Well-baby Visits Research Articles

15 Predictive validity of two developmental screening tools at the 18-month visit and neurodevelopmental consultation at an average age of 8 years

Abstract Background The Canadian Paediatric Society (CPS) recommends an enhanced 18-month well-baby visit incorporating a developmental screening tool to stimulate discussion with parents, and notes that a widely used tool is the Nipissing District Developmental Screen (NDDS). For early detection of autism spectrum disorder, the CPS notes that a commonly used screening tool is the Infant Toddler Checklist (ITC). Objectives To examine the predictive validity of the ITC and NDDS at the 18-month visit using later neurodevelopmental consultation as the criterion measure; and examine whether positive developmental screening was associated with health care utilization (HCU). Design/Methods Using a prospective design, parents completed the ITC and the NDDS at the 18-month visit in primary care practices. Seven types of HCU were collected from health administrative databases, via linkage using the child’s health insurance number, including: neurodevelopmental consultation, special paediatric consultation, scheduled primary care visit billings, unscheduled primary care or minor visit billings, other non-primary care visit billings, hospitalizations, and emergency department visits. Covariates included child and family characteristics. We calculated screening test properties (using neurodevelopmental consultation as the criterion) and used multivariable negative binomial regression to estimate rate ratios (RR) for each of the 7 types of HCU. Results For both the ITC (n=1460) and NDDS (n=802) cohorts, mean age at screening was 18 months and mean age at follow up was 8 years. Of the ITC cohort, 11% were screen positive, 2.6% had a neurodevelopmental consultation. A positive ITC had 40% sensitivity (95% CI 24%-57%), 90% specificity (95% CI 88%-91%), 10% false positive rate (95% CI 9%-12%). A positive ITC was associated with 6 of 7 types of HCU, including neurodevelopmental consultation (RR=2.78, 95% CI 1.37-5.67). Of the NDDS cohort, 36% were screen positive, 2.5% had a neurodevelopmental consultation. A positive NDDS had a sensitivity of 50% (95% CI 27%-73%), specificity of 65% (95% CI 61%-68%), false positive rate of 35% (95% CI 31%-40%). A positive NDDS was associated with only 1 of 7 types of HCU: unscheduled primary care or minor visit billings 1.24 (95% CI 1.01, 1.53, p=0.04). Conclusion The predictive validity of the ITC was stronger than the NDDS due to high specificity and low false positive rates. The low sensitivity of the ITC is similar to other screening tools used at 18 months, highlighting the importance of ongoing developmental surveillance. The false positive rate of the NDDS is unacceptably high for a screening tool.

Healthcare Needs of Provincially Uninsured Migrant Families with Newborn Infants: A Qualitative Descriptive Study

Aim: This project aimed to explore the healthcare needs of provincially uninsured migrant families with newborns receiving care at a nurse practitioner (NP)-led clinic in Montreal, Quebec, Canada. The findings of this study are intended to guide primary healthcare professionals and administrators in understanding and addressing the specific needs of these families, enabling them to tailor their services appropriately. Background: Newborns of provincially uninsured migrant families in Quebec can experience delays in accessing provincial health insurance, preventing timely access to primary care services. In Montreal, a publicly funded NP-led clinic was created to enable newborns without provincial health insurance to access recommended well-baby visits in the first 4 months of life. There exists a paucity of literature on the specific healthcare needs of uninsured families with newborn infants, making tailored care difficult. Methods: A qualitative descriptive study was undertaken. Semi-structured interviews were conducted with the parents of provincially uninsured Quebec-born newborns being treated at a NP-led clinic. Ten interviews were conducted with a total of 13 participants between October 2023 and January 2024. Socio-demographic data were collected. Content analysis was undertaken to identify important themes. Findings: Two overarching themes were identified including (a) healthcare service needs related to newborn care, maternal postpartum care, and family healthcare; (b) healthcare access needs related to navigating the local healthcare system, transportation, and provincial health insurance. Conclusion: Provincially uninsured migrant families with newborns in Quebec face barriers to accessing healthcare. This study provides information on the healthcare services and access-related needs of these families and provides recommendations including how NP-led clinics can facilitate access to the healthcare services needed by these families.

Linking Inter-professional Newborn and Contraception Care (LINCC) trial: Protocol for a stepped wedge cluster randomized trial to link postpartum contraception care with routine Well-Baby Visits

BackgroundPregnancies conceived within 18 months of a prior delivery (termed short inter-pregnancy interval [IPI]) place mothers and infants at high risk for poor health outcomes. Despite this, nearly one third of U.S. women experience a short IPI. ObjectiveTo address the gap in the current model of postpartum (PP) contraception care by developing and implementing a novel approach to link (co-schedule) PP contraception care with newborn well-baby care to improve access to timely PP contraception. MethodsThe LINCC Trial will take place in seven clinical locations across five community health centers within the U.S. PP patients (planned n = 3150) who are attending a Well-Baby Visit between 0 and 6 months will be enrolled. The LINCC Trial aims to leverage the Electronic Health Record to prompt providers to ask PP patients attending a Well-Baby Visit about their PP contraception needs and facilitate co-scheduling of PP contraception care with routine newborn care visits. The study includes a cluster randomized, cross-sectional stepped wedge design to roll out the intervention across the seven sites. The outcomes of the study include receipt of most or moderately effective methods of contraception by two and six months PP; and rate of short IPI pregnancies. Implementation outcomes will be assessed at baseline and 6 months after site enters intervention period. ConclusionsThe LINCC Trial seeks to evaluate the effectiveness and feasibility of a linked care model in comparison to usual care.

A Novel “Well Baby Clinic Service” Mobile Application: User Requirement Assessment and App Development

Abstract Background Utilization of under 5 year old child health care services in Egypt is considered low, the highest proportion of well-baby visits is mainly for immunization in the first two years of age. Parents may rely upon the internet and mobile applications (apps) for support in handling day to day parenting situations. mHealth (Mobile Health) interventions have the potential to be a useful and low-cost way to disseminate information about proper nutrition, can be used to monitor children’s growth using the official charts of World Health Organization, also can help in accessing vaccine-related information and recommended immunization schedules. Objectives To assess needs and requirements for a new comprehensive well-baby clinic mobile app. Also, to develop a mobile app prototype covering all well baby clinic service components which are: Physical growth, Developmental milestones, Immunizations, Nutrition and Safety & emergency measures. Methods This work is done over two phases. In Exploratory phase, we assessed the need for the new app by performing bibliographic review of previous mHealth interventions in child-care field, market search of the available related apps and an online survey to assess the need and expectations of the new app. In preparatory phase, we developed the novel well baby clinic app that constituted all well baby clinic services for children’s health monitoring which are: Physical growth, Developmental milestones, Immunizations, Nutrition and Safety & emergency measures relying on evidence-based information and honoring data safety. Results 13 Arabic apps were downloaded and extracted for review. All of these apps (100%∼13/13) were in the form of written articles that offered no interactive features for parents. All offered general health education not tailored according to the status of the child. None of them were developed by a university or a certified health organization. Almost all of them (92.3%∼12/13) were commercial apps as they included ads. Our online survey on 374 mothers showed that almost all of them (97.5%) reported the need of a new app to regularly follow their children’s health. They also reported the need of nutrition, developmental milestones and physical growth services in the app. We developed “Sehhat Tefly” app constituting caregiver information, child sociodemographic characteristics and the 6 previously mentioned services, it also included health education videos and a conclusive report section. Conclusion After vigorous review of literature, market search and user requirement assessment, apps reviewed didn’t provide any comprehensive approach to well-baby clinic services on a scientific basis. Upon market requirement for child m-health, we developed “Sehhat Tefly” app. The full potential of this app is yet to be defined. Further studies are needed to assess accessibility and usability of the app and to explore difficulties and barriers faced by users in different services.

The design and implementation of a multi-center, pragmatic, individual-level randomized controlled trial to evaluate Baby2Home, an mHealth intervention to support new parents

BackgroundBecoming a parent is a transformative experience requiring multiple transitions, including the need to navigate several components of health care, manage any mental health issues, and develop and sustain an approach to infant feeding. Baby2Home (B2H) is a digital intervention built on the collaborative care model (CCM) designed to support families during these transitions to parenthood. ObjectivesWe aim to investigate the effects of B2H on preventive healthcare utilization for the family unit and patient-reported outcomes (PROs) trajectories with a focus on mental health. We also aim to evaluate heterogeneity in treatment effects across social determinants of health including self-reported race and ethnicity and household income. We hypothesize that B2H will lead to optimized healthcare utilization, improved PROs trajectories, and reduced racial, ethnic, and income-based disparities in these outcomes as compared to usual care. MethodsB2H is a multi-center, pragmatic, individual-level randomized controlled trial. We will enroll 640 families who will be randomized to: [1] B2H + usual care, or [2] usual care alone. Preventive healthcare utilization is self-reported and confirmed from medical records and includes attendance at the postpartum visit, contraception use, depression screening, vaccine uptake, well-baby visit attendance, and breastfeeding at 6 months. PROs trajectories will be analyzed after collection at 1 month, 2 months, 4 months, 6 months and 12 months. PROs include assessments of stress, depression, anxiety, self-efficacy and relationship health. ImplicationsIf B2H proves effective, it would provide a scalable digital intervention to improve care for families throughout the transition to new parenthood.

A modified Michaelis-Menten equation estimates growth from birth to 3 years in healthy babies in the USA

BackgroundStandard pediatric growth curves cannot be used to impute missing height or weight measurements in individual children. The Michaelis–Menten equation, used for characterizing substrate-enzyme saturation curves, has been shown to model growth in many organisms including nonhuman vertebrates. We investigated whether this equation could be used to interpolate missing growth data in children in the first three years of life and compared this interpolation to several common interpolation methods and pediatric growth models.MethodsWe developed a modified Michaelis–Menten equation and compared expected to actual growth, first in a local birth cohort (N = 97) then in a large, outpatient, pediatric sample (N = 14,695).ResultsThe modified Michaelis–Menten equation showed excellent fit for both infant weight (median RMSE: boys: 0.22 kg [IQR:0.19; 90% < 0.43]; girls: 0.20 kg [IQR:0.17; 90% < 0.39]) and height (median RMSE: boys: 0.93 cm [IQR:0.53; 90% < 1.0]; girls: 0.91 cm [IQR:0.50;90% < 1.0]). Growth data were modeled accurately with as few as four values from routine well-baby visits in year 1 and seven values in years 1–3; birth weight or length was essential for best fit. Interpolation with this equation had comparable (for weight) or lower (for height) mean RMSE compared to the best performing alternative models.ConclusionsA modified Michaelis–Menten equation accurately describes growth in healthy babies aged 0–36 months, allowing interpolation of missing weight and height values in individual longitudinal measurement series. The growth pattern in healthy babies in resource-rich environments mirrors an enzymatic saturation curve.

"An Act of Complete Care": Provider Perspectives on Linking Maternal Contraceptive Care With Well-Baby Visits in Community Health Centers.

Short inter-pregnancy interval (IPI) is associated with adverse health outcomes for women and infants, and low-income women experience disproportionate rates of short IPI. An essential solution is providing postpartum (PP) women with timely contraceptive care. However, patient-centered approaches for facilitating care access are needed. To explore Community Health Center (CHC) staff and provider perspectives on the implementation of a clinical trial offering co-scheduled well-infant/maternal contraceptive care for women with infants 0 to 6 months at the Well-Baby Visit (WBV). Eighteen participants (providers, staff, and administrators) representing 7 diverse CHC sites in 2 U.S. states completed semi-structured telephone interviews. Audio-recordings were transcribed and analyzed using hybrid thematic analysis. Offering co-scheduled visits was perceived as beneficial for facilitating timely PP contraception, convenient care access, and encouraging family planning considerations during the PP period. However, provider and staff discomfort with initiating family planning and contraceptive care conversations at the WBV emerged as a salient barrier. Paired approaches to well-infant/maternal contraceptive care may promote increased access to timely contraception for PP women, possibly reducing unintended short IPI. Comprehensive training, ongoing support, and patient-centered implementation strategies tailored to context and developed with care team input are needed to ensure competency and comfortability with facilitating contraceptive care conversations at the WBV.

Age at initial diagnosis of autism spectrum disorders: a retrospective comparison of screening techniques between the southern and northwestern regions of Switzerland.

Early diagnosis of autism spectrum disorders (ASD) offers the possibility of early intervention and, in turn, gains in adaptive behaviour, language and cognition. The aim of the present study was to analyse whether age at diagnosis of autism spectrum disorders decreased in two regions of Switzerland from 2006 to 2016 following the implementation of different screening and referral techniques. In southern Switzerland, systematic paediatric screening using the Modified Checklist for Autism (M-CHAT) in toddlers was implemented in 2013, whereas in northwestern Switzerland, periodic trainings were used to increase paediatrician awareness of ASD. We investigated which method was associated with a younger average age at diagnosis. We conducted a retrospective, two-centre study searching clinical records of children and adolescents (aged 0-16 years) diagnosed with ASD in two neuropaediatric departments at Swiss hospitals between January 2006 and December 2016. All patients were diagnosed via a standardised evaluation based on two approved diagnostic tests: the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and the Autism Diagnostic Interview-Revised (ADI-R). In southern Switzerland, training and subsequent widespread use of the M-CHAT among paediatricians appeared to contribute to a significantly younger age at diagnosis. Age at diagnosis did not significantly decrease during the same period in northwestern Switzerland. Our results point to the possibility of successfully reducing age at diagnosis in specific geographic areas through the implementation of screening questionnaires, such as the M-CHAT, at year 2 well-baby visits.

New Mothers With Postpartum Depression: A Qualitative Exploration of Healthcare Decision-Making.

Postpartum depression (PPD) is a significant health issue for many new mothers in the weeks and months following a child's birth. Quantitative data suggest that a mother's PPD negatively impacts healthcare decision-making for the child via routine well-baby visits and pediatric care. However, little is known from a qualitative perspective about the factors that challenge or facilitate these healthcare decisions. The purpose of this descriptive qualitative study was to understand the perceptions of new mothers about factors contributing to their healthcare decision-making, for themselves and for their children, while living with PPD. The researchers used purposive sampling to recruit eight women from clinics, community organizations, and social media support groups who met the study's inclusion criteria. Individual semi-structured interviews were carried out with eight participants about their PPD experiences, motherhood, and healthcare decision-making influences. Transcribed interviews and initial themes were shared with participants to verify researcher interpretations and aid in the analysis process. The researchers analyzed interview data using thematic analysis to cultivate an understanding of the phenomenon by identifying and interpreting patterns in the data. Three primary themes were drawn from the data analysis: (1) Importance of Clinician Trust and Support; (2) Balancing the Health of the Mother and Child; and (3) Other Support Structures That Facilitate Healthcare Decision-Making for the Mother and Baby Dyad. Participant experiences underscored the need for cohesive approaches by clinical providers of pre- and postnatal care. Group model approaches to postnatal care appear to mitigate or reduce the impact of PPD.

Teaching antenatal hand expression: a feasibility study in an inner urban U.S. hospital

BackgroundMany women have low confidence in breastfeeding and have concerns regarding low milk volume or discomfort with breastfeeding. Antenatal hand expression may be an opportunity to help women feel more comfortable with breastfeeding and help promote exclusive breastfeeding. A study at a hospital in Philadelphia, Pennsylvania, U.S. assessed the feasibility of teaching antenatal hand expression at 39 weeks among socioeconomically disadvantaged populations, overall participant satisfaction and adoption of hand expression and breastfeeding.MethodsFrom March 2020 to June 2021, women recruited at 34–39 weeks were taught to hand express, collect, and store colostrum. Starting from 39 weeks, participants were asked to practice hand expression 1–3 times / day until delivery, log their experiences, and store colostrum expressed. Women were contacted to encourage continued hand expression and answer any questions. Postpartum, a survey assessed satisfaction with hand expression and issues encountered. The survey also inquired about breastfeeding plans and barriers, and whether women were exclusively breastfeeding (defined as infants who received only breastmilk from the time of birth). Chart review of postpartum or well-baby visit notes determined whether women continued breastfeeding.ResultsOf the 29 participants, 72% (21/29) reported hand expressing at home, and no women reported contractions when hand expressing. Participants rated mean satisfaction of 8.1/10 (SD = 1.62) with antenatal hand expression, mean satisfaction of 9.4/10 (SD = 0.90) toward hand expression education, mean likelihood of 9.4/10 (SD = 1.24) recommending hand expression to others, and a mean score of 8.1/10 (SD = 1.69) on how helpful hand expression was in breastfeeding initiation. 90% (26/29) of women initiated breastfeeding after birth and 72% (21/29) exclusively breastfed on discharge, but only 11/29 (38%) continued exclusively breastfeeding when re-assessed 4–6 weeks postpartum. Barriers included maternal discomfort, low milk supply, and maternal or infant illness.ConclusionsThis study suggests that women in an urban setting would be willing to practice antenatal hand expression. A larger and adequately powered study could be feasible to determine associations between antenatal hand expression and breastfeeding rates and confidence.

A novel wide scale well-baby clinic mobile application: an Egyptian pilot study

BackgroundUtilization of under 5-year-old child healthcare services in Egypt is considered low, the highest proportion of well-baby visits is mainly for immunization in the first 2 years of age. Mobile health (mHealth) interventions have the potential to be a useful and low-cost way to disseminate information about proper nutrition, can be used to monitor children’s growth using the official charts of World Health Organization, can also help in accessing vaccine-related information and schedules.ObjectivesTo assess needs and requirements for a new comprehensive well-baby clinic mobile application (app) covering well-baby clinic service components. Thereafter, to develop the app prototype and validate it.MethodsThis study was conducted in four phases: User requirements, development, validation and usage. In user requirement phase, the need for the new app was assessed by performing literature review, market app research and an online survey. In development phase, we developed the novel well-baby clinic app that constituted all well-baby clinic services for children’s health monitoring relying on evidence-based information and honoring data safety. In validation phase, after a series of testing, the app was validated using Mobile app rating scale (MARS) by public health and pediatrics consultants to assess its quality. Finally, the app was launched and made available to the public on Android platform.ResultsSehhat Tefly app was developed based on the demands and requirements of mothers of under 5-year-old children. The app constituted caregiver, child information and seven service elements: physical growth, developmental milestones, immunizations, nutrition, teething, safety & emergency measures and report. The app quality mean was rated 3.7 out of 5 by the panel of experts. The app was downloaded 1445 times in a 4 month period.ConclusionsSehhat Tefly app can meet the need for a free, easy and accessible tool for caregivers to track the progress of children’s development and wellbeing. It can also provide advice for referral to physician consultation in case of deviation from normal measures.

I bilanci di salute trent'anni dopo

The well-baby visit represented the transition from a “demand” medicine to a “supplied” medicine to identify early risk factors and problems in the psycho-physical development of the child. Therefore, a significant number of screenings were introduced at the filter ages and prevention and health education interventions to families became part of the health balance. This work aims to evaluate the efficacy of this instrument, which was introduced about 30 years ago. Despite the fact that the health balance has become a significant part of the activity of the primary care paediatricians, and in face of the quantity of economic resources invested by the NHS, even in the traditionally virtuous Italian regions, they have produced results that are not entirely satisfactory. In fact, the coverage of the population served was not satisfactory and decreased with increasing age. However, as it is well known, the missing ones are precisely the ones who need most attention. The least encouraging data was the collection and analysis of data, which was not uniform in the various regions, sometimes completely absent, betraying one of the priority purposes of the health-childhood project, i.e. community diagnostics. The awareness that only a commitment to real collaboration between operators in the area and public epidemiologists will be able to transform the health balance from a precious individual clinical tool for managing the child into a real tool to improve the health of the community, as virtuous regions have tried to demonstrate.

Evaluation of a Pilot Protocol for Detecting Infant Hyperopia.

Highly hyperopic children are at greater risk for developing conditions such as strabismus, amblyopia, and early literacy and reading problems. High hyperopia is a common finding in infants in a pediatric medical practice, and early detection can be done effectively in that setting with tropicamide autorefraction. This study aimed to evaluate the effectiveness of a pilot screening program to detect high hyperopia in 2-month-old infants in a pediatric medical practice in Columbus, Ohio. Cycloplegic refractive error (1% tropicamide) was measured by retinoscopy and autorefraction with the Welch Allyn SureSight (Welch Allyn/Hillrom, Skaneateles Falls, NY) in 473 infants (55.4% female) who were undergoing their 2-month well-baby visit at their pediatrician's medical practice. Cycloplegic retinoscopy (1% cyclopentolate) was repeated at a subsequent visit in 35 infants with ≥+5.00 D hyperopia in the most hyperopic meridian during the screening. Twenty-eight infants (5.9%) had high hyperopia (spherical equivalent, ≥+5.00 D), and 61 (12.9%) had high hyperopia (≥+5.00 D in at least one meridian of at least one eye) by retinoscopy with 1% tropicamide. The mean ± standard deviation spherical equivalent tropicamide cycloplegic refractive error measured with retinoscopy was +2.54 ± 1.54 D (range, -3.25 to +7.00 D) and with SureSight was +2.29 ± 1.64 D (range, -2.90 to +7.53 D). Retinoscopy done using 1% cyclopentolate was 0.44 ± 0.54 D more hyperopic in spherical equivalent than with 1% tropicamide ( P < .001). High hyperopia was a common finding in 2-month-old infants in a pediatric medical setting that could be detected effectively by cycloplegic autorefraction using tropicamide. Greater cooperation between pediatric primary vision and medical care could lead to effective vision screenings designed to detect high hyperopia in infants.

Preventive Health Care Among Children of Women With Schizophrenia: A Population-Based Cohort Study.

ABSTRACT Objective: To compare well-baby visit and vaccination schedule adherence up to age 24 months in children of mothers with versus without schizophrenia. Methods: Using administrative health data on births in Ontario, Canada (2012–2016), children of mothers with schizophrenia (ICD-9: 295; ICD-10: F20/F25; DSM-IV schizophrenia or schizoaffective disorder) (n = 1,275) were compared to children without maternal schizophrenia (n = 520,831) on (1) well-baby visit attendance, including an enhanced well-baby visit at age 18 months, and (2) vaccine schedule adherence for diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B (DTaP-IPV-Hib), and measles, mumps, rubella (MMR). Cox proportional hazard regression models were adjusted for each of maternal sociodemographics, maternal health, and child health characteristics in blocks and all together in a fully adjusted model. Results: About 50.3% of children with maternal schizophrenia had an enhanced 18-month well-baby visit versus 58.6% of those without, corresponding to 29.0 versus 33.9 visits/100 person-years (PY), a hazard ratio (HR) of 0.82 (95% CI, 0.76–0.89). The association was dampened after adjustment for maternal sociodemographics, maternal health, and child health factors in blocks and overall, with a fully adjusted HR of 0.91 (95% CI, 0.84–0.98). Full vaccine schedule adherence occurred in 40.0% of children with maternal schizophrenia versus 46.0% of those without (22.6 vs 25.9/100 PY), yielding a HR of 0.86 (95% CI, 0.78–0.94). The association was dampened when adjusted for maternal sociodemographics and child health characteristics and became nonsignificant when adjusted for maternal health characteristics. The fully adjusted HR was 0.95 (95% CI, 0.87–1.04). Conclusions: Increased efforts to ensure that children with maternal schizophrenia receive key early preventive health care services are warranted.

Implementing the Get SET Early Model in a Community Setting to Lower the Age of ASD Diagnosis.

The objective of this study was to implement a validated, university-based early detection program, the Get SET Early model, in a community-based setting. Get SET was developed to improve Screening, Evaluation, and Treatment referral practices. Specifically, its purpose was to lower the age of diagnosis and enable toddlers with autism spectrum disorder (ASD) to begin treatment by 36 months. One hundred nine pediatric health care providers were recruited to administer the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist at 12-month, 18-month, and 24-month well-baby visits and referred toddlers whose scores indicated the need for a developmental evaluation. Licensed psychologists were trained to provide diagnostic evaluations to toddlers as young as 12 months. Mean age of diagnosis was compared with current population rates. In 4 years, 45,504 screens were administered at well-baby visits, and 648 children were evaluated at least 1 time. The overall median age for ASD diagnosis was 22 months, which is significantly lower than the median age reported by the CDC (57 months). For children screened at 12 months, the age of first diagnosis was significantly lower at 15 months. Of the 350 children who completed at least 1 follow-up evaluation, 323 were diagnosed with ASD or another delay, and 239 (74%) were enrolled in a treatment program. Toddlers with ASD were diagnosed nearly 3 years earlier than the most recent CDC report, which allowed children to start a treatment program by 36 months. Overall, Get SET Early was an effective strategy for improving the current approach to screening, evaluation, and treatment. Efforts to demonstrate sustainability are underway.

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.

Revisiting Excess Diagnoses of Illnesses and Conditions in Children Whose Parents Provided Informed Permission to Vaccinate Them

Controversy over a reported increase in office visits specifically scheduled for illnesses and conditions in children has stalled progress in understanding adverse outcomes associated with an increasingly crowded schedule of pediatric vaccines. Studies finding associations between vaccines and adverse conditions have been targeted for retraction. Here, we revisit data from one such study, comparing the increase in office visits for conditions independent of the routine “well-child” visits (hereafter, Health Care Visits; HCVs). The retraction occurred after &gt;1/4 of a million people had read the peer-reviewed study. It was targeted by one anonymous reader who complained he did not believe the published results. His complaint hinged on the supposition — unsupported by any data — that vaccinated children made their scheduled HCVs more regularly than unvaccinated, implying that those unkept appointments led to fewer diagnoses. We show, here, new data from the same practice that the opposite is true. When the data for vaccinated versus unvaccinated children are examined, the critic’s claim is exactly reversed. Relative Risk and Odds Ratios sustain and augment the original report. Additional office visits, beyond scheduled HCVs, are quantified, controlling for variation in kept HCVs and age/days of care. Estimates of Health Care Incidence (HCI) show that visits above regular HCVs increase due to vaccination by 2.56 to 4.98 per year. Blocking and multiple linear regression analysis of interactions indicate both that the unvaccinated are keeping scheduled HCVs more often than the vaccinated, and that vaccination comes with a net increase in non-routine office visits, i.e., not “well-baby visits” but trips to the doctor for reasons other than vaccination. Taking account of the complexities of healthcare-seeking with measured covariates and outcomes, especially adverse health events, suggests that vaccination may be driving the increased need for non-routine office visits for specific health complaints. Meanwhile, one reader’s unsupported and false criticism of the former study, reflects a pervasive bias leading to systematic removal of many well-designed studies attributing adverse outcomes to vaccines. Hiding such well-designed and faithfully reported, not to mention peer-reviewed and published research, clears the way for marketing programs bought and paid for by vaccine manufacturers and the Centers for Disease Control and Prevention (CDC).

Early (years) reactions: comparative analysis of early childhood policies and programs during the first wave of the COVID-19 pandemic

BackgroundDuring the first wave of COVID-19 there was little evidence to guide appropriate child and family programs and policy supports.MethodsWe compared policies and programs implemented to support early child health and well-being during the first wave of COVID-19 in Australia, Canada, the Netherlands, Singapore, the UK, and the USA. Program and policy themes were focused on prenatal care, well-baby visits and immunization schedules, financial supports, domestic violence and housing, childcare supports, child protective services, and food security.ResultsSignificant heterogeneity in implementation of OECD-recommended policy responses was found with all of the included countries implementing some of these policies, but no country implementing supports in all of the potential areas.ConclusionsThis analysis gives insight into initial government reactions to support children and families, and opportunities for governments to implement further supportive programs and policies during the current pandemic and future emergencies.

Health Care Clinician Perceptions of OTs Providing Services During Well-Baby Visits: A Descriptive Research Study

Abstract Date Presented 04/01/2022 Parents and caregivers of newborns and infants rely on the expertise of primary care physicians (PCPs) to provide guidance throughout their child’s earliest stages of life. PCPs currently lack time and resources, limiting information imparted at periodicity visits regarding infant health, growth, and development. This study explores perceptions of health care clinicians pertaining to the addition of OTs to provide education during periodicity visits to bridge the gap. Primary Author and Speaker: Sonja Burmeister Additional Authors and Speakers: Maria Nagle Contributing Authors: Lauren Kresge, Alexis Brenner, Trisha MacLeod, Rebecca McMaster

Iron Deficiency in Infants—What Nurse Practitioners Need to Know

Iron deficiency anemia (IDA) in infancy is associated with negative, potentially irreversible impacts on cognitive and socioemotional development that persist into adulthood and may result in reduced potential and decreased quality of life. Infants are at particularly high risk of IDA due to rapid growth rates and high iron requirements during this stage of life. There are currently no universal screening programs for IDA. Existing screening guidelines in Canada and the United States provide multiple, conflicting recommendations. Primary care nurse practitioners are uniquely situated to improve accessibility to quality health care and screen, diagnose, and treat IDA at routine well-baby visits.