Unmet social needs in paediatric patients contribute to poor health outcomes and increased healthcare utilisation. In order to identify unmet social needs, we aimed to improve social determinant of health (SDoH) screening of children admitted to the general paediatrics teams at our institution. Between September 2021 and September 2024, we conducted a quality improvement project by a multidisciplinary stakeholder team to improve identification of unmet social needs at our institution. We set two aims: (1) develop a screening process acceptable to families and (2) increase the percentage of children admitted to general paediatrics with SDoH screening documented across four domains, including food insecurity, transportation barriers, housing insecurity and financial strain from 0% to 60%. During the project period, 4229 patients were eligible for screening. Screening was found to be acceptable by a pilot group of patients and their families (n=22). Rates of screening improved from 0% to 56.7% after various interventions, including nursing education and feedback, providing meal trays from the cafeteria to families in need, and integration of the screening questionnaire into the electronic health record. Food insecurity screening positively correlated with SDoH screening across all four domains. This multidisciplinary quality improvement project implemented SDoH screening on general paediatrics which was found acceptable by patients, and rates of screening improved by addressing identified needs. Tangible resources, such as providing meal trays during the hospitalisation, were a unique aspect of this project that helped families and alleviated distress of the screeners.

The use of image and performance enhancing drugs (IPEDs) and the consumption of nutritional supplements are rising in young people, yet most paediatricians have limited experience in this emerging area of practice. This article aims to increase awareness of the scale of the issue; to suggest when IPED use might be suspected; and how to investigate and manage it practically and holistically. It stresses the risks of online nutritional supplements, which are frequently contaminated with potentially harmful substances and increasingly easy to purchase online on social media. It summarises what is known about the risks and adverse effects, particularly cardiac, endocrine and psychological complications, some of which can be irreversible. The article then highlights the risk that some young people involved in sport may be underdosing themselves with necessary medication out of concerns that they could fail drug testing. It also discusses how to prescribe for young competing athletes; how to check which medications are banned for that athlete; and how to prescribe medication which is clinically indicated but on the prohibited list.

To evaluate the impact of a national career exploration program, Exploring DBP, on trainee interest in pursuing exploring developmental-behavioral pediatrics (DBP) fellowship, and to describe participant demographics, knowledge gains, and perceived barriers to entering the field. Presurvey and postsurvey results were analyzed from the program's 2019 to 2023 cohorts assessing demographics, DBP knowledge, program satisfaction, and likelihood to apply for fellowship. Data were analyzed descriptively. Qualitative responses were analyzed to explore career decision factors. From 2019 to 2023, 239 participants completed the program (50.1% residents, 44.8% medical students, and 5.0% general pediatricians). The cohort had greater representation of trainees from ethnically diverse backgrounds compared with national averages (e.g., 26.6% Hispanic vs 7%-9%). Participants consistently rated mentorship and personal stories from DBP professionals as the most valuable program components. After the program, the proportion of participants who were "likely" or "very likely" to apply for a DBP fellowship rose from 46% to 79%. Key reported barriers to pursuing fellowship included inadequate compensation, training length, student loan burden, and competing interest in fields such as child psychiatry or neurology. A 2022 follow-up survey found that 41% of eligible early participants had successfully matched into a DBP fellowship program. The program effectively increased knowledge and interest in pursuing a DBP career. Structured early exposure may support recruitment into undersubscribed pediatric subspecialties.

Workforce Projections on the Supply and Demand of General Pediatricians Across the United States: Identifying Deficiencies to 2037.

IntroductionNutrition management is essential for disease prevention and improvement of clinical outcomes in children. However, pediatric trainees routinely acknowledge knowledge gaps in nutrition management. We designed and implemented an interactive, case-based module for pediatric residents to facilitate knowledge acquisition and retention of high-yield pediatric gastroenterology and nutrition topics.MethodsCurriculum development followed the Kern model. A formal needs assessment was conducted among current pediatric residents to identify priority topics that were aligned with the American Board of Pediatrics Exam Content Outline. Through an iterative review process, eight 15-minute case-based modules were created with specific educational objectives and delivered weekly during resident continuity clinic by general pediatric faculty. Each session included structured discussion prompts and teaching guides to ensure consistency. Residents completed pre- and postsession assessments for each module and a 9-month follow-up assessment to evaluate knowledge retention.ResultsA total of 57 pediatric residents received the curriculum from August to October 2023. A mean of 32 paired pre- and postsession assessments were completed per module. Knowledge scores significantly improved postsession (p < .05) for seven of eight modules, with a mean score increase of 20%. Eighty-four percent of previous learners completed the 9-month follow-up assessment. There was no statistically significant difference between postsession and follow-up knowledge test scores for seven of eight modules, suggesting knowledge retention.DiscussionA brief, interactive, case-based curriculum on high-yield topics within pediatric gastroenterology and nutrition facilitates both acquisition and retention of knowledge among general pediatrics trainees in an academic primary care clinic.

Abstract Objectives Early Relational Health (ERH)—a foundational determinant of lifelong mental and physical health—is emerging as a critical component of paediatric practice. However, its integration into Canadian paediatric residency training remains poorly defined. This study conducted an environmental scan of Canadian paediatric residency programs to examine the current state of ERH education, as reported by Program Directors (PDs). Methods PDs from Canadian paediatric residency programs were invited to complete an anonymous survey (September–December 2023). The survey explored PDs' definitions of ERH, existing training opportunities, perceptions of how well ERH is addressed, and motivators for incorporating structured curricula. Data were analyzed using descriptive statistics. Results Ten PDs completed the survey (37% response rate). All (100%) General Pediatrics PDs reported their program teaches positive parenting and early child development “Not Very Well,” compared with 20% of subspecialty PDs. Sixty per cent of General Pediatrics PDs and all Subspecialty PDs rated an ERH curriculum as “Very Important” for their learners. Nearly all respondents expressed interest in implementing a structured, evidence-based, self-guided ERH curriculum to improve resident knowledge and skills. Discussion This is the first study to evaluate ERH training within Canadian paediatric residency programs. While some subspecialty programs have integrated ERH content, most General Pediatrics programs identified clear training gaps. All PDs recognized ERH as an essential topic despite limited formal education opportunities. Development of a structured, competency-based ERH curriculum represents a key next step in advancing paediatric training and care quality in Canada.

Sitosterolemia is a rare autosomal recessive disorder of lipid metabolism, with varied incidence rates of 1/200 000 to 1/1 000 000. The condition often presents prepubertally, but is commonly misdiagnosed as familial hypercholesterolemia. We want to raise clinical suspicion across pediatric generalists and subspecialties with our case report of a 7-year-old girl who presented via ophthalmology following the surgical removal of a lipid keratopathy of her cornea. Four years before her presentation at ophthalmology, she also underwent surgical excision of a large xanthoma from her left buttock. There was no further diagnostic workup at that point. On examination, she had multiple tuberous xanthomas on her knuckles and knees in addition to the corneal deposits. Baseline lipid investigation revealed a markedly elevated total cholesterol of 11.9mmol/L and an LDL cholesterol of 10.2mmol/L. She was given a presumptive diagnosis of familial hypercholesterolemia and started on statin therapy, to which she had a partial response. Molecular genetic analysis for familial hypercholesterolemia was negative, but because of the high index of suspicion, an expanded genetics panel was requested that demonstrated compound heterozygous variants in the ABCG5 gene, pathogenic for sitosterolemia. Sterol analysis demonstrated markedly elevated phytosterol levels consistent with the genetic findings. The patient was treated with dietary restriction of plant sterols and Ezetimibe. Computed tomography coronary angiogram showed no coronary artery calcification. An awareness of sitosterolemia amongst pediatricians is vitally important as this condition may present to numerous specialties, as evidenced in this case. Recommended lifestyle and pharmacotherapy interventions differ between sitosterolemia and familial hypercholesterolemia.

ABSTRACT Purpose The global shortage of healthcare professionals disproportionately affects low/middle income countries. Bangladesh is facing critical health workforce shortages, exacerbating workload and the risk of doctors’ burnout. However, there is a lack of qualitative research into causes of occupational burnout in Bangladeshi doctors. This study investigated the factors contributing to burnout among Bangladeshi doctors. Methods An exploratory approach was employed using Reflexive Thematic Analysis with a Critical Realist approach. Fifteen semi-structured interviews were conducted with Bangladeshi doctors (general practitioners, cardiologists, surgeons, and paediatricians). Data were collected in English or Bangla and analysed using Atlas.ti version 24. Results Four themes were developed: (1) the postgraduate phase is a pressure pinch-point, (2) there is limited awareness of mental health issues and insufficient support, (3) high workload and competing demands, (4) unhelpful public attitudes and media narratives. Findings highlight structural, cultural, and organizational factors driving burnout. Discussion Addressing burnout in Bangladeshi doctors requires systemic and policy-level interventions. Mental health support, workload management strategies, and public awareness initiatives are critical to improving doctors’ well-being and sustaining the healthcare workforce in Bangladesh. Overall, the study offers the first in-depth qualitative account of how intersecting structural and cultural pressures shape doctors’ experiences of burnout in Bangladesh.

Abstract Introduction: Community-based health camps under the family adoption programme (FAP) aim to extend preventive and primary care services to under-resourced populations. However, there is limited evidence on morbidity patterns and healthcare utilisation in such settings. Materials and Methods: This retrospective study analysed records of 384 attendees from four FAP areas in Nainital, Uttarakhand, India (April–July 2024). Socio-demographic data, ICD-11-coded diagnoses and service utilisation details were extracted using a standardised pro forma. Descriptive statistics were applied using Jamovi version 26.1. Results: The median age of attendees was 33 years 67.7% were female and 69.8% from rural areas. Anaemia (67.6%), obesity (52.7%) and elevated blood pressure (29.9%) were prevalent. General symptoms (45.8%), musculoskeletal issues (14.1%) and infectious diseases (13.5%) were most frequently diagnosed. General medicine (47.4%) and paediatrics (25%) were the most utilised services. Calcium and vitamin supplements were commonly prescribed. Conclusion: These camps proved effective in identifying undiagnosed morbidity and served a much wider population than originally intended.

The primary objective of this study was to examine the perceptions, common referral practices, and resources utilized by pediatricians and Early Intervention (EI) personnel in facilitating the direct enrollment of children with established medical conditions into EI program. A survey, developed through a literature review, policy document review, and cognitive interviewing with pediatricians and EI personnel, was completed by 69 general pediatricians and 193 EI personnel involved in intake and eligibility evaluations in Michigan and Washington. Descriptive analysis was used to analyze the results. Most pediatricians (76%) and EI personnel (81%) rated the EI referral system as “ Excellent ,” “ Very good ,” or “ Good .” EI personnel primarily rely on state-approved established conditions list, internet searches, and colleague consultations for eligibility determination. Pediatricians reported “ Rarely ” utilizing the established conditions list, and instead they “ Often ” refer children to EI for eligibility determination, with limited or no accompanying medical information. Inconsistencies in key referral practices among these professionals were observed. Understanding perceptions and practices of pediatricians and EI personnel is crucial for improving early childhood preventive care. Addressing identified gaps and promoting consistency in referral practices can enhance access to EI services for children with established medical conditions and developmental delays.

Background/Objectives: Gastrointestinal and eating disorders are highly prevalent problems in children with Down syndrome (DS) and have a significant impact on their daily lives. It is important to investigate the bowel habits of children with DS, specifically the prevalence of functional constipation (FC), in order to develop practice guidelines for pediatricians that support diagnosis and treatment. Materials and Methods: This observational, analytical, and cross-sectional study was approved by the Ethics Committee and included 36 children with DS under pediatric outpatient follow-up at a university hospital. To assess bowel habits, an interview was held with the parents using the Rome IV criteria and the Bristol Stool Scale. The children were divided into two groups: those with and those without FC. Specific curves for individuals with DS were used for nutritional assessment. Results: The median age of the children was 46.6 months (5 to 144 months); a total of 80.5% of those included were eutrophic. The median age at initiation of toilet training was 36 months. Most children achieved bowel control when training started after 30 months of age. A total of 15 (41.7%) of the 36 children included were assigned to the group with FC, and 21 (58.3%) were assigned to the group without FC. The FC group had a lower frequency of bowel movements, hardened stools, pain during bowel movement, and used laxatives. According to the Rome IV criteria, the three most prevalent criteria were hard stools, large-volume stools, and painful bowel movements. Conclusions: Children with DS had a high prevalence of FC, and it was possible to identify an association between delayed sphincter training and FC. A care and monitoring protocol and flowchart are useful tools for the general pediatrician.

Pediatric infectious disease (ID) outpatient settings do not routinely screen for household-level psychosocial needs. We assessed the prevalence of health-related social needs (HRSNs), caregiver adverse childhood experiences (ACEs), and neighborhood-level socioeconomic deprivation index (SDI) scores in pediatric ID outpatient settings. We approached English- and Spanish-speaking caregivers of pediatric ID outpatients to complete HRSN and ACE paper questionnaires from August 2023 to August 2024. The SDI scores were identified using geocoded addresses (higher scores indicating more deprivation). We surveyed 306 caregivers regarding HRSNs and ACEs. Caregivers reported anxiety (70%), depression (20%), and food insecurity (10%), with 20% reporting ≥4 ACEs. Median SDI scores were higher for children with reported food insecurity (0.61) compared to those without food insecurity (0.28, P < .001). In addition to general pediatricians, ID clinicians could play a critical role in addressing challenges in ways that could decrease inequities, approaches aided by HRSN and ACE screening and SDI risk stratification.

Antibiotic-associated diarrhea (AAD) is known to be a common problem in children receiving antibiotic treatment. However, there is insufficient data in children hospitalized with a diagnosis of pneumonia. The aim of our study was to evaluate the incidence of AAD in children hospitalized with a diagnosis of pneumonia without known comorbidities and to investigate the protective effect of Bifidobacterium animalis ssp. lactis B94 against diarrhea. We conducted a retrospective preliminary observational study in children diagnosed with pneumonia who were admitted to the Department of General Pediatrics at a Tertiary Hospital in the Mediterranean Region of Turkey between January 2021 and December 2023. Children diagnosed with pneumonia who met the study criteria were included in the study. AAD was defined as ≥ 3 loose or watery stools per day for a minimum of 48h during antibiotic treatment. For patients with AAD, clinical data, antibiotic use, diarrhea incidence, and probiotic use were recorded. A total of 202 patients were enrolled. Of these, 116 (57.4%) were female, with a median age of 33.6 months. AAD developed in 14 patients (6.9%). AAD developed more frequently in children younger than 24 months (p = 0.004). Age and gender distribution were similar between the probiotic and control groups (p > 0.05). AAD developed significantly less in the probiotic group (2.9% vs. 11.0%, p = 0.022). After multivariate adjustment, probiotic use remained protective (adjusted OR: 2.435, 95% CI: [(1.464)-(2.717), p = 0.031]). Additionally, children given probiotics required less IV hydration (1.9% vs. 8.0%, p = 0.041). This preliminary observational study suggests the incidence of AAD is low among children hospitalized with pneumonia without comorbid diseases. Prophylactic use of Bifidobacterium animalis ssp. lactis B94 may reduce the risk of diarrhea, though larger prospective studies are needed for confirmation.

Data exploring family-centered rounds (FCR) participation for caregivers who prefer a language other than English (LOE) are limited. We sought to characterize baseline rates of LOE-preferring caregiver FCR participation and reasons for not participating as part of the current-state analysis for a QI initiative. From July 1, 2023, to April 19, 2024, rounding data were recorded, including caregiver presence at bedside and caregiver participation in rounds, for patients admitted to general pediatrics resident teams at a free-standing children's hospital. For LOE-preferring caregivers, we documented reasons for not joining rounds. We used logistic regression to compare FCR participation rates by preferred language and team; we used statistical process control P-charts to visualize participation over time. Data were recorded for 7586 rounding encounters. This included 6781 encounters with English-preferring caregivers and 805 encounters with LOE-preferring caregivers, representing 231 patients with LOE-preferring caregivers. LOE-preferring (70.3%, n = 566) and English-preferring (69.7%, n = 4725) caregivers were present at bedside with equal frequency. Of caregivers present at bedside, LOE-preferring caregivers participated in 55.6% (n = 315) of rounding encounters compared with 88.1% (n = 4165) for English-preferring caregivers (P < .001). The most-common reason that LOE-preferring caregivers did not participate in FCR was not being invited to join (82%, n = 251). LOE-preferring caregiver participation varied over time (27%-81%), by care team (39%-91%), and by individual LOE (27%-83%). LOE-preferring caregivers participated in FCR less often than English-preferring caregivers despite similar bedside presence, largely because they were not invited to join. Identifying opportunities to improve LOE-preferring caregiver participation in FCR is essential to ensure the provision of equitable care.

We examine the relationship between entrustable professional activity (EPA)-based assessments made by clinical competency committees at the conclusion of pediatric residency training and general pediatrics initial certifying examination performance. Between 2015 and 2018, 21 residency programs evaluated residents' readiness to perform subsets of the 17 general pediatrics EPAs without supervision. These data were linked with scores from the American Board of Pediatrics General Pediatrics Initial Certifying Exam. Certifying exam performance for graduates deemed ready for unsupervised practice was compared with the exam performance of those not deemed ready. Of 934 graduates, 851 (91%) passed the initial certifying exam on their first attempt. Of these, 520 (61%) were deemed ready for unsupervised practice for all observed EPAs, and 331 (39%) were not. Of the 83 who failed on their first exam attempt, 43 (52%) were deemed ready for unsupervised practice for all observed EPAs, and 40 (48%) were not. Practice readiness assessment using the EPA framework does not correlate well with the passing of board exams. These assessments measure different, albeit overlapping, components necessary for the care of children. Continued effort is needed to determine how to integrate a competency-based approach that uses information from different sources to help make informed and defensible decisions regarding each individual's educational needs and ultimate readiness for practice into both training and certification processes.

A Generalist-Deliverable Bio-Psycho-Social Model for Pediatric Chronic Daily Headache: A 24-Month Retrospective Study.

Sudden cardiac arrest is a major cause of sudden cardiac death (SCD) in youth, including athletes and nonathletes. In Lebanon, the survival rate after out-of-hospital cardiac arrest in individuals <35 years old is only 16.7%. We aim to assess the knowledge, attitudes, and practices of primary care physicians in Lebanon regarding screening for SCD risk factors in youth. A cross-sectional survey was distributed to general practitioners, pediatricians, and family medicine physicians across Lebanon. The questionnaire, based on American Heart Association guidelines, assessed physician knowledge, attitudes, and practices toward screening for SCD in athletes and nonathletes. Sixty-eight physicians completed the survey (49% male; 68% >50 years old; 53% general practitioners (GPs), 32% pediatricians, 15% family doctors). Family doctors had the highest mean knowledge score (1.9), followed by GPs (1.56). Attitude assessment showed that 70% of family physicians, 58.3% of GPs, and 59.1% of pediatricians believed there is sufficient screening for SCD risk factors in young adults. Practice assessment using American Heart Association criteria showed mean scores of 12.4 for family doctors and pediatricians and 10.9 for GPs. While awareness and knowledge of SCD among Lebanese primary care physicians are moderate, they are not consistently translated into clinical practice. These findings underscore the need for targeted education, implementation of standardized screening protocols, and further research to address this gap.

Abstract Background Pediatric-onset inflammatory bowel disease(pIBD) often presents with nonspecific symptoms, contributing to diagnostic delay(DD) and increased morbidity. Despite the importance of referral quality, few studies have systematically classified and analyzed diagnostic pathways in pIBD. The primary aim of this study was to assess the appropriateness of diagnostic pathways in pIBD, from first medical contact to endoscopy. Secondary aims included evaluating the impact of pathway adequacy on DD and early disease severity, and identifying factors associated with prolonged delay. Methods This retrospective, single-center observational study included 128 patients consecutively diagnosed with pIBD over a ten-year period, at a regional tertiary center in Italy. Pathways prior to referral to the pediatric gastroenterology service were classified as: appropriate when preceded by a general pediatrician(GP) evaluation, including fecal calprotectin(FC) and/or abdominal ultrasound(AUS); partially appropriate when referred by a GP or another specialist, without these investigations; inappropriate when the patient presented spontaneously to the emergency department (except in urgent cases) or was self-referred to an outpatient clinic. DD was defined as the time from symptom onset to endoscopy. Descriptive, univariate, and multivariate analyses were performed (significance p &amp;lt; 0.05). Results Pathways were inappropriate in 60.9%, partially appropriate in 21.9%, and appropriate in 17.2%. The median DD was 3.9months(IQR:2.9–4.7), with no significant differences among groups. Clinical features influenced pathway adequacy (p &amp;lt; 0.05): acute severe colitis(ASUC, OR = 32.2) and tenesmus(OR = 5.8) were associated with appropriate pathways, whereas fever and oral aphthosis with inappropriate ones. A shorter DD was independently associated (p &amp;lt; 0.05) with: ASUC (B=–6.13months), hematochezia(B=–3.48months), fever(B=–4.25months), and weight loss(B=–3.42months). Regarding prereferral screening, 60.2% had FC measured and 42.2% underwent AUS; however, several patients with partial/completed screening were still inappropriately referred. Among those undergoing AUS, 51.9% showed bowel wall thickening ≥3 mm. AUS positivity rates differed by setting: 100% at our pediatric radiology service vs 33.3% for externally performed AUS (p &amp;lt; 0.001). Conclusion Inappropriate pathways and lack of prereferral screening are highly prevalent although they do not consistently result in longer DD. Severe presentations may prompt earlier and more appropriate investigations. Systemic and extraintestinal manifestations are more likely to be associated with inappropriate pathways, suggesting limited early recognition. Standardized screening and referral protocols are essential to optimize pIBD management.

Pediatric Leaders' Perspectives on Climate Change Advocacy.

Pediatric emergency transfers (ETs), unplanned intensive care unit (ICU) transfers in which a child needs intubation, vasopressor initiation, or at least 60mL/kg fluid resuscitation within 1 hour, are associated with longer stays and higher mortality, yet their financial burden is unknown. Thus, we compared post-transfer financial charges for ETs vs non-ETs. We conducted a retrospective cohort study of 2034 ICU transfers between 2015 and 2019 at a freestanding children's hospital. We compared charges between ETs and non-ETs, including aggregate post-transfer ICU charges (transfer through ICU discharge), aggregate total post-transfer hospital charges (transfer through 100days post-transfer), and average daily post-transfer charges over the first 100days. Charge comparisons were adjusted for age, presence of complex chronic conditions, pretransfer length of stay, originating service, and deterioration type using regression models with generalized estimating equations. Compared to non-ETs, ETs had higher unadjusted post-transfer charges (ICU: 108% [95% CI 51-188], P < .01; total: 91% [95% CI 50-143], P < .01; daily: 61% [95% CI 35-91], P < .01). After adjustment, ETs remained associated with higher post-transfer charges (ICU: 65% [95% CI 22-123], P < .01); total: 49% [95% CI 17-90], P < .01; daily: 20% [95% CI 3-98], P = .02). ET-associated post-transfer charge increases varied significantly by originating service (general pediatrics: 104% [95% CI 30-221] vs surgical services: -19% [95% CI -55 to 47], P < .01) and deterioration type (respiratory: 177% [52%-407%] vs circulatory: 2% [-28% to 47%], P < .01). ETs are associated with significantly higher post-transfer charges for hospitalized children. This financial impact highlights the economic imperative, alongside clinical benefits, for investing in systems aimed at preventing delayed escalation and reducing ETs.