Academic Pediatrics最新文献

Objectives: The purpose of this study is to describe dietary restrictions among a sample of breastfeeding women in the United States, focusing on maternal-reported infant reactions to breastmilk, and examine the association between dietary restrictions and breastfeeding continuation.

Methods: A total of 891 women who were <12 months postpartum and had ever breastfed were recruited using Facebook/Instagram from July 2023-February 2024. Using a doubly robust, data-adaptive, nonparametric estimator, we estimated the adjusted association between adopting dietary restrictions and risk of discontinuing breastfeeding in the following month.

Results: About one-sixth of women reported an infant allergy to breastmilk and about 13% restricted their diet while breastfeeding. Dietary restriction (for any reason) was associated with a 4.8 times increased risk of stopping breastfeeding (relative risk (RR): 4.8, 95% CI 2.9, 10.8) within the next month. Among those reporting infant breastmilk allergy, dietary restriction was associated with a 5.7 times increased risk of stopping breastfeeding (RR: 5.7, 95% CI 2.2, 15.2).

Conclusion(s): Food restriction diets are common among some postpartum populations and associated with subsequent increased risk of breastfeeding discontinuation. Given the potential risks of dietary restriction while breastfeeding or postpartum, providers and women should carefully weigh costs and benefits.

Objective: Despite recent progress on breastfeeding indicators in the U.S., breastfeeding remains stigmatized in certain contexts; for example, breastfeeding beyond infancy and breastfeeding in public. The purpose of this study was to assess and identify correlates of attitudes toward breastfeeding in social settings and breastfeeding beyond infancy among U.S. mothers.

Method: In this cross-sectional study, a nationwide sample of U.S. mothers of children between the ages of 1 and 4 years (N=881) completed an online survey. We used multivariable logistic regression to assess associations between sociodemographic and infant feeding intention variables and odds of: 1) low support for breastfeeding in social settings, 2) agreeing it is appropriate to breastfeed a 1-to-2-year-old toddler, and 3) agreeing it is appropriate to breastfeed a 2-to-4-year-old child.

Results: Intention to exclusively formula-feed was associated with low support for breastfeeding in social settings (OR=1.89, 95% CI [1.23, 2.89]) and reduced odds of agreeing it is appropriate to breastfeed a 1-to-2-year-old toddler (OR= 0.32, 95% CI [0.21, 0.50) or 2-to-4-year-old child (OR=0.35, 95% CI [0.20, 0.61). Non-Hispanic Black (NHB) and Hispanic race/ethnicity were associated with increased odds of low support for breastfeeding in social settings (OR=2.20, 95% CI [1.39, 3.47 and OR=1.58, 95% CI [1.05-2.38], respectively). However, Hispanic ethnicity was associated with increased support for breastfeeding a 2-to-4-year old child (OR=1.64, 95% CI [1.07-2.50]).

Conclusions: There are opportunities to shift attitudes toward breastfeeding in public and breastfeeding beyond infancy. Future research should investigate the directionality of the relationship between these attitudes and infant feeding intentions.

Objective: This study aimed to examine the independent and combined effects of screen time and physical activity on flourishing among U.S. children and adolescents in the post-pandemic era.

Methods: This cross-sectional study used existing data from the 2022-2023 National Survey of Children's Health, a nationally representative survey of U.S. children. A total of 47,673 children and adolescents aged 6 to 17 years were included. Multivariate logistic regression models were applied to examine the main effects and interactions between screen time and physical activity on flourishing, adjusting for sociodemographic covariates.

Results: Lower screen time and higher physical activity were each significantly associated with increased odds of flourishing. The interaction analysis revealed a dose-response pattern, where the combination of high physical activity and low screen time yielded the highest odds of flourishing (OR = 4.00, p < 0.001). Even among youths with high screen time, high physical activity remained a strong predictor of flourishing.

Conclusion: This study highlights the association between lifestyle behaviors and the well-being of children and adolescents. Encouraging regular physical activity and managing screen time may help promote flourishing. Because physical activity appears to buffer the negative effects of excessive screen use, fostering an active and balanced routine could support healthy development, even in high-screen-use environments.

Objective: Identify common diagnostic codes for pediatric visits related to caregiver IPV in a healthcare system.

Design/methods: We conducted a secondary analysis of pediatric encounters for IPV-related care at a single urban healthcare system from July 2019 to June 2022. The study included visits to the pediatric emergency department (PED) or child advocacy center (CAC) following a child protective service referral. ICD-10-CM codes associated with each visit were descriptively summarized. We examined the relationship between the site of evaluation and the use of IPV-related diagnostic codes.

Results: Among 92 pediatric encounters (39 in the PED, 53 in the CAC), we identified 174 distinct ICD-10 codes. A majority of encounters, 78 (85%), were associated with IPV-related diagnostic codes, suspected abuse and/or a social concern (e.g., Z63, T74, T76, Z60). CAC encounters were more likely to have IPV-related diagnostic codes when compared to PED evaluations (98% vs 66%, p <0.01).

Discussion and conclusion(s): In the current study, ICD-10 code groups Z63, T74, T76, and Z60 were frequently used to document IPV exposure; however, their use varied significantly between the CAC and the PED. This variability may reflect both uncertainty among healthcare providers regarding documentation practices, along with concerns about the safety of children and caregivers following such disclosure. Additionally, the identified code groups lack specificity for IPV, limiting their effectiveness for systematically identifying such encounters. Given these limitations, ICD-10 codes alone may not constitute a robust mechanism for identifying IPV exposure in pediatric encounters.

Objective: Describe primary care pediatrician knowledge and confidence in caring for children affected by intrauterine opioid exposure (IOE) and neonatal opioid withdrawal syndrome (NOWS) and identify priorities for additional training.

Methods: We conducted a cross-sectional survey at seven U.S. children's hospitals from April-June 2022. Eligible participants were pediatric attendings and pediatric residents practicing in primary care teaching clinics. Survey questions were adapted from prior studies of self-reported clinician knowledge and confidence and assessed clinician interest in additional training on various clinical topics related to IOE and NOWS. Frequencies were tabulated and chi-square comparisons were used to describe differences by demographics, practice setting, and patient population characteristics.

Results: Of 1004 invited clinicians, 329 (32.8%) responses were returned, of whom 324 were included in the final analytic sample. Most respondents (n=203, 62.7%) were residents, while 121 (37.4%) were attendings. One-third endorsed confidence that their training was sufficient to provide high quality primary care to children affected by IOE and NOWS, with no significant difference between residents (32.5%) and attendings (34.0%). Both residents and attendings desire further training in anticipatory guidance topics, such as feeding and gastrointestinal symptoms, breastfeeding recommendations, monitoring after Hepatitis C exposure, and neurodevelopmental outcomes of children with IOE.

Conclusions: Most pediatricians feel that their training has been insufficient to provide high quality primary care to infants affected by maternal opioid use. Additional training in graduate and continuing medical education aligned with pediatrician interest may enhance care for children with IOE and NOWS.

Objective: Identify sources of emotional support among caregivers of children with more complex special health care needs (SHCN) and examine their relationships with caregiver emotional well-being.

Methods: Secondary analysis of the 2016-2022 National Survey of Children's Health. We categorized children by degree of medical complexity: no special health care needs (SHCN), less complex SHCN, and more complex SHCN. Our primary outcome was caregivers' self-reported sources of emotional support. Chi-squared testing compared caregivers' sources of emotional support across child medical complexity levels. Adjusted logistic regression analyses then examined the associations between emotional support sources and our secondary outcomes (caregiver-reported mental health, parental coping, and parental aggravation) among caregivers of children with more complex SHCN.

Results: Compared to caregivers of children with no and less complex SHCN, caregivers of more complex SHCN (weighted n=10.1 million) were significantly less likely (p < 0.01) to report receiving emotional support from a spouse/domestic partner (74.9% vs. 78.9-84.5%) and more likely from a healthcare provider (43.3% vs. 27.8-33.1%), mental health professional (30.1% vs. 7.7-10.3%), advocacy group (13.3% vs. 3.0-4.1%), and peer support group (15.4% vs. 12.4-12.7%). Among caregivers of more complex SHCN, emotional support from a family member/close friend, place of worship/religious leader, and peer support group was associated with significantly lower odds of adverse emotional well-being.

Conclusions: Caregivers of children with more complex SHCN report relying on a wide network of emotional support sources. Enhanced care coordination models should include screening for and connecting families to alternative sources of emotional support as central service.

Background: The pediatric workforce has not achieved representation of diversity that reflects the general US population. Data confirm significant underrepresentation of underrepresented in medicine (URIM) trainees in pediatric subspecialty fellowship programs.

Objectives: We aimed to describe: (1) how program directors leverage data regarding applicants' race and ethnicity in the recruitment process; (2) program strategies to recruit a diverse fellowship class; and (3) perceived barriers and facilitators to the recruitment of a diverse fellowship class.

Methods: In collaboration with the Association of Pediatric Program Directors Subspecialty Pediatrics Investigator Network (APPD SPIN), we conducted a national survey of pediatric subspecialty fellowship program directors (FPDs).

Results: With 516 respondents, FPDs overwhelmingly agreed that diversity in subspecialty trainees is important and that it improves patient care. However, race and ethnicity were identified as a top factor influencing the rank list for fewer than 24% of respondents. FPDs employed several strategies to prioritize diversity in recruitment, but none were perceived as effective by more than 40% of respondents. The most prevalent facilitators for recruiting a diverse fellowship class were institutional culture and addressing diversity with applicants. Key barriers included diversity of the applicant pool and institution faculty.

Conclusions: Diversity in pediatric subspecialty fellowship programs is important to FPDs and is thought to improve patient care. Although strategies are being utilized to recruit URIM fellows, FPDs give only modest ratings to their effectiveness.

Introduction: Mistreatment by patients and families is linked to adverse patient outcomes and physician burnout, and particularly affects women and underrepresented in medicine (UIM) physicians. We sought to explore how this source of mistreatment affects trainee professional identity formation (PIF), a key process in the development of altruistic physicians.

Methods: We conducted this multi-institutional qualitative study between May and October 2023 with semi-structured interviews of pediatric residents. We used the constant comparative method consistent with modified grounded theory to analyze data through a lens of Cruess et al's model of PIF in medicine.

Results: We interviewed 32 pediatric residents and identified four primary themes, which we used to develop a conceptual model. 1) Residents identify patient and family-centered care as core to their professional identity, while acknowledging their vulnerability to mistreatment from patients and families. 2) Mistreatment threatens resident PIF through fractured patient-provider relationships, negative impacts on patient care, and decreased psychological safety of the learning environment. 3) Mistreatment that is frequent, unaddressed, and centered around personal traits is particularly damaging to PIF. 4) Residents employ various strategies to mitigate the negative impacts of mistreatment and ultimately deepen their professional identity.

Conclusions: Mistreatment from patients and families negatively affects pediatric resident well-being, learning, and professional identity, with particular impacts on women and UIM residents. Our study informs ways that institutions can best structure support to navigate mistreatment while optimizing trainee learning and PIF, along with patient care.

Objective: We examined the association between in utero cannabis exposure and well child care (WCC) attendance, emergency department (ED) visits, and developmental delay (DD) diagnosis during the first two years of life.

Methods: Infants with a meconium drug screen conducted between April 1, 2014 and April 30, 2022 were identified from Carolina Data Warehouse and linked with NC Medicaid claims to create a merged dataset. Infants were categorized as cannabis-exposed (meconium positive for cannabis only) or substance-unexposed (meconium negative and urine absent/negative for all substances). The primary outcome was WCC attendance; secondary outcomes were ED encounters and DD in the first two years. Negative binomial and logistic regression were used to examine the association between cannabis exposure and outcomes. DD sub-analysis was conducted over three years.

Results: Among 7,240 infants with a meconium screen, 5,448 infants (75%) were linked to Medicaid. There were 1,671 infants with a meconium screen positive for cannabis only and 2,599 infants negative for all substances. No difference in WCC or ED visits was observed between cannabis-exposed and substance-unexposed infants. There was a decrease in the odds of DD in the first 2 years among cannabis exposed infants and no difference at 3 years.

Conclusions: Compared to those unexposed, Medicaid-insured children who were exposed to cannabis in utero have similar WCC attendance and ED use over the first 2 years and similar developmental outcomes at 3 years.