Clinical Pediatrics最新文献

This study explored a mother's experience of caring for her child with Jeune syndrome through a phenomenological qualitative approach using letter writing. Data were analyzed inductively, and four major themes emerged: challenges and successes in medical treatment, emotional resilience and family dynamics, overcoming developmental and educational barriers, and hopes and aspirations for the future. The mother described interactions with health care providers, her child's surgeries, treatments, and postoperative care. She emphasized the importance of family support, emotional struggles, and concerns about her child's future health. Developmental delays, social difficulties, and limited access to formal education were noted. Future plans involved tracheostomy closure, dietary improvements, and genetic testing. Despite these challenges, the mother remained hopeful, emphasizing her child's postoperative recovery and potential for greater independence. This analysis highlights the struggles, victories, and aspirations of a mother facing a rare disease and offers inspiration to others in similar circumstances.

Objective: To establish whether infants with macrocephaly and non-acute subdural hematomas (SDHs) had missed opportunities for measuring fronto-occipital circumference (FOC) and obtaining neuroimaging prior to diagnosis. Macrocephaly due to SDH in infancy is initially detected by FOC measurements and/or neuroimaging, as neurologic symptoms may be subtle or missed.

Methods: Retrospective chart review of infants with macrocephaly and non-acute SDHs referred to child abuse pediatricians for suspected abusive head trauma (AHT) over an 8-year period. A study sample of 35 infants met inclusion criteria and had complete prior medical records which were reviewed for missed opportunities for earlier SDH diagnosis. Four types of missed opportunities were identified: not initiating a workup for nonaccidental trauma (NAT) with a history or exam finding of a sentinel injury, not obtaining FOC when presenting with nonspecific neurologic symptoms, no neuroimaging for macrocephalic infants, and incomplete or delayed workup for macrocephaly.

Results: Most (91%) infants had missed opportunities for earlier diagnosis of macrocephaly and/or SDH. The most common missed opportunity was no neuroimaging when macrocephalic (N = 28; 54%). Other missed opportunities included not obtaining FOC on a symptomatic infant (N = 10), macrocephaly with incomplete or delayed workup (N = 9), and no NAT workup with a sentinel injury (N = 5). Most of these 35 infants (77%) were diagnosed with concerns for abuse and 43% required surgery upon diagnosis with SDH.

Conclusion: Measuring and reviewing FOC, especially in infants with nonspecific neurologic symptoms or infants with sentinel injuries, may facilitate earlier assessment for AHT. An earlier diagnosis of AHT will assist in developing appropriate safety and treatment interventions.

The impact of the COVID-19 pandemic on pediatric obesity and comorbidities was investigated via a retrospective analysis of new patient visits at a pediatric weight management clinic. Prepandemic (N = 1590, January 1, 2017, to March 20, 2020) and postpandemic (N = 1040, April 1, 2020, to June 8, 2023), patients ages 2-21 years with overweight or obesity were studied. Results revealed significant increase in obesity severity during the postpandemic period (OR = 1.70 [1.45, 1.99]), with more comorbidities (OR = 1.28 [1.22, 1.34]). Prediabetes (OR = 1.62 [1.07, 2.47]), eating disorder/hyperphagia (OR = 1.77 [1.26, 2.50]), and attention deficit hyperactivity disorder (OR = 1.36 [1.09, 1.69]) diagnoses were more prevalent postpandemic. Patients aged 10 to <14 years (OR = 2.39 [1.51, 3.79]) and non-Hispanic patients (OR = 1.44 [1.07, 1.94]) had higher odds of mood/mental health disorder diagnoses postpandemic. In conclusion, the COVID-19 pandemic is associated with worsening pediatric obesity severity and higher prevalence of obesity-related comorbidities in new patients presenting for treatment.

Gallstones are sometimes detected as a cause of a clinical finding in children and sometimes incidentally. This study aimed to investigate the demographic and clinical characteristics of pediatric patients with gallstones. Pediatric cases diagnosed with gallstones between 2017 and 2023 in a tertiary hospital were retrospectively examined. A total of 65 patients were included in the study. The mean age of the cases was 10.8 ± 5.3 years, and 44 (67.7%) were adolescents. The most common complaint of the cases was abdominal pain (60%), and 33.8% were diagnosed incidentally. Obesity was the most frequently identified cause (26.2%) and was significantly higher in adolescents. Forty-five (69.2%) cases were symptomatic, and 10 (15.3%) were complicated. This study found that the frequency of gallstones in children increases with age, and that the underlying cause is likely to be obesity as age increases. Clinicians should avoid medications that may cause gallstones in obese adolescents.

We conducted a cross-sectional survey of complex care programs on behavioral health services provided to children with medical complexity (CMC). Quantitative and qualitative data were analyzed by using convergent mixed methods. Rates of CMC receiving behavioral health services were at or above national averages for the general pediatric population and the most reported concerns were externalizing behaviors. Of 25 programs, 7 (28%) reported integrated care and programs with integrated care found the service improved access and were more likely to screen for caregivers' mental health. Themes included: 1. Current models of care for pediatric mental and behavioral health limits access for CMC; 2. Collaboration is highly desired by medical teams; 3. Providing mental health for family members of CMC is important. Despite high service use and frequent availability of integrated care, complex care programs still report insufficient access to behavioral health services required to meet the needs of CMC.

Technology enhanced learning (TEL) modules on common pediatric respiratory conditions have often not been aligned to appropriate pedagogy. This study appraised the impact of a new TEL module on the skills and knowledge of pediatric trainees. The TEL module on common pediatric respiratory conditions was piloted using a combination of medical educational theories and feedback from participants was collected. The feedback from 32 participants was largely positive as demonstrated by high Likert scores on the evaluation forms. The post-module quiz scores significantly improved when compared with the pre-module quiz scores (67.0 ± 21.9% versus 42.5 ± 23.8%, P < .0001). Participants reported that the TEL module was time efficient and tailored to different levels of learners providing a self-directed and flexible learning approach based on their clinical practice. Trainees perceived that this new TEL module improved their skills and knowledge, enhancing their management of pediatric respiratory conditions going forward.