Search

Given the rising prevalence of pediatric obesity, new approaches to the delivery of targeted nutrition counseling to not only prevent but also treat pediatric obesity are needed. The integration of a dietitian virtually was a successful quality improvement measure in this academic pediatric primary care clinic. The virtual dietitian provided age-appropriate nutrition counseling at well-child visits from 9 months to 6 years of age. Dietary counseling was also provided for children with overweight and obesity regardless of age. Vegetable, fruit, snack, and dairy intake was assessed in children who received counseling versus those who had traditional well childcare. Improved dairy habits were noted in the counseling cohort. A decrease in body mass index was not demonstrated in the patients with obesity or overweight; however, patient and provider satisfaction was quite high with this novel quality improvement measure. Virtual nutrition counseling can be easily integrated to facilitate a comprehensive pediatric medical home. [ABSTRACT FROM AUTHOR]

Over the last decade, there have been widespread efforts to reduce non-evidence-based therapies for viral bronchiolitis. We question whether this change in practice has inadvertently impacted the diagnosis and management of other pediatric lower-respiratory-tract illnesses. We used the Pediatric Health Information System (PHIS) and logistic regression to describe trends in relative diagnosis frequency of bronchiolitis, viral pneumonia, and reactive airway disease (RAD)/asthma as well as systemic corticosteroid use among children of the age range 1 to 4 years over a 10-year period. Among 169,207 children, the relative frequency of asthma/RAD diagnoses declined over a 10-year period, while bronchiolitis and viral pneumonia diagnoses increased among children of the age range 1 to 3 years and 2 to 4 years, respectively. Frequency of systemic corticosteroid use declined. We question whether the observed shift in diagnosis from asthma/RAD to bronchiolitis or viral pneumonia is reflective of true disease pathophysiology or if it represents an unintended consequence of campaigns surrounding bronchiolitis. [ABSTRACT FROM AUTHOR]

Marching band is both a sport and a performance art. Organized athletics like American football, soccer, and cheerleading all have established epidemiologic trends of injury, including stigmata from head trauma. Despite the potential for mild to severe injury, there is a paucity of data on marching band-related morbidity. We examined the National Electronic Injury Surveillance System from 2012 to 2021 to describe demographic information and injury patterns. There were an estimated 20 335 marching band injuries (95% confidence interval: 12 892-27 777). The majority of injuries occurred in females (70%), and those aged 14 to 18 years (85%). Fifty percent of all injuries occurred in the lower extremity, and soft tissue injuries were the most frequently observed diagnosis (49%). Mild traumatic brain injury accounted for 6% of all injuries. Of marching band injury, 98% did not require escalation of care. Based on these findings, we suggest targeted public health intervention by sports medicine teams. [ABSTRACT FROM AUTHOR]

There is still no evidence-based guideline and consensus on the treatment Sydenham's Chorea (SC). The first-line medication preference of specialists depends on personal experience and is variable. In this study, we evaluate the treatment results of pediatric patients who were treated with valproic acid (VPA). The medical records of 17 patients diagnosed with SC were reviewed retrospectively. The mean time to clinical improvement was found as approximately 5 days, the mean duration of remission as 13.60 ± 3.94 weeks and the mean duration of medication use was found as 17.96 ± 3.81 weeks. No side effects were observed in any of the patients and relapse occurred in 2 patients. A positive correlation was found between the initial C-reactive protein (CRP) level and the duration of medication use. Until evidence-based guidelines are established, VPA can be used as an effective, safe, and inexpensive first-line treatment option, especially in pediatric patients. [ABSTRACT FROM AUTHOR]

For pediatric patients with cancer, a healthy lifestyle is important for treatment outcomes and beyond. General pediatricians play a major role in the care of these patients, particularly given the improved rates of survival. Pediatric obesity has many negative consequences, but it is an area where primary care providers can make an impact and provide support to childhood cancer survivors. To provide the best quality of care for this population, there must be collaboration between primary care and oncology providers. Additionally, general practioners should feel empowered to offer standard nutrition and physical activity recommendations to all childhood cancer survivors. For pediatric patients who carry a cancer diagnosis, cure is no longer the only goal. Pediatric providers across specialties need to work as a team to improve long-term quality of life for these patients, starting with modifiable healthy habits. [ABSTRACT FROM AUTHOR]

Human parechovirus is a relatively lesser known virus that has recently spread across the United States, primarily affecting newborns and young infants. A particular strain of parechovirus, PeV-A3, has been found in the cerebrospinal fluid studies of many young patients in the spring and summer of 2022; however, short- and long-term neurologic effects of this virus are often not well known. We present a case series of 4 infants, 60 days of age or younger, found to have human parechovirus meningitis. Our retrospective study found that none of the 4 infants presented with any significant neurological findings, nor did they develop any specific neurologic signs or symptoms during their hospitalizations. Patients should continue to be monitored for long-term neurological and neurodevelopmental sequelae. [ABSTRACT FROM AUTHOR]

Controversy exists over the use of electrocardiograms (ECGs) in sports pre-participation screening. We performed a meta-analysis comparing the effectiveness of history and physical examination (H&P) with ECG at detecting both cardiac disease and sudden cardiac death–associated conditions (SCD-AC). Pre-participation studies published from 2015 to 2020 with athletes 10 to 35 years old were included. This yielded 28 011 athletes screened and 124 cardiac diagnoses, 103 of which were SCD-AC. A meta-analysis of log odds ratios (ORs) was conducted using a random-effects model. The ORs for the association between H&P and detecting both cardiac disease and SCD-AC were not statistically significant (OR = 3.4, P =.076; OR = 2.9, P =.078). The ORs for the association between ECG and detecting both cardiac disease and SCD-AC were statistically significant (60, P <.001; 148, P <.0001). In conclusion, the odds of detecting both cardiac disease and conditions related to SCD with ECG are greater than with H&P during sports pre-participation screening. [ABSTRACT FROM AUTHOR]

Some children and young people (CYP) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) experience persistent symptoms, commonly called "long COVID." It remains unclear whether symptoms of SARS-CoV-2 persist longer than those of other respiratory viruses, particularly in young children. This cross-sectional study involved 372 CYP (0-15 years) tested for SARS-CoV-2. Character and duration of symptoms (cough, runny nose, sore throat, rash, diarrhea, vomiting, sore muscles, fatigue, fever, loss of smell) were compared between CYP with a positive test (n = 100) and those with a negative test (n = 272), while controlling for medical/demographic covariates. The average duration of symptoms for CYP with a positive SARS-CoV-2 test (8.5 ± 10 days) did not differ from that of CYP with a negative test (7.2 ± 5 days, P =.71, d = 0.046). A positive SARS-CoV-2 test did not increase the risk (36/372, 10%) of symptoms persisting for ≥3 weeks (odds ratio = 0.96, 95% confidence interval = 0.45-2.0). These results suggest CYP with non-SARS-CoV-2 infections experience a similar duration of symptoms as peers with SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

While autism spectrum disorder (ASD) has traditionally been diagnosed in specialty care, rising prevalence rates have strained specialist capacity and created significant diagnostic bottlenecks. With long wait times for specialist evaluations, pediatricians are increasingly being asked to play a greater role in identifying, diagnosing, and managing ASD within the medical home. In this commentary we draw parallels between the challenges pediatricians faced two decades ago learning how to manage pediatric asthma in the medical home, to those faced today in the field of primary care ASD management. Reflecting on the lessons learnt in primary care asthma management may help us construct a roadmap towards a higher and more consistent standard of ASD primary care for patients and their families. [ABSTRACT FROM AUTHOR]

Severe pediatric influenza outcomes disproportionately affect racial minority groups, yet flu vaccination rates are often lower in these populations. Community Engagement Studios were conducted among parents/caregivers who refused flu vaccination for their children to discuss vaccination decision-making. A pilot program, Mobile Flu Fighter!, was created for pediatric patients in Nashville, Tennessee, and 4 events were conducted during the 2021 to 2022 flu season. Events provided free flu vaccines to all eligible children (aged 6 months to <18 years old), recorded vaccinations in electronic medical records and the state vaccine registry, and incorporated community partners. Events resulted in 49 pediatric flu vaccinations. Patient flu vaccination rates were compared with previous seasons, which resulted in an overall decrease in 2.9% to 3.5%. The decrease may be influenced by factors like COVID-19 vaccine hesitancy, vaccine infodemics, and not employing family-centered approaches. More work is necessary to reduce pediatric vaccination disparities. [ABSTRACT FROM AUTHOR]

Severe pediatric influenza outcomes disproportionately affect racial minority groups, yet flu vaccination rates are often lower in these populations. Community Engagement Studios were conducted among parents/caregivers who refused flu vaccination for their children to discuss vaccination decision-making. A pilot program, Mobile Flu Fighter! , was created for pediatric patients in Nashville, Tennessee, and 4 events were conducted during the 2021 to 2022 flu season. Events provided free flu vaccines to all eligible children (aged 6 months to < 18 years old), recorded vaccinations in electronic medical records and the state vaccine registry, and incorporated community partners. Events resulted in 49 pediatric flu vaccinations. Patient flu vaccination rates were compared with previous seasons, which resulted in an overall decrease in 2.9% to 3.5%. The decrease may be influenced by factors like COVID-19 vaccine hesitancy, vaccine infodemics, and not employing family-centered approaches. More work is necessary to reduce pediatric vaccination disparities., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr EW became employed by Pzifer Inc after the completion of the Mobile Flu Fighter! events. Pzifer Inc did not contribute in any way to this publication or funding.

Penicillin allergy knowledge has not been evaluated specifically in the pediatric resident population. An anonymous electronic survey was distributed to all the pediatric residents in a single residency program to ascertain knowledge of penicillin allergies and allergy history taking skills. Responses among each resident class were compared using the Fisher exact test, 2-tailed. A total of 46 (52%) of 88 pediatric residents completed the survey. Only 63% reported to have had prior penicillin allergy education. All residents incorrectly identified low-risk symptoms as high-risk symptoms. The knowledge of penicillin allergy was poor across all training levels with no improvement over the duration of training. There is large support in the literature for de-labeling penicillin allergy in patients. Pediatric residents evaluate patients in childhood when most of the allergy labeling occurs. We need to consider strategies for incorporating penicillin allergy education in pediatric residency training. [ABSTRACT FROM AUTHOR]

Pharyngitis is commonly diagnosed in the emergency department (ED) and accounts for substantial antibiotic burden in pediatrics. This study describes ED patterns of group A streptococcal (GAS) pharyngitis diagnosis and antibiotic prescribing patterns. This was a secondary data analysis of the National Hospital Ambulatory Medical Care Survey. Diagnosis and antibiotic treatment for GAS and non-GAS (viral) pharyngitis were reported in all ages and specifically examined in children <3 years of age from 2010 to 2015. GAS pharyngitis was diagnosed in 29% of visits for children with pharyngitis; however, 60% of patients with any pharyngitis received antibiotics. Twenty percent of children <3 years were diagnosed with GAS pharyngitis, yet over half were given antibiotics. Broad-spectrum antibiotics were commonly prescribed. Antibiotic treatment of pharyngitis, including broad-spectrum antibiotics, remains high when compared with the known prevalence of GAS pharyngitis. Diagnosis and treatment of GAS pharyngitis in patients <3 years persists despite recommendations against testing. [ABSTRACT FROM AUTHOR]

Background. Observation is necessary following racemic epinephrine (RE) for patients with croup. The ideal length of this observation period is unclear. Objective. To compare the rate of failed outpatient management utilizing different observation times after RE administration for croup. Methods. We performed a retrospective chart review of children with croup who required RE. Failure of treatment was defined as requiring a second RE treatment and/ or returning to the pediatric emergency department for croup symptoms within 24 hours of discharge. Results. The primary analysis considered patients observed between 2.1 and 3 hours compared with those observed for 3.1 to 4 hours. The patients in the 2.1- to 3-hour group had a higher rate of treatment failure (16.7% vs 7.1%, OR = 2.44, P < .01). Conclusions. Patients requiring RE for croup are more likely to have treatment failure if observed for between 2.1 and 3 hours as opposed to 3.1 to 4 hours. [ABSTRACT FROM AUTHOR]

This study sought to determine the nutritional quality of snacks and beverages provided at licensed daycare centers of variable sizes in Southeastern Virginia. This cross-sectional study employed self-report surveys about snack offerings administered at each daycare site that agreed to participate. In addition, researchers completed an observation survey on the day of visit to observe and document the food and beverages actually served at snack time. Although many daycare directors reported serving fresh fruit and vegetables for snacks, there was a poor correlation on the offering of these healthy snacks between researchers and directors (P < .05). Researchers observed salty, caloric dense foods for snack time more frequently than fresh fruits and vegetables. These findings demonstrate the importance of improving and perhaps regulating the quality and diversity of snacks and beverages offered in childcare, as dietary amendments may prevent the development of childhood obesity. [ABSTRACT FROM AUTHOR]

Children with autism spectrum disorder (ASD) have complex medical problems, yet they are at high risk for unmet health care needs. Primary care providers are perfectly positioned to meet these needs; however, they often lack training in ASD. This pilot project developed and tested a new model for training primary care providers in best-practice care for ASD using the Extension for Community Healthcare Outcomes (ECHO) framework. The 6-month ECHO Autism pilot project consisted of 12 biweekly clinics focused on screening and identification of ASD symptoms and management of medical and psychiatric comorbidities. Participants completed measures of practice behavior and self-efficacy in screening and management of children with ASD at baseline (pretest) and after 6 months of ECHO Autism (posttest). Statistically significant improvements were observed in self-efficacy, in adherence to ASD screening guidelines, and in use of ASD-specific resources. Participants also reported high satisfaction with the program. [ABSTRACT FROM AUTHOR]

Primary care providers are charged with distinguishing children with an underlying growth problem from those with healthy variant short stature. Knowing the heights of the biological parents aids in making that decision. This study sought to determine the feasibility and functionality of an electronic mid-parental height (MPH) auto-calculator in the clinical assessment of child growth in a pediatric primary care setting. Clinicians completed surveys for 62% of 6803 children (mean height 13 ± 7 percentile) with recorded parent heights. Collecting parent height data required <30 seconds in 91% of encounters. The MPH tool confirmed clinicians’ initial growth assessment in 79% of cases and changed it in 4%; the remainder did not use the tool. Clinicians who changed assessment were more likely (P < .0001) to pursue more comprehensive evaluation. The MPH tool was a quick, functional resource as a component of an electronic health record system in actual, busy, pediatric primary care practices. [ABSTRACT FROM AUTHOR]

Infantile colic is a self-limiting condition characterized by recurrent, prolonged periods of intense crying in an inconsolable infant. The etiology is unknown although many hypotheses have been proposed. Colic can be very frustrating for parents to deal with, thus it is important to provide reassurance and resources. Also, there are therapeutic interventions available that have shown some efficacy in reducing the symptoms of colic, but more evidence is needed to support their use. [ABSTRACT FROM AUTHOR]

Celiac disease is a gluten enteropathy that is treated with dietary elimination of gluten. Exposure to nondietary sources of gluten, which are used in the manufacture of products such as plastics, dental equipment, and cosmetics, can also trigger or exacerbate disease. We report the case of a 9-year-old child who presented with nonspecific abdominal discomfort with abnormal serology for celiac disease. She underwent duodenal biopsies that revealed Marsh 3B histopathology. Despite strict dietary elimination of gluten, she continued to be symptomatic and demonstrate positive serum markers for active disease. It was then discovered that the child was exposed to gluten from her orthodontic retainer that contained a plasticized methacrylate polymer. Gluten is a common additive in plastics. She discontinued its use and demonstrated symptom resolution and complete normalization of serology. All possible sources of gluten, including nondietary, must be considered when managing a child with celiac disease.

Background. Toilet training is an important marker of physical and psychosocial development, but the best strategy for implementing training is still unknown. The purpose of this study is to compare dysfunctional voiding outcomes for 2 common toilet training strategies: parent-oriented training and child-oriented training. Materials and methods. This study was completed using a case-control design, with participants between the ages of 4 and 12 years. All participants were asked to complete questionnaires related to demographics and toilet training method. Results were then analyzed between cases and controls. Results. In all, 215 patients with a mean age 7.76 years participated in this study. Cases and controls showed no significant difference for demographic measures and socioeconomic status. Furthermore, there was no significant difference in dysfunctional voiding between toilet training methods. Conclusion. Toilet training method does not seem to have any long-term effect on dysfunctional voiding. As such, clinicians should advise parents that both methods are acceptable. [ABSTRACT FROM AUTHOR]

Background. Peripheral intravenous (PIV) line placement is a time-consuming procedure performed on the majority of general pediatric inpatients, with significant discomfort to patients. Objective. To determine parameters of pediatric PIV placement, including success rates, time to success, and factors associated with success. Design. Prospective study involving direct observation of PIV placement by trained research staff. Setting. General inpatient wards at 2 medium-sized pediatric hospitals. Patients. Hospitalized children younger than 19 years. Results. Successful placement was achieved in 95.8% (567/592) cases with a median time of 9 minutes. Children younger than 2 years were less likely to have success on the first attempt (38.9% vs 53.5%) and have longer time to success (11 minutes). Conclusions. Children younger than 2 years experienced lower first-attempt successful PIV placement and took longer. The overall success rate was similar to prior reports; these data are the first to show differential PIV success by patient age. [ABSTRACT FROM PUBLISHER]

Objectives: To identify parent-reported reasons for non-receipt of adolescent vaccinations by provider recommendation status. Methods: Parental reasons for non-receipt of adolescent vaccines were analyzed among adolescents 13-17 years using data from the 2009 National Immunization Survey-Teen (n=20,066). Results: Among unvaccinated adolescents, 87.9% (Td/Tdap), 90.9% (MenACWY), and 66.0% (HPV) of parents reported that they did not receive a healthcare provider recommendation for their adolescent to receive the vaccine. Among those without a provider recommendation, the most common reasons for not receiving the vaccines were ‘vaccine not recommended’ [Td/Tdap, MenACWY] and ‘not needed’ [HPV]. Among those with a recommendation, the most common parental reasons were ‘lack of knowledge’ [Td/Tdap], ‘vaccine not needed’ [MenACWY], and ‘lack of knowledge’ [HPV]. Conclusions: Non-receipt of provider recommendations was a main parent-reported reason for not getting vaccinated. Increasing parental knowledge and vaccination coverage through increased provider-parent communication about disease risk and vaccine benefits is needed. [ABSTRACT FROM PUBLISHER]

The diagnosis of attention deficit/hyperactivity disorder (ADHD) in children has been steadily increasing over the past 10 years. ADHD is associated with numerous health, behavioral, social, and academic outcomes. The use of medication is common for the treatment of ADHD. However, the evidence base for pharmacological and non-pharmacological treatments for children younger than 6 years of age is limited. Both short-term and long-term studies of efficacy and safety of all interventions are needed in this population, especially the use of psychotropic medications. Understanding the long-term effects of psychotropic medication on the developing brains of preschoolers has important implications for outcomes into adulthood. Nonpharmacologic evidence-based interventions are available and should serve as the first line of treatment in this population. Future research needs include further evidence regarding specific curricula, dose, duration, delivery methods, and staff training to ensure optimal intervention outcomes. [ABSTRACT FROM PUBLISHER]

Purpose: The purpose of this study is to review all cases of tularemia, a tick-borne illness, among inpatients at Arkansas Children’s Hospital (ACH) from 1996-2006 to discuss clinical presentation, diagnosis and treatment. Records of the Infectious Disease Section were reviewed to identify cases of suspected or proven tularemia.Results: Seventeen patients presented with ulceroglandular tularemia and thirteen with glandular disease. Most patients had been ill for 10-14 days prior to admission and were evaluated at least once by another physician. Serology was positive in 77% of patients, including several positive on convalescent testing alone. Most patients responded well to treatment with gentamicin. Conclusions: This series emphasizes the importance of tularemia as an early consideration among children with fever and lymphadenopathy in Arkansas. Convalescent serology is an important tool, as many patients will remain seronegative early in illness. Gentamicin remains effective treatment and should be considered first-line therapy for suspected tularemia. [ABSTRACT FROM PUBLISHER]

Hypertension (HTN) in children and adolescents has become increasingly common. We sought to identify variability in the approach to HTN among general pediatricians as well as obstacles to care of hypertensive youth by surveying pediatricians referring to an urban children's hospital. Although most pediatricians begin blood pressure measurement at 3 years, there was substantial variability in the initial diagnostic evaluation of hypertensive patients. Just 7% of pediatricians routinely start antihypertensive drug treatment for HTN, whereas 82% refer their hypertensive patients to a specialist; 40% of pediatricians felt uncomfortable evaluating and treating HTN. Pediatricians unfamiliar with The Fourth Report were more likely to be uncomfortable with the care of hypertensive patients than those familiar with it (54% vs 33%, P < .05). Current practice does not appear to follow recent consensus recommendations. Interventions designed to address the issues identified in this survey may lead to improved care for pediatric patients with HTN. [ABSTRACT FROM AUTHOR]

Infantile colic is an easily identified childhood entity that has no clear treatment guidelines. The management of infantile colic varies among physicians, and families are often frustrated by the medical community's inability to prescribe a cure for colic. This article reviews the current concepts for management options of infantile colic. [ABSTRACT FROM AUTHOR]

Objective Infants with respiratory syncytial virus (RSV) infection are at risk for developing apnea. The authors compared patients with RSV infection who develop apnea with those who do not, to help ambulatory physicians risk stratify their patients with RSV infection. Methods Entry criteria were age less than 1 year, RSV infection, and presentation to the authors' pediatric emergency departments.Randomandweighted sampling techniques were used to identify the study group and provide the control sample. Charts were abstracted for 34 clinical variables. Results The study group consisted of 42 patients with apnea, and the control group consisted of 198 patients without apnea. Logistic regression analysis identified 2 independent variables associated with apnea: young age and presentation with apnea. Most patients with apnea were less than 2 months of age and were ill for less than 5 days. Conclusions Age and duration of illness may help clinicians determine which previously healthy infants are at risk for apnea. [ABSTRACT FROM AUTHOR]