Pub Date : 2026-01-13DOI: 10.1542/peds.2025-072476
Shelley S Selph,Erika Brodt,Tracy Dana,Andrea C Skelly,Chandler Atchison,Rongwei Fu,Yun Yu,Dakota Riopelle,Shay Stabler Morris,Linda Schmidt,Azrah Ahmed,Leah Williams,Kurt A Freeman
CONTEXTIn childhood and adolescence, disruptive behavior is a common reason for childhood referral to mental health services.OBJECTIVETo determine the most effective psychosocial interventions for disruptive behavior in children and adolescents.DATA SOURCESOvid MEDLINE, the Cochrane Library, PsycINFO, and Embase were searched from 2014 to July 22, 2024.STUDY SELECTIONRandomized controlled trials comparing psychosocial interventions with treatment as usual or waitlist.DATA EXTRACTIONData abstraction, risk of bias, and strength of evidence were completed by 1 reviewer and checked by a second reviewer; disagreements were resolved by consensus.RESULTSSixty-four RCTs in preschool and school-aged children were included in meta-analyses. An additional 20 trials in adolescents were included but could not be pooled. Based on meta-analyses, both parent-only interventions and multicomponent interventions that included a parent, caregiver, or teacher plus a child were associated with reductions in disruptive behavior in preschool (SMD, -0.61 [95% CI, -0.99 to -0.31] and SMD, -0.96 [95% CI, -1.39 to -0.60]) and school-aged (SMD, -0.39 [95% CI, -0.58 to -0.22] and SMD, -0.61 [95% CI, -1.05 to -0.20]) children when assessed immediately posttreatment. Results were less consistent with longer follow-up across interventions.LIMITATIONSThere was substantial heterogeneity across age groups regarding interventions and outcomes, which made drawing definitive conclusions challenging.CONCLUSIONSMulticomponent psychosocial interventions and parent-only psychosocial interventions were better than treatment as usual or waitlist at reducing parent-reported disruptive behaviors for preschool and school-aged children immediately posttreatment. Evidence for long-term outcomes and studies conducted in adolescents was limited.
{"title":"Psychosocial Interventions for Disruptive Behavior in Children and Adolescents: A Meta-analysis.","authors":"Shelley S Selph,Erika Brodt,Tracy Dana,Andrea C Skelly,Chandler Atchison,Rongwei Fu,Yun Yu,Dakota Riopelle,Shay Stabler Morris,Linda Schmidt,Azrah Ahmed,Leah Williams,Kurt A Freeman","doi":"10.1542/peds.2025-072476","DOIUrl":"https://doi.org/10.1542/peds.2025-072476","url":null,"abstract":"CONTEXTIn childhood and adolescence, disruptive behavior is a common reason for childhood referral to mental health services.OBJECTIVETo determine the most effective psychosocial interventions for disruptive behavior in children and adolescents.DATA SOURCESOvid MEDLINE, the Cochrane Library, PsycINFO, and Embase were searched from 2014 to July 22, 2024.STUDY SELECTIONRandomized controlled trials comparing psychosocial interventions with treatment as usual or waitlist.DATA EXTRACTIONData abstraction, risk of bias, and strength of evidence were completed by 1 reviewer and checked by a second reviewer; disagreements were resolved by consensus.RESULTSSixty-four RCTs in preschool and school-aged children were included in meta-analyses. An additional 20 trials in adolescents were included but could not be pooled. Based on meta-analyses, both parent-only interventions and multicomponent interventions that included a parent, caregiver, or teacher plus a child were associated with reductions in disruptive behavior in preschool (SMD, -0.61 [95% CI, -0.99 to -0.31] and SMD, -0.96 [95% CI, -1.39 to -0.60]) and school-aged (SMD, -0.39 [95% CI, -0.58 to -0.22] and SMD, -0.61 [95% CI, -1.05 to -0.20]) children when assessed immediately posttreatment. Results were less consistent with longer follow-up across interventions.LIMITATIONSThere was substantial heterogeneity across age groups regarding interventions and outcomes, which made drawing definitive conclusions challenging.CONCLUSIONSMulticomponent psychosocial interventions and parent-only psychosocial interventions were better than treatment as usual or waitlist at reducing parent-reported disruptive behaviors for preschool and school-aged children immediately posttreatment. Evidence for long-term outcomes and studies conducted in adolescents was limited.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"90 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1542/peds.2024-070582
Nisa S Atigapramoj,Kevan McCarten-Gibbs,Irma T Ugalde,Mohamed Badawy,Pradip P Chaudhari,Kenneth Yen,Paul Ishimine,Allyson C Sage,Donovan Nielsen,Jeffery S Uppermann,Nicole D Kravitz-Wirtz,Daniel J Tancredi,James F Holmes,Nathan Kuppermann
OBJECTIVETo determine whether race or ethnicity is associated with computed tomography (CT) use in children after minor blunt head trauma (BHT) or blunt abdominal trauma (BAT).METHODSThis was a prospective secondary analysis of children (<18 years) with BHT and/or BAT at 6 pediatric trauma centers. Injury severity was assessed using the Pediatric Emergency Care Applied Research Network prediction rules. We performed multivariable logistic regression, controlling for site, age, sex, Social Deprivation Index, and injury severity.RESULTSIn total, 17 339 patients with BHT were enrolled. For patients aged 2 years or older, compared with the reference group (∼85% non-Hispanic white patients), there was no difference in CT use for Hispanic ethnicity (adjusted odds ratio [aOR], 0.96; 95% CI, 0.86-1.08), non-Hispanic Asian (aOR, 1.06; 95% CI, 0.82, 1.37), or Black race (aOR, 1.03; 95% CI, 0.89-1.19). For patients aged younger than 2 years, there was no difference in CT use for Asian (aOR, 1.07; 95% CI, 0.70-1.63) or Black race (aOR, 1.20; 95% CI, 0.89-1.62) but less CT use for Hispanic patients (aOR, 0.75; 95% CI, 0.59-0.96). In all, 6821 patients with BAT were enrolled. Compared with the reference group (∼95% non-Hispanic white), there were no significant differences in CT use for patients who were Asian (aOR, 0.98; 95% CI, 0.68-1.40), Black (aOR, 0.89; 95% CI, 0.73-1.40), or Hispanic (aOR, 0.96; 95% CI, 0.81-1.13).CONCLUSIONSCT use in children with BAT was similar across racial and ethnic groups. However, head CT rates in Hispanic children aged younger than 2 years may reflect disparities in imaging practices.
{"title":"Perceived Race and Ethnicity on CT Use in Children With Minor Head or Abdominal Trauma.","authors":"Nisa S Atigapramoj,Kevan McCarten-Gibbs,Irma T Ugalde,Mohamed Badawy,Pradip P Chaudhari,Kenneth Yen,Paul Ishimine,Allyson C Sage,Donovan Nielsen,Jeffery S Uppermann,Nicole D Kravitz-Wirtz,Daniel J Tancredi,James F Holmes,Nathan Kuppermann","doi":"10.1542/peds.2024-070582","DOIUrl":"https://doi.org/10.1542/peds.2024-070582","url":null,"abstract":"OBJECTIVETo determine whether race or ethnicity is associated with computed tomography (CT) use in children after minor blunt head trauma (BHT) or blunt abdominal trauma (BAT).METHODSThis was a prospective secondary analysis of children (<18 years) with BHT and/or BAT at 6 pediatric trauma centers. Injury severity was assessed using the Pediatric Emergency Care Applied Research Network prediction rules. We performed multivariable logistic regression, controlling for site, age, sex, Social Deprivation Index, and injury severity.RESULTSIn total, 17 339 patients with BHT were enrolled. For patients aged 2 years or older, compared with the reference group (∼85% non-Hispanic white patients), there was no difference in CT use for Hispanic ethnicity (adjusted odds ratio [aOR], 0.96; 95% CI, 0.86-1.08), non-Hispanic Asian (aOR, 1.06; 95% CI, 0.82, 1.37), or Black race (aOR, 1.03; 95% CI, 0.89-1.19). For patients aged younger than 2 years, there was no difference in CT use for Asian (aOR, 1.07; 95% CI, 0.70-1.63) or Black race (aOR, 1.20; 95% CI, 0.89-1.62) but less CT use for Hispanic patients (aOR, 0.75; 95% CI, 0.59-0.96). In all, 6821 patients with BAT were enrolled. Compared with the reference group (∼95% non-Hispanic white), there were no significant differences in CT use for patients who were Asian (aOR, 0.98; 95% CI, 0.68-1.40), Black (aOR, 0.89; 95% CI, 0.73-1.40), or Hispanic (aOR, 0.96; 95% CI, 0.81-1.13).CONCLUSIONSCT use in children with BAT was similar across racial and ethnic groups. However, head CT rates in Hispanic children aged younger than 2 years may reflect disparities in imaging practices.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"144 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1542/peds.2025-073884
Elyse N Portillo,Victoria Hartwell
{"title":"Standardizing Clinical Care to Reduce Disparities.","authors":"Elyse N Portillo,Victoria Hartwell","doi":"10.1542/peds.2025-073884","DOIUrl":"https://doi.org/10.1542/peds.2025-073884","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"82 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1542/peds.2025-073625
Margaret G Parker,Lisa Stellwagen,Emily R Miller,Lawrence Noble,Mark R Corkins,Mark L Hudak, , ,
Mother's own milk (MOM), appropriately fortified, provides optimal nutrition for hospitalized very low birth weight (VLBW [≤1500 g]) infants in the neonatal intensive care unit (NICU) and confers a myriad of other short- and long-term health benefits. Every family of a VLBW infant should receive information about the critical importance of MOM to the health of their infants and receive intensive support throughout the full course of their infant's hospitalization to achieve their personal lactation goals. Provision of pasteurized donor human milk (PDHM) is recommended when MOM is not available, insufficient in volume, or is contraindicated. PDHM should optimally be continued until the infant's risk to develop necrotizing enterocolitis is low (approximately 34-36 weeks' postmenstrual age). Preterm infant formula is recommended when MOM is not available and PDHM is either not available or the family declines use. Promotion of human milk and breastfeeding for VLBW infants requires access to efficient, effective, and comfortable double electric breast pumps in the hospital and at home and multidisciplinary and system-wide adoption of lactation support practices, including early and frequent milk expression, skin-to-skin care (SSC), and direct breastfeeding. Addressing social inequities in provision of human milk at the local level requires access to PDHM, peer lactation support, maximizing use of interpreter services as appropriate, and implementation of standardized approaches to identify and address unmet basic needs.
{"title":"Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant: Clinical Report.","authors":"Margaret G Parker,Lisa Stellwagen,Emily R Miller,Lawrence Noble,Mark R Corkins,Mark L Hudak, , , ","doi":"10.1542/peds.2025-073625","DOIUrl":"https://doi.org/10.1542/peds.2025-073625","url":null,"abstract":"Mother's own milk (MOM), appropriately fortified, provides optimal nutrition for hospitalized very low birth weight (VLBW [≤1500 g]) infants in the neonatal intensive care unit (NICU) and confers a myriad of other short- and long-term health benefits. Every family of a VLBW infant should receive information about the critical importance of MOM to the health of their infants and receive intensive support throughout the full course of their infant's hospitalization to achieve their personal lactation goals. Provision of pasteurized donor human milk (PDHM) is recommended when MOM is not available, insufficient in volume, or is contraindicated. PDHM should optimally be continued until the infant's risk to develop necrotizing enterocolitis is low (approximately 34-36 weeks' postmenstrual age). Preterm infant formula is recommended when MOM is not available and PDHM is either not available or the family declines use. Promotion of human milk and breastfeeding for VLBW infants requires access to efficient, effective, and comfortable double electric breast pumps in the hospital and at home and multidisciplinary and system-wide adoption of lactation support practices, including early and frequent milk expression, skin-to-skin care (SSC), and direct breastfeeding. Addressing social inequities in provision of human milk at the local level requires access to PDHM, peer lactation support, maximizing use of interpreter services as appropriate, and implementation of standardized approaches to identify and address unmet basic needs.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"93 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1542/peds.2025-072913
Robert M Hoffmann,Michael C Monuteaux,Cynthia A Gravel,Isabel Hardee,Susan C Lipsett,Alexander W Hirsch,Kyle A Nelson,Mark I Neuman
BACKGROUND AND OBJECTIVEChest radiographs (CXRs) are often obtained among children presenting to the emergency department (ED) with an asthma exacerbation, despite guidelines recommending against their routine use. The clinical consequences and hospital-level variation of this practice remain unclear. This study's objective was to assess trends, interhospital variation, and factors associated with CXR utilization for asthma exacerbations across US pediatric EDs.METHODSUsing the Pediatric Health Information System (PHIS), we identified ED encounters for children aged 2 to 18 years with asthma between 2016 and 2024. Asthma exacerbations were identified using a combination of a discharge diagnosis code for asthma and receipt of albuterol during the ED encounter. We evaluated CXR trends, patient/hospital-level predictors, and downstream outcomes using multivariable logistic regression models.RESULTSCXRs were obtained in 145 059 children (22.3%). No significant temporal trend in overall CXR use was observed; however, CXR use declined among the subset of children diagnosed with pneumonia. Rates varied widely across hospitals (13.1%-37.7%). Higher CXR use was associated with younger age, female sex, white race, private insurance, and winter presentation. Hospitals with higher imaging rates had more pneumonia diagnoses and 3-day return visits but similar admissions, length of stay, and charges.CONCLUSIONSCXR utilization in pediatric asthma exacerbations is common, highly variable, and linked to increased pneumonia diagnoses and return visits. Persistent low-value imaging suggests hospital-level practices may influence diagnostic labeling and patient outcomes. Targeted interventions, such as decision support and benchmarking, are needed to reduce unnecessary imaging and promote equitable, evidence-based care in pediatric EDs.
{"title":"Trends and Associations of Chest Radiography Utilization in Children With Asthma Exacerbations.","authors":"Robert M Hoffmann,Michael C Monuteaux,Cynthia A Gravel,Isabel Hardee,Susan C Lipsett,Alexander W Hirsch,Kyle A Nelson,Mark I Neuman","doi":"10.1542/peds.2025-072913","DOIUrl":"https://doi.org/10.1542/peds.2025-072913","url":null,"abstract":"BACKGROUND AND OBJECTIVEChest radiographs (CXRs) are often obtained among children presenting to the emergency department (ED) with an asthma exacerbation, despite guidelines recommending against their routine use. The clinical consequences and hospital-level variation of this practice remain unclear. This study's objective was to assess trends, interhospital variation, and factors associated with CXR utilization for asthma exacerbations across US pediatric EDs.METHODSUsing the Pediatric Health Information System (PHIS), we identified ED encounters for children aged 2 to 18 years with asthma between 2016 and 2024. Asthma exacerbations were identified using a combination of a discharge diagnosis code for asthma and receipt of albuterol during the ED encounter. We evaluated CXR trends, patient/hospital-level predictors, and downstream outcomes using multivariable logistic regression models.RESULTSCXRs were obtained in 145 059 children (22.3%). No significant temporal trend in overall CXR use was observed; however, CXR use declined among the subset of children diagnosed with pneumonia. Rates varied widely across hospitals (13.1%-37.7%). Higher CXR use was associated with younger age, female sex, white race, private insurance, and winter presentation. Hospitals with higher imaging rates had more pneumonia diagnoses and 3-day return visits but similar admissions, length of stay, and charges.CONCLUSIONSCXR utilization in pediatric asthma exacerbations is common, highly variable, and linked to increased pneumonia diagnoses and return visits. Persistent low-value imaging suggests hospital-level practices may influence diagnostic labeling and patient outcomes. Targeted interventions, such as decision support and benchmarking, are needed to reduce unnecessary imaging and promote equitable, evidence-based care in pediatric EDs.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"84 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1542/peds.2025-074007
Meredith B Brooks,Silvia S Chiang
{"title":"Opportunities to Improve Outcomes for Children With Tuberculosis.","authors":"Meredith B Brooks,Silvia S Chiang","doi":"10.1542/peds.2025-074007","DOIUrl":"https://doi.org/10.1542/peds.2025-074007","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"29 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1542/peds.2025-072223
Lauren R Brown,Mariette Smith,Cari van Schalkwyk,Leigh F Johnson,Vanessa Mudaly,Erika Mohr-Holland,H Simon Schaaf,James A Seddon,Anneke C Hesseling,James Nuttall,Helena Rabie,Mary-Ann Davies,Andrew Boulle,Karen du Preez
BACKGROUNDPediatric tuberculosis (TB) remains a major public health concern in high-burden settings like the Western Cape (WC), South Africa. We analyzed geographic differences in TB burden among children and young adolescents, described temporal trends, and quantified gaps in the TB care cascade.METHODSWe conducted a population-based descriptive study of pediatric TB episodes recorded in the Provincial Health Data Centre (PHDC) from 2017 to 2023, stratified by 5-year age groups. We assessed HIV status, drug resistance status, microbiological testing, disease classification, place of diagnosis, and TB treatment outcomes. Reporting gaps were estimated by comparing PHDC-recorded episodes with national notifications. Incidence rates of diagnosis were calculated using mid-year population estimates.RESULTSIn 2023, TB incidence rates of diagnosis in the WC were 722.4, 189.1, and 171.2 per 100 000 population for ages 0 to 4, 5 to 9, and 10 to 14 years. Children aged 0 to 4 years accounted for 68.9% of pediatric TB episodes. In the Cape Winelands district in 2023, TB incidence of diagnosis among 0- to 4-year-olds was double that of adults in the district and 2 to 4 times higher than 0- to 4-year-olds in other districts. We found high levels of underreporting (20.6%) and initial loss to follow-up (17.9%) among children and young adolescents diagnosed with TB between 2017 and 2023.CONCLUSIONSOur findings highlight geographic variation in pediatric TB burden in the WC, emphasizing the need to address local drivers to inform targeted interventions. Gaps in the pediatric TB care cascade remain major concerns. Strengthening integrated data systems beyond TB treatment registers could improve surveillance, health system planning, and patient outcomes.
{"title":"Epidemiology of Pediatric Tuberculosis in the Western Cape: A Population-Based Study (2017-2023).","authors":"Lauren R Brown,Mariette Smith,Cari van Schalkwyk,Leigh F Johnson,Vanessa Mudaly,Erika Mohr-Holland,H Simon Schaaf,James A Seddon,Anneke C Hesseling,James Nuttall,Helena Rabie,Mary-Ann Davies,Andrew Boulle,Karen du Preez","doi":"10.1542/peds.2025-072223","DOIUrl":"https://doi.org/10.1542/peds.2025-072223","url":null,"abstract":"BACKGROUNDPediatric tuberculosis (TB) remains a major public health concern in high-burden settings like the Western Cape (WC), South Africa. We analyzed geographic differences in TB burden among children and young adolescents, described temporal trends, and quantified gaps in the TB care cascade.METHODSWe conducted a population-based descriptive study of pediatric TB episodes recorded in the Provincial Health Data Centre (PHDC) from 2017 to 2023, stratified by 5-year age groups. We assessed HIV status, drug resistance status, microbiological testing, disease classification, place of diagnosis, and TB treatment outcomes. Reporting gaps were estimated by comparing PHDC-recorded episodes with national notifications. Incidence rates of diagnosis were calculated using mid-year population estimates.RESULTSIn 2023, TB incidence rates of diagnosis in the WC were 722.4, 189.1, and 171.2 per 100 000 population for ages 0 to 4, 5 to 9, and 10 to 14 years. Children aged 0 to 4 years accounted for 68.9% of pediatric TB episodes. In the Cape Winelands district in 2023, TB incidence of diagnosis among 0- to 4-year-olds was double that of adults in the district and 2 to 4 times higher than 0- to 4-year-olds in other districts. We found high levels of underreporting (20.6%) and initial loss to follow-up (17.9%) among children and young adolescents diagnosed with TB between 2017 and 2023.CONCLUSIONSOur findings highlight geographic variation in pediatric TB burden in the WC, emphasizing the need to address local drivers to inform targeted interventions. Gaps in the pediatric TB care cascade remain major concerns. Strengthening integrated data systems beyond TB treatment registers could improve surveillance, health system planning, and patient outcomes.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"11 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1542/peds.2025-071049
Corinna J Rea,Rachel Sklar,Eli Sprecher,Grace Chi,Alison C Shea,Michael A Beasley,Karameh Kuemmerle,Maria Pearl,Michaela E Nolan,Rebecca Hirsch,Barbara Hernandez,Anthony Dekermanji,Shannon Regan,Alexandra Epee-Bounya,Amy Starmer
BACKGROUND AND OBJECTIVESPediatric concussion is a common condition, yet limited standardization in its evaluation and management within primary care-where most patients initially present-can result in delayed recovery, prolonged symptoms, inconsistent guidance on returning to school and play/sport, and increased disparities in care. We aimed to increase to 70% the proportion of patients with concussion presenting to primary care who (1) completed a standardized concussion symptom scale (PCSS); (2) received educational and instructional materials after the initial visit; and (3) were seen for concussion follow-up within 2 weeks if indicated.METHODSAt 2 hospital-affiliated primary care clinics, we implemented a multidisciplinary process improvement initiative using Plan-Do-Study-Act cycles within the Model for Improvement framework. Interventions included creating a clinical pathway, integrating the PCSS into the electronic medical record, creating a standardized instruction auto-text, and conducting staff education. We monitored monthly screening, education/instruction, and follow-up rates using statistical process control charts. Measures were stratified by patient language, race/ethnicity, and insurance status.RESULTSPCSS use increased from 37% to 85% (1348 total visits), distribution of education/instructions increased from 42% to 83%, and follow-up visit completion improved from 47% to 71%. Notably, disparities based on language and insurance status observed at baseline in PCSS use and distribution of written instructions were attenuated. Emergency department use was unchanged.CONCLUSIONSThis multifaceted interdisciplinary improvement effort standardized concussion evaluation and management in primary care, improving adherence to best practices and reducing disparities. Future work should investigate the impact of care standardization on clinical outcomes and patient recovery.
{"title":"Improving Pediatric Concussion Management in the Primary Care Setting.","authors":"Corinna J Rea,Rachel Sklar,Eli Sprecher,Grace Chi,Alison C Shea,Michael A Beasley,Karameh Kuemmerle,Maria Pearl,Michaela E Nolan,Rebecca Hirsch,Barbara Hernandez,Anthony Dekermanji,Shannon Regan,Alexandra Epee-Bounya,Amy Starmer","doi":"10.1542/peds.2025-071049","DOIUrl":"https://doi.org/10.1542/peds.2025-071049","url":null,"abstract":"BACKGROUND AND OBJECTIVESPediatric concussion is a common condition, yet limited standardization in its evaluation and management within primary care-where most patients initially present-can result in delayed recovery, prolonged symptoms, inconsistent guidance on returning to school and play/sport, and increased disparities in care. We aimed to increase to 70% the proportion of patients with concussion presenting to primary care who (1) completed a standardized concussion symptom scale (PCSS); (2) received educational and instructional materials after the initial visit; and (3) were seen for concussion follow-up within 2 weeks if indicated.METHODSAt 2 hospital-affiliated primary care clinics, we implemented a multidisciplinary process improvement initiative using Plan-Do-Study-Act cycles within the Model for Improvement framework. Interventions included creating a clinical pathway, integrating the PCSS into the electronic medical record, creating a standardized instruction auto-text, and conducting staff education. We monitored monthly screening, education/instruction, and follow-up rates using statistical process control charts. Measures were stratified by patient language, race/ethnicity, and insurance status.RESULTSPCSS use increased from 37% to 85% (1348 total visits), distribution of education/instructions increased from 42% to 83%, and follow-up visit completion improved from 47% to 71%. Notably, disparities based on language and insurance status observed at baseline in PCSS use and distribution of written instructions were attenuated. Emergency department use was unchanged.CONCLUSIONSThis multifaceted interdisciplinary improvement effort standardized concussion evaluation and management in primary care, improving adherence to best practices and reducing disparities. Future work should investigate the impact of care standardization on clinical outcomes and patient recovery.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"25 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1542/peds.2025-072664
Cristina M Gago,Cara F Ruggiero,Anisha Gundewar,Wilhelgyne Rose,Will Escalera Pinet,Ariadne Caballero Gonzalez,Valeria Sanchez,Meghan Perkins,Kate Adams,Jacob Mirsky,Lauren Fiechtner
OBJECTIVEChild-level food insecurity threatens the health and well-being of one-in-three Massachusetts households with children. Federal and charitable nutrition assistance programs are the most important safeguards against food insecurity, but underutilization is common. This qualitative study explored how food pantry users with children leveraged multiple charitable and federal nutrition assistance programs during and since the COVID-19 pandemic to address household food needs and promote child health.METHODSIn 2024, we conducted 26 semistructured virtual interviews in English and Spanish with parents who used a plant-based food pantry incorporated into a community-based, academic medical clinic. Trained qualitative researchers audio-recorded, professionally transcribed, coded, and analyzed transcripts via thematic analysis.RESULTSResources offered through federal and charitable nutrition assistance programs return agency to parents over child diet decisions amidst destabilizing environmental change (eg, inflation and grocery shortages). However, participation in multiple programs is necessary to meet household food needs, and coordination across programs incurs learning, adherence, and psychological costs. Although pandemic-era outreach and policy change temporarily improved multibenefit program enrollment and related diet outcomes for some, many did not benefit from federal efforts, given immigration or income restrictions. Further, the rollback of these reforms threatened food security and the child's diet. Ultimately, charitable food systems filled critical gaps that were unmet by federal programs due to eligibility shortfalls and rollbacks.CONCLUSIONSThe experiences of pantry users with children underscore the need to reinvest in charitable and federal nutrition assistance programs, broaden the eligibility criteria, and alleviate the administrative burden associated with federal nutrition program access.
{"title":"Parent Perspectives on the Interactive Role of Charitable and Federal Nutrition Assistance.","authors":"Cristina M Gago,Cara F Ruggiero,Anisha Gundewar,Wilhelgyne Rose,Will Escalera Pinet,Ariadne Caballero Gonzalez,Valeria Sanchez,Meghan Perkins,Kate Adams,Jacob Mirsky,Lauren Fiechtner","doi":"10.1542/peds.2025-072664","DOIUrl":"https://doi.org/10.1542/peds.2025-072664","url":null,"abstract":"OBJECTIVEChild-level food insecurity threatens the health and well-being of one-in-three Massachusetts households with children. Federal and charitable nutrition assistance programs are the most important safeguards against food insecurity, but underutilization is common. This qualitative study explored how food pantry users with children leveraged multiple charitable and federal nutrition assistance programs during and since the COVID-19 pandemic to address household food needs and promote child health.METHODSIn 2024, we conducted 26 semistructured virtual interviews in English and Spanish with parents who used a plant-based food pantry incorporated into a community-based, academic medical clinic. Trained qualitative researchers audio-recorded, professionally transcribed, coded, and analyzed transcripts via thematic analysis.RESULTSResources offered through federal and charitable nutrition assistance programs return agency to parents over child diet decisions amidst destabilizing environmental change (eg, inflation and grocery shortages). However, participation in multiple programs is necessary to meet household food needs, and coordination across programs incurs learning, adherence, and psychological costs. Although pandemic-era outreach and policy change temporarily improved multibenefit program enrollment and related diet outcomes for some, many did not benefit from federal efforts, given immigration or income restrictions. Further, the rollback of these reforms threatened food security and the child's diet. Ultimately, charitable food systems filled critical gaps that were unmet by federal programs due to eligibility shortfalls and rollbacks.CONCLUSIONSThe experiences of pantry users with children underscore the need to reinvest in charitable and federal nutrition assistance programs, broaden the eligibility criteria, and alleviate the administrative burden associated with federal nutrition program access.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"14 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1542/peds.2025-072174
Johanna Catherine Maclean,Jiaxin Wei,Bradley D Stein,Ezra Golberstein
Paid sick leave (PSL) can be an important determinant of health care use. The United States lacks a federal PSL policy, but some employers have offered PSL benefits voluntarily, and a number of states and localities have mandated PSL benefit provision by employers. Access to PSL among adults has increased over time but less is known about trends in family-level access to PSL, which could impact children. This study documented trends over time in children's access to family-level PSL. We hypothesized that children's access to family-level PSL increased over time. We examined trends in the percentage of children who lived in families with at least 1 working parent in which an employed parent had PSL, using 2010 to 2024 nationally representative National Health Interview Survey data. We found that children gained family-level PSL access over time, with more than three-quarters of children having access to family-level PSL in 2024. However, these gains were not equally experienced across all children, and substantial differences in family-level PSL access existed across populations. Children in the United States have been gaining access to family-level PSL, but some groups, in particular, children of Hispanic ethnicity, have lagged behind other children in terms of access to this benefit.
{"title":"Parental Access to Paid Sick Leave: 2010-2014.","authors":"Johanna Catherine Maclean,Jiaxin Wei,Bradley D Stein,Ezra Golberstein","doi":"10.1542/peds.2025-072174","DOIUrl":"https://doi.org/10.1542/peds.2025-072174","url":null,"abstract":"Paid sick leave (PSL) can be an important determinant of health care use. The United States lacks a federal PSL policy, but some employers have offered PSL benefits voluntarily, and a number of states and localities have mandated PSL benefit provision by employers. Access to PSL among adults has increased over time but less is known about trends in family-level access to PSL, which could impact children. This study documented trends over time in children's access to family-level PSL. We hypothesized that children's access to family-level PSL increased over time. We examined trends in the percentage of children who lived in families with at least 1 working parent in which an employed parent had PSL, using 2010 to 2024 nationally representative National Health Interview Survey data. We found that children gained family-level PSL access over time, with more than three-quarters of children having access to family-level PSL in 2024. However, these gains were not equally experienced across all children, and substantial differences in family-level PSL access existed across populations. Children in the United States have been gaining access to family-level PSL, but some groups, in particular, children of Hispanic ethnicity, have lagged behind other children in terms of access to this benefit.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"30 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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