Pediatric Special Interest Group Research Articles

The Current State of Pediatric Functional Neurological Disorder Treatment in the United States

BackgroundPediatric functional neurological disorders (FNDs) are common but grossly under-researched. This survey study aims to define the current landscape of pediatric FND treatment in the United States, identifying treatment programs, care team composition, treatment approaches, and aftercare management. MethodsThe Functional Neurological Disorder Society (FNDS) Pediatric Special Interest Group (SIG), a diverse set of clinician and caregiver stakeholders, collected information on available treatment programs in the United States via survey. Current programs were identified through the FNDS Pediatric SIG and FND Hope's provider registry. ResultsThirty-nine care team members from 24 health care centers yielded 31 unique FND treatment settings. Centers existed in 16 states, concentrated in the Midwest and Southern regions. Outpatient settings (62%) were more prevalent than inpatient. A psychologist (PhD/PsyD) was the most common clinician (52%) with dedicated time to treat FNDs. Most settings accepted ages six to 21 (55%) and treated all FND symptoms (77%). A spectrum of treatment approaches was endorsed with the most common being cognitive behavioral therapy (77%) and personalized approaches (58%). A biopsychosocial approach was evident, with most settings reporting active involvement with school (97%) and caregivers (94%). Most settings (74%) encouraged treatment re-engagement when needed with no strict time limits. All respondents provided aftercare recommendations or referrals. ConclusionsPediatric FND treatment is available across the United States, but there is high variability in care team membership, treatment approach, and aftercare management. Future research is necessary to develop effective and sustainable treatment to improve access for this population.

Quality indicators for care in juvenile idiopathic arthritis.

To develop a set of quality indicators (QIs) tailored to improve the care provided to children with juvenile idiopathic arthritis (JIA) in countries across the Asia-Pacific region. An adaptation of the Research and Development Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) was used. An initial set of 32 QIs was developed after a systematic search of the literature. These were presented to members of a Delphi panel composed of pediatric rheumatologists and other relevant stakeholders from the Asia Pacific League of Associations for Rheumatology Pediatric Special Interest Group (APLAR-Pediatric SIG). After each round, the mean scores for validity and reliability, level of disagreement, and median absolute deviation from the mean were calculated. The panelists were presented with 32 QIs in two rounds of voting, resulting in the formulation of a final set of 22 QIs for JIA. These QIs are categorized within six domains of care, including access to care, clinical assessment, medications and medication monitoring, screening for comorbidities, counseling, and self-efficacy and satisfaction with care. These QIs have been developed to evaluate and improve the quality of care provided to children with JIA, aiming to enhance health outcomes and ensure that healthcare services are tailored to the unique needs of this patient population.

Priorities and Future of the ISBER Standards Community of Practice and Pediatric Special Interest Group

Priorities and Future of the ISBER Standards Community of Practice and Pediatric Special Interest Group

Defining Core Competencies and a Call to Action: Dissecting and Embracing the Crucial and Multifaceted Social Work Role in Pediatric Palliative Care

While social workers are a well-established, part of the pediatric palliative care team, this manuscript presents the first published definition of the core competencies of a pediatric palliative care social worker. National experts in the field, guided by the pediatric special interest group of the Social Work Hospice and Palliative Network (SWHPN), worked together to articulate, and define core competencies. As the field of pediatric palliative care (PPC) continues to grow and develop, these competencies will help to better delineate the specific skill base of social workers in PPC. Such competencies may also create clearer role definition for emerging PPC social workers, guide training, clinical supervision, and mentorship in the field. They can also support improved interdisciplinary practice by assisting interprofessional colleagues in understanding and articulating the critical role of social workers as part of the PPC team. Additionally, such competencies may contribute to the growing development of role descriptions necessary for the hiring of social workers onto growing PPC teams, while also providing a framework for the creation and support of curricula centered on the subspeciality education and training of the next generation of PPC social workers.

Azithromycin Prescribing by Respiratory Pediatricians in Australia and New Zealand for Chronic Wet Cough: A Questionnaire-Based Survey.

Aims: To determine how respiratory pediatricians across Australia and New Zealand prescribe azithromycin for children with chronic wet cough, including recurrent protracted bacterial bronchitis, chronic suppurative lung disease (CSLD) and bronchiectasis.Methods: A prospective web-based questionnaire was emailed to members of the Pediatric Special Interest Group of the Thoracic Society of Australia and New Zealand (TSANZ) between April and May 2018. It comprised eight demographic and 15 clinically focused questions.Results: Of the 73 respiratory pediatricians listed across Australia and New Zealand, 29 (40%) responded and all prescribed azithromycin for chronic wet cough. Twelve (41%) indicated that they would consider prescribing a short-course (2–4 weeks) of azithromycin for children with a chronic wet cough. Although most respondents reported prescribing long-term (>4-weeks) azithromycin for either CSLD (n = 23, 79%) or bronchiectasis (n = 24, 83%), only nine (31%) respondents would commence treatment if in the previous 12-months these children experienced three non-hospitalized exacerbations and just 12 (41%) would do so if there had been two hospitalisations for severe exacerbations during the same period in accordance with the TSANZ national guidelines. A lower threshold for prescribing azithromycin was described for Indigenous children or if co-morbidities were present. None prescribed azithromycin for >24-months. Macrolide-resistance was reported in Streptococcus pneumoniae and Staphylococcus aureus.Conclusion: Although Australian and New Zealand respiratory pediatricians in this survey prescribed azithromycin for chronic wet cough most often in children with either CSLD or bronchiectasis, many did so outside the current national guidelines. Reasons for this need exploring.

An international survey of pediatric and neonatal clinicians' vascular access practice: PediSIG assessment of vascular access, education, and support (PAVES) catheter selection.

There is a wide variance in neonatal and pediatric vascular access workforce models, training, and competency assessments. Pain control during procedures is critical for children, yet it is not consistently used. Procedural support has shown improved patient outcomes, yet is not standardly used for every distressful procedure. Core standards are needed to ensure proper training and support for the pediatric and neonatal vascular access clinicians. Despite evidence to support best practice in neonatal and pediatric venipuncture delivery and procedural support, there are inconsistencies in practice. To inform future research, education, and workforce innovation, the Association for Vascular Access Pediatric Special Interest Group (PediSIG) developed and undertook a survey to describe the current vascular access practice for clinicians caring for neonatal and pediatric patients. Describe the current state of workforce models, training, and clinical practices surrounding pediatric and neonatal vascular access. Cross-sectional, electronic survey using convenience sampling. International clinicians who provide vascular access (peripheral intravenous catheter insertion, venipuncture for blood sampling) for neonatal and pediatric patients. An electronic survey was developed by the PediSIG. The survey covered workforce models, clinician training and competency, pain relief, procedural support, and device securement. The electronic survey was then distributed to the PediSIG membership and shared among several neonatal/pediatric email lists. Data were analyzed descriptively, with an exploration of association between clinical outcomes, workforce, and training. There were 242 responses from 5 countries showing a wide variance of practice. Workforce models showed many different team names and responsibilities along with a variance of personnel and staffing hours. Clinician training was described as 4 hours or less by 44% (n = 69) of respondents. Less than half of the responses (47%; n = 99) reported having a formal procedure to escalate a patient to an expert care and not having a set number of max attempts before escalation. Only two-thirds (n = 115) of respondents said they had a standardized protocol for pain control and procedural support, with only 13% (n = 23) and 15% (n = 27), respectively, self-reporting that they always followed the protocol. The respondents reported a wide variance in neonatal and pediatric vascular access procedures and the resources used to support this practice. Core standards need to be developed to help guide neonatal and pediatric clinicians and their institutions. The standards should encompass recommendations for workforce models, proper training, competency, insertion guidelines, pain control.

An International Survey of Pediatric and Neonatal Clinician’s Vascular Access Practice: PediSIG Assessment of Vascular Access, Education, and Support (PAVES)

Highlights Abstract Background: Despite evidence to support best practice in neonatal and pediatric venipuncture delivery and procedural support, there are inconsistencies in practice. To inform future research, education, and workforce innovation, the Association for Vascular Access Pediatric Special Interest Group (PediSIG) developed and undertook a survey to describe the current vascular access practice for clinicians caring for neonatal and pediatric patients. Objective: Describe the current state of workforce models, training, and clinical practices surrounding pediatric and neonatal vascular access. Design: Cross-sectional, electronic survey using convenience sampling. Settings: International clinicians who provide vascular access (peripheral intravenous catheter insertion, venipuncture for blood sampling) for neonatal and pediatric patients. Methods: An electronic survey was developed by the PediSIG. The survey covered workforce models, clinician training and competency, pain relief, procedural support, and device securement. The electronic survey was then distributed to the PediSIG membership and shared among several neonatal/pediatric email lists. Data were analyzed descriptively, with an exploration of association between clinical outcomes, workforce, and training. Results: There were 242 responses from 5 countries showing a wide variance of practice. Workforce models showed many different team names and responsibilities along with a variance of personnel and staffing hours. Clinician training was described as 4 hours or less by 44% (n = 69) of respondents. Less than half of the responses (47%; n = 99) reported having a formal procedure to escalate a patient to an expert care and not having a set number of max attempts before escalation. Only two-thirds (n = 115) of respondents said they had a standardized protocol for pain control and procedural support, with only 13% (n = 23) and 15% (n = 27), respectively, self-reporting that they always followed the protocol. Conclusions: The respondents reported a wide variance in neonatal and pediatric vascular access procedures and the resources used to support this practice. Core standards need to be developed to help guide neonatal and pediatric clinicians and their institutions. The standards should encompass recommendations for workforce models, proper training, competency, insertion guidelines, pain control, procedural support, and access to vascular access specialists to provide the best care for every neonate and child.

Current needs in pediatric pharmacoepidemiology.

We report on a needs assessment conducted by the International Society of Pharmacoepidemiology (ISPE) Pediatric Special Interest Group (SIG) to identify critical needs in pediatric pharmacoepidemiology and directions for future activities. A mixed methods survey using a structured interview was conducted in the SIG and ISPE membership to elicit information about current activities in pediatric pharmacoepidemiology and identify critical methodologic issues. The interviews were conducted in two phases over 2013 and 2014, beginning with interviews of SIG members and expanding to the wider ISPE membership. Members of the SIG conducted the interviews and summarized the responses. Twenty-nine ISPE members participated in the needs assessment The respondents reported working with a total of 59 distinct databases, with only eight databases used by more than one respondent. Seventeen respondents (57%) reported issues of limited sample sizes, noting that the problem intensifies when studying age sub-groups or specific genetic populations. Missing data elements were a problem in three main areas: lack of detailed medication information, inability to link to parental data, and lack of detailed information about age. Respondents reported the need for data elements not typically required in studies of adults, such as birthweight and current height and weight, as well as school performance and mental health status. Our needs assessment describes a preliminary picture of the emerging sub-specialty of pediatric pharmacoepidemiology encompassing a range of age sub-groups, disease areas, and medical specialties. The assessment also documents a body of methodologic challenges unique to pharmacoepidemiologic research in children. Copyright © 2016 John Wiley & Sons, Ltd.

Paediatric reference intervals

Worldwide there appear to be two main approaches to addressing the gap in paediatric biochemistry reference intervals: (1) large scale, government-funded reference interval studies based on recruiting healthy children, and (2) ‘harmonisation' to achieve common reference intervals (CRI). The first are national paediatric-focused reference interval studies, including CALIPER study (Canadian Laboratory Initiative on Pediatric Reference Intervals,), KiGGS (The German Health Interview and Examination Survey for Children and Adolescents), NORICHILD (Scandinavian Initiative for the Establishment of Pediatric Reference Intervals) and CHILDx (Children's Health Improvement through Laboratory Diagnostics) by ARUP Laboratories and the University of Utah, NIH. The second approach is a national or regional group undertaking the task of defining common reference intervals using a multicentre study design. The RIs are determined via collaboration of laboratories from different regions that use analytical methods traceable to a reference method. UK Harmony, ARQAG (Auckland Regional Quality Assurance Group) and SIQAG (South Island Quality Assurance Group) have taken this approach for adult and paediatric biochemistry RIs. This is also the approach recommended by the Australian Association of Clinical Biochemists (AACB) Paediatric Special Interest Group. Unfortunately there is no perfect solution; both approaches have obstacles that hinder the implementation by laboratories. Recent data from CALIPER suggest transference of RIs to all major instrument platforms may be possible based on their population studies

An evaluation of a paediatric radiation oncology teaching programme incorporating a SCORPIO teaching model

Many radiation oncology registrars have no exposure to paediatrics during their training. To address this, the Paediatric Special Interest Group of the Royal Australian and New Zealand College of Radiologists has convened a biennial teaching course since 1997. The 2009 course incorporated the use of a Structured, Clinical, Objective-Referenced, Problem-orientated, Integrated and Organized (SCORPIO) teaching model for small group tutorials. This study evaluates whether the paediatric radiation oncology curriculum can be adapted to the SCORPIO teaching model and to evaluate the revised course from the registrars' perspective. Teaching and learning resources included a pre-course reading list, a lecture series programme and a SCORPIO workshop. Three evaluation instruments were developed: an overall Course Evaluation Survey for all participants, a SCORPIO Workshop Survey for registrars and a Teacher's SCORPIO Workshop Survey. Forty-five radiation oncology registrars, 14 radiation therapists and five paediatric oncology registrars attended. Seventy-three per cent (47/64) of all participants completed the Course Evaluation Survey and 95% (38/40) of registrars completed the SCORPIO Workshop Survey. All teachers completed the Teacher's SCORPIO Survey (10/10). The overall educational experience was rated as good or excellent by 93% (43/47) of respondents. Ratings of satisfaction with lecture sessions were predominantly good or excellent. Registrars gave the SCORPIO workshop high ratings on each of 10 aspects of quality, with 82% allocating an excellent rating overall for the SCORPIO activity. Both registrars and teachers recommended more time for the SCORPIO stations. The 2009 course met the educational needs of the radiation oncology registrars and the SCORPIO workshop was a highly valued educational component.

Hospice and Non-Hospice Models of Palliative Care Delivery in Long-Term Care (327)

medicine provider. Some of the most difficult of these cases are those at occur at the extremes of childhood. This session will discuss medical decision-making in four cases, including an unborn with life-limiting pathology, a terminally ill neonate in the NICU, an adolescent with advanced cancer and no parental support, and a previously independent 19-year-old who is suddenly ventilator-dependent with a devastating neurologic condition. These illustrative cases will demonstrate surrogate decision-making for the not-yet-competent individual, principles of assent versus consent, continuation of pregnancy against medical advice, adolescent parents as surrogates, loss of recently acquired adult maturation, withdrawal of medical therapies in children, and other unique aspects of medical decision-making with and for vulnerable child patients. Components of good pediatric palliative decision-making will become evident to the participant via interaction with the presenters. Tools to facilitate good pediatric medical decisionmaking will be presented. Application of principles of pediatric palliative care learned in four geographic, cultural, academic, and clinically diverse care settings will be shared by multidisciplinary, multispecialty faculty. AAHPM Pediatric Special Interest Group members suggested this presentation as most likely to be helpful to the Annual Assembly attendee as well as the pediatric palliative care provider. Exposure to these cases of pediatric medical decision-making at the extremes of life will build skills and enhance the participants comfort in the practice of palliative care.

Cervical Spine Clearance in the Nonalert, Noncommunicative, or Unreliable Pediatric Blunt Trauma Patient

Currently, there is no nationally recognized evidence-based guideline or protocol for cervical spine clearance in nonalert, noncommunicative, or unreliable pediatric blunt trauma patients. This descriptive survey study sought to identify current practices and elicit expert opinion data regarding pediatric cervical spine clearance in a specialized population of children in trauma centers in the United States. A 93-item electronic Pediatric Cervical Spine Clearance Survey was sent to 309 members of the Pediatric Special Interest Group of the National Society of Trauma Nurses. The main areas of interest in the survey included trauma verification, annual volume of pediatric trauma cases, and sequence and time frames of diagnostic testing for cervical spine clearance by age group. Additional areas of interest were perceived supports and barriers to meeting target time frames for diagnostic testing and outcomes to evaluate the impact of a cervical spine clearance guideline for pediatric blunt trauma. The results from 44 respondents demonstrate that trauma centers are using a variety of diagnostic testing sequences and time frames when clearing children for suspected cervical spine injury.

A new era, new editor plus ISI listing

On my second last day as editor I received the important news that Thomson ISI had listed the Australian Occupational Therapy Journal for inclusion on their data base. This means the journal should get an Impact Factor in 2009, which will be released in mid-2010. The ISI maintains a large collection of bibliographic and indexing data for scientific literature and measures the impact and influence of published research. The AOTJ Board and Wiley–Blackwell have been working towards this listing for a number of years. This listing means that the AOTJ will become more attractive for authors whose employers require an Impact Factor for ranking their publications, this particularly relates to universities. A journal's Impact Factor is improved by increasing the number of citations; this is also affected by the visibility of the journal, we are fortunate to have online access to enhance this. We first applied for listing in 2003, but were unsuccessful, so it is a perfect way for me to hand over to Elspeth Froude, our new editor, after this second application has been successful. We were fortunate to have several applicants for this position, thus necessitating a thorough appraisal and interview process by a panel selected by OT Australia. Elspeth graduated in 1987 from Cumberland College of Health Sciences, NSW with a Bachelor of Applied Science in Occupational Therapy. She then went on to work in a number of paediatric settings in Tasmania and Victoria. Elspeth joined the School of Occupational Therapy, LaTrobe University as a lecturer in 1991. She has taught and supervised honours and postgraduate students in the field of paediatrics. Elspeth completed a Graduate Diploma in Neuroscience and then enrolled in a PhD researching in the area of children's handwriting. She has always been a keen supporter of the AOTJ through publishing and extensive reviewing. She has also been involved with OT AUSTRALIA through the paediatric special interest group and has been an Accredited OT since the program's inception. I wish Elspeth every success in her new role and take this opportunity to thank the AOTJ Editorial Board, the Editorial Advisory Board, and most importantly all at Wiley–Blackwell.

Health Care Epidemiology Perspective on the October 2006 Recommendations of the Subcommittee on Diagnosis and Management of Bronchiolitis

The recent evidence-based clinical practice guideline “Diagnosis and Management of Bronchiolitis,”1 developed by the American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis and published in the October 2006 issue of Pediatrics , is a welcome comprehensive and practical tool for assisting clinicians in managing bronchiolitis in young children. In this commentary we present the views of the Pediatric Special Interest Group (PSIG) of the Society for Healthcare Epidemiology of America on several aspects of the guideline related to the management of children who are hospitalized with bronchiolitis. Established in October 2006, the PSIG comprises pediatric infectious-disease physicians and infection-control professionals who have expertise in pediatric health care epidemiology and infection control. The PSIG requests that the American Academy of Pediatrics subcommittee clarify and reconsider its recommendations regarding the target population for the guideline, viral diagnostic testing, and interventions for preventing transmission of respiratory syncytial virus (RSV) and other viral agents that are associated with bronchiolitis, especially in inpatient settings. Although it was stated that the guideline applies to the management of bronchiolitis in healthy children, it is important to note that the absence of an identified underlying condition does not necessarily imply that hospitalized children with bronchiolitis are otherwise healthy. Severe bronchiolitis may be an … Address correspondence to Jo-Ann S. Harris, MD, Division of Infectious Disease, Pediatric Special Interest Group of the Society for Healthcare Epidemiology of America, Department of Pediatrics, MS 4004, 3901 Rainbow Blvd, Kansas City, KS 66160. E-mail: jharris7{at}kumc.edu

Paediatric radiotherapy in Australia and New Zealand: an anachronism in 2003?

This report reviews the activities of the Paediatric Special Interest Group of the Royal Australian and New Zealand College of Radiologists in terms of its involvement with the Australian and New Zealand Children's Cancer Study Group and its research and educational activities. Examples of when and how radiotherapy is currently used in the management of paediatric malignancies are provided. Some thoughts for the future of both paediatric radiotherapy and our subspecialty are also presented.

Physical Therapy in Preschool Classrooms: Successful Integration of Therapy into Classroom Routines

This exploratory investigation identifies factors that contribute to success of physical therapy services delivered in the context of the daily routines in preschool classroom settings. Ten pediatric physical therapists from rural and urban communities across North Carolina served as informants during telephone interviews. Qualitative analysis of the data led to the identification of six major themes: interactions among classroom personnel, impact of the classroom environment, individual characteristics of the child, logistical considerations, administrative policies and practices, and service delivery options. All 10 informants shared the perception that the cooperation and commitment of the teacher was essential for successful incorporation of therapy activities in classroom routines. Furthermore, the informants agreed that multiple models of service delivery were necessary to meet the individual needs of children. These results lead the authors to question the wisdom of promoting any one service delivery model as "best practice" and suggest guidelines for successful integration of physical therapy in the preschool classroom.

Perceptual-Motor Contributions to Static and Dynamic Balance Control in Children

Pediatric Physical Therapy is the first and only peer-reviewed journal devoted to this discipline. The Journal provides a forum for scientific and professional exchange among researchers and practitioners throughout the world that represent subspecialties of the discipline, including early intervention, neonatology, pediatric sports and fitness, school physical therapy, acute care for seriously ill children, and the prevention of primary and secondary conditions that lead to disabling conditions. Official Journal of APTA Pediatrics, an Academy of the American Physical Therapy Association, The Dutch Association for Pediatric Physical Therapy, Physiotherapia Paediatrica, The New Zealand Society of Physiotherapists Pediatric Special Interest Group, and The Pediatric Division of the Canadian Physiotherapy Association.

Pediatric Balance Scale: A Modified Version of the Berg Balance Scale for the School-Age Child with Mild to Moderate Motor Impairment

The Pediatric Balance Scale (PBS), a modification of Berg's Balance Scale, was developed as a balance measure for school-age children with mild to moderate motor impairments. The purpose of this study was to determine the test-retest and interrater reliability of the PBS. To determine test-retest reliability, 20 children (aged five to 15 years) with known balance impairments were tested by one examiner on the PBS. Ten pediatric physical therapists independently scored 10 randomly selected videotaped test sessions. There was no significant difference in total test scores [intraclass correlation coefficient (ICC) model 3,1 = 0.998] or individual items (Kappa Coefficients, k = 0.87 to 1.0; Spearman Rank Correlation Coefficients, r = 0.89 to 1.0) measured by one therapist on two occasions. No significant difference among ratings by different physical therapists was found on the PBS for total test score (ICC 3,1 = 0.997). The PBS has been demonstrated to have good test-retest and interrater reliability when used with school-age children with mild to moderate motor impairments.

Tone Abnormalities Are Associated with Maternal Cigarette Smoking During Pregnancy in In Utero Cocaine-Exposed Infants

Pediatric Physical Therapy is the first and only peer-reviewed journal devoted to this discipline. The Journal provides a forum for scientific and professional exchange among researchers and practitioners throughout the world that represent subspecialties of the discipline, including early intervention, neonatology, pediatric sports and fitness, school physical therapy, acute care for seriously ill children, and the prevention of primary and secondary conditions that lead to disabling conditions. Official Journal of APTA Pediatrics, an Academy of the American Physical Therapy Association, The Dutch Association for Pediatric Physical Therapy, Physiotherapia Paediatrica, The New Zealand Society of Physiotherapists Pediatric Special Interest Group, and The Pediatric Division of the Canadian Physiotherapy Association.

Outcome After Ischemic Stroke in Childhood

Pediatric Physical Therapy is the first and only peer-reviewed journal devoted to this discipline. The Journal provides a forum for scientific and professional exchange among researchers and practitioners throughout the world that represent subspecialties of the discipline, including early intervention, neonatology, pediatric sports and fitness, school physical therapy, acute care for seriously ill children, and the prevention of primary and secondary conditions that lead to disabling conditions. Official Journal of APTA Pediatrics, an Academy of the American Physical Therapy Association, The Dutch Association for Pediatric Physical Therapy, Physiotherapia Paediatrica, The New Zealand Society of Physiotherapists Pediatric Special Interest Group, and The Pediatric Division of the Canadian Physiotherapy Association.