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OBJECTIVE Kentucky ranks among the highest in the nation for attention-deficit/hyperactivity disorder (ADHD) prevalence in children aged 4 to 17 years. In 2011, the American Academy of Pediatrics (AAP) released a clinical practice guideline based on the DSM-IV. A guideline revision based on the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) was released in October 2019. In this study, we assess and describe pediatric providers' ADHD practices using the 2011 guideline and DSM-5 diagnostic criteria. METHODS This was a cross-sectional, survey-based descriptive study. Kentucky Chapter of the AAP (KY AAP) members were anonymously surveyed. The results were examined for trends in routine practice. RESULTS Fifty-eight general pediatricians and pediatric residents responded to the survey, yielding a 38% (58/154) response rate. Among respondents performing routine diagnosis of ADHD (N = 51), 73% (37/51) used DSM-5 criteria. Most providers usually or always initially assessed for coexisting behavioral conditions (96%; 49/51), developmental conditions (78%; 39/51), and adverse childhood experiences (73%; 37/51). Among respondents performing routine management of ADHD (N = 55), only 11% (6/55) of respondents indicated that they titrated stimulant medications every 3 to 7 days. After initiation of medication, 78% of providers scheduled a follow-up visit within 2 to 4 weeks. During subsequent visits, only half indicated discussing behavioral interventions, screening for coexisting conditions, and reviewing follow-up teacher-rated ADHD scales. CONCLUSION Pediatricians in the KY AAP adhere to the DSM-5 criteria for diagnosing ADHD. Pediatric providers' practices would benefit from education in improvements in pharmacotherapy titration, surveillance of coexisting conditions associated with ADHD, discussion of psychosocial interventions, and school support strategies.

Objectives: The National Survey of Children's Health reported a concerning increase in children 2–5 years being diagnosed with attention-deficit/hyperactivity disorder (ADHD) in 2016. Concerns incl...

Objective : Rates of pediatric bipolar disorders have increased and some are concerned about diagnostic accuracy. Disruptive mood dysregulation disorder (DMDD) was added to the DSM-5 in 2013. The purpose of this study was to assess diagnostic trends of bipolar disorders and DMDD and to identify predictors of receiving the DMDD diagnosis since implementation of DSM-5. Method : Kentucky Medicaid claims from 2012–2017 for children under 18 years (N = 814,919; 2012 n = 473,389; 2013 n = 470,918; 2014 n = 499,094; 2015 n = 517,199; 2016 n = 529,048; 2017 n = 535,814) were used. Logistic regression was used to identify predictors of a diagnosis of DMDD in 2015–2017 for a sub-sample (n = 5,071). Results : The use of DMDD rose after 2013 and mood disorder NOS decreased steadily through 2017. This decrease was seen when there was a diagnosis of bipolar and oppositional defiant disorder (ODD) combined with mood disorder NOS. A diagnosis of only mood disorder NOS in 2012 did not predict DMDD in 2015–2017, but the same diagnosis in 2013 was predictive (OR 2.14, p = 0.049). The reverse is true for a diagnosis of only ADHD in 2013, which did not predict DMDD in later years, but its presence in 2012 was predictive (OR 1.36, p = 0.010). Conclusions : DMDD increased after 2013, and this was associated with a diagnosis of mood disorder NOS, ADHD, as well as with bipolar disorders comorbid with ODD. Given the complexity of comorbid diagnoses, DMDD may be more accurate in classifying some children. Administrative claims data have limitations, which are discussed; and the data represent only children living in Kentucky.

Background The use of antipsychotic medication and psychotropic polypharmacy has increased in the United States over the last two decades especially for children from low-income families and those in foster care. Although attention has been paid to providing greater insight, prescribing patterns remain concerning since there is a lack of evidence related to safety and efficacy. High-level psychotropic polypharmacy has not been described. We aim to compare the use of HLPP for children receiving Medicaid services and those in foster care and identify factors associated with the duration of use of high-level psychotropic polypharmacy. Additionally, we will examine the frequency of laboratory metabolic screening and emergency department, inpatient, and outpatient visits. Methods A cross-sectional, secondary analysis of statewide data describes trends in high-level psychotropic polypharmacy from 2012 to 2017 and the prevalence and predictors of high-level psychotropic polypharmacy duration and resource use in 2017 for all children on Medicaid and those in foster care. High-level psychotropic polypharmacy included concurrent use, at least four classes of medications including an antipsychotic, and at least 30 days duration. Results High-level psychotropic polypharmacy increased from 2012 to 2014 for both groups but stabilized in 2015–2016. Children in foster care showed a slight increase compared to their peers in 2017. There was no association between duration and demographic characteristics or foster care status. Diagnoses predicted duration. Neither group received metabolic monitoring at an acceptable rate. Conclusions Concerning patterns of high-level psychotropic polypharmacy and metabolic monitoring were identified. Cautious use of high-level psychotropic polypharmacy and greater oversight to ensure that these children are receiving comprehensive services like behavioral health, primary care, and primary prevention.

Purpose The primary purpose of this study was to evaluate acceptability by new mothers of postpartum depression (PPD) screening and education about community resources by hospital-based perinatal nurses. A secondary purpose was to determine further screening for PPD that women received by community providers in the first few weeks after birth. Methods The study design was descriptive. As per standard practice on the unit, all new mothers were screened for depression the night before hospital discharge using the Edinburgh Postnatal Depression Scale (EPDS). New mothers identified as high risk for depression by EPDS scores greater than or equal to 10 (n = 75) and a comparison group of mothers at low risk for depression with EPDS scores less than 10 (n = 26) were recruited from an academic health sciences center. Participants were contacted by telephone 2 to 4 weeks later and asked about the acceptability of screening for depression and education about community resources by hospital-based perinatal nurses, as well as if they had received further screening for depression by community providers. Descriptive and correlational statistics were used to analyze data. Results The majority of new mothers found it acceptable to be screened for depression and educated about community resources by hospital-based perinatal nurses. Many new mothers were not asked about depressive symptoms by community providers. There was no significant correlation between demographics and depression risk. Clinical implications New mothers viewed depression screening and receiving information on community resources as a positive part of their care. Communication between inpatient and community caregivers should be improved so that new mothers can benefit from seamless depression assessment, evaluation, and treatment.

The rates of mental health diagnoses in children have increased. Children in poverty have the highest rates. The use of psychotropic medication for children has been increasing, which is concerning because of the unknown long-term effects and the increased burden on the health care system. The state of Kentucky ranks among the highest in the United States for children with mental health problems, children living in poverty, and children receiving psychotropic medication.To examine recent trends and determinants of interclass psychotropic polypharmacy (PP) use for children and youth receiving Medicaid to inform intervention development.A retrospective cohort study was conducted using 2012-2015 Kentucky Medicaid claims for children aged 0-17 years, with continuous enrollment for ≥ 90 days with at least 1 behavioral health diagnosis (N = 237,393). Interclass PP was defined as the presence of at least 2 psychotropic medication prescription fills for at least 2 different classes of medication that, if taken as directed, would be used concurrently for at least 90 consecutive days (allowing for a single 15-day lag). The outcome variables were the presence of any interclass PP and the number of months a child received interclass PP. We conducted a descriptive analysis and developed 2 separate generalized linear regression models to test for associations between individual characteristics of children treated with psychotropic medication for ≥ 90 days (n = 75,639) and each outcome of interest.For the sample of children with at least 90 days of psychotropic medication treatment, 38% had at least 3 covered months of PP over the 4 years studied. Children in foster care received alpha agonists (116 vs. 69 per 1,000 children) or antidepressants (225 vs. 176 per 1,000) at a higher rate than other children receiving Medicaid but received stimulants at a lower rate (403 vs. 638 per 1,000). The primary 2-drug class combinations were stimulants with either alpha agonists or antidepressants. Children in foster care (OR = 1.7, 95% CI = 1.58, 1.84, P0.001), with a bipolar disorder (OR = 2.24, 95% CI = 2.10, 2.38, P0.001), mood disorder not otherwise specified (OR = 1.11, 95% CI = 1.04, 1.17, P0.001), or autism spectrum disorders (OR = 1.17, 95% CI = 1.08, 1.26, P0.001) had increased the odds of ever receiving PP. Black children had lower odds (OR = 0.72, 95% CI = 0.67, 0.77, P0.001) of ever receiving PP. Children aged 6-11 years (beta = 3.08, 95% CI = 2.87, 3.29) and 12-17 years (beta = 1.61, 95% CI = 1.38, 1.83) had more covered months with PP compared with those aged 0-5 years. Black children had fewer covered months of PP compared with white children (beta = -1.36, 95% CI = -1.61, -1.11]. Children in foster care (beta = 1.83, 95% CI = 1.53, 2.13) had more covered months with PP. Children residing in nonurban areas had fewer months with PP (beta = -0.4, 95% CI = -0.54, -0.26) compared with those residing in urban areas, as did those children with depression (beta = -3.32, 95% CI = -3.55, -3.1), impulse control disorder (beta = -2.07, 95% CI = -2.28, -1.85), and conduct disorder (beta = -1.34, 95% CI = -1.64, -1.05). Children with bipolar disorder (beta = 3.62, 95% CI = 3.38, 3.86) and autism (beta = 2.04, 95% CI = 1.75, 2.33) had more covered months with PP. As comorbidity increased, the duration of PP treatment increased (beta = 2.49, 95% CI = 2.36, 2.62).The rates of PP are concerning, especially for children in foster care and children aged 6-11 years. Efforts to safeguard medication use are needed, as well as future exploration of racial differences in PP.This project was supported by the Kentucky Cabinet for Health and Family Services, Department for Medicaid; Norton Healthcare; and the School of Medicine, Department of Pediatrics; School of Public Health and Information Sciences; and Kent School of Social Work at the University of Louisville. Kentucky Medicaid approved the use of the data and granted permission to publish but played no role in the interpretation of data. Lui is employed by Kentucky Medicaid. The other authors report no potential conflicts of interest. An earlier version of this study was presented at the Pediatric Academic Societies' Annual Meeting in Baltimore, MD, on April 30-May 3, 2016. A poster presentation was given at the Society for Developmental and Behavioral Pediatrics in Cleveland, OH, on October 14-16, 2017.

Purpose The purpose of this study was to describe new mothers' knowledge related to maternal mortality. Study design and methods Using a cross-sectional design, new mothers were recruited from a postpartum unit of an academic health sciences center where the population was predominately low-income women. Before hospital discharge, they answered questions on their knowledge of potential postpartum complications that could lead to maternal mortality. Questions were based on recommendations from an expert nursing panel. Descriptive statistics were used for data analysis. Results One hundred twenty new mothers participated. Results indicated that most new mothers knew that they should watch for heavy bleeding, a severe headache, and swelling after hospital discharge. However, fewer participants knew that a new mother could experience feelings that she could harm herself or her baby, have blood clots larger than a baby's hand, a temperature of 100.4 °F or higher, and odor with vaginal discharge. Courses of action new mothers would take if experiencing any of the warning signs included 18% of mothers would take no action, 76.7% would tell their boyfriend/husband/partner, 72.5% would inform their mother. Only 60% who would call the labor and delivery unit. Only 38% of the sample knew that pregnancy-related complications can occur for up to 1 year after birth, and 13% of mothers reported not knowing that complications can occur for up to 6 weeks postpartum. Clinical implications Our findings provide a foundation to enhance postpartum education for new mothers and their families and to potentially decrease rates of maternal mortality in the United States.

OBJECTIVES Residency interviews play an integral part in medical residency placement. We aimed to develop and evaluate a mock interview program for fourth-year medical students interested in a pediatric specialty. METHODS A mock interview program for fourth-year medical students interested in pediatrics was developed and implemented. Preinterview quantitative data and postinterview qualitative data were collected. Fifty-nine students completed the program across three consecutive academic years. Preinterview surveys were completed regarding comfort and confidence levels specific to aspects of the interview process. Descriptive analyses were used. In addition, a focus group was held with nine of the participating students to obtain qualitative data via a paper blog process. Themes in student responses were identified through constant comparative analysis. RESULTS Before the mock interview, students were most uncomfortable with introductory and closing remarks and their confidence levels varied by topic. A thematic analysis of focus group data identified five themes (preparation, stress reduction, interview process familiarity, confidence of skills, and receiving feedback) for which the mock interviews were most helpful. CONCLUSIONS Implementation of a mock interview program was feasible and acceptable for senior medical students and may improve comfort and confidence levels in the residency interview process. Further longitudinal research is needed.

PURPOSE Educational materials used by healthcare agencies frequently do not follow national health guidelines for plain talk. Adolescent mothers are a vulnerable population in need of accurate and accessible health information to promote their own health and that of their baby. The aims of our study were to: Determine acceptability of simple, written educational pamphlets to adolescent mothers; Determine efficacy of simple, written educational pamphlets in improving an adolescent mother's knowledge related to breastfeeding, infant care, postpartum depression, and mother-infant relationship; Determine if higher knowledge scores are maintained after a 2-week period; and Determine general parenting health literacy of adolescent mothers. STUDY DESIGN AND METHODS Using a prospective, experimental design, students enrolled in a teen parent program (n = 123) completed a pretest and The Parent Health Literacy Activities Test (PHLAT), read the health educational materials, and completed an immediate posttest of knowledge and acceptability. Two weeks later, the same participants completed a second posttest of knowledge. RESULTS Adolescent mothers found the intervention (simple, written educational materials) to be acceptable. The intervention was initially effective in improving knowledge scores in all four content areas. However, knowledge was not retained and scores were not significantly different from baseline at the 2-week assessment. The mean health literacy of the adolescent mothers was poor. CLINICAL IMPLICATIONS A booster session may be necessary for knowledge retention. Other methods of education should be studied to evaluate efficacy for adolescent mothers' knowledge retention of important health information.

OBJECTIVE/BACKGROUND: Approximately 400,000 adolescents give birth in the US annually. Although one-half experience depressive symptoms, less than 25% comply with referrals for depression evaluation and treatment. The current study tested the effectiveness of an internet based depression intervention on seeking depression treatment. METHODS: Based upon the Theory of Planned Behavior (TPB), the intervention included vignettes, questions and answers, and resources. Before the intervention, immediately after the intervention, and two-weeks later the adolescent mothers (n=151) answered questions related to TPB variables and depression treatment. Data were compared to adolescent mothers (n=138) in the control group. Data were collected in community organizations or home visits for the control group. Adolescent mothers in the intervention group answered questions and completed the intervention from a computer of their choice. RESULTS: The adolescents were primarily African American (89.2%); less than high school educated (51.7%); had given birth in last year (97.1%); with a mean age 18.2 years. The intervention led to significant changes in attitude, perceived control, intention to seek mental health treatment, and actually seeking depression treatment. CONCLUSIONS/DISCUSSION: Untreated postpartum depression dramatically impacts a mother’s relationships with her child, her functioning at work and school, health care seeking behaviors, mothering skills, and her development as well as the development of her child. An Internet based depression intervention is an inexpensive method to increase rates of depression treatment.

Purpose Millions of adults lack adequate reading skills and many written patient education materials do not reflect national guidelines for readability and suitability of materials, resulting in barriers to patients being partners in their own health care. The purpose of this study was to evaluate commonly used printed health materials for readability and suitability for patients with limited general or health literacy skills, while providing easy recommendations to health care providers for how to improve the materials. Methods Materials (N = 97) from three clinical areas that represented excellence in nursing care in our organization (stroke, cancer, and maternal-child) were reviewed for a composite reading grade level and a Suitability Assessment of Materials (SAM) score. Results Twenty-eight percent of the materials were at a 9th grade or higher reading level, and only 23% were 5th grade or below. The SAM ratings for not suitable, adequate, and superior were 11%, 58%, and 31%, respectively. Few materials were superior on both scales. The SAM scale was easy to use and required little training of reviewers to achieve interrater reliability. Conclusions Improving outcomes and reducing health disparities are increasingly important, and patients must be partners in their care for this to occur. One step to increasing patient understanding of written instructions is improving the quality of the materials in the instruction for all patients and their families, especially those with limited literacy skills. Clinical Relevance Using materials that are written in a manner that facilitates the uptake and use of patient education content has great potential to improve the ability of patients and families to be partners in care and to improve outcomes, especially for those patients and families with limited general literacy or health literacy skills.

Health literacy has been shown to predict health behaviors and outcomes above the effects of education or socioeconomic status. Much remains unknown about the health literacy of parents and the role it plays in children’s health outcomes or in health disparities. The current study explored the health communication needs and health literacy indicators in a diverse sample of parents (n = 75) to identify potential areas for future interventions. The sample consisted of parents of children 18 to 36 months old who were visiting 3 different pediatric medical offices, 2 of which served low-income families and 1 located in an affluent suburb. When comparisons were made between 2 educational attainment groups, there were variations in indicators of health literacy and health communication needs. These data can be used to guide the development of interventions by primary care providers to improve parent education.

Early childhood is an important period for development. Parents play an important role in structuring children’s physical and psychosocial environments. Much remains unknown about the best methods for engaging parents in health promotion programs. It is critical that programs meet the needs of the families while encouraging the use of positive parenting strategies. The article describes how one pediatrician used the American Academy of Pediatrics’ Community Access to Child Health grant program to develop and implement The Arts of Parenting program with input from predominantly low-income families. A community mapping and needs assessment was conducted as well as stakeholder interviews and parent focus groups to determine the needs of the families with preschoolers. Family programs that are centered in play and the arts provide families with a supportive environment in which to engage their children and learn about their child’s socioemotional development, and build a network with neighborhood peers.

Fragmentation in behavioral and mental health care to children has resulted in suboptimal care and high rates of psychotropic medication use, especially antipsychotic medications (APM). A qualitative study, based on the Theory of Planned Behavior (TPB), aimed to better understand prescribing practices, barriers to optimal treatment, and potential interventions to safeguard the use of APM for children in Kentucky. The most common barrier to optimal care was access to mental health specialists. Social norms and pressure from families contribute to increased medication use. We identify promising interventions to safeguard the use of APM through the lens of the TPB.

Background Parents of infants hospitalized in the neonatal intensive care unit (NICU) frequently need guidance to prepare them for the care and health promotion of their child after hospital discharge. The health literacy of the parents should be considered so that education can be tailored to meet their needs. It is also important to understand the parents' preferences for how, and from whom, they receive education. Purpose The purpose of this study was to identify health literacy levels of parents of infants in an NICU and preferences for who they want to provide them with education. Methods An exploratory, descriptive design was used to assess participant health literacy and preferences for obtaining child health information. Only mothers (no fathers) with babies in the NICU were available to complete the survey. Mean participant age was 26.4 years (SD = 6.7). Results Participants had a mean Rapid Estimate of Adult Literacy in Medicine, Revised, score of 5.64 (SD = 2.4), indicating a low level of health literacy. Questions regarding when to administer medication were correctly answered by 69% of participants. Proper medication dosage was understood by 92% of participants; however, only 30% were able to correctly convert measurements. One-on-one discussions with a physician were the preferred source of health information for 80% of participants. Implications for practice/research The current exploratory study provides new information that will help inform the development of future studies and increase awareness of nurses regarding health literacy and the specific types of skills for which parents need the most help.

This study describes the experiences of and barriers for pediatricians in Kentucky in providing behavioral/mental health (B-MH) services in primary care settings. These data will serve as a foundation for improving service delivery. An online survey was completed by 70 pediatricians. Descriptive data are presented. More than 90% of the respondents said that they saw at least one patient a month with 1 of 10 specific B-MH diagnoses. Physicians' comfort with diagnosing and treating disorders varied widely by diagnosis, age-group, and drug classification. Major barriers to providing optimal care were inaccessibility of mental health professionals for consultation and referral, lack of communication, and lack of knowledge. Respondents were more likely to favor consultation and co-location models over an integration model of care delivery. Overall, the authors found that pediatricians are dealing with patients with B-MH problems for which they may not have been adequately trained. Communication and collaboration needs were identified.

This study reviewed Kentucky Medicaid claims data for children with autism spectrum disorders to determine psychotropic drug (PTD) use in this population. Children with autism spectrum disorders (ICD-9 code 299.XX) in 3 different age-groups from 2005 to 2008 were identified; PTD use was defined as at least 1 prescription per year. PTD use in all age ranges was higher than in previously reported studies. High PTD use in children between 1 and 5 years is particularly of concern and may reflect perceived inadequacies of comprehensive educational/behavioral services for these children.

Changes in nutritional strategies over the past decade have been shown to improve postnatal growth in extremely low birth weight (ELBW) infants. We showed 10 years ago that the majority of these ELBW infants with bronchopulmonary dysplasia (BPD) suffer postnatal growth failure. We theorized that recent changes in nutritional support strategies would positively affect growth outcomes in ELBW infants with BPD.A retrospective study of 88 ELBW infants with BPD. Nutritional data, postnatal growth and BPD severity were compared across three cohorts: (1) weight gain ≤14 g kg(-1) per day, (2) 14.1 to 16 g kg(-1) per day and (3) ≥16 g kg(-1) per day from return to birth weight through discharge. We also compared these to a historical cohort.In all, 73% of current subjects grew at or above fetal rates. There was less extrauterine growth restriction (EUGR) by weight and head circumference for those ELBW infants with BPD receiving higher amounts of protein. Aggressive early TPN and receipt of caloric-dense milk seemed to be the 'new' nutritional strategies improving growth for current ELBW infants with BPD compared with those 10 years ago.Despite a diagnosis of BPD, improved nutritional strategies have enhanced postnatal growth in infants at high risk for EUGR.

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.

Introduction The aim of this study is to understand low-income parents' preferences for and barriers to receiving child health promotion information. Methods A mixed-methods approach was used. Data were collected in an urban pediatric primary care setting serving predominantly low-income African American families. Parents ( n = 190) of 3- to 8-year-old children completed a survey; a randomly selected subset participated in focus groups. Results The quantitative and qualitative samples differed with regard to whether they would like to get parenting information from their doctors. The most commonly cited obstacles to attending parenting classes were time (50.6%), work schedule (40.6%), transportation (37.7%), and own health (22.4%). Discussion New and creative methods are needed to promote child health and development that do not increase the burden associated with raising children in the context of limited resources.

Membership in The Academy of Neonatal Nursing has been gradually increasing to the current level of 7,078 members. The National Advanced Practice Neonatal Nurses Conference, sponsored by the Academy, which took place April 16–18, 2004, in St. Louis, was very well received. Some of the speakers who the attendees really enjoyed were Dr. Sherry Courtney, who spoke on various respiratory issues; Dr. Luciana Young, who spoke on cardiac topics; Dr. Susan Abdel-Rahman, who spoke on developmental pharmacokinetics; and Jeanne Giebe, MSN, NNP who spoke on DIC. There were many other great speakers at the conference, including: Dr. Martin Keszler, Dr. F. Sessions Cole, Dr. Brian Ohning, and Dr. Carol Trotter. A copy of the program for this conference can be found in the November/December 2003 issue of Neonatal Network.®

Purpose A literature review to contrast the role of social and professional support in improving maternal and infant outcomes in pregnant and parenting women. In addition, recommendations are made for future research and policy and program development concerning support needed by pregnant and parenting women. Data sources Data were limited to published studies. Searches of computerized databases, hand searches of journals, and backward searches from reference lists of studies were conducted. Nursing, medicine, psychology, public health, sociology, and social work literatures were searched (CINAHL, Medline, PsychLit, Social Sciences Abstracts, Social Sciences Citation, and Social Work Abstracts). Study selection The studies focused on outcomes of social support and professional support to pregnant and parenting women. The samples of the studies included pregnant women and parenting women up to 2 years postpartum. Studies reviewed were conducted in the United States or Canada and included maternal and/or infant outcomes. All ages and races of pregnant and parenting women were considered. Data extraction Data were extracted from each study concerning the theoretical framework, variables, sample, design, measuring instruments, interventions, and outcomes. Data synthesis Social support outcomes were summarized in paragraphs while a table was used to summarize professional support intervention outcomes. Conclusions Outcomes associated with specific support interventions should be clearly identified, informed by theory, and include assisting the pregnant and parenting woman to improve her social support.

Background: Childhood obesity is a growing problem for children in the United States, especially for children from low-income, African American families. Objective: The purpose of this qualitative study was to understand facilitators and barriers to engaging in healthy lifestyles faced by low-income African American children and their families. Methods: This qualitative study used semi-structured focus group interviews with eight African American children clinically identified as overweight or obese (BMI > 85) and their parents. An expert panel provided insights in developing culturally appropriate intervention strategies. Results: Child and parent focus group analysis revealed eleven barriers and no definitive facilitators for healthy eating and lifestyles. Parents reported confusion regarding what constitutes nutritional eating, varying needs of family members in terms of issues with weight, and difficulty in engaging the family in appropriate and safe physical activities; to name a few themes. Community experts independently suggested that nutritional information is confusing and, often, contradictory. Additionally, they recommended simple messaging and practical interventions such as helping with shopping lists, meal planning, and identifying simple and inexpensive physical activities. Conclusions: Childhood obesity in the context of low-resource families is a complex problem with no simple solutions. Culturally sensitive and family-informed interventions are needed to support low-income African American families in dealing with childhood obesity.

The medical home model of care is widely accepted as the ideal for children with autism spectrum disorders (ASDs) but may be very difficult to implement. In this study, parents of children with autism and pediatricians caring for children with autism in Kentucky were surveyed to determine the current status of primary care services for children with ASDs. Results indicated that the majority of families and physicians were comfortable with the routine health care provided to children with ASDs, but had concerns about physician ability to provide information regarding community resources, address comorbid conditions associated with autism, and discuss treatment options. The need for physician education regarding available national and regional autism resources is clear. Creative strategies involving collaboration across medical, educational, and community systems appear to be essential for establishing effective medical homes for children with ASDs.

Objective The current study aimed to better understand trends and risk factors associated with non-fatal drowning of infants and children in the USA using two large, national databases. Methods A secondary data analysis was conducted using the National Inpatient Sample and the Nationwide Emergency Department Sample databases. The analytic sample (n=19 403) included children

Objective Significant numbers of U. S. children have diagnosable mental health problems, but only a small proportion of them receive appropriate services. The current study aims to understand factors, including stigma, associated with parents’ help-seeking behaviour related to child behaviour problems and to determine if there are cultural differences in those factors. Method Participants were the parents and/or legal guardians of children ages 3–8 years recruited from primary care settings in 2 locations within the U. S. One group was Caucasian (n = 128) from a rural area and one group was African American (n = 101) from an urban location. Variables included child behaviour, stigma (self, friends/family, and public), object of stigma (parent or child), obstacles for engagement, intention to attend parenting classes, sources of and preferences for parenting advice, and demographics. Results Parents perceive stigma associated with child behaviour problems and there were differences between the groups on the types of stigma, the object of the stigma, and the relationships to help-seeking. Group differences were also found regarding the sources of and preferences for parenting advice. Conclusions Parent stigma should be considered in the design of care models to ensure that children receive appropriate and timely preventative and treatment services for behavioural/mental health problems.

Background: To better understand factors that may impact infant mortality rates (IMR), we evaluated the consistency across birth hospitals in the classification of a birth event as either a fetal death or an early neonatal (infant) death using natality data from North Carolina for the years 1995–2000. Methods: A database consisting of fetal deaths and infant deaths occurring within the first 24 hours after birth was constructed. Bivariate, followed by multivariable regression, analyses were used to control for relevant maternal and infant factors. Based upon hospital variances, adjustments were made to evaluate the impact of the classification on statewide infant mortality rate. Results: After controlling for multiple maternal and infant factors, birth hospital remained a factor related to the classification of early neonatal versus fetal death. Reporting of early neonatal deaths versus fetal deaths consistent with the lowest or highest hospital strata would have resulted in an adjusted IMR varying from 7.5 to 10.64 compared with the actual rate of 8.95. Conclusions: Valid comparisons of IMR among geographic regions within and between countries require consistent classification of perinatal deaths. This study demonstrates that local variation in categorization of death events as fetal death versus neonatal death within the first 24 hours after delivery may impact a state-level IMR in a meaningful magnitude. The potential impact of this issue on IMRs should be examined in other state and national populations.