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This study aimed to evaluate the attitude of pediatricians toward the use of complementary and Traditional Medicine (TM) on children in Muscat, Oman. A cross-sectional survey was performed using a self-completed questionnaire during the year 2012. A total of 67 pediatricians, comprising of 30 males (44.8%) and 37 females (55.2%) participated in the study. The majority of the studied group (83.5%) was of the opinion that most types of complementary and TM are not safe for children, except spiritual healing, to which 53.7% considered as safe. About one third (29.9%) of the participants reported that they might recommend complementary and TM for sick children in the future. Almost half the participants (52.2%) acknowledged personal use of complementary and TM in the past and 67.2% reported that their family members used these medicines. Herbal therapy was found to be the most commonly used method (38.9%) followed by spiritual (33.9%), cautery (20.2%) and Curucoma (15.7%). Other methods, which include; acupuncture, bone healing and Chinese healing were also found to be in use but in rare manner. Knowledge level of TM and complementary medicine of most of the doctors was found to be low but one third of them acknowledged that they may recommend these treatments to their patients in future. Therefore, training pediatricians on the types, benefits and side effects of complementary and TM is recommended.

Background: Atopic dermatitis (AD) is a chronic dermatological condition, often diagnosed and managed by pediatricians. However, pediatricians have difficulties with adhering to guidelines, which recommend the use of topical corticosteroids (TCS) as a first-line treatment and oral corticosteroids (OCS) for resistant cases. Our aim was to assess pediatricians' self-confidence in using steroids in the management of pediatric AD, and investigate which characteristics are related to high self-confidence in prescribing corticosteroids (CS)., Methods: We conducted a cross-sectional questionnaire study among Israeli pediatricians between April 2022 and June 2022. Participants were asked to answer questions dealing with self-assessment of prescribing CS in the management of AD., Results: A total of 171 residents and pediatricians participated in the survey; 86.6% and 28.1% admitted feeling either average or below-average confidence in the prescription of OCS and TCS, respectively. Physicians who were exposed to higher AD patients (P=0.048) and worked at the clinics (88.2% vs. 60.4%, P<0.001) had high self-confidence in treating AD with TCS. Males (20.3% vs. 8%, P=0.03), and having gone to medical school outside Israel (22.2% vs. 10.4%, P=0.09) were all related to high self-efficacy in prescribing OCS. In total, 11.7% of participants confessed to refraining from prescribing steroids because of fear of side effects., Conclusions: Most pediatricians have below-average confidence in prescribing OCS for the treatment of AD. Males, working in a community setting, and previous exposure improve the confidence level and can be easily considered in future pediatric training programs., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-23-271/coif). The authors have no conflicts of interest to declare., (2023 Translational Pediatrics. All rights reserved.)

Objective: The principal aim of this randomized clinical trial (RCT) was to test the effectiveness in the prevention of Early Childhood Caries (ECC) through an educational intervention program with the use of a printed guide for pediatricians and parents both designed by pediatric dentists., Materials and Methods: After ethical approval, the first step was to design the educational guides, which were based on the information obtained from a focus group with pediatricians ( n  = 3), phone interviews with mothers to toddlers' ( n  = 7), and the best evidence available about children's oral health. For the RCT, 309 parents with their 10-12 months old children were randomly allocated to either the intervention or the control group. Parents in the intervention group received oral health education from the pediatricians supported by the printed guides. Parents in both groups received an oral health kit with a toothbrush and toothpaste at the first visit as well as at each 6-month follow-up visit. After 18 months the children were evaluated using ICDAS criteria., Results: At baseline, data were available from 309 children (49.8% girls). The mean age of the children was of 10.8 months (SD = 0.8) and 69.3% had not had their teeth brushed with toothpaste. After 18 months, a total of 28 (22%) children in the intervention group and 44 (24%) in the control group were clinically examined. Regarding the number of tooth surfaces with caries lesions, the children in the intervention group had a mean of 6.50 (SD = 6.58) surfaces, while the children in the control group had a mean of 5.43 (SD = 4.74) surfaces with caries lesions. This difference was not significant ( p  = 0.460)., Conclusion: The RCT showed no effectiveness in caries-progression control. Despite this result, this study managed to identify barriers that do not allow pediatricians from offering parents adequate oral health recommendations. With this learning, it is possible to work on collaborative programs with pediatricians that over time likely will increase dental health by controlling for ECC., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Abreu-Placeres, Ekstrand, Garrido, Bakhshandeh and Martignon.)

Pediatric sleep medicine is an area of intense research. The importance of screening for obstructive sleep apnea syndrome (OSAS) has been emphasized in the recently published international guidelines for the diagnosis and management of childhood OSA. In Romania, the fi rst steps of diagnosis and treatment of sleep disorders in children have been recently made and we wanted to assess the current awareness and management option in a group of HCPs. A self-administered questionnaire was sent by email to pediatricians, family doctors, medical doctors of other specialties, including pneumologysts, psychiatrists and ENT specialists. The results, important for the qualitative information, show that pediatric sleep disorders, mainly OSAS, are diagnosed rather by specialists than by family doctors, and that in most cases the management strategy was re-evaluation of the child and/or referral to another specialist. Half of the respondents completed the fi nal open qestion showing the need for improvement, both theoretical and practical knowledge, for a better communication between specialists and improvement of access to diagnostic tools, as well as increase of education of parents and older children and adolescents. Further research is needed to confi rm these qualitative data, however the questionnaire allowed the identifi cation of poor areas for various working groups, fi nally elaborating recommendations for various interventions which might infl uence the development of this fi eld in our country as well.

Background and Objectives Pediatricians face numerous challenges in providing care for children with special health care needs (CSHCN). Few studies have described health care resources available to support pediatricians to care for CSHCN. This study investigated available resources to care for CSHCN and factors associated with having a greater proportion of CSHCN in practice. Methods We conducted a statewide survey of active members of the American Academy of Pediatrics in California to study pediatric subspecialty care access, community and office resources and practice barriers. We performed a logistic regression model on having an “above average proportion” of CSHCN in practice, adjusting for demographics, practice type (rural vs. suburban/urban) and medical resources, care satisfaction, and ease of subspecialty access. Results Our response rate was 50.2% (n = 1290); 75% of respondents reported providing some primary care services, with many primary care pediatricians caring for a high proportion of CSHCN. Pediatricians reported an average of 28% CSHCN in their practices. Rural pediatricians lacked subspecialty access (10-59% reporting no access to the various subspecialties). Factors relating to higher CSHCN in practice included being in academic medical centers and satisfaction in caring for CSHCN. Conclusions Pediatricians report lack of access to mental health services, care coordination and case management. Academic medical centers and higher physician satisfaction in care delivery for CSHCN are associated with more CSHCN in practice. Promoting ways to support pediatricians, such as practice collaboration with behavioral specialists, may be necessary to encourage primary care pediatricians to provide medical homes for CSHCN. [ABSTRACT FROM AUTHOR]

Venezuela through a complex humanitarian emergency, according to the Organization of United Nations, which is the result of a combination of political instability, conflicts and violence, social inequality and underlying poverty. The impact of this situation on the living conditions of the population, especially children, has been registered by national non-governmental and international organizations to silence an accomplice of the State. Reviews of the indicators that allow evaluating the degree of welfare of the Venezuelan child population in terms of level of poverty, nutrition and food security, health, education and other social determinants. Conclusion: As result of the complex humanitarian emergency, Venezuelan children is threatened by the increase in poverty, from which it has generated an increase in all forms of malnutrition and food insecurity, an increase of the maternal, neonatal and child mortality, the emergence of diseases preventable by vaccines and those transmitted by arthropods, a serious deterioration of the educational system and the obligation of many families to migrate to survive. The pediatrician has an important role in the care of children and adolescents to identify risk factors denounce the violation of their rights and unite efforts to ensure their well-being. [ABSTRACT FROM AUTHOR]

Objective: Early intervention is aimed at preventing or mitigating common pediatric oral diseases and conditions while initiating a relationship between the mother, the child, and the dental caregiver. Every expectant mother should receive oral health education and risk assessment. There are a number of reports that showed the association between oral diseases and preterm, low birth weight, and gestational diabetes. The purpose of this study is to understand the attitude and knowledge regarding prenatal as well as infant oral health care among gynecologists in the medical colleges in Bhubaneswar, Odisha, India.Materials and Methods: The study involved a survey involving gynecologists in medical colleges in Bhubaneswar, Odisha. A pretested questionnaire was provided to all the gynecologists (21) working in the medical colleges in Bhubaneswar regarding prenatal and perinatal oral health care.Results: The study gave an idea that most gynecologists working in a medical college in Bhubaneswar, Odisha, India, had adequate knowledge regarding oral health of expectant mothers, but lack in knowledge when it comes to imparting knowledge on infants' health care.Conclusion: There is an adequate knowledge among the gynecologists about oral health of expectant mothers and infants, but still, there is a need of a multidisciplinary collaboration among gynecologists, pediatricians, and pediatric dentists to prevent the dental diseases rather than treating them. [ABSTRACT FROM AUTHOR]

Supraglottic airway devices (SADs) have been introduced to assist medical professionals in emergency situations with limited experience in securing airways via conventional endotracheal intubation (ETI). Literature on the use of SADs for securing an airway during pediatric critical settings is scarce, and there is a lack of studies comparing different SADs to each other and to conventional ETI. We conducted a study comparing five different SADs to ETI with regard to success rate, time to first ventilation, and personal rating in a pediatric manikin under simulated physiologic and pathologic airway conditions in 41 pediatricians of varying clinical experience and training. Only the AirQ, AuraG, and laryngeal tube (LT) were inserted within 30 s correctly by all participants under physiologic conditions. In tongue edema (TE), AirQ and LT had the highest success rate. In limited mobility of the cervical spine (CS), AirQ, AuraG, and LT again all were inserted within 30 s. In a multivariate analysis, factors influencing the success were experience with the respective device and level of medical education. Under TE conditions, there were significantly longer insertion times for the ETI, laryngeal mask airway (LMA), and EzT. Under CS conditions, there were significantly longer insertion times for the ETI, LMA, LT, and EzT. A multivariate analysis showed experience with the respective device to be the only factor of influence on time to first ventilation.Conclusion: LT, AuraG, and AirQ were superior in providing fast and effective ventilation during simulated difficult airway situations in pediatricians. What is Known: • Supraglottic airway devices have been introduced for medical professionals who lack experience for managing difficult airway situations. • A variety of these devices have been developed so far, but not compared to each other yet. What is New: • We compared five different supraglottic airway devices with regard to success rate, time to first ventilation, and personal rating in a pediatric manikin under simulated physiologic and pathologic airway conditions. • Laryngeal tube, AuraG, and AirQ were superior in providing fast and effective ventilation during simulated difficult airway situations in pediatricians with varying clinical experience. [ABSTRACT FROM AUTHOR]

Objective The aim of the study was to investigate pediatricians’ experiences of working with breastfeeding. Method Semi-structured interviews were conducted with 12 pediatricians working at hospitals in Stockholm County. The interviews were recorded, transcribed and analyzed using content analysis and an inductive approach. Results All pediatricians saw their role in working with breastfeeding as an important one, but their primary role as pediatricians was to ensure that infants received good nutrition. They delegated the practical aspects of breastfeeding to midwives, who were seen as experts, although the pediatricians believed they had a greater understanding of the necessity for supplemental feeding than did midwives. They also expressed the need for a common strategy regarding supplemental feeding and better teamwork with the midwives. Some respondents noted that it was difficult to advocate for breastfeeding without seeming critical of mothers who experienced problems with it or who did not want to do it. The results comprised a general theme, that breastfeeding is a genuine and difficult task, and five categories: factors decreasing breastfeeding, competence, roles of the professionals, supplemental feeding, the health-care system's responsibility. Conclusions Pediatricians have an interest in breastfeeding. However, they perceive inadequate communication with midwives and a need for better collaboration with them regarding breastfeeding. The study also identified a need for a national breastfeeding strategy and for improved conditions that create a breastfeeding-friendly environment. [ABSTRACT FROM AUTHOR]

Objectives Acute otitis media (AOM) is predominantly a disease of childhood and one of the common reasons for prescribing antibiotics. Ear pain is the main symptom of AOM, with the result that parents frequently seek immediate medical assistance for their children. Antibiotic therapy for AOM does not provide symptomatic relief in the first 24 hours, and analgesics are commonly recommended for relieving the pain associated with AOM. The aims of the present study were to assess pediatricians' attitudes toward AOM and ear pain management in Turkey. Methods This multicenter descriptive questionnaire study was conducted in 20 centers from different geographic locations in Turkey, with 977 pediatricians, between June 2015 and December 2016. The questionnaire comprised 20 questions focusing on the pediatricians' sociodemographic variables, experiences, and treatment related to AOM and ear pain. Results Of the pediatricians, 58.2% were residents, 36.5% were specialists, and 4.3% were lecturers. Most participants were working in a university hospital (54.8%) or education and research hospital (32.2%). In general daily practice, the AOM diagnosis rates were between 6% and 20% in outpatient clinics, and 52.3% of the participants stated the patients complained about ear pain in pediatric clinics. The watchful waiting (WW) rate, as opposed to immediate antibiotic treatment, was 39.8% for all the pediatricians. The pediatric residents used the WW strategy less than the specialists and lecturers did (p = 0.004). The rates of the WW strategy were higher in outpatient clinics where AOM was commonly diagnosed (p < 0.001). The most common antibiotic prescribed for AOM was amoxicillin clavulanate (76.7%). The mean recommended treatment period for AOM was 9.3 ± 2.2 days. The choices for systemic ear pain treatment were acetaminophen (26.8%), ibuprofen (29.4%), and alternating between ibuprofen and acetaminophen (43.9%). Moreover, 34.6% of the participants recommended topical agents for otalgia. Topical agents were more commonly recommended by the pediatric residents than specialists or lecturers (p < 0.001). Finally, 58.3% of pediatricians had experiences of the parents' usage of a variety of herbal and folk remedies, such as breast milk or olive oil, for their children's ear pain. Conclusion Amoxicillin clavulanate was the most frequently prescribed antibiotic for AOM. WW was approved by the pediatricians, and having more AOM patients was a significant factor in the physicians' choice of WW; nevertheless, the WW rate was poor. Implementation of educational intervention strategies will help pediatricians in improving their compliance with evidence-based guidelines for AOM treatment. Otalgia is taken seriously by parents and pediatricians, and otalgia treatment seems to be well accepted in Turkey for providing symptomatic relief and enhancing the patients' quality of life. [ABSTRACT FROM AUTHOR]

Aim: Pediatricians and family doctors are at the first step in the education of parents about oral health, as well as the prevention of oral diseases and the provision of oral health in children. The aim of this study is to evaluate the knowledge, attitudes, and practices of pediatricians and family doctors about oral health in children. Methodology: A questionnaire consisting of 50 items was sent to pediatrician and family doctors via mail. Descriptive analysis and ttests were done to analyze the data. Participation in the survey, with a total of 240 participants (58 pediatricians, 182 family doctors), was 100%. Results: It was found that pediatricians believe that they have more important role in the development of oral health and prevention of oral diseases and they are more interested in participating in the oral health program than are the family doctors. Conclusions: Pediatricians and family doctors should work with dentists to improve the quality of oral hygiene in all young children. [ABSTRACT FROM AUTHOR]

Recommendations for the prevention of childhood obesity encourage providers to counsel parents and their children on healthy diet and activity behaviors. This study evaluated the feasibility of a theory-based, tailored communication intervention for obesity prevention (Team Up for Health) delivered during a well-child visit. A twoarmed randomized controlled trial was used. Parents of children aged 4-10 years were recruited from a list of patients due for a wellchild visit at a pediatric primary care clinic. Parents were randomized to either the 'immediate' condition (parent and pediatrician received the tailored report at the well-child visit) or the 'delayed' condition (parent received the report at the end of the study). Self-report measures assessed physical activity, fruits, vegetables, television time, sugary drinks, and 100% fruit juice. Parents completed assessments at baseline, <48 h and 4-week follow-up. Providers were interviewed at the end of the study. Independent t-tests were used to examine between group differences. Seven areas of feasibility were evaluated: Recruitment, randomization, measurement, retention, acceptability, implementation and demand. Results showed high rates of measurement (85%) and acceptability (89%) and implementation (80%) of the intervention. In conclusion, Team Up for Health was feasible; however, a larger study is needed to evaluate its efficacy. [ABSTRACT FROM AUTHOR]

Expanded partnership with the medical community is an important strategy for reducing dental caries disparities. The purpose of this study was to assess the relationship between fluoride (F) "in office" (drops/tablets and/or varnish), as prescribed or applied by a health care professional by age 1 y, and 1) caries development and 2) presence of other caries risk factors or mediators (e.g., socioeconomic status). Child--primary caregiver (PCG) pairs (N = 1,325) were recruited in Indiana, Iowa, and North Carolina as part of a longitudinal cohort study to validate a caries risk tool for primary health care settings. PCGs completed a caries risk questionnaire, while children received caries examinations per the criteria of the International Caries Detection and Assessment System at ages 1, 2.5, and 4 y. Baseline responses regarding children's history of F in office were tested for association with other caries risk variables and caries experience at ages 2.5 and 4 y via generalized estimating equation models applied to logistic regression. The sample was 48% female, and many children (61%) were Medicaid enrolled. The prevalence of cavitated caries lesions increased from 7% at age 2.5 y to 25% by age 4 y. Children who received F in office were likely deemed at higher caries risk and indeed were significantly (P < 0.01) more likely to develop cavitated caries lesions by ages 2.5 and 4 y, even after F application (odds ratios: 3.5 and 2.3, respectively). Factors significantly associated with receiving F included the following: child being Medicaid enrolled, not having an employed adult in the household, child and PCG often consuming sugary drinks and snacks, and PCG having recent caries experience. Increased F in office from a health care provider by age 1 y was associated with known caries risk factors. Most (69%) children had never been to the dentist, suggesting that risk factors could be alerting medical providers and/or parents, thereby affecting in-office F recommendations. Differences among states could also be related to state-specific F-varnish reimbursement policies (ClinicalTrials.gov NCT01707797). [ABSTRACT FROM AUTHOR]

Background Parents often use social media such as blogs to inform decisions about vaccinations, however little is known about pediatrician blogs addressing vaccines. The objective of this study was to assess content, citations, audience engagement and accuracy of vaccine information on pediatrician blogs. Study design We conducted a content analysis of vaccine information on pediatrician blogs. A national sample of pediatrician blogs was identified using a search rubric of terms applied to multiple search engines. Inclusion criteria were: (1) the writer identified as a pediatrician (2) US based (3) ≥1 post since 1/1/2014. We identified 84 blogs; 56 fit inclusion criteria. Data were collected on all posts mentioning vaccines from 1/1/14 to 2/28/15. We identified the major topic for each post, examined citations to determine sources of information and counted the number of comments per post to evaluate audience engagement. We assessed accuracy of vaccine information using evaluation criteria adapted from information for parents on the CDC website. Results We identified 324 unique blog posts containing information about vaccines on 31 pediatrician blogs. The most common major topic was vaccine-specific posts (36%); Influenza and MMR were the most prevalent. Other common topics included: activism against anti-vaccine information (21%), vaccine exemptions (10%), autism (8%), and vaccine safety (6%). Activism against anti-vaccine information was the topic with the most reader engagement. The most common sources cited were governmental organizations such as the CDC and WHO (34%), and medical journals (31%). All blogs except 2 included information that was consistent with CDC information. Conclusions Pediatrician bloggers frequently address vaccinations; most provide accurate information. Pediatrician blogs may be a new source to provide vaccine education to parents via social media. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Health Policy, Insurance & Management / Polityka Zdrowotna is the property of Insurance Institute in Poland and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Children with special health care needs (CSHCN) use relatively high quantities of healthcare resources and have overall higher morbidity than the general pediatric population. Embedding clinical pharmacists into the Patient-Centered Medical Home (PCMH) to provide comprehensive medication management (CMM) through collaborative practice agreements (CPAs) for children, especially for CSHCN, can improve outcomes, enhance the experience of care for families, and reduce the cost of care. Potential network infrastructures for collaborative practice focused on CSHCN populations, common language and terminology for CMM, and clinical pharmacist workforce estimates are provided. Applying the results from the CMM in Primary Care grant, this paper outlines the following: (1) setting up collaborative practices for CMM between clinical pharmacists and pediatricians (primary care pediatricians and sub-specialties, such as pediatric clinical pharmacology); (2) proposing various models, organizational structures, design requirements, and shared electronic health record (EHR) needs; and (3) outlining consistent documentation of CMM by clinical pharmacists in CSHCN populations.

Background: We aimed to determine the knowledge and attitudes of Turkish pediatricians concerning vitamin D supplement. Methods: The study was planned cross-sectional to be carried out between April-May 2015 in Turkey. A questionnaire form that determined the participants' opinions and practices concerning vitamin D supplement was completed via face-to-face interview. Results: A total of 107 pediatricians (49.3%) and 110 pediatric residents (50.7%) participated in the study. Of the physicians, 85.2% recommended vitamin D supplement for all infants and children regardless of diet, 13.4% recommended for the infants which are solely breastfed. Vitamin D supplement is recommended at a dose of 400 IU/day by 88.8% of pediatricians and by 90% of pediatric residents. Of the pediatricians and pediatric residents, 72% and 68.2%, respectively commence vitamin D supplement when the newborn is 15 days old. The rates of recommending vitamin D supplement until the age of one and two years were higher among pediatricians (48.6% and 41.1%, respectively) than pediatric residents (40.9% and 32.7%, respectively). The rate of starting vitamin D supplement for fontanelle closure was significantly higher among pediatric residents (15.5%) than pediatricians (3.7%) (p = 0.002). It was determined that the rate of prescribing vitamin D supplement until fontanelle closure was higher among pediatric residents (18.2%) than pediatricians (0.9%). Conclusions: The present study suggest that the knowledge of pediatricians about recommendation of vitamin D needs to be enhanced by education programs in addition to free vitamin D supplement provided by the Ministry of Health. [ABSTRACT FROM AUTHOR]

Correct use of a child safety seat (CSS) can reduce the risk of fatal motor vehicle crash-related injury by up to 71%; however, misuse rates for CSS are as high as 70%. We recruited 189 caregivers at 2 large suburban pediatric office practices; 94 in the intervention group and 95 in the control group. All participants completed a baseline survey and received a CSS safety brochure. Intervention participants had their CSS installation checked at enrollment by a certified child passenger safety (CPS) technician. Follow-up was conducted 4 months post enrollment. Intervention group participants had a 21.3% reduction in critical misuse at follow-up, whereas control participants critical misuse rate at follow-up was identical to the intervention group at baseline. A consult with a certified CPS technician, at the time of a routine visit to the pediatrician, resulted in a reduction in CSS misuse rates. [ABSTRACT FROM AUTHOR]

Copyright of Pediatrie pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Although pediatric asthma continues to be a highly studied disease, data to suggest clear strategies to decrease asthma related revisits or readmissions is lacking. The purpose of our study was to assess the effect of emergency department (ED) direct dispensing of beta-agonist metered dose inhalers on pediatric asthma ED revisit and readmission rates.Methods: We conducted a retrospective cohort study of pediatric patients discharged from the pediatric ED with a diagnosis of asthma. Our primary outcome measured the rate of asthma revisits to the ED or admissions to the hospital within 28 days. Logistic regression analysis was used to assess ED beta-agonist MDI dispensing and revisit and/or readmission as the outcome.Results: A total of 853 patients met eligibility for inclusion in the study, with 657 enrolled in the Baseline group and 196 enrolled in the ED-MDI group. The Baseline group experienced a revisit and readmission rate of 7.0% (46/657) versus 2.6% (5/196) in the ED-MDI group, (p = 0.026). ED direct dispensing of MDIs was found to be independently associated with a decreased risk of revisit or readmission (odds ratio 0.37; 95% confidence interval 0.14–0.95).Conclusions: In our study, ED direct dispensing of beta-agonist MDIs resulted in a reduction in 28-day revisit and readmission to the hospital. Further studies should be performed to evaluate the economic impact of reducing these revisits and readmissions against the costs of maintaining a dispensing program. Our findings may support modification of asthma programs to include dispensing MDIs from the emergency department. [ABSTRACT FROM PUBLISHER]

Objective: To evaluate the potential impact of a concussion management education program on community-practicing pediatricians.Study Design: We prospectively surveyed 210 pediatricians before and 18 months after participation in an evidence-based, concussion education program. Pediatricians were part of a network of 38 clinically integrated practices in metro-Atlanta. Participation was mandatory for at least 1 pediatrician in each practice. We assessed pediatricians' self-reported concussion knowledge, use of guidelines, and comfort level, as well as self-reported referral patterns for computed tomography (CT) and/or emergency department (ED) evaluation of children who sustained concussion.Results: Based on responses from 120 pediatricians participating in the 2 surveys and intervention (response rate, 57.1%), the program had significant positive effects from pre- to postintervention on knowledge of concussions (-0.26 to 0.56 on -3 to +1 scale; P < .001), guideline use (0.73-.06 on 0-6 scale; P < .01), and comfort level in managing concussions (3.76-4.16 on 1-5 scale; P < .01). Posteducation, pediatricians were significantly less likely to self-report referral for CT (1.64-1.07; P < .001) and CT/ED (4.73-3.97; P < .01), but not ED referral alone (3.07-3.09; P = ns).Conclusions: Adoption of a multifaceted, evidence-based, education program translated into a positive modification of self-reported practice behavior for youth concussion case management. Given the surging demand for community-based youth concussion care, this program can serve as a model for improving the quality of pediatric concussion management. [ABSTRACT FROM AUTHOR]

Context: Palliative sedation is a means of relieving intractable symptoms at the end of life, however, guidelines about its use lack consistency. In addition, ethical concerns persist around the practice. There are reports of palliative sedation in the pediatric literature, which highlight various institutional perspectives. Objectives: This survey of 4786 pediatric providers sought to describe their knowledge of and current practices around pediatric palliative sedation. Methods: Our survey was administered to pediatricians who care for children at the end of life. The survey assessed agreement with a definition of palliative sedation, as well as thoughts about its alignment with aggressive symptom management. Bivariate analyses using χ2 and analysis of variance were calculated to determine the relationship between responses to closed-ended questions. Open-ended responses were thematically coded by the investigators and reviewed for agreement. Results: Nearly half (48.6%) of the respondents indicated that the stated definition of palliative sedation “completely” reflected their own views. Respondents were split when asked if they viewed any difference between palliative sedation and aggressive symptom management: Yes (46%) versus No (54%). Open-ended responses revealed specifics about the nature of variation in interpretation. Conclusions: Responses point to ambiguity surrounding the concept of palliative sedation. Pediatricians were concerned with a decreased level of consciousness as the goal of palliative sedation. Respondents were split on whether they view palliative sedation as a distinct entity or as one broad continuum of care, equivalent to aggressive symptom management. Institutional-based policies are essential to clarify acceptable practice, enable open communication, and promote further research. [ABSTRACT FROM AUTHOR]

Previous research has demonstrated high satisfaction and perceived relevance of Project DOCC (Delivery of Chronic Care), a parent led curriculum in developmental disabilities, across a sample of medical residents.Aims: The influence of such a training program on the clinical practices and professional activities of these residents once they are established in their careers as physicians, however, has not been studied; this was the aim of the present study.Methods: An anonymous follow-up survey was designed and disseminated to physicians who participated in Project DOCC during their one-month developmental disabilities rotation as part of their pediatrics or medicine/pediatric residency between 2002 and 2010. Fifty-eight physicians completed the survey.Results: The findings suggest that participation in a parent led curriculum during medical residency had a lasting impact on physicians' relationships with families. Specifically, a majority of the physicians espoused a family-centered approach to care, a sensitivity to the interactional effect that caring for a Child with Special Health Care Needs (CSHCN) has on family members, the need for physicians to have a prominent role in community resource coordination, and the importance of an integrated approach to health care provision.Conclusions: Use of a parent led curriculum as a means to increase the provision of family-centered care by physicians is supported. [ABSTRACT FROM AUTHOR]

Background: Of the available treatment options for attention-deficit/hyperactivity disorder (ADHD), the use of medications remains the most controversial and it is often difficult for parents to make decisions about treatment. Provision of relevant, reliable information about treatment during consultations may help address parents' concerns about treatment options. Question prompt lists are structured lists of disease and treatment-specific questions intended for use by patients during consultations to encourage communication with clinicians. They may prove useful in empowering parents to ask questions during consultations and to make informed decisions about treatments for ADHD.Objectives: To evaluate the acceptability and usefulness of a question prompt list (QPL) for attention-deficit/hyperactivity disorder (ADHD) during consultations between parents of diagnosed children and their pediatricians.Methods: Parents of children recently diagnosed with ADHD (n = 17) received a copy of the QPL 7 days before their child's appointment and completed questionnaires before and after their consultations to elicit: satisfaction with the consultation and QPL; situational anxiety levels; achievement of decision-making and information preferences. Pediatricians (n = 3) completed questionnaires after each consultation to determine the impact of the QPL on consultation flow and to ascertain their willingness to incorporate the QPL into their practice.Results: All parents reported that the QPL helped them to ask more questions, was easy to understand and would be useful to them in future. After receiving the QPL and seeing the pediatrician, parents' anxiety decreased significantly. All described their decision-making roles as 'just right' and were satisfied with the information obtained during their consultations. All pediatricians agreed that the QPL was helpful for parents, made communication easier, and helped parents to initiate discussion about difficult topics. The QPL was not found to impede flow of the consultation. All agreed QPL provision was feasible as part of routine clinical care.Conclusions: The QPL received strong support from parents and pediatricians and may be a useful tool in facilitating communication and shared decision-making in this setting. The findings warrant further investigation in a larger randomized controlled study. [ABSTRACT FROM AUTHOR]

Background & Aims Functional constipation (FC) is a common childhood problem often related to pelvic floor muscle dysfunction. We compared the effectiveness of pelvic physiotherapy (PPT) vs standard medical care (SMC) in children with FC. Methods We performed a multicenter randomized controlled trial of 53 children (age, 5–16 y) with FC according to the Rome III criteria, at hospitals in The Netherlands from December 2009 to May 2014. Group allocation was concealed using a central computer system. SMC consisted of education, toilet training, and laxatives (n = 26), whereas PPT included SMC plus specific physiotherapeutic interventions (n = 27). Results were obtained from written reports from the subjects’ pediatricians and parents. The primary outcome was absence of FC, according to Rome III criteria, after a 6-month follow-up period. Secondary outcomes were global perceived effect (range, 1–9; success was defined as a score ≥ 8), numeric rating scales assessing quality of life (parent and child; scale, 1–10), and the strengths and difficulties questionnaire (SDQ). Results Treatment was effective for 92.3% of the children receiving PPT and for 63.0% of the children receiving SMC (adjusted odds ratio for success of PPT, 11.7; 95% confidence interval, 1.8–78.3) ( P = .011). Significantly more children undergoing PPT stopped using laxatives (adjusted odds ratio, 6.5; 95% confidence interval, 1.6–26.4) ( P = .009). Treatment success (based on global perceived effect) was achieved for 88.5% of subjects receiving PPT vs 33.3% of subjects receiving SMC) ( P < .001). PPT also produced larger adjusted mean differences, before vs after treatment, in numeric rating scales to assess quality of life: an increase of 1.8 points for parents ( P = .047) and 2.0 points for children ( P = .028). Results from the SDQ did not differ significantly between groups ( P = .78). Conclusions In a randomized controlled trial of children with FC, PPT was more effective than SMC on all outcomes measured, with the exception of findings from the SDQ. PPT should be considered as a treatment option for FC in children 5–16 years old. Dutch Clinical Trial Registration no: NL30551.068.09. [ABSTRACT FROM AUTHOR]

While the needs for pediatric care are increasing and becoming more diverse, pediatric private practice in France is encountering difficulties linked to a growing medical demographic deficit. The objective of this study was to give an overview of pediatric private practice in the Nord-Pas-de-Calais region and to describe the main challenges encountered., Methods: For this descriptive observational survey, private practice pediatricians in the Nord-Pas-de-Calais region filled out an online questionnaire between April 2019 and October 2020., Results: The response rate was 64%. Most respondents practiced in an urban area (87%) and shared the practice with other physicians (59%). A majority (85%) had previously worked in hospital; 65% reported training in a subspecialty. Overall, 48% had other professional activities; 28% worked night shifts and 96% accepted urgent requests for consultations. A total of 33% reported having difficulties contacting specialists for consults, and 46% had difficulties in obtaining written reports of their patients' hospitalizations. All respondents participated in a form of ongoing medical education. The main difficulties were: lack of information about how to found a private practice (68%), lack of personal time (61%), balance between medical and administrative work (59%), and an excess of patients to care for (57%). The main satisfactions were: trusting relationships with patients (98%), freedom in their choice of practice (85%), and the diversity of problems and situations encountered (68%)., Conclusion: Our study underlines that private practice pediatricians are involved in healthcare provision, in particular regarding ongoing medical training, subspecialties, and continuity of care. It also highlights the problems encountered and the possible improvements: developing better communication between private practice and hospitals, reinforcing training during residency, and highlighting the importance and complementarity of private practice in children's healthcare., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)

Gender dysphoria is a clinical condition characterized by significant distress due to the discordance between biological sex and gender identity. Currently, gender dysphoria is also found more frequently in children and adolescents, thanks to greater social sensibleness and new therapeutic possibilities. In fact, it is estimated that the prevalence of gender dysphoria in pediatric age is between 0.5% and 2% based on the statistics of the various countries. Therefore, the pediatrician cannot fail to update himself on these issues and above all should be the reference figure in the management of these patients. Even if the patient must be directed to a referral center and be followed up by a multidisciplinary team, the treating pediatrician will care to coordinate the clinical and therapeutic framework. The aim of the present report is therefore to integrate literature data with our clinical experience to propose a new clinical approach in which the pediatrician should be the reference in the care of these patients, directing them towards the best therapeutic approach and staying in contact with the specialists of the referral center., (© 2023. The Author(s).)

Background: SARS-CoV-2 vaccination of all age-eligible populations is an important part of the COVID-19 pandemic response. In Ontario, vaccination coverage in 5-to-11-year-old children has remained lower than in other age groups. We sought to understand pediatricians' perception, practices, and barriers to SARS-CoV-2 vaccination in children, particularly children aged 5-to-11 years, to inform interventions and promote capacity of pediatricians as vaccinators and vaccination promoters., Methods: This is a descriptive, cross-sectional study consisting of an online self-administered questionnaire distributed to 1,313 pediatricians in Ontario. Descriptive statistics, including Chi-square or Fisher's exact tests, were performed., Results: In total, 152 Pediatricians responded (11.6% response rate), from February 17, 2022 to March 17, 2022. 78% of respondents were general pediatricians and 22% were pediatric subspecialists. Median years of practice was 17 (8-31), with 68% female, 32% male. Most pediatricians thought it was unlikely that children aged 5-to-11 years would become seriously ill from acute COVID-19 caused by Delta (66%) or Omicron (80%). 92% were very likely to recommend the COVID-19 vaccine for children aged 5-to-11 years. COVID-19 vaccine was perceived as safe, with higher safety perception in children aged 5-to-11 compared to 12-to-17 years (p < 0.0001). COVID-19 vaccines were thought to be effective in reducing hospitalization or severe illness, and reducing SARS-CoV-2 infection, with higher perceived effectiveness against Delta compared to Omicron (p < 0.0001). 97% felt confident counselling caregivers of children aged 5-to-11 years on the COVID-19 vaccine. Few pediatricians did not feel confident in accessing resources for health professionals (6%) or for patients/caregivers (12%)., Conclusions: Most surveyed pediatricians were very likely to recommend COVID-19 vaccination for children aged 5-to-11-years, perceived COVID-19 vaccines as safe and effective, and felt confident in their COVID-19 vaccine counselling for children aged 5-to-11 years. However, there remains areas for further training and capacity development., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: SKM has received honoraria for lectures from GlaxoSmithKline, was a member of ad hoc advisory boards for Pfizer Canada, Sanofi Pasteur, and Merck and is a co-investigator on an investigator-led grant from Pfizer, all unrelated to this study., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Rheumatology laboratory tests are often inappropriately ordered in situations for which they are of low diagnostic utility. We surveyed pediatricians to investigate reasons for ordering these tests. The response rate was 15.3% (93/609). The most commonly ordered tests were antinuclear antibody (ANA), anti-double-stranded DNA (dsDNA) antibody, and rheumatoid factor (RF). Of the 89% (83/93) who ordered an ANA, 86% ordered it for correct/possibly correct reasons; of the 73% (68/93) who ordered RF, 80% did so for correct/possibly correct reasons; and among the 59% (54/92) who had ordered anti-dsDNA antibody, 34% ordered it for correct reasons. A positive relationship was seen between years since residency completion and correct use of ANA. However, positive associations were not seen between measures of pediatric rheumatology experience and correct use of other tests. Interventions are needed to improve pediatricians’ utilization of rheumatology tests. [ABSTRACT FROM AUTHOR]

High quality perinatal-neonatal care can prevent severe Retinopathy of Prematurity (ROP) in most cases. Preterm infants who do develop retinopathy can also have good visual outcomes if screening and treatment are done timely. National Neonatology Forum published clinical practice guidelines for timely screening and treatment of ROP in neonatal care units in the country in 2010. It is also listed as one of the condition under Rashtriya Bal Swasthya Karyakram for early identification and early intervention, and is currently a focus area under the National Program for Control of Blindness. Technical and operational guidelines for screening and treatment have been released. Programs like home-based neonatal care can be utilized for ensuring timely screening and followup of high-risk infants. Prevention, timely diagnosis and treatment requires well-coordinated teamwork between neonatologists, ophthalmologists, nurses and obstetricians. The neonatal care team should have an evidence-based screening policy, must coordinate and facilitate screening by ophthalmologist, and provide pre and post-operative support, if treatment is required. The neonatologist also has an important responsibility of educating the healthcare workers and the families. A team approach and inter-sectoral coordination are the keys to success of a national drive to decrease the burden of preventable blindness due to ROP. [ABSTRACT FROM AUTHOR]