Pediatric Primary Care Visits Research Articles

Addressing tobacco screening and treatment among racially and ethnically minoritized parents in pediatric clinics: barriers and facilitators.

Household secondhand smoke (SHS) exposure remains a significant health issue for racially and ethnically minoritized children in the United States. Delivering parental tobacco treatment during pediatric primary care visits can reduce children's SHS exposure. This study examined current tobacco screening practices and health system stakeholder perceptions of facilitators and barriers to addressing tobacco use during pediatric visits among racially and ethnically minoritized parents. We conducted 25 semi-structured interviews with clinicians, staff, and health system leaders from 5 pediatric primary care clinics in Minneapolis-St. Paul, Minnesota. The study was informed by the Health Equity Implementation Framework. Interviews were analyzed using both directed content and thematic analysis. Participants identified multilevel facilitators and barriers to addressing parental tobacco use in minoritized families. Within the clinical encounter, barriers included linguistic and cultural barriers, health system navigational challenges, medical mistrust, low levels of clinician and staff knowledge, skills, and confidence, time constraints, and lack of alignment with external metrics. Facilitators centered on leveraging interpreters' cultural knowledge and the presence of culturally-congruent clinicians and staff to reduce medical mistrust and stigma, developing linguistically and culturally relevant resources, and integrating prompts and resources into the electronic health record. Participants described how lessons from previous system change mechanisms would facilitate this work. Addressing health system, training and resources, and linguistic and cultural barriers among clinicians and staff is essential to strengthen their capacity to address household SHS exposure among racially and ethnically minoritized populations as a component of pediatric preventive care. Clinicians and health system staff perceive unique barriers to identifying and addressing parental tobacco use among racially and ethnically minoritized parents during pediatric primary care visits. Solutions to expand tobacco treatment access to minoritized parents in pediatric settings must attend to clinician training needs on tobacco treatment, embedding clinical encounter resources and reminders that match the linguistic and cultural needs and preferences of their patient populations, and increasing access to high quality interpreting services and culturally-congruent staff.

Caregivers’ and Community Members’ Perspectives on Firearm Safety Screening and Counseling During Pediatric Primary Care Visits

Caregivers’ and Community Members’ Perspectives on Firearm Safety Screening and Counseling During Pediatric Primary Care Visits

Severe Bullous Impetigo in A 4-Month-Old Infant: A Case Report

Background: Impetigo is a skin bacterial infection that mainly affects the superficial skin; however, it can spread deeper into the tissues. It commonly affects children under 5 years of age. It frequently occurs in crowded areas such as daycare centers, and schools that have poor hygiene. There are two forms: bullous and non-bullous impetigo (impetigo contagiosa). Non-bullous impetigo is more common and is mostly seen as a secondary infection in conditions that affect the skin. Case Presentation Summary: We present an interesting case of a 4-month-old male infant brought to our pediatric outpatient clinic with a one-week history of fragile fluid-filled vesicles, flaccid blisters, and peeling of the skin. Multiple fluid-filled vesicles and flaccid blisters were present mainly on the scalp, face, neck, part of the trunk, and upper limbs. The mother reported having received a prior treatment 3 days before of calamine lotion and erythromycin. However, the symptoms were increasing gradually and the vesicles enlarging. No other medication was given. Conclusion: Skin changes and skin-related problems occur frequently in children and account for about 30% of pediatric primary care visits. There are many different causes of pustules in childhood including infectious and non-infectious causes. Clinical suspicion and culture and sensitivity are important guides in diagnosis. Besides, Pediatric dermatology services and mentorship are highly inaccessible, especially in low and middle-income countries. This greatly impacts the management of pediatric dermatology cases as many are either misdiagnosed or take a long referral process.

Trends in Pediatric Primary Care Visits During the COVID-19 Pandemic.

Context: The COVID-19 pandemic has impacted the volume and nature of pediatric primary care visits nationwide. Objective: This study aimed to identify trends in pediatric visits during COVID-19 at our institution to reveal challenges and opportunities to improve care. Study Design: Retrospective chart review of all pediatric visits from January 1, 2019 through September 30, 2021 using the electronic health record (EHR). Descriptive statistics were used for data analysis. Setting or Dataset: Single family medicine clinic within a large academic medical center in Northern California. Data collected for each pediatric primary care visit included age, sex, type of visit (preventive or problem-focused), reason for visit (if problem-focused), and mode of visit (in-person or video). Population Studied: Pediatric patients (<18 years old). Intervention/Instrument: N/A Outcome Measures: Volume and nature of pediatric primary care visits. Results: A total of 4,846 pediatric visits occurred during the study period. Visit volume dropped 9% from 2019- 2020, mostly during April-May 2020, and recovered afterward to pre-pandemic baseline through 2021. There were no significant changes to age, sex, or type of visit during the study period with one exception: the proportion of problem-focused visits increased 23% (p=0.004) from 2019-2021 in adolescents aged 12-<18, driven largely by a 107% increase (p<0.001) in the proportion of behavioral health visits (14% in 2019, 18% in 2020, and 29% in 2021). Video visits accounted for 4% of all visits in 2019, 39% in 2020, and 35% in 2021. Video visit volume decreased from 2020-2021 in all age categories except for adolescents aged 12-<18, which remained stable at 43% of all visits. Conclusions: A sharp increase in behavioral health concerns among adolescents stands out as the most notable impact of COVID-19 on pediatric care at our institution. Our findings raise questions about how behavioral health care can be optimized for children and adolescents now and in the post-pandemic era.

Characteristics of Pediatric Primary Healthcare Visits in a University-Based Primary Healthcare Center in Saudi Arabia.

This study aimed to identify the characteristics of pediatric primary health care (PHC) visits and evaluate the outcomes of patients presenting with complaints along with their referral and consultation capabilities. This was a retrospective medical record-based study. The study population included any pediatric patient (≤14 years old), including females and males, Saudis, and non-Saudis. Research data were gathered for visits from 2016-2021. Sampling was performed using a stratified random sample based on age groups, followed by simple random sampling with proportional allocation to different age groups. The number of pediatric visits included was 1439 (males, 52.2%). The most common age group was toddlers, and 60% of the total sample was from Saudi Arabia. The most common cause of visits was vaccination (32%), followed by general checkups and/or a well-baby visit (25.4%), and fever (11.2%). Approximately 10% of visits needed referral to other subspecialties. Approximately 50% of visits with complaints concerning ophthalmology, cardiology, and surgical intervention were referred to a specialized department. More awareness needs to be raised about the important role of PHC services in the pediatric age group, as it was capable of handling approximately 90% of their cases.

Impact of the Coronavirus Disease 2019 Pandemic on Mental Health Visits in Pediatric Primary Care.

Describe the impact of the coronavirus disease 2019 (COVID-19) pandemic on pediatric primary care visits for 7 mental health categories before and during the COVID-19 pandemic. This interrupted time series analysis compared the rate of mental health visits to pediatric primary care providers in Massachusetts before and during the COVID-19 pandemic. Three time periods were defined: prepandemic period (January 2019-February 2020), emergency pandemic period (March 2020-May 2020), and pandemic period (June 2020-September 2021). The 7 mental health visit diagnoses included alcohol and substance use disorders, anxiety disorders, attention-deficit hyperactivity disorders, behavior disorders, eating disorders, mood disorders (depressive and bipolar), and stress or trauma disorders. Significant increases in slope (P < .001) were observed for eating disorder visits, with the annualized visit rate increasing from 9.3 visits per 1000 patients per year in the prepandemic period to 18.3 in the pandemic period. For mood disorder visits, the annualized visit rate increased from 65.3 in the prepandemic period to 94.0 in the pandemic period. Significant decreases in level and slope (both P < .001) were observed for alcohol and substance use disorder visits, with the annualized visit rate decreasing from 5.8 in the prepandemic period to 5.5 in the pandemic period. Eating disorder visits and mood disorder visits significantly increased, whereas alcohol and substance use disorder visits significantly decreased during the pandemic period among pediatric patients, highlighting the need to identify and manage mental health conditions in the pediatric primary care setting.

The Greenlight Plus Trial: Comparative effectiveness of a health information technology intervention vs. health communication intervention in primary care offices to prevent childhood obesity

BackgroundThe first 1000 days of a child's life are increasingly recognized as a critical window for establishing a healthy growth trajectory to prevent childhood obesity and its associated long-term comorbidities. The purpose of this manuscript is to detail the methods for a multi-site, comparative effectiveness trial designed to prevent childhood overweight and obesity from birth to age 2 years. MethodsThis study is a multi-site, individually randomized trial testing the comparative effectiveness of two active intervention arms: 1) the Greenlight intervention; and 2) the Greenlight Plus intervention. The Greenlight intervention is administered by trained pediatric healthcare providers at each well-child visit from 0 to 18 months and consists of a low health literacy toolkit used during clinic visits to promote shared goal setting. Families randomized to Greenlight Plus receive the Greenlight intervention plus a health information technology intervention, which includes: 1) personalized, automated text-messages that facilitate caregiver self-monitoring of tailored and age-appropriate child heath behavior goals; and 2) a web-based, personalized dashboard that tracks child weight status, progress on goals, and electronic Greenlight content access. We randomized 900 parent-infant dyads, recruited from primary care clinics across six academic medical centers. The study's primary outcome is weight for length trajectory from birth through 24 months. ConclusionsBy delivering a personalized and tailored health information technology intervention that is asynchronous to pediatric primary care visits, we aim to achieve improvements in child growth trajectory through two years of age among a sample of geographically, socioeconomically, racially, and ethnically diverse parent-child dyads.

Impact of Concurrent Hospice Care on Primary Care Visits Among Children in Rural Southern Appalachia.

The purpose of the study was to test the effect of receiving pediatric concurrent hospice care on primary care visits. This retrospective study was limited to pediatric decedents younger than 21 years with a hospice service claim from 2011 to 2013. Our outcome of interest concerned whether concurrent hospice care impacted primary care visits. Of the 460 pediatric decedents in rural Southern Appalachia, 42% continued to visit their primary care provider during hospice enrollment, whereas 51% received concurrent hospice care. Concurrent hospice care was significantly related to pediatric primary care visits (β=2.31; p < .001). Findings revealed that receipt of concurrent hospice care impacted primary care. Children in concurrent care were twice as likely to continue to receive care from their primary care provider. This finding is consistent with our hypothesis; however, the magnitude of the finding was unexpected given their residence in medically underserved areas.

Characteristics of acute otitis media in primary care are associated with tympanostomy tube outcomes.

ObjectiveTo identify characteristics of acute otitis media (AOM) at primary care presentation associated with TT placement and outcomes.MethodsA retrospective cohort study of pediatric patients (birth—12 years old) with AOM at an academic primary care pediatric practice and affiliated tertiary referral free‐standing Children's hospital from August 1, 2017 to December 31, 2019 was performed. The outcomes measured were TT placement, postoperative otorrhea, need for additional tube placement, and other complications (i.e., perforation and/or granulation).ResultsThe 3189 patients were included, 484 of whom were referred to otolaryngology. Multivariate logistic regression analysis revealed that a greater number of AOM episodes diagnosed at primary care was associated with tube placement (OR = 1.21; 95% CI, 1.04–1.41, p = .02). Of the 336 patients who received tubes, older age at first AOM diagnosis was associated with postoperative otorrhea (OR = 1.02; 95% CI, 1.01–1.03; p = .001) and additional tube placement (OR = 1.03; 95% CI, 1.02–1.04; p < .001). Older age was also associated with other complications (OR = 1.02; 95% CI, 1.01–1.03; p = .001) by univariate analysis. Additionally, postoperative otorrhea was more common among patients who first received an AOM diagnosis at primary care in the spring (OR = 2.69; 95% CI, 1.37–5.29; p = .004), summer (OR = 2.88; 95% CI, 1.46–5.69; p = .002), and fall (OR = 2.18; 95% CI, 1.20–3.96; p = .01) seasons.ConclusionsClinical data from pediatric primary care visits found older age at first AOM diagnosis and having a first AOM diagnosis outside of winter to be associated with a more complicated eventual disease course.Level of evidence3—cohort study.

Association Between Unscheduled Pediatric Primary Care Visits and Risk of Developmental Delay.

Primary care centers are trialing open access scheduling models to expand access. Given evidence linking irregular caregiver work schedules with adverse child developmental outcomes, we hypothesized that children presenting for unscheduled "walk-in" visits would have higher odds of developmental concerns than those presenting for scheduled visits. We conducted a retrospective review of electronic health record data for children aged 6 to 66 months visiting an academic pediatric primary care center between July 1, 2013 and February 1, 2019. Our primary outcome was presence of developmental concerns, defined by results below cutoff on a child's Ages & Stages Questionnaire, Third Edition (ASQ-3). We examined associations between visit stream (unscheduled vs scheduled; time of day) and ASQ-3 using multivariable logistic regression, adjusting for child demographics, visit type (well-child vs ill), and responses to a standardized social history questionnaire. Of 11,169 eligible total encounters each for a unique child, 8% were unscheduled (n=848); 19% had developmental concerns in at least one domain (n=2100). Twenty-eight percent of children presenting for unscheduled visits had developmental concerns compared to 18% of those presenting for scheduled visits (P < .0001). Compared to those presenting for scheduled well-child visits, children presenting for unscheduled ill visits had a higher odds of an ASQ-3 score below cutoff (adjusted odds ratio 2.02; 95% confidence interval, 1.54-2.65). As pediatric primary care centers implement open access scheduling models, they should be prepared to identify and respond to developmental concerns at a rate that may be higher than what is typically seen during scheduled visits.

Impact of COVID-19 on Pediatric Primary Care Visits at Four Academic Institutions in the Carolinas

We aimed to determine how COVID-19 affected the number and type of pediatric primary care visits in April 2020, compared to April 2019, and which characteristics were associated with obtaining care in 2020. We performed a retrospective chart review of patients receiving care in April 2019 and April 2020 from four large, academic institutions across two states. The subjects were included if they were aged 0–18 years and were seen in a pediatric clinic in April 2019 or April 2020. We extracted the number of visits, visit type, and visit diagnosis; and the patient characteristics, including age, race/ethnicity, and insurance status. Logistic regression analysis identified characteristics associated with obtaining care in April 2020. We included 120,230 visits. Participants were 50% white and half had Medicaid. In 2020 there were significantly fewer visits for both well and acute visits with 42,670 visits in 2020 compared to 77,560 in 2019; 6616 were telehealth visits in 2020. Visits for chronic conditions were significantly decreased in 2020. Attending a visit in 2020 was more likely if the participant was black or Hispanic, younger, attending an acute visit, or had private insurance. During the COVID-19 pandemic, pediatric primary care decreased substantially for both well visits and follow-up of chronic conditions.

All Hands on Deck: Addressing Adolescent Depression in Pediatric Primary Care.

This study examines prevalence rates of elevated depression symptoms utilizing the Patient Health Questionnaire-9 Item Modified for Adolescents (PHQ-9A), characterizes recommendations and interventions by primary care providers (PCPs) and behavioral health clinicians (BHCs) in response to elevated PHQ-9As, and identifies factors associated with improved PHQ-9A scores at follow-up pediatric primary care visits. A mixed methods approach was taken. Visit data, demographics, and PHQ-9A scores for 2,107 adolescents aged 11-18 were extracted using clinical informatics between January 3, 2017 and August 31, 2018. Descriptive statistics and chi-square analyses were conducted, followed by conventional content analysis of electronic medical records to examine qualitative results. Qualitative analyses were transformed into quantitative results and analyzed using point biserial correlations. Of the 2,107 adolescents, 277 (13%) had an elevated PHQ-9A. Content analysis resulted in 40 actions (17 PCP codes, 23 BHC codes) in response to an elevated PHQ-9A. Significant correlations were found between an improved PHQ-9A at a follow-up visit and the PCP referring to integrated behavioral health (r = .20, p < .01), and BHCs recommending and checking in at a follow-up visit (r = .20, p < .05), conducting a risk assessment (r = .15, p < .05), and providing psychoeducation about mood symptoms (r = .15, p < .05). Primary care is an ideal setting to address the public health crisis of untreated adolescent depression. Implications for screening processes, practice implications for PCPs and BHCs, future directions, and limitations are discussed.

Presymptomatic Detection and Intervention for Autism Spectrum Disorder.

Universal screening for autism spectrum disorder (ASD) is recommended during pediatric primary care visits in the first 2 years of life. However, many children are missed by initial screening and not diagnosed with ASD until years later. Research efforts are underway to develop and evaluate new objective measures of risk for ASD that can be used in infancy, before symptoms emerge. Initial studies with these tests, particularly MRI-based screening for infants at high familial risk, have shown promise but have not yet been evaluated in clinical trials. We present the study design for a hypothetical clinical trial that would combine presymptomatic detection and intervention for ASD and consider, through commentaries from diverse perspectives, the ethical issues that should be anticipated in advance of beginning such trials. Commentators Drs Pruett and Piven address the social value of the proposed research and importance of researcher-bioethicist collaborations. Drs Estes and Wolff discuss the clinical potential and challenges of developing presymptomatic interventions for infants at risk for ASD. Dr Harrington takes a neurodiversity view of presymptomatic prediction and intervention and their implications for autistic identity and quality of life. Finally, Drs MacDuffie, Peay and Wilfond consider the potential risks and benefits that must be evaluated and weighed in the next phases of research on presymptomatic detection and intervention for ASD.

Case Report: Managing Growth Failure While Maintaining Exclusive Breastfeeding

This case study presents a mother who was able to maintain exclusive breastfeeding after having an infant who experienced growth failure between the two- and four-month pediatric primary care visits. This mother was exclusively breastfeeding her child and the infant was noted to “fall off the growth curve” at the four-month infant pediatric visit. At this point the mother was advised to formula feed her infant. The mother did not want to give formula and sought out assistance from the first author who connected the mother with an advance practice nurse at the pediatric site.By working with a nurse practitioner to develop an individualized feeding plan, the mother's breastfeeding relationship was able to be maintained and the infant gained weight.Despite receiving initial recommendations to formula feed her child, we were able to work beyond those recommendations by providing evidence based breastfeeding interventions and support. A breastfeeding assessment is an important factor in each wellness visit.

National Referral and Treatment Patterns Among Mental Health Pediatric Primary Care Visits.

The current study explored factors that predict referral from pediatric primary care to mental health specialty care among a nationally representative sample of visits (N=2056). Results of a logistic regression indicated that patient visits that included rarer/serious diagnoses (e.g., bipolar disorder) were more likely to receive a referral in comparison to those with ADHD (OR=4.75, SE=1.37). Other characteristics associated with increased likelihood of referral were those with comorbid mental health conditions (OR=2.20, SE=0.84) and those from a metropolitan area (OR=2.23, SE=0.75). Implications are discussed.

Embedded Maternal Mental Health Care in a Pediatric Primary Care Clinic: A Qualitative Exploration of Mothers’ Experiences

ObjectiveThe American Academy of Pediatrics recommends screening parents for postpartum depression during pediatric primary care visits. Unfortunately, many women who screen positive do not obtain treatment. Providing mental health services for women in the same location as their children's primary care may facilitate treatment, but few such clinics exist. We designed a qualitative study to evaluate women's perceptions and experiences with receiving mental health services from psychiatrists embedded in a safety-net pediatric primary care clinic. MethodsSemistructured interviews were conducted with women receiving mental health care from embedded psychiatrists in a safety-net pediatric clinic. Data were analyzed using an inductive approach. ResultsTwenty women participated. Five major themes emerged: 1) barriers to maternal mental health care, including psychiatric symptoms impairing access, stigma, and fear of Child Protective Services; 2) benefits of embedded care, including convenience, low barrier to entry and trust; 3) motherhood as facilitator to care, with early motherhood described as a time of vulnerability to relapse; 4) focus on parenting, including appreciation for parenting skills and normalization of the mothering experience; 5) treatment modality preferences, including concerns about medications and a preference for psychotherapy. ConclusionsPostpartum women face many barriers to psychiatric care. Mental health care embedded within the pediatric setting lowers barriers to care during this critical period. These insights should inform further collaboration between adult psychiatrists and pediatric care providers.

Evidence-Based Physiatry: The Center for Disease Control Guideline on Pediatric Mild Traumatic Brain Injury and the Expanded Role of Physiatry.

A mild traumatic brain injury (mTBI) or concussion is the most commonly occurring type of traumatic brain injury in adults and children. Between 2005 and 2009, the United States Center for Disease Control estimated 2–3 million pediatric mTBI-related emergency department and primary care visits occurred. Although there are subtle variation in definitions of mTBI, a consensus has formed around defining this injury as an acute neurological disturbance manifesting with confusion and/or disorientation after a mechanical force to the head and meeting the following parameters: (1) length of loss of consciousness of less than 30 mins; (2) posttraumatic amnesia less than 24 hrs; and (3) a Glasgow Coma Scale of 13–15, 30 mins after injury or at time of presentation to medical care. Guidelines have emerged to direct treatment of specific groups that commonly sustain mTBI, such as the Consensus Statement on Concussion in Sport directed at student athletes, the Ontario Neurotrauma Foundation guidelines for those with mTBI and persistent symptoms, and Veteran’s Affairs/Department of Defense guidelines for mTBI in military service members and veterans. However, evidence based guidelines for pediatric mTBI in the United States were lacking until the most recently published Center for Disease Control Guideline on the Diagnosis and Management of mTBI among Children (https://www.cdc.gov/media/releases/2018/p0904-tbi-guidelines.html).1 GUIDELINE DEVELOPMENT AND METHODOLOGY The new Center for Disease Control guideline is a set of 19 recommendations based on a systematic review of the literature and expert consensus. Clinical questions were developed by the Pediatric Mild Traumatic Brain Injury Work Group, a panel of experts that included rehabilitation specialists and physiatrists. Guidelines were developed in three clinical areas diagnosis, prognosis, and management/treatment. A systematic review of pediatric mTBI and related topics from 1990 to 2015 was conducted using the American Academy of Neurology Guidelines. Each recommendation was based on evidence obtained in the systematic review as well as other relevant scientific information and expert opinion deemed significant by the work group. This work considered strength of evidence as well as additional factors, such as the risks and benefits of the recommendation, importance of the recommendation, feasibility, patient preference, and financial cost. WHAT ARE THE HIGHLIGHTS IN THE NEW GUIDELINES? These guidelines outline a series of practical and feasible recommendations for emergency department, primary care, and specialty providers focusing on readily available mTBI assessment tools, early identification of poor prognostic factors, and education and active rehabilitation as mainstays of treatment. A complete list of recommendations is located in the guideline supplement and patient and family resources are available online (https://www.cdc.gov/traumaticbraininjury/PediatricmTBIGuideline.html).1 In summary, the guideline recommends against the routine use of neuroimaging or serum based biomarkers for diagnosis of mTBI, except when intracranial injury is suspected. Age-appropriate symptom inventories and computer-based cognitive testing should not be used alone but in conjunction with clinical assessment. In the area of prognosis, the guidelines strongly support education of patients and families about the general course of recovery in pediatric mTBI (1–3 mos) and risk factors that are associated with prolonged recovery (premorbid conditions, injury, and noninjury-related factors). Close monitoring of individuals with multiple risk factors for prolonged symptoms and referral to specialty care within 4–6 weeks of injury if symptoms persist. The guidelines strongly support education of patients and families regarding warning signs in the acute period, the emergence of postconcussive symptoms, prevention of a second, overlapping head injury, and guidance for return to school and activity. Although rest was once the mainstay of concussion treatment, the guideline emphasizes a brief period (2–3 days) of reduced activity in the acute period followed by a gradual return to school and noncontact physical activity that does not exacerbate symptoms. The guideline supports the use of individualized return to school plans based on symptom severity and highlights the importance of a collaborative effort in return to school recommendations. Referral specialists and formal neuropsychological testing is recommended in students struggling with return to school or with persistent cognitive symptoms, respectively. Treatment recommendations focus on multidisciplinary care and dedicated symptom-based treatments for acute and chronic headache, sleep dysfunction, and vestibular and oculomotor symptoms are provided. WHY IS THIS RELEVANT TO PHYSIATRISTS? Physiatrists are uniquely positioned to care for children with mTBI because of their role in leading multidisciplinary rehabilitation teams and their specific clinical expertise in pediatric rehabilitation, sports medicine, and traumatic brain injury. The guideline recommends referral to specialty and rehabilitation care in the early subacute period meaning that the number of children with mTBI referred to specialists, such as physiatry, will likely increase. The guideline supports a paradigm shift in the treatment of mTBI from a rest and recover model to an active rehabilitation, symptom-based approach including physical activity, cognitive activity, and specialized rehabilitation (i.e., vestibular). Such an approach is an ideal forum to leverage physiatric skills.

Family Functioning in Pediatric Primary Care Patients.

The purpose of this study was to pilot a brief measure of family functioning (Family Assessment Device-General Functioning [FAD_GF]) with caregivers of children aged 2 to 18 years, seen for routine pediatric primary care visits. This study evaluated the psychometric properties of the FAD_GF in a pediatric primary care sample of 400 families. Confirmatory factor analysis was used to validate the FAD_GF using R, and WLSMV was used to estimate missing variables. The FAD_GF was found to be reliable with this sample, α = .90. The model fit was χ2(54) = 56.44, P = .38, with root mean square error of approximation = .01 and comparative fit index = .99. The 12 items were significantly predicted by family functioning, and family functioning explained more than 20% of the variance in the items, R2 > .25. Overall, 12.6% (n = 46) of families were identified as having clinically impaired family functioning. The FAD_GF provides clinicians the ability to make evidence-informed decisions regarding referrals to family therapists.

Improving education on child language and cognitive development in the primary care settings through a technology-based curriculum: A randomized controlled trial

Purpose: According to the National Survey of Early Childhood Health, parents of young children report unmet needs for anticipatory guidance on reading, vocabulary development, and social development during their pediatric primary care visits. Barriers to integration of these topics into the primary care setting include time and staff constraints, as well as lack of knowledge or resources among providers. Guidance on language and cognitive development is particularly important among low-SES parents as disparities in early language input lead to academic achievement gaps. The Well-Baby educational curriculum, a series of four interactive 10-minute video …

Teaching the Electronic Health Record to Find Pediatric Hypertension

Although blood pressure measurement has become a routine part of pediatric primary care visits, hypertension is easy to miss, as it requires the