Child Visits Research Articles

Interdisciplinary Quality Improvement Project Increases Vitamin D Supplementation in Infants.

American Academy of Pediatrics guidelines recommend 400 IU of vitamin D supplementation daily for certain infants <1 year of age. We aimed to increase the proportion of reported appropriate vitamin D supplementation for infants born at our institution and those who followed up in our resident clinic through 6 months from 49% to 80% over 24 months. Our interdisciplinary quality improvement effort included vitamin D medication delivery before nursery discharge and family and staff education. The process measure was the percentage of families discharged from birth hospitalization with vitamin D and teaching. The outcome measure was the percentage of families reporting appropriate vitamin D supplementation at 2-, 4-, and 6-month well child visits. The balancing measure was the percentage of infants discharged from the nursery by 2 pm. Data were displayed on Statistical Process Control p charts and established rules for detecting special causes were applied. Baseline and improvement data were collected for 587 hospital discharges and 220 outpatient encounters. The percentage of families discharged with vitamin D increased from 24.8% to 98% from 2016 to 2018. Percent of families reporting appropriate vitamin D supplementation at well child visits increased from 49% to 89% from 2016 to 2018. Overall, the percentage of discharges by 2 pm remained stable at 60%. Bedside medication delivery and education in the newborn nursery improved reported vitamin D supplementation rates in the first 6 months of life. The intervention did not delay newborn hospital discharge.

“Can I go into the artwork?” Material–relational situations with abstract art

The purpose of this article is to study museum educational situations, where 5–7-year-old children encounter abstract art, from a new materialist perspective. The children visit an exhibition curated by me, where abstract modernist art is mediated, with an emphasis on multisensory experiences and experimentation. The visits were recorded with stationary and action cameras. By focusing on material–relational situations, I investigate how learning takes place when the children engage with the museum educational setting. A girl asks a surprising question that challenges the takenfor-granted beliefs about what art can be. The children break rational and logical patterns by creating abstract art, and “aesthetic-intuitive order” takes place in the compositions. A child and an adult relate differently to the agential “teaching matter.” Embodied and material pedagogy with abstract art indicates how “making sense” of the world is not only done in verbal and logical ways but also by experimenting with bodies and senses with teaching matter.

Canadian dentists' views on the first dental visit for children.

IntroductionEarly dental visits set children on an upward trajectory, toward a lifetime of optimal oral health. The purpose of this study was to analyze data from a survey of Canadian dentists to determine their knowledge, attitudes, and behaviors regarding first dental visits.MethodsThe Canadian Dental Association (CDA) surveyed general and pediatric dentists regarding the timing of the first dental visit. Demographic and practice information was collected. Analyses included descriptive analyses, bivariate analyses, and multiple logistic regression with forward stepwise selection. Significance was set at p ≤ 0.05.ResultsOverall, 3,232 dentists participated. The majority were male (58.5%), general dentists (96.6%), in non-metropolitan areas (50.5%), and practiced for 20.6 ± 12.8 years. The mean age recommended for first visits was 20.4 ± 10.8 months. Only 45.4% of dentists recommended a first visit ≤ 12 months. A majority (59.5%) knew that the correct age recommended for first visits was no later than 12 months. Most dentists who had seen a patient ≤ 12 months before did not typically do so (82.3%). General dentists were 61% less likely to recommend first visits by 12 months (OR = 0.39; 95% CI: 0.16, 0.91). Dentists in Central Canada (OR = 1.83; 95% CI: 1.44, 2.32); dentists who typically saw patients ≤ 12 months (OR = 3.41; 95% CI: 2.41, 4.83); those who echoed the importance of visits by 12 months (OR = 19.3; 95% CI: 8.2, 45.71); dentists with staff that encouraged infant/toddler care (OR = 1.76; 95% CI: 1.34, 2.31); and those who knew official North American recommendations for first visits (OR = 5.28; 95% CI: 4.13, 6.76) were all more likely to recommend first visits by 12 months.ConclusionsA majority of Canadian dentists did not recommend first visits by 12 months of age, despite it being the CDA's official position. Provider characteristics can influence the age that is recommended for first visits. Findings from this study may inform educational campaigns on early childhood oral health targeted toward dentists.

Adherence of caregivers of children to advice provided by a National Poison Information Center

Introduction Most calls to poison information centers are from the public, pertaining to young children, and due to minor or nontoxic exposures. Rational poison center consultations can prevent unnecessary visits to emergency departments (EDs), callers’ adherence to such advice is required. Objectives Estimate adherence of callers from the public to the poison center concerning exposures of young children to the advice provided by the clinical toxicologist, estimate the number of unnecessary ED visits of these children prevented by poison center consultations. Methods Prospective, phone-survey cohort study. Calls from the public concerning children under 6 years old were recorded and collected, telephone follow-up was performed within two weeks. Data collected included: demographics, exposure, severity, triage advised, adherence to the advice, reasons for nonadherence, and what the caller would have done had the poison center been unavailable. The study was conducted over 3 months representing different seasons and holidays times during a 1-year period. Results 1762 callers completed the telephone follow-up; 1443 (81.9%) cases were asymptomatic at the time of call; 1452 (82.3%) were advised to remain at home, 175 (9.9%) and 137 (7.8%) were referred to community clinics and EDs, respectively; 1648 (93.5%) of callers adhered to the advice provided; highest adherence rate was among callers advised to stay home (98.3%, 1427), and 78.9% (108) and 62.1% (109) among callers referred to EDs and community clinics, respectively. Among callers advised to stay home, 491 stated that they would have referred themselves to the ED had the poison center been unavailable, an annual estimate of 4309 cases. The main parameter predicting nonadherence was calls made during night shift. Conclusions The high adherence of callers to the poison center consultation suggests it plays an important role in preventing unnecessary ED visits of young children due to poison exposures, and may substantially reduce ED load and costs.

Effects of extreme temperatures on childhood allergic respiratory diseases with and without sensitization to house dust mites in Shanghai, China

BackgroundThe negative impacts of environmental factors on allergic respiratory diseases (ARD) in children have gotten a lot of attention recently. However, the influence of climatic conditions, especially extreme temperatures, on childhood ARD induced by house dust mites (HDM-ARD) is uncertain. ObjectiveWe aimed to quantify the associations between outpatient visits for HDM-ARD and extreme temperatures in Shanghai, China. MethodsA distributed lag nonlinear model combined with Quasi-Poisson generalized linear model was used to analyze data. ResultsDaily mean temperature was significantly associated with outpatient visits for childhood ARD and HDM-ARD. Exposure to extreme temperatures increased the cumulative relative risks of outpatient visits for ARD and HDM-ARD in children (RRlag0–28 for the 5th percentile of Tmean: 2.97, 95% confidence interval (CI): 1.25, 7.06; RRlag0–28 for the 95th percentile of Tmean: 2.85, 95% CI: 1.03, 7.86). Boys were vulnerable to extreme lower temperature, while girls were more sensitive to extreme higher temperature in both ARD and HDM-ARD. The effect seemed to be most pronounced among 6–11 years of age school children. ConclusionOur study presents quantitative evidence that extreme temperatures prompted outpatient visits for children with ARD, especially HDM-ARD, in Shanghai, China. These findings might have significant consequences for developing appropriate preventive measures for vulnerable populations.

Cost-effectiveness and estimated net monetary benefits of a fluoride varnish application program during well-child visits by 9- to 30-month-old children in three areas of Thailand.

To evaluate the cost-effectiveness and estimated net monetary benefits of a fluoride varnish application program during well-child visits in young children in three Thai provinces. Costs and benefits from both the provider and patients are presented. Cost-effectiveness and estimated net monetary benefit analysis of one to five visits for fluoride varnish application using a retro-prospective cohort study design. Cost and outcomes were estimated using dental personnel survey data, hospital procurement data and guardian survey. The primary outcomes were decayed (treatment needed), missing due to caries and filled teeth (dmft). From the provider's perspective, one to three visits for fluoride varnish application decreased dmft and saved costs compared to no visits, one visit and two visit strategies (ICER=-468.36, -424.40 and -65.72, respectively). These strategies also showed an estimated net monetary benefit of 430.89, 216.44 and 7.23 THB, respectively. From the patient's perspective, the estimated net monetary benefits were positive for up to three visits (383.24, 212.45 and 45.82 THB, respectively); however, the incremental cost-effectiveness ratios were no different with these strategies (ICER=-416.56). The one and two visit strategies had a very high chance of showing cost saving in the probabilistic sensitivity analysis (97.1% and 95.5%, respectively). The one to three visits fluoride varnish application program during well-child visits appears to be cost-effective with estimated net benefit interventions for dental caries prevention. These findings suggest that children between 9 and 30 months old should attend at least three visits of the fluoride varnish application program during well-child visits.

Remote Versus In-person Outpatient Clinic Visits and Antibiotic Use Among Children During the COVID-19 Pandemic.

Background:The proportion of remote clinic visits was expected to increase among children during the COVID-19 pandemic which might result in antibiotic overuse.Methods:In southern Israel, 2 ethnic groups, Jewish and Bedouin, live side-by-side. Computerized data on visits for children <18 years were examined from clinics with ≥50 insured children, active both pre-COVID-19 and during the COVID-19 pandemic. Visits were divided into in-person and remote. Monthly infectious diagnoses and dispensed antibiotic prescription rates were calculated by age (<5, 5–17 years) and ethnic groups. Mean monthly rates of 2 parallel seasons (pre-COVID-19 and COVID-19 periods) were compared.Results:Overall 2,120,253 outpatient clinic visits were recorded. Remote clinic visit rates (per 1000 children) increased from 97.04 and 33.86 in the pre-COVID-19 to 179.75 and 50.05 in the COVID-19 period in Jewish and Bedouin children, respectively (P < 0.01) along with a reduction of in-person visit rates in both populations. Comparing pre-COVID-19 and COVID-19 periods, the rates of overall infectious diagnoses in remote visits increased. Nevertheless, dispensed antibiotic prescription rates in remote visits (per 1000 visits) remained unchanged (9.84 vs. 8.67, P = 0.70, in the Jewish population and 14.32 vs. 14.17, P = 1.00, in the Bedouin population in the pre-COVID-19 and COVID-19 periods, respectively) with a similar distribution of antibiotic categories.Conclusions:COVID-19 pandemic resulted in an expansion of remote visits of children <18 years with an increase in infectious diagnoses. However, remote dispensed antibiotic prescription rates remained unchanged. These dynamics were more accentuated in Jewish children, characterized by higher socio-economic conditions, compared to Bedouin children.

“Struggle at night – He doesn’t let me sleep sometimes”: a qualitative analysis of sleeping habits and routines of Hispanic toddlers at risk for obesity

BackgroundHispanic children face disproportionately higher risks for early life obesity and resultant comorbidities such as Type 2 diabetes and fatty liver disease. Sleep habits are modifiable behaviors that impact early childhood obesity; Hispanic infants have been shown to have less nighttime sleep compared to their white counterparts. Pediatricians often coach families on parents’ nighttime responsive feeding and longer child sleep duration as protective factors against early life obesity, but must understand the family context and potential barriers. This study aimed to discover the sleeping habits and routines of Hispanic toddlers at risk for obesity through the perspective of their mothers.MethodsThis qualitative study used a phenomenological approach. 14 Hispanic mothers were recruited from a Federally Qualified Health Center in Central Texas for qualitative interviews regarding their experience raising a small child. Children aged 6 to 18 months with child weight-for-length ratio ≥ 85% for age were approached for study involvement and consented during well child visits. Interviews occurred over several months during 2018–2019; NVivo software was used for analysis of qualitative themes. Two reviewers coded and used constant comparative methods to identify common themes.ResultsMothers diverged from AAP recommended guidelines for infant and toddler feeding and sleep habits. Mothers shared their intentions and the real-life barriers to implementing recommended habits. Mothers discussed wanting to have their child sleep in a separate bed or room but not having the resources (i.e., financial, space) to do so. Additionally, mothers discussed knowing not to feed to soothe at night but couldn’t bring themselves to let their child cry if they knew feeding would soothe them. Co-sleeping, feeding to sleep, middle of the night feeding, and lack of structured sleep habits were common interview themes and potentially modifiable factors.ConclusionsPediatricians need to be sensitive to culture and the real-world needs of families to determine if best practices are “practical.” Themes from these parent interviews can inform tailored interventions for children at high risk of obesity. Interventions should promote responsive nighttime feeding and structured sleep, working with individual family logistics, to coach families towards optimal healthy environments and healthy child weight.

Prevalence of hypertension and hypertension phenotypes after three visits in Chinese urban children.

This study aims to evaluate the prevalence of hypertension and hypertension subtypes among Chinese children aged 6-17 years in a multicenter school-based sample by three separate screenings. Students from six major cities in China (Changchun, Beijing, Jinan, Shanghai, Chongqing, and Chengdu) were recruited in this cross-sectional survey during 2012 and 2015. Each participant was seated and had three consecutive blood pressure measurements on the right arm in the morning by an automated oscillometric device and the hypertensive ones were followed to the next visit. Hypertension was diagnosed by BP references for Chinese children and adolescents in 2010. Data from 44 396 children aged 6-17 years were included in analysis, 50.9% of whom were boys. The prevalence of confirmed hypertension after three separate screenings was 4% in the total population, 5% in boys, and 3% in girls, respectively. The prevalence of confirmed isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic and diastolic hypertension (SDH) in the total population was 2.7, 0.3 and 1%, respectively. Around 4% urban Chinese children and adolescents aged 6 -17 years were hypertensive after three separate BP screenings in 2012 -2015. ISH was the most frequent form of hypertension in children.

Description of Mother's Knowledge of Posyandu and Toddler Visits to Posyandu in Sidoarjo Regency

Toddler visits to posyandu are toddlers who come to posyandu to get health services such as weighing, immunization, and others. Based on initial data obtained at the Posyandu of Sumber Terik Village in January-December 2018 from 128 toddlers, it was found that 55 (43%) toddlers regularly came to Posyandu, and as many as 73 (57%) toddlers did not regularly come to Posyandu. The research design used descriptive. The population is 30 mothers in Rt:09 Rw:03 who have toddlers aged 1-5 years. The data obtained were recapitulated and then presented in the frequency table and the cross table was analyzed descriptively without statistical tests. Data collection uses primary data from questionnaire sheets and secondary data from KMS/KIA books. The results showed that most (66.7%) of mothers' knowledge was lacking, most (60%) of under-five visits were not routine, indicating that almost half (33.3%) of respondents had sufficient knowledge. Almost half (40%) visits under five are routine. The conclusion of the study is that the visits of children under five to the posyandu are routinely carried out by mothers who have sufficient knowledge compared to mothers who have less knowledge.

Description of Mother's Knowledge of Posyandu and Toddler Visits to Posyandu in Sidoarjo Regency

Toddler visits to posyandu are toddlers who come to posyandu to get health services such as weighing, immunization, and others. Based on initial data obtained at the Posyandu of Sumber Terik Village in January-December 2018 from 128 toddlers, it was found that 55 (43%) toddlers regularly came to Posyandu, and as many as 73 (57%) toddlers did not regularly come to Posyandu. The research design used descriptive. The population is 30 mothers in Rt:09 Rw:03 who have toddlers aged 1-5 years. The data obtained were recapitulated and then presented in the frequency table and the cross table was analyzed descriptively without statistical tests. Data collection uses primary data from questionnaire sheets and secondary data from KMS/KIA books. The results showed that most (66.7%) of mothers' knowledge was lacking, most (60%) of under-five visits were not routine, indicating that almost half (33.3%) of respondents had sufficient knowledge. Almost half (40%) visits under five are routine. The conclusion of the study is that the visits of children under five to the posyandu are routinely carried out by mothers who have sufficient knowledge compared to mothers who have less knowledge.

Human Papillomavirus Vaccination Trends Among Adolescents: 2015 to 2020.

To assess trends in recent human papillomavirus (HPV) vaccination initiation and factors associated with vaccination among adolescents. The 2015 to 2020 National Immunization Survey-Teen data were used to assess vaccination trends. Multivariable logistic regression analysis were conducted to assess factors associated with vaccination. Overall, HPV vaccination coverage (≥1 dose) among adolescents significantly increased from 56.1% in 2015 to 75.4% in 2020. There were larger increases in coverage among males (4.7 percentage points annually) than females (2.7 percentage points annually) and coverage differences between males and females decreased in 2015 through 2020. Coverage in 2020 was 75.4% for adolescents aged 13 to 17 years; 73.7% for males and 76.8% for females (P < .05); 80.7% for those with a provider recommendation and 51.7% for those without (P < .05); and 80.3% for those with a well child visit at age 11 to 12 years, and 64.8% for those without (P < .05). Multivariable logistic regression results showed that main characteristics independently associated with a higher likelihood of vaccination included: a provider recommendation, age 16 to 17 years, non-Hispanic Black, Hispanic, or American Indian or Alaskan Native, Medicaid insurance, ≥2 provider contacts in the past 12 months, a well-child visit at age 11 to 12 years and having 1 or 2 vaccine providers (P < .05). Overall, HPV vaccination coverage among adolescents increased during 2015 to 2020. Coverage increased faster among males than females and differences by sex narrowed during this time. Receiving a provider recommendation vaccination was important to increase vaccination coverage.

Identifying and understanding challenges to inform new approaches to improve vaccination rates: A qualitative study in Indonesia

PurposeThis study aimed to identify and understand challenges to inform new strategies to increase the COVID‐19 vaccination rate according to involved vaccinators' perspectives in Belitung, Indonesia.DesignA qualitative descriptive study design was used.MethodsOnline interviews and chatting were done among 11 vaccinators for data collection between August 2021 and January 2022. Data were analyzed using a content analysis model.FindingsFour main themes emerged, including (1) communication strategies (evidence‐based, electronic‐based, and culturally based communication), (2) cross‐sectoral strategies (collaboration with police, religious leaders, customary leaders, heads of village divisions, and non‐governmental organizations), (3) “picking‐up the ball” system (home visits for elderly and people with disability and school visits for children), and (4) setting‐up priorities (between mandatory vaccines and boosters).ConclusionDespite making vaccination mandatory, the roles of communication, cross‐sectoral innovations, “picking‐up the ball” system, and priority setting may have useful potential to improve vaccination rates.Clinical RelevanceThe findings may serve as an input to overcome challenges and accelerate the vaccination coverage in Indonesia and beyond. However, further research is needed.

Unintentional Acute Poisoning Related Emergency Department Visits in Children in a Single-Center: A Nine-Year Prospective Survey.

Pediatric morbidity due to unintentional poison exposure is a significant burden on public health. We prospectively characterize patterns of unintentional poison exposure in a single pediatric emergency department, using a detailed computerized questionnaire for all unintentional injuries admitted during 2009 to 2017. Out of 71,765 visits due to unintentional injuries, 252 children were admitted due to unintentional poison exposure. Most (198/252, 79%) were between 1 and 3 years of age. The majority of events (209/252, 82.9%) occurred at the patient's home and 81% (205/255) were classified as exploratory ingestion. In 41/252 (14%) cases, exposure to more than one substance was reported. Most events 231/293 (79%) involved medications and 21% were due to domestic products. Four medications account for 45% of the events (Paracetamol, Salbutamol, Antihypertensive, and Antidepressants). Opioids were responsible for only 1.7%. By, collaboration between government, public health, educational institutions and commercial companies, can the burden of pediatric unintentional poison exposure be reduced.

Multidisciplinary Treatment for Childhood Obesity: A Two-Year Experience in the Province of Naples, Italy.

Childhood obesity must be faced through an integrated multi-level preventive approach. This study was aimed at assessing the adherence and the outcomes of an outpatient service for childhood obesity treatment activated in the province of Naples, Italy, throughout a 2-year follow-up period. At first visit (T0), weight, height, waist circumference, and body composition of children were assessed, together with sociodemographic features and physical activity levels of children and parents. Anthropometric and body composition parameters of children were measured at 6 ± 3 months (T1) and 12 ± 3 months (T2). A total of 451 non-related children who accessed the service were analyzed: 220 (48.7%) of them returned at least once (attrition rate 51.3%). Returner outpatients showed higher age (p = 0.046) and father’s educational level (p = 0.041) than non-returner ones. Adherence to the treatment was found to be related to father’s (Rho = 0.140, p = 0.005) and mother’s (Rho = 0.109, p = 0.026) educational level. All the outcomes improved between T0 and T1 (p < 0.001), while only body mass index (BMI) decreased significantly at T2. Changes in BMI-SDS were associated with baseline value (OR 0.158, 95%CI 0.017–0.298, p = 0.029). The multidisciplinary approach seems to be promising to treat childhood obesity in this geographic context. Lower parents’ educational level should be considered as an attrition determinant.

Drowning prevention counselling by paediatricians to educate caregivers on water safety.

Drowning is the leading cause of unintentional injury death for children 1-4 years of age in the USA. Texas, a southeastern state, is disproportionately burdened by paediatric drowning. The aim of this project was to increase drowning prevention counselling provided during well-child visits to families with children aged 0-10 years. We developed and implemented a water safety counselling programme for paediatricians to impart to families during well child, urgent care and ED visits for 0-10year age group. Physicians completed and self-reported demographic, pre- and post-intervention, counselling rate and project evaluation surveys, while caregivers completed post-intervention surveys only. Both physicians and caregivers were surveyed on evidence-based drowning prevention strategies (four-sided fencing of pools, touch supervision, life jackets and swim/cardio-pulmonary resuscitation classes). Thirty-three physicians and 1934 caregivers participated in the project. Physicians demonstrated statistically significant improvement in discussing drowning prevention with patients (3.5 vs. 4 on Likert scale; P=0.002) in 2018 versus 2019. The counselling frequency in primary care settings increased from 54% to 70% from year 1 to 2. 100% of physicians correctly identified the best drowning prevention strategy and 80.6% of caregivers reported learning new water safety information in 2019 versus 68.8% in 2018 (P value < 0.001). This water safety education programme demonstrated increased drowning prevention counselling during well-child visits. The counselling was effective as demonstrated by increased caregiver acquisition of new water safety information. Paediatricians had adequate drowning prevention knowledge; an efficient counselling strategy helped them impart this knowledge to their patients.

Determinants of contraceptive use among women 0-23 months postpartum in Kitui County, Kenya: A cross-sectional study.

The risk of unintended pregnancy is high in the postpartum period, especially during the first year of delivery. Yet, short birth intervals are associated with increased risk of adverse maternal and infant outcomes. In Kenya, despite women having multiple contacts with healthcare providers during their pregnancy and postpartum journeys, uptake of contraceptives during the postpartum period remains low. We examine factors that determine contraceptive use among postpartum women in Kitui County, Kenya.A cross-sectional study was conducted in six sub-counties of Kitui County covering a random sample of 768 postpartum women in April 2019. Logistic regression was used to study the association between uptake of contraceptives among women 0-23 months postpartum and several explanatory variables that included socio-demographic characteristics and facility-level factors. Overall, 68% of women in Kitui County reported using contraceptives. The likelihood of contraceptive use increased with the increase in the number of known family planning methods. Women who discussed family planning with a health worker within the last 12 months were 2.58 (95%CI: 1.73, 3.89) times more likely to use contraceptives during the postpartum period compared to those who did not. There was an increased odds of contraceptive uptake among women who received family planning information or service during postnatal care than those who did not (aOR = 2.04, 95%CI: 1.30, 3.24). A positive association was also found between contraceptive use and receipt of family planning information or service during immunization visits or during child well visits. It is evident that facility-level factors such as discussing family planning with women; educating women about different family planning methods; providing family planning information or services during postnatal care, immunization, or well child visits are associated with increased likelihood of contraceptive uptake by women during postpartum period. Programs targeting enhancing women's attendance of postnatal care clinics should be encouraged.

Analysis of Racial and Ethnic Diversity of Population Served and Imaging Used in US Children’s Hospital Emergency Departments

Lower rates of diagnostic imaging have been observed among Black children compared with White children in pediatric emergency departments. Although the racial composition of the pediatric population served by each hospital differs, it is unclear whether this is associated with overall imaging rates at the hospital level, and in particular how it may be associated with the difference in imaging rates between Black and White children at a given hospital. To examine the association between the diversity of the pediatric population seen at each pediatric ED and variation in diagnostic imaging. Cross-sectional analysis of ED visits by patients younger than 18 years at 38 children's hospitals from January 1, 2016, through December 31, 2019, using data from the Pediatric Health Information System. Data were analyzed from April to September 2021. Proportion of patients from minoritized groups cared for at each hospital. The primary outcome was receipt of an imaging test defined as radiography, ultrasonography, computed tomography, or magnetic resonance imaging; adjusted odds ratios (aORs) were calculated to measure differences in imaging by race and ethnicity by hospital, and the correlation between the proportion of patients from minoritized groups cared for at each hospital and the aOR for receipt of diagnostic imaging by race and ethnicity was examined. There were 12 310 344 ED visits (3 477 674 [28.3%] among Hispanic patients; 3 212 915 [26.1%] among non-Hispanic Black patients; 4 415 747 [35.9%] among non-Hispanic White patients; 6 487 660 [52.7%] among female patients) by 5 883 664 pediatric patients (mean [SD] age, 5.84 [5.23] years) to the 38 hospitals during the study period, of which 3 527 866 visits (28.7%) involved at least 1 diagnostic imaging test. Diagnostic imaging was performed in 1 508 382 visits (34.2%) for non-Hispanic White children, 790 961 (24.6%) for non-Hispanic Black children, and 907 222 (26.1%) for Hispanic children (P < .001). Non-Hispanic Black patients were consistently less likely to receive diagnostic imaging than non-Hispanic White patients at each hospital, and for all imaging modalities. There was a significant correlation between the proportion of patients from minoritized groups cared for at the hospital and greater imaging difference between non-Hispanic White and non-Hispanic Black patients (correlation coefficient, -0.37; 95% CI, -0.62 to -0.07; P = .02). In this cross-sectional study, hospitals with a higher percentage of pediatric patients from minoritized groups had larger differences in imaging between non-Hispanic Black and non-Hispanic White patients, with non-Hispanic White patients consistently more likely to receive diagnostic imaging. These findings emphasize the urgent need for interventions at the hospital level to improve equity in imaging in pediatric emergency medicine.

EPS1.01 Home spirometry and virtual visits in children with cystic fibrosis – the child’s perspective

ePS1.01 Home spirometry and virtual visits in children with cystic fibrosis – the child’s perspective

Predictors of family resilience, emotional, behavioral, and developmental concerns and emergency room visits for children with asthma.

The current study fills a gap in the literature by examining relations among physical health and resilience factors, family functioning, emergency visits, and mental health problems for youth with asthma. The study purpose was to assess associations among four predictors-asthma severity, body mass index (BMI), having an adult mentor, and ability to make and keep friends-and 3 three outcomes-family resilience, emotional, behavioral and developmental concerns, and emergency room (ER) visits among youth with asthma. The sample included 2,589 youth with asthma between 10 and 17 years old from the 2017-2018 National Survey of Children's Health. Multivariable logistic regressions examined associations between asthma severity, BMI, having an adult mentor, ability to make and keep friends and two outcomes: family resilience, and emotional behavioral and developmental concerns. A multinomial logistic regression examined the relationship between predictor variables and number of ER visits. Findings indicated having a mentor, being able to make/keep friends, and being underweight, average, or overweight compared to being obese were related to having family resilience. Making/keeping friends was a protective factor for emotional behavioral and developmental concerns. Having a mentor was related to higher levels of emotional behavioral and developmental concerns than not having a mentor. Youth who had mentors and friendship skills were less likely to have ER visits than youth with no mentors and difficulty with friendships. Youth with mild asthma severity and who were not obese had lower levels of ER visits than those with moderate/severe asthma or obesity. Child level protective factors were related to higher levels of family resilience and fewer ER visits for children with asthma. Further research to identify risk and protective factors is needed to develop interventions for youth with asthma. (PsycInfo Database Record (c) 2022 APA, all rights reserved).