Pediatric Health Care Providers Research Articles

84 Methods to screen caregivers for previous and current substance use in the paediatric office: A scoping review

Abstract Background Paediatric healthcare providers have been shown to miss opportunities to screen caregivers for substance use. Individuals who use or have used substances face general healthcare barriers and may disengage with the system to avoid stigma or discrimination. Poorly worded or administered substance use screening practices by paediatricians could lead to retraumatization or judgment of caregivers that may affect the ability to continue providing healthcare to the child. There is limited information in the literature regarding best approaches for screening caregivers for substance use in paediatrics. Objectives The unique objective of this review was to identify current methods for, approaches to, and acceptability of caregiver substance use screening in paediatric offices. Design/Methods Searches were performed in CINAHL, PsycInfo, MEDLINE, and Social Sciences Abstracts databases with results limited from 2000 to 2023. Keywords included “perinatal”, “postnatal” “paediatric OR paediatric”, “substance use” OR “substance abuse” OR substances OR “alcohol use” OR “alcohol abuse” OR “addiction”, AND “screening”. Studies must have been conducted in Canada, the USA, Australia, or Scandinavia. Literature that was published in a language other than English, described screening caregivers for substance use using biological samples, or that focused solely on screening pregnant caregivers for substance use was excluded. Individual approaches to and provider and patient perspectives on screening were identified. Three authors completed title, abstract, and full text screening in Covidence screening software. Qualitative thematic coding identified geographical setting, the specific paediatric clinical setting, substances for which each study screened, characteristics of the participants, method of screening, and feedback related to acceptability, outcomes, or methods of screening. Results Practitioners used standardized and informal substance use screening tools. This review found that paediatric practitioners reported gaps in guidance on how best to screen caregivers for substance use and a desire for more improvement. Lack of guidance made it uncomfortable to screen caregivers. Increased comfort with screening was noted when a social needs survey was used as guidance. Caregivers were generally highly comfortable being screened for substance use and felt it was an acceptable action for paediatricians to undertake. However, the input of families in caregiver substance use screening methods was otherwise lacking. Substance use questions were often paired with questions asking caregivers to rate acceptability while other studies simply used the openness of being approached or absence of objections as acceptance of being screened. None of the studies identified in this review included the ability for families to participate more fully in screening acceptability or design. Conclusion Family engagement in research regarding the ideal acceptability and design of screening methods is lacking while paediatric healthcare providers continue to be uncomfortable screening caregivers for substance use and wish for improved methods that facilitate trust with families. Further research into the design of trauma-informed caregiver substance use screening in paediatric settings may be needed.

Decreasing Social Media Use Through Motivational Interviewing: A Pediatric Primary Care Quality Improvement Project

BackgroundSocial media use has been correlated to worsening anxiety and depression in teenagers. Local ProblemIn the United Staes, social media is frequently used amongst adolescents, and rates of anxiety and depression in this population have increased over time. MethodsA convenience sample of adolescents aged 12 to 18 years old were evaluated using a pre-post design. InterventionsThis quality improvement project introduced screen time assessment and motivational interviewing to decrease social media use and improve mental health among adolescents. ResultsPHQ-9 scores remained consistent throughout the project. There was an overall decrease in participant SCARED scores and social media use declined over the 12-week period. ConclusionsResults from this project suggest an opportunity for pediatric healthcare providers to standardize social media use screening in adolescent care and utilize motivational interviewing to promote adolescent wellbeing.

Transitioning Adolescents and Young Adults with Lipid Disorders to Adult Health Care.

Pediatric healthcare providers have increasingly become aware of the need for timely and informative transition of adolescents and young adults with chronic medical conditions such as diabetes and cystic fibrosis. However, there is paucity of published data on the importance of and most effective way to transition youth with lipid disorders who are at increased risk of premature cardiovascular disease. Evidence shows that atherosclerosis begins at a young age. However, there are no guidelines on the transition of adolescents and young adults with dyslipidemia. In addition, there are conflicting guidelines for lipid management in children versus adults, despite advances in medical pharmacotherapies for dyslipidemia. The lack of guidelines for transition and discordant recommendations for management of this vulnerable population places young adults at-risk for worsening of their underlying disease, and premature cardiovascular events.

HECO-01 CONSTRAINTS AND CHALLENGES OF TREATMENT ABANDONMENT IN PEDIATRIC CANCER PATIENTS DIAGNOSED WITH BRAIN TUMORS, LOW MIDDLE INCOME SETTING

Abstract ABSTRACT Treatment abandonment is a critical issue in pediatric oncology that significantly impacts patient outcomes and survival rates. This study investigates the prevalence and factors contributing to treatment abandonment among pediatric solid cancer patients. A comprehensive literature review was conducted to explore the cultural, socioeconomic, and healthcare system-related factors influencing treatment abandonment in this population. Data was collected from 148 pediatric pediatric cancer patients diagnosed with Brain tumors in National Cancer institute, Cairo University over a 2 year period. The study also examines the implications of treatment abandonment on disease progression, patient prognosis, and overall healthcare burden. RESULTS The study found that 14 % of pediatric Brain tumors ‘patients at our institute experienced treatment abandonment during their course of care. Factors contributing to treatment abandonment included financial constraints (34 %), lack of awareness about the importance of treatment adherence (26 %), distance to healthcare facilities (20%), and cultural beliefs (20). The impact of treatment abandonment on disease progression and patient outcomes was substantial, with [58 % p value <0.01}. By understanding the complex factors contributing to treatment abandonment in Egyptian pediatric cancer patients, healthcare providers and policymakers can implement targeted interventions to improve treatment adherence, enhance patient outcomes, and reduce the burden of pediatric cancer in Egypt.

School Suspension and Expulsion: Policy Statement.

Exclusionary school discipline practices-ie, suspension and expulsion-represent some of the most severe consequences a school district can implement for unacceptable student behavior. Suspension and expulsion were traditionally used for student behaviors that caused serious harm, such as bringing a weapon to school. Currently, the most common indications for exclusionary school discipline are for behaviors that are neither violent nor criminal. There is little evidence that exclusionary school discipline practices make schools safer or deter future misbehavior. American Indian/Alaska Native students, Black students, students whose caregivers have low socioeconomic status, male students, lesbian, gay, bisexual, transgender, and queer or questioning students, and students with disabilities are disproportionately disciplined with suspension and expulsion. In addition, exclusionary school discipline in the preschool period can be harmful to early childhood development. Children and adolescents affected by exclusionary school discipline are at higher risk for dropping out of high school and for involvement with the juvenile justice system. Both of those experiences are associated with a worse profile of physical and mental health outcomes. A multidisciplinary and trauma-informed approach to reducing exclusionary school discipline practices is described. Recommendations are provided at both the practice level for pediatric health care providers and at the systems level for both pediatric health care providers and educators.

Leukocoria and Retinoblastoma in an Infant: A Case Presentation

It is imperative that pediatric health care providers preach and practice the importance of a thorough newborn (NB) assessment, whether within the first 24 hours of life, during the very first outpatient NB examination, or at any outpatient visits with the provider. These NB assessments identify abnormalities associated with anomalies, birth injuries, jaundice, or cardiopulmonary issues. The American Academy of Pediatrics (AAP, 2024) recommends that Preventative Pediatric Health Care include NBs being seen for their initial or interval history between days three to five of life.

Assessment of the reliability of at-home caregiver-collected anthropometric measurements.

Anthropometric measurements provide valuable information about infant growth patterns and can help identify nutrition, growth, and developmental concerns. With the increasing use of telehealth and decentralized clinical trial approaches, there is potential for caregivers to collect anthropometric measurements at home via teleconference with healthcare providers (HCPs) to monitor infant growth, which indirectly reflects health status. This study aimed to evaluate whether telehealth-guided caregivers can utilize standardized methods and home-use measurement equipment to collect reliable anthropometric measurements compared to HCPs and study nurses. The study compared the weight, length, and head circumference measurements collected by caregivers (n = 8 pairs), pediatric HCPs (n = 7), and study nurses (n = 4), who served as the gold standard comparator group. Four silicone dolls with varied anthropometrics were used as surrogates for human infants. Caregiver inter- and intra-observer technical errors of measurement (TEMs) were all equal to or below the maximum allowed error (MAE). For HCPs, only intra-observer TEM for length and inter-observer TEM for HC and length were within the MAE. There was no evidence of bias for either caregiver or HCP measurements compared to the gold standard. Coefficients of reliability (R) were greater than 0.96 for all measurements. Preliminary results from this study demonstrate that telehealth-guided caregivers can capture accurate and reliable anthropometric measurements compared to HCPs. The results suggest that remote measurement collection allows for more frequent monitoring while reducing the burden on patients and caregivers in primary care and clinical trials such as infant formula growth monitoring studies.

Integrating Simulation in Pediatric Health Care: Collaboration of Primary and Acute Care Pediatric Nurse Practitioners Across Settings

Pediatric nurse practitioner (PNP) education continues to evolve. Clinical placement availability significantly impacts student’s exposure to complex pediatric patients. The intricacy of pediatric health care demands innovative educational approaches, especially in managing high-risk, low-frequency emergencies. Simulation-based education is a vital tool to bridge learning gaps and enhance core competencies, particularly in diagnosing and managing pediatric patients across diverse health care settings. Here we explore a collaborative formative simulation experience for primary care PNPs and acute care PNPs, focusing on a single patient transitioning through primary care, emergency, and acute care settings. Results demonstrate enhanced student satisfaction and self-confidence, underscoring the efficacy of such simulations in preparing future pediatric health care providers. Opportunities for improvement and future directions are discussed, highlighting the significance of interprofessional collaboration and continuous innovation in PNP education.

COVID-19 Vaccination in Historically Marginalized Communities: Examining Barriers and Facilitators in a Pediatric Population

ObjectiveCoronavirus disease (COVID-19) hospitalization rates among unvaccinated children are double that of vaccinated children, and this difference is greater among racial and ethnic minority children. Vaccination rates among children remain suboptimal. Few studies have characterized barriers to COVID-19 vaccination among historically marginalized communities. MethodsFrom January 2022 to May 2022, parents, and guardians of children ages 12 months to 18 years presenting for pediatric care at a hospital-based primary care clinic were surveyed about perceptions of COVID-19 vaccines, intentions to vaccinate their child, and trusted sources of information. Results113 parents/guardians participated, with 92% self-identifying with a historically marginalized racial/ethnic group. 54% of respondents either did not plan to vaccinate their child against COVID-19 or were unsure. The obstacles to vaccination most frequently cited were related to: 1) unknown side effects, 2) the rapid development of the vaccine, and 3) unsafe ingredients. Worries about being used as experimental subjects and potential impacts on fertility were also reported. Parents who planned to vaccinate their child reported higher rates of trust in doctors, local clinics, hospitals, and health departments. ConclusionsHigh rates of COVID-19 vaccination hesitancy exist among parents/guardians from historically marginalized groups. Barriers to vaccination were frequently related to side effects, while a high level of trust in healthcare providers as sources of information may be a facilitator. Strategies to improve health outcomes and boost vaccination rates should focus on equipping pediatric healthcare providers with the knowledge and skills necessary to address these known barriers to COVID-19 vaccination.

Risk factors for severe and fatal childhood unintentional injury: a systematic review protocol

BackgroundUnintentional injuries are a leading cause of death among children aged 1–19 years worldwide. Systematic reviews assessing various risk factors for different childhood injuries have been published previously. However, most of the related literature does not distinguish minor from severe or fatal injuries. This study aims to describe and summarize the current knowledge on the determinants of severe and fatal childhood unintentional injuries and to discuss the differences between risk factors for all injuries (including minor injuries) and severe and fatal injuries. The study also aims to quantify the reduction in childhood injuries associated with a reduction in exposure to some of the identified risk factors in the Canadian population.MethodsA systematic review and meta-analysis will be conducted by searching MEDLINE, Embase, CINAHL, and Web of Science. Observational and experimental cohort studies assessing children and adolescents aged ≤ 19 years old and determinants of severe and fatal unintentional injury, such as personal behaviors, family and environmental characteristics, and socioeconomic and geographic context, will be eligible. The main outcome will be a composite of any severe or fatal unintentional injuries (including burns, drowning, transport-related injuries, and falls). Any severity measurement scale will be accepted as long as severe cases require at least one hospital admission. Two authors will independently screen for inclusion, extract data, and assess the quality of the data using the Cochrane ROBINS-E tool. Meta-analysis will be performed using random effects models. Subgroup analyses will examine age subgroups and high- vs low-income countries. Sensitivity analysis will be conducted after restricting analyses to studies with a low risk of bias. Attributable fractions will be computed to assess the burden of identified risk factors in the Canadian population.DiscussionGiven the numerous determinants of childhood injuries and the challenges that may be involved in identifying which individuals should be prioritized for injury prevention efforts, this evidence may help to inform the identification of high-risk children and prevention interventions, considering the disproportionate consequences of severe and fatal injuries. This evidence may also help pediatric healthcare providers prioritize counseling messaging.Systematic review registrationPROSPERO CRD42023493322.

A Clinician's Guide To Effectively Transitioning and Transferring Care For Pediatric Patients With Inflammatory Bowel Diseases From The Pediatric To Adult Gastroenterologist.

Transition of care for pediatric patients with inflammatory bowel diseases (IBD) is a continuous, dynamic process that takes place over several years with a coordinated approach executed by a multidisciplinary team. We review the concepts, tools, and research in effective transitioning and transfer of care for adolescent/young adult patients with IBD. Given the constraints within the healthcare system, effective transitioning can be challenging to implement in everyday clinical practice. Different barriers include resources and expertise in effective transitioning by pediatric and adult gastroenterology healthcare providers and the impact of non-gastrointestinal issues facing young adult patients who are learning to manage and coordinate all aspects of their medical care and health maintenance. Factors that facilitate successful care transitioning and transfer include structured transitioning programs, utilization of validated transition checklists, and IBD medical summaries. Proactive transitioning by pediatric gastroenterologists in partnership with their emerging young adult patients with IBD leads to better clinical and psychosocial outcomes and ultimately, effective transfer of care to adult gastroenterology. By utilizing utilize comprehensive transition assessment tools and medical summaries in partnership with their patients, pediatric and adult gastroenterology teams can better prepare patients as they transfer to independent care and health maintenance.

Exploring the Link Between Oral Health Factors and Hearing Impairments in Children: A Cross-Sectional Study.

Background Hearing-impaired children may face challenges in communication, social interaction, academic performance, and emotional well-being, which can have a notable impact on their overall quality of life. Beyond these challenges, oral health can also be significantly impacted. The relationship between hearing impairment and dental diseases is an intriguing and interconnected aspect of overall well-being that merits attention and exploration. This study aimed to assess the relationship between various oral health factors and hearing impairments. Methodology This cross-sectional study involved 90 hearing-impaired children aged 6-12 years. To evaluate the children's hearing abilities, diagnostic tools such as pure-tone audiometry were employed. To measure dental health, the decayed, missing, and filled teeth (DMFT) and decayed, missing, and filled primary teeth (dmft) indices, as well as plaque index (PI) and gingival index (GI) were calculated. The chi‑square test was used to identify significant differences between genders. Spearman's test was used to determine the correlation between variables. Results The severity of hearing impairment varied, with 5.6% having severe hearing loss, 8.9% having profound hearing loss, and 85.6% having complete hearing loss. The mean DMFT score was 2.5 ± 1.86, with no significant difference observed between males and females. The mean dmft score was 4.2 ± 3.12, with no significant difference between genders. However, there was a difference in the PI scores between males and females. Males presented a higher PI score of 2.6 ± 0.09 compared to 1.8 ± 0.08 for females. The overall mean PI was 2.1 ± 0.80. The mean GI was 1.5 ± 0.90, and no significant difference was observed between males and females. Spearman's test identified a significant positive correlation between the severity of hearing impairment and both PI scores (p = 0.000) and GI scores (p = 0.000). Conversely, the severity of hearing impairment showed a weak positive correlation with both DMFT scores (p = 0.487) and dmft scores (p = 0.229), but these correlations were not statistically significant. Conclusions The connection between oral health and severe hearing impairment in children is significant and has potential implications. Pediatric healthcare providers, including dentists and audiologists, need to work collaboratively to monitor the oral and aural health of young patients.

Differences in the knowledge, attitudes, and needs of caregivers and healthcare providers regarding palliative care: a cross-sectional investigation in pediatric settings in China

BackgroundCountries abroad have implemented pediatric palliative treatment for several years; however, complete pediatric palliative treatment guidelines and legal guidance remain lacking in China, making the implementation of palliative care difficult.PurposeThis study aimed to understand the current situation, similarities, and differences in the knowledge, attitudes, and needs of caregivers and healthcare providers regarding palliative care for children.MethodsThis cross-correlation study collected data from pediatric and neonatal intensive care units of four hospitals in China. The participants comprised 180 caregivers and 172 healthcare providers. The measurement tools included the palliative care knowledge scale, palliative care attitude scale, and pediatric palliative care needs scale. This study adhered to the STROBE reporting guidelines.ResultsSignificant differences in palliative care knowledge, attitudes, and needs were observed between caregivers and healthcare providers (p < 0.005). Pediatric healthcare providers demonstrated higher knowledge and positive attitudes regarding palliative care than caregivers. Needs for communication in general and relief from pain and other symptoms of caregivers were higher than those of healthcare providers (p < 0.001). Furthermore, palliative care attitude and needs of healthcare providers were positively correlated with each other (r = 0.212, p < 0.005).ConclusionPediatric healthcare providers and caregivers demonstrated different perceptions of needs for palliative care. The results of this study can serve as a reference for the future development of guidelines related to children’s needs and related interventions.

Reflections on the regulatory field covering the development of paediatric medicinal products: a brief overview of current status and challenges.

Many medicinal products are initially developed and tested in adults, and often, only a limited amount of data on their safety and efficacy in children exist. Consequently, paediatric healthcare providers sometimes need to make informed decisions about using medicinal products in children based on available fragmentary data. Ethical guidelines emphasise the importance of protecting children and ensuring they receive safe and effective medical treatments. Paediatric clinical trials should be conducted to provide evidence-based care with specific attention to minimise risks to children. This highlights the dilemma of finding a balance between protecting children and adolescents (and avoiding unnecessary clinical trials) and obtaining reliable, robust and justified data to treat them adequately and not in an off-label manner with unknown risks. For years, paediatricians maintained that children and adolescents are not treated based on up-to-date scientific knowledge and justification. The slogan "children are not small adults" summarised the concerns in a catch phrase. Different stakeholders have taken a variety of actions to address this concern.

Managing cow's milk protein allergy during the 2022 formula shortage: decision-making among pediatric healthcare providers.

Cow's milk protein allergy (CMPA) affects 2%-7% of infants and is managed with hypoallergenic formulas. The 2022 recalls of infant formulas due to factors including contamination led to specialty formula shortages, highlighting CMPA management challenges. Understanding healthcare providers' (HCPs) decision-making in transitioning to alternative formulas during shortages is crucial. Limited attention has been given to how pediatric physicians make these choices. This study utilized US HCPs' de-identified survey data to assess driving factors when switching extensively hydrolyzed formulas during shortages. 104 eligible HCPs participated, including general pediatrics, pediatric allergy/immunology, and pediatric gastroenterology specialists. Safety, tolerability, and efficacy were identified as top factors for switching formulas. Formula 1 was considered well-tolerated, patient-accepted, and safe by all HCPs. Most expressed strong belief in Formula 1's safety and effectiveness. Findings inform CMPA management during shortages, offering guidance to HCPs for suitable formula selection and enhanced infant care.

Day to Day Advocacy by Pediatric Health Care Providers

This manuscript highlights the impressive advocacy work that members of the American Academy of Pediatrics have achieved and serves to inspire pediatric health care providers of all specialties to pursue such efforts beyond the acute physical need of the child. This article represents one of the Symposia presented at the 2023 American Academy of Pediatrics Section on Surgery.

Grieving lost selves: Throop's concept of presencing forth of an absence.

This article expands on C.J. Throop's concept of "presencing forth of an absence" introduced in his 2010 article "Latitudes of loss: on the vicissitudes of empathy," applying it to elucidate personal stories of grief, including an experience of the ambiguous loss of a child. The author provides a novel framework for the intersubjective experience of the grieving person. The author offers pediatric healthcare providers fresh insight into the experience of patient families.

Current and future state of pharmacological management of pediatric obesity.

Pediatric obesity is a highly prevalent chronic disease, which has traditionally been treated with lifestyle therapy alone. Yet for many youth, lifestyle intervention as a monotherapy is often insufficient for achieving clinically significant and durable BMI reduction. While metabolic/bariatric surgery achieves robust and long-lasting outcomes, it is neither widely accessible nor wanted by most pediatric patients and families. In the past 3 years, this treatment gap between lifestyle therapy and metabolic/bariatric surgery has been filled with a number of landmark clinical trials examining the safety and efficacy of anti-obesity medication (AOM) for use in children and adolescents. These trials include studies of liraglutide, phentermine/topiramate ER, semaglutide, and setmelanotide, all of which have led to FDA and/or EMA approval. Concurrent with this developing evidence base, in 2023, the American Academy of Pediatrics published their first Clinical Practice Guideline on the assessment and management of childhood obesity. The Guideline includes the recommendation that pediatric health care providers should offer AOM to youth ages ≥12 years with obesity. Recognizing that AOM use in the pediatric population will likely become the standard of care and to provide perspective on the recently generated data regarding new AOM, this narrative review summarizes the published randomized controlled trials (RCTs) from the past 10 years that examine AOM for the pediatric population. This report additionally includes RCTs examining AOM for special populations of pediatric obesity including monogenic obesity, Bardet Biedl syndrome, Prader Willi syndrome, and hypothalamic obesity. Finally, the clinical application of AOM for children and adolescents, as well as future directions and challenges are discussed.

Adverse childhood experiences screening in healthcare settings: A focus on pediatric primary care

BackgroundAdverse Childhood Experiences (ACEs) screening in healthcare settings is emerging as one of the tangible responses to address the consistent evidence linking ACEs with health. Kaiser Permanente Southern California (KPSC) began ACEs screening in pediatric primary care in 2018 and has developed screening and referral processes based on continued feedback from stakeholders as well as data driven assessment. ObjectiveWe give an overview of the state of ACEs screening in pediatric healthcare settings, challenges facing pediatric providers, and suggestions to address them. We then describe the development of our ACEs screening and referral process within KPSC as an example of how a large healthcare system has implemented and adapted ACEs screening from pilot testing, to phased expansion, to complete implementation. Participants and settingChildren aged 2–18 years old who were members of KPSC 2018–2023. ResultsWe present data on the tailored screening and referral workflows we have developed, rates of positive screens and referrals, and how the initiation of ACEs screening may affect the rates of visit to behavioral health as a treatment option. We also integrate qualitative data to demonstrate the perspective of parents, with the goal of understanding what might help or hinder receipt of behavioral health treatment after ACEs screening. ConclusionsWe close with future directions for ACEs screening in healthcare settings and considerations for pediatric healthcare providers who may want to begin ACEs screening or adapt their screening and referral processes.

Perspectives from community-based pediatric healthcare providers on sleep health practices among children in economically stressed urban environments

Perspectives from community-based pediatric healthcare providers on sleep health practices among children in economically stressed urban environments