Pediatric Health Care Research Articles

Language Matters: Language Inclusivity in Pediatric Health Care

Language Matters: Language Inclusivity in Pediatric Health Care

Reduction of Pediatric Gastrostomy Tube Healthcare Utilization and Socioeconomic Disparities: Longitudinal Benefits of Quality Improvement

BackgroundDisparities in emergency department (ED) utilization after gastrostomy (G-) tube placement were previously demonstrated at our children’s hospital. We aimed to reduce postoperative G-tube dislodgements and ED visits with a particular focus on socially vulnerable children. MethodsOur improvement team implemented a G-tube care bundle (6/2018-9/2019) targeting caregiver preparedness and standardizing care in the pre-, intra-, and post-operative periods. Patients who had G tubes placed between 1/2011-8/2022 were categorized to either pre- or post-intervention groups. Primary outcomes were tracked prospectively. National area deprivation index (ADI) was assigned retrospectively and employed to evaluate social risk. Univariate comparisons were made between pre- and post-intervention groups, and between High ADI (≥80) and Low ADI (<80) subgroups in both pre- and post- intervention periods. We used statistical process control methods to further analyze change over time. Results396 children were included (188 pre-intervention, 208 post-intervention). The post-intervention cohort demonstrated a lower rate of outpatient dislodgement at 90 days following G-tube placement (21.3% vs 10.1%, p=0.002) and fewer G-tube-related ED visits per G-tube placed within one year of placement (mean 0.8 visits vs 0.6 visits, p=0.012). Pre-intervention, children from high ADI neighborhoods had significantly greater healthcare utilization compared to those from lower ADI neighborhoods. Post-intervention, previously statistically significant disparities were no longer present. Outpatient G-tube dislodgements within 90 days were particularly mitigated. ConclusionsA longstanding quality improvement initiative has led to sustained reductions in overall G-tube-related health care utilization. Care standardization and improvement may mitigate outcome disparities related to socioeconomic advantage. Type of studyRetrospective Comparative Study and Prospective Quality Improvement Level of EvidenceLevel III

Evidence-Based Design: A Sustainable Approach for Planning and Designing Pediatric Healthcare Environments

Evidence-Based Design: A Sustainable Approach for Planning and Designing Pediatric Healthcare Environments

Medical Crowdfunding Via Social Media for Paediatric Patients – Where Do We Draw the Line?

Medical crowdfunding may provide means to fund treatments or interventions; however, it raises individual and societal ethical dilemma due to its complex understanding and interpretation. Crowdfunding can be viewed as a phenomenon at the intersection between the disciplines of finance, entrepreneurship, marketing, e-commerce, social networking and medicine. Most of these campaigns get initiated on behalf of the patients, especially the very sick and dependent ones, to garner financial support. The success of these efforts will depend on campaigners’ digital skills, ability to penetrate wider social networks and strong emotional connectedness to the issue raised. This article will explore the role of medical crowdfunding in pediatric healthcare settings, examining its benefits, challenges, and ethical implications. There is however a paucity of literature on medical crowdfunding among paediatric population despite numerous anecdotal campaigns in the social media platform.

Empowering Voices: Understanding Children's Roles and Preferences in Shared Decision-Making

Introduction: Shared decision-making (SDM) in paediatric healthcare presents a unique dynamic involving children, parents, and healthcare professionals. While previous research has focused on the roles of parents and healthcare professionals in this process, little attention has been given to the roles adopted by children themselves. This study aimed to explore the nature of children’s participation and their preferred roles in the SDM process during hospitalisation. Method: Using a genP6 qualitative approach, data was collected from 26 hospitalised children aged 7 to 12 years, their parents, and 48 healthcare professionals across three teaching hospitals in Malaysia. Data collection involved participant observation and a single interview with nine of the study’s child participants. Results: Children assumed either passive or active roles in the SDM process, with their roles fluctuating depending on the circumstances and adult involvement in communication. While some children were content with passive participation, others expressed a desire for greater involvement. Those who actively participated appreciated their role. Conclusion: The study highlights the challenge of determining the most appropriate role for children, as their preferences may not consistently align with their actual level of participation. Those involved in SDM with children must possess the ability to thoroughly understand their desires and communication needs, ensuring that their active involvement is both meaningful and fulfilling.

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.

Next-generation pediatric care: nanotechnology-based and AI-driven solutions for cardiovascular, respiratory, and gastrointestinal disorders.

Global pediatric healthcare reveals significant morbidity and mortality rates linked to respiratory, cardiac, and gastrointestinal disorders in children and newborns, mostly due to the complexity of therapeutic management in pediatrics and neonatology, owing to the lack of suitable dosage forms for these patients, often rendering them "therapeutic orphans". The development and application of pediatric drug formulations encounter numerous challenges, including physiological heterogeneity within age groups, limited profitability for the pharmaceutical industry, and ethical and clinical constraints. Many drugs are used unlicensed or off-label, posing a high risk of toxicity and reduced efficacy. Despite these circumstances, some regulatory changes are being performed, thus thrusting research innovation in this field. Up-to-date peer-reviewed journal articles, books, government and institutional reports, data repositories and databases were used as main data sources. Among the main strategies proposed to address the current pediatric care situation, nanotechnology is specially promising for pediatric respiratory diseases since they offer a non-invasive, versatile, tunable, site-specific drug release. Tissue engineering is in the spotlight as strategy to address pediatric cardiac diseases, together with theragnostic systems. The integration of nanotechnology and theragnostic stands poised to refine and propel nanomedicine approaches, ushering in an era of innovative and personalized drug delivery for pediatric patients. Finally, the intersection of drug repurposing and artificial intelligence tools in pediatric healthcare holds great potential. This promises not only to enhance efficiency in drug development in general, but also in the pediatric field, hopefully boosting clinical trials for this population. Despite the long road ahead, the deepening of nanotechnology, the evolution of tissue engineering, and the combination of traditional techniques with artificial intelligence are the most recently reported strategies in the specific field of pediatric therapeutics.

Exploring Machine Learning Applications in Pediatric Asthma Management: Scoping Review.

The integration of machine learning (ML) in predicting asthma-related outcomes in children presents a novel approach in pediatric health care. This scoping review aims to analyze studies published since 2019, focusing on ML algorithms, their applications, and predictive performances. We searched Ovid MEDLINE ALL and Embase on Ovid, the Cochrane Library (Wiley), CINAHL (EBSCO), and Web of Science (core collection). The search covered the period from January 1, 2019, to July 18, 2023. Studies applying ML models in predicting asthma-related outcomes in children aged <18 years were included. Covidence was used for citation management, and the risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool. From 1231 initial articles, 15 met our inclusion criteria. The sample size ranged from 74 to 87,413 patients. Most studies used multiple ML techniques, with logistic regression (n=7, 47%) and random forests (n=6, 40%) being the most common. Key outcomes included predicting asthma exacerbations, classifying asthma phenotypes, predicting asthma diagnoses, and identifying potential risk factors. For predicting exacerbations, recurrent neural networks and XGBoost showed high performance, with XGBoost achieving an area under the receiver operating characteristic curve (AUROC) of 0.76. In classifying asthma phenotypes, support vector machines were highly effective, achieving an AUROC of 0.79. For diagnosis prediction, artificial neural networks outperformed logistic regression, with an AUROC of 0.63. To identify risk factors focused on symptom severity and lung function, random forests achieved an AUROC of 0.88. Sound-based studies distinguished wheezing from nonwheezing and asthmatic from normal coughs. The risk of bias assessment revealed that most studies (n=8, 53%) exhibited low to moderate risk, ensuring a reasonable level of confidence in the findings. Common limitations across studies included data quality issues, sample size constraints, and interpretability concerns. This review highlights the diverse application of ML in predicting pediatric asthma outcomes, with each model offering unique strengths and challenges. Future research should address data quality, increase sample sizes, and enhance model interpretability to optimize ML utility in clinical settings for pediatric asthma management.

Fetal Brain MRI Abnormalities in Pyruvate Dehydrogenase Complex Deficiency.

Pyruvate dehydrogenase complex deficiency (PDCD) is a disorder of mitochondrial metabolism that is caused by pathogenic variants in multiple genes, including PDHA1. Typical neonatal brain imaging findings have been described, with a focus on malformative and encephaloclastic features. Fetal brain MRI in PDCD has not been comprehensively described. The aims of this study were (1) to further characterize the fetal brain MRI findings in PDCD using comprehensive fetal imaging and genetic testing and (2) to determine whether markers of diagnosis of PDCD could be identified on prenatal imaging. Fetuses with a diagnosis of PDCD related to a genetic etiology that had undergone fetal MRI were included. Fetuses were identified retrospectively from local databases of 4 fetal diagnostic clinics within tertiary pediatric health care centers. Electronic medical records were reviewed retrospectively: demographics, maternal and pregnancy history, fetal outcomes, and neonatal outcomes (if available) were reviewed and recorded. Fetal and neonatal imaging reports were reviewed; source fetal and neonatal brain MRI scans were reviewed by a single pediatric neuroradiologist (J.W.S.) for consistency. Genetic testing strategies and results including variant type, zygosity, inheritance pattern, and pathogenicity were recorded. Deidentified data were combined and reported descriptively. A total of 10 fetuses with a diagnosis of PDCD were included. 8 fetuses had corpus callosum dysgenesis, 6 had an abnormal gyration pattern, 10 had reduced brain volumes, and 9 had cystic lesions. 1 fetus had intraventricular hemorrhages. 1 fetus had a midbrain malformation with aqueductal stenosis and severe hydrocephalus. 6 fetuses imaged in the second trimester had cystic lesions involving the ganglionic eminences (GEs) while GE cysts were not present in the 4 fetuses imaged in the third trimester. Fetuses with PDCD have similar brain MRI findings to neonates described in the literature, although some of these findings are subtle early in pregnancy. Additional features, such as cystic lesions of the GEs, are noted in the second trimester in fetuses with PDCD. These may represent an early diagnostic marker of PDCD, although more data are needed to validate this association. Early diagnosis of PDCD using fetal MRI may inform genetic counseling, pregnancy decision making, and neonatal care planning.

Surveying current perceptions of artificial intelligence among pediatric healthcare professionals.

Surveying current perceptions of artificial intelligence among pediatric healthcare professionals.

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.

Relative Health Risk Reduction from an Advanced Multi-Modal Air Purification System: Evaluation in a Post-Surgical Healthcare Setting.

Advanced air treatment systems have the potential to reduce airborne infection risk, improve indoor air quality (IAQ) and reduce energy consumption, but few studies reported practical implementation and performance. PlasmaShield®, an advanced multi-modal HVAC-integrated system, was directly compared with a standard MERV-13 system in a post-surgical paediatric healthcare setting. The evaluation entailed monitoring of multi-size airborne particles, bioaerosols and key IAQ parameters. Measurements were taken for outside air, supply air and air in the occupied space for 3 days prior to, and after, the installation of the PlasmaShield system. Compared with the existing arrangement, very significant reductions in particle number concentrations were observed in the occupied space, especially with virus-like submicron particles. Significant reductions in airborne culturable bacteria and fungi were observed in the supply air, with more modest reductions in the occupied space. In the case of virus-like particles, there was an eight-fold improvement in equivalent clean air, suggesting a five-fold infection risk reduction for long-range exposure. The data suggest multiple benefits of airborne particle and bioaerosol reduction, with applications beyond healthcare. Long-term studies are recommended to confirm the combined IAQ, health and energy benefits.

Comprehensiveness of State Insurance Laws and Perceived Access to Pediatric Mental Health Care

Many US children and adolescents with mental and behavioral health (MBH) conditions do not access MBH services. One contributing factor is limited insurance coverage, which is influenced by state MBH insurance parity legislation. To investigate the association of patient-level factors and the comprehensiveness of state MBH insurance legislation with perceived poor access to MBH care and perceived inadequate MBH insurance coverage for US children and adolescents. This retrospective cross-sectional study was conducted using responses by caregivers of children and adolescents aged 6 to 17 years with MBH conditions in the National Survey of Children's Health and State Mental Health Insurance Laws Dataset from 2016 to 2019. Data analyses were conducted from May 2022 to January 2024. MBH insurance legislation comprehensiveness defined by State Mental Health Insurance Laws Dataset (SMHILD) scores (range, 0-7). Perceived poor access to MBH care and perceived inadequacy of MBH insurance were assessed. Multivariable regression models adjusted for individual-level characteristics. There were 29 876 caregivers of children and adolescents with MBH conditions during the study period representing 14 292 300 youths nationally (7 816 727 aged 12-17 years [54.7%]; 8 455 171 male [59.2%]; 292 543 Asian [2.0%], 2 076 442 Black [14.5%], and 9 942 088 White [69.6%%]; 3 202 525 Hispanic [22.4%]). A total of 3193 caregivers representing 1 770 492 children and adolescents (12.4%) perceived poor access to MBH care, and 3517 caregivers representing 1 643 260 of 13 175 295 children and adolescents (12.5%) perceived inadequate MBH insurance coverage. In multivariable models, there were higher odds of perceived poor access to MBH care among caregivers of Black (adjusted odds ratio [aOR], 1.35; 95% CI, 1.04-1.75) and Asian (aOR, 1.69; 95% CI, 1.01-2.84) compared with White children and adolescents. As exposures to adverse childhood experiences (ACEs) increased, the odds of perceived poor access to MBH care increased (aORs ranged from 1.68; 95%, CI 1.32-2.13 for 1 ACE to 4.28; 95% CI, 3.17-5.77 for ≥4 ACEs compared with no ACEs). Compared with living in states with the least comprehensive MBH insurance legislation (SMHILD score, 0-2), living in states with the most comprehensive legislation (SMHILD score, 5-7) was associated with lower odds of perceived poor access to MBH care (aOR, 0.79; 95% CI, 0.63-0.99), while living in states with moderately comprehensive legislation (score, 4) was associated with higher odds of perceived inadequate MBH insurance coverage (aOR, 1.23; 95% CI, 1.01-1.49). In this study, living in states with the most comprehensive MBH insurance legislation was associated with lower odds of perceived poor access to MBH care among caregivers for children and adolescents with MBH conditions. This finding suggests that advocacy for comprehensive mental health parity legislation may promote improved child and adolescent access to MBH services.

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.

Amplifying Their Voice: Inclusive Healthcare Provider Perspectives to Improve Advancement, Resilience, and Retention.

Addressing the issues of workplace advancement, resilience, and retention within medicine is crucial for creating a culture of equity, respect, and inclusivity especially towards women and nonbinary (WNB) providers including advanced practice providers (APPs), most notably those from marginalized groups. This also directly impacts healthcare quality, patient outcomes, and overall patient and employee satisfaction. The purpose of this study was to amplify the voices on challenges faced by WNB providers within a pediatric academic healthcare organization,to rank workplace interventions addressing advancement, resilience, and retention highlighting urgency towards addressing these issues, and, lastly, to provide suggestions on how to improve inclusivity. Participants were self-identified WNB providers employed by a pediatric healthcare organization and its affiliated medical university. An eligibility screener was completed by 150 qualified respondents, and 40 WNBs actually participated in study interviews. Interviews were conducted using a semi-structured interview guide to rank interventions targeted at improving equity, with time allotted for interviewees to discuss their personal lives and how individual circumstances impacted their professional experiences. WNB providers called for efficient workflows and reducing uncompensated job demands. Support for family responsibilities, flexible financial/compensation models, and improved job resources all were endorsed similarly. Participants ranked direct supervisor and leader support substantially lower than other interventions. Conclusions:Career mentorship and academic support for WNB individuals are recognized interventions for advancement and retention but were not ranked as top priorities. Respondents focused on personal supports as they relate to family, job resources, and flexible compensation models. Future studies should focus on implementing realistic expectations and structures that support whole lives including professional ambitions, time with family, personal pursuits, and self-care.

A More Nuanced Story: Pediatric Gender-Affirming Healthcare is Associated With Satisfaction and Confidence

PurposePediatric gender-affirming medical care has strong research evidence and support, and transition-related regret is uncommon. Misinformation about regret has nonetheless been used to limit adolescents from accessing this care. This study is the first of a 3-part initiative to clarify long-term satisfaction and regret related to pediatric gender-affirming care (GAC). MethodsAn anonymous survey was distributed to individuals of age 15 and older who participated in at least one prior appointment at a large pediatric gender clinic. The survey questions included (1) demographics; (2) use of gender-affirming interventions; (3) barriers to accessing medical interventions; (4) reasons for any discontinuation of medical interventions; (5) emotions associated with GAC; and (6) intervention-related regret. ResultsParticipants (N = 150; Mage = 18.6) were predominantly transmasculine-identified and/or assigned female at birth (86%). The most common emotions associated with GAC were satisfaction (88.0%) and confidence (86.7%). A total of 141 participants reported taking hormones, 30 of whom reported ever discontinuing (21.3%). Among these, 11 have already resumed hormones, and 16 might resume. Of the three with no plan to resume hormones, one is fully satisfied with the results, and the remaining two no longer identify as transgender. Only one participant (0.7% of those who ever took hormones) wishes they had never started testosterone or had top surgery, both of which occurred in adulthood. DiscussionIndividuals who accessed GAC as adolescents are largely satisfied with this care. Care-related satisfaction and regret are more nuanced than sometimes portrayed and should not be used to limit access.

Dr. Fe Del Mundo: The Pioneer Who Transformed Pediatrics and Child Healthcare in the Philippines.

Dr. Fe del Mundo was a female Filipino pediatrician, humanitarian, and advocate of Filipino children, dedicating her life to seven decades of service. Her programs on maternal and child health, preventive medicine, nutrition, vaccination, and family planning transformed the healthcare landscape in the Philippines. Overcoming adversity, she pursued a road less traveled for women of her time. After training in the United States of America, she returned to the Philippines to take care of sick children during the Second World War and later opened the first pediatric hospital in the country. Her research, inventions, and health programs set the groundwork for the improvement of pediatric and childhood outcomes in the country and the world. She is a woman of many firsts, being a beacon for generations of physicians and women. Her legacy endures through the programs she started, the lives she has saved, the doctors she trained, and the institutions she has founded for the welfare of the children she dearly cared for.

Immersive Virtual Reality Versus Video Distraction for the Management of Emergence Delirium in Children: A Randomized Controlled Study

PurposeEmergence delirium (ED) presents challenges for both parents and health care providers in pediatric surgical settings. This study aims to evaluate the effectiveness of immersive virtual reality (VR) distraction and video distraction combined with parental presence in reducing ED in preschool-aged children undergoing elective surgery. DesignA prospective, randomized, controlled clinical trial was conducted with 90 children ages 4 to 7. Participants were randomly assigned to three groups: VR distraction (group V), tablet video distraction with parental presence (group T), and standard care (group C). The primary endpoints were the incidence of ED and Pediatric Anesthesia Emergence Delirium Scale scores, with secondary measures encompassing scores from the Parental Separation Anxiety Scale and the Faces, Legs, Activity, Cry, Consolability (FLACC) scale. MethodsParticipants were assigned to one of the three intervention groups, and relevant scales were used to assess ED, parental separation anxiety, and postoperative pain. The immersive VR distraction and video distraction with parental presence interventions were compared against standard care. FindingsImmersive VR distraction significantly reduced the incidence of ED (6.67% in group V vs 40% in group T and 60% in group C), and the incidence of ED in group V was notably lower than in the other groups (P = .023 vs group T and P = .004 vs group C). Children in group V displayed significantly lower FLACC compared with the other groups as well (P < .05). However, no significant differences between the 3 groups were observed in perioperative anxiety as assessed by the Parental Separation Anxiety Scale scores (P = .27). ConclusionsThis study underscores the potential of immersive VR distraction as an effective intervention for mitigating ED in pediatric surgical patients. The findings suggest that incorporating VR technology during the perioperative period can positively impact postoperative outcomes. Further research in diverse surgical contexts is recommended to validate these findings and explore the broader applicability of VR distraction in pediatric health care settings.

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.