Academic Pediatrics最新文献

Objective: To describe patterns of social media use, including underage (under 13 years) use and sex differences, in a diverse, national sample of early adolescents in the U.S.

Methods: We analyzed the social media use data in the Adolescent Brain Cognitive Development Study (2019-2021, Year 3), which includes a national sample of early adolescents in the U.S. Specifically, using chi-squared and t-tests, we compared social media use patterns across demographic characteristics stratified by age and sex.

Results: In the sample of 10,092 11-to-15-year-old adolescents, 69.5% had at least one social media account; among social media users, the most common platforms were TikTok (67.1%), YouTube (64.7%), and Instagram (66.0%). A majority (63.8%) of participants under 13 years (minimum age requirement) reported social media use. Under-13 social media users had an average of 3.38 social media accounts, with 68.2% having TikTok accounts and 39.0% saying TikTok was the social media site they used the most. Females reported higher use of TikTok, Snapchat, Instagram, and Pinterest, while males reported higher use of YouTube and Reddit. Additionally, 6.3% of participants with social media accounts reported having a secret social media account hidden from their parents' knowledge.

Conclusion: Our findings reveal a high prevalence rate of underage social media use in early adolescence. These findings can inform current policies and legislation aimed at more robust age verification measures, minimum age requirements, and the enhancement of parental controls on social media. Clinicians can counsel about the potential risks of early adolescent social media use.

What's new: In a sample of 10,092 U.S. early adolescents, a majority (63.8%) of participants under 13 years old (minimum age requirement) reported social media use. Under-13 social media users had an average of 3.38 social media accounts.

Objectives: In children admitted after an out-of-hospital cardiac arrest (OHCA), this study 1) determines the proportion that undergo: physical abuse and toxin exposure evaluation, child protection team (CPT) consultation, and child protective services (CPS) referral, and 2) evaluates the association between demographic, social, clinical characteristics with CPT consultation and CPS referral.

Methods: Retrospective chart review was conducted of children < 4 years old admitted following an OHCA between November 2012 and February 2023. Associations between demographics, caregiver social risk factors, and clinical characteristics with CPT consultation and CPS referral were examined using logistic regression.

Result: Among 157 cases, 70 (45%) had skeletal surveys; eight (11%) identified an occult fracture. Seventy-five (48%) children had toxicology testing; Sixteen of the 75 (21%) revealed a toxic ingestion. Sixteen of the 49 (33%) patients receiving ophthalmologic evaluations had significant retinal hemorrhages. Seventy-seven (49%) patients had a CPT consultation, while 74 (47%) were referred to CPS. A history concerning for ingestion perfectly predicted CPT consultation. History of ingestion, injury on exam, positive skeletal survey, and positive toxicology testing perfectly predicted CPS referral. In multivariate analyses, unsafe sleep history (84% versus 41%, p<0.001) and caregiver social risk factors (82% versus 31%, p<0.001) were associated with CPT consultation, while caregiver social risk factors (70% versus 34%, p<0.001) and normal medical work-up (53% versus 38%, p=0.050) were associated with CPS referral.

Conclusions: Following OHCA, a child maltreatment evaluation may be underutilized with medical decision-making around CPT consultation and CPS referral driven by knowledge of caregiver social risk factors.

Introduction: Shared decision making (SDM) involving adolescents presents unique challenges. To adequately support and evaluate SDM that includes adolescents, parents, and healthcare providers, it is imperative to understand adolescent perspectives. This study aims to describe the perspectives of adolescents with chronic health conditions regarding sharing medical decisions with their parents and healthcare providers.

Methods: Adolescents ages 12-17 years with chronic health conditions participated in semi-structured qualitative interviews via video conference. Interview questions focused on adolescents' decision-making experiences. Additionally, concepts of SDM were explored in depth. Transcribed interviews were coded and thematically analyzed using a combination of inductive and deductive coding.

Results: Sixteen adolescents participated in qualitative interviews (median age 14 years, 62% male, 62% non-white). Analysis of interviews revealed four themes that highlight adolescent perspectives on the process of SDM: defining the adolescent's role and degree of participation in decisions, understanding complex information, sharing the adolescent's unique perspective, and coming to consensus. Adolescents in this study described increasingly active participation in more complex decisions as they gained independence, experience, and understanding of health information. Adolescents discussed the importance of their perspectives being acknowledged in the final decision. They also felt it was important to identify values they have in common with their parents and healthcare providers.

Discussion: Results from this work indicate that adolescents with chronic health conditions experience evolving roles in SDM. These data can be used to tailor and improve SDM to address adolescent needs through active engagement, personalized communication and inclusion of adolescent values.

Microaggressions undermine health professionals' performance in patient care, research, and education. This study aimed to develop and evaluate an intervention addressing microaggressions in healthcare settings by empowering bystanders to act as upstanders across an academic medical center (AMC). This was achieved through an educational intervention that included a novel framework, didactics, video demonstrations, and practice with realistic scenarios. Methods Participants were faculty, trainees, education experts, clinical and administrative staff from a large, urban pediatric AMC. Participants were recruited from 3 training sessions, and taught the "Be Aware" and "ACT" framework, a novel tool for bystanders to use when witnessing microaggressions. Pre-training, retrospective pre-post, and 10-week follow-up surveys evaluated changes in awareness, confidence, and intervention rates. Quantitative analyses were conducted using generalized linear mixed effects models across the 3 surveys to assess participants' changes in confidence. Qualitative analysis used inductive content analysis. Results Among the 205 attendees, 134 (65.4%) completed the pre-training survey. The study cohort (n=108) included those who completed the pre-training survey with either the retrospective pre-post (n=24), 10-week follow-up (n=26), or both (n=58). Participants reported increased confidence in intervening during microaggressions, with confidence rising from 7.5% pre-training to 24.2% at 10-week follow-up (p=0.004). Qualitative analysis revealed a shift from passive response to active intervention, with participants applying the "Be Aware" and "ACT" framework during actual incidents. Conclusions The "Be Aware" and "ACT" framework increased and sustained awareness and confidence in addressing microaggressions. This AMC-wide intervention successfully equipped participants to move from passive bystanders to active upstanders.

Objective: To evaluate the accuracy of extractable electronic health record (EHR) data to define clinician recognition of hypertension in pediatric primary care.

Methods: We used EHR data to perform a cross-sectional study of children aged 3 to 18 years at well-visits in Connecticut from 2018 to 2023 (n = 50,290) that had either 1) incident hypertension (hypertensive blood pressure [BP] at the well-visit and ≥2 prior hypertensive BPs without prior diagnosis of hypertension) or 2) isolated hypertensive BP at the well-visit without necessarily having prior hypertensive BPs. We tested the accuracy of EHR phenotypes to detect recognition of incident hypertension or hypertensive BP using structured elements, including diagnosis codes, problem list entries, number of BP measurements, orders, and follow-up information. The primary outcome of hypertension recognition was determined by chart review.

Results: Among 239 children with incident hypertension and a random sample of 220 children with hypertensive BP, 13% in each sample had clinician recognition of hypertension and hypertensive BP, respectively. An algorithm using International Classification of Diseases, Tenth Revision (ICD-10) encounter diagnosis code, ICD-10 problem list, or multiple BPs during the visit had the highest area under the curve (AUC) for attention to incident hypertension (AUC, 0.84; sensitivity, 71.9%; specificity, 95.7%). Adding follow-up BP information to this algorithm had the highest AUC for attention to hypertensive BP (AUC, 0.85; sensitivity, 75.9%; specificity, 93.2%). For patients with hypertension recognition by chart review, ∼20% had only free text documentation of hypertension without any structured elements.

Conclusions: EHR phenotypes for hypertension recognition have high specificity and moderate sensitivity and may be used in clinician decision support to improve guideline-recommended care.

Objectives: Outpatient follow-up visits are often recommended for children with ambulatory care-sensitive conditions (ACSCs) who are discharged from emergency departments or urgent care centers (acute care settings). We sought to assess whether attending a follow-up visit within 7 days is associated with seeking initial office-based care rather than acute care during a subsequent ACSC illness. Understanding this association is crucial to guide recommendations for routine short-term follow-up visits in children who seek acute care for these common conditions.

Methods: This was a cohort study of Medicaid-insured children younger than 18 years diagnosed with ACSCs and discharged from acute care settings in a multistate claims database in 2017-2019. We used generalized estimating equations to assess the association between a follow-up visit within 7 days and the site of initial care (office vs. acute care) during a subsequent ACSC illness. Models were adjusted for demographics, clinical characteristics, and prior patterns of healthcare utilization.

Results: Among 866,392 acute care visits for ACSCs, 250,578 (28.9%) had an outpatient follow-up visit within 7 days. Follow-up was independently associated with increased odds of initial office-based care rather than initial acute care during the subsequent ACSC illness (adjusted OR [aOR], 1.41, 95% CI, 1.39-1.42).

Conclusions: Outpatient follow-up after acute care visits for ACSCs was associated with increased odds of initial office-based care during the next illness episode. This association may support recommendations for follow-up visits for certain children to promote subsequent utilization of office-based settings during acute illnesses.

Objectives: To describe children with medical complexity (CMC) in Montana according to their clinical characteristics, rurality and distance from specialty care, and to assess for disparities in geographic access to specialty care for American Indian children.

Methods: In this cross-sectional study we categorized children in 2016-2021 Montana Medicaid claims data using the Pediatric Medical Complexity Algorithm and compared the associations of medical complexity and demographic traits using Chi-squared tests. Using a database of providers we calculated drive times from children's residences to the nearest pediatric subspecialist and calculated bootstrap confidence intervals for the difference in median driving distances by complexity and race.

Results: Among 126,873 children, 23% lived in rural areas and 20% were reported as American Indian. In all, 10,766 children (8.5%) had complex chronic conditions (CMC) and 27431 (21.6%) had non-complex chronic conditions. Medical complexity was associated with age, race, ethnicity, sex, CHIP enrollment, disability, and rurality. CMC had shorter median drive times to care than children with noncomplex medical conditions and children without chronic conditions (28 vs 34 and 43 minutes, 95% CI of differences 4-9 and 6-11). At each level of medical complexity, the median distance from care was greater for American Indian children than children of other races.

Conclusions: Although children with medical complexity tend to live closer to specialists than other children, many CMC live far from subspecialty care. American Indian children live farther from specialists than other children, regardless of complexity. Future work should support access to care for rural and American Indian CMC.

Objective: Despite encountering many barriers to inclusion, people with disabilities are entering residency training in increasing numbers. However, the increase in representation among people with physical disabilities remains low, and published case studies and accommodations processes for wheelchair users in pediatric residency are absent in the literature. To support the inclusion of residents with physical disabilities in residency, we outline a proactive approach to the accommodations process and inclusion of a resident with a physical disability in pediatric residency.

Methods: A multidisciplinary team, including residency program leadership, disability professionals, the hospital system, and the resident, developed and implemented reasonable accommodations for a resident wheelchair user entering pediatric residency utilizing an iterative and interactive process.

Results: A pediatric resident wheelchair user completed residency training and specialty requirements utilizing reasonable accommodations.

Conclusions: Early planning and communication regarding necessary accommodations and the presence of an inclusive and supportive learning environment are key components for the successful inclusion of residents with physical disabilities in residency programs.

Background: In 2022, the American Academy of Pediatrics recommended annual social/emotional/behavioral (SEB) screening at preventive pediatric visits. Numerous SEB screeners have considerable empirical support for children of all ages. However, few studies inform the longitudinal use of SEB screeners in pediatrics.

Methods: Using electronic health records (EHR) from seven pediatric clinics in a large hospital system, we analyze the longitudinal stability of three SEB screeners among 9153 children and adolescents who were screened multiple times over a 3-year period, and we evaluate associations with International Classification of Disease (ICD) codes for SEB diagnoses.

Results: Moderate stability was documented for the Baby Pediatric Symptom Checklist (intraclass correlation coefficient [ICC]=.57), Preschool Pediatric Symptom Checklist (ICC=.60), and Pediatric Symptom Checklist-17 (ICC=.69). Stability of positive/negative results was sensitive to each screener's threshold. Across a range of thresholds that classify 7-20% of children as positive, all three screeners achieved positive predictive values (PPVs) of approximately 40-65% and diagnostic odds ratios ranging from 8 to 15. These findings compare favorably to published results for longer measures and structured interviews. Recommended thresholds varied markedly across screeners, and associations with ICD codes demonstrate that higher thresholds yield higher specificity but lower sensitivity (ie, a majority of ICD codes are not anticipated by positive screens).

Conclusions: Three common SEB screeners display longitudinal stability similar to longer, more established measures. Results demonstrate that recommended thresholds vary markedly across measures and that choice of threshold strongly influences sensitivity and specificity, underscoring the need for greater attention to selection of thresholds.

Objective: This study introduces the SEEK Teen Questionnaire, expanding the Safe Environment for Every Kid (SEEK) approach to include adolescent perspectives alongside caregiver responses for dual psychosocial screening. The objective of this study was to triangulate adolescent responses with those of their caregivers to demonstrate the benefits of dual psychosocial screening.

Methods: The SEEK Teen Questionnaire was developed by integrating input from primary care and adolescent medicine professionals, national experts, and adolescent stakeholders. The resulting 32-item psychosocial screening tool was administered to adolescent patients aged 11-18 during well visits simultaneously with caregiver completion of the SEEK Parent Questionnaire from August to October, 2022 with interventions offered for identified problems. Responses were compared using McNemar's and Fisher's exact tests.

Results: Four hundred and eighty caregivers and adolescents consented to the study. Participants were generally white (64%), non-Hispanic (81%), and privately insured (62%). Adolescents had a high completion rate (97%) with concordant responses among matched caregivers between 83% and 96%. Among discordant dyads, adolescents disclosed concerns for their caregivers more commonly than caregivers expressed for themselves: discipline (83% vs. 17%, P<0.001), food insecurity (71% vs. 29%, P=0.09), intimate partner violence (78% vs. 22%, P<0.018), stress (81% vs. 19%, P<0.001), depression (64% vs. 36%, P=0.12), and substance misuse (91% vs. 9%, P<0.001).

Conclusions: This study demonstrates adolescents' willingness to provide insights into their caregivers' well-being and their high awareness of stressors affecting them. Incorporating adolescent perspectives enhances the identification of issues that may otherwise go unnoticed, underscoring the importance of dual psychosocial screening during adolescence.