Academic Pediatrics

PURPOSE: This project aimed to prevent obesity in high-risk infants using community health workers (CHW's) to provide mothers with culturally appropriate nutrition and health education. METHODS: This randomized controlled trial enrolled mothers prenatally and infants at birth. Mothers were Spanish-speaking WIC participants with obesity. Trained, Spanish-fluent, CHW's visited homes of intervention mothers to encourage breastfeeding, and promote delayed introduction of solid foods, adequate sleep, limited screen time, and active play...

OBJECTIVES: The goal of this study was to examine the association between self-reported social needs and postpartum depression (PPD) symptoms of mothers screened in pediatric primary care clinics. METHODS: This retrospective cohort study used electronic health record data from 3,616 pediatric patients (age 0 to 6 months), whose mothers completed the Edinburg Postpartum Depression Scale (EPDS) and a social needs screening in a large pediatric primary care network between April 2021 and February 2022...

OBJECTIVE: Infant well-child visits are increasingly being explored as opportunities to address parental postpartum health needs, including those related to reproductive health. To inform potential pediatric clinic-based interventions, this study assessed postpartum contraceptive needs and health services preferences. METHODS: We surveyed postpartum individuals attending 2-6 month well-child visits at three Northern California pediatric clinics (2019-20). We examined unmet contraceptive need; the acceptability of contraceptive education, counseling, and provision at well-child visits; and sociodemographic and clinical correlates...

OBJECTIVE: Acute agitation episodes in the emergency department (ED) can be distressing for patients, families, and staff and may lead to injuries. We aim to understand availability of ED resources to care for children with acute agitation, perceived staff confidence with agitation management, barriers to use of de-escalation techniques, and desired resources to enhance care. METHODS: We conducted a survey of pediatric emergency care coordinators (PECCs) in EDs in Massachusetts, Rhode Island, and Los Angeles County, California...

PROBLEM: Palliative care (PC) is high value, holistic care for a child and their family across the entire arc of an illness. All physicians should be competent in symptom management and providing goal-concordant care that acknowledges quality of life; however, there is insufficient education in pediatric residency to develop competence in basic or "Primary" Palliative Care (PC). APPROACH: We completed a needs assessment and developed a longitudinal, comprehensive, and integrated primary PC curriculum for pediatric residents with the goal of developing foundational primary PC skills regardless of eventual career trajectory...

OBJECTIVE: To identify factors associated with participation in group well-child care (GWCC), wherein families share preventive health care visits. METHODS: We extracted electronic health record data of mother-infant dyads with infants born 2013-2018 at Yale New Haven Hospital and followed at the primary care center. Using chi-square analysis and multivariate logistic regression, we examined the extent to which (1) maternal/infant characteristics and recruitment timing were associated with GWCC initiation and continued engagement and (2) initiation was associated with primary care visits...

OBJECTIVES: In the United States, caregivers of children and youth with special healthcare needs (CYSHCN) must navigate complex, inefficient health care and insurance systems to access medical care. We assessed for sociodemographic inequities in time spent coordinating care for CYSHCN and examined the association between time spent coordinating care and forgone medical care. METHODS: This cross-sectional study used data from the 2018-2020 National Survey of Children's Health, which included 102,740 children across all 50 states...

PURPOSE: To determine whether a formal note-writing session and note template for medical students (MS) during the Core Clerkship in Pediatrics (CCP) increases note quality, shortens note length, and decreases time of documentation. METHODS: In this single site, prospective study, MS participating in an 8-week CCP received a didactic session on note-writing in the electronic health record (EHR) and utilized EHR template developed for the study. We assessed note quality [measured by Physician Documentation Quality Instrument-9 (PDQI-9)], note length and note documentation time in this group compared to MS notes on the CCP in the prior academic year...

PURPOSE: The purpose of this paper was to understand associations between low sleep duration (<8 hours) and positive mental health screens among adolescents (ages 13-18) seen for preventive visits in primary care. METHODS: Data were from two randomized controlled trials testing the efficacy of an electronic health risk behavior screening and feedback tool for adolescent preventive visits. Participants (n=601) completed screeners at baseline, 3-, and 6-months which included sleep duration in hours and the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 screeners for depression and anxiety, respectively...

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OBJECTIVES: Residents and fellows are often the first healthcare providers to discuss sexual health and prevention with adolescents and young adults (AYA) at academic institutions. This study characterized when learners in Pediatrics, Obstetrics and Gynecology, and Family Medicine believed that one should receive training in pre-exposure prophylaxis (PrEP) and it described confidence in prescribing PrEP. METHODS: Learners at a large, urban, southern academic center completed an online survey about adolescent sexual health services...

OBJECTIVE: To describe differences in agentic (achievement) and communal (relationship) terms in letters of recommendation (LORs) for pediatric residency candidates by applicant and letter writer demographics and to examine if LOR language is associated with interview status. METHODS: A random sample of applicant profiles and LORs submitted to one institution were analyzed from the 2020-21 Match. LOR text was inputted into a customized natural language processing application which determined the frequency of agentic and communal words in each LOR...

OBJECTIVE: The purpose of the current study was to explore provider perspectives on the strengths and challenges of telehealth services (e.g., behavioral interventions, physical, speech, and occupational therapy, medication management) for children with ASD during COVID-19 related shutdowns. METHODS: From September 2020 to May 2021, we conducted qualitative interviews with 35 providers across multiple disciplines from 17 sites in the Autism Care Network. Qualitative data was analyzed using a framework approach and common themes were identified...

OBJECTIVES: To examine climate change concerns among parents in Chicago - a large and diverse urban setting that experiences climate change-related weather events and rising water levels, which have the potential to affect more than 1 million children living in the city. METHODS: We collected data through the Voices of Child Health in Chicago Parent Panel Survey from May-July 2021. Parents indicated their personal level of worry about climate change, concern about the impact of climate change on themselves and their family, and how well they understood the issue of climate change...

OBJECTIVE: To understand US parent health care-seeking decisions in the context of multiple in-person and telehealth care options. As the health care landscape evolves, new research is needed to explain how parents now decide when and where to seek acute pediatric health care. METHODS: We applied a mental models approach, focusing on the archetypal example of care-seeking for pediatric acute respiratory tract infections (ARTIs), by first reviewing pediatric ARTI guidelines with 16 health care professionals to inform 40 subsequent semi-structured interviews with parents of young children in 2021...

OBJECTIVES: Annual influenza vaccination rates for children remain well below the Healthy People 2030 target of 70%. We aimed to compare influenza vaccination rates for children with asthma by insurance type and to identify associated factors. METHODS: This cross-sectional study examined influenza vaccination rates for children with asthma by insurance type, age, year, and disease status using the Massachusetts All Payer Claims Database (2014-2018). We used multivariable logistic regression to estimate the probability of vaccination accounting for child and insurance characteristics...

BACKGROUND AND OBJECTIVES: Community level social determinants of health impact asthma outcomes among children, however individual patient's priorities are not often included in designing social care interventions. Identifying connections between patient-prioritized unmet social needs and asthma severity status may allow for improved patient-centered approaches to asthma management. In this analysis, we examined the association between unmet social needs and asthma severity in an urban population of children...

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Mentorship in academic medicine is critical at every stage of one's career. Here, we provide insights into the mentorship and sponsorship needs and strategies of academic faculty that span from early to senior career.

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