Academy Of Pediatrics Research Articles

Answering a Call to Action: Reducing Fetal Alcohol Spectrum Disorders Using a Healthcare Champion Model.

Prenatal alcohol exposure and fetal alcohol spectrum disorders (FASDs) remain critical public health issues. Alcohol use in pregnancy is a leading preventable cause of birth defects, developmental disabilities, and learning disabilities. Alcohol screening and brief intervention (SBI) is effective at reducing excessive alcohol use. However, this clinical preventive service remains critically underutilized in primary care. In 2014, the Centers for Disease Control and Prevention called for the creation of FASD Champion programs to promote clinician education about FASDs. Six professional health organizations and groups providing reproductive and child health services set out to create FASD Champion programs. The American College of Obstetricians and Gynecologists FASDs Prevention Program was created to focus on reducing alcohol-exposed pregnancies. The American Academy of Pediatrics' Champion program maintains the goal of improving health outcomes for children with FASDs by improving pediatricians' diagnostic capacity. The American Academy of Family Physicians has prioritized training family physician champions to improve the delivery of alcohol SBI among adult patients. The University of Alaska Anchorage has partnered with the National Association of Nurse Practitioners in Women's Health, the American College of Nurse-Midwives, and the Association of Women's Health, Obstetric, and Neonatal Nurses to assure advanced practice registered nurses and midwives have the knowledge and skills to prevent alcohol-exposed pregnancies and FASDs. The American Association of Medical Assistants has prioritized expanding the knowledge and skills of medical assistants related to promoting alcohol-free pregnancies. Finally, the Champions program at the University of Texas at Austin was established to train health social workers in alcohol SBI. Through the advocacy, education, and mission of these 6 health sectors in collaboration with national organizations and educational institutions, the evidence-based approach of alcohol SBI is being disseminated throughout the United States to reduce the harmful effects of prenatal alcohol exposure.

European paediatricians need to be more aware of the risks faced by children who swallow button batteries and how to treat them.

The aim of this study was to assess how aware European paediatricians were of the risks faced by children who swallowed button batteries and the advice for managing such cases. An Internet-based survey was conducted among European paediatricians between 1 April 2023 and 31 May 2023. The researchers contacted members of the European Academy of Paediatrics Research in Ambulatory Setting Network and a number of European national paediatric societies. Responses were received from 605 paediatricians (66.0% females) in 41 countries and 64.5% had encountered cases of button battery ingestion. Only 31.2% had received specific training and only 35.7% were familiar with the advice issued by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Academy of Pediatrics. While 90.8% of respondents correctly recognised the need for hospitalisation of a child after button battery ingestion, only 30.1% of them identified all symptoms and 58.2% could accurately determine the appropriate diagnostic scope. One in ten underestimated the health or life risks. These deficiencies were significantly attributed to a lack of adequate training (p < 0.01). The overwhelming majority of the respondents expressed the need to increase awareness among physicians and childcare providers, mainly through social media campaigns and advertisements. European paediatricians were insufficiently aware of button battery ingestion risks and management, with significant gaps in training and familiarity with advice. Respective education for medical practitioners and raising public awareness should be markedly strengthened.

Disparities in Guideline Adherence for Febrile Infants in a National Quality Improvement Project.

Interventions aimed to standardize care may impact racial and ethnic disparities. We evaluated the association of race and ethnicity with adherence to recommendations from the American Academy of Pediatrics' clinical practice guideline for febrile infants after a quality improvement (QI) intervention. We conducted a cross-sectional study of infants aged 8 to 60 days enrolled in a QI collaborative of 99 hospitals. Data were collected across 2 periods: baseline (November 2020-October 2021) and intervention (November 2021-October 2022). We assessed guideline-concordance through adherence to project measures by infant race and ethnicity using proportion differences compared with the overall proportion. Our study included 16 961 infants. At baseline, there were no differences in primary measures. During the intervention period, a higher proportion of non-Hispanic white infants had appropriate inflammatory markers obtained (2% difference in proportions [95% confidence interval (CI) 0.7 to 3.3]) and documentation of follow-up from the emergency department (2.5%, 95% CI 0.3 to 4.8). A lower proportion of non-Hispanic Black infants (-12.5%, 95% CI -23.1 to -1.9) and Hispanic/Latino infants (-6.9%, 95% CI -13.8 to -0.03) had documented shared decision-making for obtaining cerebrospinal fluid. A lower proportion of Hispanic/Latino infants had appropriate inflammatory markers obtained (-2.3%, 95% CI -4.0 to -0.6) and appropriate follow-up from the emergency department (-3.6%, 95% CI -6.4 to -0.8). After an intervention designed to standardize care, disparities in quality metrics emerged. Future guideline implementation should integrate best practices for equity-focused QI to ensure equitable delivery of evidence-based care.

The risk of sleep-related death in an inclined sleep environment

BackgroundUnsafe sleep environments are the primary modifiable risk factor for sudden unexpected infant death (SUID). Despite this knowledge, products that deviate from the American Academy of Pediatrics (AAP) safe sleep recommendations continue to be commonplace, such as inclined sleepers. Analyses to estimate risk among these products are lacking, perpetuating their presence in the marketplace. We present a method of comparing risk of SUID in an inclined sleeper to an AAP-recommended sleep environment.MethodsA case-control analysis using publicly available and previously published survey data was conducted for SUID events occurring between January 1, 2018 and April 12, 2019 (the date of the first inclined sleeper recall). SUID deaths were categorized as occurring in an AAP-recommended sleep environments or in an inclined sleeper. Exposure Odds Ratios (OR) are reported as the risk of SUID among infants using inclined sleepers relative to an AAP-recommended sleep environment.ResultsDuring the study period, 4,900,573 births and 4,363 SUID deaths occurred in the US. Control characteristics were similar between previous night users of an AAP-recommended sleep environment (24%) and inclined sleepers (3.8%). Inclined sleepers were associated with a 5-fold (OR: 5.1; 95% CI: 3.2, 7.9) increased risk of SUID among infants < 12 months compared to infants in an AAP-recommended sleep environment. This risk was greatest among infants ≥ 4 months (RR: 10.4; 95% CI: 5.1, 21.5).ConclusionsThis novel analysis fills a longstanding gap in risk assessments of inclined infant sleep products. More timely risk analyses may improve the safety of the marketplace.

Burns, Foreign Bodies, and Beyond

This article reviews the American Academy of Pediatrics (AAP) coding webinar, “Burns, Foreign Bodies, and Beyond: Coding Acute Procedures in Pediatrics” (https://publications.aap.org/codingnews/info-parent/28119/Burns-Foreign-Bodies-and-Beyond-Coding-Acute). The webinar addresses the following topics: What is included in the payment for procedures?Commonly performed office and outpatient proceduresSeparately reported evaluation and management (E/M) services

A pediatric primary care practice-based obesity intervention to support families: a cluster-randomized clinical trial.

The American Academy of Pediatrics recommends that pediatric practices help families make lifestyle changes to improve BMI, but provider time and access to treatment are limited. This study compared the effectiveness of two pediatric practice-based referral interventions in reducing BMI. In this cluster-randomized clinical trial, 20 pediatric primary care practices were randomized to telephonic coaching (Fitline Coaching) or mailed workbook (Fitline Workbook). Parents and their 8- to 12-year-old children with BMI ≥ 85th percentile completed assessments at baseline and at6 and 12 months post baseline. Primary outcomes were 12-month BMI percentile and z score. A total of 501 children and their parents received Fitline Coaching (n = 243) or Fitline Workbook (n = 258); 26.8% had overweight, 55.4% had obesity, and 17.8% had severe obesity. Mean (SD) age was 10.5 (1.4), and 47.5% were female. BMI percentile improved in both groups; 12-month decline in continuous BMI z score was not statistically significant in either group. However, 20.8% of telephonic coaching participants and 12.4% of workbook participants achieved a clinically significant reduction of at least 0.25 in BMI z score, a significant between-group difference (p = 0.0415). Both low-intensity interventions were acceptable and produced modest improvements in BMI percentile. One in five children in the telephonic coaching condition achieved clinically meaningful BMI z score improvements. However, more research is needed before such a program could be recommended for pediatric primary care practice.

Universal versus targeted treatment of neonatal herpes simplex virus among neonates presenting for sepsis evaluations.

The American Academy of Pediatrics recently published guidance for the evaluation and management of febrile infants. However, guidance on testing and empiric treatment for neonatal herpes simplex virus (HSV) remains less standardized and subject to clinical practice variation. Recent reports reveal that high numbers of infants presenting for sepsis evaluations need to be treated empirically with acyclovir to capture one case of neonatal HSV. Clinical and laboratory risk factors for neonatal HSV identified in the literature can be used for a targeted approach to testing and treating infants for HSV to optimize resource utilization. The literature supports a targeted approach to evaluation and empiric acyclovir treatment for neonatal HSV, but additional studies are needed to validate this approach given the rarity of disease.

Development and Evaluation of a Web-Based Family-Centered Decision Support Tool About Firearm Storage.

Many youth in the USA have access to a loaded and unlocked firearm in their home. Discussions between adult family members have the potential to positively influence firearm storage. Work with firearm-owning parents to develop and obtain preliminary data about the efficacy of a family-centered decision support tool about firearm storage. We adapted the Ottawa Personal Decision Guide for Two to the issue of firearm storage, producing the Family Safety Check-In. Subsequently, we evaluated its acceptability and impact on intentions to make a plan with their partner (or other adult sharing parental duties) about safer firearm storage. Participants were parents/guardians of at least one school-aged child, had firearms in their home, and resided in the USA (n = 402). They completed a web-based pre-test survey, were randomized to the Family Safety Check-In or an American Academy of Pediatrics (AAP) informational resource about firearm storage for families, and then completed a post-test survey. The Family Safety Check-In had higher ratings for acceptability (B = 1.24, 95% CI = 0.58-1.90) and appropriateness (B = 1.46, 95% CI = 0.72-2.19) than the AAP resource. Participants in the Family Safety Check-In condition also had greater intentions to make a plan with their partner about storing firearms more safely (OR = 1.90, 95% CI = 1.26-2.87). The Family Safety Check-In is a promising direction for harm reduction that warrants further evaluation.

Impact of Elevated Screen Time on School-Age Adolescents During the COVID-19 Pandemic: An Analytical Study.

The rise in digital technology use, especially during the COVID-19 pandemic, has heightened concerns about extended "screen time" (ST) among adolescents. Excessive screen use is linked to negative physical and cognitive effects, yet digital media also offers educational and social advantages. Cultivating healthy digital habits is crucial as technology continues to evolve. Thiscross-sectional studywas conducted betweenJuly and August 2022 amongschool-going adolescents and a total of 221 participants were assessed through questionnaires, employing statistical analysis. In the current study, all participants fell within the 16-18 year age group, with 114 (51.6%) being male and 107 (48.4%) female. The majority 209 (94.5%) identified as Hindu, while the rest were from Muslim and Christian communities. Most participants, both male and female, resided in urban areas, 140 (63.3%) were pursuing Class 12, and73 (33.1%) were pursuing Class 11. Mobile phones were the most commonly owned devices, followed by desktops or laptops and tablets. Males generally spend more time on these devices than females. Notably, 168 (76.01%) adolescents exceeded the recommended 2-hour daily screen time limit set by the American Academy of Pediatrics (AAP), with92 (80.7%) males more likely to do so than 76 (71%) females. The study found a significant link between increased screen time, reduced physical activity, and academic performance, while no association was observed for behavioral risk factors. There is increased digital device use among youth, with many exceeding recommended screen time limits, particularly males. This was significantly linked to reduced physical activity and academic decline, highlighting the need for further research and balanced digital use.

Defining childhood hypertension: is it too complicated? An evaluation of the potential impact of different approaches in an Australian paediatric population.

Current American Academy of Pediatrics (AAP) and European Society of Hypertension (ESH) thresholds defining hypertension in children use blood pressure (BP) normalised to age, sex and height. However, scare data exists regarding the relative importance of these variables to accurately model the 95th quantile of BP. We hypothesised that height alone may fit the population data equally well compared to more complex definitions. We also compare the potential impact of various thresholds for defining hypertension in an Australian population. Longitudinal data from the Raine Study were used, with 2248 participants contributing 7479 valid BP values across the 3/5/10/14/17-year study visits. BP was measured after 5 min rest, ≥3 times at each visit, using a Dinamap device. Quantile regression was used to predict the 95th percentile of BP, with nonlinear modelling of covariates through restricted cubic spline terms. At a single visit, 6-16% of young children exceeded the ESH threshold and 12-23% the AAP threshold. The transition to fixed thresholds (≥13 years AAP, ≥16 years ESH), increased the number of males (AAP only) and reduced the number of females considered hypertensive. A quantile regression model constructed with Raine Study data using height-only as the explanatory variable better predicted BP than the respective model using age-only (or a combination of the two). There may be large differences in the prevalence of hypertension according to AAP and ESH criteria, with a marked sex-discrepancy emerging from the point of fixed threshold application in adolescence. It may not be necessary to normalise BP by both age and height, the latter being a better predictor of childhood BP. Simpler methods may be preferable in clinical practice but require validation against clinical outcomes.

Multilevel Interventions and Dental Attendance in Pediatric Primary Care

Untreated tooth decay is disproportionately present among low-income young children. While American Academy of Pediatrics (AAP) guidelines require pediatric clinicians to implement oral health care, the effectiveness of these oral health interventions has been inconclusive. To test the effectiveness of multilevel interventions in increasing dental attendance and reducing untreated decay among young children attending well-child visits (WCVs). The Pediatric Providers Against Cavities in Children's Teeth study is a cluster randomized clinical trial that was conducted at 18 pediatric primary care practices in northeast Ohio. The trial data were collected between November 2017 and July 2022, with data analyses conducted from August 2022 to March 2023. Eligible participants included Medicaid-enrolled preschoolers aged 3 to 6 years attending WCVs at participating practices who were enrolled at baseline (WCV 1) and followed-up for 2 consecutive examinations (WCV 2 and WCV 3). Clinicians in the intervention group received both the practice-level (electronic medical record changes to document oral health) and clinician-level (common-sense model of self-regulation theory-based oral health education and skills training) interventions. Control group clinicians received AAP-based standard oral health education alone. Dental attendance was determined through clinical dental examinations conducted by hygienists utilizing International Caries Detection and Assessment System criteria and also from Medicaid claims data. Untreated decay was determined through clinical examinations. A generalized estimating equations (GEE) approach was used for both clinical examinations and Medicaid claims data. Eighteen practices were randomized to either intervention or control. Participants included 63 clinicians (mean [SD] age, 47.0 [11.3] years; 48 female [76.2%] and 15 male [23.8%]; 28 in the intervention group [44.4%]; 35 in the control group [55.6%]) and 1023 parent-child dyads (mean [SD] child age, 56.1 [14.0] months; 555 male children [54.4%] and 466 female children [45.6%]; 517 in the intervention group [50.5%]; 506 in the control group [49.5%]). Dental attendance from clinical examinations was significantly higher in the intervention group (170 children [52.0%]) vs control group (150 children [43.1%]) with a difference of 8.9% (95% CI, 1.4% to 16.4%; P = .02). The GEE model using clinical examinations showed a significant increase in dental attendance in the intervention group vs control group (adjusted odds ratio, 1.34; 95% CI, 1.07 to 1.69). From Medicaid claims, the control group had significantly higher dental attendance than the intervention group at 2 years (332 children [79.6%] vs 330 children [73.7%]; P = .04) but not at 3 years. A clinically but not statistically significant reduction in mean number of untreated decay was found in the intervention group compared with controls (B = -0.27; 95% CI, -0.56 to 0.02). In this cluster randomized clinical trial, children in the intervention group had better dental outcomes as was evidenced by increased dental attendance and lower untreated decay. These findings suggest that intervention group clinicians comprehensively integrated oral health services into WCVs. ClinicalTrials.gov Identifier: NCT03385629.

Forgotten interventions to promote relational health to prevent child maltreatment

Harsh parenting and intimate partner violence increased during the pandemic. However, pediatrician-led evidence-based models that link primary care, home visiting, and child maltreatment prevention have been neglected, despite C. Henry Kempe’s successful programs from 1971 to 1973. The Kempe randomized trial included comprehensive pediatric follow-up by a single physician and a lay health visitor whenever indicated, and/or weekly visits by a public health nurse in the home 50 years ago. The interventions responded to abnormal parenting practices and early warning signs during pregnancy, labor and delivery, and postnatally and reduced the hospitalization for serious injuries among those 2 years old. The Kempe trial was not cited in many publications but only 402 times in Google Scholar in October 2023. Kempe's call for promoting emotional health and parent bonding 40 years ago was echoed in the American Academy of Pediatrics’ Bright Futures and Policy Statements on Promoting Relational Health in 2021. Relational health is a strengths-based approach, which can promote safe, stable, and nurturing relationships, buffer adversity, and build resilience. Screening for relational health should be integrated into Obstetric and Pediatric Care, and home visitation should become linked to primary care as a basic health benefit. Pediatric care must be transformed based on the evidence in the Kempe trial, focus on promoting primary prevention and trusted relationships from pregnancy on, and engage community resources to address unmet social needs, enabling integrated behavioral health, and changing financial incentives that now prioritize procedures and crisis interventions over cognitive services and prevention. The education and training of future pediatricians needs to emphasize the importance of relational health in the family, and the moment is now to collaborate and implement these forgotten interventions.

Screen Time and its Relation to Toddlers’ Development

Abstract Background Screen-time or digital-screen exposure is the duration of time spent by the individual in using electronic/digital media like television (TV), smartphone, tablet or computer. Even background television exposure has been shown to impact development by reducing the amount and quality of interactions between parents and children. Studies showed that while babies do not absorb content from TV, it can catch and hold their attention. Aim of the Work The aim of the current study was to determine the effect of screen time on different developmental aspects of toddlers. Patients and Methods This was a cross sectional observational study that was conducted in the outpatients’ and Neurodevelopment Clinics, Children’s Hospital, Faculty of Medicine, Ain Shams University on 83 toddlers aged from 1 year to 3 years old who were exposed to screens for a longer duration than the recommended according to the American Academy of Paediatrics (AAP) guidelines. Of 13 months’ time frame, total duration of screen exposure was calculated in minutes/day and was correlated to the composite scores of Bayley scales of infants’ and toddlers’ development third edition. Results A significant negative correlations were found between duration of screen time exposure and all Bayley scales (cognitive, language and motor) composite scores and language scale is more affected. Conclusion The results of this study supported the directional association between screen time and child development. Parents and all the society should be educated about the hazards of screen time exposure on infants and toddlers’ development.

Clinical and environmental considerations for neonatal, office-based circumcisions compared with operative circumcisions

Neonatal male circumcision is a commonly performed procedure in the United States. Circumcisions are performed at various ages by a variety of clinical providers for multiple reasons, including religious, cultural, personal, and medical indications. In the United States, neonatal circumcision is routinely performed by non-urologic providers in the hospital within the first few days of life or as a religious ceremony on the 8th day of life. If neonatal circumcision is deferred in the hospital and subsequently not performed in the outpatient setting, it is then typically performed in the operating room under general anesthesia after 6 months of life. Neonatal circumcision is supported by both the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) due to the belief that the health benefits outweigh the minimal risk of the procedure. Despite this, neonatal circumcision rates have decreased in the United States in recent decades, in part due to access to the procedure, often related to changing insurance coverage. This has led to increased rates of operative circumcisions. Operative circumcisions are more costly to the healthcare system, subject the patient to cardiopulmonary and potentially neurotoxic effects of general anesthesia, and carry an increased environmental footprint, compared to neonatal circumcision. The intention of this paper is not to promote or justify circumcision for all patients, but rather to compare the clinical and environmental impact of neonatal versus operative circumcisions.

Retention and transition to adult health care in adolescent bariatric surgery

The American Society of Metabolic and Bariatric Surgery (ASMBS) and the American Academy of Pediatrics (AAP) recommend bariatric surgery as a treatment option for severe obesity. Bariatric surgery results in weight loss and improves obesity-related comorbidities. After surgery, adolescents and young adults require close observation and interdisciplinary care to help optimize weight loss, minimize nutrient deficiencies, address mental or physical health complications, and ensure a smooth transition to adult care. Yet, the extant literature on adherence and transition of care in bariatric programs is limited. Using 3 case studies from 2 bariatric programs, one on retention and 2 on transition of care, this paper highlights learning opportunities for care delivery after bariatric surgery. A quality improvement framework and an embedded electronic medical health registry can improve retention rates within a bariatric program. In addition, implementing a workflow ensures standardization of care; however, a key challenge is inadequate staffing. The programs established a transition of care policy and protocol by incorporating several of the Six Core Elements, a recognized guide for ensuring a safe and appropriate transfer from pediatric to adult care. Several research gaps remain, and further work is needed to determine and standardize best practices for adolescent bariatric surgery.

Impact of a Helmet Distribution Program in the Pediatric Emergency Department.

Bicycle helmet use has repeatedly been shown to protect riders from serious injury. Despite this, a majority of children and adolescents do not regularly wear helmets. Our primary objective was to determine if an emergency department (ED)-based helmet distribution program could increase the amount of time children report wearing helmets. This was a prospective cohort study of children aged 3 to 17 years presenting to the ED of an urban, tertiary care hospital. Participants were surveyed on their helmet use habits and perceptions regarding the efficacy and importance of helmets. Participants then received a bicycle helmet along with safety counseling in the ED and bicycle safety handouts provided by the American Academy of Pediatrics. Participants were contacted for follow-up 8 weeks after enrollment. We enrolled a total of 94 patients. Post-intervention surveys were obtained from 47% of participants. Our helmet program resulted in a statistically significant increase in the amount of time children reported wearing bicycle helmets. Prior to ED intervention, 48% of participants reported wearing a helmet "most of the time" or "all of the time." After participating, 86% of participants indicated that they wore a helmet "most of the time" or "all of the time." Participants indicated a variety of reasons for not wearing helmets. Of all patients contacted for follow-up, 16% indicated that they were involved in an accident after participating where the helmet they were given prevented a head injury. Helmet distribution programs based in the pediatric ED increase rates of bicycle helmet usage among pediatric patients. Additional study is needed to determine effect on head injury prevention.

Parents' Perspectives on Early Relational Health: A Qualitative Study.

The American Academy of Pediatrics endorses a paradigm shift toward promoting early relational health (ERH) in pediatrics. Pediatric clinicians have a unique opportunity to promote ERH, yet little work has sought parents' perspectives on how clinicians can do so effectively. We sought to understand diverse parents' perspectives on ERH and the role of pediatric clinicians in supporting it. We conducted virtual focus groups using a guide prepared with input from community partners and parent advisors. We purposively sampled a diverse group of parents of children aged ≤7 years. Focus groups were recorded and transcribed verbatim. We analyzed data as it was collected and identified themes using an inductive and iterative process. Thirty-seven parents participated in 8 focus groups (median parent age: 36.0 years; 43.2% Asian, 18.9% Black/African-American; 32.4% Hispanic/Latino; 78.4% mothers). We identified 3 organizing themes: (1) Time, attention, and open communication with children lay a foundation for ERH; (2) Pediatric clinicians have an opportunity to promote ERH, but disconnected parent-clinician relationships are a major barrier; and (3) Enhanced communication and careful attention to child development and family well-being represent key opportunities to strengthen parent-clinician relationships. Parents identified time, attention, and open communication as essential to ERH. Although participants expressed openness to clinicians addressing ERH, such work is contingent on strong parent-clinician relationships. Policymakers and clinicians seeking to address ERH in pediatric settings must also be prepared to address potential barriers through strategies like providing adequate time to facilitate relationship-building and careful attention to address this critical topic.

An Emergency Department Quality Improvement Project to Decrease Lumbar Puncture Rates in Febrile Infants 22 to 28 Days Old.

Most providers have routinely performed universal lumbar puncture (LP) on well-appearing, febrile infants 22 to 28 days old. In 2021, the American Academy of Pediatrics recommended clinicians should perform an LP in this age group if inflammatory markers are abnormal. This quality improvement project aimed to decrease LP rates in febrile infants 22 to 28 days old in the emergency department (ED) within 1 year, regardless of race/ethnicity, from a baseline of 87%. We used our institution's quality improvement framework to perform multiple Plan-Do-Study-Act cycles. A multidisciplinary team reviewed the febrile infant literature, local epidemiology, and identified key drivers. We provided departmental education, updated our clinical pathway, and used clinical decision support. We analyzed baseline (January 2017-March 2022) and intervention data (April 2022-March 2024) and tracked data using statistical process control charts. Our primary outcome measure was rates of LP in the ED for this cohort. Process measures included rates of infants with procalcitonin results. ED length of stay, rates of first LP attempt after hospitalization, and missed bacterial meningitis were balancing measures. The baseline LP rate of 87% decreased to 44% during the intervention period, resulting in a downward centerline shift. There were no significant differences when LP rates were analyzed by race/ethnicity. There was an upward centerline shift in the process measure of infants with procalcitonin results. There was no observed special cause variation in our balancing measures. Quality improvement efforts, including education, clinical pathway updates, and clinical decision support, safely reduced rates of LPs in febrile infants 22 to 28 days old.

Barriers and Facilitators to Adhere to Updated Breastfeeding Recommendations of the American Academy of Pediatrics

Barriers and Facilitators to Adhere to Updated Breastfeeding Recommendations of the American Academy of Pediatrics

Improving Completion Rates for Autism Screening - A Quality Improvement Project

Introduction: Autism spectrum disorder (ASD) may be the most well-known and most studied neurocognitive disorder responsible for developmental delay. The medical community, in response to the noted increase in prevalence, emphasized the importance of routine screenings at 18 months and 24 to 30 months of age. Ascension St. John Children’s Hospital Resident Clinic utilizes the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) or MCHAT for short, validated for ages 16 through 30 months. It was noted that screening is frequently missed or undocumented. Because of the need for timely diagnosis and intervention, these missed opportunities can be costly for children and their families. Purpose: To improve compliance with the American Academy of Pediatrics’ (AAP) recommendation to screen all children for ASD at 18 and 24 months of age. Methods: An educational lecture was provided to the pediatric residents to screen all children in the above age group being seen for a well-child visit. A visual reminder red pen mark was also applied to eligible patient charts as they were checked in. Baseline completion rates in two three month periods, one year before and three months after the intervention, were compared. Results: A total of 337 charts were reviewed with similar baseline characteristics between pre- and post-intervention groups. Overall MCHAT completion rates were lower after the intervention: 64% pre- vs. 49% post-intervention (p &lt;0.05). Subgroup analysis of visits where screening was directly indicated (excluding ages 16-17 months, &gt;24 month olds where a screen was already passed at a 24 month well visit, or children already diagnosed with autism, n = 281), had similar completion rates (67.5% and 64.5% respectively, p = 0.59). Conclusion: MCHAT completion did not improve after the combined intervention of a single, in-person lecture and visual reminder chart marking.