Journal of Developmental and Behavioral Pediatrics最新文献

Objective: To identify key barriers and facilitators to designing and implementing collaborative care (CC) for children with developmental disabilities (DD) in safety-net primary care.

Methods: This pre-implementation qualitative study involved semi-structured interviews with safety-net primary care leaders. Using purposive and respondent-driven sampling, interviews were conducted with 16 leaders across 9 safety-net organizations in Northern California between August 2024 and January 2025. Key Consolidated Framework for Implementation Research (CFIR) constructs guided data collection. Data were analyzed using the Rapid Assessment Process and validated through structured member checking.

Results: Leaders from 8 of 9 organizations reported existing integrated behavioral health programs staffed by mental health counselors and/or psychiatrists, but nearly all noted that these programs did not address the specific needs of children with DD. When asked about developing a CC intervention for this population, leaders identified implementation barriers and facilitators that mapped to CFIR inner and outer setting domains. Four themes were distilled: inner setting barriers (space and cost), inner setting facilitators (perceived clinical need among leadership), outer setting barriers (restrictive Medicaid reimbursement policies and limited performance measurement pressure), and outer setting facilitators (alternative financing mechanisms).

Conclusion: Safety-net leaders indicate a clinical need for CC models specifically for children with DD, but implementation success will depend on addressing space, financing, and policy barriers through targeted implementation strategies.

Aim: This study was conducted to investigate the effects of skin-to-skin contact between newborns born by cesarean section and their fathers on the newborns' physiological parameters, salivary cortisol levels, and comfort.

Materials and methods: In this study, which used a randomized controlled experimental design, 80 healthy term newborns delivered by cesarean section. In the intervention group, the fathers applied skin-to-skin contact (SSC) for 45 minutes to their newborns. In the control group, the newborns received routine care. Data were collected using a parent descriptive information form, newborn descriptive information form, (SSC) monitoring form, and Neonatal Comfort Behavior Scale|Newborn Comfort Behavior Scale. Body temperature, oxygen saturation, heart rate, and respiration were measured, and salivary cortisol analysis was performed.

Results: No significant differences were found regarding the sociodemographic characteristics in the intervention and control groups. Body temperature was significantly higher during (20th minute) and after (45th minute) SSC, whereas heart and respiratory rates were significantly lower in newborns in the intervention group than those in the control group. The 45-minute SPO2 values and comfort levels of the intervention group newborns were also significantly higher than those of the control group newborns. The salivary cortisol level was significantly higher in the intervention group at the 20th minute, but there was no significant difference between the groups at the 45th minute.

Conclusion: Paternal SSC with newborns has positive effect on physiological parameters and patient comfort. However, it is recommended that salivary cortisol levels be studied in larger samples with repeated and long-term measurements.

Objective: Supporting early relational health (ERH) positively affects lifelong health. We investigated perspectives of low-income parents of preterm children regarding child factors and parenting behaviors (defined as responsive parenting, structure/routines, and warm parent-child relationship) associated with ERH and factors associated with these behaviors.

Methods: We conducted in-depth, semi-structured interviews with low-income parents of children born preterm between Neonatal Intensive Care Unit (NICU) discharge and age 3 years. We examined perceptions of ERH and used the PRECEDE framework to identify predisposing, enabling, and reinforcing factors affecting parenting behaviors associated with ERH. We developed codes and themes iteratively using a deductive qualitative approach.

Results: We interviewed 22 parents of children born 24 to 34 weeks' gestation at 1 to 35 months corrected age. Regarding perspectives on ERH, parents shared that the NICU hospitalization heightens attention to children after discharge and that they feel an intense, sometimes overwhelming, bond with children born preterm. Parents both make accommodations for their preterm children and treat them the same as children born full term. Medical vulnerability affects how they spend time with their children. Regarding predisposing, enabling, and reinforcing factors of parenting behaviors associated with ERH, parents noted that developmental professionals can support relationships, that perceptions of preterm birth affect parents' relationships with their children, and that prior experience parenting preterm and full-term children affects confidence and knowledge of how to form relationships.

Conclusion: Adaptation of existing ERH interventions should incorporate ways that NICU hospitalization and views of prematurity inform low-income parents' perceptions and use of parenting behaviors associated with ERH.

Objective: Children born very preterm (VPT) are vulnerable to academic challenges; however, it remains unclear whether these difficulties persist into early adolescence. This study aimed to investigate rates of academic impairment in children born VPT and full-term, and impairment stability from 7 to 13 years in children born VPT using 2 approaches: academic underachievement and IQ-achievement discrepancy.

Method: Participants were children born <30 weeks' gestational age and/or <1250 g and full-term (≥37 weeks' gestational age) assessed at 7 (VPT n = 197, full-term n = 69) and 13 years (VPT n = 179, full-term n = 61) on general cognitive ability (WASI-4 and KBIT-2), word reading, spelling, and mathematics (WRAT-4).

Results: Using an underachievement approach, children born VPT were more likely to have an academic impairment at ages 7 and 13 years compared with term-born controls, particularly in reading (odds ratio [OR] and confidence interval [CI] at 7 years: 3.72 [1.67-8.27], at 13 years: 2.55 [1.06-6.11]) and mathematics (OR [CI] at 7 years: 5.77 [2.51-13.25], at 13 years: 2.78 [1.36-5.69]). Rates of impairment were low for both groups using an IQ-achievement discrepancy approach, although a group difference was evident for mathematics impairment at 7 years (OR [CI] 5.94 [1.37-25.8]), with higher rates in the VPT group (15% vs 3%). Rates of academic impairment remained relatively stable between 7 and 13 years of age, regardless of the approach applied.

Conclusion: The rate of academic impairment varies depending on the approach used to classify impairment. Our findings suggest that academic difficulties in children born VPT may reflect a general cognitive impairment rather than a specific academic deficit.

Objective: The Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4), which was released in 2019, received updated normative data in 2023, raising concerns about potential score shifts in previously collected data. This study examined whether developmental interpretations based on the original versus revised norms differ within a cohort of medically complex children.

Method: Scores from 61 children assessed with the Bayley-4 before revised norms were released were used in this study. Frequency of changes in results across Standard Scores at the composite level (cognitive, language, motor) and paired samples t tests of original and new Standard Scores sets were analyzed.

Results: Score changes witnessed went beyond the publisher's descriptions that resulted in increases and decreases throughout several descriptive classifications that are used for clinical interpretation. Of the 3 domains analyzed, language scores showed a minor but statistically significant increase between sample sets (p < 0.01), whereas motor and cognitive scores showed no significant difference (p > 0.05). Only 1 change between original and revised scores in the motor domain resulted in a different descriptive classification.

Conclusion: Although many of the revised scores on the Bayley-4 yielded minor differences, unanticipated changes were observed such as score decreases, classification change, and notable differences in mean language scores. Because of these discrepancies, researchers and clinicians using the Bayley-4 during 2019 to 2023 should consider re-evaluating scores.

Objective: Children with autism may be more likely to experience challenges and adverse effects from digital media use; however, prior work has not qualitatively examined children's and caregivers' experiences. Among caregivers and school-age children with autism, we aim to qualitatively examine the context, content, and function of digital media use, behavioral strategies, and challenges navigating digital media.

Methods: Caregivers of school-aged children with autism (aged 6-11 years) completed questionnaires on demographic information, child characteristics, and digital media habits. A total of 22 caregivers and 10 children with autism participated in qualitative interviews by Zoom. Questions probed for family experiences, challenges, and digital media strategies. A multidisciplinary team used interview transcripts to conduct an inductive thematic analysis.

Results: Children with autism in the study had an average of 4.3 hours of screen media use daily; 68.2% had their own tablet and 27.3% had their own mobile device. We identified 7 themes: Wired World (children are exposed to digital media across settings), Diving Deep and Building Skills (children use media to learn and delve into interests), Retreat/Relief from Reality (digital media is less stressful than other tasks), No Size Fits All (caregivers used diverse strategies), Societal Blame and Parental Shame (caregivers expressed internalized guilt around children's media use), The Digital Dark Side (concerns about inappropriate content and privacy), and The Double Edged Sword (digital media comes with both benefits and challenges).

Conclusion: Results from this study emphasize the need for individualized guidance, flexibility, and understanding of digital media's functional role in families of children with autism.

Objective: To evaluate the impact of a national career exploration program, Exploring DBP, on trainee interest in pursuing exploring developmental-behavioral pediatrics (DBP) fellowship, and to describe participant demographics, knowledge gains, and perceived barriers to entering the field.

Method: Presurvey and postsurvey results were analyzed from the program's 2019 to 2023 cohorts assessing demographics, DBP knowledge, program satisfaction, and likelihood to apply for fellowship. Data were analyzed descriptively. Qualitative responses were analyzed to explore career decision factors.

Results: From 2019 to 2023, 239 participants completed the program (50.1% residents, 44.8% medical students, and 5.0% general pediatricians). The cohort had greater representation of trainees from ethnically diverse backgrounds compared with national averages (e.g., 26.6% Hispanic vs 7%-9%). Participants consistently rated mentorship and personal stories from DBP professionals as the most valuable program components. After the program, the proportion of participants who were "likely" or "very likely" to apply for a DBP fellowship rose from 46% to 79%. Key reported barriers to pursuing fellowship included inadequate compensation, training length, student loan burden, and competing interest in fields such as child psychiatry or neurology. A 2022 follow-up survey found that 41% of eligible early participants had successfully matched into a DBP fellowship program.

Conclusion: The program effectively increased knowledge and interest in pursuing a DBP career. Structured early exposure may support recruitment into undersubscribed pediatric subspecialties.

Objective: The Survey of Well-being of Young Children (SWYC) supports developmental screening at well-child visits. However, a US Preventive Services Task Force report suggests insufficient evidence for this approach for speech-language delay identification. The objective of this study was to determine associations between SWYC use and score at 24-month visits and timing of speech-language delay diagnoses and whether timing differed by sociodemographic characteristics.

Methods: Using electronic health records of 7,198 children born January 2016-December 2020 in a mid-sized health care system, we fit Kaplan-Meier survival curves for time to speech-language delay diagnosis based on SWYC use and score. Cox proportional hazards time-to-event analyses were run, and interactions between SWYC use and score and sociodemographics were assessed.

Results: Fifty percent received the SWYC, with use increasing during the study period with no sociodemographic differences detected. While SWYC use had no association with diagnosis (hazard ratio: 0.986, 95% confidence interval: 0.856-1.1136), lower SWYC scores (indicating greater developmental concern) were associated with higher likelihood of diagnosis (hazard ratio: 0.114, 95% confidence interval: 0.095-0.137). Interactions between scores and diagnostic timing by payer type and race/ethnicity were detected. Boys, publicly insured children, and those with lower SWYC scores were more likely to receive a speech-language delay diagnosis at their 24-month visit.

Conclusion: While clinicians likely rely on clinical judgement to identify delays, results suggest the SWYC is associated with speech-language delay identification. The ability of the SWYC to identify speech-language delay was moderated by insurance and race/ethnicity, warranting further study of factors shaping diagnostic decision-making.