Child's Appointment Research Articles

0805 Targeting Sleep Disordered Breathing Screening During the SARS-CoV2 Pandemic: Parents or Providers?

Abstract Introduction Sleep-disordered breathing (SDB) can significantly impact a child’s physical and psychological well-being. Primary care teams are strongly positioned to first note the signs of SBD and the American Academy of Pediatrics recommends routine screening for snoring at all well-child visits (WCV). However, the literature demonstrates low rates of application of this recommendation. This is likely multifactorial as noted by previous studies on the subject. This study aimed to assess if providing an electronic questionnaire to families ahead of the WCV would increase the snoring screening rate. Methods This quality improvement (QI) program consisted of a convenience sample (control n=504, program n=222) of 726 children, age 2-17 years presenting for their new or well-child-visit (WCV) over six weeks during the SARS-CoV2 pandemic. The Pediatric Sleep Questionnaire (PSQ) was delivered to parents via the electronic patient portal (EPP) 1-2 weeks before their child's appointment. The questionnaire was then auto imported into the physician's note at the time of the appointment. Results The QI program showed a lower overall SDB screening rate (16.7%) than the pre-program control (21%), however, 3 of 4 (75%) of the participating physicians saw an increase in SDB screening during the program. Statistical significance was seen in two physicians (X2 (1, N=262) = 27.150, p=.000, Phi = .332 and Fisher exact test p=.000, 2-tailed, Phi = .366. Conclusion The screening rate for snoring significantly increased among physicians when electronic questionnaires were provided to families prior to scheduled WCV. This is an early but promising pattern. The electronic patient portal can serve as an important asynchronous tool for providers to gather valuable information about the sleep quality of children in their practice, aligning with AAP goals and better supporting families. Support (if any) none

A Telehealth Initiative to Decrease No-Show Rates in a Pediatric Asthma Mobile Clinic

Background/problemFailed patient care appointments (no-shows) can lead to negative patient health outcomes and increased healthcare costs. There is evidence that telehealth is a safe, effective, and a cost-efficient option for those unable to attend in-person visits. No-show rates in pediatrics are unique due to reliance on caregivers to attend appointments. A pediatric asthma mobile van, which provides specialty care to children at schools in low-income communities in Chicago, was experiencing a high no-show rate. Methods/interventionsBuilding on evidence that the use of telehealth technology improves access to care, the purpose of this quality improvement initiative was to implement a new telehealth option for off-site parents to attend their child's on-site appointment. The designed initiative followed the Plan-Do-Study-Act model with three small phases of change. The first phase assessed telehealth interest using a Likert-scale questionnaire. The second phase designed and implemented a telehealth option and collected no-show rates pre- and post- implementation. The final phase assessed parental satisfaction using a Telehealth Usability Questionnaire. ResultsOver 50% of participants stated interest in the parent off-site telehealth option for their child's appointment. No-show rates decreased from 36% to 7.9%–18% per month over a 10-month implementation period. Post-telehealth surveys completed by parents revealed this version of telehealth improved access to care for their child, saved them time, and was simple to use. ConclusionNo-show rates decreased after successful implementation of an innovative approach to telehealth. This parent off-site telehealth model can be another approach toward increasing pediatric healthcare access.

CITIZENSHIP STATUS AND INHERITANCE OF ADOPTED CHILDREN CARRIED OUT BY SPOUSES OF FOREIGN NATIONALS IN INDONESIA

Children are a gift from God Almighty that is dreamed of by every couple. Couples who do not have offspring usually adopt children to continue their lineage and maintain their marriage. Appointment of children in Indonesia is the adoption of children between Indonesian citizens (domestic adoption) and the adoption of children by Foreign Citizens (Intercountry adoption). Requirements and procedures the appointment of an Indonesian citizen by a foreign national is explained in PP No. 54 of 2007 concerning Implementation of Child Appointment, Minister of Social Affairs Regulation No. 110 / HUK / 2009 Regarding the Requirements for Appointment of Children, the two regulations are inseparable from Law No. 35 of 2014 concerning Child Protection. The purpose of this study is to examine and determine the status of inheritance and legal consequences on the citizenship status of the process of adopting Indonesian Citizens' children by Foreign Citizens after a court ruling. The research method used is a normative juridical approach that is by focusing on data and field interviews to study primary, secondary, tertiary data collected in the form of traditional materials that are related to the problem under study which will then be analyzed in a qualitative juridical manner, then analyzed descriptively analytically to obtain a comprehensive and systematic picture of the problem under investigation connected with applicable legal regulations. The results showed that there were still many Indonesian citizens being adopted by foreign citizens who did not comply with the procedures. Problems that arise are regarding citizenship status and inheritance of adopted children. If the adopted child has a foreign nationality, he/she cannot obtain an estate with ownership status, but can only control the usage rights. This is stated in Article 21 of the Basic Agrarian Law.

Evaluating the Relationship Between Adolescent Fatherhood and Routine Health Care in a Nationally Representative Sample: A Descriptive, Cross-Sectional Study.

This study evaluates whether fatherhood status is associated with receipt of preventive care (i.e., a routine physical) among adolescent males and whether attending their child's appointments is associated with greater odds of preventive care. This study is a secondary analysis of cross-sectional data collected from the 2011-2017 National Survey of Family Growth. The sample consisted of 3,831 males aged 15-21 years. Logistic regression models were constructed to assess the odds of having a routine physical in the previous year. Adolescent fatherhood (adjusted odds ratio = 0.56, 95% confidence interval = [0.32, 0.99]) was associated with reduced odds of having a routine physical in the previous year. Attending a child's appointment was not associated with having a routine physical in the previous year (adjusted odds ratio = 0.18, 95% confidence interval = [0.01, 2.31]). Having a child is associated with foregoing routine physical care in the previous 12 months. Elucidating barriers may inform interventions to increase the uptake of preventive care for adolescent fathers.

"It Takes a Whole Day, Even Though It's a One-Hour Appointment!" Factors Impacting Access to Pediatric Feeding Services.

Feeding disorders can have a significant impact on children and their families. Access to supportive multidisciplinary care is central to improving outcomes; however, there are numerous factors that can impact service access. Using a mixed methods design, the current study examined parents' experiences and satisfaction with accessing a state-wide government-funded tertiary pediatric feeding clinic in Australia. Parents of 37 children (aged 7weeks to 17years) participated in the study, residing 6-1435km from the service. Each completed questionnaires regarding satisfaction (Client Satisfaction Questionnaire-8 Child Services) and costs, and participated in a semi-structured interview. Costs were measured as both direct (e.g., accommodation) and indirect (measured as lost productivity) associated with accessing their feeding appointment. Results revealed parents were highly satisfied with their child's feeding services, but considerable impacts were reported in accessing the service with 85% of the group noting that attending their child's appointment took at least half a day. The total cost per appointment ranged between $53 and $508 Australian dollars. Interviews identified three main barrier themes: distance and travel, impact on daily activities (e.g., work, school), and parent perception of inaccurate representation of their child's feeding skills within the clinic environment. The issues raised were also tempered by an overarching theme of parental willingness to do "whatever was needed" to meet their child's needs, regardless of these barriers. Service providers should be cognizant of the factors that impact access for families and consider alternative service-delivery models where appropriate to help reduce family burden associated with accessing necessary care.

Status Harta Waris terhadap Anak Angkat Perspektif Adat Jawa dan KHI

The presence of adopted children in the family allows for a high level of emotional bonding, which no longer separates one another. So, in time the adopted child can be counted as the person who deserves the property of foster parents after death. This is the result of what happened in the later days. In relation to the problem in this study, that the existence of the adopted child above has a position on the inheritance of treasures. According to Javanese customary law, although the child's appointment does not decide the child's relationship with the parent and adopted child does not become the child of the adoptive parents, but the adopted child is entitled to the inheritance of both the parents and the adoptive parents. Under Islamic law, although it is clear that Islam cannot accept the existence of an adopted child on his or her position on the inheritance of adoptive parents. However, KHI which is a legal written law that is applied as a special guideline for Muslims in resolving all legal issues including the position of the adopted child, in article 209 KHI explained that the adopted child is entitled to receive a testament of a general order of 1/3 from the heritage property of foster parents

Adult Caregiver Influenza Vaccination Through Administration in Pediatric Outpatient Clinics

Pediatric exposure to influenza-infected adult caregivers (AC) is a significant risk factor for developing influenza. Poor access to vaccines contributes to low adult vaccination rates. We offered adult vaccination at regularly scheduled pediatric office visits and examined barriers to improve future vaccination rates. Via a retrospective chart review, we identified ACs who received an influenza vaccination at 1 of 3 pediatric clinics within an academic center from August 2015 to May 2016. We screened for demographics of ACs and their children. Rates of AC vaccination and AC refusal were not measured. A total of 297 ACs representing 518 children received their influenza vaccine at their child's pediatric office. The mean age of ACs was 35.9 years (range, 22-70 years) and 68.5% were mothers. Most ACs (n = 294, 99%) receiving the vaccine had private insurance. Almost all ACs received their vaccination on the day of the child's visit (n = 250, 84%). A total of 49.6% of AC's children had high-risk illnesses. Parents of children with Medicaid were under-represented because of high parental copays (n = 3, 1%). The highest clinic vaccine participation was noted at the clinics with lowest Medicaid populations. ACs readily accepted influenza vaccination at their child's pediatric primary care office. Increased vaccination acceptance occurred when ACs were female, had private insurance, if their child had a chronic illness and if the vaccination was offered the same day as their child's appointment. Likely reason for low acceptance in ACs with Medicaid insurance is high cost; thus, staff, well-aware of Medicaid's nonreimbursement, likely offered the vaccine less to these parents.

A Patient Information Leaflet Reduces Parental Anxiety Before Their Child's First Craniofacial Multidisciplinary Outpatient Appointment.

It is expected that a child's first outpatient appointment with a craniofacial multidisciplinary team (MDT) instills anxiety in parents. Limited data exist on the aspects of the appointment that parents are most concerned about and what information they desire. The effect of written information provision on this cohort is unstudied. Parents attending their child's first outpatient appointment with the Birmingham Children's Hospital Craniofacial MDT between September and December 2012 completed a questionnaire to identify concerns they had relating to the appointment. A patient information leaflet was subsequently developed and distributed. From September 2015 to January 2016, questionnaires completed by parents assessed the usefulness of the leaflet and whether it reduced parental anxiety. Twenty-six initial questionnaires were returned. Seventeen respondents (65%) reported that they were concerned about some aspect of their child's appointment. Twenty-two (86%) expressed a desire for more information surrounding their child's appointment. Thirteen (50%) requested for this information to be provided using a patient information leaflet. After the introduction of the leaflet, 30 questionnaires were returned. All 30 (100.0%) found the leaflet easy to understand. Twenty-nine (96.7%) felt the leaflet provided helpful information. Eighteen (60.0%) felt less worried about the appointment after reading the leaflet. The majority of parents of children referred to a craniofacial MDT appointment displayed concerns that related to the appointment itself. Specific information relating to the appointment process itself was desired. A purpose-built leaflet successfully provided parents with desired information and lowered anxiety among the majority of attendees.

Medical service use in children with cerebral palsy: The role of child and family factors characteristics.

The aim of the study was to investigate the patterns of medical service use in children with cerebral palsy (CP), taking into account child and family characteristics. Nine hundred and one parents and carers of children registered with the Victorian CP Register were invited to complete a survey. Participants were asked about their child's appointments with general practitioners and public and private paediatric medical specialists over the preceding 12 months. Information on family characteristics and finances was also collected. Data on CP severity and complexity were extracted from the CP Register. Three hundred and fifty parents and carers (39%) participated. Of these, 83% reported that their child had ≥1 appointment with a general practitioner over the preceding 12 months, while 84% had ≥1 appointment with a public or private paediatric medical specialist. Overall, 58% of children saw 2-5 different paediatric medical specialists, while 9% had appointments with ≥6 clinicians. Children with severe and complex CP were more likely to have had ≥1 appointment with a publically funded paediatric medical specialist and had seen a greater number of different clinicians over the study period. Family characteristics were not associated with service use. Children with CP are managed by a number of paediatric medical specialists, and they continue to see a range of specialists throughout adolescence. In Victoria, differences in service use are not based on family characteristics; instead the highest service users are those with severe and complex CP. For this group, care co-ordination and information sharing between treating clinicians are important, if gaps in care are to be avoided.

The evaluation of a question prompt list for attention-deficit/hyperactivity disorder in pediatric care: A pilot study.

Of the available treatment options for attention-deficit/hyperactivity disorder (ADHD), the use of medications remains the most controversial and it is often difficult for parents to make decisions about treatment. Provision of relevant, reliable information about treatment during consultations may help address parents' concerns about treatment options. Question prompt lists are structured lists of disease and treatment-specific questions intended for use by patients during consultations to encourage communication with clinicians. They may prove useful in empowering parents to ask questions during consultations and to make informed decisions about treatments for ADHD. To evaluate the acceptability and usefulness of a question prompt list (QPL) for attention-deficit/hyperactivity disorder (ADHD) during consultations between parents of diagnosed children and their pediatricians. Parents of children recently diagnosed with ADHD (n=17) received a copy of the QPL 7 days before their child's appointment and completed questionnaires before and after their consultations to elicit: satisfaction with the consultation and QPL; situational anxiety levels; achievement of decision-making and information preferences. Pediatricians (n=3) completed questionnaires after each consultation to determine the impact of the QPL on consultation flow and to ascertain their willingness to incorporate the QPL into their practice. All parents reported that the QPL helped them to ask more questions, was easy to understand and would be useful to them in future. After receiving the QPL and seeing the pediatrician, parents' anxiety decreased significantly. All described their decision-making roles as 'just right' and were satisfied with the information obtained during their consultations. All pediatricians agreed that the QPL was helpful for parents, made communication easier, and helped parents to initiate discussion about difficult topics. The QPL was not found to impede flow of the consultation. All agreed QPL provision was feasible as part of routine clinical care. The QPL received strong support from parents and pediatricians and may be a useful tool in facilitating communication and shared decision-making in this setting. The findings warrant further investigation in a larger randomized controlled study.

Caregivers’ Satisfaction with Pediatric Dental Care in a University Clinical Setting in North Philadelphia

The aims of this study were twofold: to describe different aspects of caregiver satisfaction with pediatric dental treatment provided at a dental school clinic and to explore differences in satisfaction by caregivers' demographics and compliance with their children's appointments. A cross-sectional study was conducted in two phases. In Phase I, a convenience sample of caregivers (n=100) eighteen years of age and older whose children had been receiving dental care in Philadelphia, Pennsylvania, were invited to complete a self-administered dental satisfaction questionnaire. In Phase II, sociodemographic data and the child's reason for visit were extracted from axiUm. Descriptive analyses stratified by sociodemographic variables were conducted. Results indicated that almost half of the caregivers reported feeling concerned about pain at the dental office. Those with the lowest levels of education and income reported feeling the most concern about pain at the dental office, as well as sometimes avoiding bringing their child to the dentist because of their fear of pain and not complying with scheduled dental appointments for the child. Operational aspects related to access and motivational aspects such as fear of pain when seeking dental treatment were identified as barriers to treatment.

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Exploration of the factors influencing parental decisions to allow their children to participate in clinical trials in paediatric infectious diseases

AimsTo explore the reasons behind parental decisions about participation of their children in specific paediatric infection clinical research scenarios in order to improve recruitment strategies.MethodsParents of children aged 0–10 years...

Preschool Children as Frequent Attenders in Primary Health Care in Croatia: Retrospective Study

To define predictive factors for frequent attenders among preschool children in primary health care and investigate the association between socioeconomic factors and medical factors, as well as the reasons for child's appointment in the physician's office. This retrospective study was conducted in 7 primary health care offices (6 family physician practices and 1 pediatric practice) in Zagreb, Croatia. The study included 964 preschool children from 1-6 years who visited these practices during 2005. Children in the highest quartile of consultation frequency (n=255) were defined as frequent attenders, while the children in the lowest quartile of consultation frequency (n=302) represented the control group (non-frequent attenders). We collected data on consultation rate, socioeconomic factors, health care providers, prescriptions and referrals, symptoms, and diagnoses. Association of the parameters and the frequency of consultations was investigated by logistic regression analysis. Frequent attenders sought for consultations 10 times per year (median, range 4-26), and they had the following characteristics: had 2-3 years, attended day care center, were treated by a pediatrician, and received more prescriptions and referrals. Their major complaints were: cough, nasal discharge, rash, fever, difficult breathing, earache, digestive problems, throat soreness, and injuries. Logistic regression analysis showed significant association between frequent attendance and age of 2-3, the symptom of nasal discharge, and diagnoses of infectious and parasitic diseases, middle ear diseases, respiratory system diseases, and skin and subcutaneous tissue diseases. Socioeconomic characteristics, symptoms, and diagnoses were important predictors for defining preschool frequent attenders in primary health care.

The Well‐being of Children in the UK, 2nd edn

The Well‐being of Children in the UK, 2nd edn