Pediatric Health Care Research Articles

High caregiver adverse childhood experiences are associated with increased pediatric infection-related healthcare utilization and antibiotic use

Abstract Background Higher caregiver adverse childhood experiences (ACEs) have been associated with a range of pediatric outcomes, including hospitalizations. We recently found that higher caregiver ACEs are associated with higher rates of influenza vaccine uptake. However, to our knowledge, no studies have examined links between caregiver ACEs and specific infections or infection-related outcomes, such as antibiotics prescribed. We sought to evaluate associations between caregiver ACEs and pediatric infection-related outcomes. Methods We conducted a retrospective cohort study of two pediatric primary care sites, each serving a predominantly non-Hispanic Black, publicly insured population. At one primary care site (Clinic A), routine screenings for caregiver ACEs began in 2019 at the 1-month well-child check and were retrieved from the electronic health record. For the other primary care site (Clinic B), a prior research study surveyed caregiver ACEs of 283 children. Focusing on children 0-4 years of age in both primary care sites, we retrieved data from the electronic health record, including patient infection-related outcomes, demographic characteristics, and social risk screen results for those who had caregiver ACEs systematically recorded. The number of reported caregiver ACEs was our exposure variable, dichotomized as high (≥4) or low (≤3). Patient demographic characteristics, results of the overall social risk and maternal depression screen, and area deprivation index scores linked to patients’ geocoded home addresses were also collected. Bivariate analyses were pursued using chi square test statistics. Results A total of 1,442 children 0-4 years of age were included in the study, and 50.0% were female, 74.7% Black, and 2.6% Hispanic. Fifteen percent of caregivers had high (≥4) ACEs. Differences in infection-related outcomes, and relevant covariates, based on high and low caregiver ACEs are depicted in Table 1. Children of caregivers with high ACEs had more outpatient infection-related visits (80% versus 72.6%, p = 0.03), including more diagnoses of streptococcal pharyngitis (10.1% versus 4.1%, p = 0.0004). They also had more prescriptions for any oral antibiotic (30.9% versus 23.2%, p = 0.02). In bivariate analyses, high caregiver ACEs (31.3% versus 23.7%, p = 0.03), lower area deprivation index score (mean (SD) of 0.47 (0.16) versus 0.50 (0.16), p < 0.01), older patient age (mean (SD) of 2.73 (1.10) versus 1.73 (1.00) years, p < 0.0001), and any outpatient (35.9% versus 2.2%, p < 0.0001), emergent (40.0% versus 10.9%, p < 0.0001), or inpatient visit (42.7% versus 23.0%, p < 0.0001) were each associated with the presence of antibiotic use. Race, ethnicity, a positive social risk screen, and positive depression screen were not associated with antibiotic use. Conclusion High caregiver ACEs appear to be associated with some types of pediatric infectious diagnoses, antibiotic use and increased infection-related outpatient healthcare utilization. Future adjusted analyses assessing for potential links between ACEs and infection-related outcomes, independent of variables like insurance status, social risk, and area-level deprivation, are warranted and planned.

Perspective: Expanding Pediatric Mental Health Care Access Programs Into Hospital Settings.

Perspective: Expanding Pediatric Mental Health Care Access Programs Into Hospital Settings.

Pediatric Dental Care and Antibiotics: A Comprehensive Update

Abstract Antimicrobial agents, a foundational component of contemporary medical practice, have significantly transformed the management of microbial infections, effectively protecting human well-being and prolonging life expectancy. Nevertheless, this extraordinary advancement faces a mounting challenge in the form of antimicrobial resistance (AMR). The ongoing evolution of microorganisms to withstand the impact of these substances has led to a decline in the efficacy of formerly dependable treatments, thereby presenting a critical menace to medical progress and prompting an exigent need for action. This paper undertakes a comprehensive exploration of the utilisation and correct application of antimicrobials within the context of paediatric dental healthcare. By meticulously examining the intricate interplay between therapeutic efficacy and the emergence of AMR, the overview delves into the pivotal function these agents fulfil in both preventing and treating dental infections in young patients. In addition, this update sheds light on the potential repercussions stemming from improper prescription practices, unwarranted overutilisation and insufficient adherence to established guidelines.

Challenges and opportunities in pediatric residency: an analysis of the increasing number of residents in Italy.

Pediatric residency in Italy has undergone significant changes in recent years, with a notable increase in the number of pediatric residents. Exploring the implications of this increase, highlighting disparities in training opportunities, and discussing the broader socio-economic impacts on pediatric healthcare, represent a crucial consideration for the healthcare system in the future. The Italian National Association of Pediatric Residents ("Osservatorio Nazionale Specializzandi in Pediatria", ONSP) conducted an extensive survey among pediatric residents to assess the current state of pediatric residency. Key findings indicate that 50% of respondents believe the number of residents is excessive for the available training opportunities, leading to concerns about the quality of education and hands-on experience. Despite the increased number of residents, the workload has increased, but up to one-third of residents feel that the autonomy provided by their programs is insufficient. Significant disparities in training quality were found across different regions, with notable shortages in neonatology and pediatric emergency departments. Research opportunities are also limited, with only 17% of residents finding the time allocated to research satisfactory, especially in central and southern Italy. The increase in pediatric residents presents both challenges and opportunities. Addressing these challenges through strategic reforms, such as implementing standardized national curricula, investing in training resources and mobility programs, and enhancing research opportunities, is crucial for the future of pediatric residency in Italy. Ensuring high-quality training for all residents is an ethical and practical obligation that will significantly impact pediatric healthcare.

Increased access to pediatric specialist healthcare using eConsult: A retrospective observational cohort and case–control study

ABSTRACT Objectives Primary care practitioners (PCPs) report that using the Champlain BASE™ eConsult service (eConsult) averts one-third of face-to-face (FTF) specialist referrals, however, there are concerns about duplication of services and adverse patient outcomes. Following an eConsult, we evaluated patient healthcare utilization and associated treatment costs. Methods Retrospective cohort study (2014 to 2018) of patients (<18 years old) for whom an eConsult visit averted a FTF specialist referral. Patients were linked to provincial health administrative databases and hospital electronic medical records for healthcare use for the same diagnosis and specialty for the 18 months following the eConsult. Concurrently, a retrospective case–control study compared utilization and costs between an eConsult versus a matched FTF visit for the same diagnosis. We also assessed PCP satisfaction. Results In follow-up, <5% of the study cohort of eConsult patients (n = 242) later accessed the healthcare system for the identical diagnosis and specialty type. FTF visits generate more frequent outpatient visits (12.6 times more [95% CI: 2.28 to 69.66, P = 0.002]) and higher costs compared to eConsult visits. There were no hospital admissions or deaths in patients with eConsult. PCPs (98%) described eConsult as an excellent service. Conclusions Using eConsult is associated with <5% of patients subsequently having a FTF visit for the same reason. Matched FTF visits generated more healthcare utilization and higher costs compared with eConsult. eConsult in pediatrics is safe and can minimize FTF specialist visits in elective cases and increase capacity, towards a more efficient and cost-effective healthcare system.

Risk for Suicide Attempts Assessed Using the Patient Health Questionnaire–9 Modified for Teens

Suicide is a leading cause of death in US youths. To assess whether screening with supplemental items 10 to 13 on the Patient Health Questionnaire-9 modified for teens (PHQ-9M) improves prediction of youth suicide attempts beyond the information provided by the first 9 items alone (the PHQ-9). This retrospective cohort study used a retrospective cohort of adolescents aged 12 to 17 years who were screened for depression in outpatient facilities within a pediatric health care system between January 1, 2016, and December 31, 2022, with up to 1 year of follow-up to assess the occurrence of suicidal behavior. Follow-up was completed on December 31, 2023. Screening with the PHQ-9M. This study developed and compared prediction using 3 Cox proportional hazards regression models (CR-9, CR-13, and CR-3) of subsequent suicide attempts, determined by the hospital's electronic health records up to 1 year following the last PHQ-9M screening. The CR-9 model used the PHQ-9 and the CR-13 model used all 13 items of PHQ-9M. The CR-3 model used the 3 most impactful variables selected from the 13 PHQ-9M items and PHQ-9 total score. All models were evaluated across 4 prediction horizons (30, 90, 180, and 365 days) following PHQ-9M screenings. Evaluation metrics were the area under the receiver operating characteristic curve (AUROC) and the area under the precision recall curve (AUPRC). Of 130 028 outpatients (65 520 [50.4%] male) with 272 402 PHQ-9M screenings, 549 (0.4%) had subsequent suicide attempts within 1 year following the PHQ-9M screening. The AUROC of the CR-9 model in the 365-day horizon was 0.77 (95% CI, 0.75-0.79); of the CR-13 model, 0.80 (95% CI, 0.78-0.82); and of the CR-3 model, 0.79 (95% CI, 0.76-0.81); the AUPRC of the CR-9 model was 0.02 (95% CI, 0.02-0.03); of the CR-13 model, 0.03 (95% CI, 0.02-0.03); and of the CR-3 model, 0.02 (95% CI, 0.02-0.03). The 3 most impactful items using adjusted hazard ratios were supplemental item 13 (lifetime suicide attempts; 3.06 [95% CI, 2.47-3.80]), supplemental item 10 (depressed mood severity in the past year; 2.99 [95% CI, 2.32-3.86]), and supplemental item 12 (serious suicidal ideation in the past month; 1.63 [95% CI, 1.25-2.12]). All of the models achieved higher AUROCs as prediction horizons shortened. In this cohort study of adolescent PHQ-9M screenings, the supplemental items on PHQ-9M screening improved prediction of youth suicide attempts compared with screening using the PHQ-9 across all prediction horizons, suggesting that PHQ-9M screening should be considered during outpatient visits to improve prediction of suicide attempts.

Patterns of use of malnutrition risk screening in pediatric populations: A survey of current practice among pediatric hospitals in North America.

Information on the use of validated malnutrition risk screening tools in pediatric facilities to guide malnutrition identification, diagnosis, and treatment is scarce. Therefore, a survey of pediatric healthcare facilities and practitioners to ascertain malnutrition risk screening practices in North America was conducted. A pediatric nutrition screening practices survey was developed and sent to members of the American Society for Parenteral and Enteral Nutrition, the Council for Pediatric Nutrition Professionals and the Academy of Nutrition and Dietetics Pediatric Nutrition Practice Group. Respondents represented 113 pediatric hospitals in the United States and six in Canada, of which 94 were inpatient and 59 were outpatient. Nutrition risk screening was completed in 90% inpatient settings, and 63% used a validated screening tool. Nurses performed most malnutrition risk screens in the inpatient setting. Nutrition risk screening was reported in 51% of outpatient settings, with a validated screening tool being used in 53%. Measured anthropometrics were used in 78% of inpatient settings, whereas 45% used verbally reported anthropometrics. Measured anthropometrics were used in 97% outpatient settings. Nutrition risk screening was completed in the electronic health record in 80% inpatient settings and 81% outpatient settings. Electronic health record positive screen generated an automatic referral in 80% of inpatient and 45% of outpatient settings. In this sample of pediatric healthcare organizations, the results demonstrate variation in pediatric malnutrition risk screening in North America. These inconsistencies justify the need to standardize pediatric malnutrition risk screening using validated pediatric tools and allocate resources to perform screening.

What aspects of outcome measurement instruments are important to parents and caregivers in child health trials: Survey protocol

Background Trials of interventions to prevent illness and/or improve health outcomes in children play a crucial role in the advancement of paediatric healthcare, research, and policy. It is important for researchers and trialists involved in such trials to understand factors which are important to parents/caregivers when deciding to participate and provide data about their child. There is little evidence to date surrounding the impact of outcome measurement instruments (OMIs) on parents/caregivers’ decisions about participation and provision of data in trials. The aim of this project is to examine what characteristics of OMIs are important in parents/caregivers’ decisions to engage with and participate in trials of interventions to prevent childhood illness and/or improve child health outcomes. Methods An online cross-sectional survey is being conducted. Survey recruitment began July 2024 and will be completed in October 2024. Parents/caregivers are eligible to participate if they have at least one child up to 12 years of age; there are no restrictions based on factors such as gender or nationality. Survey participants are being recruited using convenience sampling via social media, parenting websites, and online forums. This survey includes questions about parents/caregivers’ preferences for how, when, where, and with whom data is collected in child health research, as well as the types of OMIs parents/caregivers would be most comfortable using. Data will be analysed using descriptive statistics. Conclusions Findings from this study will address the current gap in knowledge related to preferences of parents/caregivers in how data are collected in trials of interventions to improve health outcomes in children. Study findings will inform trialists in the design and conduct of child health research in the future. Implementation of study findings in future trials can also improve experiences of children and their caregivers engaged in research and enhance the quality and quantity of data being collected.

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.

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.

MHealth Apps in the Digital Marketplace for Pediatric Patients With Cancer: Systematic Search and Analysis.

The substantial increase in smartphone ownership has led to a rise in mobile health (mHealth) app use. Developing tailored features through mHealth apps creates a pathway to address the health care needs of pediatric patients with cancer and their families who have complex care needs. However, few apps are designed specifically to integrate with pediatric cancer care. This study reports a systematic search and analysis of mHealth apps available on the Apple App (iOS) and Google Play (Android) stores designed for pediatric cancer through a list of features that serve (1) patients, (2) caregivers, or (3) both audiences. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we reviewed apps for pediatric patients with cancer and caregivers available as of January 30, 2024. We searched the Apple App and Google Play stores with a list of keyword combinations focusing on pediatric cancer care. The inclusion criteria were (1) specifically apps targeted toward pediatric patients with cancer, their families, or both; (2) available in either app store; and (3) available in English. Apps were assessed using the Mobile Application Rating Scale (MARS). The MARS is a quality assessment for mHealth apps, including components of engagement, functionality, aesthetics, and informational quality (5-point Likert scale items-1: low and 5: high quality). In total, 22 apps were identified and 17 of those apps were available on both platforms. The most popular features (n=12) were resource sharing, symptom tracking, reminders, care team connections, journaling, community support, medication tracking, data visualizations, and appointment tracking. Features and interfaces were designed for caregivers (n=9) more frequently than the patients (n=7) while a subset of apps created options for both users (n=6). A total of 16 apps received positive reviews (mean 4.4, SD 0.59; Min=3.1, Max=5.0). A small subset (n=3) achieved over 5000 downloads; however, the majority (n=15) had fewer than 500. More than half (n=12) of the apps were not available in English. Apps requested access to a range of device functionalities to operate (mean 2.72, SD 3.13; Min=0, Max=10). Out of 22, a total of 17 apps were publicly accessible. The mean MARS scores for the apps ranged from 1.71 (SD 0.75) to 4.33 (SD 0.82). Overall, apps scored high on functionality (mean 3.72, SD 0.54) but low on engagement (mean 3.02, SD 0.93). Our review highlights the promising yet underdeveloped potential of mHealth apps in pediatric oncology care, underscoring the need for more inclusive, comprehensive, and integrative digital health solutions. Future developments should actively involve key stakeholders from the pediatric oncology community, including patients, families, and health care professionals, to ensure the apps meet specific needs while addressing linguistic and cultural barriers.

Mitigating Risk of Acute Kidney Injury Among Children With Methicillin-resistant Staphylococcus aureus Osteomyelitis.

Children with acute hematogenous osteomyelitis (AHO) from methicillin-resistant Staphylococcus aureus (MRSA) are treated with vancomycin despite the risk of acute kidney injury (AKI). This study evaluates the rate of AKI and resource utilization for children with or without AKI when vancomycin is used in this setting. Children with MRSA AHO treated with vancomycin were retrospectively studied. AKI was assessed by clinical diagnosis and Kidney Disease Improving Global Outcomes (KDIGO) criteria. Cohorts of children with or without AKI were compared for differences in treatment, resource utilization, and outcomes. Multivariate logistic regression analysis assessed factors associated with risk for AKI. Cost analysis was performed using the Pediatric Health Information System and Healthcare Cost and Utilization Project databases. Among 85 children studied, 14 (16.5%) had chart-diagnosed AKI and 24 (28.2%) met KDIGO criteria. Children with AKI had more febrile days and higher thrombosis rates. They had longer vancomycin treatment (8 vs 5d), higher troughs (27.8 vs 17.5mg/L), and prolonged hospitalization (19.9 vs 11.1d). Multivariate analysis found a maximum vancomycin trough level (odds ratio: 1.05, P = 0.003) with a cutoff of 21.7mg/L predicted AKI.Only 2 of 20 (10%) children who had MRSA isolates with a minimum inhibitory concentration of 2 achieved therapeutic vancomycin levels. Pediatric Health Information System data of 3133 children with AHO treated with vancomycin identified 75 (2.4%) with AKI who had significantly longer lengths of stay (13 vs 7d) and higher billed charges ($117K vs $51K) than children without AKI. Chart documentation of AKI (16.5%) grossly underestimated KDIGO-defined occurrence (28.2%). This study showed that vancomycin-associated AKI required substantially greater resource utilization and higher health care costs. Lowering the targeted trough range, shortening the duration of vancomycin therapy, and considering alternative antibiotics when minimum inhibitory concentration ≥2 will reduce the risk and cost of AKI among children with MRSA AHO. Level III-retrospective comparative therapeutic study.

Everyday Ethics or Deference to Expertise: Experiences of Pediatric Palliative Care Teams with Ethics Consultancy.

Background: Little is known about the extent to which pediatric palliative care (PPC) clinicians are engaged in ethics consults or how they perceive interactions with ethics consultants. Objective: Describe the extent to which PPC team members serve in pediatric health care ethics (PHCE) consultancy roles and to describe their experiences interacting with pediatric ethic consultant services. Design: Online survey distributed to members of the American Academy of Pediatrics and American Academy of Hospice and Palliative Care pediatric and ethics section and special interest groups in the United States. Results: Eighty-six responses were obtained (response rate 45%) from PPC teams in 70 different children's hospitals located in 34 states. Almost all (97%) reported a functional ethics consult service such that PPC is not expected to meet the ethics need of the institution. A person involved on the PPC team also performed ethics consults in half (49%) of the settings, predominantly the PPC physician. Most respondents who perceive PPC teams engage in ethics-relevant work as part of their everyday PPC work. Formal ethics training was lacking among PPC members involved in ethics consults with few ethics degrees (15%), certifications (6%), or fellowships (2%). Discord (67%), conflict (49%), limitations to treatment (48%), and distress (41%) were cited as the most frequent reasons for which PPC teams consult ethics. PPC respondents identified role clarity, coordinated engagement, timely presence, and open communication as strong PHCE consultant practices. Conclusions: PPC team members performing ethics consults may benefit from additional ethics education and training. Further research is warranted to delineate scope of ethics consultancy relevant to PPC and role clarity.

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.

In Their Own Words: Narratives of Sudanese Pediatricians Displaced By Conflict

Background: This study examines the profound personal and professional impact of the armed conflict in Sudan since April 2023 on pediatricians, particularly focusing on their displacement from Khartoum and the resultant challenges in providing essential health services to children in conflict-affected areas. Methods: Utilizing a mixed-methods approach, this study targeted displaced pediatricians from Khartoum identified via purposive sampling. Data were collected through a semi-structured questionnaire, featuring both quantitative items and an open-ended question for qualitative insights, administered electronically. The analysis combined descriptive statistics and thematic analysis with ethical oversight provided by the IRB of Prince Sattam Bin Abdulaziz University. Results: In a study of 42 displaced pediatricians from Sudan, 66.67% were female and the majority were aged between 30 and 45 years. Despite facing adversities due to armed conflict, these pediatricians displayed remarkable resilience and continued to provide pediatric care under challenging conditions. Key themes emerged from their narratives, including professional commitment amid scarcity, emotional turmoil coupled with spiritual reflection, and relentless pursuit of providing care. Safety concerns primarily drove displacement, with 95.24% citing this as a reason. While 61.90% of the respondents relocated within Sudan, 38.10% moved abroad, reflecting the profound personal and professional impact of the conflict. Conclusion: The armed conflict in Sudan has severely disrupted the pediatric healthcare system, leading to widespread displacement of pediatricians and jeopardizing child healthcare. The study highlights the resilience of healthcare professionals amidst adversity, their struggle to maintain care delivery, and the critical need for support and strategic planning to restore healthcare services in conflictaffected areas.

Toddler’s fracture: an updated guide on evaluation and management

Toddler’s fractures are commonly encountered in pediatric healthcare. These injuries are associated with little to no risk of fracture displacement or failure to heal, regardless of treatment modality. The standard treatment for these injuries has historically been several weeks of weightbearing restriction and immobilization in a circumferential cast or posterior splint. Over the last decade, numerous reports comparing clinical outcomes and iatrogenic complication rates between treatment modalities have emerged, revealing a concerning trend of higher rates of skin breakdown in patients treated with traditional management compared to those treated with removable walking boot immobilization or no immobilization. Current management practices for toddler’s fractures vary widely with respect to both initial and follow-up care, reflecting a need for additional guidance on this topic. This review provides an updated, evidence-based review of evaluation and management strategies for the toddler’s fracture.

Barriers to initiating and implementing palliative and end-of-life care for children with life-limiting conditions: a mixed-methods study in a UK children’s hospital

BackgroundTo ensure that children with life-limiting conditions (LLC) and their families have access to a palliative care pathway from diagnosis to death and bereavement, a better understanding of the challenges...

Paediatric medical imaging in Ireland- challenges, training, and the use of distraction techniques

The National Model of Care for Paediatric Healthcare Services, published in 2016, aims to ensure high-quality care for children across Ireland. However, with few exceptions, radiology departments in general hospitals “lack the necessary physical infrastructure, facilities, and staff training required for paediatrics.” These deficiencies can adversely affect a patient's behaviour and emotions, exacerbating fear of the healthcare system. This study sought to identify the challenges faced by radiographers in Ireland during paediatric imaging, with a focus on post-qualification training and the use of distraction techniques. A cross-sectional, qualitative online survey was conducted via Microsoft Forms, comprising 37 close-ended and eight open-ended questions on paediatric training, challenges, and distraction use. Ninety-six participants were recruited through snowball sampling from 26 hospitals and private clinics across Ireland. Only a small proportion of radiographers (n = 25, 26%) undertook post-qualification training in paediatric imaging, and many reported inadequate educational opportunities (n = 52, 60%). Patient cooperation (n = 45, 52%) and toddlers (n = 75, 90%) were identified as the most challenging aspect and age group, respectively. While distraction is commonly employed (n = 79, 91%), radiology departments often provide insufficient equipment (n = 65, 76%). The lack of equipment and training highlights the need for improvement in paediatric medical imaging services. The development of new training courses and distraction tools may enhance practice, ensuring the provision of high-quality paediatric care. Expanding radiographer training and implementing distraction tools may help paediatric patients better cope with the anxiety and stress associated with healthcare settings.

'Omics-Based Digital Twins for Personalised Paediatric Healthcare.

Digital twins offer potential to enhance the precision and personalisation of healthcare delivery. As part of a collaborative project between La Trobe University and the Murdoch Children's Research Institute, Melbourne, Australia, multidimensional 'omics-based digital twins of children are being developed. The aim is to explore their application to a range of health contexts in children. A pilot project is commencing that focuses on food allergy diagnosed at one year of age.

Efficacy of Gamified Digital Mental Health Interventions for Pediatric Mental Health Conditions

Anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) affect up to 20% of children and adolescents. Despite demonstrated efficacy, evidence-based treatments for these conditions are often inaccessible; innovative solutions are essential to meet the demand for pediatric mental health care. To examine the efficacy and moderators of gamified DMHIs for anxiety, depression, and ADHD in randomized clinical trials (RCTs) for children and adolescents. A systematic search of PubMed, PsycInfo, and Web of Science was conducted for RCTs published before March 20, 2024. RCTs that evaluated the efficacy of gamified DMHIs for treating pediatric ADHD, depression, or anxiety were included. Studies were excluded if they did not use a gamified DMHI, provide sufficient data for effect sizes, or were unavailable in English. Efficacy data were extracted from rating scales for ADHD, depression, and anxiety. Extracted moderator variables included participant characteristics (eg, age and sex), intervention characteristics (eg, delivery modality and time limit), and trial design characteristics (eg, outcome measure and risk of bias). The primary outcome was change in ADHD, depression, or anxiety severity in the treatment group compared to the control group. Hedges g quantified treatment effects. The search strategy identified 27 RCTs that included 2911 participants across ADHD, depression, and anxiety disorders. There were modest significant effects of gamified DMHIs on ADHD (g, 0.28; 95% CI, 0.09 to 0.48) and depression (g, 0.28; 95% CI, 0.08 to 0.47) but small, nonsignificant effects for anxiety disorders (g, 0.07; 95% CI, -0.02 to 0.17). Moderator analyses revealed that DMHIs for ADHD delivered on a computer and those RCTs that had a greater preponderance of male participants produced larger treatment effects. DMHIs for depressive disorders that used preset time limits for gamified DMHIs also exhibited larger treatment effects. The findings suggest a benefit of gamified DMHIs for youth with ADHD or depressive disorder. Pediatricians and other health care professionals have new information about novel, accessible, and efficacious options for pediatric mental health care.