Pediatric Health Care Settings Research Articles

Simulation-based education to promote confidence in managing clinical aggression at a paediatric hospital

BackgroundAn increasing number of incidents involving aggressive behaviour in acute care hospitals are being witnessed worldwide. Acute care hospital staff are often not trained or confident in managing aggression. Competent management of clinical aggression is important to maintain staff and patient safety. Training programmes for acute care staff are infrequently described in the literature and rarely reported for paediatric staff. Simulation training allows practice of skills without patient risk and may be more effective than traditional teaching formats for aggression management.Aim and designThe aim of this proof of concept study was to develop a simulation-based education session on aggression management for acute care paediatric staff based on best practice principles, to evaluate the acceptability of this training programme and to gain an understanding of the impact of the training on participants’ perceived confidence in managing clinical aggression. Two separate simulation exercises were delivered as a 2-h component of a hospital management of clinical aggression (MOCA) training day. Participants completed a written survey immediately prior to, at completion of the simulation-based group training, and at 3–6 months following the simulation training.FindingsNine training days were conducted in 2017 for nursing, medical, allied health, education and security staff with a total of 146 participants (83% were acute care nurses). Two thirds (68%) of participants had experienced clinical aggression as part of their routine work, with 51% overall reporting a lack of confidence managing these patients. Immediately following the simulation training, 80% of all participants reported feeling more confident in managing clinical aggression, 47% reported a 1-point increase in confidence, whilst 33% of participants reported a 2- or 3-point increase. At 3–6 months post-training, 66% of respondents (N = 44) reported continued confidence in managing aggression with 100% of participants stating they would recommend simulation training to colleagues.ConclusionsSimulation training is an acceptable method of training and shows promise to improve staff-perceived confidence for managing behavioural emergencies in acute paediatric health care settings. In addition, there were potential enduring positive impacts at 3 months after the study. Whilst resource and time intensive, further research assessing the benefits of utilising simulation training in this setting is warranted in order to minimise staff burn-out and improve outcomes for these very vulnerable patients.

Building a Children\u2019s Health Service and System Research Strategy: development and integration in an Australian paediatric healthcare setting

BackgroundHealth services and systems research (HSSR) strategies dedicated to paediatric health care and service delivery are limited. Strategies are available but are outdated and yet to be optimised for use in a paediatric health system. We aim to describe the development and integration of a Children’s Health Service and System Research Strategy (CHSSR-S) in Children’s Health Queensland (CHQ), a large specialist quaternary hospital and health service caring for children and young people in Queensland and northern New South Wales, Australia.MethodsThe CHSSR-S was developed using an inductive, bottom-up, participatory systems approach across three phases: (1) Identifying local HSSR capacity; (2) Development; (3) Integration. A HSSR “Champion” was appointed to lead all phases. Clinical, research and system-based stakeholders (n = 14) were individually identified, contacted and participated in dedicated meetings and a workshop to iteratively design the CHSSR-S. A health system-wide CHSSR-S governance committee was established to drive phase three. Health system integration was achieved by multicomponent, action-based strategies.ResultsThe final CHSSR-S comprised ten Research Priorities and three Research Enablers, and was successfully integrated within CHQ via a range of platforms. Research Priorities included: (1) Population Health; (2) Adolescent and Young Adult (AYA) Cancer; (3) Indigenous Health; (4); Mental Health; (5) Nutrition and Obesity; (6) Rare Neurodevelopmental Disorders; (7) Sepsis; (8) Screening, surveillance and monitoring; (9) Innovation; and (10) Electronic Medical Record (EMR). Research Priorities were supported by three Research Enablers: (1) Data; (2); Evaluation and Health Economics; and (3) Policy.ConclusionsThe CHSSR-S is the first known paediatric HSSR strategy developed and integrated within a large dedicated paediatric health system. The CHSSR-S may be used to guide global paediatric healthcare systems to prioritise HSSR in their local setting to optimise health service delivery and patient outcomes.

Estimated Prevalence of Asthma in US Children With Developmental Disabilities

The prevalence of asthma in US children with various developmental disabilities and delays is unclear, including how estimates vary by ethnic group. To report asthma prevalence estimates by various disability categories and developmental delays in a diverse sample of the US pediatric population. This population-based cross-sectional study encompassed a total of 71 811 families with children or adolescents aged 0 to 17 years (hereinafter referred to as children) who participated in the 2016 and 2017 National Survey of Children's Health. Data were collected from June 10, 2016, to February 10, 2017, for the 2016 survey and from August 10, 2017, to February 10, 2018, for the 2017 survey. Data were analyzed from September 20, 2019, to April 5, 2020. Developmental disability, including attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, seizure, intellectual and/or learning disability, and vision, hearing, and/or speech delay. Delay was defined as not meeting growth milestones with unknown cause. Weighted asthma prevalence estimates and 95% CIs were generated for children with and without disabilities. A total of 71 811 participants (mean [SE] age, 8.6 [0.1] years; 36 800 boys [51.1%; 95% CI, 50.2%-52.0%]; 50 219 non-Hispanic white [51.4%; 95% CI, 50.6%-52.3%]) were included in our final analytical sample, of whom 5687 (7.9%; 95% CI, 7.5%-8.4%) had asthma and 11 426 (15.3%; 95% CI, 14.7%-16.0%) had at least 1 disability. Overall asthma prevalence estimates were 10 percentage points higher in children with a disability (16.1%; 95% CI, 14.3%-17.8%) vs children without a disability (6.5%; 95% CI, 6.0%-6.9%). The odds of asthma were significantly higher in children with a disability (odds ratio [OR], 2.77; 95% CI, 2.39-3.21) or delay (OR, 2.22; 95% CI, 1.78-2.77) vs typically growing children. Adjusted models remained significant for all disability categories (overall adjusted OR, 2.21; 95% CI, 1.87-2.62). Subgroup analyses showed ethnic minorities had a higher prevalence of concurrent asthma and developmental disabilities vs non-Hispanic whites (19.8% [95% CI, 16.6%-23.0%] vs 12.6% [95% CI, 11.1%-14.0%]; P < .001). These results suggest that US children with various developmental disabilities or delay may have higher odds for developing asthma vs their typically developing peers. These findings support asthma screening in pediatric health care settings among patients with developmental disabilities and delays, particularly among those from ethnic minority backgrounds. In addition, very young children with asthma should be screened for disabilities and delays, because temporality cannot be determined by the current data source and analytical approach.

A Phenomenological Study to Assess the Lived Experiences of Parents of Children with Congenital Disorders Admitted in Paediatric Health Care Settings of Selected Paediatric Hospitals, Vadodara

A Phenomenological Study to Assess the Lived Experiences of Parents of Children with Congenital Disorders Admitted in Paediatric Health Care Settings of Selected Paediatric Hospitals, Vadodara

Risk Factors of Klebsiella pneumoniae Infections in Pediatric Healthcare Settings

Relevance. Klebsiella pneumoniae is a major cause of severe healthcare-associated infections in children, representing one of the six most widespread multidrug-resistant microorganisms worldwide and requiring the implementation of population-wide treatment strategies.Aim. To study the risk factors for Klebsiella spread in pediatric healthcare settings.Materials and Methods. Here we performed a descriptive retrospective epidemiological study of Klebsiella spp. cases in pediatric units across the entire Kemerovo region (2012–2019). In total, we documented 27,852 treatment outcomes. We further selected 52 confirmed cases and assessed their risk profiles in comparison with 738 condition-matched control children.Results. Average incidence of Klebsiella spp. detection in pediatric healthcare settings was 78.52 per 1,000 patients (95% CI = 75.42–81.74). We revealed a declining incidence of Klebsiella pneumoniae infection in the region, with notable 4-year cyclicity. The proportion of Klebsiella pneumoniae-infected patients increased 2-fold after 5 days of antibiotic therapy. Among the risk factors of Klebsiella pneumonia infection were artificial feeding (OR = 9,21, 95% = 3,31–35,45, р = 0,0001), assisted ventilation (OR = 7,36, 95% CI = 3,92–14,0], р = 0,0001), use of nebulizers (OR = 5,34, 95% CI =2,49 – 10,9], р=0,0001), airway management (OR = 4,62, 95% CI =2,49–8,56, р = 0,0001), preterm birth (OR = 2,55, 95% CI =1,38 – 4,69, р=0,001), low body weight (OR = 2,48, 95% CI = 1,34–4,56, р = 0,002), enema administration (OR = 1,80, 95% CI = 0,78–3,81, р = 0,088), and nasogastric intubation (OR = 1,79, 95% CI = 0,85–3,54, р = 0,065).Conclusions. The incidence of Klebsiella pneumoniae infections is currently lowering and has 4-year cyclicity. Antimicrobial treatment is associated with 2-fold increased risk if administered for ≥ 5 days. A number of healthcare-associated risk factors of Klebsiella pneumoniae infections have been found.

Risk Factors of Klebsiella pneumoniae Infections in Pediatric Healthcare Settings

Relevance. Klebsiella pneumoniae is a major cause of severe healthcare-associated infections in children, representing one of the six most widespread multidrug-resistant microorganisms worldwide and requiring the implementation of population-wide treatment strategies.Aim. To study the risk factors for Klebsiella spread in pediatric healthcare settings.Materials and Methods. Here we performed a descriptive retrospective epidemiological study of Klebsiella spp. cases in pediatric units across the entire Kemerovo region (2012–2019). In total, we documented 27,852 treatment outcomes. We further selected 52 confirmed cases and assessed their risk profiles in comparison with 738 condition-matched control children.Results. Average incidence of Klebsiella spp. detection in pediatric healthcare settings was 78.52 per 1,000 patients (95% CI = 75.42–81.74). We revealed a declining incidence of Klebsiella pneumoniae infection in the region, with notable 4-year cyclicity. The proportion of Klebsiella pneumoniae-infected patients increased 2-fold after 5 days of antibiotic therapy. Among the risk factors of Klebsiella pneumonia infection were artificial feeding (OR = 9,21, 95% = 3,31–35,45, р = 0,0001), assisted ventilation (OR = 7,36, 95% CI = 3,92–14,0], р = 0,0001), use of nebulizers (OR = 5,34, 95% CI =2,49 – 10,9], р=0,0001), airway management (OR = 4,62, 95% CI =2,49–8,56, р = 0,0001), preterm birth (OR = 2,55, 95% CI =1,38 – 4,69, р=0,001), low body weight (OR = 2,48, 95% CI = 1,34–4,56, р = 0,002), enema administration (OR = 1,80, 95% CI = 0,78–3,81, р = 0,088), and nasogastric intubation (OR = 1,79, 95% CI = 0,85–3,54, р = 0,065).Conclusions. The incidence of Klebsiella pneumoniae infections is currently lowering and has 4-year cyclicity. Antimicrobial treatment is associated with 2-fold increased risk if administered for ≥ 5 days. A number of healthcare-associated risk factors of Klebsiella pneumoniae infections have been found.

The impact of paediatric dose range checking software

ObjectiveDosing errors can cause significant harm in paediatric healthcare settings. Our objective was to investigate the effects of paediatric dose range checking (DRC) clinical decision support (CDS) software on overdosing-related...

The “slightly” abnormal thyroid test: What is the pediatrician to do?

Thyroid disorders are common in pediatrics. Tests of thyroid function are widely available and frequently ordered in the pediatric healthcare setting. This is sometimes driven by common signs or symptoms of thyroid disease. All too often, it is driven by patients and their parents requesting thyroid tests for nonspecific symptoms, such as fatigue, obesity or family history of thyroid disease. The decision to order thyroid tests, as well as which test(s) of thyroid function to order, deserves careful thought rather than a reflexive "thyroid panel" for every patient. Thyroid stimulating hormone (TSH) is the single most appropriate test of thyroid function when screening a pediatric or adolescent for thyroid disorders. Adding more tests only increases the likelihood that a minor (and often insignificant) abnormality will be found. These incidental abnormalities can create anxiety for the parent and child, and usually results in additional testing, referral to a pediatric endocrinologist, and further expense. This review will aim to guide the pediatric primary care provider on the choice of appropriate screening test(s) for acquired thyroid dysfunction in children and adolescents, as well as the proper interpretation of the test(s). Emphasis will be placed on the "slightly" abnormal thyroid screening test. Specific thyroid tests to be reviewed include TSH, (free) T4, (free) T3, and thyroid antibodies. Finally, this review will aim to guide decisions on follow-up, additional testing, and reasons for referral to a pediatric endocrinologist. Congenital hypothyroidism, including abnormalities on state newborn screening, will not be discussed.

Expert Perspectives on Intimate Partner Violence Power and Control in Pediatric Healthcare Settings.

Childhood exposure to intimate partner violence (IPV) is a pervasive public health epidemic with profound impact on child health. While past work has demonstrated how abusive partners exert control over IPV survivors in a variety of settings (eg workplace, courts, home), scant research has examined how IPV power and control behaviors manifest themselves in pediatric healthcare settings. In this study, we explore the perspectives of pediatric IPV experts about: (1) behaviors used by abusive partners to control IPV survivors in pediatric healthcare settings; (2) how controlling behaviors impact healthcare access and quality; and (3) recommendations for the pediatric healthcare team. Individual semi-structured interviews were conducted with pediatric IPV experts recruited through snowball sampling. Interviews were individually coded by two research team members and analyzed using thematic analysis. Twenty-eight pediatric IPV experts participated. Participants described several types of controlling behaviors including limiting healthcare access, dominating conversations during medical visits, controlling medical decision making, and manipulating perceptions of the healthcare team. Participants acknowledged the challenges of recognizing controlling behaviors and provided several recommendations to addressing behaviors such as leveraging the expertise of multidisciplinary teams. Participants described how abusive partners may attempt to control or discredit their partners in pediatric healthcare settings, using subtle behaviors that may be easily missed by the healthcare team. These results set the stage for further research and clinical practice innovation including triangulating the findings with IPV survivors, examining how frequently these behaviors occur, and developing multidisciplinary IPV training for the pediatric healthcare team.

Child/youth, family and public engagement in paediatric services in high-income countries: A systematic scoping review.

BackgroundPatient and public engagement in paediatric health‐care decision making is under‐researched, and there is a lack of systematically reviewed literature in this area.ObjectiveTo examine the extent, range and nature of published research investigating the engagement of children/youth, families and the public in paediatric service improvement, to summarize key aspects of the research identified and to identify gaps to help inform future research needs.MethodsLiterature was sought in MEDLINE, EMBASE, PsycINFO and CINAHL. Eligible articles presented research focused on patient, family and public engagement strategies in the paediatric health‐care setting. Two reviewers extracted and charted data and analysed findings using a descriptive numerical summary analysis and a thematic analysis.ResultsFrom 4331 articles, 21 were eligible. Most were from the United States. The majority of studies were undertaken in hospital settings and used quantitative methods. Various patient and public engagement strategies/interventions were examined, including shared decision‐making tools, questionnaires, youth councils/family advisory groups, patient portals and online networks. Most of the studies examined child/youth/parent satisfaction, with fewer investigating treatment outcomes or service improvement. The majority of studies investigated an engagement strategy at the ‘individual treatment’ level of engagement. Regarding the continuum of engagement, most of the studies were at either the ‘consultation’ or ‘involvement’ stage.ConclusionFuture research needs to focus on the investigation of engagement strategies delivered in primary care, and the use of more qualitative and mixed methods approaches is recommended. There is a gap in the area of engagement strategies directed towards ‘service design and resources’ and ‘macro/policy’ levels.

Adolescent food insecurity: A review of contextual and behavioral factors.

ObjectiveThe purpose of this review is to examine recent research on contextual and behavioral factors that will lead to better understanding of adolescent food insecurity and health outcomes.DesignA literature search for peer‐reviewed, English language, research articles published between 2009 and 2019, using CINAHL, Embase®, Pubmed, and the Cochrane Library.SampleThe final sample represents thirty studies on food insecurity with a sample including adolescents, and that employ a measure of food insecurity.ResultsVariables of interest and results on topics such as weight‐related factors, maternal parenting and behaviors, mental health, and adolescent‐level behavioral factors are summarized.ConclusionFood insecurity is associated with poor adolescent health and mental health. All adolescents should be screened for food insecurity, involving pediatric and mental health care settings. Future research on adolescent food insecurity should explore parent and parenting factors, household composition and family dynamics, psychological factors, health behaviors, and stress; peer influences might also be an important area of research with adolescents. While previous research has relied on parents’ reports, adolescents'experiences are unique, and they are willing and reliable research participants; they should be included in future food insecurity research.

Screening Instruments for Developmental and Behavioral Concerns in Pediatric Hispanic Populations in the United States: A Systematic Literature Review.

Racial and ethnic disparities in the identification of developmental and behavioral concerns in children are public health problems in the United States. Early identification of developmental delay using validated screening instruments provides a pathway to prevention and intervention in pediatric health care settings. However, the validity of Spanish-language screening instruments, used in clinical settings in the United States, has not been systematically examined. This study aims to review the literature of clinically administered developmental and behavioral instruments with Hispanic caregivers to investigate implementation variation due to language and cultural factors. A systematic literature review using PubMed and PsycINFO was conducted of articles published from January 1, 2006 to December 12, 2017. Abstract, full-text, and critical appraisal resulted in 11 studies that met criteria for inclusion. Five different instruments were used to screen Hispanic or Spanish-speaking caregivers of children younger than 6 years. None of the instruments established validity and reliability apart from Spanish translation. Two studies identified differences in screening results with Spanish-speaking caregivers due to language and 6 described cultural differences that impacted screening implementation. Two studies reported differential item functioning in Spanish-translated instruments. Language and cultural considerations are critical to the administration of valid and reliable screening in pediatric health care settings. Available developmental and behavioral Spanish-language-screening instruments function differently because of both language and culture, suggesting the tools are not as psychometrically valid when administered to Spanish-speaking families. Validation of translated screening instruments is essential to eliminate the possibility of detection bias or misidentification of developmental risk, improving early access to clinical services for Hispanic and Spanish-speaking families.

Parental Perceptions of Culturally Sensitive Care and Well-Child Visit Quality.

Incorporating culturally sensitive care into well-child visits may help address pediatric preventive care disparities faced by racial and ethnic minorities, families with limited English proficiency, and immigrants. We explored parents' perspectives about the extent to which their children's pediatric care is culturally sensitive and potential associations between culturally sensitive care and well-child visit quality. We conducted cross-sectional surveys with parents attending a well-child visit for a child ages 3 to 48 months. To measure culturally sensitive care, we created a composite score by averaging 8 subscales from an adapted version of the Clinicians' Cultural Sensitivity Survey. We assessed well-child visit quality through the Promoting Healthy Development Survey. Multivariate linear regression was used to understand associations between demographic characteristics and parent-reported culturally sensitive care. We used multivariate logistic regression to examine associations between culturally sensitive care and well-child visit quality. Two hundred twelve parents (71% of those approached) completed the survey. Parents born abroad, compared with those born in the United States, reported significantly higher culturally sensitive care scores (+0.21; confidence interval [CI]: 0.004, 0.43). Haitian parents reported significantly lower culturally sensitive care scores compared with non-Hispanic white parents (-0.49; CI: -0.89, -0.09). Parent-reported culturally sensitive care was significantly associated with higher odds of well-child visit quality including receipt of anticipatory guidance (adjusted odds ratio: 2.68; CI: 1.62, 4.62) and overall well-child visit quality (adjusted odds ratio: 2.54; CI: 1.59, 4.22). Consistent with prior research of adult patients, this study demonstrates an association between parent-reported culturally sensitive care and well-child visit quality. Future research should explore best practices to integrating culturally sensitive care in pediatric preventive health care settings.

Nurses' Knowledge and Practices Regarding Peripheral Intravenous Cannulation and Blood Sampling in Pediatric Health Care Settings

Background: peripheral intravenous cannulation and blood sampling are most frequently procedures for hospitalized children. Aim of the present study was to: Investigate nurses' knowledge and practice regardingPeripheral Intravenous Cannulation and Blood Sampling in Pediatric Health Care Settings. Research design: descripitive research design was used. Setting: The study was carried out in Pediatric Intensive Care, Neonatal Intensive Care units, Pediatric inpatient and Pediatric emergency department affiliated to Suez Canal University Hospitals and Ismailia General Hospital of Ismailia city affiliated to the ministry of health. The subjects of the study were all nurses (81) working at the above previously mentioned settings. Tools of data collection: two tools were used to collect the data; structured interview questionnaire and observational checklists. Results: the results of the study revealed that half of the studied nurses had satisfactory knowledge regarding peripheral intravenous cannulation and blood sampling while the majority of them had unsatisfactory practice. There was no statistically significant relation between total nurses’ level of knowledge regarding peripheral intravenous cannulation and blood sampling and their practice. Conclusion: the study concluded that nurses were lacking knowledge as well as practice toward peripheral intravenous cannulation and blood sampling in pediatric health care settings. Recommendation: the study recommended that continuing training, educational programs and workshops concern the care of children with peripheral intravenous cannulation and blood sampling to nursing staff working in pediatric health care setting.

Association between Asthma and Developmental Disability and Delay in the United States Pediatric Population

Background. To date, few studies have systemically examined the association between asthma and various developmental disabilities and delays among pediatric populations. To address this scientific gap, we report here the asthma prevalence estimates by, and associations with, various disability categories and developmental delay in the United States (US) pediatric population. Methods: A total of 71 811 families with children/adolescents aged 0-to-17 years old who participated in the 2016-2017 National Survey of Children’s Health were included in this cross-sectional analytical sample. Weighted asthma prevalence estimates were calculated and compared between children with and without disabilities or delays. Disabilities included Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, Cerebral Palsy, seizure, vision, hearing and speech, intellectual-, and learning disability. Delay was defined as not meeting growth milestones with unknown cause. Logistic regression analysis generated the odds of an asthma diagnosis by disability status adjusted for demographics and birth weight. Findings: Overall asthma prevalence estimates were 10% higher in children with a disability (~16%) versus children without a disability (~6%) (p<0·0001). The risk of asthma was nearly three times higher in children with a disability versus children with no disability (Odds Ratio [OR] 2·77, 95% Confidence Interval [CI] 2·39-3·21, p<0·0001) and two times higher among children with a developmental delay versus their peers with no delay (OR 2·22, 95% CI, 1·78-2·77, p<0·0001). Adjusted models remained significant for all disability categories (overall adjusted OR [aOR] 2·21, 95% CI 1·87-2·62, p<0.0001). Subgroup analyses showed ethnic minorities had a higher prevalence of concurrent asthma and developmental disabilities versus non-Hispanic whites. Interpretation: Results suggest that US children with various developmental disabilities or delay are at higher odds for asthma versus their typically developing peers. These findings support asthma screening in pediatric healthcare settings among patients with developmental disabilities and delays, and particularly among those from ethnic minority backgrounds. Funding Statement: This study was not supported by any funding. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: Our research was exempted from the University of Texas Institutional Review Board approval process because it is publicly available data.

Analysis of Falls within Paediatric Hospital and Community Healthcare Settings

PurposeTo identify characteristics of paediatric falls within a healthcare setting. Design and methodsA retrospective analysis of falls occurring within inpatient, outpatient, emergency and community healthcare settings of children aged 0–<18 years was conducted using data from the Children's Health Queensland Hospital and Health Service (CHQ-HHS) Clinical Incident Database and Electronic Medical Record between January 1st 2015 and December 31st 2017. One-sample and two-sample Chi-squared tests with post-hoc tests were performed to assess relationships between categorical variables. ResultsThe final dataset contained 385 fall events. Children 0–2 years fell most frequently (46.75%) and falls were higher in males (55.58%). Falls from bed were the most common mechanism (30.65%). The incidence rate of inpatient falls was 0.53 falls per 1000 bed days in the tertiary hospital setting and 1.2% of presentations to inpatient community health facilities. Falls from bed were most common in the tertiary hospital inpatient setting (39.84%, p < .001) and the emergency department (72.13%, p < .001). Falls from furniture/equipment constituted 26.04% of outpatient falls. Most falls occurred in the presence of parents/caregivers (79.48%) and 4.66% of fallers sustained multiple falls. ConclusionsThis study provides a comprehensive review of the characteristics of fall events in CHQ-HHS over a three-year period and summarises the existing literature in paediatric fall prevention. Practice implicationsRisk assessment and management plans should focus on education, particularly surrounding bed safety. Our findings have informed the development of an integrated evidence-based paediatric-specific fall risk assessment tool and management plan to prevent falls in hospital and community healthcare settings.

Intimate Partner Violence: Identification and Response in Pediatric Health Care Settings.

Intimate Partner Violence: Identification and Response in Pediatric Health Care Settings.

8.3 COLLABORATION BETWEEN CHILD PSYCHIATRY AND PRIMARY CARE

Pediatric medical care providers are likely to be the first and often most consistent professionals with the opportunity to assess the myriad of symptoms demonstrated by children experiencing trauma and maltreatment. For instance, 68 percent of children seen in a pediatric health care setting have experienced exposure to traumatic events, much of it related to abuse or neglect. This Institute section aims to provide child and adolescent psychiatrists with a nuanced consideration of the role of pediatrics in addressing the needs of children exposed to maltreatment to mitigate risks and support resiliency from early childhood to young adulthood.

Health Literacy Understanding of Early Intervention Providers: A Scoping Review

In early intervention (EI) and other pediatric health care settings, providers communicate health information to caregivers of children with disabilities. Although more than 21 million American parents have inadequate health literacy skills, understanding of health literacy practices used in communication by EI providers or pediatric providers typically working in an EI setting is limited. This scoping review examined the understanding of providers’ health literacy. No studies reported on research with EI providers in an EI setting. This scoping review yielded studies that were primarily published in the nursing literature. Results indicate providers have low health literacy knowledge and understanding and infrequent use of health literacy practices, such as plain language and the teach-back method.

An interactive web-based educational program improves prescription opioid risk knowledge and perceptions among parents.

Aim: This study evaluated the effect of an interactive, web-based educational program on parents' opioid risk knowledge, risk perceptions, analgesic self efficacy and decision-making. Patients & methods: Totally, 64 parents from a tertiary care pediatric healthcare setting were assessed for risk understanding at baseline, immediately and 3days after receiving the educational program. Results: Participants gained increased opioid risk knowledge, enhanced risk perceptions as well as enhanced analgesic self efficacy after program exposure. The program had no effect on parental decisions about when to give or withhold a prescribed opioid. Conclusion: The interactive web-based program improved parental knowledge about opioid risks. Program enhancements may be needed to improve pain management decisions about when it is safe to use opioids and when they should be withheld.