Clinical Pediatrics最新文献

We compared the quantity of labs ordered in selected hospitalized children throughout the COVID-19 pandemic. Utilization of X-ray, magnetic resonance imaging (MRI), echocardiograms, and electrocardiograms (ECG), length of stay (LOS) and timing of antibiotics were secondary outcomes. Retrospective cohort study of patients >60 days to <22 years with cellulitis, pneumonia, and urinary tract infections discharged from hospital medicine March 2018 to February 2020 (pre-) March 2020 to February 2022 (peak) and March 2022 to April 2023 (post peak). Fisher-Freeman-Halton exact test was performed for categorical variables. Kruskal-Wallis test compared continuous variables. Patients admitted peak pandemic incurred more labs and ECGs and fewer MRIs and X-rays. There were no differences in echocardiograms, LOS, or timing of antibiotics. While lab utilization returned to pre-pandemic levels, increased ECG use continued. Increased lab and ECG utilization was observed in patients with certain bacterial infections during the peak of the pandemic, likely reflective of diagnostic uncertainty.

Parenting practices are vital in a child's development. The modified Block "Child Rearing Practices Report" has been used to assess these practices, allowing further analysis combining other parental characteristics. This study aimed to validate the measure in a Greek sample and explored the associations between parenting practices, styles, and parental characteristics. The sample consisted of 547 parents of pre-school children. The psychometric properties of the Q-short Child Rearing Practices Report (CRPR) provide evidence for its feasibility as an assessment tool for parenting approaches. Two factors of parenting practices were validated from the CRPR Greek version. Authoritative style predicted nurturing approaches. Authoritarian and strict styles indicated restrictive practices among mothers, as fathers adopted permissive and strict styles. The higher the mother's educational level was, the lower the restrictive behaviors she exhibited toward the child. These links may enrich the existing scientific evidence on the effects of parenting styles in parenting practices and allow cross-cultural comparisons.

This retrospective cohort study across 77 pediatric practices in Massachusetts assessed the frequency of CXR utilization among children with pneumonia diagnosed in the primary care setting and determined whether CXR utilization was associated with differences in antibiotic treatment and outcomes. Multivariable logistic regression was used to evaluate the association between CXR performance and future clinic revisit, CXR performance, antibiotic change, and a composite treatment failure outcome, adjusting for markers of illness severity. Among 29 528 children treated for pneumonia, 2462 (10.1%) had a CXR performed. CXR utilization varied by practice (range 0%-75% [IQR 2.7%-16.5%]). The odds of a composite outcome of treatment failure did not differ between children who had a CXR performed and those who did not (aOR 1.06; 95% CI [0.68, 1.65]). CXR was performed in the minority of patients diagnosed with pneumonia. Children who had a CXR performed had similar outcomes to those treated for pneumonia without CXR.

Abdominal pain-related disorders of gut-brain interaction (DGBIs) are common and challenging conditions affecting many children and adolescents. Multidisciplinary programs represent one promising approach to these complex disorders. However, the composition of these programs and the therapies offered is unknown. We sought to better understand characteristics of these multidisciplinary programs. A survey was taken of pediatric gastroenterologists in the United States who practice in multidisciplinary DGBI programs to determine the characteristics of currently available programs. Fourteen pediatric gastroenterologists reported caring for children with DGBI in multidisciplinary programs distributed across all regions of the United States. The number of disciplines varied from 2 to 5, with the most common aside from pediatric gastroenterologists being dietitians (in 79% of programs) and behavioral psychologists (57%). The least common included physical therapists (14%). The number of therapies offered varied from 2 to 10 and included pharmacologic therapy (100%), dietary therapy (93%), and psychotherapy (86%), among others. The number of patients seen per clinic session varied (range: <3 to 6) across programs, and 6 programs (43%) assessed outcomes using validated questionnaires. Future studies may evaluate patient outcomes to identify an ideal pediatric DGBI multidisciplinary approach (eg, program composition and therapies offered).

Families of patients aged 3 to 6, evaluated between January and March 2023, were invited to respond to a questionnaire to investigate attitudes toward food in the first years of life. Based on the presence of food selectivity, 2 study groups were compared: 39 selective (42%) and 54 non-selective children (58%). Selective children tended to be less exposed to game activities with food (P < .01), did not show curiosity toward new flavors (P < .01), and presented a diet lacking a group of macronutrients (P < .01). Moreover, selective eaters were more likely to use pacifier and baby bottle (P = .02), to demand something different from what was presented on the dish (P = .04), to be distracted by screens during meals (P = .04). Also, selective children considered mealtime stressful (P < .01) and were forced to eat (P = .03). Finally, selectivity is a frequent reason of discussion between parents on their children nutrition (P = .02).

This feasibility study evaluated the developmental coaching TREE (Talk Read Engage Encourage) program for historically marginalized children ages 0 to 2 years, embedded within pediatric visits, examining if TREE could enhance caregiver-child interactions and increase pediatric resident report of competency and self-efficacy in coaching caregivers. Using a quasi-experimental design, a convenience sample (n = 167 families) was recruited (79 intervention; 88 control). Follow-up data were obtained from 45% of families (38 intervention; 38 control), impacted by COVID-19 attendance. Analyses demonstrated significant increases in self-reported Parent Verbal Responsivity (d = 0.68; 95% confidence interval [CI] = 0.17 to 1.18; P = .009) by intervention group caregivers. Intervention pediatric residents reported significant increases in promoting positive caregiver-child interactions and confidence in conveying child development (d = -.73; 95% CI = -1.21 to -0.22; P = .003). The TREE program is a promising practice that operationalizes promotion of relational health and positive early childhood experiences within pediatric primary care.