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Objective: To assess the effect of Passy-Muir® Valve (PMV) tolerance on respiratory illness and respiratory related hospital admissions in tracheostomy-dependent children. Methods: Retrospective cohort study of 262 patients who underwent tracheostomy placement between 2012 and 2018 at a tertiary free-standing children’s hospital. Outcome measures studied were number of reported upper respiratory infections and respiratory related hospitalizations per year (RRH/year). Results: About 135 (51.5%) tracheostomy-dependent children underwent PMV trials, and 106 (78.5%) of these children were able to tolerate PMV for at least 1 hour daily. When comparing children who tolerated PMV versus those who did not, the latter group had significantly higher rates of subglottic stenosis but no significant differences in RRH/year or average age. In those children who tolerated PMV and achieved routine use of PMV > 1 hour/day, an average of 1.14 RRH/year occurred prior to PMV tolerance, as compared with 0.57 RRH/year after PMV tolerance ( P = .003). Multivariate analysis shows that in patients Conclusion: In tracheostomy-dependent children who tolerate PMV use routinely >1 hour/day there are decreased rates of respiratory related hospitalizations (RRH). Children

1. Emily E. Wikner, BA* 2. Collin F. Mulcahy, MD†,‡ 3. Lyuba Gitman, MD‡ 4. Pamela A. Mudd, MD, MBA‡ 1. *School of Medicine and Health Sciences, 2. †Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, George Washington University, Washington, DC 3. ‡Department of Pediatric Otolaryngology, Children’s National Medical Center, Washington, DC A 15-year-old otherwise healthy boy presents to plastic surgery clinic with a 1-year history of a painless, but enlarging submental neck mass. He denies pain, odynophagia, dysphagia, or change in size or movement of the mass while eating. The patient undergoes a neck and thyroid ultrasound, which reveals a heterogeneous soft tissue focus in the submental triangle (level 1A of the neck), as well as unusual hypoechoic, elongated tissue situated posterior to the left lobe of the thyroid of unclear etiology. The patient then presents to the Pediatric Otolaryngologic clinic at our institution. Physical examination reveals a firm, nontender, 3-cm submental mass without any other palpable lymphadenopathy. His trachea is midline, he has full neck range of motion, and there are no visible or palpable abnormalities of his thyroid gland. Additionally, the patient’s floor of mouth is soft to palpation without any evidence of mass or abnormality. A computed tomography scan soft tissue neck with contrast is obtained (Fig 1), which reveals a left submental soft tissue mass that was well-circumscribed, isodense, measuring 2.7 × 1.5 × 1.9 cm. There is no extension or invasion into adjacent structures, and there are no abnormalities in the retro-esophageal area, or thyroid lesions or abnormalities. Figure 1. (Left) Axial slice of computed tomography (CT) scan soft tissue neck with contrast demonstrating a well-circumscribed lesion …

Background. Despite evidence that social network members influence the eating behaviors of adults, no study to date has had the primary aim of examining children as support partners for parents in a weight loss intervention. Aim. To evaluate parent adherence with eating/exercise goals and weight loss in a 6-month study engaging children as support partners. Method. Adults with obesity (body mass index ≥ 30 kg/m2, n = 102) and at least one child ≥12 years were randomized to a child support or control group. In the child support group, children enrolled with their parent and engaged in a supportive behavior 2 days/week. In the control group, there was no enrolled child support. Parents in both groups selected a healthy eating strategy and daily step goal. Results. There was no difference in weight loss between the child support and control groups (−5.97 vs. −5.42 lbs, p = .81). In the child support group, 30% of children did not engage in the study. The majority of parents whose children did not engage withdrew from the study. In secondary analyses, parent adherence with eating/exercise goals increased with the days of child support ( p < .001). For all participants, low chaos in the home environment ( p < .04) and increased parent adherence with follow-ups ( p < .008) predicted weight loss. Conclusions. We found no treatment effect of child support on weight loss. Active child support of eating/exercise goals appeared to facilitate goal adherence, while anticipated but unrealized child support may have had iatrogenic consequences. Further investigation of family-focused weight loss interventions is warranted.