Journal of Pediatric Health Care最新文献

This case report describes a full-term infant with a cleft palate who experienced malnutrition because of the delayed introduction of a cleft-adapted bottle and identifies potential areas for improvement in clinical practice. The infant's weight for age z-score at birth was 0.05 and dropped to -1.45 by 2 months of age, indicating mild malnutrition. The infant established care with a cleft team and a cleft-adapted bottle was recommended as the primary feeding method. Feeding time subsequently decreased from 60 minutes per feeding to 20 minutes. The infant presented for palate repair at 9 months of age, and his z-score was -0.01, indicating he was no longer malnourished. Cleft-adapted bottles aid in feeding efficiency in infants with cleft palate, which may subsequently impact weight gain. Appropriate weight gain is essential to receive timely cleft palate repair and support healing.

Introduction: The purpose of this study is to explore challenges within the home care system encountered by parental caregivers of children with medical complexity in Massachusetts.

Method: A qualitative descriptive study was completed with 11 parental caregivers interviewed.

Results: Using conventional content analysis of transcripts, three themes emerged: (1) lack of discharge preparedness causes emotional distress, (2) care becomes increasingly complex creating new unanticipated challenges, and (3) psychological toll of parents assuming provider role.

Discussion: Navigating a variety of complex systemic challenges with minimal preparation or support contributes to an overall feeling of parental caregiver burnout. Additionally, mental health supports for parental caregivers are lacking, further exacerbating the negative impact of these challenges. Future work should focus on research, advocacy, and system reform that ensures parental caregivers receive necessary supports to care for children within a sustainable and supportive home care model. Nurses across the profession are in unique position to facilitate this change.

Assessment for autism spectrum disorder (ASD) in the pediatric female population entails unique diagnostic complexities. Females are often misdiagnosed, undiagnosed, or receive an ASD diagnosis at a later age than males. Male bias in ASD, masking behaviors, cultural norms, and overlapping neurodevelopmental comorbidities (such as attention deficit/hyperactivity disorder and intellectual disability) contribute to this phenomenon. The authors present two clinical cases evaluated in an interdisciplinary developmental behavioral pediatrics (DBP) team to highlight these considerations. Cases describe adolescent and school aged females with medical complexity who did not initially appear to have ASD symptoms but later were diagnosed with ASD. Patient anonymity is preserved. Best practice recommendations are discussed. Shared decision making, intentional history taking, thorough observation of behavior and restrictive/repetitive/sensory interests in multiple settings, and attention to social communication in the context of cognitive capacity are essential for ASD assessment in pediatric females.

Introduction: Understanding caregiver willingness to participate in pediatric clinical research is needed. We examined caregiver perceptions of pediatric clinical research during COVID-19 and examined research attitudes and sociodemographic factors as predictors of willingness.

Methods: A cross-sectional telephone survey was administered to caregivers of children from August 2020 to April 2021. We examined caregiver willingness to participate in the following research modalities during COVID-19: telehealth, in-person, and vaccine-focused.

Results: Participants included 600 caregivers (52.8% non-Hispanic White; Child Age M = 9.3 years; 50.0% from rural areas). Caregivers reported more willingness to participate in nonvaccine research (64.0% telehealth, 59.4% face-to-face) compared to vaccine research (22.1%). Different predictors were found for caregivers living in rural and nonrural areas and specific research attitudes predicted willingness.

Discussion: Caregiver willingness to participate in pediatric clinical research during COVID-19 differed by modality and research attitudes predicting willingness differed by geography. Surveillance regarding pediatric vaccine and clinical research hesitancy broadly should continue.

Introduction: Screening for depression in caregivers of children with developmental disabilities is not routine, representing missed opportunities for support.

Method: A quality improvement project was initiated in our pediatric clinic. Root causes of limited screening included unclear guidelines for support, caregiver perception that help is unavailable, and lack of a quick screening tool. A clinical pathway was constructed and integrated into existing practice using quality improvement methodology.

Results: Baseline screening rate was 5%-10%. During the 12-week pilot, weekly rates ranged from 46.0% to 91.0% (mean 70.2%). Monthly rates subsequently averaged 55.0%. Approximately 20% had a positive screen; over half were caregivers of children with autism. About 5% had moderate depression, of whom 40% required referral to social workers.

Discussion: Structured depression screening of caregivers of children with developmental disabilities is feasible and sustainable in a busy clinic. Further research is needed to measure the impact on child and family outcomes.

Background: Uncontrolled pediatric asthma leads to poorer outcomes; school-based telehealth (SBTH) is an opportunity to intervene.

Local problem: The connection rate to primary care after SBTH visits for asthma exacerbations was below organizational goals. Additionally, there was a gap in assessing SBTH's role in providing access to rescue medication.

Method: A 3-month plan-do-study-act design was used to improve SBTH referral rates among SBTH providers. Data was collected via EHR reports and chart reviews.

Interventions: SBTH providers were trained to complete a 3-question checklist on referral orders for all patients treated for an asthma exacerbation.

Results: Chi-square analysis showed a statistically significant increase (p < .001) in the "Connect to PCP" rate, 21% to 71%. Additionally, 86% of eligible participants had access to rescue medication at school, with one-third requiring SBTH to bridge a gap.

Conclusions: PCP connection can be increased; however, automation is needed for sustainability. Additionally, SBTH may increase access to asthma medication.

Introduction: The present study investigated the relationship between screen use and social-emotional problems in preschoolers aged 46 to 72 months from migrant families.

Methods: The parents of 427 children completed the Ages and Stages Questionnaire: Social Emotional II (ASQ: SE II) and the survey on screen use at two time points (T1 and T2) with one-year interval.

Results: There were no significant changes in preschoolers' social-emotional problems and screen use over one year. Preschoolers who exceeded 1 hr per day on screens at T1 increased the risk for social-emotional problems at T2. Those who had parental involvement at T1 reduced the risk for social-emotional problems at T2. Those who viewed educational content at T1 reduced the risk for social-emotional problems between T1 and T2.

Discussion: These findings highlight the protective and risk factors of screen use independently predicted children's social-emotional problems from highly educated migrant families.

Respiratory syncytial virus (RSV) is a common respiratory tract infection that causes bronchiolitis and pneumonia in infants and children. It is the leading cause of hospitalization of infants in the United States. Nirsevimab is a long-acting monoclonal antibody recommended for the prevention of severe disease in all infants under 8 months of age and certain high-risk toddlers. Recent data demonstrate a 90% protection against hospitalization from severe RSV disease for infants who received nirsevimab in their first RSV season. Providers should understand the mechanism of action, safety, efficacy, and prescribing recommendations for nirsevimab, especially when confronted with caregivers who are hesitant about medications and vaccines. Special circumstances may require nuanced prescribing of nirsevimab to safely provide optimal protection. In these circumstances, and during drug shortages, a lens of health equity should be used to protect the highest risk populations.