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Background: Vocal fold nodules (VFNs) are the main cause of paediatric dysphonia. Voice therapy is recommended as the preferable treatment option for VFNs in children. Aim: The aim of this systematic review is to provide an overview of the existing literature concerning the effects of voice therapy in children with VFNs. Methods & Procedures: This systematic literature review was developed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed) and Embase were searched and the grey literature was checked. The search strategy was based on three concepts: VFNs, voice therapy and children. Two examiners independently determined article eligibility and extracted all relevant data from the included studies. The methodological quality of the included study was assessed using the QualSyst tool. Main contributions: By identifying, evaluating and summarizing the results of all relevant studies about voice therapy in paediatric VFNs, this systematic review makes the available evidence more accessible to voice therapists, otolaryngologists and other relevant stakeholders. Conclusions & Implications: 24 studies were included in this systematic review. Eight studies (8/24) reported a significant improvement for at least one outcome parameter after voice therapy. However, five papers (5/24) could not demonstrate significant changes after voice therapy. All studies that did not test for significance (11/24) found improvements for one or more outcome parameters. The overall quality of the included studies is adequate (55%). In sum, there is some evidence that voice therapy is effective in children with VFNs, but further well-designed research, especially randomized controlled trials, is necessary to confirm these results.

Background: The COVID-19 pandemic and subsequent measures to reduce transmission risk has led to unprecedented digital transformation across health, education and social care services. This includes UK paediatric speech and language therapy (SLT), which sits at the crossroads of these services. Given the rapid onset of this pandemic-induced digital transition, there is now a need to capture, reflect and learn from the SLT profession so that benefits can be sustained, and barriers addressed. Aims: To survey the impact of COVID-19 remote working on UK paediatric SLTs' digital views and experiences using the Capability, Opportunity, Motivation and Behaviour (COM-B) model. Methods & Procedures: An online survey was conducted from May to October 2020. Respondents were asked to rate their use of technology in service delivery before and during the pandemic, to select factors facilitating digital practice, and to provide open-response aspirations for the future role of technology in paediatric SLT which were analysed thematically using the COM-B behaviour change model. Outcomes & Results: A total of 424 UK paediatric SLTs responded to the survey. Findings indicate a marked increase in clinicians' perception of their frequency, convenience and confidence with digital practice during COVID-19 compared with before the pandemic. Respondents identified that specialist training (27%), funding for workplace devices (22%) and supportive leadership (19%) were most likely to facilitate sustained digital practice. Clinicians hoped for a blended approach going forward with technology enhancing existing best practice. Further prominent themes included digital accessibility for all and maintaining the increased opportunity for multidisciplinary working that videoconferencing has afforded. More service-specific aspirations were bespoke technological solutions as well as parents/carers being able to engage remotely with school-based provisions. Conclusions & Implication: During COVID-19, paediatric SLTs' recognition and acceptance of how technology can augment practice has accelerated, with particular value being placed on inclusivity, choice, training, resources, leadership and indication of effectiveness. These are important considerations to help guide the profession towards the long-term digital enhancement of SLT services.

The main aim of this report is to describe the healthcare staff's perceptions and difficulties encountered in the relationship with foreign children and their families, collecting their personal judgment on their intercultural skills, on the necessity of training courses and their opinion related to the possible aid given by a linguistic and cultural mediator (LCM). We have carried out a survey in the paediatric health services of the Azienda Socio Sanitaria Territoriale (ASST) Lariana located in Como, through the provision of a questionnaire addressed to the healthcare staff. The questions presented in the survey relate to the relationship between the healthcare staff and the foreign patients, highlighting issues connected to linguistic and cultural factors in the use of the health services. The health professionals state that assistance to the minor and the foreign family is more complex (41.27%), more stressful (36.5%), more time-consuming (44.4%) but also more motivating (65.07%) than the assistance to native users. Referring to the figure of the LCM, 47 (74.6%) health workers believed it would be useful to integrate the role into the operational units. Through the analysis of data, the results obtained provide a picture of the challenges encountered between foreign citizens and medical staff, who admit a lack of intercultural skills. It is desirable to introduce the figure of a linguistic and cultural mediator, who could help both in terms of better management of the diagnostic and assistance path and in terms of staff satisfaction.

Best practice supports the use of occupation as a therapeutic agent of change for pediatric occupational therapy practice. However, limited tools to promote the development of and implementation of occupation-centered practice exist. This study explored the clinical utility of the Occupation Centered Intervention Assessment (OCIA) as a tool to facilitate occupation-centered practice in outpatient and school-based pediatric settings. The OCIA allows practitioners to reflect on their own practice by scoring interventions on personal, contextual, and occupational relevance. This qualitative, descriptive study utilized semi-structured interviews (n = 12) with practitioners in outpatient and school settings to glean information regarding tool utility. A six-step thematic analysis process guided the coding process. Four themes emerged from the data related to clinical utility of the OCIA: reflection on practice habits, practice settings influence therapy service delivery, translation of theoretical knowledge into practice technique, and the distinct value of occupation. Preliminary evidence supports the use of the OCIA in outpatient and school pediatric settings to promote reflection on occupation-centered practice for students and novice practitioners, although some setting are more conducive to use of an occupation-centered approach than others.

This paper relays the findings of the evaluation of an applied theatre project for children in hospital as perceived by hospital teachers. A mixed qualitative approach was used. Data were analysed using thematic analysis to explore the teachers' views on children's engagement with learning and the improvement of the hospital experience as a whole through applied theatre. The article presents examples of children's stories that illustrate the findings. The study concludes that applied theatre in paediatrics can engage children with hospital tuition and learning during treatment; improve the management of emotions; help them relax and communicate with the outside world.

Background: Brazilians are a growing immigrant population in the United States and there is a lack of interventions to promote healthful energy balance-related behaviors (EBRBs) and prevent obesity among Brazilian preschool-age children. To develop needed interventions, information is required about parents' perceptions of the importance of EBRBs and where they obtain information about these behaviors. Purpose: To assess Brazilian immigrant parents' perception of the importance of EBRBs and information sources they use to support their preschool-age children's healthful EBRBs. Methods: Cross-sectional survey. Results: Fifty-two immigrant parents, most classified as having low acculturation, participated. In total, about 20-50% of parents perceived the six examined EBRBs as being extremely important. Parents reported that pediatricians, nurses, and WIC professionals were their primary sources for information about EBRBs. Discussion: Increased health education on the importance of EBRBs is needed. Health educators can facilitate linguistic and culturally sensitive communication, education, and provide guidance to parents on how to foster the development and maintenance of their preschool-age children's healthful EBRBs. Translation to Health Education Practice: Bicultural, bilingual health educators can help raise awareness, facilitate communication, provide education and guidance to Brazilian immigrant parents about the importance of children's healthful EBRBs in the prevention of obesity. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars/

Purpose: Globally, cancer represents an increasing proportion of child mortality as progress against infectious causes is made. Approximately 400,000 children will develop cancer, each year, around the world. Only about half of these cancers will ever be diagnosed. In high-resource settings, 80% of children will survive, but only about 30% will survive in low-resource settings. Digital solutions have a valuable role in increasing health professional knowledge, skills and empowerment to diagnose, treat and otherwise care for children and adolescents with cancer. This review sought to identify digital resources that support the training and development of the paediatric oncology workforce in resource -poor settings. Design/methodology/approach: This paper presents a narrative descriptive review of peer-reviewed publications and digital platforms that contribute to health professionals' education and training regarding paediatric oncology, particularly in rural and other low-resource settings. Findings: Digital solutions were identified for building communities of practice, facilitating access to information and support and providing access to training, education and supervision specifically for paediatric oncology health professionals. A total of 33 resources are discussed in depth. A quality assessment of the digital resources is provided using the Currency, Relevance, Authority, Accuracy and Purpose (CRAAP) tool and suggestions to improve the quality of resources are discussed. Practical implications: The authors anticipate that this summary of digital resources for the global paediatric oncology professional community will inform digital health investments and design of digital innovations to meet emerging needs and will have an impact on the workforce in the real world. Ultimately, this work will contribute to an improvement in the diagnosis and treatment of children and adolescents with cancer in resource-poor settings. Originality/value: This is the first discussion and summary of digital education platforms which educate, train and offer support to health professionals with respect to paediatric oncology. These digital platforms are often aimed at, and are essential for, health professionals in rural and other low-resource settings.

Congenital heart disease (CHD), the result of structural changes to the heart present at birth, is the most common congenital birth condition. As survival rates for infants with complex CHD have increased in recent years, risk for neurodevelopmental challenges has also increased. Early referral to developmentally supportive care is recommended as best practice; however, there is limited information about how to best support occupations of infants with CHD as early as possible while still in the hospital. Recommendations for developmentally supportive care structured around occupations of infancy, existing developmental care models, and current evidence are reviewed and discussed for infants hospitalized following cardiac surgery. Key occupations of infancy discussed include movement and sensory exploration, procurement (communication of needs), sleep, feeding, and social interaction and play. Future work is recommended to develop occupation-based training and education resources for interprofessional hospital staff about developmentally supportive care for the hospitalized infant with CHD.

The utility of three-dimensional (3D) printed models for medical education in complex congenital heart disease (CHD) is sparse and limited. The purpose of this study was to evaluate the utility of 3D printed models for medical education in criss-cross hearts covering a wide range of participants with different levels of knowledge and experience, from medical students, clinical fellows up to senior medical personnel. Study participants were enrolled from four dedicated imaging workshops developed between 2016 and 2019. The study design was a non-randomized cross-over study to evaluate 127 participants' level of understanding of the criss-cross heart anatomy. This was evaluated using the scores obtained following teaching with conventional images (echocardiography and magnetic resonance imaging) versus a 3D printed model learning approach. A significant improvement in anatomical knowledge of criss-cross heart anatomy was observed when comparing conventional imaging test scores to 3D printed model tests [76.9% (61.5%-87.8%) vs. 84.6% (76.9%-96.2%), P < 0.001]. The increase in the questionnaire marks was statistically significant across all academic groups (consultants in pediatric cardiology, fellows in pediatric cardiology, and medical students). Ninety-four percent (120) and 95.2% (121) of the participants agreed or strongly agreed, respectively, that 3D models helped them to better understand the medical images. Participants scored their overall satisfaction with the 3D printed models as 9.1 out of 10 points. In complex CHD such as criss-cross hearts, 3D printed replicas improve the understanding of cardiovascular anatomy. They enhanced the teaching experience especially when approaching medical students.

Preterm birth consequences may lead to developmental deficits, psychiatric disorders and may also cause parental mental health problems. Our aim was to describe quality of life and internalizing-externalizing behaviours of preterm children at 2 years regarding parental mental health. 112 mothers of preterm children provided the following information: pediatric quality of life, internalizing-externalizing behaviours, maternal perceived stress, anxiety, depression and satisfaction with life. Regarding emotional and behavioural problems and low quality of life, risk factors are lower birthweight, neonatal morbidities and lower socioeconomic status. Mothers with higher stress, more anxiety and depression symptoms and lower satisfaction with life reported more internalizing-externalizing behaviours and lower quality of life about their children. Among low birthweight children, conduct and hyperactivity problems are the most common at 2 years old. We emphasize the importance of parental mental health and the need for early prevention and intervention in order to minimalize the burden of hyperactivity symptoms.

The present study examined the test-retest reliability of the Ghent University dribbling test and short dribble test in a pediatric population. Fifty-four boys aged 9-14 years (mean ± SD = 11 ± 2 years) undertook the Ghent University and dribbling tests on two occasions separated by 2 weeks. Intraclass correlation coefficients, coefficient of variation, and 95% limits of agreement were conducted for each test. Intraclass correlation coefficients and coefficient of variation indicated good to excellent reliability, and relatively small variability for both dribbling tests. The 95% limits of agreement indicated relatively little bias Ghent University dribbling test for both running alone and running with the ball components, and the Bangsbo and Mohr short dribble test. The results of the present study suggest both dribbling tests examined in the present study demonstrate good reliability and low levels of systematic bias.

An onboarding program is a powerful tool to welcome new employees and support their productivity. Children's Mercy Hospital created a systematic Research Faculty Onboarding Program (RFOP) to engage new research faculty from their first day with the hospital and to shorten the startup time to productivity. Surveys and interviews indicated that onboarding has provided new faculty with a sense of community with the larger organization. The RFOP has four aims: 1) to increase new researcher productivity, 2) to improve retention rates of new faculty by helping them become involved and connected with the organization, 3) to provide audience-specific, in-depth, timely information that is useful and memorable, and 4) to reduce redundant conversations while guaranteeing the delivery of high-quality, consistent, and accurate information. Prior to their start date, faculty receive a web survey designed to communicate the scope of their research and immediate logistical needs. Based on this information, faculty receive personalized quick-start guides, crucial introductions, and logistical setup within their first 10 days. Finally, the program includes a Triage Unit to provide just-in-time training as faculty set up their first research projects. This structured Research Faculty Onboarding Program is competency-based through mentorship and classroom-setting lectures.

The nation's leading academic hospitals aspire to being the leader in medical research, but as the role of medical research grows in size and complexity, many departments are left without proper research support or oversight. This research explored the need for a research administrative support program to resolve many of the issues facing faculty researchers in the 21st century. This research resulted in a comprehensive departmental program design for the General Research Administrative Support Program (GRASP) within the Department of Pediatrics at a prominent Midwestern pediatric hospital. The program fosters ongoing communication among all research centers, the department, and the researcher. It will maintain a viable research effort by developing a strategic plan that adheres to the institution's long-term research objectives. The program will create an interactive website that contains educational resources, a research toolkit, and announcements of new funding opportunities. The program office will update faculty regularly on issues with compliance to keep researchers abreast of trends in funded research and requirements, and will create a research mentorship program for new faculty members. The General Research Administrative Support Program (GRASP) will standardize the research support system to foster consistent and reliable administrative support for the modern academic pediatric researcher.

Purpose: The purpose of the study was to identify major symptom domain variables common to child trauma and create a prototype short trauma symptom screening tool (STST) intended for use in pediatric medical settings. Methods: This manuscript describes the first two phases of an on-going prospective mixed-method instrument development study. Phase 1 exploratory factor analysis was conducted with an archived LONGSCAN CBCL dataset to: (1) identify behavioral symptoms endorsed by children with known trauma exposure; and (2) generate a preliminary STST item pool. During Phase 2, researchers convened an expert panel (N = 10) and conducted Content Validity Index (CVI) procedures with the 20-item preliminary STST item pool, to further inform item retention, elimination and modification for an updated prototype STST. Findings: Expert quantitative scores yielded a CVI of 0.90 for the overall preliminary STST. The first two phases of this study assisted researchers with identifying 12 items that represent nine child trauma symptom domain variables, which include: (1) aggression/anger; (2) anxiety/fear; (3) sexual concerns; (4) elimination concerns; (5) somatic concerns; (6) depression; (7) dissociation; (8) physical acting out; and (9) dysregulation. Conclusions: The first two phases of STST development resulted in development of a brief, empirically-derived prototype screening tool that features 12 items operationalizing nine domains of child trauma symptoms. Developers can now advance to the next phase of STST development; feasibility assessment and psychometric testing.

Purpose: To facilitate precise diagnosis and provide tailored treatment of postural anomalies in the pediatric population, appropriate assessments are essential. In light of the multicomponent structure of postural control, understanding underlying constructs of an assessment is valuable in selecting and interpreting assessments. This study investigates the construct validity of the Gaits and Stations variables in the Revised Physical and Neurological Examination of Subtle Signs, a measure used to evaluate standing postural control in youth with mild neurological deficits. Methods: Data were included from 350 healthy participants ages 10-19 years old. An exploratory factor analysis with varimax rotation was performed. Individual loadings of [greater than or equal to]0.4 were used for factor designation. Results: Three latent factors were identified and labeled, based on evidence, as dynamic stability, movement strategies/coordination, and underlying motor systems--musculoskeletal strength. Conclusions: These brief, easily administered Gaits and Stations measures of the Physical and Neurological Examination of Subtle Signs facilitate evaluation of three constructs of standing postural control relevant to youth with mild neuromotor impairments. This information will potentially assist in clinical practice to identify youth with postural control deficits and establish developmentally appropriate interventions and in research to refine understanding of pathology and the impact on components of postural control.

This study investigated speech-language pathologists' (SLPs) perceptions of factors that influence application of a new taxonomy with terminology for describing child language assessment and identified strategies that may facilitate use of taxonomy terminology to collect data on SLP assessment practice. Semi-structured interviews were conducted with 13 SLPs and data were analyzed using thematic analysis. Three main themes were identified in relation to factors that may influence application including applying the taxonomy is arduous, contextual factors may influence application, and SLP experience and knowledge may influence application. Participants identified a number of strategies to facilitate use of taxonomy by SLPs. Findings from this study give insight into the factors that influence SLPs' application of a taxonomy of assessment terms. These findings are important for all SLPs in the child language field to consider if the profession is to be effective in establishing greater consistency in use of professional terminology.

Background: The COVID-19 pandemic presents unique opportunities for preexisting school telemedicine programs to reach pediatric populations that might otherwise experience a lapse in health care services. Methods: A retrospective analysis of one of the largest school-based telemedicine programs in the country, based in the Dallas-Fort Worth (DFW), Texas was conducted that included 7021 pediatric patients who engaged in telehealth visits from 2014 to 2019. Results: Asthma or other respiratory disease was the primary diagnosis (28.4%), followed by injury or trauma (18.4%), digestive disorders (6.9%), and ear/eye/skin disease (6.9%). More participants were from the North (34.4%) and West (33.2%) ISD compared to the South (20.6%) and East (11.7%) schools. Likewise, the majority of COVID-19 cases were in the North (61.8%) and West (31.6%) DFW regions, leading to 989 (59.9%) and 551 (33.4%) deaths, respectively. Conclusions: School-based telehealth programs have the potential to reach large pediatric populations most in need of health care due to COVID-19-related lapses in services, and to address COVID-19-related health issues as schools reopen. In the future, utilization could be expanded to contact tracing, testing, and screening for COVID-19.

Most pediatric residency programs do not provide adequate practical experiences for residents in autism-related care, with a specific dearth of training in diagnostic processes. Without this training, residents enter the primary care workforce with uncertainty surrounding implementation of standard-of-care recommendations for children with autism. Our curriculum was designed to improve upon previously passive shadowing experiences within our developmental-behavioral pediatric rotation by integrating hands-on training in within-practice diagnostic identification and care coordination. In addition to multiple web-based learning activities (including a tutorial teaching administration of an interactive assessment tool), residents were required to actively participate in autism evaluations under supervision of an attending provider. Data were collected to assess feasibility of curricular changes as well as increased comfort level across recommended practice behaviors. Regarding feasibility, 95% of residents completed training components and pre-/post-ratings indicated significant increases in comfort in identifying symptoms/risk for autism, providing feedback about diagnostic decision, and effectively connecting families with services. Outcomes suggest feasibility of model and significantly increased resident comfort level across a range of recommended practice behaviors. This project reflects a first step in advancing incorporation of autism training into pediatric residency programs.

Handover between colleagues is a complex task. The problem is that handovers are often inadequate because they are not structured according to theoretically grounded guidelines. Based on the cognitive load theory, we suggest that allowing a clarifying dialogue and thereby optimizing germane cognitive load enhances the information quality and diagnostic accuracy at handover, but may prolong handover duration. We also expect that mentioning key information first and thus decreasing intrinsic cognitive load improves information quality and diagnostic accuracy. We developed two representative paediatric cases for presentation in a factorial 2 × 2 design. Sixth-year medical students (N = 80) were randomly assigned to one of four groups that differed with regard to how the case histories were delivered to them (chronological order versus key information mentioned first) and direction of information exchange (unidirectional versus a clarifying dialogue). The receivers of the handover were asked to write a report of the cases and suggest the best diagnosis. Dependent variables were information quality of the written report (Information score), quality of the diagnosis (Diagnostic accuracy score) and the time it took to deliver the written handover case report (Handover report duration). Seen through the lens of cognitive load theory, allowing a clarifying dialogue at handover, and thus optimizing the germane cognitive load, significantly increased the Information score (p < 0.0005), Diagnostic accuracy score (< 0.05) and Handover report duration (p < 0.001).

Purpose: The purpose of this study was to analyze the impact of cumulative hearing hour percentage (HHP) on pediatric cochlear implant users' speech and language development at age 3 years and to determine an evidence-based wear time recommendation that yields typical spoken language standard scores. Method: A retrospective chart review of 40 pediatric cochlear implant recipients was completed. Children met the following criteria: prelingually deafened, implanted at age 2 years or younger, utilized a speech processor with datalogging capabilities, a minimum of 1 year of cochlear implant use, and language testing completed at approximately age 3 years. Exclusion criteria included significant inner ear malformation (i.e., common cavity) or developmental delay that would preclude spoken language development. Results: Multiple regression analysis revealed that age and implantation and HHP were predictive of spoken language skills at age 3 years. Further analysis yielded wear time recommendations associated with age-appropriate spoken language based on the age at implantation. Conclusions: When the goal is age-appropriate spoken language, wear time recommendations should reflect a child's current age, age at implantation, and the comparative daily sound access of age-matched normal-hearing peers. The HHP measurement can help provide that information. The minimum wear time recommendation should be set to 80% HHP with the ultimate goal of 100% HHP to give pediatric cochlear implant recipients enough access to sound and language to achieve their spoken language goals.

Health care continuity during the transition from pediatric to adult care is critical to helping individuals with autism spectrum disorders manage complex medical and psychiatric co-morbidities that start in childhood and evolve with age. We conducted a brief online survey of pediatric and adult providers at Kaiser Permanente Northern California, a large integrated health care delivery system, to assess departmental policies and personal approaches to transitioning patients with special health care needs, including autism spectrum disorders. A total of 354 pediatric (43% response rate) and 715 adult providers (30% response rate) completed the survey. A large majority of departments did not have transition policies in place. Many providers in both primary care and mental health did not provide transition resources, review legal changes, use standardized assessment tools, or communicate with the next/previous provider. Transition planning was usually delayed until age 17 or later. Most providers did not have consistent approaches to the transition of care for youth with special health care needs and may be inadequately prepared to handle the process for patients with autism spectrum disorders. As the population of transition-age youth with autism spectrum disorders continues to grow, there is urgent need to understand how to best implement transition policies that promote early communication between providers and families and track outcomes among transitioning patients with special health care needs.

Children with autism spectrum disorder are at increased risk for obesity compared to typically developing children. Many obesity intervention programs exclude children with autism spectrum disorder. There is little research on developmentally inclusive approaches to pediatric weight management. We examined the outcomes of children and families with autism spectrum disorder in an inclusive, comprehensive behavioral family-based lifestyle intervention. A secondary analysis of a randomized controlled trial on families enrolled in a comprehensive behavioral family-based lifestyle intervention was conducted. Analyses included chi-square or Fisher's exact tests to examine family and child differences in program completion rates and multivariate regression analysis using generalized estimating equation to further examine differences in weight outcomes between children with autism spectrum disorder versus no autism spectrum disorder accounting for other covariates. There were 158 families; 15 families had children with autism spectrum disorder. There were no significant differences in demographics, program completion, or weight outcomes between the two groups. Children who completed the intervention had a significant decrease in body mass index Z-scores, but no change in their percentage of the 95th percentiles. Families of children with autism spectrum disorder participated in a comprehensive behavioral family-based lifestyle intervention alongside children without autism spectrum disorder with similar outcomes. Comprehensive behavioral family-based lifestyle intervention can meet the weight management needs of children with autism spectrum disorder using an inclusive approach, expanding access to needed obesity interventions.

Youth with autism spectrum disorder often have complex medical needs. Disruptions of healthcare during the transition from pediatric to adult healthcare may put youth with autism spectrum disorder at higher risk of medical emergencies and high medical costs. We conducted a study among transition-age youth (14-25 years old) receiving healthcare at Kaiser Permanente Northern California during 2014-2015. We examined the differences in healthcare utilization and costs among youth with autism spectrum disorder (n = 4123), attention deficit and hyperactivity disorder (n = 20,6015), diabetes mellitus (n = 2156), and general population controls (n = 20,615). Analyses were also stratified by age and sex. Youth with autism spectrum disorder had the highest utilization of outpatient primary care, mental health, and psychotropic medications and the lowest utilization of obstetrics/gynecology and urgent care. Costs for youth with autism spectrum disorder were higher than those for attention deficit and hyperactivity disorder and general population peers and lower than for diabetes mellitus. Utilization patterns varied by age. Transition-age youth with autism spectrum disorder generally utilize healthcare at higher rates relative to attention deficit and hyperactivity disorder and general population peers but at similar or lower rates than diabetes mellitus peers, indicating this group's complex combination of psychiatric and medical healthcare needs. The relatively high utilization of psychiatric services and low utilization of women's health services in transition-age youth with autism spectrum disorder may have implications for long-term health and warrants additional research.

Purpose: This study explored the intervention processes used by speech-language pathologists (SLPs) to treat children with speech sound disorders (SSDs). Method: Semistructured, individual, in-depth interviews were conducted with 11 Australian SLPs. Inductive content analysis was used to classify the data to provide a description of current intervention processes for children with SSDs. Results: Three main factors were identified relating to the intervention processes used by SLPs: (a) target selection, (b) therapy approaches, and (c) structural and procedural aspects of therapy sessions, including feedback. The findings revealed that SLPs often combine elements of four therapies: the minimal pairs approach, traditional articulatory approaches, auditory discrimination, and Cued Articulation. Initial therapy targets typically aligned with a developmental approach or were functional speech targets with meaningful relevance to the child and their family. Conclusions: These findings contribute to the current state of knowledge about the intervention processes used by SLPs for children with SSDs. The use of hybrid speech pathology therapies, which combined elements of favored approaches, was common. Hybrid methods were intended to help tailor the interventions to individual needs. Client needs were highly prioritized by SLPs and influenced their choice of therapy targets and therapy approaches.

The simulation technology is rapidly expanding and has been used in several nursing programs around the world and in Saudi Arabia too. The aim of this study was to evaluate the effect of using a simulation based scenarios on the pediatric nursing students' students' knowledge, self-efficacy, satisfaction, and confidence. This study used Bandura's Social Cognitive Learning Theory (1977; 1986) as a theoretical framework. 158 third year baccalaureate nursing students enrolled in a pediatric nursing course participated in the study. Data was collected using demographic data profile questionnaire, knowledge questionnaire, Learner Satisfaction and Self Confidence in Learning Questionnaire (NLN, 2009) and the General Self-Efficacy. The simulation activities were conducted in the pediatric nursing lab. The simulation activities consisted of three respiratory problems and one cardiac scenario. High and low fidelity simulators were used. The majority of the students were unmarried (96.84%) and had no previous experience in simulation. There was a significant statistical difference in pre- and posttest knowledge and self-efficacy scores. Students were satisfied with the simulation experience and their self-confident scores were higher after the simulation session. The post simulation self-efficacy was positively correlated with satisfaction (r = 0.46, P = 0.001) and self-confidence (r = 0.50, P = 0.001). Satisfaction with simulation was also positively correlated with self-confidence (r = 0.46, P = 0.001). Although the interpretation of the study results is limited due to the short time frame between the pretest and the posttest, this study provides a stepping point for understanding how simulation may affect the pediatric nursing students' knowledge, self-efficacy and confidence.

The American Academy of Pediatrics recommends using an autism-specific screening tool for all young children at primary care well visits. Screening can detect risk of autism spectrum disorder (ASD) in young children whose parents and pediatrician may not otherwise have developmental concerns. The identification of children with or at-risk for ASD increases their access to early intervention services, which helps ameliorate skill deficits associated with ASD. Recent studies indicate pediatricians use autism-specific screening and diagnostic tools infrequently. Some research has been conducted to determine whether providing training to primary care providers increases screening practices; however, evidence-based practices for training pediatricians to conduct ASD screenings or use other ASD identification tools have not been identified. We conducted a review of the research on training primary care providers (e.g., pediatricians) on the use of ASD identification tools with young children and their families. The results of this review point to a lack of high-quality research in this area. The information can be used to advance research, policy, and practice.

The aims of this study were to describe the practice patterns for early screening and evaluation for ASD diagnosis in Bulgaria, as well as to identify potential barriers and facilitators in this process. We surveyed a sample of pediatricians and pediatric psychiatrists to analyze the use of standardized instruments, application of biomarkers, parental collaboration and future policy prospects. We found a significant support for the idea of a national program for ASD in Bulgaria. These insights provide an evidence-based analysis that could help improve services, guide research and inform policies in regard to ASD. Further work is necessary to better understand other stakeholders' opinions and perspectives, especially those of patients and their families.

Often clinicians are interested in determining whether a subject's measurement falls within a normal range, defined as a range of values of a continuous outcome which contains some proportion (eg, 95%) of measurements from a healthy population. Several studies in the biomedical field have estimated reference ranges based on a meta-analysis of multiple studies with healthy individuals. However, the literature currently gives no guidance about how to estimate the reference range of a new subject in such settings. Instead, meta-analyses of such normative range studies typically report the pooled mean as a reference value, which does not incorporate natural variation across healthy individuals in different studies. We present three approaches to calculating the normal reference range of a subject from a meta-analysis of normally or lognormally distributed outcomes: a frequentist random effects model, a Bayesian random effects model, and an empirical approach. We present the results of a simulation study demonstrating that the methods perform well under a variety of scenarios, though users should be cautious when the number of studies is small and between-study heterogeneity is large. Finally, we apply these methods to two examples: pediatric time spent awake after sleep onset and frontal subjective postural vertical measurements.

How can learners be supported to engage productively in the kinds of feedback practices they may encounter after they graduate? This article introduces a novel concept of authentic feedback to denote processes which resemble the feedback practices of the discipline, profession or workplace. Drawing on the notion of authentic assessment, a framework for authentic feedback is proposed with five dimensions: realism, cognitive challenge, affective challenge, evaluative judgement and enactment of feedback. This framework is exemplified and interrogated through two cases of authentic feedback practice, one in the subject of digital media in an Australian university, the other focussed on bedside rounds in medicine at a university in Hong Kong. The framework enables the identification of both highly authentic aspects of feedback, and aspects that could be made more authentic. The framework informs the design of feedback practices that carry the potential to bridge university and workplace environments.

In the United States, there is a widespread concern with not referring more infants and toddlers with a risk of or identified autism spectrum disorder (ASD) to Early Intervention (EI) under Part C of the Individuals with Disabilities Education Act (IDEA, 2004). Despite early signs and screening initiatives, most children with ASD are not referred for services covered by IDEA until after the age of 4 years. To explore the prevalence of and factors correlated with a potential "wait and see" mindset among one group of stakeholders influencing referral decisions, we disseminated an expert-reviewed survey to pediatric health care providers in a southeastern metro area (n = 99). They self-reported views on waiting to refer, perceived roadblocks to screening and referral, and viable recommendations. Most participants reported using a "wait and evaluate further" approach instead of "wait and see," and the large majority were not very comfortable discussing suspected ASD with parents of young children (birth to 5 years of age). Those with more years of experience reported being less likely to wait to refer an infant/toddler and more comfortable speaking with parents about suspected signs of ASD. We discuss findings and implications for a comprehensive, multisector approach to outreach and referral.

Nurses and actors both require the ability to demonstrate empathy in their practice. Mastering communication skills and techniques can inform an empathetic response. This skill is particularly important for nurses working in paediatric palliative and end of life care but there is lack of consensus whether empathy can be taught. The process an actor follows when getting into character incorporates drawing on personal emotive experiences and necessitates being receptive to others on stage in order to 'journey' from listening and empathising to actually being a character. We have translated this practice into the way we teach nursing students to communicate empathy.

Pediatric complex care clinics offer an optimal environment for integrated behavioral health services for infants and young children with medical complexity (CMC). Integrated behavioral health providers are well positioned to provide accessible care and promote development and well-being for this population with unique psychosocial needs and stressors. Furthermore, given the long-standing racial and ethnic disparities in the health care system, integrated behavioral health providers must confront and combat these disparities and the impact of racial injustice and trauma on the health of infants, young children, and families. This article describes a family and their infant who were seen by an early childhood integrated behavioral health provider (HealthySteps specialist) in a complex pediatric primary care clinic and the realities of systemic racism that the family faced as they navigated their infant's medical care. This example highlights the application and adaptation of the HealthySteps program in a complex pediatric primary care clinic and ways to support and partner with families and providers to combat systemic racism and promote health equity.

The proliferation of electronic content and limited exposure of children to books in Jordan has made both parents and health-care providers more concerned about healthy child development. This research aimed to determine if pediatric primary prevention programs were helpful in reducing screen-time and improving reading habits of children in Jordan, and if there was a correlation between these two factors. Parents attended classes on various topics, one of which dealt with screen-time and reading. Six months later, they were surveyed on these topics. The test group (took the relevant class) and control group (did not take the class) included 30 families each. The mean screen-time was above the recommended guideline of 2 h/day in both groups. Only 37% of the families in the test group, and 17% in the control group followed the guideline. A significant difference in screen-time between the groups was found only during weekends. When asked about the ideal screen-time, parents from the test group reported screen-times that were significantly closer to the recommendations, showing an increase in knowledge, but not a significant change in behavior. Parents, also, believed that children's exposure to books should be at the much later age of 3-4 years, with actual exposure being < 1 h/day. Moreover, no correlation was found between screen-time and reading time. These findings suggest that short, evidence-based classes helped raise awareness, but were not sufficient for parents to fully adopt the guidelines. Programs that promote behavior modification should be explored to reinforce knowledge gained from educational classes.

Improving autism spectrum disorder screening and referral in primary care may reduce autism spectrum disorder disparities for Latino children. The REAL-START intervention aimed to increase primary care provider adherence to autism spectrum disorder and developmental screening guidelines, and to increase Early Intervention referral for children at developmental risk in primary care clinics serving Latinos. This quasi-experimental study enrolled six Oregon primary care clinics. Clinic staff attended one initial and three follow-up trainings. Trainings addressed screening, billing, referral, and follow-up issues specific to Latinos. Clinic leaders met with a quality improvement facilitator to review performance. Medical record review measured screening and referral at 18- and 24-month well-child visits at baseline and 3, 6, 9, and 12 months. State Early Intervention database queries assessed Early Intervention eligibility. Overall, 2224 well-child visits were assessed (39% Latino). Clinics improved rates of autism spectrum disorder screening from 70% to 94% and general developmental screening from 62% to 95%. Adherence to screening guidelines increased from 46% to 91%. Proportion of children referred to Early Intervention was unchanged, but total referrals increased and age range of referred children broadened. Time to Early Intervention evaluation was slightly shorter among screening-age children. REAL-START may improve screening and referral for autism spectrum disorder and developmental delay in Latino communities.

Many school psychologists will work with a student with a medical condition in their careers, and information on the student's condition is crucial to understanding their individual needs. One type of medical condition that a school psychologist may encounter is childhood-onset autoimmune disease, such as pediatric systemic lupus erythematosus (PSLE). While PSLE is uncommon, a student with this diagnosis may have a variety of needs in the classroom requiring support, and these needs may not be obvious to those unfamiliar with PSLE. Students with PSLE can have clear medical needs, but they may also need assistance academically and socially, and these needs can change over time since PSLE is a dynamic condition. Since PSLE can vary widely between individuals, this article is intended to serve as a guideline of factors to consider when working with these students.

Objective: The purpose of this study was to evaluate whether participation in a community event developed using Health Belief Model constructs increased intention to follow the American Academy of Paediatrics Safe Sleep Guidelines for infants. Design: Observational cohort study. Setting: Safe Sleep Community Baby Showers held between Spring 2015 and Spring 2019. Method: Women attending the Safe Sleep Community Baby Showers completed pre- and post-assessments measuring intentions based on constructs derived from the Health Belief Model. Results: Following the Safe Sleep Community Baby Showers, significantly more of the 812 participants demonstrated positive changes in Health Belief Model constructs, including beliefs about severity and susceptibility (infant is at risk, sleeping with infant can cause death, loose blankets can cause death), benefits (putting infant alone, on back in crib will help protect), barriers (infant will [not] choke on back) and self-efficacy (know what to do). Two barriers did not result in significant change: room for crib (cot) in parents' room and able to keep infant warm without blankets. Most reported intention to only place infant supine (99%), in safe sleep locations (97.8%) and to include only safe items (86.2%; all p < 0.001). Conclusion: Structuring a community event based on the Health Belief Model resulted in significant increases in participants intending to follow the AAP Safe Sleep Guidelines. Further work is needed to address barriers around blankets and room sharing without bed sharing. Safe Sleep Community Baby Showers can impact Health Belief Model constructs related to the AAP Safe Sleep Recommendations, which may in turn impact behaviour.

Paediatric Autism Communication Therapy is a parent-mediated, video-aided, communication-focussed intervention for young children with autism spectrum disorder. It has been shown in a UK randomised controlled trial to lead to improvements in parent--child communication and family quality of life, together with a sustained reduction in child autism symptom severity. This qualitative study examined parental perceptions of their participation in Paediatric Autism Communication Therapy within the context of the randomised controlled trial. Semi-structured interviews were carried out with 18 parents within 12 months of completion of the therapy. The thematic analysis provides insights into parents' hopes, expectations, and learning processes when working with Paediatric Autism Communication Therapy therapists and carrying out daily practice in the home. Parents reported positive changes in their interaction and relationship with their child and improvements to their child's communication and interaction. Some also highlighted poignant realisations and emotional challenges associated with taking part in this post-diagnostic therapy. Practical difficulties were also emphasised. Implications for the clinical practice of parent-mediated interventions with young children with autism spectrum disorder are discussed. [This article was written with the PACT Consortium.]

This study investigated the effects of hospital Clown Doctors intervention on child and caregiver preoperative anxiety at the entrance to the surgery care unit and separation from caregivers. A total of 88 children (aged 4-12 years) were assigned to one of the following two groups: Clown Doctors intervention or control group (standard care). Independent observational records using the modified Yale Preoperative Anxiety Scale instrument assessed children's anxiety, while the State-Trait Anxiety Inventory measured caregiver's state anxiety. In addition, caregivers assessed the children's functional health problems by completing the Functional Status Questionnaire. Although no effects of Clown Doctors were found on children's anxiety, results showed that both low functional health problems and Clown Doctors intervention were significant predictors of lower caregiver anxiety. Caregivers also reported being very satisfied with their intervention. Overall, this study demonstrated the positive role of Clown Doctors for caregivers at a specific pediatric hospital setting.

Objective: In this study, it was aimed to determine knowledge, "attitudes" and "behaviors" in mothers with a child aged 0-5 years regarding factors causing "home accidents" and prevention. Method: The target population of the study consisted of mothers with a child aged 0-5 years who were admitted to pediatrics ward of A County Hospital. The sample size was determined as 305 subjects by power analysis. Overall, 340 mothers were recruited. The data sheet developed by researchers and a questionnaire on parental attitudes about home accidents developed by Yalaki et al. were used for data collection. Before data collection, verbal consent was obtained from mothers. The study was approved by local Ethics Committee. Data were analyzed by using Kruskal-Wallis test, t test and chi-square test. Results: Mean age was 30.11 ± 5.8 years among mothers included. A significant association was detected between experiencing home accident and maternal age, maternal education level, number of child, number of person in the family and income of family (p<0.05). In this study, it was found that wrong attitudes and behaviors were more common among mothers of children experienced home accident (p<0.05). Conclusions: It was found that there is a significant association between home accident and maternal age, maternal education level, number of child, number of person in the family, residence and income level. In addition, it was found that mother of "children" experience home accident have inappropriate attitudes and behaviors regarding prevention of home accidents and that education is an important factor in prevention of home accidents.

Venipuncture and other invasive procedures as blood draws, intramuscular injections or heel pricks are the most commonly performed painful procedures in children. These can be a terrifying and painful experience for children and their families. The present study aimed to identify Pain intensity after an ice pack application prior to venipuncture among school-age children. Fifty (50) school-age children aged from 6-12 years whom ordered to vein-puncture were included in the study, and they are chosen by simple random sample from the pediatric medical, surgical wards and pediatric emergency department in King Fahd Hospital of the University (KFUH) at the Al-Khobar city, Kingdom of Saudi Arabia. They divided equally into 2 groups, the study group who received an ice pack application for three minutes prior to venipuncture procedure over the insertion site while the control group received routine hospital care. A structured interview questionnaire sheet was used included age, gender, venipuncture procedure data and log table for recorded child's blood pressure, pulse rate and oxygen saturation as well as Wong-Baker (FACES) Self- report Pain Rating Scale, to assess pain intensity during the venipuncture among children in both groups. Results of the study revealed that, during venipuncture procedure, mean self-report pain score was lower among children in the study group than those in the control group with statistically significant difference, Mean ±SD (1.92±0.316 and 4.40±0.490) respectively P<0.001. Self-reported pain intensity was decreased in older school-age children than the younger ones and was higher among male's children than females. The study concluded that the application of an ice pack prior to vein puncture procedure was effective in reducing pain intensity among school age children and it recommended that application of an ice pack has to be a part of the routine care of all children admitted to venipuncture procedure, so educational course related the ice back storage, uses and its application time over the vein puncture site should be conducted.