Well-child Checkups Research Articles

Covid-19 Pandemi Sürecinde Sağlıklı Çocuk Takibi ve Kronik Hastalık Kontrollerinin Sürekliliği ve Pandeminin Poliklinik Başvurularına Erken ve Geç Dönemdeki Etkisinin Karşılaştırılması

Aim: Pandemic disrupted health care access in many centers all around the world. CDC recommended that seperating pandemic and non-pandemic hospitals, prioritizing emergency visits, postponing elective operations and, where possible, converting outpatient visits to telehealth calls. In this period, well-child checkups were cancelled and routine childhood vaccination was interrupted. We aimed to evaluate the impact of pandemic on the routine immunization schedule, neonatal screening program, chronic disease follow ups and outpatient clinic visits. 
 Material and Method: In total, 401 children and their parents were included in this study and patient population of interest was children of routine immunization age. Outpatient visit features and compliance with the childhood vaccination and neonatal screening program before and during the pandemic were asked. 
 Results: Compared to 2021, there was a significant increase in both the number of patients with upper respiratory tract infection symptoms and their hospital admissions. While the rates of hospital admissions increased in 2022 in those with diarrhea, almost all of the patients with lower respiratory tract infection symptoms stated that they applied to the hospital in both periods. It was observed that routine vaccination and newborn screening programs were carried out successfully during the pandemic process in Turkey. It was found that chronic disease follow-ups of children were interrupted in 2021. 
 Conclusion: This study has shown how the 3 major components of health system (outpatient clinic visits, well child check-ups and chronic disease follow-ups) were affected at different times of the pandemic in Turkey. Successful management in childhood vaccinations and neonatal screening program should also be ensured in chronic disease follow-up bythe separation of pandemic and non-pandemic hospitals. Showing the strengths and weaknesses of strategies implemented in health system during the pandemic guides the measures to be taken for similar situations that may occur in the future.

Integration of Oral Health Screening, Intervention, and Referral Into the Pediatric Well-Child Visit

Parents of children usually understand the importance of getting primary care pediatric well-child checkups during certain stages of childhood, yet few know the importance of early routine dental visits to proactively incorporate good oral hygiene and relate the connection of oral care to overall systemic physical health. The purpose was to determine the impact of integrating oral health screening, intervention, and referral into the pediatric well-child visit. Children (aged 0-18 years) received oral health screening, oral photographs, fluoride varnish, oral health education, and referral during well-child visits. Forty-two percent of our population had never had a dental examination. Fifty-eight percent had no established dental home, and 73% drank sugar-sweetened beverages weekly. The overall impact of this model was providing comprehensive oral health care to children who have never been to the dentist and providing a smooth transition between medical and dental, increasing access to care.

Trends in Health Care Utilization Among United States Children With Eczema by Age, Sex, Race, and Hispanic Ethnicity: National Health Interview Survey 2006-2018.

Background: Higher health care utilization has been proven among US children with eczema than those without, but disparities may exist among sociodemographic subgroups. Objective: To determine health care utilization trends among children with eczema across sociodemographic factors. Methods: We included children (0-17 years old) from the US National Health Interview Survey 2006-2018. We calculated the survey-weighted health care utilization by determining proportion of children attending a well-child checkup, seen by a medical specialist, and seen by a mental health professional in the previous 12 months for children with and without eczema, by race (white, black, American Indian/Alaska Native, Asian, and multiracial), Hispanic ethnicity (yes/no), age (0-5, 6-10, 11-17), and gender (male/female) subgroups using SPSS complex samples. Joinpoint regression was used to estimate piecewise log-linear trends in the survey-weighted prevalence, annual percentage change, and disparities between subgroups. Results: We included 149,379 children-there was higher health care utilization in children with eczema than those without. However, when comparing the average annual percentage change (AAPC), white children had a significantly higher AAPC of "attending a well-child checkup" than black children. In addition, only white children showed a significantly increasing trend in being "seen by a medical specialist," whereas all other minority race subgroups had stagnant trends. For those "seen by a mental health professional," there were increasing trends only in the male and non-Hispanic subgroups out of all the sociodemographic subgroups. Conclusion: Improving awareness among primary care physicians to refer children with moderate-to-severe eczema to medical specialists (eg, allergists, dermatologists, and mental health/attention-deficit/hyperactivity disorder professionals) when necessary could improve quality of life and reduce emergency department visits-especially among minority race, Hispanic, and female children.

Validation of the Electronic Modified Checklist for Autism in Toddlers, Revised with Follow-Up: A Nonrandomized Controlled Trial

To examine the classification rates and screening properties, including sensitivity and specificity, of the web-based Modified Checklist for Autism in Toddler, Revised with Follow-Up (M-CHAT-R/F) compared with paper-phone administration, and to determine the extent to which electronic M-CHAT-R/F streamlines screening, increases screening fidelity, increases diagnostic evaluation participation, and decreases waiting time from screening to evaluation compared with paper-phone modality. Primary-care practices in urban and suburban settings administered either the web-based or paper-phone M-CHAT-R/F using a prospective nonrandomized control design. Toddlers (n=17 900) were screened between 2009 and 2016 at routine well-child check-ups. Toddlers who screened at risk on the M-CHAT-R/F were invited to complete diagnostic evaluations; 176 children were diagnosed with autism. The χ2, Fisher exact, and t-tests, as well as regression and screening properties, were used to compare outcome distributions, screening properties, and implementation by modality. Classification rates of the initial M-CHAT-R into low, medium, and high risk were significantly different across modalities with very small effect sizes. Sensitivity and specificity were high across both modalities. For children in the medium-risk range, the web-based modality had a greater rate of predicting risk for autism after Follow-Up compared with the paper-phone modality, and the web eliminated delay between initial screen and Follow-Up. The web-based modality showed increased screening fidelity, no data loss, and similar rates of evaluation attendance and time to evaluation from Follow-Up administration. The web-based M-CHAT-R/F is a valid tool for universal autism screening. Systems-level decisions should balance the increased feasibility of the electronic administration with the increase in Follow-Up accuracy provided by skilled clinician interview.

Pediatric health care use during the COVID-19 pandemic: Lessons learned from the initial 2020 wave.

ObjectiveDuring the height of the coronavirus disease‐2019 (COVID‐19) pandemic, there was a decline and shift in pediatric medical care use. We aimed to assess changes to pediatric medical use and perceptions/barriers that influenced caregivers’ decision‐making during the New York State mandated lockdown from March 22 to June 8, 2020, in a population that opted to use the pediatric emergency department (PED) during this period. This study was conducted in New York City (NYC), one of the epicenters at the height of the COVID‐19 pandemic.MethodsFrom June 14 to December 28, 2020, a convenience sample of caregivers who brought children 0–17 years to a NYC PED completed a survey.ResultsParticipants in the survey included 290 caregivers: 76% were Hispanic; 91% reported having accessed medical care when their children were ill during the lockdown. In‐person primary care visits decreased from 64% before to 9% during lockdown; 28% missed well‐child checkups or vaccinations, and 26% missed specialist appointments. Telemedicine usage increased from 10% to 54%; none reported lack of internet or electronic devices as barriers to using telemedicine. Regarding access to care: 36% perceived increased difficulty during the lockdown, whereas 56% felt no difference. Barriers included fear of contracting COVID‐19 and government advice to avoid health care visits for minor problems.ConclusionDuring the initial wave of the COVID‐19 pandemic, medical care shifted from an in‐person to a virtual platform. Identification of factors and barriers surrounding caregivers’ decision‐making may positively inform strategies toward future public health emergencies.

Screening for Autism Spectrum Disorder in Toddlers During the 18- and 24-Month Well-Child Visits.

ObjectiveEarly screening contributes to the early detection of children with autism spectrum disorder (ASD). We conducted a longitudinal ASD screening study in a large community setting. The study was designed to investigate the diagnostic rate of ASD screening and determine the effectiveness of ASD screening model in a community-based sample.MethodsWe enrolled children who attended 18- and 24-month well-child care visits in Shanghai Xuhui District. Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) and Binomial Observation Test (BOT) were selected as screening instruments. Screen-positive children were referred to a tertiary diagnostic center for comprehensive ASD diagnostic evaluation. Screen-negative children received well-child checkups and follow-up every 3–6 months until age three and were referred if they were suspected of having ASD.ResultsA total of 11,190 toddlers were screened, and 36 screen-positive toddlers were diagnosed with ASD. The mean age at diagnosis for these children was 23.1 ± 4.55 months, diagnosed 20 months earlier than ASD children not screened. The diagnostic rate of ASD was 0.32% (95% CI: 0.23–0.45%) in this community-based sample. In addition, 12 screen-negative children were diagnosed with ASD during subsequent well-child visit and follow-up. The average diagnostic rate of ASD rose to 0.43% (95% CI: 0.32–0.57%) when toddlers were followed up to 3 years old. The positive predictive values (PPVs) of M-CHAT-R/F, M-CHAT-R high risk, and BOT for ASD were 0.31, 0.43, and 0.38 respectively.ConclusionOur findings provide reliable data for estimating the rate of ASD detection and identifying the validity of community-based screening model. M-CHAT-R/F combined with BOT can be an effective tool for early detection of ASD. This community-based screening model is worth replicating.

Use of Virtual Reality in the Reduction of Pain After the Administration of Vaccines Among Children in Primary Care Centers: Protocol for a Randomized Clinical Trial.

BackgroundPain and anxiety caused by vaccination and other medical procedures in childhood can result in discomfort for both patients and their parents. Virtual reality (VR) is a technology that is capable of entertaining and distracting the user. Among its many applications, we find the improvement of pain management and the reduction of anxiety in patients undergoing medical interventions.ObjectiveWe aim to publish the protocol of a clinical trial for the reduction of pain and anxiety after the administration of 2 vaccines in children aged 3 to 6 years.MethodsWe will conduct a randomized, parallel, controlled clinical trial with 2 assigned groups. The intervention group will wear VR goggles during the administration of 2 vaccines, while the control group will receive standard care from a primary care center for the procedure. Randomization will be carried out by using the RandomizedR computer system—a randomization tool of the R Studio program. This trial will be an open or unblinded trial; both the subjects and the investigators will know the assigned treatment groups. Due to the nature of the VR intervention, it will be impossible to blind the patients, caregivers, or observers. However, a blind third-party assessment will be carried out. The study population will include children aged 3 to 6 years who are included in the patient registry and cared for in a primary care center of the region of Central Catalonia. They will receive the following vaccines during the Well-Child checkup: the triple viral+varicella vaccine at 3 years of age and the hepatitis A+diphtheria-tetanus-pertussis vaccine at 6 years of age.ResultsThe study is scheduled to begin in January 2022 and is scheduled to end in January 2023, which is when the statistical analysis will begin. As of March 2022, a total of 23 children have been recruited, of which 13 have used VR during the vaccination process. In addition, all of the guardians have found that VR helps to reduce pain during vaccination.ConclusionsVR can be a useful tool in pediatric procedures that generate pain and anxiety.International Registered Report Identifier (IRRID)PRR1-10.2196/35910

Sleep pattern regularity and measures of infant weight and length during the first 6 months

PurposeTo examine the association between sleep pattern regularity and measures of weight and length in infants. Design and methodsThis was a prospective observational study conducted in a university-affiliated children's hospital in northern Taiwan. A total of 316 healthy infants recruited during their 6-month well-child checkups had their weight and recumbent length measured, and wore an actigraph on the ankle for a week. Based on average weekday, weekend, and all-week sleep durations, infants were categorized into 3 groups: regular sleep, weekend catch-up sleep, and weekend sleep curtailment. General linear model analyses were performed with the 3 sleep regularity groups as the primary predictor variable of interest and infant anthropometry as the dependent variable. ResultsAt risk of overweight, overweight, and obese was present in a total of 62 (19.6%) infants. In both unadjusted and adjusted models, infants in the weekend catch-up sleep group (30.4%) and those in the weekend sleep curtailment group (34.5%) had significantly higher weight-to-length ratios, body mass index, weight-for-age z-scores, and weight velocity of 6-month increments z-scores when compared with infants in the regular sleep group (35.1%, all p < 0.05). ConclusionsDifferences in weekday-weekend sleep exist as early as in the first 6 months of life, and both catch-up sleep and sleep curtailment over the weekend is associated with higher measures of weight and length in infants. Practice implicationsSleep assessments in well-child checkups should include not only global assessments of average sleep duration but also address sleep patterns and their regularity.

Adherence to the Mediterranean diet and risk of functional constipation in children in Turkey: case–control study

Background: Functional constipation is often seen in children, affecting quality of life and imposing a considerable burden on health care services. The Mediterranean diet is associated with a lower risk of functional gastrointestinal disorders. Aims: This study aimed to evaluate the relationship between functional constipation and adherence to the Mediterranean diet in Turkish children aged 6–18 years. Methods: In this case–control study, 221 children with functional constipation (cases) were selected from a paediatric gastroenterology clinic between May 2018 and September 2019, and 230 children without constipation (controls) were randomly selected from those attending a well-child check-up. Cases and controls were matched on sex, age and socioeconomic characteristics. Compliance with the Mediterranean diet was assessed using the KIDMED index score. Multivariable logistic regression analysis was used to analyses the data. Results: KIDMED index scores in cases and controls were 4.0 (SD = 2.5) and 6.3 (SD = 2.4), respectively (P &lt; 0.001). Odds ratios for functional constipation were 0.23 (95% confidence interval (CI): 0.13–0.38) for KIDMED index score 4–7 and 0.05 (95% CI: 0.03–0.11) for score ≥ 8 compared with the lowest category (score ≤ 3; P &lt; 0.001). A negative correlation was observed between age and adherence to the Mediterranean diet. Conclusion: Good adherence to the Mediterranean diet was associated with a lower risk of functional constipation, and adherence to the Mediterranean diet decreased with age. Education on nutrition and health is warranted to help maintain and improve the health of young people in Turkey.

Association of parental cancer and school absenteeism, medical financial hardship, healthcare use, and psychological distress among minor children.

6544 Background: A cancer diagnosis can affect the entire family, including minor children. However, little is known about the association of parental cancer on minor children’s school absenteeism, family’s financial ability to afford healthcare for children, as well as healthcare use, psychological distress, and behavioral problems. Methods: The 2015 to 2018 National Health Interview Survey was used to identify minor children (ages 5-17 years) whose parent(s) reported a cancer history (n = 695, representing 1.2 million children) and children whose parent did not report a cancer history (n = 19,122, representing 35.7 million children). Separate multivariable logistic regressions were used to compare school absenteeism, financial hardship, healthcare use, and psychological distress among children with and without parental cancer history. All analyses adjusted for children’s age group (5-11 years, 12-14 years, and 15-17 years), sex, family income as a percentage of the federal poverty line, marital status of their parents, survey year, and region. Results: Children of cancer survivors were more likely to receive annual well-child checkups, experience school absenteeism, take prescription medications for more than 3 months, visit hospital emergency rooms, suffer psychological distress, and have behavioral problems than children of parents without a cancer history (Table). Conclusions: Parental cancer history is associated with disruption in their minor children’s life. The associated psychological distress and physical and emotional health among these children may develop into more severe health issues in adulthood. Special attention to minor children of parents with a cancer history may be required to help prevent development of longer-term physical and mental health problems.[Table: see text]

598 Sleep Variability and Infant Anthropometry during the First 6 Months

Abstract Introduction Sleep plays a crucial role in children’s health and development, and emerging evidence suggests that sleep disturbances during infancy negatively impact both the neurocognitive and socioemotional outcomes later in life. However, no study has taken the variability of sleep into account when examining physical growth in infancy, which is a critical period for both healthy sleep and weight development. The purpose of the study was to examine the association between sleep variability and physical growth in infants aged 6 months. Methods 316 healthy infants recruited during their 6-month well-child checkups had their weight and length measured, and wore an actigraph on the ankle for a week. Average weekday, weekend, and all week sleep duration were computed, with infants categorized into three groups: regular sleep, weekend catch-up sleep, and weekend sleep curtailment. General linear model analyses were performed with sleep variability as the primary predictor variable of interest and infant anthropometry as the dependent variable. Results Average weekday daily sleep duration was 10.76 (1.06) hours which was similar to the average weekend daily sleep duration of 10.68 (1.06) hours. In both unadjusted and adjusted models controlling for potential confounding variables, infants in the weekend catch-up sleep group (30.4%) and those in the weekend sleep curtailment group (34.5%) had significantly higher weight-to-length ratios, body mass index, and weight-for-age z scores when compared with infants in the regular sleep group (35.1%, all p &amp;lt; 0.05). Conclusion Weekday-weekend sleep pattern differences exist even as early as in the first 6 months of life, and either weekend catch-up sleep or weekend sleep loss is associated with higher infant anthropometric markers. Our findings suggest that sleep assessments in infants in well-child checkups should include not only global assessments of average sleep duration but also address sleep pattern regularity. Support (if any) This study was funded by the National Health Research Institutes, Taiwan, NHRI-EX102-10229PC.

Basketball and Volleyball (Care of the Young Athlete)

Patient Education| 2021 Basketball and Volleyball (Care of the Young Athlete) Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Basketball and Volleyball (Care of the Young Athlete). Pediatric Patient Education 2021; 10.1542/peo_document298 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Subjects: Care of the Young Athlete Topics: ankle sprains, athlete, basketball, brain concussion, pain, sports, volleyball, knee joint, knee region, fractures Acute and overuse injuries are common in jumping sports like basketball and volleyball. Acute injuries include bruises (contusions); cuts and scrapes (lacerations); ankle, knee, or finger sprains or fractures; shoulder dislocations; eye injuries; and concussions. Overuse injuries include patellar tendonitis (also called jumper's knee) or Osgood-Schlatter disease, spondylolysis (stress fracture of the spine), rotator cuff tendinopathy, stress fractures, and shin splints. The following is information from the American Academy of Pediatrics (AAP) about how to prevent basketball and volleyball injuries. Also included is an overview of common basketball and volleyball injuries. Sports physical exam. Athletes should have a preparticipation physical evaluation (PPE) to make sure they are ready to safely begin the sport. The best time for a PPE is about 4 to 6 weeks before the beginning of the season. Athletes also should see their doctors for regular health well-child checkups.... Copyright © 20112011 American Academy of Pediatrics You do not currently have access to this content.

Development and validation of a three-item version of the Edinburgh Postnatal Depression Scale.

To develop and validate a brief screening instrument for postpartum depression in resource-constrained primary care settings. Secondary data analysis of a cohort of 305 mothers (Mdnage = 26) attending well-child check-ups in six primary care centers in Santiago, Chile, answered the Edinburgh Postnatal Depression Scale (EPDS), the 36-Item Short Form Health Survey, and the Mini International Neuropsychiatric Interview depression module. A predictive model for postpartum depression was built using logistic and least absolute shrinkage and selection operator regressions, with bootstrap validation. A three-item version of the EPDS exhibited excellent discriminative capacity (c statistic = 0.95) and showed no significant differences versus the full version of the EPDS (χ2 (1) = 1.75, p = .187). The best trade-off between sensitivity (92.86%) and specificity (86.70%) was achieved at a cut-off score of 8/9. The three-item version of the EPDS can save clinicians valuable time, which might potentially improve communication of results to patients.

Influenza vaccination among U.S. pediatric patients receiving care from federally funded health centers

IntroductionDuring the 2018–2019 influenza season, vaccination coverage among U.S. children was 62.6%. The purpose of this study was to estimate the prevalence of influenza vaccinations among pediatric patients seen in U.S. health centers, and to explore potential disparities in vaccination coverage among subpopulations. Funded by the Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services, these health centers provide primary and preventive care to underserved and vulnerable individuals and families in order to reduce health disparities based on economic, geographic, or cultural barriers. MethodsCross-sectional data, analyzed in 2019, came from the most recent waves of the Health Center Patient Survey (2009, 2014). The sample consisted of children ages 2–17 years receiving care from HRSA-funded health centers. The outcome of interest was self- or parent-reported receipt of influenza vaccine in the past year. Multivariable logistic regression was used to estimate the adjusted prevalence rate ratios for the association between demographic characteristics (age, sex, race/ethnicity, poverty level, urban/rural residence, geographic region), health-related variables (receipt of well-child check-up, asthma diagnosis), and influenza vaccination. ResultsInfluenza vaccination coverage among pediatric health center patients increased from 46.6% in 2009 to 67.8% in 2014. In the adjusted model for 2014, there were few statistically significant differences in vaccination coverage among subpopulation groups, however American Indian/Alaska Native children had 31% increased vaccination coverage compared with non-Hispanic White children (aPRR: 1.31, 95% CI: 1.02–1.60) and children living in the South had 26% decreased vaccination coverage compared with those living in the Northeast (aPRR: 0.74, 95% CI: 0.54–0.93). ConclusionsInfluenza vaccination coverage among pediatric health center patients in 2014 exceeded the national average (as of 2018–2019), and few differences were found among at-risk subpopulations. HRSA-funded health centers are well-positioned to further increase the vaccination rate among children living in underserved communities.

Newborn feeding recommendations and practices increase the risk of development of overweight and obesity

BackgroundThe prevalence of obesity among infants less than 2 years of age has increased by more than 60% over the last three decades. Obese infants and toddlers are at an increased risk for staying overweight into adolescence and adulthood. Metabolic programming has been demonstrated in animal models whereby early life feeding habits result in life-long changes in hormone balance and metabolism. Our study explores if newborn over-nutrition on the first day of life (DOL1) is associated with risk for future overweight and obesity in childhood.MethodsRetrospective chart data was collected for full term formula-fed infants born between January 2008 and December 2012 who continued care at the same institution. Data included the volume of formula (ml) consumed on DOL1 as well, as subsequent yearly BMI measures from well child checkups (WCC). Overfeeding was categorized as any feed greater than or equal to 30 ml on any of the first seven feeds while controlling for birth weight.ResultsThe final data set included 1106 infants (547 male; 559 female). 1023 of the 1106 newborns (93%) were overfed at least once during DOL1, while 789 of 1106 (71%) were overfed 3 or more times during their first 7 feeds. After adjusting for birth weight, infants who were overfed 5 of the first 7 feeds were 5 times as likely to be overweight or obese at their 4th year well child check-up (p < 0.05) compared to children not overfed. Infants who were overfed on all 7 of their first 7 feeds were 7 times more likely to be overweight or obese at their 4th year WCC (p = 0.017).ConclusionsInfants overfed on DOL1 were significantly more likely to be overweight or obese at their 4th year WCC, compared to infants not overfed on their first day of life. Newborn families may benefit from counseling regarding age-appropriate volumes of formula during this critical time period. Future studies will aim to look at effect of implementation of smaller feeding bottle size on reducing overfeeding practices and future risk of overweight and obesity.

QuickStats: Percentage* of Children† Aged

QuickStats: Percentage* of Children† Aged <18 Years Who Received a Well-Child Checkup in the Past 12 Months,§ by Age Group and Year - National Health Interview Survey, United States, 2008 and 2018¶.

Physician Utilization of a Universal Psychosocial Screening Protocol in Pediatric Primary Care.

This study evaluated physicians' utilization of a universal psychosocial screening protocol within a pediatric primary care setting. Pediatricians (n = 20) adopted a multitiered screening algorithm using the Pediatric Symptom Checklist-17 (PSC-17) within well-child checkups (WCC) for children, ages 7 and 11 years. Descriptive analyses were performed to evaluate the initial 3 years of physician screening protocol implementation to: (1) determine frequency and proportion of use and (2) examine patient outcomes associated with accessing behavioral health care. Physicians frequently initiated the protocol, administering the PSC-17 within 3678 WCC encounters, with frequency progressively increasing over the 3-year period. Results highlighted elements of screener utilization, cost-effectiveness, screening algorithm fidelity, and prevalence of psychosocial concerns identified. Secondary implementation challenges were observed after initial screening, specific to implementation of prescribed follow-up procedures. Primary care behavioral health collaborations appear helpful for improving universal screening utilization and cost-effectiveness, and for ensuring children with psychosocial problems are identified early and directed to follow-up care as needed.

Missed Opportunities in the Preparticipation Physical Examination for High School Athletes.

The preparticipation sports examination (PPE) is required for US high school athletes. We queried members of the Illinois Chapter of the American Academy of Pediatrics (ICAAP) about what they actually include in a PPE, allotted PPE time, and counseling about full contact sports participation. Of 2300 ICAAP members contacted electronically, 228 (10%) responded, yielding 205 usable surveys. When performing a PPE, 34 (25%) always complete all of 6 selected AAP-recommended PPE components and 102 (74%) always get a concussion history. In contrast, 29 (21%) always complete all of the 6 selected AAP PPE components and 70 (49%) always get a concussion history as part of well-child checkup. Main interferences with clinician proficiency are lack of time and training cited by 49% and 37%, respectively. Pediatricians were evenly divided about whether or not to counsel against full contact sports, but were more likely to do so after the athlete sustained a first concussion.

Screening and barriers for treatment of postpartum depression in Chilean public primary health care centers

Postpartum depression (PPD) is a public health issue, and appropriate screening may lead to clinical gains. To describe the screening for PPD, its relationship with the use of health care services, and treatment access barriers in Chilean public primary health care (PHC) centers. Puerperal women attending PHC centers for a well-child check-up were assessed for the presence of PPD using the Edinburgh Postnatal Depression Scale and a structured psychiatric interview. PPD cases were assessed by telephone three months later. Also, women with PPD and PHC workers were interviewed to explore treatment barriers. Of the 305 women assessed, 21% met diagnostic criteria for PPD. Sixty five percent of assessed women were previously screened for PPD while attending well-child check-ups. The results of the screening were communicated to 60% of them and 28% received some management indication. After three months of follow up, 70% of PPD cases continued to be depressed, and two thirds of them did not consult a health care provider and most of them rejected psychotherapy or medical treatment. Management of postpartum depression should be substantially improved in public PHC from screening to treatment.

Impact of an American board of pediatrics maintenance of certification (MOC) on weight-related counseling at well-child check-ups

ObjectiveThe Healthy Weight Counseling Maintenance of Certification (MOC) program integrates pediatrician training and clinic changes to promote use of evidence-based, diet and physical activity (PA) health messages and counseling strategies. This interrupted time series study assessed the impact of this MOC program on provision of weight-related counseling. MethodsWe randomly selected 10–15 well-child visit charts at three time points before and three time points after 102 Georgia pediatricians began the MOC in 2012–2015. Linear binomial regression compared the frequency of behavior-change goal setting and health messaging documentation (fruit/vegetable consumption, sugar-sweetened beverage consumption, out-of-home food consumption, PA, and screen time) before and after MOC participation. ResultsAt baseline, pediatricians documented behavior-change goals with 44% of patients, with an additional 49% of patients having documented goals after their pediatrician started the MOC (99.5% confidence interval [CI]: 21–77%). Similarly, absolute increases in the proportion of patients with documentation for sugar-sweetened beverage consumption (adjusted prevalence difference [aPD]: 37%; 99.5% CI: 13–62%) and out-of-home eating were observed (aPD: 38%; 99.5% CI: 12–64%). ConclusionThe Healthy Weight Counseling MOC is associated with increased and sustained use of evidence-based health messages and counseling strategies. Practice implicationsContinuing education and facilitation of system changes help improve physicians’ weight-related counseling.