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Background: COVID-19 necessitated emergency telepractice for student-led speech-language therapy clinical practicals in training institutions, with limited preparation and evidence-based guidelines. Beyond the pandemic, practitioners and university training sites are likely to continue to offer telepractice necessitating thorough preparation for telepractice services underpinned by a comprehensive understanding of the complexities involved in online therapy. Aims: Adopting realist evaluation principles, our aim in this paper was to explore broadly what works and does not work in a set of student-led telepractice sessions in a diverse, resource-limited context. The broader goal of this project was to provide evidence-based support to enhance the efficiency and success of telepractice sessions in student clinical training contexts. Methods & Procedures: We used qualitative observational methods with reflexive thematic analysis to analyse 28 video recordings and 61 observation notes of student-led paediatric telepractice sessions from a South African university clinic as part of a pilot study. Outcomes & Results: We identified four overarching considerations for student-led telepractice: (1) additional, specific preparation is required, (2) with greater management of technology and adaptation of tasks, especially during times of poor connectivity; (3) telepractice relies heavily on caregiver input and collaboration; and (4) promoting engagement online, holding a client's attention, building rapport and offering reinforcement are critical skills that are complicated by the lack of face-to-face contact. Conclusions & Implications: Our findings indicate that telepractice pedagogy needs to be explicitly taught and students require practical assistance as they learn how to use this service delivery approach effectively. There are some aspects peculiar to telepractice that require unique consideration and planning, especially in contexts where service providers and users may be unfamiliar with this form of service provision. The findings of this pilot study can be used by clinical educators and student clinicians to enhance clinical training opportunities involving telepractice.

The Special Education Process (SEP) demands the collaboration of various professionals and personalities to create the Individualised Education Plan (IEP), beginning with the evaluation conducted by clinical psychologists, psychiatrists and in this study, developmental paediatricians. Assessments acts as a keystone document, serving as basis for determining placement levels, student support requirements and depth of academic training to be implemented. With inclusion gradually being implemented in the Philippines, the study sought to determine the translatability of the assessment report produced by developmental paediatricians into the IEP. The study used documentary analysis of 50 individualised education plans derived from the assessment reports of 10 different developmental paediatricians. The documents were analysed to determine the presence of components needed to refer to in making the IEP. The data shows that the assessment reports have four components, namely profile, present level of condition, report and recommendation. These components can be used as reference material in creating the IEP, and as a basis for a structured approach in creating the document. However, the study also shows how the report content and structure slightly differ for each other, making some of the reports easier to refer to compared to others.

To explore issues surrounding re-consenting youth in longitudinal studies as they reach legal adulthood interviews were conducted with 46 parents plus 13 autistic teens enrolled in the Simons Foundation Powering Autism Research for Knowledge (SPARK) study. Qualitative analysis focused on family sensitivities regarding guardianship decisions, transition concerns, and the re-consenting process. Questions regarding guardianship were difficult for parents unsure of a teen's future status. Mothers were key facilitators of re-consenting for soon-to-be-independent teens. As legal adulthood approached, parents were willing to assist teens with re-consenting but needed support, asking for multiple contacts, transition resources, and explanatory materials from the research team. Most teens were not cognizant of SPARK but willing to continue participation once made aware.

The hospital setting may be especially difficult for pediatric patients on the autism spectrum and their families compared to those not on the spectrum. Child life specialists are healthcare professionals specifically trained to support parents and their children and help prepare them for hospital procedures. Because of this specialized skill set, these professionals likely have a wealth of expertise to share relevant to caring for autistic patients. This study aimed to understand 21 child life specialists' experiences working with patients on the spectrum. Our findings highlighted the following themes: Parents are the Experts, Proactive and Individualized Care, Disclosure, and Hospital-Wide Suggestions to Improve Patient Care. We discuss the practice implications of these findings on the healthcare experiences of pediatric patients on the spectrum.

Identification procedures for autism spectrum disorders in paediatric settings include screening and routine clinical surveillance. Screening tools are perceived as challenging, and a preference for direct observation has been reported in Ecuadorian paediatric settings. Augmentative observational procedures could prompt the application of screening tools, increase professionals' sense of self-efficacy and support referral decision-making. Following the recommendations that identification procedures should be tested in a group of children without autism from local populations, we tested a set of observational tasks on 125 children from 12 to 59 months of age in various socio-economic settings, in semi-experimental conditions and on a group of 33 non-autistic children in a paediatric-setting condition. Results indicated that the social referencing task did not produce the expected response in most children in semi-experimental conditions. Responses to the elicitation of a gesture were significantly influenced by socio-economic status and geographic area. Three other tested tasks (response to name, eye contact, response to joint attention) produced the expected responses in semi-experimental and clinical conditions, suggesting that they could be used in daily routines if fidelity to training is ensured. We discuss the implication of those findings in clinical practice and professional education in an Ecuadorian context.

Intrinsic inequity in assessment refers to sources of harmful discrimination inherent in the design of assessment tools and systems. This study seeks to understand intrinsic inequity in assessment systems by studying assessment policies and associated procedures in residency training, using general pediatrics as a discourse case study. Foucauldian discourse analysis (FDA) was conducted on assessment policy and procedure documents. Two authors independently prepared structured analytic notes using guiding questions. Documents and respective analytic notes were subsequently reviewed independently by all authors. Each author prepared further unstructured analytic notes on the documents' discourse. The authors then compared notes and constructed truth statements (i.e., interpretations of what the discourse establishes as true about the construct under study) and sub-strands (i.e., themes) that were repeated and legitimized across the documents via iterative discussion. Based on analysis, the authors constructed two truth statements. These truth statements, "good assessment is equitable assessment," and "everyone is responsible for inequity," conceptualized inequity in assessment as an isolated or individual-level aberration in an otherwise effective or neutral system. Closer examination of the truth statements and sub-strands in the discourse presented an alternative view, suggesting that inequity may in fact not be an aberration but rather an inherent feature of assessment systems.

Background: Pediatric programs focused on treating chronic pain often do not include an educational liaison (EL) to coordinate services between the patient's medical home and school. As chronic pain in youth can have deleterious effects on school functioning, collaboration between the medical home and the school system are needed to assure these students receive appropriate accommodations. Contributions to Theory: This manuscript describes a model of coordinated care for students with chronic pain that includes a systemic strategy for collaborative care across settings. Specifically, the role of an EL is described in the context of advocating for the patient to receive appropriate educational accommodations. Conclusions: This paper provides a guide for caregivers and professionals to assure appropriate access to support services across settings. Recommendations are included for school accommodations and services to improve academic functioning and outcomes for students with chronic pain.

Fragile X syndrome (FXS) is characterized by variable neurobehavioral abnormalities, which leads to difficulties in developing and evaluating treatments and in determining accurate prognosis. We employed a pediatric cross-sectional sample (1,072 males, 338 females) from FORWARD, a clinic-based natural history study, to identify behavioral subtypes by latent class analysis. Input included co-occurring behavioral conditions, sleep and sensory problems, autistic behavior scales (SCQ, SRS-2), and the Aberrant Behavior Checklist revised for FXS (ABC[subscript FX]). A 5-class solution yielded the most clinically meaningful, pharmacotherapy independent behavioral groups with distinctive SCQ, SRS-2, and ABC[subscript FX] profiles, and adequate non-overlap ([greater than or equal to] 71%): "Mild" (31%), "Moderate without Social Impairment" (32%), "Moderate with Social Impairment" (7%), "Moderate with Disruptive Behavior" (20%), and "Severe" (9%). Our findings support FXS subtyping, for improving clinical management and therapeutic development. [Written with the FORWARD Consortium.]

The extent to which observed disparities in access to primary pediatric care are mirrored in student access to school nursing services is unknown. Using school employment records, we linked 1,346 nurses to school districts serving 1,141,495 students in Washington state. The percentage of students who are Black is negatively associated with the student-to-nurse ratio, while the percentage of students eligible for free-or-reduced-price lunch is positively associated, and relative to urban districts, rural districts have higher student-to-nurse ratios. Disparities in access to school nursing services mirror access gaps for pediatric care along socioeconomic status and geography. The increased number of nurses working in districts with more racial/ethnic minority students may play a protective role and ameliorate access gaps observed in pediatric primary care. States can likely use existing employment and licensing data to understand where school nurses work and therefore guide resource allocation decisions.

Pediatric cancer is the second leading cause of death among children ages 1-14 (Whitehead et al., 2016). Approximately 10,500 children ages 1-14 and 5090 adolescents ages 15-19 have been diagnosed with cancer in 2021 (American Cancer Society, 2021). An estimated 28% of childhood cases and 13% of adolescent patients will be diagnosed explicitly with Leukemia (American Cancer Society, 2021). Leukemia is a broad term that encompasses the malignant disease of bone marrow and other structures responsible for blood production (Olin et al., 2018). Children and adolescents experiencing pediatric leukemia often undergo treatment that produces biological, psychosocial, and cognitive impacts. Due to the occurrence of this disease in school-aged children and the wide-ranging consequences they face, school psychologists may be called upon to work with students and their families while they go through treatment during school-aged years. This article will discuss pediatric leukemia, treatment options, long-term impacts of treatment for patients, and considerations for working with children in the school system.

Children with autism spectrum disorder (ASD) have more frequent use of healthcare services, including visits to the emergency department (ED). Medical care for children with ASD can be adversely affected by the highly stimulating environment of the ED. In this study, we gained insights from stakeholders with lived experience (parents of children with ASD, children with ASD, and ED healthcare providers) to create and implement a sensory equipment kit. The kit was evaluated and iteratively improved based on observations of children using the sensory equipment, satisfaction surveys from their parents, and interviews with healthcare providers in the ED. Findings from this study can be used to guide other EDs in creating their own ASD sensory kit.

Background: The association between early childhood psychosocial problems and poorer educational outcomes is well-documented, but the extent to which this association persists is less understood. The current study assessed the correlations between first-grade psychosocial functioning and educational outcomes through eighth grade in a large longitudinal sample of Chilean students. Methods: The Pediatric Symptom Checklist-Chilean (PSC-CL) and Teacher Observation of Classroom Adaptation Re-Revised (TOCA-RR) assessed psychosocial functioning for 9736 students who were screened four times from first through eighth grade through the Skills for Life program. Adjusted linear mixed effects models assessed the association between first grade PSC-CL and TOCA-RR risk and third, sixth, and eighth grade GPA and school attendance. Results: First-grade PSC-CL and TOCA-RR risk both significantly predicted lower third, sixth, and eighth grade GPAs; all p < 0.001. The relationships between first-grade psychosocial functioning and later school attendance rates were less consistent but still significant at certain time points. Conclusions: First-grade psychosocial risk was persistently associated with lower academic performance in a longitudinal sample of Chilean students followed through elementary and middle school. Implications for School Health Policy, Practice, and Equity: Early school-based psychosocial screening and follow-up interventions have the potential to improve students' long-term educational outcomes.

Background: School nurses are rarely integrated into primary care teams to their full potential. We aimed to characterize school nurses' perceptions related to current and optimal collaboration with primary care providers (PCPs) and identify actionable solutions to improve efficiency, quality, and coordination of pediatric care. Methods: We conducted and qualitatively analyzed interviews with school nurses to characterize structures, processes, and perceived benefits of optimized school nurse-PCP collaboration. Results: School nurse interviewees (n = 23) identified factors important to school nurse-PCP collaboration within 2 domains: information sharing and relationship building. Information sharing themes included health information sharing laws, data sharing systems, and technology-based communication systems. Relationship building themes included health care sector understanding of the school nurse role, PCP knowledge of school health requirements, shared professional development opportunities, and time and personnel. Perceived benefits of optimized PCP-school nurse collaboration were identified for children, PCPs, school nurses, and parents. Implications for School Health Policy, Practice, and Equity: Needs assessments and action plans guided by the domains of information sharing and relationship building can inform local improvements to optimize school nurse-PCP collaboration. Conclusions: School nurses highlighted cross-sector solutions to enhance school nurse-PCP collaboration including integrated information sharing systems and intentional relationship building.

Delays in autism spectrum disorder identification/services could impact developmental outcomes. Although trends are encouraging, children from historically underrepresented minority backgrounds are often identified later and have reduced engagement in care. It is unclear if disparities exist throughout the screen-evaluate-treat chain, or if early detection programs such as "Get SET Early" that standardize these steps are effective countermeasures. Pediatricians/primary care providers administered Communication and Symbolic Behavior Scales IT Checklist screens at 12-, 18-, and 24-month well-baby examinations, and parents designated race, ethnicity, and developmental concerns. Toddlers who scored in the range of concern, or whose pediatricians/primary care providers had concerns, were referred for evaluations. Rates of screening and evaluation engagement within ethnic/racial groups were compared to U.S. Census proportions. Age at screen, evaluation, and treatment and quantity was compared across groups. Regressions examined whether key factors were associated with ethnicity or race. No differences were found for mean age of screen, evaluation, initiation of behavioral therapy, or quantity received between racial and ethnic groups. Historically underrepresented minority children were more likely to fall into the range of concern, referred for evaluations, and have their parents express developmental concerns. Although there remain gaps within the pipeline, implementation of systemized programs can be effective in ensuring equitable access to resources across communities.

In this retrospective cohort study using data from an integrated primary care and subspecialty network, we examined medical records of children seen in primary care at eligible autism spectrum disorder (ASD) screening ages and followed through at least 4 years of age. We examined the prevalence of ASD; age of first documented ASD diagnosis; and whether the prevalence and age of documented diagnosis varied by race, ethnicity, socio-economic status (SES) and site of care (urban versus suburban/rural). The prevalence of ASD across the cohort was 3.2%, with a median age of diagnosis of 3.93 years. ASD prevalence was unexpectedly higher among Asian children, non-Hispanic Black children, children with higher Social Vulnerability Index scores (a neighborhood-level proxy of socio-economic risk), and children who received care in urban primary care sites. There were no statistically significant differences in age at which ASD diagnosis was documented across socio-demographic groups. Receiving primary care at an urban site accounted for most other socio-demographic differences in ASD prevalence rates, except among Asian children, who were found to have higher adjusted odds of ASD diagnosis compared to White children (aOR = 1.82, p < 0.001). Determining what clinical-, individual- or systems-level factors contribute to ASD diagnosis remains important to improve equity.

This is a retrospective case series of pediatric patients referred to the psychogenic nonepileptic events clinic (PNEE) who had comorbid diagnoses of autism spectrum disorder (ASD) or intellectual disability (ID). We describe 15 patients, nine with ASD and six with ID who had a telephone visit follow-up at 12 months. There were higher rates of male gender (40%) and comorbid epilepsy (53%) compared to the larger PNEE cohort. Eleven patients were available for follow-up and ten patients had improvement in events or were event-free. We report that patients with ASD or ID can develop PNEE and experience improvement from events.

Background: Sleep plays an integral role in a child's physical and neuropsychological development. Children with sleep disorders are at risk of developing inattention, hyperactivity, and learning difficulties, challenges that impact them, their families, their classmates, and their communities. There is a paucity of pediatric sleep medicine providers equipped to partner with families in identifying and addressing sleep disorders. Additional barriers to accessing this specialized care include geographic proximity, parental ability to take time off from work, and hesitance for a child to miss valuable learning time at school. During the SARS-CoV-2 pandemic, our pediatric sleep department transitioned from largely in-person care to a predominantly virtual platform and collected data to monitor the impact of this transition. In this study, we share several key trends that emerged which may have broad implications on how pediatric sleep medicine providers can better support school-aged children with sleep challenges. Methods: We performed a chart review of all scheduled pediatric sleep medicine visits from June 2019 to June 2021, a time frame that included the pandemic-driven overnight transition from in-person to virtual clinic visits. The STEM framework was developed by pediatric telehealth experts to provide a unified approach to assessing the impact of telehealth programs. We applied this framework to the collected data to gauge the impact on the four major domains highlighted in STEM: health outcomes, healthcare delivery, individual experience (patient and provider), and program implementation. Results: The data demonstrated an increased proportion of completed visits and a decreased proportion of canceled/no-show visits when care was provided virtually. Patients accessing virtual care were doing so from greater distances than those who had in-person visits. The school-aged (5-12 years) cohort utilizing telehealth had notable differences in past medical history, with significantly more Attention Deficit-Hyperactivity Disorder. They also presented with significantly more insomnia and behavioral sleep difficulties. Discussion: Sleep disorders are common, and school-aged children have much to gain from sleep optimization. However, pediatric sleep care can be challenging to access. Geographic distance and time away from school and work preclude many families from formal sleep consultations. Telehealth allows high-quality pediatric sleep care to be offered in an easily accessible format to those near and far, resulting in clinics running more efficiently and school-aged children, who need it most, to receive the tools they need to sleep soundly. With a convenient click, families are better able to fit virtual sleep consultations into their day, without the stress of travel or the waiting room. They complete more scheduled visits, allowing pediatric sleep medicine departments to deliver care more efficiently. The low-pressure virtual platform also permits families to seek care for behavioral sleep issues. While our department's transition to predominantly virtual care occurred amidst a pandemic, with many confounding factors limiting the interpretation of the data we collected, the trends seen are very promising.

The integration of behavioral health services in primary care has become increasingly popular in pediatric settings in recent years. While there are various models of integrated behavioral health (IBH), the aim is constant: to increase access to behavioral and mental health care through collaboration between behavioral health providers and physicians. Prior to the pandemic, only 20%-50% of children and adolescents received mental health care from a professional. Since COVID-19, access to care has only worsened. Given this reality, the use of IBH has promising benefits, including: (1) positive outcomes for patients and providers; (2) improved screening, identification, and intervention; (3) improved mental health outcomes; and (4) reduction of provider burnout. Given these aims and outcomes, a major opportunity exists for school psychologists to bring unique, but highly transferable, knowledge and skills to an emerging field. In this article, the authors share the real-life experiences of a licensed school psychologist and advanced practicum student to highlight how the comprehensive training of school psychologists prepares us to perform well in an integrated setting. The authors also call attention to the numerous possibilities available for those looking for an alternative setting or expansion of their current practice.

Transitioning autistic youth from pediatric to adult healthcare requires coordination of multiple stakeholders, including youth, caregivers, and pediatric and adult care providers, whose interests at times overlap but often differ. To understand barriers and facilitators to inclusive transition experiences, we conducted thematic analysis of interviews with 39 stakeholders from the same large, integrated healthcare system. We identified three major themes: (1) Navigating the healthcare transition without guidance, (2) Health consequences of a passive healthcare transition, and (3) Strategies for inclusion and continuous engagement. Facilitators included gradual transition planning, a warm handoff between providers, and support of shared healthcare decision-making. Providers also sought clinical tools and logistical supports such as care coordinators and longer transition-specific visit types to enhance patient-centered care.

Background: Many children with intellectual developmental disorders are insufficiently physically active and do not reach recommendations for physical activity. Pediatric healthcare providers play a key role in addressing these children's needs, including promoting interventions for physical activity. Aim: To explore pediatric healthcare providers' perceived needs, barriers, and facilitators for promoting physical activity for children with intellectual developmental disorders. Methods: Semi-structured focus groups, analyzed using qualitative content analysis. Sixteen healthcare providers participated. Results: Main findings are the importance of parental support and engagement, need for structure, and stakeholder collaboration to bridge the gap between pediatric organizations and external stakeholders. Conclusion: The study highlights the need for developing and implementing strategies to promote physical activity for children with intellectual developmental disorders in pediatric health care, and for producing guidelines regarding physical activity interventions for this vulnerable group.

Objective: To evaluate cardiopulmonary resuscitation (CPR) skills performance and retention in schoolchildren aged 8 to 12 years following instruction by their teachers and with the guidance of a school nurse using paediatric manikins. Design: Descriptive simulation trial. Method: A school nurse provided support to six schoolteachers as they taught a modified 40-minute CPR course. Pupils were shown an out-of-hospital cardiac-arrest recognition video followed by a CPR simulation using paediatric manikins. 117 schoolchildren aged 8 to 12 years received the training. Both the schoolchildren and teachers completed a survey before and afterwards. Children completed an out-of-hospital cardiac-arrest recognition test and a 1-minute CPR test 1 week later. Results: After training, schoolchildren increased their self-efficacy as rescuers (8 ± 2 vs 10 ± 2; p < 0.001). Irrespective of age differences, 74% of schoolchildren performed the entire out-of-hospital cardiac-arrest recognition sequence correctly. Children aged 11 to 12 years and 10 to 11 years performed higher quality CPR (49% and 47%, respectively) compared to 8 to 9 year olds (14%, p = 0.008 and p = 0.014). Children aged 11 to 12 years outperformed younger children aged 8 to 9 years with respect to compression depth (48 ± 6 mm vs 43 ± 5 mm, p = 0.008) Conclusion: Schoolchildren's teachers, who were guided by a nurse using paediatric manikins, taught children aged 10 to 12 years to perform high-quality CPR. We suggest integrating paediatric manikins as part of children's CPR training as feedback from successful CPR performance increases motivation and confidence to act as a rescuer as well as improves skills retention.

We conducted an open-trial proof of concept study to determine the safety, acceptability, and feasibility of Mindful Self-Care for Caregivers (MSCC) for parents of children with Autism Spectrum Disorders (ASD) (N = 13). The intervention was offered as a co-located care model in a pediatric specialty center where the participants' children received care. Results demonstrated that the intervention was: highly acceptable to all stakeholders (i.e., participants, the group facilitator, and center administration) and could be conducted safely by a masters-level practitioner with minimal resources. Further, secondary measures support a hypothesized interventional model of MSCC, demonstrating gains in mindfulness skills and sense of competency in the parenting role reduced perceived stress and depression in parents of children with ASD.

Children with attention-deficit/hyperactivity disorder (ADHD) may also have undiagnosed developmental coordination disorder (DCD). Prevalence rates of the ADHD/DCD comorbidity are estimated between 30% and 50%. Given the significant impact these disorders have on a child's occupational performance, lack of detection of DCD is of concern. Occupational therapists play a key role in screening children for the presence of DCD to provide timely and targeted intervention opportunities. However, despite synthesized research and clinical guidelines being available, inconsistency with identification of DCD continues to be reported. Currently, no clear decision-making support tool is available in Australia to aid DCD identification. We aimed to bridge this research-practice gap by developing an evidence-based decision tree tool (ADITA), to guide this identification process. Mapping of assessment and identification processes for DCD was undertaken, in accordance with DSM-5 diagnostic criteria and the European Academy for Childhood Disability (EACD) clinical practice recommendations. A pilot study was conducted to test agreement in identification of DCD between an occupational therapist and pediatrician when the decision tree tool was applied. The ADITA decision tree tool created was trialed with a sample of 19 children with ADHD, aged 8-12 years. Twenty-six percent of participants were assessed as having likely DCD by the occupational therapist, with 21% of ADHD participants subsequently confirmed with DCD by a pediatrician. An agreement rate of 94% was achieved. Preliminary support is provided for the use of ADITA, an evidence-based decision tree tool, to identify DCD in school-aged children with ADHD. The ADITA supports knowledge translation by facilitating implementation of research evidence for DCD, thereby assisting occupational therapists and health professionals to bridge the existing research-practice gap.

As a popular tenant underpinning paediatric health service provision, the ability of health professionals to achieve Family-Centred Care (FCC) is often questioned. A major factor has been the judgmental attitudes and behaviour of health professionals. According to expectancy-value theory, individuals' behavioural decisions are based on their attitudes and beliefs. In this sense, this study assessed the hypothesis: when necessity beliefs (beliefs and attitudes) rise, the actual implementation of FCC components (behavioural decisions) will improve. Using a correlation design, the study measured staff perceived self-reported implementation of FCC in their practice and their necessity beliefs of its core components using a modified questionnaire. Outcomes of 65 questionnaires revealed an overall mean of self reported implementation of 2.37/5.0 (SD = 0.57) and an overall mean of necessity beliefs of 3.06/5.0 (SD = 1.04). A significant moderate correlation (Spearman's rho (64) = -0.4, p < 0.001) indicated that professionals better practiced FCC components they favourably perceived necessary. It is recommended that policymakers should focus on changing attitudes of professionals towards FCC elements. The outcomes suggest that education that positively influences the attitudes and beliefs of health professionals may facilitate the involvement of families, and subsequently, better health outcomes for children.

Background: Poor complementary feeding practices can expose young children to increased burdens of undernutrition, morbidity, and poor health outcomes in adulthood. Parents and caregivers, who feed the children, are shaped by socio-cultural beliefs and pervasive socioeconomic realities. Also, parental values are influenced by their perceptions and childhood feeding experiences among others. This study, therefore, explored the role of parental childhood feeding experiences and changing socioeconomic realities on complementary feeding practices in urban households of Aba, Nigeria. Method: Twenty-eight in-depth interviews and eight focus group discussions were held with parents of young children aged 6-23 months attending postnatal care clinics in selected healthcare facilities in Aba city, Nigeria. Aba city is one of the sprawling urban centers in South-East Nigeria. Data were thematically analyzed using Atlas.ti software. Results: Complementary feeding practices in the Aba urban households of South-East Nigeria did not meet the recommended feeding guidelines on timely complementary feeding and dietary diversity. Consumption of processed foods and sweetened beverages was prevalent. Data suggest this feeding pattern was affected by two factors: parental feeding experiences in early life and changing socioeconomic realities. Parents who lacked satisfactory feeding experiences in their childhood but achieved some socioeconomic success in later life exhibited poor complementary feeding practices. Also, certain food types were associated with affluence notwithstanding their nutritional values. Poor complementary feeding was also linked to the parental desire to not reliving their poor childhood feeding experiences. Conclusion: The parental perceived poor childhood feeding experience has led many to adopt the consumption of processed foods and sweetened beverages. This may expose children to risks of undernutrition, obesity, and overall poor health outcomes in later adulthood. More effort should be made to educate parents on healthful eating patterns and the dangers of poor complementary feeding practices in children's overall health well-being in later life.

Background: The Montreal Children's Hospital Feeding Scale (MCH-FS) allows paediatricians and other health care professionals to identify feeding difficulties among children. Aim: To translate and adapt the MCH-FS into Italian, and to evaluate the validity and reliability of this Italian version of the Montreal Children's Hospital Feeding Scale (I-MCH-FS). Methods & Procedures: A total of 150 children with special healthcare needs were admitted to the Rare Disease Unit of the Paediatrics Department at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, between March 2021 and March 2022 (74 males; mean age = 3.85 ± 1.96 years; median age = 4 years; age range = 6 months-6 years and 11 months) and 150 healthy participants (83 males; mean age = 3.5 ± 1.98 years; median age = 3 years; age range = 6 months-6 years and 11 months) were included in the study, which was approved by the local ethics committee. The original version of the MCH-FS was translated and cross-cultural adapted through five stages: (1) initial translation, (2) synthesis of the translations, (3) back translation, (4) expert committee and (5) test of the prefinal version. Test-retest reliability and internal consistency were assessed using Pearson r, Spearman r and Cronbach's alpha, respectively. Construct validity was established by comparing data obtained from patients with those of healthy participants using the Mann-Whitney U-test. Outcomes & Results: A Pearson "r" of 0.98, a Spearman "r" of 0.95 and Cronbach's alpha value of 0.86 were obtained. In the clinical group, 40.6% children were classified as having feeding disorders (n = 61), while in the normative group 4.7% were diagnosed with feeding problems (n = 7). Mean total score of the clinical group was significatively different from the normative's. Conclusions & Implications: The I-MCH-FS is a valid and reliable one-page, quick screening tool used to identify feeding disorders among children with special needs in outpatient paediatric setting.

A survey was distributed to Part C early intervention (EI) service coordination (SC) stakeholders in one state in order to gain a deeper understanding of service coordinator knowledge, skills, and motivators for professional growth and recognition. Survey participants (N = 107), including dedicated service coordinators, program managers, social emotional consultants, parent liaisons, local interagency council coordinators, and developmental pediatric consultants, identified knowledge and skills required for the role of service coordinators. Key motivators for professional growth within the SC role were also identified, including monetary, award/acknowledgment, and varied levels of responsibility. Data collected were analyzed, reviewed with Part C administrators, system point of entry leadership, and shared with EI stakeholders. Findings are being used to guide systems planning and decision-making to ensure service coordinators have opportunities for professional growth and are well prepared with the knowledge, skills, and supports necessary to partner with families and other professionals in EI. Information gained may also inform other state Part C programs and professional development entities as they (1) create and assess systems to support SC personnel; (2) build service coordinators' capacity to implement evidence-informed practices; (3) recognize service coordinators' critical role and expertise; and (4) foster the retention of well-trained, well-supported service coordinators.

Background: Play is an essential component of children's development. Children with intellectual disability tend to have poor socioemotional abilities and impaired play. This study examined the effects of a medical/therapeutic clowning play intervention on the playfulness of children with intellectual disability. Method: Two medical clowns facilitated a play intervention in a preschool classroom setting with a total of 52 children with intellectual disability. We compared before and after two groups that received the intervention: group 1 met the medical clowns once a week for 6 months (long-intervention group) and group 2 for 3 months (short intervention group). Children's functioning was assessed using the Vineland Adaptive Behaviour Scales. Children's playfulness was scored using the Test of Playfulness observational assessment. A teachers' focus-group was used to gather additional information on the clowns' work. Results: Children's playfulness increased significantly at the end of the intervention, whereas the improvement in the playfulness scores of group 1 was significantly larger than those of group 2 (t[subscript 50] = -4.82, p < 0.001). The teachers' focus group revealed additional benefits of the medical clowns' work. Conclusion: The results shed light on the play and playfulness of children with intellectual disability and the possible contribution of a clowning play intervention to their development.

Despite documented healthcare disparities among Latino autistic children, little is known about how their families experience the autism "diagnostic odyssey." Pediatricians have a critical role in the "diagnostic odyssey," but when it becomes arduous, parents may also use complementary health approaches, particularly when conventional care does not adequately address their concerns. Shared decision-making is important in healthcare for autistic children, especially when parents also choose complementary health approaches; but little is known about shared decision-making among Latino parents of autistic children. We conducted a 12-month ethnography with 12 bicultural/bilingual Latino families of autistic children to understand their healthcare experiences (conventional and complementary health approaches) for their children, focusing on shared decision-making. Thematic analysis revealed: (1) most pediatricians were involved early in the "diagnostic odyssey" but were largely uninvolved thereafter; (2) conventional healthcare was satisfactory to the parents for physical health, but not developmental issues; and (3) parents who used complementary health approaches were more frustrated about a lack of autism information from pediatricians than those who did not. Finally, (4) we describe two exemplars of successful shared decision-making between Latino parents and pediatricians. Increasing pediatricians' autism knowledge and ability to discuss complementary health approaches may facilitate shared decision-making and reduce healthcare disparities for Latino autistic children.

Research ethics committees (RECs) have a crucial role in protecting children in research. However, studies on REC members' perspectives on paediatric research are scarce. We conducted a qualitative study to explore Swedish scientific REC members' perspectives on ethical aspects in applications involving children with severe health conditions. The REC members considered promoting participation, protecting children and regulatory adherence to be central aspects. The results underscored the importance of not neglecting ill children's rights to adapted information and participation. REC members supported a contextual and holistic approach to vulnerability and risk, which considers the child's and parents' psychological wellbeing and the child's integrity, both short and long term. The ethical complexity of paediatric research requires continuous ethical competence development within RECs.

Background: The aim of this study was to investigate the demographic, clinical characteristics, and service systems of patients with autism spectrum disorder (ASD) and/or intellectual disability presenting to a large paediatric hospital emergency department (ED) with behaviours of concern (BOC) over a two-year period. Method: Retrospective audit of ED presentations with BOC in patients with ASD and/or intellectual disability from 1 January 2019 to 31 December 2020, at the Royal Children's Hospital, Melbourne, Australia. Results: There were 124 presentations (84 patients) in 2019 and 129 presentations (82 patients) in 2020. The mean age was 11.7 years. 55% arrived by ambulance, 24% required physical restraint, and 26% required sedation. Re-presentation was predicted by single-parent household, child protection involvement, and requirement of an interpreter. Conclusions: Children and adolescents with ASD and/or intellectual disability regularly present to ED with BOC. New models of care are required to better support this highly vulnerable patient group.

Background: Extensive variation in the terminology used for paediatric diagnoses across the speech and language therapy research literature is an internationally recognized problem. Little is known, however, about how and how often diagnoses are given in a clinical context. In the UK, speech and language therapists (SLTs) identify and support children who have speech and language needs. To understand and address clinically rooted terminological issues that may directly impact clients and families, there is a need for exploration of how the diagnostic process is operationalized in practice. Aim: To identify, from the perspective of SLTs, areas that present as enabling and obstructive factors to conducting diagnosis in clinical practice. Methods & Procedures: Taking a phenomenological approach, 22 paediatric SLTs were interviewed using a semi-structured format. Thematic analysis revealed a number of factors that were either classified as 'enabling' or 'obstructive' to their diagnostic processes. Outcomes & Results: Participants were often hesitant to provide a diagnosis to families and universally reported the need for targeted guidance, which accounts for the demands of current clinical practice, to guide their diagnostic process. Four enabling factors were identified from participant data: (1) working to a medical model, (2) the availability of collegiate support, (3) recognizing the benefits of diagnosis,, and (4) relating to the needs of the family. Seven themes portrayed obstructive factors in practice: (1) the complex presentation of clients, (2) the risk of giving a 'wrong' diagnosis, (3) participants' uncertainty about diagnostic criteria, (4) insufficient training, (5) service models, (6) concerns about stigma and (7) not having enough clinical time. The obstructive factors created dilemmas for participants and resulted in hesitancy to give a diagnosis, potentially contributing to delays in diagnosis experienced by families as reported in previous literature. Conclusions & Implications: Of paramountcy to SLTs were the individual needs and preferences of their clients. Practical barriers and areas of uncertainty increased hesitance to diagnose, which may inadvertently preclude families from accessing resources. Recommendations include more widely accessible training in diagnostic practice, guidelines to support clinical decision-making, and a greater understanding of client preferences with regard to terminology and its potential relationship with social stigma.

Background: Children with communication disorders experience difficulty in one or more areas of articulation and speech, language, fluency, voice and social communication, and they work with speech-language pathologists (SLPs) to improve their communication. With the rise of adoption and use for mobile applications among special education and healthcare service providers, SLPs also have implemented, and for some, contributed to the design of, mobile applications (apps) during clinical practice. However, how these mobile apps are designed and implemented for clinicians to facilitate their clients' communication and learning experiences during therapy remains underinvestigated. Aims: This qualitative research study investigated how mobile apps were designed for clinicians to target assessment and intervention goals. Additionally, it focused on how clinicians adopted these apps while integrating therapy techniques to facilitate their clients' learning. Methods and Procedures: Informed by the Research, Practice, and Design for iPad Apps (iRPD) framework and the Consolidated Framework for Implementation Research (CFIR), semi-structured interviews were conducted with 37 licensed pediatric SLPs, including 23 SLPs who have used apps and 14 SLPs who have contributed to the design of their own mobile apps. Two rounds of qualitative coding via template analysis and thematic analysis were then used to analyse client and clinician characteristics, clinical practice, therapy tools, app characteristics, influential factors and app design and use recommendations. Outcomes and Results: Results showed SLPs utilise different genres of assistive, educational and recreational game apps to support children's communication development when working with children who have diverse disorders and therapy needs across different age groups. SLPs who have designed their own apps emphasised the importance of following evidence-based practice, well-researched teaching methods and learning theories. Additionally, multiple financial, sociocultural, political and ethical factors contributed to the design, adoption and implementation of mobile apps during services. Conclusions and Implications: By understanding the clinician's app use practices situated in various therapy activities and techniques, we specified a list of design recommendations for app designers who are interested in creating mobile apps for supporting children's speech and language development. By bringing insights from both clinical practitioners as well as those with additional technical design backgrounds, this study contributes to the understanding of clinical practice needs and strategies and will lead to the most optimal app design and adoption practice to support the well-being of children with communication disorders.

It became necessary to integrate alternative teaching methods having excellent results in the nursing curriculum such as high-fidelity human patient simulation. High fidelity simulation improves nursing students' thinking, and emotional and decision-making capabilities. The pretest-posttest control group design was conducted to examine the effect of high-fidelity simulation (HFS) intervention on clinical decision-making for pediatric nursing students at the Arab American University in Palestine. One hundred fifty participants took part in the present study, where 50% (n = 75) were in each of the intervention and control groups. The intervention group received theory-based learning and high fidelity simulation, while the control group was provided with theory based learning and usual training in the nursing laboratory. Findings showed that after implementing the intervention, a significant change was noticed in means of clinical decision-making between the control and intervention groups. Therefore, high fidelity simulation intervention was effective, thus it could benefit the nursing students by enhancing clinical decision-making. The results support nursing educators and universities especially in developing countries to adopt such an intervention strategy for nursing students.

Clerkships are defining experiences for medical students in which students integrate basic science knowledge with clinical information as they gain experience in diagnosing and treating patients in a variety of clinical settings. Among the basic sciences, there is broad agreement that anatomy is foundational for medical practice. Unfortunately, there are longstanding concerns that student knowledge of anatomy is below the expectations of clerkship directors and clinical faculty. Most allopathic medical schools require eight "core" clerkships: internal medicine (IM), pediatrics (PD), general surgery (GS), obstetrics and gynecology (OB), psychiatry (PS), family medicine (FM), neurology (NU), and emergency medicine (EM). A targeted needs assessment was conducted to determine the anatomy considered important for each core clerkship based on the perspective of clinicians teaching in those clerkships. A total of 525 clinical faculty were surveyed at 24 United States allopathic medical schools. Participants rated 97 anatomical structure groups across all body regions on a 1-4 Likert-type scale (1 = not important, 4 = essential). Non-parametric ANOVAs determined if differences existed between clerkships. Combining all responses, 91% of anatomical structure groups were classified as "essential" or "more important." Clinicians in FM, EM, and GS rated anatomical structures in most body regions significantly higher than at least one other clerkship (p = 0.006). This study provides an evidence-base of anatomy content that should be considered important for each core clerkship and may assist in the development and/or revision of preclinical curricula to support the clinical training of medical students.

Provider referral is one of the most influential factors in research recruitment. To ease referral burden on providers, we adapted the Best Practice Alert (BPA) in the "EPIC" Electronic Health Record and assessed its utility in recruiting pediatric patients with autism spectrum disorder for the national SPARK study. During a year-long surveillance, 1203 (64.0%) patients were "Interested" in SPARK and 223 enrolled. Another 754 participants not recruited via the BPA also enrolled; 35.5% of these participants completed their participation compared to 58.3% of BPA-referred participants. Results suggest that (a) a BPA can successfully engage providers in the study-referral process and (b) families who learn about research through their providers may be more engaged and effectively retained.

A relatively large number of children with autism spectrum disorder (ASD) exhibit disruptive behavioral problems. While accumulating data have shown behavioral parent training programs to be efficacious in reducing disruptive behaviors for this population, there is a dearth of literature examining the impact of such programs across the range of ASD severity. To evaluate the effectiveness of Parent-Child Interaction Therapy (PCIT), an evidence-based treatment for children with problem behaviors and their families, in reducing disruptive behaviors among children (4-10 years) with ASD (without intellectual disabilities). Fifty-five children (85.5% male, 7.15 years; SD 1.72) were enrolled from pediatric offices and educational settings into a randomized clinical trial (PCIT: N = 30; Control: N = 25). PCIT families demonstrated a significant reduction in child disruptive behaviors, increase in positive parent-child communication, improvement in child compliance, and reduction in parental stress compared to the control group. Exploratory analyses revealed no differential treatment response based on ASD severity, receptive language, and age. Results are promising for the use of PCIT with children demonstrating disruptive behaviors across the autism spectrum.

Psychoeducation, where clinicians teach problem-solving skills in a supportive environment, can help address families' social vulnerabilities and promote well-being. Group well-child care (GWCC) may provide unique opportunities for pediatric residents to improve their skills in psychoeducation. Our aim was to characterize pediatric residents' perspectives and experiences of communication while conducting both individual well-child care and GWCC. We used a longitudinal qualitative study design to conduct 15 semistructured interviews with five pediatric residents who facilitated GWCC. Using the constant comparative method, we characterized pediatric residents' perspectives and experiences of communication while conducting both individual well-child care and GWCC. Four themes emerged. Residents perceived that GWCC (i) enabled families to honestly share their knowledge and parenting practices, (ii) allowed time and a space for families to share personal stories and scenarios, (iii) facilitated discussions of maternal health and psychosocial matters, toward which residents felt ambivalence, and (iv) fostered skills in psychoeducation that transferred to the rest of their clinical practice. When pediatric residents lead GWCC, they perceive that they can facilitate key aspects of psychoeducation, enabling them to assist families in meeting complex social needs. Residents describe that they transfer psychoeducation skills learned in GWCC to the rest of their practice.

The University of Minnesota's Birth to Three Clinic has adopted a holistic approach to supporting children's needs within an attachment-focused, trauma-informed, and neurodevelopmental framework rooted in the DC:0-5™ classification framework. This clinical framework of infant and early childhood mental health (IECMH) assessment has been applied in two settings: (1) a pediatric inpatient intensive care unit (PICU) working with medically complex young children and (2) a multidisciplinary outpatient clinic for children in the foster care system or post-adoption. In both settings, our work is focused on young children who have experienced a variety of early life stressors and adversity.

Background: Health Education England (HEE) and the Royal College of Speech and Language Therapists (RCSLT) have identified the need to increase placement capacity. Speech and language therapy is a shortage profession in the UK, so services need to consider innovative placement models to increase their placement offers without increasing the time burden on speech and language therapists (SLTs). Aims: To increase capacity for pre-registration practice-based learning by using peer-assisted learning (PAL) in a group model of student placement to enable student-led service delivery which provides high standards of clinical care and student experience and is an efficient use of SLT time. Methods & Procedures: A paediatric speech and language therapy service hosted eight student speech and language therapists (SSLTs) for their final pre-registration placement. SSLTs completed pre- and post-placement confidence ratings for a range of clinical skills; SSLTs and SLTs rated how useful different types of support were, and education settings provided feedback about working with the SSLTs. The number of clinical sessions completed by the SSLTs and the percentage of outcomes achieved for children with speech, language and communication needs were calculated. SLTs completed time-trackers for placement-related activities. Outcomes & Results: The impact of the placements was assessed using a tri-vector methodology consisting of: self-reporting by the student (using an evaluation form), feedback from the placement sites (schools) and analysis of targets set for individual children. SSLTs reported increased confidence in all clinical areas in their post-placement evaluation form. SLTs reported increased confidence in SSLTs working independently and an increase in the perceived benefit to the service for having SSLTs in comparison with the time invested in supporting SSLTs. SSLTs and SLTs found all types of support provided during the placement useful. Schools reported high levels of satisfaction for working with SSLTs. SSLTs completed more clinical sessions than an SLT would have been able to in the time SLTs invested in placement-related activities. Children achieved 60% of the targets set by SSLTs. Conclusions & Implications: This placement model increased the capacity for SSLT placements by using PAL in a group model of student placement to enable student-led service delivery. The model provided high standards of clinical care and student experience and was an efficient use of SLT time. Wider use of this placement model would increase placement capacity and could also address vacancies in services.

Empathy is a fundamental quality that nursing staff should possess, but the empathy ability of nursing students in China is currently at an intermediate level and requires improvement. This study aimed to explore teaching methods for nursing humanistic education, that can improve the empathy ability of nursing students and cultivate high-quality nursing talents. This study employed narrative education and experiential teaching methods to develop empathic competence in teaching pediatric nursing courses. The empathic ability of nursing students was measured using the JSPE-NS scale before and after teaching and was analyzed to refine the teaching reflection theme words. After teaching, nursing students scored higher on the total empathy scale, perspective-taking dimension, and emotional care dimension than before teaching, with statistically significant differences (p < 0.05). Five themes were extracted from the teaching reflection, including emotional empathy, pediatric nursing skills, gratitude to parents, reverence for life, and course experience. The results show that the combination of narrative education and experiential teaching methods applied to pediatric nursing courses effectively improved nursing students' empathy, strengthened their identification with the nursing profession, and promoted the teaching reform of humanistic education in nursing courses. The combination of narrative education and experiential teaching methods can improve the empathic ability of nursing students. This approach is suitable for integrating humanistic education into nursing professional courses and provides a feasible idea for developing humanistic qualities in nurses.

Background: Mobile crisis (MC) services is a pediatric behavioral health service that diverts those who need a lower level of care away from the Emergency Department (ED), enabling EDs to focus on providing acute behavioral health services. However, despite MC's efficacy, utilization could be enhanced. Implementation science provides an informative analytic framework. Objective: This study explores implementation-related factors from the service providers' perspective using qualitative methods, to ascertain the strengths, challenges, and adaptations made in accord with local factors. Method: Between April and November 2017, seven focus groups were conducted with 33 MC services providers. A semi-structured interview elicited descriptions of program strengths and challenges including micro and macro factors affecting MC services delivery. Transcripts were coded thematically and related to the four implementation science concepts--fidelity, acceptability, penetration, and sustainability. Results: MC providers prioritize safety and family engagement. They are aware of the many community and personal barriers to practice, including the inadequacy of the continuum of care, and intervene accordingly. Conclusions: Implementing a community-based program such as MC requires focused efforts to build relationships with families, agencies, and community organizations. To get families and referring agencies to use MC rather than the ED for youth in behavioral health crisis, practitioners coordinate with EDs, hospitals, and the needed services. By building essential relationships, providers were able to overcome many barriers and challenges, enabling them to successfully implement MC programs throughout the state. Nevertheless, several remaining challenges will need to be addressed to sustain successful program implementation in the future.

Although pediatricians and family physicians often refer children to early intervention (EI) and provide support and information to families, medical school training that provides information about special education policy and procedures is often limited. We piloted a program whereby medical students, during their pediatric clerkship, observed school classrooms that included young children with disabilities. Visit impact was measured through assessments of perceived competency and a written reflection. Students showed perceived competency growth across all areas measured. Written reflections demonstrated understanding of special education practices and collaborative opportunities. These findings suggest that incorporating experiential learning through facilitated school visits is a way to enhance the learning experience of medical students on topics essential to supporting children with disabilities and their families.