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Prior studies using single-center populations have established associations between social risks and health care utilization among children with asthma. We aimed to evaluate associations between social risks and health care utilization among a nationally representative sample of children with asthma.In this cross-sectional study, we utilized the 2018-2019 National Survey of Children's Health to identify children 2 to 17 years old with asthma. Using the Healthy People (HP) 2030 social determinants of health (SDOH) framework, we identified 31 survey items assessing 18 caregiver-identified social risks as exposure variables and classified them into the 5 HP SDOH domains (Economy, Education, Health care, Community, and Environment). Primary outcome was caregiver-reported health care utilization. Associations between individual social risks and total number of SDOH domains experienced with health care utilization were assessed.The weighted study population included 8.05 million children, 96% of whom reported ≥1 social risk. Fourteen social risks, spanning all 5 SDOH domains, were significantly associated with increased health care utilization. The 3 risks with the highest adjusted odds ratios (aOR) of health care utilization included: experiencing discrimination (aOR 3.26 [95% confidence interval (CI): 1.75, 6.08]); receiving free/reduced lunch (aOR 2.16, [95% CI 1.57, 2.98]); and being a victim of violence (aOR 2.11, [95% CI 1.11, 4]). Children with risks across more SDOH domains reported significantly higher health care utilization.Among our national population of children with asthma, social risks are prevalent and associated with increased health care utilization, highlighting their potential contribution to pediatric asthma morbidity.

Objective: To describe a case of idiopathic cricopharyngeal achalasia (CPA) in a pediatric patient with acute onset of dysphagia managed conservatively with supportive care. Methods: Sixteen-month-old boy presented with acute onset of gagging and coughing with feeding. His exam was notable for a well-appearing child with pooling of oral secretions and coarse breath sounds. Plain film series did not show radio-opaque foreign body (FB) and an esophagram demonstrated an endoluminal filling defect of the cervical esophagus and aspiration of contrast. He was taken to the operating room for urgent endoscopy but no FB or food impaction was observed. He had persistent symptoms that required further evaluation and a multidisciplinary team approach. Bedside laryngoscopy did not reveal any abnormalities. Modified barium swallow (MBS) study revealed upper esophageal sphincter (UES) dysfunction, consistent with cricopharyngeal achalasia. Repeat upper endoscopy with biopsies demonstrated mucosal irritation overlying the UES but histologic studies were negative for infectious causes. Results: He was treated with supportive care, including nasogastric feedings for nutrition supplementation as he was unable to tolerate oral feedings without aspiration. Over the course of 3 months after discharge, his symptoms resolved and repeat MBS was normal. Conclusion: CPA is a rare cause of dysphagia in the pediatric population. Conservative management with supportive care is a reasonable approach in cases with acute onset in otherwise healthy children without underlying medical problems.

OBJECTIVE To describe associations between the Child Opportunity Index (COI) and multisystem inflammatory syndrome of childhood (MIS-C) diagnosis among hospitalized children. METHODS We used a retrospective case control study design to examine children ≤21 years hospitalized at a single, tertiary care children’s hospital between March 2020 and June 2021. Our study population included children diagnosed with MIS-C (n = 111) and a control group of children hospitalized for MIS-C evaluation who had an alternative diagnosis (n = 61). Census tract COI was the exposure variable, determined using the patient’s home address mapped to the census tract. Our outcome measure was MIS-C diagnosis. Odds ratios measured associations between COI and MIS-C diagnosis. RESULTS Our study population included 111 children diagnosed with MIS-C and 61 children evaluated but ruled out for MIS-C. The distribution of census tract overall COI differed significantly between children diagnosed with MIS-C compared with children with an alternate diagnosis (P = .03). Children residing in census tracts with very low to low overall COI (2.82, 95% confidence interval [CI]: 1.29–6.17) and very low to low health/environment COI (4.69, 95% CI 2.21–9.97) had significantly higher odds of being diagnosed with MIS-C compared with children living in moderate and high to very high COI census tracts, respectively. CONCLUSION Census tract child opportunity is associated with MIS-C diagnosis among hospitalized children suggesting an important contribution of place-based determinants in the development of MIS-C.

OBJECTIVES: Outpatient screening for social determinants of health (SDH) improves patient access to resources. However, no studies have examined if and how inpatient pediatric providers perform SDH screening. We aimed to identify inpatient pediatric provider screening practices for SDH, barriers to screening, and the acceptability of screening for hospitalized patients. METHODS: We conducted a multicenter descriptive study at 4 children’s hospitals surveying inpatient hospitalists and nurses on the general wards about their SDH screening practices. A survey instrument was developed on the basis of literature pertaining to SDH, content expert review, cognitive interviews, and survey piloting. Descriptive statistics and logistic regression analyses are reported. RESULTS: Results from 146 hospitalists and 227 nurses were analyzed (58% and 26% response rate, respectively). Twenty-nine percent of hospitalists and 41% of nurses reported screening for ≥1 SDH frequently or with every hospitalized patient. Only 26% of hospitalists reported consistently communicating SDH needs with primary care providers. Most respondents (97% of hospitalists and 65% of nurses) reported they do not use a specific screening tool, and only 34% of hospitalists and 32% of nurses reported feeling competent screening for SDH. Lack of time, resources, and a standardized inpatient screening tool were reported as barriers to screening. CONCLUSIONS: Hospitalization provides an opportunity for SDH screening and connecting patients to resources; however, a minority of pediatric providers currently report screening. Professional development activities training inpatient providers in SDH screening, using a screening instrument, and communicating identified needs to primary care providers may improve the effectiveness of SDH screening in the hospital.

BACKGROUND: Food insecurity (FI) affects 1 in 9 Americans. While pediatric residency programs begun including FI training, many are didactic-based. Engagement with FI requires community-based training in partnership with need-based organizations. METHODS: In the curriculum, PL1s visit a food bank. Experiential learning is utilized as a conceptual framework, through which knowledge is gained. The day begins with service learning in the urban garden and a discussion …

1. Tamara Gayle, MD, MEd* 1. *Division of Hospital Medicine, Children’s National Medical Center, Washington, DC An 11-month-old boy presents to an emergency department (ED) after multiple witnessed episodes that were concerning for seizures. His parents note that he was in his normal state of health last night but this morning started becoming increasingly fussy. He then developed a blank stare and went limp. This happened 1 more time where he was seen to have perioral cyanosis. There were no convulsions, noted abnormal movements, or incontinence. He was quiet for a few minutes after this occurred but started to cry afterward. He was then taken to the community ED. He again developed a blank stare and went limp, which was witnessed by the care team on arrival in the ED. The family denies any fever or diarrhea, although he has had 2 episodes of nonbilious, nonbloody emesis after his staring episode. There was no witnessed ingestion or concern for nonaccidental or accidental trauma. He had been taking fluids well, with good urine output. There are no sick contacts at home, he does not attend child …

Background Food insecurity (FI) affects 1 in 9 Americans. While residency programs now include FI training, many are didactic-based. Engagement with this complex social issue is enhanced by community-based training. Methods In our FI curriculum, PL1s visit a food bank. We utilize experiential learning as a conceptual framework, through which knowledge is gained and evolves through experience and reflection. The day begins with service learning in the garden and discussion of sustainable food sources. The interns then create healthy, low-cost meals to teach to families, and then participate in a simulation that recreates a day in the life of families experiencing FI. They confront barriers such as low literacy, immigrant status, and food deserts. The day ends with a reflection on their role in advocacy and connecting families to food resources. Evaluation includes assessment of knowledge (based on the AAP Food Security Policy pre-reading) and attitudes (self-efficacy for advocacy) completed pre, post, and 6-12mo post. Results From 2016-2019, 113 interns completed the curriculum. Data were captured for 86 post and 26 thus far in 6-12mo post. There was no significant change in knowledge from pre (79.3% correct) to post (79.5%, P=.95) nor from post to 6-12mo post (76.9%, P=.55). From pre to post, advocacy-related self-efficacy increased significantly by an average of 21.2% (range 7.6-39.6%, P Conclusion A community-based experience early in residency can enhance self-efficacy for addressing FI, particularly on the patient level, and is sustained months later. A community partner enhanced resident knowledge of local resources. Future improvements include better incorporation of the AAP Food Security policy to increase knowledge. This curriculum can be replicated in programs seeking community partnerships for experiential learning.

Pediatric cardiomyopathies, which are rare but serious disorders of the muscles of the heart, affect at least one in every 100,000 children in the USA. Approximately 40% of children with symptomatic cardiomyopathy undergo heart transplantation or die from cardiac complications within 2 years. However, a significant number of children suffering from cardiomyopathy are surviving into adulthood, making it an important chronic illness for both pediatric and adult clinicians to understand. The natural history, risk factors, prevalence and incidence of this pediatric condition were not fully understood before the 1990s. Questions regarding optimal diagnostic, prognostic and treatment methods remain. Children require long-term follow-up into adulthood in order to identify the factors associated with best clinical practice including diagnostic approaches, as well as optimal treatment approaches. In this article, we comprehensively review current research on various presentations of this disease, along with current knowledge about their causes, treatments and clinical outcomes.

During my teacher education training I have become fascinated with the idea of teaching social studies through historical novels. As a result of this fascination, I chose curriculum development pertaining to this idea as the subject of my honors project. The purpose of this project was for me to develop, teach, and evaluate an integrated unit using historical novels to teach social studies and a variety of other subjects. I selected the American Revolution as the theme of my unit. In this paper I have included a brief overview of my review of the literature on this topic, the procedures I used in developing my unit, a description of the implementation of the unit, and an evaluation of my students' learning.