BACKGROUND AND OBJECTIVES Psychiatric boarding has implications for youth, their families, and hospital systems. We undertook a quality improvement (QI) project to address boarding at our institution. We aimed to stabilize patients who were boarding in our emergency department (ED) observation unit and to decrease the percentage of patients admitted to psychiatric facilities. METHODS A multidisciplinary

Pediatricians and pediatric trainees in North America are increasingly involved in caring for children and adolescents in or from low- and middle-income countries (LMICs). In many LMICs, hazardous environmental exposures-notably outdoor and household air pollution, water pollution, lead, pesticides, and other manufactured chemicals-are highly prevalent and account for twice the proportion of disease

Pediatricians and pediatric trainees in North America are increasingly involved in caring for children and adolescents in or from low- and middle-income countries (LMICs). In many LMICs, toxic environmental exposures-notably outdoor and household air pollution, water pollution, lead, hazardous waste disposal, pesticides, and other manufactured chemicals-are highly prevalent and account for twice as

OBJECTIVE Youth behavioral health inpatient beds are limited during a time of crisis. Around one-third of youth admitted to a behavioral health unit (BHU) will be readmitted within 1 year of discharge, with 8% to 13% being admitted within 30 days. In one study, they found that more than one-third of patients initially admitted for suicidal ideation or attempt were readmitted within 7 days. Our objective

Fractures are common injuries in childhood and can be caused by unintentional injury, medical conditions, and child abuse. Although the consequences of failing to diagnose an abusive injury in a child can be grave, the consequences of incorrectly diagnosing child abuse in a child whose fractures have another etiology are also significant. This report aims to review recent advances in the understanding

BACKGROUND AND OBJECTIVE To evaluate the efficacy of Family-Centered Advance Care Planning for Teens With Cancer (FACE-TC) on adolescents' quality of life. METHODS A clinical trial randomized adolescent-family dyads at a 2:1 ratio to either FACE-TC or control. FACE-TC dyads received 3 weekly 60-minute sessions: Lyon Pediatric Advance Care Planning Survey; Next Steps: Respecting Choices; and Five Wishes

OBJECTIVE The 2021 American Academy of Pediatrics clinical practice guideline (CPG) for well-appearing febrile infants aims to promote evidence-based care, reduce practice variability, enhance care quality, and optimize cost. We aimed to examine the trends in resource utilization and cost associated with the evaluation and management of febrile infants aged 8 to 60 days before and after the CPG's publication

CONTEXT Extubation failure (EF) is common in preterm neonates and may be associated with adverse outcomes. OBJECTIVE To systematically review and meta-analyze the existing literature on predictors and outcomes of EF in preterm neonates. DATA SOURCES MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Embase (OvidSP), CINAHL (EBSCOHost), and Cochrane Library (Wiley) from 1995 onward

BACKGROUND Zika virus (ZIKV) infection during pregnancy can lead to congenital Zika syndrome (CZS) and may result in neurodevelopmental alterations in exposed children, with and without CZS. This study aimed to evaluate ZIKV infection during pregnancy as a risk factor for early and long-term adverse outcomes. METHODS This retrospective-prospective, matched cohort study was conducted in Mato Grosso

BACKGROUND Although sex differences in pain are well documented, little is known regarding the relationship between gender and pain. Gender-diverse youth experience unique pain risk factors, including minority stress exposure, but are underrepresented in research. OBJECTIVE Elicit experiences of gender-diverse youth who live with chronic pain. METHODS Semistructured interviews were conducted with youth

We present the case of a child born with hypoplastic left heart syndrome. After developing multiple complications following the first surgical stage (Norwood procedure), her parents decide not to proceed with the second stage (Glenn operation). Cardiac surgeons, pediatric intensivists, a psychologist, and a bioethicist analyze whether further surgical intervention is ethically obligatory. A cardiac

Pediatric home health care represents a vital system of care for children with disability and medical complexity, encompassing services provided by family caregivers and nonfamily home health care providers and the use of durable medical equipment and supplies. Home health care is medically necessary for the physiologic health of children with disability and medical complexity and for their participation

CONTEXT Exposure to adverse childhood experiences (ACEs) is associated with adverse impacts on subsequent generations. The extent to which caregiver ACEs are associated with their child's ACE score is unclear. OBJECTIVE To meta-analytically examine the association between caregiver and child ACE score. Potential moderators of this association were explored. DATA SOURCES Systematic searches were conducted

OBJECTIVES To assess whether exposure to an infant safe sleep initiative was associated with maternal report of infant safe sleep practice at home and to identify other predictive factors. METHODS After linking Pennsylvania data on infant safe sleep initiative implementation at 27 hospitals to birth certificate and Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2017 to 2021, we generated

BACKGROUND AND OBJECTIVES Vaccine doses provided outside the Advisory Committee on Immunization Practices for minimum and maximum ages of vaccination and minimum intervals between doses are considered invalid. Our objective was to quantify the prevalence of and factors associated with invalid doses among US children aged 0 to 35 months. METHODS We analyzed provider-verified vaccination records from

BACKGROUND Traditional classification of children's and nonchildren's hospitals is based on physical structure and branding. We grouped hospitals with the most similar types of pediatric patients. METHODS Retrospective analysis of 2.8 million hospitalizations in 3993 hospitals for patients 0 to 20 years in the 2019 Kids' Inpatient Database. After stratifying low-volume hospitals (greater than 100 annual

BACKGROUND AND OBJECTIVES The likelihood and severity of neurodevelopmental impairment (NDI) affects critical health care decisions. NDI definitions were developed without parental perspectives. We investigated the agreement between parental vs medical classification of NDI among children born preterm. METHODS In this multicenter study, parents of children born preterm (<29 weeks) evaluated at 18 to

BACKGROUND AND OBJECTIVES Human papillomavirus (HPV) vaccination rates are suboptimal, and missed vaccination opportunities are common. We hypothesized that a bundled intervention improves missed HPV vaccination opportunities. METHODS We used a pre-post design to assess differences in HPV vaccine missed opportunities (visits when vaccine-eligible adolescents are not vaccinated). We compared rates for

Pleural tuberculoma is often observed during treatment for tuberculous pleurisy; however, this condition is rarely found as a solitary pleural nodule in patients without a history of tuberculosis treatment, and no cases have been reported in children. We report a case of a 12-year-old boy with pleural tuberculoma presenting as a solitary mass. He had a fever and cough that prompted chest radiography

OBJECTIVES Homelessness is a public health crisis in the United States, yet homelessness prevalence, especially among children and youth, is not well understood. In this study, we use an indirect estimation method known as multiple systems estimation to further evaluate prevalence of youth experiencing homelessness in Denver, Colorado. METHODS We performed a multiple systems estimation ("capture-recapture")

BACKGROUND Febrile young infants are at risk of invasive bacterial infections (IBIs; bacteremia or bacterial meningitis). American Academy of Pediatrics (AAP) guidelines recommend that when procalcitonin testing is unavailable, C-reactive protein (CRP), absolute neutrophil count (ANC) and temperature should be used to identify low-risk infants. We sought to determine the optimal combination of these

In response to a record number of immigrant families arriving in the United States through the southern border, a multidisciplinary team at a tertiary care children's hospital developed an inpatient asylum protocol (IAP) whose goals were to identify, screen, and support hospitalized asylum-seeking patients and their families. Identified patients were provided with specialized social work, case management

OBJECTIVE Breastfeeding enhances maternal and child health, yet US breastfeeding rates remain below optimal levels and substantial disparities persist. The 2022 infant formula crisis had the potential to influence infant feeding practices due to formula shortages and fears about the safety of formula feeding in the wake of recalls. This report studies the evolution of breastfeeding-initiation trends

We present the first description of a family in which 2 siblings show alternative expression of CRKL gene deletion as the phenotypes of Zinner (OSVIRA, obstructed seminal vesicle and ipsilateral renal agenesis) and OHVIRA (obstructed hemivagina with an ipsilateral renal anomaly) syndromes. The male infant with Zinner syndrome and his sister aged 5 years with OHVIRA syndrome both have a paternally inherited

BACKGROUND AND OBJECTIVES A death scene investigation is required to determine sudden infant death syndrome, and a doll reenactment optimizes the information obtained. The aim of this study was to explore how acutely bereaved parents experience doll reenactments that are conducted after the sudden and unexpected deaths of their infants. METHODS A mixed-methods design, including surveys and semi-structured

OBJECTIVES The burden and health impact of heat stress on child hospitalization is limited. This study aims to investigate associations between extreme heat stress exposure based on a Universal Thermal Climate Index (UTCI), emergency department (ED) visits, and ED visits that translate into unplanned hospital admissions. METHODS This population-based case-crossover study included all ED visits and

OBJECTIVES To identify opportunities for improvement in quality of care, we explore Black families' experiences of family support in the neonatal intensive care unit (NICU) during their infant's hospital stay. METHODS Semistructured qualitative interviews or focus groups (FGs) were conducted to explore Black families' experiences of NICU hospitalization. Inclusion criteria were self-identification

Public health emergencies, including climate-related and manmade disasters such as active shooter incidents, occur regularly in the United States. A comprehensive approach is needed to ensure that children's mental health needs are adequately addressed following disasters. This article summarizes the latest evidence on how health systems can effectively address children's unique developmental, social

Critical congenital heart disease (CCHD) screening was added to the US Recommended Uniform Screening Panel in 2011 and adopted by all US states and territories by 2018. In addition to reviewing key developments in CCHD screening since the initial American Academy of Pediatrics (AAP) endorsement in 2011, this clinical report provides 3 updated recommendations. First, a new AAP algorithm has been endorsed

BACKGROUND AND OBJECTIVES Preterm birth results in neonatal and childhood morbidity and mortality. Additionally, population-based studies show poorer cardiovascular health in adult survivors, but a full range of health outcomes has not been investigated into midlife. We aimed to assess the health outcomes after preterm vs term birth at 50 years in survivors of a randomized trial of antenatal betamethasone

The sudden onset of severe behavioral and neuropsychiatric symptoms in children is a frightening and potentially life-changing situation. The pediatric health care providers and clinicians to whom families turn need guidance on how to accurately diagnose and treat new-onset neuropsychiatric symptoms in children. They need expert guidance about whether these symptoms indicate a diagnosis compatible

BACKGROUND AND OBJECTIVES Research on conversations between caregivers and their children about how to prepare or conduct themselves when stopped by police (ie, "the talk") has grown in recent years. However, little is known about how having "the talk" may influence youths' stress about future experiences of police brutality (ie, anticipatory stress of police brutality). The objective of the present

OBJECTIVE Our institutional data revealed high pneumothorax rates in term neonates resuscitated in the delivery room (DR). Other studies have reported that high rates of continuous positive airway pressure (CPAP) in the DR are associated with increased pneumothorax rates. We sought to test the hypothesis that quality improvement efforts to reduce the use of CPAP in the DR would be associated with a

BACKGROUND AND OBJECTIVES Many neonatal intensive care units (NICUs) do not give rotavirus vaccines to inpatients due to a theoretical risk of horizontal transmission of vaccine strains. We aimed to determine incidence and clinical significance of vaccine-strain transmission to unvaccinated infants in a NICU that routinely administers pentavalent rotavirus vaccine (RV5). METHODS This prospective cohort

CONTEXT Treatments for obsessive-compulsive disorder (OCD) in children and adolescents. OBJECTIVE Evaluate the comparative efficacy of behavioral and pharmacologic treatments. DATA SOURCES Six databases and ClinicalTrials.gov registry; search last updated on 5/15/2024. STUDY SELECTION Dual screening augmented by Abstrackr machine learning algorithm. DATA EXTRACTION/ANALYSIS Participant characteristics

CONTEXT Children and adolescents with suspected obsessive-compulsive disorder (OCD). OBJECTIVE To estimate the comparative performance of brief diagnostic assessment tools. DATA SOURCES PubMed, the Cochrane Register of Clinical Trials, the Cochrane Database of Systematic Reviews, Embase, CINAHL, PsycINFO, and ERIC, and for unpublished studies with reported results in ClinicalTrials.gov through May

Obsessive-compulsive disorder (OCD) is a common and potentially debilitating condition affecting approximately 1%-3% of children and adolescents.1,2 It is characterized by obsessions and/or compulsions that are time-consuming or cause clinically significant distress or impairment in school, social, family, or other important areas of functioning. OCD can have a lasting impact on both academic and social

BACKGROUND Federal guidelines and equitable care mandate that patients who use a language other than English receive interpretation in their preferred language. Substantial variability exists in interpreter use in intensive care settings. We aimed to increase the rate of interpretations in our pediatric intensive care unit (PICU) through a series of targeted interventions. METHODS A multidisciplinary

Children and youth with special health care needs (CYSHCN) are living longer than ever. These advances come with a price: Patients, families, communities, and systems must absorb the challenges of chronic caregiving, including protracted stress and poor mental health. In 2023, the National Academies of Science, Engineering, and Medicine convened thought-leaders for conversations about supporting the

BACKGROUND In 2023, nirsevimab, a monoclonal antibody against respiratory syncytial virus (RSV), was approved in the United States to be given to infants to prevent bronchiolitis, a leading cause of pediatric hospitalizations. We sought to better understand how parents of otherwise healthy newborns would respond to this recommendation. METHODS We conducted semistructured interviews of purposefully