseling in the Setting of Periviable Delivery

Background/Objectives: According to the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, pregnant people facing periviable delivery should be counseled on expected neonatal outcomes and available pregnancy options. The objective of this study is to evaluate if rates of neonatology consultation and pregnancy option counseling for those facing periviable delivery differ based on social vulnerability factors or Social Vulnerability Index (SVI). Methods: This was a retrospective cohort study of patients who delivered at 22 0/7 weeks to 25 6/7 weeks of gestation at two academic medical centers with level III or IV neonatal intensive care units from 2019 to 2022. We analyzed the association between individual-level social vulnerability factors and census-tract-level SVI (released by the Center for Disease Control) and the rates of neonatology consultation and pregnancy option counseling. Results: In 138 periviable deliveries, 70.3% had a neonatology consultation, 92.0% were offered expectant management, 88.4% were offered neonatal full intervention, 41.3% were offered neonatal comfort care, and 44.9% were offered pregnancy termination. The rate at which neonatology consultations were completed and each pregnancy option was addressed did not differ by individual-level social vulnerability factors including race/ethnicity, government insurance, marital status, English proficiency, and parity, or by SVI. Conclusions: While these findings suggest that individual-level social vulnerability factors and SVI do not influence periviability counseling, we did identify gaps in comprehensive periviability counseling. Focus should be placed on increasing the rate of neonatology consultation and discussing the options of neonatal comfort care and pregnancy termination.

Optimizing Variables for Contingency Management Among Infant Caregivers Using a Simulated Purchase Task.

Behavioral economics offers a framework for understanding choice making around public health concerns such as drug use and distracted driving. Such a framework could be beneficial to understanding caregiver choices related to arranging an infant sleep environment. Nonadherence to infant sleep safety guidelines provided by the American Academy of Pediatrics increases the risk of sleep-related infant deaths. The present study adopted a willingness-to-accept purchase task procedure, used in previous research to evaluate variables that predict abstaining from consuming alcohol, to evaluate intention to adhere to recommendations for arranging a safe infant sleep environment. This analysis would inform contingency management incentive scales used to measure caregiver adherence following training caregivers to arrange an infant sleep environment and identify variables that might predict treatment engagement. The results identified incentive sizes, condition duration, and participant variables that predict caregiver adherence. The results can be applied to future investigations that train caregivers to arrange an infant sleep environment.

Understanding parental choices related to infant sleep practices in the United States using a mixed methods approach

BackgroundThis study aimed to gather information about parental practices, knowledge, and attitudes regarding infant sleep habits and environments, among families who practice non-recommended sleep practices.MethodsWe conducted one-on-one phone interviews with parents who had practiced non-recommended sleep methods with their infant and had or had not experienced an undesirable sleep event such as a fall. Interviews were recorded and coded with MAXQDA software. Intercoder reliability was assessed for consistency.ResultsThirty-one parents consented, and 21 interviews were conducted. Parents were aware of current American Academy of Pediatrics (AAP) sleep recommendations for infants, knew about the sleep risks of non-recommended practices and had access to a recommended sleep environment. Parents reported developing modifications to the sleep environment which they perceived made their infant’s sleep safer. Many parents felt that they could not be honest with their primary care provider about utilizing a non-recommended sleep environment; many had not had a detailed conversation with their primary care provider about safe sleep.ConclusionsOur data are consistent with previous studies which demonstrate that lack of access to a recommended sleep space or lack of knowledge about AAP sleep guidelines are not the primary reasons for practicing non-recommended sleep habits. Our data highlights the disconnect between the current AAP safe sleep recommendations and what parents feel is feasible to do on a daily basis. Evaluating the impact of a risk elimination strategy which is used in the US compared with a risk mitigation strategy which is used in other countries on parental practice and ability to communicate honestly with primary care providers is a future area of research.

Case Report: Neurological Sequels in Infant with Salmonella Meningitis

Salmonella meningitis in infant was reported in few cases worldwide [1-4]. All reported cases associated with increased morbidity and mortality. The American Academy of Paediatrics (AAP) recommends that Salmonella meningitis patients should be treated for four weeks or three weeks after sterilisation of CSF even if there is a response to medications to prevents relapse [10].

Association between weekday sleep, weekday-weekend sleep duration gap, and hypertension in American adolescents: a nationwide cross-sectional study

BackgroundThe increasing prevalence of primary hypertension among children and adolescents is a global health concern, with inadequate sleep duration identified as a significant risk factor. This study investigates the impact of weekday-weekend sleep duration gap (WWSDG) on hypertension among American adolescents.MethodsUsing data from the NHANES 2017-2020 cohort, we analyzed sleep patterns and hypertension prevalence among 430 adolescents. Sleep durations on weekdays and weekends were used to calculate WWSDG. Hypertension was defined according to the American Academy of Pediatrics guidelines.ResultsThe study found that among 430 American adolescents, shorter weekday sleep duration (less than 8 hours) was significantly associated with an increased risk of hypertension (OR: 1.092, 95% CI: 1.042–1.144), while extended weekend sleep did not show a protective effect. Additionally, longer total weekly sleep duration (over 10 hours) was linked to a reduced risk of hypertension, but the difference in sleep duration between weekdays and weekends was not significantly correlated with hypertension risk.ConclusionsThe study highlighted that insufficient weekday sleep duration significantly increases hypertension risk among adolescents. Contrary to popular belief, compensating for sleep deprivation through extended WWSDG did not mitigate this risk. Public health interventions should focus on promoting consistent and adequate sleep throughout the week for cardiovascular health benefits in adolescents. Further longitudinal research is necessary to explore causal relationships and the long-term effects of sleep variability on health outcomes.

Association between prenatal exposure to phthalate esters and blood pressure in children aged 3-7 years: A prospective cohort study.

An increasing number of animal studies have indicated that exposure to phthalate esters (PAEs) may cause high blood pressure. However, population-based evidence is limited, particularly for pregnant women and young children. To examine the correlation between prenatal exposure to phthalate ester metabolites (mPAEs) and blood pressure in preschool children. In our cohort study, 497 pairs of mothers and children (aged 3-7 years) were enrolled at the Wuhan Maternal and Child Healthcare Hospital, Wuhan, China, between 2016 and 2017. Eight mPAEs were detected in the urine samples of pregnant women during the third trimester. Systolic (SBP) and diastolic blood pressure (DBP) were measured by physicians using an automated oscillometric sphygmomanometer and childhood hypertension was defined according to the American Academy of Pediatrics 2017 guidelines. Mixed-effects linear regression models were used to estimate the correlations between individual mPAEs and the SBP and DBP z-scores of preschoolers. Binary logistic regression models were used to examine the correlation between individual mPAEs and hypertension risk. A weighted quantile sum (WQS) regression was implemented to explore the correlation between mixed mPAEs and the SBP/DBP z-scores in children. Monomethyl phthalate, monobutyl phthalate (MBP), monoethyl phthalate, mono(2-ethylhexyl) phthalate, mono(2-ethyl-5-hydroxyhexyl) phthalate and mono(2-ethyl-5-oxohexyl) phthalate were significantly positively correlated with increases in the SBP and DBP z-scores, whereas MBP was significantly correlated with hypertension risk, with an odds ratio of 1.695 (95 % confidence interval: 1.322, 2.173). Moreover, the WQS regression analyses revealed that MBP increased SBP (67.7 %) and DBP (80.8 %). The present study suggests that prenatal exposure to PAEs was positively correlated with increased blood pressure in pre-school children, and MBP is of particular concern because it contributed the most to the combined effect of PAE mixture on the risk of childhood hypertension.

Newborn Screening for Critical Congenital Heart Disease: A New Algorithm and Other Updated Recommendations: Clinical Report.

Critical congenital heart disease (CCHD) screening was added to the US Recommended Uniform Screening Panel in 2011 and adopted by all US states and territories by 2018. In addition to reviewing key developments in CCHD screening since the initial American Academy of Pediatrics (AAP) endorsement in 2011, this clinical report provides 3 updated recommendations. First, a new AAP algorithm has been endorsed for use in CCHD screening. Compared with the original AAP algorithm from 2011, this new algorithm a) has a passing oxygen saturation threshold of ≥95% in both pre- and post-ductal measurements; and b) has only 1 retest instead of 2 for infants who did not pass the first screen. Second, to continue to improve screening, state newborn screening programs should collect a recommended minimum uniform dataset to aid in surveillance and monitoring of the program. Finally, stakeholders should be educated on the limitations of screening, the significance of non-CCHD conditions, and the importance of protocol adherence. Future directions of CCHD screening include improving overall sensitivity and implementing methods to reduce health inequities. It will remain critical that the AAP and its chapters and members work with health departments and hospitals to achieve awareness and implementation of these recommendations.

Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Clinical Report.

The sudden onset of severe behavioral and neuropsychiatric symptoms in children is a frightening and potentially life-changing situation. The pediatric health care providers and clinicians to whom families turn need guidance on how to accurately diagnose and treat new-onset neuropsychiatric symptoms in children. They need expert guidance about whether these symptoms indicate a diagnosis compatible with pediatric acute-onset neuropsychiatric syndrome (PANS). The cause of PANS is unknown, but it is theorized to be triggered, in some cases, by a recent infection and/or autoimmunity issues (similar to Sydenham chorea, autoimmune encephalitis [AE], and Guillain-Barré syndrome). The condition is challenging from a clinical perspective, because it lacks disease-specific biomarkers, strong evidence for pathogenic causes, and consensus on treatment of clinical symptoms. Further, the evidence base for PANS encompasses multiple subspecialties, including child and adolescent psychiatry, pediatric rheumatology, pediatric neurology, pediatric infectious diseases, pediatric immunology, and developmental-behavioral pediatrics.Given this complexity, there is a clear need for guidance and advice for pediatric clinicians and the families they serve and support. To that end, with the encouragement of the Board of Directors, the American Academy of Pediatrics (AAP) has developed this clinical report. It focuses primarily on PANS, an umbrella condition that encompasses pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Although PANDAS is, by definition, associated with streptococcal infection,1 it is now considered by many to represent a subset of the larger spectrum of infection-induced acute-onset neuropsychiatric symptoms.2,3 This clinical report was developed after a comprehensive literature review and analysis of the findings. Because they are limited by the present level of evidence on the topic, the findings are presented as a report rather than a clinical practice guideline. The contents are intended to aid the pediatric health care provider in evaluating, diagnosing, and treating sudden-onset and severe behavioral changes in children that could indicate potential PANS and in supporting these children and their families.

External Validation of Brief Resolved Unexplained Events Prediction Rules for Serious Underlying Diagnosis

The American Academy of Pediatrics (AAP) higher-risk criteria for brief resolved unexplained events (BRUE) have a low positive predictive value (4.8%) and misclassify most infants as higher risk (>90%). New BRUE prediction rules from a US cohort of 3283 infants showed improved discrimination; however, these rules have not been validated in an external cohort. To externally validate new BRUE prediction rules and compare them with the AAP higher-risk criteria. This was a retrospective multicenter cohort study conducted from 2017 to 2021 and monitored for 90 days after index presentation. The setting included infants younger than 1 year with a BRUE identified through retrospective chart review from 11 Canadian hospitals. Study data were analyzed from March 2022 to March 2024. The BRUE prediction rules. The primary outcome was a serious underlying diagnosis, defined as conditions where a delay in diagnosis could lead to increased morbidity or mortality. Of 1042 patients (median [IQR] age, 41 [13-84] days; 529 female [50.8%]), 977 (93.8%) were classified as higher risk by the AAP criteria. A total of 79 patients (7.6%) had a serious underlying diagnosis. For this outcome, the AAP criteria demonstrated a sensitivity of 100.0% (95% CI, 95.4%-100.0%), a specificity of 6.7% (95% CI, 5.2%-8.5%), a positive likelihood ratio (LR+) of 1.07 (95% CI, 1.05-1.09), and an AUC of 0.53 (95% CI, 0.53-0.54). The BRUE prediction rule for discerning serious diagnoses displayed an AUC of 0.60 (95% CI, 0.54-0.67; calibration intercept: 0.60), which improved to an AUC of 0.71 (95% CI, 0.65-0.76; P < .001; calibration intercept: 0.00) after model revision. Event recurrence was noted in 163 patients (15.6%). For this outcome, the AAP criteria yielded a sensitivity of 99.4% (95% CI, 96.6%-100.0%), a specificity of 7.3% (95% CI, 5.7%-9.2%), an LR+ of 1.07 (95% CI, 1.05-1.10), and an AUC of 0.58 (95% CI, 0.56-0.58). The AUC of the prediction rule stood at 0.67 (95% CI, 0.62-0.72; calibration intercept: 0.15). Results of this multicenter cohort study show that the BRUE prediction rules outperformed the AAP higher-risk criteria on external geographical validation, and performance improved after recalibration. These rules provide clinicians and families with a more precise tool to support decision-making, grounded in individual risk tolerance.

Longitudinal stability and predictive value of socio/emotional/behavioral screening in an Outpatient Pediatric Network.

In 2022, the American Academy of Pediatrics recommended annual social/emotional/behavioral (SEB) screening at preventive pediatric visits. Numerous SEB screeners have considerable empirical support for children of all ages. However, few studies inform the longitudinal use of SEB screeners in pediatrics. Using electronic health records (EHR) from seven pediatric clinics in a large hospital system, we analyze the longitudinal stability of three SEB screeners among 9,153 children and adolescents who were screened multiple times over a 3-year period, and we evaluate associations with International Classification of Disease (ICD) codes for SEB diagnoses. Moderate stability was documented for the Baby Pediatric Symptom Checklist (ICC =.57), Preschool Pediatric Symptom Checklist (ICC =.60), and Pediatric Symptom Checklist-17 (ICC =.69). Stability of positive/negative results was sensitive to each screener's threshold. Across a range of thresholds that classify 7-20% of children as positive, all three screeners achieved positive predictive values (PPVs) of approximately 40-65% and diagnostic odds ratios ranging from 8 to 15. These findings compare favorably to published results for longer measures and structured interviews. Recommended thresholds varied markedly across screeners, and associations with ICD codes demonstrate that higher thresholds yield higher specificity but lower sensitivity (i.e., a majority of ICD codes are not anticipated by positive screens). Three common SEB screeners display longitudinal stability similar to longer, more established measures. Results demonstrate that recommended thresholds vary markedly across measures and that choice of threshold strongly influences sensitivity and specificity, underscoring the need for greater attention to selection of thresholds. CLINICAL TRIAL REGISTRATION (IF ANY): none.

Research Progress on the Measurement Methods and Clinical Significance of Capillary Refill Time.

The monitoring of peripheral circulation, as indicated by the capillary refill time, is a sensitive and accurate method of assessing the microcirculatory status of the body. It is a widely used tool for the evaluation of critically ill patients, the guidance of therapeutic interventions, and the assessment of prognosis. In recent years, there has been a growing emphasis on microcirculation monitoring which has led to an increased focus on capillary refill time. The International Sepsis Guidelines, the American Academy of Pediatrics, the World Health Organization, and the American Heart Association all recommend its inclusion in the evaluation of the system in question. Furthermore, the methodology for its measurement has evolved from a traditional manual approach to semiautomatic and fully automatic techniques. This article presents a comprehensive overview of the current research on the measurement of capillary refill time, with a particular focus on its clinical significance. The aim is to provide a valuable reference for clinicians and researchers and further advance the development and application of microcirculation monitoring technology.

Increased sound levels in the cardiac ICU are associated with an increase in heart rate, blood pressure, and sedation.

Several organizations including the Environmental Protection Agency, World Health Organization and American Academy of Pediatrics recommend that hospital sound levels not exceed 45 decibels. Yet, several studies across multiple age groups have observed higher than recommended levels in the intensive care setting. Elevated sound levels in hospitals have been associated with disturbances in sleep, patient discomfort, delayed recovery, and delirium. We measured sound levels in a pediatric cardiac intensive care unit and collected vital signs data, sedation dosing and delirium scores. During a 5-week study period, sound levels for 68 patients in 22 private and 4 semi-private rooms were monitored. Sound levels were consistently above stated recommendations with an average daytime level of 50.6 decibels (maximum, 76.9 decibels) and an average nighttime level of 49.5 decibels (maximum, 69.6 decibels). An increase in average and maximum sound levels increased the probability of sedation administration the following hour (p-value < 0.001 and 0.01, respectively) and was predictive of an increase in heart rate and blood pressure (p-value < 0.001). Sound levels in the CICU were consistently higher than recommended. An increase in heart rate, blood pressure and sedation utilization may suggest a stress response to persistent and sudden loud sounds. Given known negative impacts of excessive noise on stress, sleep, and brain development, as well as the similar adverse effects from the related use of sedative medications, reducing excessive and sudden noise may provide an opportunity to improve short- and long-term hemodynamic and neurodevelopmental outcomes in the pediatric cardiac intensive care unit.

Association Between Severe Periodontitis and Cognitive Decline in Older Adults.

(1) Background: Periodontal disease, a progressive inflammatory condition, disrupts the oral microbiome and releases inflammatory cytokines, leading to systemic issues, including cognitive decline. This study investigates the association between severe periodontitis and cognitive decline, exploring the role of alkaline phosphatase (ALP), an enzyme linked to systemic inflammation, as an effect modifier. (2) Methods: We analyzed cross-sectional data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES). Severe periodontitis was defined using the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) case definition. A weighted multivariable logistic regression model assessed the association between severe periodontitis and cognitive decline. An interaction term examined ALP's role as an effect modifier. (3) Results: This study included 1265 participants aged 65 and older. After adjusting for confounders, each one-point increase in cognitive function score was associated with a 2% decrease in the odds of severe periodontitis (OR = 0.98; 95% CI = 0.97-0.99; p = 0.008). ALP was a significant effect modifier in the relationship between severe periodontitis and cognitive decline. (4) Conclusions: This study, using a representative U.S. adult population aged 65 and over, suggests that lower cognitive performance correlates with higher likelihood of severe periodontitis. ALP enhances the association between severe periodontitis and cognitive decline.

Performance of clinical decision aids (CDA) for the care of young febrile infants: a multicentre prospective cohort study conducted in the UK and Ireland

Between 1% and 4% of febrile infants, aged from birth to 90 days of age, presenting to hospital will be diagnosed with an invasive bacterial infection (IBI). Traditional teaching has advocated a treat all approach but more recently a number of clinical decision aids (CDA) have been developed to classify febrile infants into lower and higher risk cohorts, with lower risk infants suitable for management without immediate parenteral antibiotics and lumbar puncture. The aim of this study was to apply these CDA to a UK and Irish cohort. This was a prospective multicentre cohort study of febrile infants presenting to 35 Paediatric Emergency Research in the UK and Ireland (PERUKI) sites between the 6th July 2022 and the 31st August 2023. All infants received standard care as per local policy. IBI was defined as growth of bacterial pathogen in blood or cerebrospinal fluid. The performance of the following CDAs were assessed, National Institute for Health and Care Excellence (NICE) guidelines NG143 (Fever under 5 years), British Society Antimicrobial Chemotherapy (BSAC), Aronson rule and American Academy of Pediatrics (AAP) CDA. A cost comparison of each CDA against a treat all approach was conducted. Trial registration: NCT05259683. 1821 were included in the final analysis. The median age was 46 days (IQR: 30-64 days), with 1108 (61%) being male. Of the 1821 infants, 67 (3.7%) had IBI. The AAP and BSAC CDAs were the most sensitive at 0.99 (95% CI 0.92-1.0) for both with specificities of 0.23 (95% CI 0.21-0.25) and 0.20 (95% CI 0.18-0.22) respectively. The NICE NG143 and Aronson CDA were the most specific CDAs with values of 0.27 (95% CI 0.25-0.30) and 0.30 (95% CI 0.28-0.32) respectively, but their sensitivity was lower. The AAP CDA performed equally well with either procalcitonin (PCT) or C-reactive protein (CRP) as the biomarker of choice. Of the 1821 infants, 77% were admitted, 14% were discharged and 9% were ambulated. All CDAs were cost saving for hospital services when compared to a treat all approach, with the lowest mean cost per patient estimated for Aronson (£1171; bootstrap 95% CI £1129-£1214) and NICE NG143 CDA (£1218; bootstrap 95% CI £1174-£1263). The AAP and BSAC CDAs are highly sensitive at excluding IBI, with a cost saving to hospital services when compared to a treat all approach. The substitution of CRP for PCT made no difference to the performance of the AAP CDA in this cohort and was more costly. The Febrile Infant Diagnostic Assessment and Outcome (FIDO) study is funded by Royal College of Emergency Medicine Doctoral Fellowship (RCEM 02/03/2021). Procalcitonin analysis was supported by the Public Health Agency Northen Ireland Grant (HSC R&D-COM/5745/22). The funders played no part in the conception or design of this study.

Comparison of Antibiotic Recommendation between Early Onset Neonatal Sepsis Calculator and American Academy of Pediatrics 2018 Guidelines in a Tertiary Hospital

Comparison of Antibiotic Recommendation between Early Onset Neonatal Sepsis Calculator and American Academy of Pediatrics 2018 Guidelines in a Tertiary Hospital

Ethics Consultation in U.S. Pediatric Hospitals: Adherence to National Practice Standards

Background The American Society for Bioethics and Humanities (ASBH), a professional organization that certifies ethics consultants who pass the qualifying examination, published standards for the conduct of ethics consultations (EC). A national survey of adult hospital ethics consultants identified adherence to these standards, but no assessment of pediatric hospitals’ adherence has been done. Methods In this cross-sectional study, a national questionnaire was distributed electronically in 2022 to pediatric ethics consultants at children’s hospitals, collecting information about adherence to the ASBH standards. Hospital characteristics were extracted from the Children’s Hospital Association Annual Benchmark Report. Quantitative analysis included descriptive statistics to assess adherence and analyses of variance to investigate associations between hospital characteristics and the time taken to respond to consultations. Results Of the 181 eligible pediatric hospitals, we received 104 completed surveys (57%) from 45 states. Pediatric EC have similar adherence rates to ASBH standards as adult hospitals. High-adherence (>75%) areas included having an expert available for EC and permitting any staff member to request EC. Low-adherence areas included having comprehensive policies covering all aspects of EC activities, having a response plan for egregious violations, and the elicitation of formal feedback after EC. There is an increased average response time for ethics consultation services in smaller pediatric hospitals and church-operated hospitals. Conclusions Pediatric hospitals overall have moderate adherence to the ASBH EC standards, with the highest rates occurring for standards that are shared by the American Academy of Pediatrics. Additional research into the barriers to standard adherence and the effectiveness of standards is warranted with emphasis on the impact of adherence on consultation quality.

Transforming a hospital's organizational culture to promote parent-child relationships and child development.

Early caregiving interactions and experiences profoundly shape a child's brain development. The American Academy of Pediatrics (AAP) recently advocated for a public-health approach to promoting safe, stable, nurturing relationships that is "founded on universal primary preventions", including consistent messaging on fostering family resilience, nurturing connections, and positive childhood experiences. Hospitals have unique access to families with children ages 0-5 and therefore play a key role in supporting these early experiences. This project sought to shift the organizational culture of maternity and pediatric units at a hospital towards promoting early relationships and child development through a physical messaging campaign paired with staff training. This study examined whether the messaging campaign and staff training shifted staff's self-reported knowledge, attitudes, and behavior. Non-physician staff across six pediatric and maternity units in a large urban hospital participated in the intervention. Staff completed surveys before and after message installation and training. Analysis of 356 pre-intervention surveys and 320 post-intervention surveys showed significant changes in staff's knowledge, attitudes, and behaviors that promote early learning and parent-child relationships. Most staff also reported feeling more empowered in their work (88%) and that the hospital environment had become a friendlier place for parents and families (89%). A messaging and training intervention can create a culture whereby staff support early caregiving and child development in the hospital setting. Further research is needed to understand whether the intervention impacts caregivers and their children.

Information Sharing to Enhance Early Childhood Services.

The purpose of this study was to investigate stakeholder willingness to share information among various social service providers, and to determine perceived barriers to accessing these services in our state. The Maryland Family Network and the Maryland Chapter, American Academy of Pediatrics partnered to collect information on family information sharing preferences and barriers to services. We received 22 Survey Monkey responses and had 41 focus group participants aged25 to 44years and all regions of the state were represented. Nearly half of participants were Black or African American and participants indicated a broad range of family income. Most participants were a part of multiple assistance programs and were comfortable with all their information being shared, except their social security number. One third of participants noted they did not face barriers to accessing services. The other two thirds noted confusing applications, technology limitations and the need for self-advocacy as significant barriers. Families are very comfortable sharing information among early childhood service providers, and in fact favor having a single basic application that allows them to check off the agencies to which they would like to apply. Barriers to accessing services are logistical as well as cultural.

Bangladeshi Parents’ Awareness of Young Children’s Smartphone Use

Nowadays the tendency for smartphone use among children is noticeable and day by day this tendency is increasing at an alarming rate. The aim of this study was to explore the status of Bangladeshi children’s smartphone use and Bangladeshi parents' awareness of young children’s smartphone use in terms of AAP guidelines. The study employed a mixed-methods research approach and adopted purposive sampling. The data were collected through an online questionnaire from 83 parents who owned smartphones and whose children were between 0 and 5 years old. The findings show that 75.6% of parents did not know about the guidelines for children’s screen use recommended by the American Academy of Paediatrics. Although they did not know the recommended guidelines, 81.1% of the parents had taken various steps to control their children's excessive smartphone usage and the steps were effective in reducing children's excessive smartphone use. It is noteworthy that 98% of children use smartphones and the excessive use of smartphones is negatively associated with the development of children. Moreover, educational contents on smartphones that maintain the guidelines are positively associated with children’s development. However, it is clear that smartphones had both positive and negative effects on children’s development and most of the parents were unaware of the AAP guidelines for screen use. Therefore, there is a need for increasing proper awareness among parents to mitigate the negative effects before the problems arise.

Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Policy Statement.

Reading together often with infants and young children strengthens their relationships with parents and caregivers at a critical time in child development, stimulating brain circuitry and early attachment. A positive parenting practice, shared reading helps build the foundation for healthy social-emotional, cognitive, language, and literacy development, setting the stage for school readiness and providing enduring benefits across the life course. Pediatric physicians and advanced care providers have a unique opportunity to encourage parents and caregivers to establish routines and enjoy conversations around books and stories with their children beginning in infancy. Research has demonstrated that parents read and children learn when pediatricians offer literacy promotion as a practical and evidence-based primary prevention strategy in primary care practice to support early brain and child development. This supports families with a strengths-based approach, shaping a child's life trajectory and helping mitigate stress and adverse experiences. The American Academy of Pediatrics (AAP) recommends that pediatricians encourage shared reading, beginning at birth and continuing at least through kindergarten, as a strategy for supporting parents and caregivers, enhancing foundational relationships, promoting positive language-rich interactions, and helping families create nurturing and stimulating home environments. The integration of literacy promotion into pediatric resident education is crucial to achieve that goal and thus is also essential. The AAP supports advocacy toward establishing public and private funding for diverse high-quality, developmentally appropriate children's books in the languages preferred by the family to be provided at pediatric health supervision visits to all children but especially to children living in underresourced communities. This statement is supported by multiple AAP policies and implementation resources, including the accompanying "Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Technical Report."