Pediatrics最新文献

I. introduction and background: The sudden onset of severe behavioral and neuropsychiatric symptoms in children is a frightening and potentially life-changing situation. The pediatric health care providers and clinicians to whom families turn need guidance on how to accurately diagnose and treat new-onset neuropsychiatric symptoms in children. They need expert guidance about whether these symptoms indicate a diagnosis compatible with pediatric acute-onset neuropsychiatric syndrome (PANS). The cause of PANS is unknown, but it is theorized to be triggered, in some cases, by a recent infection and/or autoimmunity issues (similar to Sydenham chorea, autoimmune encephalitis [AE], and Guillain-Barré syndrome). The condition is challenging from a clinical perspective, because it lacks disease-specific biomarkers, strong evidence for pathogenic causes, and consensus on treatment of clinical symptoms. Further, the evidence base for PANS encompasses multiple subspecialties, including child and adolescent psychiatry, pediatric rheumatology, pediatric neurology, pediatric infectious diseases, pediatric immunology, and developmental-behavioral pediatrics.Given this complexity, there is a clear need for guidance and advice for pediatric clinicians and the families they serve and support. To that end, with the encouragement of the Board of Directors, the American Academy of Pediatrics (AAP) has developed this clinical report. It focuses primarily on PANS, an umbrella condition that encompasses pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Although PANDAS is, by definition, associated with streptococcal infection,1 it is now considered by many to represent a subset of the larger spectrum of infection-induced acute-onset neuropsychiatric symptoms.2,3 This clinical report was developed after a comprehensive literature review and analysis of the findings. Because they are limited by the present level of evidence on the topic, the findings are presented as a report rather than a clinical practice guideline. The contents are intended to aid the pediatric health care provider in evaluating, diagnosing, and treating sudden-onset and severe behavioral changes in children that could indicate potential PANS and in supporting these children and their families.

Context: Children and adolescents with suspected obsessive-compulsive disorder (OCD).

Objective: To estimate the comparative performance of brief diagnostic assessment tools.

Data sources: PubMed, the Cochrane Register of Clinical Trials, the Cochrane Database of Systematic Reviews, Embase, CINAHL, PsycINFO, and ERIC, and for unpublished studies with reported results in ClinicalTrials.gov through May 15, 2024.

Study selection: Studies of children (up to age 21) with a clinical suspicion of OCD that evaluated the accuracy (predictive validity) of brief assessment tools for OCD, compared to a reference standard.

Data extraction/analysis: We extracted participant characteristics, scale and reference standard information, results, and risk of bias assessment. We performed random-effects diagnostic meta-analysis where feasible. We assessed strength of evidence for each scale.

Results: There is moderate strength of evidence that the 8-question version of the Child Behavior Checklist-Obsessive Compulsive subscale is sufficiently sensitive and specific (summary area under the curve of 0.84, 95% CI 0.74 to 0.91) to prompt specialist referral for additional diagnostic assessment. Other tools may perform as well or better, but the current evidence is insufficient to justify broad conclusions about their performance.

Limitations: Few studies per scale, case-control studies, and homogenous White populations may preclude generalizability of tool performance.

Conclusions: Based on the current evidence the CBCL-OCS probably is sufficiently accurate to indicate which youth should be further evaluated for OCD, but further research is needed to establish that the 8-question subscale can function as a stand-alone measure. The available evidence is insufficient for other brief assessment tools.

Context: Treatments for obsessive-compulsive disorder (OCD) in children and adolescents.

Objective: Evaluate the comparative efficacy of behavioral and pharmacologic treatments.

Data sources: Six databases and ClinicalTrials.gov registry; search last updated on 5/15/2024.

Study selection: Dual screening augmented by Abstrackr machine learning algorithm.

Data extraction/analysis: Participant characteristics, intervention details and risk of bias.

Results: 71 randomized controlled trials (RCTs). In the random effects network meta-analysis of OCD symptom severity, assessed by the Children's Yale-Brown Obsessive Compulsive Scale Total (CY-BOCS), exposure and response prevention therapy (ERP) is more effective than waitlist (net mean difference [NMD] -10.5; 95% confidence interval [CI]: -12.6, -8.4) and probably more effective vs. behavioral control (NMD -5.3; 95% CI: -8.0, -2.7). Remote ERP is more effective than waitlist (NMD -9.4; 95% CI: -11.9, -7.0) and as effective as in-person ERP. Selective serotonin reuptake inhibitors (SSRIs) are more effective than placebo (NMD -4.4; 95% CI: -6.1, -2.6). Clomipramine is probably more effective than placebo (NMD -4.5; 95% CI: -6.8, -2.1). ERP is probably more effective than SSRI (NMD -2.7; 95% CI -5.4, -0.0) and combined ERP and an SSRI are probably more effective than SSRI alone (NMD -3.0; 95% CI: -5.1, -1.0). Overall, treatments including ERP (ERP+SSRI, ERP and remote ERP) comprise the 3 highest ranked interventions.

Limitations: Non CY-BOCS outcomes were sparsely reported.

Conclusions: ERP, delivered in-person or via telehealth, SSRIs and clomipramine are all effective treatments. ERP, alone or in combination with an SSRI, is probably more effective than SSRI alone.

Obsessive-compulsive disorder (OCD) is a common and potentially debilitating condition affecting approximately 1%-3% of children and adolescents.1,2 It is characterized by obsessions and/or compulsions that are time-consuming or cause clinically significant distress or impairment in school, social, family, or other important areas of functioning. OCD can have a lasting impact on both academic and social functioning. For instance, engaging in rituals can lead to isolation, tardiness, family conflict, sleep alterations, and procrastination. Children with untreated OCD are also at elevated risk of developing substance use, episodes of depression, suicidal ideation and attempts.

Early literacy promotion in pediatric primary care supports parents and caregivers in reading with their children from birth, offering counseling in interactive, developmentally appropriate strategies and providing developmentally and culturally appropriate and appealing children's books. This technical report reviews the evidence that reading with young children supports language, cognitive, and social-emotional development. Promoting early literacy in pediatric primary care offers a strengths-based strategy to support families in creating positive childhood experiences, which strengthen early relational health. An increasing body of evidence, reviewed in this report, shows that clinic-based literacy promotion, provided with fidelity to an evidence-based model, has benefits for children, for parents and caregivers, and for pediatric physicians and advanced care providers as well. Reading with young children supports early brain development and the neural "reading network," and improves school readiness. High-quality literacy promotion is especially essential for children who face disparities and inequities because of social factors, systemic racism, and socioeconomic risk. All families benefit from high-quality and diverse books and from developmentally appropriate guidance supporting interactions around books and stories. Thus, literacy promotion can be a universal primary prevention strategy to strengthen families and support healthy development. Partnerships at community, local, and state levels offer opportunities for integration with other programs, services, and platforms. Literacy promotion in primary care pediatric practice, recognized by the American Academy of Pediatrics as an essential component since 2014, has become increasingly common. There are successful models for public funding at federal, state, county, and municipal levels, but sustainable funding, including payment to pediatric physicians and advanced care providers, remains a need so that the benefits of pediatric early literacy promotion and the joys of books and shared reading can truly be offered on a population level.

Nearly 1 in 5 families with children in the United States are food insecure. Hospitalization of a child can exacerbate food insecurity, both during the hospitalization and after discharge. Although some hospitals provide free or subsidized meals during hospitalization, few address food insecurity in the immediate posthospitalization period. To address this gap, we developed an innovative Inpatient Food Pharmacy program. This program offers families of hospitalized children experiencing food insecurity a choice of 1 week of prepared meals, 6 months of monthly produce delivery, or both, after discharge. Our goals were to assess program enrollment, understand family preferences, and evaluate the program's feasibility and acceptability. Among 120 eligible families, 71 (59%) enrolled. Fifty-five families (77%) chose both prepared meals and produce delivery, 13 (18%) chose prepared meals only, and 3 (4%) chose produce delivery only. The program successfully delivered 6972 prepared meals and 348 boxes of produce over 10 months. Follow-up calls reached 41 (58%) of enrolled families, all of whom reported that the program met their acute food needs. Feedback from families and resource navigators suggested the program was acceptable. We aim to advocate for sustainable funding for food delivery for children and families experiencing food insecurity at 3 levels (1) institutionally, through our hospital's community benefit spending, (2) statewide, through a proposed Medicaid Section 1115 waiver providing grocery delivery to Medicaid-insured pregnant and postpartum individuals and their families, and (3) federally, through the Special Supplemental Nutrition Program for Women, Infants, and Children and the Supplemental Nutrition Assistance Program.

Background: Strabismus is known to negatively affect patients' self-confidence and ability to interact with society. Strabismus is commonly depicted in animated films marketed to children, potentially influencing the perception of strabismus by young impressionable audiences.

Methods: We reviewed all animated films released by Walt Disney Animation Studios from 1989 to 2022 and all films released by Pixar, DreamWorks, and Studio Ghibli before 2023 and identified all characters with strabismus. Five raters each independently performed a character trait analysis of all characters with strabismus, and a sample proportion test was used for statistical comparison of these traits.

Results: One hundred twenty five movies met inclusion criteria. We identified 46 characters with strabismus, with at least 1 character identified in 33 of the 125 films. These characters were more likely to be portrayed as unintelligent (30%) than intelligent (2%), villains (15%) than heroes (4%), and followers (41%) than leaders (7%). Twenty-six (58%) were either mute or did not speak, 24% were portrayed as frightening, 35% had other physical deformities, and 35% were clumsy. Inter-rater reliability testing demonstrated substantial agreement (Kappa 0.61-0.80) or moderate agreement (κ 0.41-0.60) among raters for most of the character traits.

Conclusions: Characters with strabismus are common in animated films, where they are significantly more likely to be portrayed negatively than positively. These films are marketed to children, and their negative depictions of strabismus likely exacerbate the social stigma faced by children with strabismus.

Drowning is the third leading cause of death from unintentional injury worldwide, accounting for 7% of all injury-related deaths. In the United States, drowning is the leading cause of death in children 1 to 4 years of age and second leading cause of death due to unintentional injury in those aged 5 to 14 years. Drowning generally progresses from initial respiratory arrest due to submersion-related hypoxia to cardiac arrest; thus, it can be challenging to distinguish respiratory arrest from cardiac arrest because pulses are difficult to accurately palpate within the recommended 10-second window. Therefore, resuscitation from cardiac arrest due to this specific circumstance must focus on restoring breathing as much as it does circulation. Resuscitation from drowning may begin with in-water rescue breathing when safely provided by rescuers trained in the technique and should continue with chest compressions, in keeping with basic life support guidelines, once the drowned individual and the rescuer are in a safe environment (eg, dry land, boat). This focused update incorporates systematic reviews from 2021 to 2023 performed by the International Liaison Committee on Resuscitation related to the resuscitation of drowning. These clinical guidelines are the product of a committee of experts representing the American Academy of Pediatrics and the American Heart Association. The writing group reviewed the recent International Liaison Committee on Resuscitation systematic reviews, including updated literature searches, prior guidelines related to resuscitation from cardiac arrest following drowning, and other drowning-related publications from the American Academy of Pediatrics and the American Heart Association. The writing group used these reviews to update its recommendations aimed at resuscitation from cardiac arrest following drowning in children.