General Pediatric Clinic Research Articles

Diagnostic value of multiple café-au-lait macules for neurofibromatosis 1 in Chinese children.

Neurofibromatosis 1 (NF1) is a common autosomal dominant condition caused by mutations in the NF1 gene. The appearance of multiple café-au-lait macules is an early sign of the condition, which often alert physicians to follow up and further examine the patient for the possibility of NF1. In order to determine the predictive value of multiple café-au-lait macules at early age for NF1 in Chinese patients, we recruited 19 children who shared the common sign of multiple café-au-lait macules from a general pediatric clinic in Shanghai. All the patients were clinically evaluated following the National Institutes of Health criteria for NF1 and molecular tested for sequence variants and copy number changes. Nine children met the clinical diagnostic criteria of NF1, and molecular tests confirmed all nine patients with pathogenic variants including two genomic deletions, two novel frame-shift variants, four novel nonsense and a splicing variants. In addition, four children who did not meet the diagnostic criteria were also found to carry pathogenic NF1 variants. Overall, 68.4% (13/19) of children with café-au-lait macules and various other clinical presentations were molecularly confirmed with NF1. This study demonstrated that the majority of Chinese children with multiple café-au-lait macules who came to seek for medical attention had NF1. Molecular testing is necessary to be used as an adjunct and sometimes as the main tool for confirming and diagnosing children of NF1 at early age.

The Hispanic Clinic for Pediatric Surgery: A model to improve parent–provider communication for Hispanic pediatric surgery patients

Introduction26 million Americans have limited English proficiency (LEP). It is well established that language barriers adversely affect health and health care. Despite growing awareness of language barriers, there is essentially a void in the medical literature regarding the influence of language disparity on pediatric surgery patients. This study was designed to assess the impact of patient–provider language concordance on question-asking behavior and patient satisfaction for pediatric surgery patients. MethodsParticipants included families of patients in a General Pediatric Surgery Clinic categorized into 3 groups by patient–provider language concordance: concordant English-speaking, LEP concordant Spanish-speaking, and LEP discordant Spanish-speaking using an interpreter. Clinical visits were audio recorded and the number of patient-initiated questions and the length of clinical encounter were measured. Families were administered a surgery-specific, 5-point Likert scale questionnaire modeled after validated surveys concerning communication, trust, perceived discrimination and patient–provider language concordance. Regression models were performed to analyze associations between language concordance and patient’s question-asking behavior and between language concordance and survey results. ResultsA total of 156 participants were enrolled including 57 concordant-English, 52 LEP concordant-Spanish and 47 LEP-discordant-Spanish. There was significant variation in the mean number of patient-initiated questions among the groups (p=0.002). Both the English and Spanish concordant groups asked a similar number of questions (p=0.9), and they both asked more questions compared to the Spanish-discordant participants (p=0.002 and p=0.001). Language discordance was associated with fewer questions asked after adjustment for socioeconomic status. Language concordant participants rated higher scores of communication. Both Spanish-concordant and Spanish-discordant patients reported significantly increased preference for, and value of language concordant care. Language discordant participants reported that they desired to ask more questions but were limited by a language barrier (p=0.001). ConclusionsIn a pediatric surgery clinic, language concordant care increases the number of patient-asked questions during a clinical visit and improves communication suggesting that discordant care is a potential source of disparities in access to information. Future efforts should focus on expanding access to language concordant providers in other surgery subspecialties as a step towards limiting disparities in surgical care for all patients.

190: Banning Tanning

The World Health Organization lists artificial tanning beds as a class one physical carcinogen. Tanning bed use is associated with a 75% increased risk of cutaneous malignant melanoma if used before the age of 35. In 2012, the Manitoba government announced a parental consent law that requires minors to have a guardian present or sign a permission form for children and youth to use artificial tanning equipment. This law falls below the national standards as set by the Canadian Pediatric Society (CPS); furthermore, parental consent laws have been shown to be ineffective at changing commercial tanning exposure in youth. Our group of senior pediatric residents worked on a project advocating for a complete ban of commercial tanning use for all youth under the age of 18 in Manitoba. The first component of the project focused on community education. Residents presented to middle and high school students about the harmful consequences of tanning, and created educational pamphlets that were made available at several general pediatric clinics. The second component of our project focused on legislative change and public forum advocacy. Residents engaged with the media to bring awareness to the general public about the risks of artificial tanning. A petition calling for a complete ban of artificial tanning for minors was also created. This petition, which included over 1000 signatures, along with evidence supporting a full ban for artificial tanning was presented to the Manitoba Ministers of Health and Healthy Living in an invited forum to advocate for legislative change. These efforts were successful and resulted in the recent proposed legislation calling for a full ban on artificial tanning for minors; this is expected to pass into Manitoba law in the spring of 2015. This project serves as an example of how physicians can promote the health of their patients via community education, collaboration with public health experts, and involvement in local government.

Oral Health in Primary Care: Creating Interprofessional Faculty Leadership and Family and Community Engagement

s / Journal of Interprofessional Education & Practice 1 (2015) 48e77 59 children.1 The patient centered medical home (PCMH) was originally developed as a system of care for CSHCN by the American Academy of Pediatrics (AAP), and is considered a significant priority in health care policy for primary care of children.2 In 2010, our community-based, federally qualified health centered, general pediatrics clinic located within a tertiary medical center established a Pediatric PCMH Program for CSHCN, to provide closely coordinated case management for CSHCN, in hopes to improve their health outcomes, reduce high cost care, and enhance patient, family and provider satisfaction. Currently, our PCMH team case manages 824 families with CSHCN, utilizing a team of pediatricians and nurse coordinators. Barriers in communication, psychosocial factors, multi-subspecialty complex care and difficulties in access are factors which create impediments to providing comprehensive, effective case management for our CSHCN population.

Internet health seeking behaviour of parents attending a general paediatric outpatient clinic: A cross-sectional observational study

Introduction Our aim was to examine the internet health seeking behaviour of parents attending a general paediatric outpatient clinic. For this purpose, the proportion of parents going online to obtain child health information, the most commonly used online resources, and factors having an influence on internet usage were identified. Methods This cross-sectional observational study was conducted at a general paediatric outpatient clinic in Vienna, Austria. Data collection was done by means of an anonymous questionnaire containing 14 items. A total number of 500 questionnaires were collected. Results Among parents visiting the outpatient clinic, 94.4% use the internet to obtain child health information in general and 21% to be informed about the reason for consultation. Most commonly used online resources are Google (91.4%), websites run by doctors (84.8%), Wikipedia (84.7%), health portals (76.4%), the outpatient clinic's homepage (76.4%), as well as health forums and communities (61.9%). Younger parents (p = 0.022) and parents of younger children (p < 0.01) display a higher tendency to use the internet for child health information purposes. Mothers and fathers (p = 0.151) as well as parents with different completed educational levels (mothers: p = 0.078; fathers: p = 0.388) do not differ in this behaviour. Discussion Important reasons for high internet use might be the inexperience of young parents regarding child health as well as the frequent infections, vaccinations, and preventive check-ups which are associated with young age of children. In contrast to former findings relating to health seekers in general, internet usage of parents is independent of their sex and educational level.

Psychological Impact of Nocturnal Enuresis on Self-esteem of School Children

Bedwetting is the cause of significant psychosocial stress especially in older children. Aim: The study aimed to assess the psychological impact of nocturnal enuresis on self-esteem of school children. Design: Descriptive research design was used in this study. Setting: The study was conducted in El-Menoufya University Hospital, in Egypt, which consisted of 18 outpatient clinics. The pediatric outpatient clinic of Shebin El-Kom, El-Menoufia University Hospital it is general pediatric outpatient clinic for all children disorders not just for enuresis. Sample: This is a convenient sample of 140 of children representing almost half of the total attendants with nocturnal enuresis during three months duration. The total number of the sample was 70 children of nocturnal enuresis. Tools: For data collection, an interview questionnaire was used to assess socio demographic data, children knowledge about enuresis, psychological impact of enuresis on the children regarding depression and social isolation, self-esteem inventory scale for the children. Finding: The results of the study showed there were no significant difference between gender and their positive self-esteem. In addition, there were no significant difference between psychological problems of the studied children and their positive self-esteem. Conclusion: This study concluded that children in this age have poor knowledge in relation to enuresis. In addition, most of studied children had law self-esteem. Recommendations: According to this study it is recommended that raise community awareness about nocturnal enuresis through educating adolescents in school and universities about nocturnal enuresis, development of health educational program for mothers of enuretic children. Also pediatric nurse, psychiatric nurse, community health nurse and school health nurse offer counseling services for the mothers and their children regarding nocturnal enuresis.

CACN Platform Presentations

Background: Fundoscopy is an important component of the neurological examination, but can be challenging in uncooperative children. This study explores whether playing a video during eye examination, improves the success, duration and ease of pediatric fundoscopy. Methods: We completed a prospective, multi-clinic, block-randomized trial. Patients 1-4 years were recruited in the emergency department, neurology, spinal cord and general pediatric clinic. Patients were randomized (by eye examined) to video/non-video assisted fundoscopy. Successful exams were defined as visualizing the fundus within 60 seconds. Time to visualize optic disc was recorded and difficulty of exam was examined using a 10-point Likert scale. Results: 101 subjects were recruited, with a mean age of 2.8 years. Overall, there was a 20% absolute improvement in the success rate of visualizing the optic disc in the video versus non-video group (p&lt;0.01). Time to visualize optic disc was also improved (Δ5.3s, p&lt;0.01). Improvement in ease of examination with video were noted by caregivers and practitioners (p&lt;0.01). Conclusion: Playing a video improved the ease, duration and most importantly the success of fundoscopy in younger children. This simple, inexpensive adjunct has great potential to improve the ease and efficacy of this aspect of the neurological examination.

Pediatric-Based Intervention to Motivate Mothers to Seek Follow-up for Depression Screens: The Motivating Our Mothers (MOM) Trial

ObjectiveTo determine the initial effectiveness of a novel, pediatric office-based intervention in motivating mothers to seek further assessment of positive depression screens. MethodsIn this pilot randomized controlled trial, English-speaking mothers (n = 104) with positive 2-question depression screens and presenting with children 0 to 12 years old for well-child care to a general pediatric training clinic received interventions from a trained research assistant. The Motivating Our Mothers (MOM) intervention included office-based written and verbal targeted depression education and motivational messages encouraging further depression assessment and a semistructured telephone booster delivered 2 days later. The control intervention included nontargeted written and verbal messages and 2 days later, an attention control telephone survey. Both groups received a list of depression care resources. The primary outcome was the proportion of mothers in each group who reported trying to contact any of 6 types of resources to discuss the positive screen at 2 weeks after intervention (ClinicalTrials.gov NCT01453790). ResultsDespite 6 contact attempts, 10 MOM and 9 control mothers were lost to follow-up. More mothers in the MOM intervention tried to contact a resource compared to control (73.8% vs 53.5%, difference 20.3%, 95% confidence interval for difference −0.1 to 38.5, P = .052). ConclusionsMothers receiving the MOM intervention made more attempts to contact a resource for follow-up of positive depression screens. If found effective in larger studies, MOM may prove a promising approach for motivating depression screen–positive mothers identified in general pediatric settings within and beyond the postpartum period to seek further depression assessment and support.

G468(P) The majority of referrals from gp to general paediatric outpatient clinic could be managed by alternative methods

Aims Audit 100 referrals made to a hospital general paediatric outpatient clinic from General Practice to assess (i) Appropriateness (ii) Possible alternative methods of management Implement alternative and innovative methods of management using a multi-professional approach Improve quality of care for patients Methods Using a proforma, each referral was assessed by 3 people: A Paediatrician (taken from a pool of 3 Consultants), A GP physician (taken from a pool of 2) and A Paediatric nurse specialist Results 76–97% of patients seen in paediatric general outpatients could have been managed with at least one alternative method. The range reflects variation in assessor’s opinions (Figure 1 and Table 1). Conclusions The majority of cases seen in general paediatric outpatients in this sample did not require secondary care. Importantly, this study suggests that, with the support and partnership of secondary care, General Practice has the potential to be able to provide a safe, more rapidly accessible and cost-effective paediatric service than that currently being offered at the level of a general paediatric outpatient clinic. In terms of our progress: (i) Telephone hotline will be rolled out shortly (ii) Rapid access clinic opens in April 2015 (ii) Roll out of Community nurses (multi-professional approach) (iii) Development of email service and virtual clinic (iv) Increased support for GPs

Prediction of autism by translation and immune/inflammation coexpressed genes in toddlers from pediatric community practices.

The identification of genomic signatures that aid early identification of individuals at risk for autism spectrum disorder (ASD) in the toddler period remains a major challenge because of the genetic and phenotypic heterogeneity of the disorder. Generally, ASD is not diagnosed before the fourth to fifth birthday. To apply a functional genomic approach to identify a biologically relevant signature with promising performance in the diagnostic classification of infants and toddlers with ASD. Proof-of-principle study of leukocyte RNA expression levels from 2 independent cohorts of children aged 1 to 4 years (142 discovery participants and 73 replication participants) using Illumina microarrays. Coexpression analysis of differentially expressed genes between Discovery ASD and control toddlers were used to define gene modules and eigengenes used in a diagnostic classification analysis. Independent validation of the classifier performance was tested on the replication cohort. Pathway enrichment and protein-protein interaction analyses were used to confirm biological relevance of the functional networks in the classifier. Participant recruitment occurred in general pediatric clinics and community settings. Male infants and toddlers (age range, 1-4 years) were enrolled in the study. Recruitment criteria followed the 1-Year Well-Baby Check-Up Approach. Diagnostic judgment followed DSM-IV-TR and Autism Diagnostic Observation Schedule criteria for autism. Participants with ASD were compared with control groups composed of typically developing toddlers as well as toddlers with global developmental or language delay. Logistic regression and receiver operating characteristic curve analysis were used in a classification test to establish the accuracy, specificity, and sensitivity of the module-based classifier. Our signature of differentially coexpressed genes was enriched in translation and immune/inflammation functions and produced 83% accuracy. In an independent test with approximately half of the sample and a different microarray, the diagnostic classification of ASD vs control samples was 75% accurate. Consistent with its ASD specificity, our signature did not distinguish toddlers with global developmental or language delay from typically developing toddlers (62% accuracy). This proof-of-principle study demonstrated that genomic biomarkers with very good sensitivity and specificity for boys with ASD in general pediatric settings can be identified. It also showed that a blood-based clinical test for at-risk male infants and toddlers could be refined and routinely implemented in pediatric diagnostic settings.

Gender Disparity among Preterm Born Neonates

Introduction: Infants born preterm remain vulnerable to many complications. Objective was to identify gender differences in morbidity and adverse outcomes among premature and low birth weight born babies.Methods: A retrospective chart review of general pediatric clinic records was conducted for children and adolescents who were born premature and survived. Demographic, maternal, family, neonatal and postnatal data were abstracted. The data was then analyzed using a statistical calculator to perform one sample t-test between percentages.Results: Total 160 charts were reviewed. Out of 160, 58.8% males and 41% females were identified. The female babies were born at a higher rate as small for gestational age (SGA) babies, with a birth weight &lt; 10th percentile (60.8% vs. 39%; p &lt; 0.05), most of the male babies although pre-term were born as appropriate for gestational age (AGA). The incidence of complications associated with prematurity were found to be at a higher rate in male babies including jaundice (63.15% vs. 36.8%; p = 0.0198), metabolic issues (64.2% vs. 35.7%; p = 0.03), and respiratory distress syndrome (RDS) (60.5% vs. 39.4%; p =0.02). Sepsis was observed in 54% vs. 45.8% (p = 0.69), intracranial hemorrhage (ICH): 75% vs. 25% (p = 0.33), hypertension (HTN) 62% vs. 37% (p = 0.108).Conclusion: Gender related health disparity exists among pre-term born children although does not have a sufficient explanation. Most males, although born AGA, had a higher incidence of prematurity and its sequel requiring intensive healthcare support compared with females.

G293(P) Does every child referred to paediatric out patients need to be seen?

Aims In the UK, the referral rate from primary care to General Paediatrics has drastically increased from from 15.5 to 25.7/1000 children per annum1. A Cochrane review identified that ‘local educational interventions involving secondary care specialists and structured referral guidelines are the only interventions shown to negatively impact referral rates’2. This study investigated whether written dialogue with GPs could empower them to appropriately manage potential General Paediatric out patient referrals in the community. Method A retrospective case note review of 300 referrals which were managed with individualised advice letters rather than outpatient appointments between October 2012 and March 2014 was conducted. Results All children under the age of 1 were offered outpatient appointments. The distribution of age groups is illustrated in Figure 1. The system based referrals are demonstrated in Table 1. 84% (n = 253) of referrals were managed by a single advice letter. Within this group, only 26% (n = 66) were re directed to more appropriate services. Of the remaining 47 referrals, 38% (n = 18) were offered outpatient appointments after further telephone discussion with the GP; 57% (n = 27) were re referred after the GP received the advice letter. Of the patients offered out patient appointments, 40% (n = 19) were discharged after the initial consultation and 4% (n = 2) did not attend. No adverse outcomes were noted. Conclusion This study demonstrates that through supporting GP colleagues, selected outpatient referrals can be appropriately managed in the community. In our trust 253 new General Paediatric appointments would represent 41 General Paediatric clinics. However the ‘Payment by Result’ offers perverse financial incentive to manage more patients in secondary care. If adopted regionally this approach would improve patient care in the community and free up Consultant time towards consultant delivered acute care.

Tachypnoea in a well baby: what to do next?

It is not uncommon to see babies in clinic who have been referred because they are persistently tachypnoeic. Sometimes this has been noticed by the parents, but more often, especially...

Prevalence of Attention Deficit Hyperactivity Disorder in Children

Objectives: The aim of the study was to determine the prevalence of attention deficit hyperactivity Disorder (ADHD) and associated risk factors among children were attended the general pediatric outpatient clinic of Menoufia University Hospital. Background: Attention deficit hyperactivity disorder is the most commonly seen developmental disorders, with significant impacts on the child's social, psychological, and scholastic functioning. Methods: The study was conducted on 600 children (5 - 12 years ) were attended the general pediatric outpatient clinic of Menoufia University Hospital . All studied patients were subjected to adequate history taking, full clinical examination, a questionnaire regarding socioeconomic, family and maternal variables and a parent-completed, ADHD Rating Scale of attention deficit hyperactivity symptoms was used. Results: The study revealed that the prevalence of probable ADHD in our study was 19.7%. and was higher in males than in females with a ratio 2.7:1. The most common type of probable ADHD was the combined type and the least frequent type was the inattentive type. There were many factors that were sought to be associated with increase possibility of developing ADHD. Conclusion: The present study shows a high prevalence of probable ADHD in children. our study also revealed that probable ADHD was associated with many risk factors, prevalence was high in the male sex, living in urban areas, low socioeconomic families, large family size, living with a single parent, family history of ADHD, preterm children, low birth weight and bottle fed children.

Team Huddle Implementation in a General Pediatric Clinic.

Teamwork and communication are critical to ensure safe and quality patient care. However, the ability to affect these constructs within well-established healthcare settings is challenging. Using a quality improvement approach, staff development educators collaborated with clinical nursing staff to implement a daily team huddle. When incorporated into the workflow, a team huddle can promote communication and positively influence how teams function within a clinical area.(See CE Video, Supplemental Digital Content 1, http://links.lww.com/JNPD/A9).

Assessment of caregiver’s knowledge about child development in the first two years of life in Saudi Arabia

Introduction: Child development refers to the changes that occur as a child grows and develops. The first two years of a child’ s life are fundamentally important. Objectives: To assess the knowledge among caregivers about child development in Saudi Arabia in the first two years of life and to improve the level of knowledge and awareness among Saudi caregivers. Materials and methods: The study was cross-sectional and was conducted in general paediatric clinics and well-baby clinics, National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. The data were collected over a period of 10 days. The questionnaires were self-administered by 350 Saudi caregiver participants of both genders of different ages. The caregivers survey included demographic characteristics and 20 questions covering the four domains of child development (sight, vocalization, social, brain and motor) and source of knowledge. Questionnaires were distributed using systematic random sampling. Results: Our results found 84% of caregivers have poor knowledge about healthy child development. According to different domains, they did not know about vocalization (98.5%), sight (98.2%), social (97.1%), total motor (95.6%) and total cognitive and brain development (88.3%). Conclusions: This study shows that there is a need to develop and deliver educational clinics and certification programmes for caregivers about healthy child development in the primary health centres. The data suggest a need to launch an awareness campaign distributing pamphlets in caregiver centres and in waiting areas in the clinics. Acknowledgements: Dr Khamisa AlMokali for supervising this project.

The effects of language concordant care on patient satisfaction and clinical understanding for Hispanic pediatric surgery patients

BackgroundHispanics account for over 60% of the U.S. population growth and 25% speak little-to-no English. This language barrier adversely affects both access to and quality of care. Surgical specialties trail other medical fields in assessing the effects of language barriers to surgical clinical care and patient satisfaction. This study was designed to assess the effects of patient–provider language concordance on a pediatric surgery practice. MethodsA surgery-specific, 7-point Likert scale questionnaire was designed with 14 questions modeled after validated patient satisfaction surveys from the literature. Questions concerning provider–patient language concordance, quality of understanding, and general satisfaction were included. Surveys were administered to families of patients in the General Pediatric Surgery Clinic at our institution. Families were categorized into three groups: English-speaking, regardless of race/ethnicity; Spanish-speaking using interpreter services with an English-speaking medical team; and Spanish-speaking communicating directly with a Spanish-speaking medical team (Hispanic Center for Pediatric Surgery, HCPS). One-way analysis of variance was used to test for group differences. ResultsWe administered 226 surveys; 49 were removed due to lack literacy proficiency. Families in the HCPS group reported a higher level of satisfaction than the interpreter and English groups (p<0.01). The HCPS group also indicated improved understanding of the information from the visit (p<0.001). Spanish-speaking only families felt that communicating directly with their health care team in their primary language was more important than their English-speaking counterparts (p<0.001). ConclusionsIn a pediatric surgery clinic, language concordant care improves patient satisfaction and understanding for Hispanic families in comparison to language discordant care. Other clinics in other surgery sub-specialties may consider using this model to eliminate language barriers and improve patient satisfaction and understanding of surgical care.

Changes in peanut allergy prevalence in different ethnic groups in 2 time periods

Changes in peanut allergy prevalence in different ethnic groups in 2 time periods

The effect of a dedicated Ponseti service on the outcome of idiopathic clubfoot treatment.

We report the effect of introducing a dedicated Ponseti service on the five-year treatment outcomes of children with idiopathic clubfoot. Between 2002 and 2004, 100 feet (66 children; 50 boys and 16 girls) were treated in a general paediatric orthopaedic clinic. Of these, 96 feet (96%) responded to initial casting, 85 requiring a tenotomy of the tendo-Achillis. Recurrent deformity occurred in 38 feet and was successfully treated in 22 by repeat casting and/or tenotomy and/or transfer of the tendon of tibialis anterior, The remaining 16 required an extensive surgical release. Between 2005 and 2006, 72 feet (53 children; 33 boys and 20 girls) were treated in a dedicated multidisciplinary Ponseti clinic. All responded to initial casting: 60 feet (83.3%) required a tenotomy of the tendo-Achillis. Recurrent deformity developed in 14, 11 of which were successfully treated by repeat casting and/or tenotomy and/or transfer of the tendon of tibialis anterior. The other three required an extensive surgical release. Statistical analysis showed that children treated in the dedicated Ponseti clinic had a lower rate of recurrence (p = 0.068) and a lower rate of surgical release (p = 0.01) than those treated in the general clinic. This study shows that a dedicated Ponseti clinic, run by a well-trained multidisciplinary team, can improve the outcome of idiopathic clubfoot deformity.

The relationship between helplessness and the child’s asthma symptoms: the role of social support

Objective: Objectives of this study were to survey parents and children independently regarding feelings of helplessness specific to asthma and to examine the relationship between helplessness and the child's symptom-free days. Methods: Parent–child dyads (children 7–12 years) from Rochester, NY were enrolled (November 2011–August 2012) from general pediatric clinics, pulmonary clinics, an Emergency Department, and area youth and asthma programs. Assessments included demographics, symptoms, ratings of helplessness related to asthma and parent social support. A multivariate linear regression was conducted to examine the relationship between feelings of helplessness and symptoms-free days: post hoc analysis assessed the moderating role of social support. Results: Overall, 107 parent–child dyads enrolled (participation rate: 72%); 104 were included in analysis. Most children were male (58%), 7–9 years (58%) and White (46%). The child's feelings of helplessness scores were positively correlated with symptom-free days indicating less feelings of helplessness as symptom-free days increased (rs = 0.273, p = 0.01). In a stratified analysis, among parents who reported minimal social support (<1 sources of support), child's helplessness scores were positively correlated with symptom-free days (rs = 0.335, p = 0.02). Conversely, among parents reporting >2 supports, no relationship was found (rs = 0.195, p = 0.15). Conclusions: This study found less feelings of helplessness among children with asthma as symptom-free days increased. Social support appears to moderate this relationship; however further studies to confirm these findings are needed.