Where do families turn? Ethical dilemmas in the care of chronically critically Ill children.

Advancements in early diagnosis and novel treatments for children with complex and chronic needs have improved their chances of survival. But many survive with complex medical needs and ongoing medical management in the setting of prognostic uncertainty. Their medical care relies more and more on preference-sensitive decisions, requiring medical team and family engagement in ethically challenging situations.

Spanish-Speaking Caregiver Preferences for Social Determinants of Health Screening.

Equitable social determinants of health (SDOH) screening has been recommended by the Centers for Medicare & Medicaid Services and the Joint Commission; however, little is known about Spanish-speaking caregiver preferences on how they would like to be screened. We conducted a cross-sectional study at 3 pediatric clinics (October-December 2019). Caregivers completed (in English or Spanish) an SDOH screening preferences survey.

COVID-19: Implications for Physical Activity, Health Disparities, and Health Equity.

Physical activity is one of the most efficacious pathways to promoting mental and physical health, preventing disease, and, most important during the COVID-19 pandemic, bolstering a stronger immune system. Efforts to "flatten the curve" have resulted in the temporary closure of exercise facilities and gyms, suspension of sport activities, and advisories to avoid public recreational spaces. All of these changes have made traditional opportunities to be physically active difficult to access.

The Transition to Adulthood for Youth Living with Rare Diseases.

More children with rare diseases survive into adulthood. The transition period to adult healthcare presents many challenges for pediatric rare diseases. Few adolescents or their families receive any transitional support for the transition to adult healthcare or for their maturing psychosocial needs.

Mental Health Aspects of Voluntary and Involuntary Sport Retirement.

Sports participation is an important factor in the mental health of athletes. A change in sports participation affects athlete mental health, in addition to other components of the athlete's life, including overall health and fitness, future career plans, current and future financial status, and available social network. Athletes should be encouraged to develop balanced lives that involve rewarding activities outside their sport.

Vaccination coverage among young homeless children compared to US national immunization survey data.

Introduction: Comprehensive vaccination coverage among homeless children in the United States (US) is largely unknown although a few studies suggest low coverage with single vaccinations. This study compared vaccination coverage with a combined 7-vaccines series among homeless children in the District of Columbia (DC) to coverage among other US children.

Materials And Methods: A cross-sectional survey of homeless children in DC was conducted from 2018 to 2019.

Musculoskeletal and Sports Medicine Curriculum Guidelines for Pediatric Residents.

Musculoskeletal (MSK) and sports-related conditions are relatively common in the pediatric population. Pediatric residencies should provide residents with the knowledge and skills to assess and manage both acute and chronic MSK and sports injuries and complaints. Residents should develop the competencies and attitudes to safeguard and promote a healthy and active lifestyle for youth.

Social network influences on new mothers' infant sleep adjustments.

Despite public awareness campaigns, some parents continue to engage in infant sleep practices that are considered risky by health experts, such as bedsharing or placing their infants on their stomachs. This study examines the role their social networks play in shaping parents' responsiveness to new information and/or suggestions about how they should place their infants for sleep, paying attention to the respective effects of health professionals and their close interpersonal ties. We collected data from a sample of 323 new mothers in Washington, D.

School-Based Health Care.

School-based health care encompasses a variety of health care professionals and practice models, including school nursing, school-based health centers, and school-based mental health programs. Services can be delivered in person or via telehealth. School-based health care is an important mechanism for removing barriers to health care services and for reaching adolescent patients.

Becoming Trauma Informed: Validating a Tool to Assess Health Professional's Knowledge, Attitude, and Practice.

Unlabelled: To effectively address the negative health effects of early childhood trauma and adversity, healthcare professionals and healthcare institutions must understand the impact of adverse childhood experiences and trauma on health. This study aimed to validate a tool to assess knowledge, attitude, and practice of trauma-informed care among interdisciplinary pediatric healthcare staff.

Methods: A 36-item survey tool, "Knowledge, Attitudes, and Practices of Trauma-Informed Practice," was adopted and modified with permission from the author.

The Influence of Social Networks and Norms on Breastfeeding in African American and Caucasian Mothers: A Qualitative Study.

Social networks and subjective norms (individuals' perceptions of what other people think) can be influential in decision-making. Although there are data about the importance of support in initiation and duration of breastfeeding, no studies have explored the influence of women's social networks and the norms within those networks on breastfeeding. To investigate, through qualitative methods, the influence of mothers' social networks and subjective norms, both within and outside of her network, with regard to breastfeeding practices.

Implications of Mothers' Social Networks for Risky Infant Sleep Practices.

Objective: To describe the structure of networks in a cohort of mothers and to analyze associations of social network characteristics and norms with infant sleep practices.

Study Design: We recruited a prospective cohort of mothers with infants <6 months of age from January 2015 to December 2016. Mothers completed a survey about their personal social networks and infant care practices.

A Qualitative Analysis of How Mothers' Social Networks Are Established and Used to Make Infant Care Decisions.

. Mothers often look to family members and friends (ie, their social network) for advice and support regarding infant care decisions. However, little is known about the process by which mothers' social networks are established and how mothers use these networks to make decisions regarding infant care.

The Giving Parents Support Study: A randomized clinical trial of a parent navigator intervention to improve outcomes after neonatal intensive care unit discharge.

Parents of infants hospitalized in a neonatal intensive care unit (NICU) experience increased anxiety and stress, which may persist after discharge. The rationale and design of a randomized clinical trial assessing the impact of a 1-year, post-discharge, peer support intervention (parent navigation) on parental mental health and infant health care utilization is described. Qualitative methods guided the adaptation of an existing parent support program to target emotional and resource-related needs of NICU families.

Is There a Return on a Children's Hospital's Investment in a Pediatric Residency's Community Health Track? A Cost Analysis.

Academic Medical Centers incur significant expenses associated with training residents and caring for underserved populations. No previous studies have analyzed hospital-level graduate medical education economics for pediatric residency training. Using data from the 2010-2011 academic year, we quantified total direct costs per year for training 12 community health track (CHT) residents.

Stock Photographs Do Not Comply With Infant Safe Sleep Guidelines.

We evaluated images in popular stock photography websites for adherence with American Academy of Pediatrics (AAP) guidelines for safe infant sleep practices. Three top stock photo websites were used to collect photographs generated from key phrases. All images depicting an infant sleep environment were analyzed for consistency with AAP guidelines.

Modifying Provider Practice To Improve Assessment of Unhealthy Weight and Lifestyle in Young Children: Translating Evidence in a Quality Improvement Initiative for At-Risk Children.

Background: We designed a quality improvement (QI) project to address the high prevalence of childhood overweight and obesity (OW/OB) in our patient population and the inconsistencies among primary care providers in recognizing and addressing OW/OB.

Methods: We used mixed methods data collection approach to evaluate a QI project, the Childhood Healthy Behaviors Intervention (CHBI), to improve provider obesity prevention practice in two low-income, predominantly African American pediatric primary care clinics. Electronic record data were extracted from all 2-9 year well visits pre- and postintervention for frequency of appropriate diagnostic coding of OW/OB.

A "Resident-as-Teacher" Curriculum Using a Flipped Classroom Approach: Can a Model Designed for Efficiency Also Be Effective?

Problem: The Accreditation Council for Graduate Medical Education requires training that enhances resident teaching skills. Despite this requirement, many residency training programs struggle to implement effective resident-as-teacher (RAT) curricula, particularly within the context of the 80-hour resident workweek.

Approach: In 2013, the authors developed and evaluated an intensive one-day RAT curriculum using a flipped classroom approach.

Risk Factors, Protective Factors, and Current Recommendations to Reduce Sudden Infant Death Syndrome: A Review.

Importance: Sudden infant death syndrome remains the leading cause of death in infants aged 1 month to 1 year in the United States.

Observations: While its exact cause is unknown, sudden infant death syndrome is believed to be multifactorial, ie, occurs in infants with underlying biological vulnerability who experience an exogenous stressor, such as prone/side sleeping or soft bedding, during a critical developmental period. Much genetic and physiologic evidence points to impaired arousal responses to hypercarbia and hypoxia, which ultimately leads to asphyxia.

Improved Contraceptive Use Among Teen Mothers in a Patient-Centered Medical Home.

Purpose: The Generations program, a patient-centered medical home, providing primary medical care, social work, and mental health services to teen mothers and their children, offers a promising approach to pregnancy prevention for teen mothers. This study tested whether the Generations intervention was associated with improved rates of contraceptive and condom use among participants 12 months after program entry.

Methods: This study compared teen mothers enrolled in Generations to those receiving standard community-based pediatric primary care over 12 months.

Strategies for Improving Vaccine Delivery: A Cluster-Randomized Trial.

Objective: New emphasis on and requirements for demonstrating health care quality have increased the need for evidence-based methods to disseminate practice guidelines. With regard to impact on pediatric immunization coverage, we aimed to compare a financial incentive program (pay-for-performance [P4P]) and a virtual quality improvement technical support (QITS) learning collaborative.

Methods: This single-blinded (to outcomes assessor), cluster-randomized trial was conducted among unaffiliated pediatric practices across the United States from June 2013 to June 2014.