Pediatric Service Research Articles

Bias, Prejudice, Discrimination, Racism, and Social Determinants: The Impact on the Health and Well-Being of Latino Children and Youth

This narrative review focuses on the impact of bias, prejudice, discrimination, racism (BPDR), social determinants of health, and structural racism on Latino children’s health and well-being. The race/ethnicity, country of origin, immigrant/generational status, limited English proficiency (LEP), acculturation level, and social class of Latino children and their parents can heighten or modify the impact of BPDR. These differences have been shown to affect BPDR among Latino adults and presumably for their children. Surveys of Latino adolescents reveal that 60% have experienced discrimination, with first- and second-generation teens having a higher prevalence. These experiences are magnified by adverse social determinants/structural racism. BPDR can impact Latino children prenatally through adolescence. Bias involving neonatal, primary, and inpatient pediatric services has been reported. In 2021, Latino children were 19% less likely to complete preventive care, and 32% of LEP children had no medical home. School-age Latino children experience system inequities associated with chronic physical and mental health conditions. BPDR is also seen in educational performance but can be buffered by a strong racial/ethnic self-identity. To address BPDR/structural racism for Latino children, we suggest pediatricians: 1) increase the Latino child-health workforce to address BPDR internally and externally, 2) advocate for data collection on and monitoring of Latino children’s disparities and racism metrics in pediatric services, to improve quality of care for Latino children and their families, and 3) advocate for child health equity. Together, these steps will help eliminate BPDR for Latino children and ensure they obtain their full potential.

Ocular toxocariasis masquerading as toxoplasmosis: a case report and literature review

Background: False-negative and false-positive results in Toxoplasma serology are possible, and this could be misleading. Here, we report the case of a boy with Toxocara-associated panuveitis who was initially treated for toxoplasmosis owing to false-positive Toxoplasma immunoglobulin M (IgM) serology. Case Presentation: A nine-year-old boy presented with intermittent headaches and blurred vision in the left eye. Close contact with domesticated animals was remarkable in the patient’s history. Upon examination, vision was 20/400 in the left eye. Slit-lamp examination revealed anterior chamber cells and flare without keratic precipitates, with vitreous cells and veils, optic disc edema, and a blurred fundus appearance. A systemic investigation revealed the presence of anti-Toxoplasma IgM antibodies. Treatment was initiated using topical cycloplegic and corticosteroid eye drops, in addition to oral trimethoprim/sulfamethoxazole. Oral corticosteroids were also administered. As the inflammation resolved, an inferior tractional detachment was detected on fundus examination, leading to the ultimate diagnosis of ocular toxocariasis. An enzyme-linked immunosorbent assay was positive for serum Toxocara antibodies. A fourteen-day course of oral albendazole was ordered by the pediatric infectious disease service because of the concern for visceral larva migrans, while topical eye drops were continued and oral prednisone was tapered. One month later, visual acuity in the left eye had improved to 20/70. The anterior chamber inflammation resolved; however, some vitreous cells and optic disc edema persisted. The inferior tractional detachment was much better visualized, and a peripheral granuloma was observed. Four months later, without any oral or topical medications, the patient’s visual acuity had improved to 20/30 and his eye had no active inflammation. The patient has been followed up for two years and has never developed any other lesions. Conclusions: False-positive results on Toxoplasma serology and diffuse vitritis from toxocariasis that limited retinal visualization complicated the initial diagnosis in this case. In diagnosing the etiology of uveitis, ocular examination and detailed history taking should be emphasized, as laboratory results may be misleading.

Nursing interventions for pediatric patients with CANCER and their families: A scoping review

BackgroundClinical nursing care is an essential element in pediatric oncology. The body of research interventions targeting pediatric oncology patients and their families has grown in recent years. However, no reviews are currently available on nursing interventions for pediatric oncology. AimThe aim was to develop a comprehensive overview of the available nursing interventions for pediatric oncology patients and their families, outline the characteristics of the interventions, and identify any knowledge gaps. MethodsThis review was conducted in accordance with the JBI guidelines for scoping reviews. Citations were retrieved from the following databases: Scopus, PubMed, CINAHL, PsyclNFO, and Embase. The following inclusion criteria were applied: peer-reviewed studies written in English, Danish, Norwegian, or Swedish from 2000 onwards, reporting on pediatric patients with cancer and/or family members of a pediatric patient with cancer who received non-pharmacological and non-procedural nursing interventions provided by a pediatric oncology hospital service. Eligible studies were screened by title and abstract, and in full text by two independent reviewers. Critical appraisal was achieved using the Mixed Methods Appraisal Tool. FindingsAmong 2762 references, 26 studies met the inclusions criteria, comprising 25 unique nursing interventions. 89 % had been published from 2013 onwards, reflecting the rapid changes occurring in pediatric oncology treatment. 36 % were qualitative, 58 % were quantitative and 8 % employed mixed methods. The studies were characterized by considerable diversity in terms of intervention content, components, timing of delivery, and delivery mode. 60 % of the interventions were targeted parents among whom mothers were highly overrepresented (75 %). 16 % adopted a family-centered focus. ConclusionThis review contributes to building a more comprehensive understanding of the evidence base within pediatric oncology nursing research. This field is evolving and holds the potential to support families with childhood cancer across various phases of their treatment trajectory. However, a clear need exists to develop and test interventions with a genuinely family-centered focus, targeting both patients and family members. A considerable gap exists in reporting of the intervention development process and intervention characteristics. Improving the reporting of intervention development is needed to enhance research quality and facilitate subsequent adaptation or upscaling of interventions for use in other populations and contexts. Tweetable abstractNursing interventions can support families with childhood cancer but future intervention studies need to enhance transparency in reporting @IJNSjournal.

A prospective registry study of the epidemiology and management of childhood cancer in the Gambia-The first year experience.

Globally, over 180,000 children develop cancers yearly, with about 80% residing in low- or middle-income countries where cancer-associated mortality is also high. In The Gambia, cumulative incidence rate of 27.6 childhood cancers/million population was reported between 2002 and 2011. The current study appraised newly-established pediatric oncological services in The Gambia. In this prospective registry study, children with cancer who presented at the pediatric units, Edward Francis Small Teaching Hospital, Banjul, between November 2022 and October 2023 were assessed. Data on sociodemographic variables, mode of admission and presentation, tumor type, diagnostic methods, and challenges such as laboratory support, treatment, use of blood/blood products; and eventual outcome were analyzed. The median (interquartile range, IQR) age at presentation of the 44 children was 36.0 (22.3-117.0) months. Wilms tumor was the most common tumor 12 (27.3%); followed by leukemia 11 (25.0%); germ cell tumor 8 (18.2%); lymphoma 6 (13.6%); retinoblastoma 4 (9.1%); rhabdomyosarcoma 2 (4.5%) and one central nervous system tumor (2.3%). The median(IQR) duration of symptoms before presentation was 48 (21-90) days, presentation to diagnosis 7.5 (3-20.8) days, and first symptom to diagnosis 62.5 (32-126.8) days. Treatment refusal and abandonment rates were 20.5% and 13.6%, respectively. Families of 93.8% of children could not procure cytotoxic drugs due to nonavailability, high cost, or both. Adequate laboratory monitoring was only available in 6.8%, and none had platelet concentrate transfusion or radiotherapy. The nine (20.5%) who completed treatment are currently being followed up, 10(22.7%) are still receiving chemotherapy, while 2(4.5%) were referred. Eight (18.2%) died, predominantly from metastasis (75%) and severe drug toxicities (25%). Late presentation and diagnosis, poverty, unavailability of drugs, suboptimal or lack of laboratory testing, blood product, adjuvant medications, and psychosocial supports contributed to high treatment refusal, abandonment, and mortality. These daunting challenges can be ameliorated with regular community sensitization, frequent cancer auditing, and strong political will.

A Quality Improvement Initiative to Reduce Duplicate Inflammatory Marker Use

Introduction: Inflammatory markers (IMs) are often ordered in multiples, even though evidence suggests that this does not add any clinical benefit. The project aimed to reduce the number of duplicate IMs for patients by 10% in 12 months. Methods: We implemented a quality improvement (QI) project at our hospital, focusing on patients admitted to the pediatric hospital medicine service. The team chose the model for improvement as the QI methodology. Key interventions included ongoing provider education, integrating the project into the physician incentive plan, and reviewing disease-specific pathways. The primary outcome measure was “duplicate IM use,” which was defined as any two or more IMs (procalcitonin, C-reactive protein, or erythrocyte sedimentation rate) obtained on the same patient within 24 hours. The secondary outcome measure was any IM use during their stay, and the balancing measures were average complete blood count use, hospital length of stay, and 7-day readmission rate. Results: The baseline duplicate IM use, and any IM use was 43% and 19%, respectively. After the start of this QI project, duplicate IM use decreased to 12%, and the use of any IM also decreased to 12%. Complete blood count use varied from 11% to 24% during the project without obvious correlation to IM use. Hospital length of stay decreased from 2.5 to 2.6 days, and the 7-day readmission rate remained at 2.8%. Conclusions: The duplicate IM use and IM use were decreased without a concurrent increase in the balancing measures, indicating that a safe reduction of IM testing is feasible in inpatient pediatric care.

Transport of critically ill children to paediatric intensive care units in the UK and Ireland: 2013–2022

ObjectiveTo explore the trends and changes in the transport of children to paediatric intensive care units (PICUs) between 2013 and 2022.DesignRetrospective analysis of routinely collected data.PatientsChildren transported for care in...

Management of medically unexplained symptoms in children and young people: a secondary analysis of a 10-year audit of referrals to a Paediatric Psychology Service

This study evaluated service use of children and young people with medically unexplained symptoms (MUS) referred to a Paediatric Psychology Service between 2008 and 2017. Univariate analyses of activity data...

Telebehavioral Health for Caregivers of Children With Behavioral Health Needs to Address Caregiver Strain: Cohort Study.

Behavioral health conditions among children have worsened over the past decade. Caregivers for children with behavioral health conditions are at risk for two types of caregiver strain: (1) an objective strain, that results directly from the child's condition and (2) subjective strain, that arises from the caregiver's feelings regarding these events. This study aimed to evaluate the impact of a technology-enabled pediatric and family behavioral health service on caregivers' strain among a commercially insured population. We also explore the common symptom clusters of caregiver strain to better understand the caregiver presentation to inform future care planning. We examined changes in caregiver strain using the Caregiver Strain Questionnaire-Short Form 7 over the course of their child's web-based behavioral health care between 2021 and 2023 using a pre-post study design. Common caregiver strain symptom clusters were identified using Ward hierarchical agglomerative clustering. The majority of children were White 60.8% (1002/1647), female 53.6% (882/1647), and aged between 5 and 9 years (33.7%, 555/1647). Families fall broadly into 4 groups based on what drives caregiver strain the most, namely those experiencing (1) disrupted family relationships and time interruption, (2) missed work, (3) worried about their child's future and feeling tired and sad, and (4) financial strain. Caregiver strain, which was associated with the child's disease severity (P<.001), decreased significantly in all therapeutic groups. Web-based family-oriented behavioral health care can improve caregiver strain and reduce family and time disruptions, missed work, and financial strain. Sources of caregiver strain vary and may be overlooked when relying on the conventional scoring of the Caregiver Strain Questionnaire-Short Form 7.

Pubertal, Auxological, and Adult Height Outcomes in Children Treated for Adrenocortical Tumors: Half a Century Experience.

Most children with adrenocortical tumors (ACTs) present with accelerated growth and skeletal maturation at diagnosis, which potentially compromises their adult heights (AHs). Knowledge about growth and pubertal patterns after ACT resection is scarce. This study presents the pubertal and auxological development of patients treated for ACT and followed up at a single pediatric endocrinology service in Brazil. Retrospective cohort study including 63 patients (47 girls) followed up between 1966 and 2021. Pubertal and auxological data from ACT diagnosis to AH were analyzed. At diagnosis, the patients had median values of bone age (BA) more advanced than chronological age (CA), height standard deviation score greater than target height (TH-SDS), and predicted adult height (PAH-SDS) lower than TH-SDS. The difference between BA and CA decreased gradually during follow-up and the PAH-SDS moved closer to the TH-SDS 7 years after tumor resection. Puberty started at a median CA of 9.3 (8.3-11.3) years in girls and 9.9 (9.2-13.6) years in boys. Nine patients (6 girls) developed central precocious puberty (CPP), which was influenced by a CA &gt;4 years at diagnosis. The difference between AH-SDS and TH-SDS was not significant (p = 0.3). The factors independently associated with AH below TH were CA &gt;4 years at diagnosis, time between clinical manifestation and diagnosis &gt;1 year, and development of CPP. Most patients treated for ACT during childhood attained AH within the TH despite presenting with advanced skeletal maturation at diagnosis. Development of CPP was not infrequent.

Disparities and Medical Expenditure Implications in Pediatric Tele-Mental Health Services During the COVID-19 Pandemic in Mississippi.

Tele-mental health (TMH) services, including both mental and behavioral healthcare (MBH) services, emerged as a cornerstone in delivering pediatric mental healthcare during the coronavirus disease 2019 (COVID-19) pandemic, yet their utilization and effects on healthcare resource utilization (HCRU) and medical expenditures remain unclear. To bridge the gap, this study aims to investigate the association between TMH utilization and sociodemographic factors and assess its associated HCRU and medical expenditures within a pediatric population in Mississippi. Studying 1,972 insured pediatric patients who accessed outpatient MBH services at the study institution between January 2020 and June 2023, age, race, insurance type, rural residency, and household income were identified as key determinants of TMH utilization. Adjusting for sociodemographics, TMH utilization was associated with 122% more MBH-associated outpatient visits and 36% higher related medical expenditures, but 27% less overall medical expenditures. This study reveals sociodemographic disparities in pediatric TMH utilization, highlights its role in augmenting outpatient mental healthcare access, and shows its potential for cost savings. Future efforts should aim at fostering more digitally inclusive, equitable, and affordable pediatric mental healthcare services.

A Medical Student-Inspired Advocacy Effort to Improve Pediatric Mental Health Services

The demand for pediatric mental health services has exceeded the supply of mental health providers for decades and increased significantly during the COVID-19 pandemic. Given the federal administration’s interest in passing a major funding bill to address the COVID-19 pandemic, the authors recognized an opportunity to collaborate in an advocacy effort to request federal financial support for Pediatric Mental Health Care Access Programs (PMHCAPs). The challenges of the pandemic and limited travel became assets as the advocacy team, who lived hundreds of miles apart in 2 states, met virtually with each other and with Congressional staff during February of 2021 on a tight timeline. In March of 2021, President Biden signed the American Rescue Plan that provided $80 million for PMHCAPs.

The tip of the reproductive screening iceberg: ‘Every mother and every fetus matters’

Introduction: This commentary expands on the routine pregnancy screening recommended during pregnancy, with genomic diagnosis and treatment following a positive fetal screening test indicating possible morbidity. Materials and Methods: Evidenced-based review article. Results/Discussion: An evidenced-based tool is identified for preconception risk assessment for maternal education; clinical service prioritization is promoted allowing for the ethnic and effective care for reproductive and pediatric care services; tertiary fetal diagnostic and treatment options are summarized; fetal therapy, as a quaternary service, is reviewed; human resource training is discussed. Fiscal considerations and barriers for fetal genomic and congenital malformation treatment are discussed. Conclusion: Prioritized healthcare service, preconception risk estimate counselling, genomic diagnosis, and fetal therapy for congenital malformations can reduce the neonatal and childhood morbidity but there may be fiscal and access to care barriers for many families.

Situation on childhood tuberculosis for 10 years and the organization of pediatric tB service in St. petersburg

Situation on childhood tuberculosis for 10 years and the organization of pediatric tB service in St. petersburg

Female Leadership in Pediatric Ophthalmology: A Descriptive Analysis.

To examine female representation among current chiefs of pediatric ophthalmology services of academic medical centers and children's hospitals, as well as program directors of ophthalmology residency and pediatric ophthalmology fellowship programs in the United States. Data collection for this cross-sectional study occurred between December 2023 and February 2024, using publicly available sources to compile a list of academic medical centers and children's hospitals, as well as ophthalmology residency programs and pediatric ophthalmology fellowship programs that participated in the 2023-2024 San Francisco Match. Chi-squared analyses were performed using Excel 2021 software, where a P value less than .05 was considered statistically significant. Of the dedicated pediatric ophthalmology services across academic medical centers and children's hospitals in the United States, 38.3% (64/167) are led by a female chief. Female representation was greater at children's hospitals (40.0%, 36/90) than at academic medical centers (36.4%, 28/77), although no significant difference was observed (P = .69). Gender distribution was near equivalent at both academic training program levels, with slightly more female directors of fellowship programs (45.7%, 21/46) than ophthalmology residency programs (42.3%, 52/123) (P = .33). The authors report near equivalent female representation in the leadership of academic training programs at the residency and fellowship level. However, the proportion of female pediatric ophthalmology division chiefs lags behind the actual gender composition of the workforce. Given the increasing prevalence of female pediatric ophthalmologists, promotion of concordant representation in leadership is necessary to reflect the changing sociocultural landscape and to close the gender gap. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

International Society of Paediatric Oncology (SIOP) Global Mapping Program: Analysis of healthcare centers in countries of the Latin American Society of Pediatric Oncology (SLAOP).

The International Society of Paediatric Oncology Society Global Mapping Program aims to describe the local pediatric oncology capacities. Here, we report the data from Latin America. A 10-question survey was distributed among chairs of pediatric oncology services. Centers were classified according to patient volume into high- (HVC; 100 or more new cases per year), medium- (MVC; 31-99 cases), and low-volume centers (LVC; 30 cases or less), respectively. National referral centers (NRC) were identified. Total 307 centers in 20 countries were identified (271 responded), and 264 responses were evaluable, accounting for 78% of the expected cases (21,359 cases per year). Seventy-seven percent of patients are treated in public centers, including additional support by civil society organizations. We found that 66% of the patients are treated in 70 centers of excellence, including 21 NRC. There was a median of one pediatric oncologist every 21 newly diagnosed patients (44 for NRC), and in 84% of the centers, nurses rotated to other services. A palliative care team was lacking in 25% of the centers. LVC with public funding have significantly lower probability of having a palliative care team or trained pediatric oncology surgeons. Psychosocial, pharmacy, and nutrition services were available in more than 93% of the centers. No radiotherapy facility was available on campus in nine of 21 NRC. Most children with cancer in Latin America are treated in public HVC. There is a scarcity of pediatric oncologists, specialized nurses and surgeons, and palliative care teams, especially in centers with public funding.

Developing a Paired Whole Genome Sequencing Service for Children With Cancer

BackgroundThe uniqueness of paired (tumor and germline) whole genome sequencing (PWGS) in cancer diagnosis and management lies in not just its ability to uncover oncogenic drivers and potential treatment targets but also on the identification of underlying cancer predisposition syndromes, which has significant implications for the patient and their family. AimsThis is a descriptive article highlighting the processes taken by our team to incorporate PWGS into routine National Health Service (NHS) clinical care for children with cancer. The main aim of this article is to share our experience with other centers that may wish to set up similar services and set the stage for future quantitative/qualitative research. MethodsThis article is further supported by an audit focusing on children in whom an underlying cancer predisposition was confirmed. ResultsThe audit highlights the success of the program to date, with 100% of families identified as being at risk of a cancer predisposition syndrome being offered referral to clinical genetics and 100% of at-risk first-degree relatives being offered predictive counseling and testing. Areas requiring improvement included discussion of reproductive options as only six out of nine families (67%) had a documented discussion. ConclusionsIncorporation of the audit recommendations will improve our service, and sharing of our experience will hopefully encourage more pediatric oncology services to introduce PWGS into routine clinical care and reduce inequity of access. Further work is required to assess the long-term cancer risk reduction and establish the psychosocial impact of PWGS for the child and family.

Factors affecting psychiatrist hesitation towards epilepsy care and care for patients with epilepsy transitioning from pediatric to adult care: A survey by the Japanese Society of General Hospital Psychiatry

ObjectiveThis study was undertaken by the Epilepsy Subcommittee of the Japanese Society of General Hospital Psychiatry (JSGHP) to explore the challenges faced by psychiatrists in treating epilepsy and the difficulties encountered during the transition of patients with epilepsy (PWE) from pediatric to adult care. MethodsAn online survey targeting 1,980 JSGHP-affiliated psychiatrists was conducted from May to July 2022. The participants were asked to complete a questionnaire on epilepsy care. We analyzed the factors associated with participant hesitancy to treat epilepsy and their professional characteristics. ResultsResponses were obtained from 545 of the 1,980 solicited psychiatrists (response rate: 27.5 %). The mean number of years of clinical experience in psychiatry was 20.9 ± 10.3 years. A majority of the psychiatrists were hesitant toward treating epilepsy (89.2 %) and managing the transition of PWE from pediatric services to adult care (83.3 %). Logistic regression analysis showed that the absence of hesitation toward epilepsy treatment was significantly associated with years of clinical experience in psychiatry (OR: 1.05, p = 0.002), being a board-certified epileptologist (OR: 4.36, p = 0.037), having colleagues who are specialists in epilepsy care that may be consulted in the workplace (OR: 2.12, p = 0.027), and general confidence in managing PWE transition from pediatric to adult care (OR 3.54, p < 0.001). Confidence in managing the transition was positively correlated with being a board-certified psychiatrist of the Japanese Society of Psychiatry and Neurology (OR: 4.55, p = 0.048), being a board-certified psychiatrist of the JSGHP (OR: 1.75, p = 0.034), treating six or more PWE per month (OR: 3.54; 95 % CI, p < 0.001), and overall confidence in treating epilepsy (OR: 3.38, p < 0.001). ConclusionsAlleviation of reluctance to providing epilepsy care and managing the process of transition are correlated; however, the factors influencing each are distinct. To reduce resistance to epilepsy treatment, enhancing the knowledge of epilepsy and creating an environment conducive to consultations are essential. Improving transition-related outcomes, having substantial psychiatric expertise, and increasing opportunities to treat PWE are of great significance. The integration of these approaches may enable psychiatrists to alleviate hesitancy towards epilepsy care and enhance both treatment and transitional care modalities.

Pediatric Sedation Assessment and Management System (PSAMS) for Pediatric Sedation in China: Development and Implementation Report.

Recently, the growing demand for pediatric sedation services outside the operating room has imposed a heavy burden on pediatric centers in China. There is an urgent need to develop a novel system for improved sedation services. This study aimed to develop and implement a computerized system, the Pediatric Sedation Assessment and Management System (PSAMS), to streamline pediatric sedation services at a major children's hospital in Southwest China. PSAMS was designed to reflect the actual workflow of pediatric sedation. It consists of 3 main components: server-hosted software; client applications on tablets and computers; and specialized devices like gun-type scanners, desktop label printers, and pulse oximeters. With the participation of a multidisciplinary team, PSAMS was developed and refined during its application in the sedation process. This study analyzed data from the first 2 years after the system's deployment. From January 2020 to December 2021, a total of 127,325 sedations were performed on 85,281 patients using the PSAMS database. Besides basic variables imported from Hospital Information Systems (HIS), the PSAMS database currently contains 33 additional variables that capture comprehensive information from presedation assessment to postprocedural recovery. The recorded data from PSAMS indicates a one-time sedation success rate of 97.1% (50,752/52,282) in 2020 and 97.5% (73,184/75,043) in 2021. The observed adverse events rate was 3.5% (95% CI 3.4%-3.7%) in 2020 and 2.8% (95% CI 2.7%-2.9%) in 2021. PSAMS streamlined the entire sedation workflow, reduced the burden of data collection, and laid a foundation for future cooperation of multiple pediatric health care centers.

Pediatric rehabilitation delivery: discussion is an antidote to disconnection and discontent

Pediatric rehabilitation is fundamentally different from that of adults. Child physiology differs significantly from that of adults, necessitating specialized rehabilitation approaches. Unique injuries and varying metabolic rates underscore the need for tailored care, which changes over the years as the child grows and develops. Waiserberg’s paper, “When Everyone is Responsible, No One Takes Responsibility”: Exploring Pediatric Physiotherapy Services in Israel,” sheds light on a critical issue. While senior practitioners oversee policy implementation and service delivery, practical physiotherapy treatment lacks continuous monitoring. This is a critical issue. Ideally, every child who requires long-term clinical therapeutic interventions to keep up with peers in mobility, communication and cognitive skills should be assessed by specialists several times throughout the school years, and their personalized rehabilitation plan discussed, reviewed, and adjusted according to their progress. The absence of a standardized protocol for overseeing and directing comprehensive rehabilitation plans leaves therapists feeling alone and adrift, whether working in schools or medical settings. Such an assessment would be an opportunity to create a registry, which is currently nonexistent. The collected data would be a priceless resource in policy decision-making and service planning.

Assessing The Relationship Between Demand And Accessibility For Pediatric Ophthalmology Services By State In The United States.

To investigate the relationship between public demand for pediatric ophthalmology services and the accessibility of such services on a statewide basis in the United States, focusing on strabismus care. Using Google Trends data, search volumes for "strabismus" were analyzed from January 2014 to December 2023. Pediatric ophthalmologist availability was assessed via the American Academy of Ophthalmology directory, normalized for state population size to create a relative demand index. Additional metrics from the United States Census Bureau and Centers for Disease Control and Prevention provided socioeconomic and health data. Correlation coefficients were used to explore relationships between search volumes, specialist availability, vision screening, socioeconomics, and demographic factors. The data revealed variability in public interest in pediatric ophthalmology across states, with Alaska showing the highest relative search volume for strabismus. The data also indicated notable disparities in pediatric ophthalmologist density, with North Dakota, Vermont, and Wyoming having no pediatric ophthalmologists. A significant correlation was identified between pediatric ophthalmologist availability and vision screening (R = 0.486, p < 0.001). Negative correlations were observed between the relative demand index and urbanization (R = -0.388, p = 0.007), as well as the strabismus prevalence (R = -0.455, p = 0.001), indicating that urbanization and specialist distribution influence eyecare demand and access. The findings highlight disparities in accessibility and demand for pediatric ophthalmology services across the US, influenced by urbanization and distribution of healthcare professionals. The study underscores the need for targeted interventions to improve access to care and bridge gaps in pediatric ophthalmology service provision.