User login
CPAP for infants with OSA is effective with high adherence
DALLAS – ), according to a study.
“Positive airway pressure is a common treatment for OSA in children,” wrote Christopher Cielo, DO, of Children’s Hospital of Philadelphia Sleep Center, and his colleagues. But the authors note that treating infants with CPAP can be more challenging because infants have less consolidated sleep, may have greater medical complexity, and have smaller faces that make mask fit, titration, and adherence difficult.
The researchers therefore compared use of CPAP for OSA on 32 infants who began the therapy before age 6 months and 102 school-age children who began the therapy between ages 5 and 10 years, all treated at a single sleep center between March 2013 and September 2018.
Only one of the infants (mean age 3 months) had obesity, compared with 37.3% of the school-age children (mean age 7.7 years), but more of the infants (50%) had a craniofacial abnormality compared with the older children (8.9%) (P less than .001).
None of the infants had had an adenotonsillectomy, whereas the majority of the older children (80.4%) had (P less than .001). Rates of neurological abnormality and genetic syndromes (including Down syndrome) were similar between the groups.
In baseline polysomnograms, infants had a higher mean obstructive apnea-hypopnea index (AHI) compared with older children (22.6 vs. 12; P less than .001) and a slightly, but significantly, lower oxygen saturation nadir (81% vs. 87%; P = .002).
Only 9.8% of the children and none of the infants used autotitrating. Similar proportions of both groups – 90.6% of infants and 93.1% of children – achieved a mean AHI below 5 with CPAP treatment, and both CPAP pressure and mean oxygen saturation nadir at final pressure were similar in both groups.
Adherence was higher in infants than in children: Infants used CPAP for at least some time for 93.3% of nights compared with children (83.4%) (P = .009), and infants used CPAP for more than 4 hours for 78.4% of nights, compared with 59.5% of nights among children (P = .04).
Barriers to adherence reported by caregivers were similar between both groups. The most common barrier was child behavior, such as crying or refusing the CPAP, which 25% of infant caregivers and 35.3% of child caregivers reported. While a higher proportion of caregivers reported a poor mask fit for infants (15.6%) than for children (10.8%), the difference was not significant (P = .47). Rates of skin irritation also did not significantly differ between the groups.
In addition to the limitations accompanying any retrospective analysis from a single center, another study limitation was the inability to account for differences in total sleep time between infants and school-age children in comparing CPAP usage.
The National Institutes of Health and the Francis Family Foundation funded the research. The authors had no disclosures.
DALLAS – ), according to a study.
“Positive airway pressure is a common treatment for OSA in children,” wrote Christopher Cielo, DO, of Children’s Hospital of Philadelphia Sleep Center, and his colleagues. But the authors note that treating infants with CPAP can be more challenging because infants have less consolidated sleep, may have greater medical complexity, and have smaller faces that make mask fit, titration, and adherence difficult.
The researchers therefore compared use of CPAP for OSA on 32 infants who began the therapy before age 6 months and 102 school-age children who began the therapy between ages 5 and 10 years, all treated at a single sleep center between March 2013 and September 2018.
Only one of the infants (mean age 3 months) had obesity, compared with 37.3% of the school-age children (mean age 7.7 years), but more of the infants (50%) had a craniofacial abnormality compared with the older children (8.9%) (P less than .001).
None of the infants had had an adenotonsillectomy, whereas the majority of the older children (80.4%) had (P less than .001). Rates of neurological abnormality and genetic syndromes (including Down syndrome) were similar between the groups.
In baseline polysomnograms, infants had a higher mean obstructive apnea-hypopnea index (AHI) compared with older children (22.6 vs. 12; P less than .001) and a slightly, but significantly, lower oxygen saturation nadir (81% vs. 87%; P = .002).
Only 9.8% of the children and none of the infants used autotitrating. Similar proportions of both groups – 90.6% of infants and 93.1% of children – achieved a mean AHI below 5 with CPAP treatment, and both CPAP pressure and mean oxygen saturation nadir at final pressure were similar in both groups.
Adherence was higher in infants than in children: Infants used CPAP for at least some time for 93.3% of nights compared with children (83.4%) (P = .009), and infants used CPAP for more than 4 hours for 78.4% of nights, compared with 59.5% of nights among children (P = .04).
Barriers to adherence reported by caregivers were similar between both groups. The most common barrier was child behavior, such as crying or refusing the CPAP, which 25% of infant caregivers and 35.3% of child caregivers reported. While a higher proportion of caregivers reported a poor mask fit for infants (15.6%) than for children (10.8%), the difference was not significant (P = .47). Rates of skin irritation also did not significantly differ between the groups.
In addition to the limitations accompanying any retrospective analysis from a single center, another study limitation was the inability to account for differences in total sleep time between infants and school-age children in comparing CPAP usage.
The National Institutes of Health and the Francis Family Foundation funded the research. The authors had no disclosures.
DALLAS – ), according to a study.
“Positive airway pressure is a common treatment for OSA in children,” wrote Christopher Cielo, DO, of Children’s Hospital of Philadelphia Sleep Center, and his colleagues. But the authors note that treating infants with CPAP can be more challenging because infants have less consolidated sleep, may have greater medical complexity, and have smaller faces that make mask fit, titration, and adherence difficult.
The researchers therefore compared use of CPAP for OSA on 32 infants who began the therapy before age 6 months and 102 school-age children who began the therapy between ages 5 and 10 years, all treated at a single sleep center between March 2013 and September 2018.
Only one of the infants (mean age 3 months) had obesity, compared with 37.3% of the school-age children (mean age 7.7 years), but more of the infants (50%) had a craniofacial abnormality compared with the older children (8.9%) (P less than .001).
None of the infants had had an adenotonsillectomy, whereas the majority of the older children (80.4%) had (P less than .001). Rates of neurological abnormality and genetic syndromes (including Down syndrome) were similar between the groups.
In baseline polysomnograms, infants had a higher mean obstructive apnea-hypopnea index (AHI) compared with older children (22.6 vs. 12; P less than .001) and a slightly, but significantly, lower oxygen saturation nadir (81% vs. 87%; P = .002).
Only 9.8% of the children and none of the infants used autotitrating. Similar proportions of both groups – 90.6% of infants and 93.1% of children – achieved a mean AHI below 5 with CPAP treatment, and both CPAP pressure and mean oxygen saturation nadir at final pressure were similar in both groups.
Adherence was higher in infants than in children: Infants used CPAP for at least some time for 93.3% of nights compared with children (83.4%) (P = .009), and infants used CPAP for more than 4 hours for 78.4% of nights, compared with 59.5% of nights among children (P = .04).
Barriers to adherence reported by caregivers were similar between both groups. The most common barrier was child behavior, such as crying or refusing the CPAP, which 25% of infant caregivers and 35.3% of child caregivers reported. While a higher proportion of caregivers reported a poor mask fit for infants (15.6%) than for children (10.8%), the difference was not significant (P = .47). Rates of skin irritation also did not significantly differ between the groups.
In addition to the limitations accompanying any retrospective analysis from a single center, another study limitation was the inability to account for differences in total sleep time between infants and school-age children in comparing CPAP usage.
The National Institutes of Health and the Francis Family Foundation funded the research. The authors had no disclosures.
REPORTING FROM ATS 2019
Stock inhalers at school effectively meet students’ rescue medication needs
DALLAS – Allowing public and private schools to store multiuse stock albuterol inhalers for students with asthma is a legally and medically feasible way to provide students with rescue medication without their need to leave school, according to a recent study.
“Stakeholder coalitions can facilitate the large-scale adoption of stock inhaler programs in schools,” concluded Ashley A. Lowe, MSPH, a senior research specialist and PhD candidate at the University of Arizona, Tucson, and colleagues in a poster at the American Thoracic Society’s international conference.“These programs improve access to rescue medication while returning students back to their classroom.”
The Arizona legislature passed H.B. 2208, “Stock Inhalers for Schools” in March 2017 to allow schools to store and administer albuterol sulfate while indemnifying trained staff against liability when they allowed students to use the inhaler in good faith. A stock inhaler can used by different students because of its disposable valved-holding chambers.
“Such laws allow schools to overcome the legal obstacles that make it difficult for them to ensure such medication is readily available to all children experiencing respiratory distress,” the authors wrote. They assessed the use and outcomes of schools’ storage of stock inhalers during the 2017-2018 school year in Pima County, Arizona.
Of the 213 public, 90 charter, and 61 private/parochial schools in Pima County, 246 (67%) total schools participated, including nearly all of the public schools (93%), nearly half the private/parochial schools (49%), and 17% of the charter schools. A total of 134,251 students had access to a stock inhaler at school.
Each participating school received a kit containing a 60-dose albuterol sulfate inhaler, 10 valved-holding chambers, a signed standing medical order, a standardized emergency protocol for albuterol use, access to an online training curriculum and template resources, along with technical support.
Each time a school used the stock inhaler, they documented whether an asthma diagnosis was known or not, total puffs administered and where the student went next – returned to class, sent home with caregiver, 911 call without transport, or 911 call with EMS transport.
Based on data analyzed from 240 schools, the stock inhalers were used 1,032 times at 152 schools during the study period, predominantly at public schools (97%) and by students with a known asthma diagnosis (82%). In 12.2% of cases, the student did not have a known asthma diagnosis, and 5.8% of the time, asthma diagnosis status was unknown. The students received a mean 2.7 puffs at each use.
Ethnicity and race data of those students who used the inhalers was not complete. Most of the students for whom ethnicity data were available (n = 343) and who used the inhaler were Hispanic/Latino (69.8%) independent of race. Based only on the 437 students for whom data on race were available, students using the inhaler included 41% white, 11.7% black, 3.1% Native American/Alaskan Native, 1% Asian and 0.6% Native Hawaiian/Pacific Islander.
Among the 915 uses of the inhaler for which subsequent student location was available, the majority of students (84%) returned to their classroom after using the inhaler. Only five were transported to a medical facility via EMS following a 911 call, and 911 was called for one student who did not receive EMS transport.
According to the Allergy & Asthma Network, the following states have school stock albuterol laws: Arizona, Colorado, Georgia, Illinois, Missouri, New Hampshire, New Mexico, Oklahoma, Ohio, Texas, Utah, and West Virginia.*
The research was funded by Banner–University Medical Center Tucson, Thayer Medical Corporation, and the Asthma & Airway Disease Research Center. The authors had no disclosures.
SOURCE: Lowe AA et al. ATS 2019, Abstract A4070.
* This article was updated on July 15, 2019.
DALLAS – Allowing public and private schools to store multiuse stock albuterol inhalers for students with asthma is a legally and medically feasible way to provide students with rescue medication without their need to leave school, according to a recent study.
“Stakeholder coalitions can facilitate the large-scale adoption of stock inhaler programs in schools,” concluded Ashley A. Lowe, MSPH, a senior research specialist and PhD candidate at the University of Arizona, Tucson, and colleagues in a poster at the American Thoracic Society’s international conference.“These programs improve access to rescue medication while returning students back to their classroom.”
The Arizona legislature passed H.B. 2208, “Stock Inhalers for Schools” in March 2017 to allow schools to store and administer albuterol sulfate while indemnifying trained staff against liability when they allowed students to use the inhaler in good faith. A stock inhaler can used by different students because of its disposable valved-holding chambers.
“Such laws allow schools to overcome the legal obstacles that make it difficult for them to ensure such medication is readily available to all children experiencing respiratory distress,” the authors wrote. They assessed the use and outcomes of schools’ storage of stock inhalers during the 2017-2018 school year in Pima County, Arizona.
Of the 213 public, 90 charter, and 61 private/parochial schools in Pima County, 246 (67%) total schools participated, including nearly all of the public schools (93%), nearly half the private/parochial schools (49%), and 17% of the charter schools. A total of 134,251 students had access to a stock inhaler at school.
Each participating school received a kit containing a 60-dose albuterol sulfate inhaler, 10 valved-holding chambers, a signed standing medical order, a standardized emergency protocol for albuterol use, access to an online training curriculum and template resources, along with technical support.
Each time a school used the stock inhaler, they documented whether an asthma diagnosis was known or not, total puffs administered and where the student went next – returned to class, sent home with caregiver, 911 call without transport, or 911 call with EMS transport.
Based on data analyzed from 240 schools, the stock inhalers were used 1,032 times at 152 schools during the study period, predominantly at public schools (97%) and by students with a known asthma diagnosis (82%). In 12.2% of cases, the student did not have a known asthma diagnosis, and 5.8% of the time, asthma diagnosis status was unknown. The students received a mean 2.7 puffs at each use.
Ethnicity and race data of those students who used the inhalers was not complete. Most of the students for whom ethnicity data were available (n = 343) and who used the inhaler were Hispanic/Latino (69.8%) independent of race. Based only on the 437 students for whom data on race were available, students using the inhaler included 41% white, 11.7% black, 3.1% Native American/Alaskan Native, 1% Asian and 0.6% Native Hawaiian/Pacific Islander.
Among the 915 uses of the inhaler for which subsequent student location was available, the majority of students (84%) returned to their classroom after using the inhaler. Only five were transported to a medical facility via EMS following a 911 call, and 911 was called for one student who did not receive EMS transport.
According to the Allergy & Asthma Network, the following states have school stock albuterol laws: Arizona, Colorado, Georgia, Illinois, Missouri, New Hampshire, New Mexico, Oklahoma, Ohio, Texas, Utah, and West Virginia.*
The research was funded by Banner–University Medical Center Tucson, Thayer Medical Corporation, and the Asthma & Airway Disease Research Center. The authors had no disclosures.
SOURCE: Lowe AA et al. ATS 2019, Abstract A4070.
* This article was updated on July 15, 2019.
DALLAS – Allowing public and private schools to store multiuse stock albuterol inhalers for students with asthma is a legally and medically feasible way to provide students with rescue medication without their need to leave school, according to a recent study.
“Stakeholder coalitions can facilitate the large-scale adoption of stock inhaler programs in schools,” concluded Ashley A. Lowe, MSPH, a senior research specialist and PhD candidate at the University of Arizona, Tucson, and colleagues in a poster at the American Thoracic Society’s international conference.“These programs improve access to rescue medication while returning students back to their classroom.”
The Arizona legislature passed H.B. 2208, “Stock Inhalers for Schools” in March 2017 to allow schools to store and administer albuterol sulfate while indemnifying trained staff against liability when they allowed students to use the inhaler in good faith. A stock inhaler can used by different students because of its disposable valved-holding chambers.
“Such laws allow schools to overcome the legal obstacles that make it difficult for them to ensure such medication is readily available to all children experiencing respiratory distress,” the authors wrote. They assessed the use and outcomes of schools’ storage of stock inhalers during the 2017-2018 school year in Pima County, Arizona.
Of the 213 public, 90 charter, and 61 private/parochial schools in Pima County, 246 (67%) total schools participated, including nearly all of the public schools (93%), nearly half the private/parochial schools (49%), and 17% of the charter schools. A total of 134,251 students had access to a stock inhaler at school.
Each participating school received a kit containing a 60-dose albuterol sulfate inhaler, 10 valved-holding chambers, a signed standing medical order, a standardized emergency protocol for albuterol use, access to an online training curriculum and template resources, along with technical support.
Each time a school used the stock inhaler, they documented whether an asthma diagnosis was known or not, total puffs administered and where the student went next – returned to class, sent home with caregiver, 911 call without transport, or 911 call with EMS transport.
Based on data analyzed from 240 schools, the stock inhalers were used 1,032 times at 152 schools during the study period, predominantly at public schools (97%) and by students with a known asthma diagnosis (82%). In 12.2% of cases, the student did not have a known asthma diagnosis, and 5.8% of the time, asthma diagnosis status was unknown. The students received a mean 2.7 puffs at each use.
Ethnicity and race data of those students who used the inhalers was not complete. Most of the students for whom ethnicity data were available (n = 343) and who used the inhaler were Hispanic/Latino (69.8%) independent of race. Based only on the 437 students for whom data on race were available, students using the inhaler included 41% white, 11.7% black, 3.1% Native American/Alaskan Native, 1% Asian and 0.6% Native Hawaiian/Pacific Islander.
Among the 915 uses of the inhaler for which subsequent student location was available, the majority of students (84%) returned to their classroom after using the inhaler. Only five were transported to a medical facility via EMS following a 911 call, and 911 was called for one student who did not receive EMS transport.
According to the Allergy & Asthma Network, the following states have school stock albuterol laws: Arizona, Colorado, Georgia, Illinois, Missouri, New Hampshire, New Mexico, Oklahoma, Ohio, Texas, Utah, and West Virginia.*
The research was funded by Banner–University Medical Center Tucson, Thayer Medical Corporation, and the Asthma & Airway Disease Research Center. The authors had no disclosures.
SOURCE: Lowe AA et al. ATS 2019, Abstract A4070.
* This article was updated on July 15, 2019.
REPORTING FROM ATS 2019
Vitamin D levels linked to depression in teens
BALTIMORE – Anna-Lisa Munson, MD, MPH, of Denver Health Medical Center in Colorado, told attendees at the Pediatric Academic Societies annual meeting.
Although several studies in adults have suggested a link between vitamin D deficiency and depression, no large-scale studies have investigated whether such a relationship exists in adolescents, up to half of whom have a vitamin D deficiency, Dr Munson said.
The researchers relied on National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2010 to assess prevalence of major depressive disorder and vitamin D 25-hydroxy levels in teens aged 12-17 years. Serum vitamin D levels of less than 30 nmol/L were considered deficient while 30-50 nmol/L was considered insufficient, and at least 50 nmol/L was sufficient. A score between 10 and 27 on the Patient Health Questionnaire-9 (PHQ-9) qualified as depression.
The researchers adjusted their findings for age and sex, as well as other covariates linked to vitamin D levels or depression in previous research: latitude, season, race/ethnicity, and poverty to income ratio.
Among the 2,815 participants who completed the National Institute of Mental Health Diagnostic Interview Schedule for Children (NIMH-DISC), 8% had major depression. Among the 2,420 of participants with serum vitamin D values, 8% had vitamin D deficiency, 33% had insufficiency, and 59% had sufficiency.
Risk of depression dropped 10% for every additional 10 nmol/L of vitamin D, the analysis showed (odds ratio, 0.90).
Although non-Hispanic white students had about twice the odds of depression as other ethnic groups, risk of depression did not vary according to gender, age, season, latitude, poverty to income ratio, or use of vitamin D supplements.
The findings are limited by the cross-sectional data and lack of data regarding other factors that could affect vitamin D absorption, such as sunscreen use or clothing worn in the sun. The researchers also had only broad – not precise – data on latitude, and the PHQ-9 was used as a proxy for major depression instead of a clinical diagnosis.
The research was funded by the Denver Health Division of General Pediatrics. The authors had no relevant financial disclosures.
BALTIMORE – Anna-Lisa Munson, MD, MPH, of Denver Health Medical Center in Colorado, told attendees at the Pediatric Academic Societies annual meeting.
Although several studies in adults have suggested a link between vitamin D deficiency and depression, no large-scale studies have investigated whether such a relationship exists in adolescents, up to half of whom have a vitamin D deficiency, Dr Munson said.
The researchers relied on National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2010 to assess prevalence of major depressive disorder and vitamin D 25-hydroxy levels in teens aged 12-17 years. Serum vitamin D levels of less than 30 nmol/L were considered deficient while 30-50 nmol/L was considered insufficient, and at least 50 nmol/L was sufficient. A score between 10 and 27 on the Patient Health Questionnaire-9 (PHQ-9) qualified as depression.
The researchers adjusted their findings for age and sex, as well as other covariates linked to vitamin D levels or depression in previous research: latitude, season, race/ethnicity, and poverty to income ratio.
Among the 2,815 participants who completed the National Institute of Mental Health Diagnostic Interview Schedule for Children (NIMH-DISC), 8% had major depression. Among the 2,420 of participants with serum vitamin D values, 8% had vitamin D deficiency, 33% had insufficiency, and 59% had sufficiency.
Risk of depression dropped 10% for every additional 10 nmol/L of vitamin D, the analysis showed (odds ratio, 0.90).
Although non-Hispanic white students had about twice the odds of depression as other ethnic groups, risk of depression did not vary according to gender, age, season, latitude, poverty to income ratio, or use of vitamin D supplements.
The findings are limited by the cross-sectional data and lack of data regarding other factors that could affect vitamin D absorption, such as sunscreen use or clothing worn in the sun. The researchers also had only broad – not precise – data on latitude, and the PHQ-9 was used as a proxy for major depression instead of a clinical diagnosis.
The research was funded by the Denver Health Division of General Pediatrics. The authors had no relevant financial disclosures.
BALTIMORE – Anna-Lisa Munson, MD, MPH, of Denver Health Medical Center in Colorado, told attendees at the Pediatric Academic Societies annual meeting.
Although several studies in adults have suggested a link between vitamin D deficiency and depression, no large-scale studies have investigated whether such a relationship exists in adolescents, up to half of whom have a vitamin D deficiency, Dr Munson said.
The researchers relied on National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2010 to assess prevalence of major depressive disorder and vitamin D 25-hydroxy levels in teens aged 12-17 years. Serum vitamin D levels of less than 30 nmol/L were considered deficient while 30-50 nmol/L was considered insufficient, and at least 50 nmol/L was sufficient. A score between 10 and 27 on the Patient Health Questionnaire-9 (PHQ-9) qualified as depression.
The researchers adjusted their findings for age and sex, as well as other covariates linked to vitamin D levels or depression in previous research: latitude, season, race/ethnicity, and poverty to income ratio.
Among the 2,815 participants who completed the National Institute of Mental Health Diagnostic Interview Schedule for Children (NIMH-DISC), 8% had major depression. Among the 2,420 of participants with serum vitamin D values, 8% had vitamin D deficiency, 33% had insufficiency, and 59% had sufficiency.
Risk of depression dropped 10% for every additional 10 nmol/L of vitamin D, the analysis showed (odds ratio, 0.90).
Although non-Hispanic white students had about twice the odds of depression as other ethnic groups, risk of depression did not vary according to gender, age, season, latitude, poverty to income ratio, or use of vitamin D supplements.
The findings are limited by the cross-sectional data and lack of data regarding other factors that could affect vitamin D absorption, such as sunscreen use or clothing worn in the sun. The researchers also had only broad – not precise – data on latitude, and the PHQ-9 was used as a proxy for major depression instead of a clinical diagnosis.
The research was funded by the Denver Health Division of General Pediatrics. The authors had no relevant financial disclosures.
REPORTING FROM PAS 2019
Flu vaccine visits reveal missed opportunities for HPV vaccination
BALTIMORE – according to a study.
“Overall in preventive visits, missed opportunities were much higher for HPV, compared to the other two vaccines” recommended for adolescents, MenACWY (meningococcal conjugate vaccine) and Tdap, Mary Kate Kelly, MPH, of Children’s Hospital of Philadelphia, told attendees at the Pediatric Academic Societies annual meeting. “In order to increase vaccination rates, it’s essential to implement efforts to reduce missed opportunities.”
According to 2018 Centers for Disease Control and Prevention data, Ms. Kelly said, vaccine coverage for the HPV vaccine is approximately 66%, compared with 85% for the MenACWY vaccine and 89% for the Tdap vaccine.
Ms. Kelly and her colleagues investigated how often children or adolescents missed an opportunity to get an HPV vaccine when they received an influenza vaccine during an office visit. This study was part of the larger STOP HPV trial funded by the National Institutes of Health and aimed at implementing evidence-based interventions to reduce missed opportunities for HPV vaccination in primary care.
The researchers retrospectively reviewed EHRs from 2015 to 2018 for 48 pediatric practices across 19 states. All practices were part of the American Academy of Pediatrics’ Pediatric Research in Office Settings (PROS) national pediatric primary care network. The researchers isolated all visits for patients aged 11-17 years who received their flu vaccine and were eligible to receive the HPV vaccine.
The investigators defined a missed opportunity as one in which a patient was due for the HPV vaccine but did not receive one at the visit when they received their flu vaccine.
The study involved 40,129 patients who received the flu vaccine at 52,818 visits when they also were eligible to receive the HPV vaccine. The median age of patients was 12 years old, and 47% were female.
In 68% of visits, the patient could have received an HPV vaccine but did not – even though they were due and eligible for one. The rate was the same for boys and for girls. By contrast, only 38% of visits involved a missed opportunity for the MenACWY vaccines and 39% for the Tdap vaccine.
Rates of missed opportunities for HPV vaccination ranged among individual practices from 22% to 81% of overall visits. Patients were more than twice as likely to miss the opportunity for an HPV vaccine dose if it would have been their first dose – 70% of missed opportunities – versus being a second or third dose, which comprised 30% of missed opportunities (adjusted relative risk, 2.48; P less than .001)).
“However, missed opportunities were also common for subsequent HPV doses when vaccine hesitancy is less likely to be an issue,” Ms. Kelly added.
It also was much more likely that missed opportunities occurred during nurse visits or visits for an acute or chronic condition rather than preventive visits, which made up about half (51%) of all visits analyzed. While 48% of preventive visits involved a missed opportunity, 93% of nurse visits (aRR compared with preventive, 2.18; P less than.001) and 89% of acute or chronic visits (aRR, 2.11; P less than .001) did.
Percentages of missed opportunities were similarly high for the MenACWY and Tdap vaccines at nurse visits and acute/chronic visits, but much lower at preventive visits for the MenACWY (12%) and Tdap (15%) vaccines.
“Increasing simultaneous administration of HPV and other adolescent vaccines with the influenza vaccine may help to improve coverage,” Ms. Kelly concluded.
The study was limited by its use of a convenience sample from practices that were interested in participating and willing to stock the HPV vaccine. Additionally, the researchers could not detect or adjust for EHR errors or inaccurate or incomplete vaccine histories, and they were unable to look at vaccine hesitancy or refusal with the EHRs.
The research was funded by the National Institutes of Health, the U.S. Department of Health & Human Services, and the National Research Network to Improve Children’s Health. The authors reported no relevant financial disclosures.
BALTIMORE – according to a study.
“Overall in preventive visits, missed opportunities were much higher for HPV, compared to the other two vaccines” recommended for adolescents, MenACWY (meningococcal conjugate vaccine) and Tdap, Mary Kate Kelly, MPH, of Children’s Hospital of Philadelphia, told attendees at the Pediatric Academic Societies annual meeting. “In order to increase vaccination rates, it’s essential to implement efforts to reduce missed opportunities.”
According to 2018 Centers for Disease Control and Prevention data, Ms. Kelly said, vaccine coverage for the HPV vaccine is approximately 66%, compared with 85% for the MenACWY vaccine and 89% for the Tdap vaccine.
Ms. Kelly and her colleagues investigated how often children or adolescents missed an opportunity to get an HPV vaccine when they received an influenza vaccine during an office visit. This study was part of the larger STOP HPV trial funded by the National Institutes of Health and aimed at implementing evidence-based interventions to reduce missed opportunities for HPV vaccination in primary care.
The researchers retrospectively reviewed EHRs from 2015 to 2018 for 48 pediatric practices across 19 states. All practices were part of the American Academy of Pediatrics’ Pediatric Research in Office Settings (PROS) national pediatric primary care network. The researchers isolated all visits for patients aged 11-17 years who received their flu vaccine and were eligible to receive the HPV vaccine.
The investigators defined a missed opportunity as one in which a patient was due for the HPV vaccine but did not receive one at the visit when they received their flu vaccine.
The study involved 40,129 patients who received the flu vaccine at 52,818 visits when they also were eligible to receive the HPV vaccine. The median age of patients was 12 years old, and 47% were female.
In 68% of visits, the patient could have received an HPV vaccine but did not – even though they were due and eligible for one. The rate was the same for boys and for girls. By contrast, only 38% of visits involved a missed opportunity for the MenACWY vaccines and 39% for the Tdap vaccine.
Rates of missed opportunities for HPV vaccination ranged among individual practices from 22% to 81% of overall visits. Patients were more than twice as likely to miss the opportunity for an HPV vaccine dose if it would have been their first dose – 70% of missed opportunities – versus being a second or third dose, which comprised 30% of missed opportunities (adjusted relative risk, 2.48; P less than .001)).
“However, missed opportunities were also common for subsequent HPV doses when vaccine hesitancy is less likely to be an issue,” Ms. Kelly added.
It also was much more likely that missed opportunities occurred during nurse visits or visits for an acute or chronic condition rather than preventive visits, which made up about half (51%) of all visits analyzed. While 48% of preventive visits involved a missed opportunity, 93% of nurse visits (aRR compared with preventive, 2.18; P less than.001) and 89% of acute or chronic visits (aRR, 2.11; P less than .001) did.
Percentages of missed opportunities were similarly high for the MenACWY and Tdap vaccines at nurse visits and acute/chronic visits, but much lower at preventive visits for the MenACWY (12%) and Tdap (15%) vaccines.
“Increasing simultaneous administration of HPV and other adolescent vaccines with the influenza vaccine may help to improve coverage,” Ms. Kelly concluded.
The study was limited by its use of a convenience sample from practices that were interested in participating and willing to stock the HPV vaccine. Additionally, the researchers could not detect or adjust for EHR errors or inaccurate or incomplete vaccine histories, and they were unable to look at vaccine hesitancy or refusal with the EHRs.
The research was funded by the National Institutes of Health, the U.S. Department of Health & Human Services, and the National Research Network to Improve Children’s Health. The authors reported no relevant financial disclosures.
BALTIMORE – according to a study.
“Overall in preventive visits, missed opportunities were much higher for HPV, compared to the other two vaccines” recommended for adolescents, MenACWY (meningococcal conjugate vaccine) and Tdap, Mary Kate Kelly, MPH, of Children’s Hospital of Philadelphia, told attendees at the Pediatric Academic Societies annual meeting. “In order to increase vaccination rates, it’s essential to implement efforts to reduce missed opportunities.”
According to 2018 Centers for Disease Control and Prevention data, Ms. Kelly said, vaccine coverage for the HPV vaccine is approximately 66%, compared with 85% for the MenACWY vaccine and 89% for the Tdap vaccine.
Ms. Kelly and her colleagues investigated how often children or adolescents missed an opportunity to get an HPV vaccine when they received an influenza vaccine during an office visit. This study was part of the larger STOP HPV trial funded by the National Institutes of Health and aimed at implementing evidence-based interventions to reduce missed opportunities for HPV vaccination in primary care.
The researchers retrospectively reviewed EHRs from 2015 to 2018 for 48 pediatric practices across 19 states. All practices were part of the American Academy of Pediatrics’ Pediatric Research in Office Settings (PROS) national pediatric primary care network. The researchers isolated all visits for patients aged 11-17 years who received their flu vaccine and were eligible to receive the HPV vaccine.
The investigators defined a missed opportunity as one in which a patient was due for the HPV vaccine but did not receive one at the visit when they received their flu vaccine.
The study involved 40,129 patients who received the flu vaccine at 52,818 visits when they also were eligible to receive the HPV vaccine. The median age of patients was 12 years old, and 47% were female.
In 68% of visits, the patient could have received an HPV vaccine but did not – even though they were due and eligible for one. The rate was the same for boys and for girls. By contrast, only 38% of visits involved a missed opportunity for the MenACWY vaccines and 39% for the Tdap vaccine.
Rates of missed opportunities for HPV vaccination ranged among individual practices from 22% to 81% of overall visits. Patients were more than twice as likely to miss the opportunity for an HPV vaccine dose if it would have been their first dose – 70% of missed opportunities – versus being a second or third dose, which comprised 30% of missed opportunities (adjusted relative risk, 2.48; P less than .001)).
“However, missed opportunities were also common for subsequent HPV doses when vaccine hesitancy is less likely to be an issue,” Ms. Kelly added.
It also was much more likely that missed opportunities occurred during nurse visits or visits for an acute or chronic condition rather than preventive visits, which made up about half (51%) of all visits analyzed. While 48% of preventive visits involved a missed opportunity, 93% of nurse visits (aRR compared with preventive, 2.18; P less than.001) and 89% of acute or chronic visits (aRR, 2.11; P less than .001) did.
Percentages of missed opportunities were similarly high for the MenACWY and Tdap vaccines at nurse visits and acute/chronic visits, but much lower at preventive visits for the MenACWY (12%) and Tdap (15%) vaccines.
“Increasing simultaneous administration of HPV and other adolescent vaccines with the influenza vaccine may help to improve coverage,” Ms. Kelly concluded.
The study was limited by its use of a convenience sample from practices that were interested in participating and willing to stock the HPV vaccine. Additionally, the researchers could not detect or adjust for EHR errors or inaccurate or incomplete vaccine histories, and they were unable to look at vaccine hesitancy or refusal with the EHRs.
The research was funded by the National Institutes of Health, the U.S. Department of Health & Human Services, and the National Research Network to Improve Children’s Health. The authors reported no relevant financial disclosures.
REPORTING FROM PAS 2019
Pediatrician knowledge of tampon safety is low
BALTIMORE – and a remarkably high proportion of them lack adequate knowledge themselves about the topic, a new survey-based study found.
“Significant knowledge gaps [were] noted, for instance, [such as] the maximum time a tampon can safely remain in the body,” Miriam Singer of Cohen Children’s Medical Center of New York told attendees of the Pediatric Academic Societies annual meeting.
More than 80% of females aged 17-21 years have used tampons by themselves or with pads, Ms. Singer noted in her background information, yet many teens have low knowledge about their use and safety.
Past research has found that only 35% of high school junior and senior girls heard about tampon use from their mothers, yet many of these mothers showed low knowledge about proper tampon use as well. That same research found that less than 15% of girls aged 10-19 years reported getting information from a health professional about products for menstruation despite recommendations from the American Academy of Pediatrics to instruct girls on feminine hygiene product usage.
Other research has found minimal to no education about menstruation in schools “due to time constraints and stigma associated with menstruation,” Ms. Singer said.
She and her colleagues emailed 2,500 AAP members in November-December 2018 a 53-question online questionnaire about their self-rated and measured knowledge of proper tampon usage and safety and how frequently they discussed tampons with their female adolescent patients. The survey included questions asking pediatricians to self-rate their knowledge about tampon use and safety on a Likert scale of 1 (not at all knowledgeable) to 5 (extremely knowledgeable).
Two incentives provided for completing the survey were a Feminine Hygiene Fact Sheet offered in the first email and an ADHD Medication Guide offered in the third and final email.
Among the 518 pediatricians who responded (21% response rate), 462 met the inclusion criteria of being a primary care pediatrician currently practicing in the United States. Most were women (79%) and white (79%). Just over half of the pediatricians worked only in private practice (54%) and in a suburban area (52%). About a quarter (26%) were in an urban area and 20% in a rural area. Distribution of years in practice (from 1-5 years to over 25 years in 5-year increments) was fairly even across respondents.
Only 9% of respondents reported they very often or almost always talk to their female adolescent patients about how to insert a tampon. The most common tampon-related conversation pediatricians reported was how often to change tampons, which only 35% of respondents said they very often or almost always do.
Yet a similar proportion, 36%, rarely or almost never discuss how often to change tampons, and 62% said they rarely or almost never discuss how to insert a tampon or talk about using tampons while sleeping. Half of respondents (51%) almost never discuss using tampons while swimming (only 21% very often or almost always do), and 77% have not discussed how tampons might affect the hymen with their patients.
More pediatricians (36%) reported almost never discussing the risks of tampon use with female teens than those who sometimes (32%) or very often/almost always (31%) discussed risks.
Respondents also were generally much more willing to discuss tampons with older adolescents than younger ones. Only 18% of respondents said they were highly likely to discuss them with 12- and 13-year-olds, compared with almost twice as many (33%) who would discuss tampons with 16- and 17-year-olds (P less than .001).
Male pediatricians were significantly less likely to discuss any of these topics with their female adolescent patients than female pediatricians (P less than .001 for all questions except risks [P = .01] and hymen [P = .04]). They also rated their knowledge about tampons as significantly lower than self ratings by female pediatricians (P less than .001). Less than half of pediatricians (43%) rated their knowledge about tampons as high or very high, and one in five (20%) rated it as low.
Actual measured knowledge reflected the self-ratings, but still revealed substantial gaps in knowledge among male and female providers. Just over half of male pediatricians (52%) answered all questions about tampon use and safety correctly; however, female pediatricians were only slightly better, with 71% answering all questions correctly (P less than .001). Less than half of male and female pediatricians knew the maximum time a tampon could stay in before it should be removed to reduce risk of toxic shock syndrome (8 hours).
The only two questions that more than half of male pediatricians answered correctly were that girls can swim in the ocean while wearing a tampon and that it can, rarely but not typically, tear the hymen. Less than half knew girls could sleep while wearing a tampon and that a girl could start using a tampon with her first menstruation.
More than half of female pediatricians answered all these questions correctly, although only about two-thirds gave correct answers on how tampons can affect the hymen (the only question that more male pediatricians than female answered correctly), whether a girl can sleep in a tampon, and that patients should use the lowest effective absorbency tampon to minimize toxic shock syndrome risk.
Although the study is limited by a nonvalidated knowledge assessment instrument, self-reporting and potential selection bias means the study may not accurately represent U.S. primary care pediatricians nationwide; however, the findings still demonstrate notably low self-rated and measured knowledge about tampons.
“Given the AAP’s recommendation that pediatricians instruct girls on the use of feminine products, pediatricians must take steps to ensure they are educating patients about tampons,” Ms. Singer said. She also recommended the development of web-based resources targeting the improvement of pediatrician knowledge about tampon use and safety, and the need for the AAP to raise awareness about the importance of discussing tampons with female adolescent patients.
The study did not use external funding, and the authors reported no relevant financial disclosures.
BALTIMORE – and a remarkably high proportion of them lack adequate knowledge themselves about the topic, a new survey-based study found.
“Significant knowledge gaps [were] noted, for instance, [such as] the maximum time a tampon can safely remain in the body,” Miriam Singer of Cohen Children’s Medical Center of New York told attendees of the Pediatric Academic Societies annual meeting.
More than 80% of females aged 17-21 years have used tampons by themselves or with pads, Ms. Singer noted in her background information, yet many teens have low knowledge about their use and safety.
Past research has found that only 35% of high school junior and senior girls heard about tampon use from their mothers, yet many of these mothers showed low knowledge about proper tampon use as well. That same research found that less than 15% of girls aged 10-19 years reported getting information from a health professional about products for menstruation despite recommendations from the American Academy of Pediatrics to instruct girls on feminine hygiene product usage.
Other research has found minimal to no education about menstruation in schools “due to time constraints and stigma associated with menstruation,” Ms. Singer said.
She and her colleagues emailed 2,500 AAP members in November-December 2018 a 53-question online questionnaire about their self-rated and measured knowledge of proper tampon usage and safety and how frequently they discussed tampons with their female adolescent patients. The survey included questions asking pediatricians to self-rate their knowledge about tampon use and safety on a Likert scale of 1 (not at all knowledgeable) to 5 (extremely knowledgeable).
Two incentives provided for completing the survey were a Feminine Hygiene Fact Sheet offered in the first email and an ADHD Medication Guide offered in the third and final email.
Among the 518 pediatricians who responded (21% response rate), 462 met the inclusion criteria of being a primary care pediatrician currently practicing in the United States. Most were women (79%) and white (79%). Just over half of the pediatricians worked only in private practice (54%) and in a suburban area (52%). About a quarter (26%) were in an urban area and 20% in a rural area. Distribution of years in practice (from 1-5 years to over 25 years in 5-year increments) was fairly even across respondents.
Only 9% of respondents reported they very often or almost always talk to their female adolescent patients about how to insert a tampon. The most common tampon-related conversation pediatricians reported was how often to change tampons, which only 35% of respondents said they very often or almost always do.
Yet a similar proportion, 36%, rarely or almost never discuss how often to change tampons, and 62% said they rarely or almost never discuss how to insert a tampon or talk about using tampons while sleeping. Half of respondents (51%) almost never discuss using tampons while swimming (only 21% very often or almost always do), and 77% have not discussed how tampons might affect the hymen with their patients.
More pediatricians (36%) reported almost never discussing the risks of tampon use with female teens than those who sometimes (32%) or very often/almost always (31%) discussed risks.
Respondents also were generally much more willing to discuss tampons with older adolescents than younger ones. Only 18% of respondents said they were highly likely to discuss them with 12- and 13-year-olds, compared with almost twice as many (33%) who would discuss tampons with 16- and 17-year-olds (P less than .001).
Male pediatricians were significantly less likely to discuss any of these topics with their female adolescent patients than female pediatricians (P less than .001 for all questions except risks [P = .01] and hymen [P = .04]). They also rated their knowledge about tampons as significantly lower than self ratings by female pediatricians (P less than .001). Less than half of pediatricians (43%) rated their knowledge about tampons as high or very high, and one in five (20%) rated it as low.
Actual measured knowledge reflected the self-ratings, but still revealed substantial gaps in knowledge among male and female providers. Just over half of male pediatricians (52%) answered all questions about tampon use and safety correctly; however, female pediatricians were only slightly better, with 71% answering all questions correctly (P less than .001). Less than half of male and female pediatricians knew the maximum time a tampon could stay in before it should be removed to reduce risk of toxic shock syndrome (8 hours).
The only two questions that more than half of male pediatricians answered correctly were that girls can swim in the ocean while wearing a tampon and that it can, rarely but not typically, tear the hymen. Less than half knew girls could sleep while wearing a tampon and that a girl could start using a tampon with her first menstruation.
More than half of female pediatricians answered all these questions correctly, although only about two-thirds gave correct answers on how tampons can affect the hymen (the only question that more male pediatricians than female answered correctly), whether a girl can sleep in a tampon, and that patients should use the lowest effective absorbency tampon to minimize toxic shock syndrome risk.
Although the study is limited by a nonvalidated knowledge assessment instrument, self-reporting and potential selection bias means the study may not accurately represent U.S. primary care pediatricians nationwide; however, the findings still demonstrate notably low self-rated and measured knowledge about tampons.
“Given the AAP’s recommendation that pediatricians instruct girls on the use of feminine products, pediatricians must take steps to ensure they are educating patients about tampons,” Ms. Singer said. She also recommended the development of web-based resources targeting the improvement of pediatrician knowledge about tampon use and safety, and the need for the AAP to raise awareness about the importance of discussing tampons with female adolescent patients.
The study did not use external funding, and the authors reported no relevant financial disclosures.
BALTIMORE – and a remarkably high proportion of them lack adequate knowledge themselves about the topic, a new survey-based study found.
“Significant knowledge gaps [were] noted, for instance, [such as] the maximum time a tampon can safely remain in the body,” Miriam Singer of Cohen Children’s Medical Center of New York told attendees of the Pediatric Academic Societies annual meeting.
More than 80% of females aged 17-21 years have used tampons by themselves or with pads, Ms. Singer noted in her background information, yet many teens have low knowledge about their use and safety.
Past research has found that only 35% of high school junior and senior girls heard about tampon use from their mothers, yet many of these mothers showed low knowledge about proper tampon use as well. That same research found that less than 15% of girls aged 10-19 years reported getting information from a health professional about products for menstruation despite recommendations from the American Academy of Pediatrics to instruct girls on feminine hygiene product usage.
Other research has found minimal to no education about menstruation in schools “due to time constraints and stigma associated with menstruation,” Ms. Singer said.
She and her colleagues emailed 2,500 AAP members in November-December 2018 a 53-question online questionnaire about their self-rated and measured knowledge of proper tampon usage and safety and how frequently they discussed tampons with their female adolescent patients. The survey included questions asking pediatricians to self-rate their knowledge about tampon use and safety on a Likert scale of 1 (not at all knowledgeable) to 5 (extremely knowledgeable).
Two incentives provided for completing the survey were a Feminine Hygiene Fact Sheet offered in the first email and an ADHD Medication Guide offered in the third and final email.
Among the 518 pediatricians who responded (21% response rate), 462 met the inclusion criteria of being a primary care pediatrician currently practicing in the United States. Most were women (79%) and white (79%). Just over half of the pediatricians worked only in private practice (54%) and in a suburban area (52%). About a quarter (26%) were in an urban area and 20% in a rural area. Distribution of years in practice (from 1-5 years to over 25 years in 5-year increments) was fairly even across respondents.
Only 9% of respondents reported they very often or almost always talk to their female adolescent patients about how to insert a tampon. The most common tampon-related conversation pediatricians reported was how often to change tampons, which only 35% of respondents said they very often or almost always do.
Yet a similar proportion, 36%, rarely or almost never discuss how often to change tampons, and 62% said they rarely or almost never discuss how to insert a tampon or talk about using tampons while sleeping. Half of respondents (51%) almost never discuss using tampons while swimming (only 21% very often or almost always do), and 77% have not discussed how tampons might affect the hymen with their patients.
More pediatricians (36%) reported almost never discussing the risks of tampon use with female teens than those who sometimes (32%) or very often/almost always (31%) discussed risks.
Respondents also were generally much more willing to discuss tampons with older adolescents than younger ones. Only 18% of respondents said they were highly likely to discuss them with 12- and 13-year-olds, compared with almost twice as many (33%) who would discuss tampons with 16- and 17-year-olds (P less than .001).
Male pediatricians were significantly less likely to discuss any of these topics with their female adolescent patients than female pediatricians (P less than .001 for all questions except risks [P = .01] and hymen [P = .04]). They also rated their knowledge about tampons as significantly lower than self ratings by female pediatricians (P less than .001). Less than half of pediatricians (43%) rated their knowledge about tampons as high or very high, and one in five (20%) rated it as low.
Actual measured knowledge reflected the self-ratings, but still revealed substantial gaps in knowledge among male and female providers. Just over half of male pediatricians (52%) answered all questions about tampon use and safety correctly; however, female pediatricians were only slightly better, with 71% answering all questions correctly (P less than .001). Less than half of male and female pediatricians knew the maximum time a tampon could stay in before it should be removed to reduce risk of toxic shock syndrome (8 hours).
The only two questions that more than half of male pediatricians answered correctly were that girls can swim in the ocean while wearing a tampon and that it can, rarely but not typically, tear the hymen. Less than half knew girls could sleep while wearing a tampon and that a girl could start using a tampon with her first menstruation.
More than half of female pediatricians answered all these questions correctly, although only about two-thirds gave correct answers on how tampons can affect the hymen (the only question that more male pediatricians than female answered correctly), whether a girl can sleep in a tampon, and that patients should use the lowest effective absorbency tampon to minimize toxic shock syndrome risk.
Although the study is limited by a nonvalidated knowledge assessment instrument, self-reporting and potential selection bias means the study may not accurately represent U.S. primary care pediatricians nationwide; however, the findings still demonstrate notably low self-rated and measured knowledge about tampons.
“Given the AAP’s recommendation that pediatricians instruct girls on the use of feminine products, pediatricians must take steps to ensure they are educating patients about tampons,” Ms. Singer said. She also recommended the development of web-based resources targeting the improvement of pediatrician knowledge about tampon use and safety, and the need for the AAP to raise awareness about the importance of discussing tampons with female adolescent patients.
The study did not use external funding, and the authors reported no relevant financial disclosures.
REPORTING FROM PAS 2019
Key clinical point: U.S. pediatricians have low knowledge of and willingness to discuss proper tampon use and safety with adolescent patients.
Major finding: 35% of U.S. pediatricians reported they very often/almost always discuss how long to wear a tampon before removing it.
Study details: The findings are based on a survey of 462 U.S. pediatricians who responded to a 53-question online survey.
Disclosures: The study did not use external funding, and the authors reported no relevant financial disclosures.
Universal adolescent anxiety screening is feasible in primary care
BALTIMORE – according to a new study.
The findings suggest that implementing a universal anxiety screening for teen patients is feasible and improves detection of patients with anxiety.
“Our providers were able to act on these positive screens and are able to catch a really serious entry-level condition that may have otherwise been missed,” presenter Sarah Malik, MD, a resident at Penn State Children’s Hospital, told attendees at the Pediatric Academic Societies annual meeting. “Hopefully, this will make a really meaningful difference in these kids’ lives, which is, of course, what we all want.”
An estimated 32% of U.S. teens have anxiety, according to the National Institute of Mental Health, and “8.3% of adolescents with anxiety have severe impairment defined by DSM4 criteria,” according to the study’s background information. Yet neither the American Academy of Pediatrics nor the U.S. Preventive Services Task Force has issued recommendations regarding screening for anxiety in teens.
“For this reason, we developed a study in which we implemented and measured the effect of a universal anxiety screening program in the pediatric primary care setting,” Dr Malik said.
The screening intervention took place in a single Penn State Health Children’s Hospital primary care practice in Hershey, Pa., that typically received 37,000 visits a year from 12,500 patients. The practice has 19 attending physicians, 4 nurse practitioners, and 21 residents.
Providers asked patients aged 11-18 years to fill out a nine-question Generalized Anxiety Disorder subscale of the Screen for Child Anxiety Related Disorders (SCARED) during their well-child visits from April 2017 to March 2018. Two-thirds of the patients had private insurance, 80% were white and 8% were black; 10% were Hispanic.
Providers had access to the screening results after nurses transcribed them into electronic medical records. The researchers used EMRs to determine how many patients completed a SCARED at their well-child visit and how many screened positive for anxiety, defined as a score of at least 9/18.
Then the providers compared the prevalence of anxiety 1 year after implementing the routine screening with the prevalence of teens with an ICD-10 anxiety diagnosis within the 36 months before the screening was implemented. The practice’s prevalence of adolescent anxiety was 13.3% 1 year after implementing universal anxiety screening, compared with 9.6% in the previous 3 years (P less than .0001).
Among 2,276 well-child visits for adolescents during the study period, 80% completed a SCARED. Of those who completed the screening, 17% screened positive. The physicians identified 70% of those patients with positive screens (214/306) as having anxiety, and 82% of those patients (n = 176) were diagnosed with anxiety.
About half of those diagnosed with anxiety (n = 93) received one or more interventions: 77 received referrals for counseling, 15 received psychiatric referrals, and 20 were prescribed new anxiety medication.
“We did find that a universal screening program for anxiety is very useful to implement in the primary care setting, and it’s also really effective at identifying adolescents with anxiety symptoms,” Dr. Malik said.
The study’s generalizability is limited by its implementation at a single academic center with integrated behavioral health, and the use of the SCARED, a portion of the GAD scale, is not considered a standard of care.
The researchers used no external funding, and they had no disclosures.
BALTIMORE – according to a new study.
The findings suggest that implementing a universal anxiety screening for teen patients is feasible and improves detection of patients with anxiety.
“Our providers were able to act on these positive screens and are able to catch a really serious entry-level condition that may have otherwise been missed,” presenter Sarah Malik, MD, a resident at Penn State Children’s Hospital, told attendees at the Pediatric Academic Societies annual meeting. “Hopefully, this will make a really meaningful difference in these kids’ lives, which is, of course, what we all want.”
An estimated 32% of U.S. teens have anxiety, according to the National Institute of Mental Health, and “8.3% of adolescents with anxiety have severe impairment defined by DSM4 criteria,” according to the study’s background information. Yet neither the American Academy of Pediatrics nor the U.S. Preventive Services Task Force has issued recommendations regarding screening for anxiety in teens.
“For this reason, we developed a study in which we implemented and measured the effect of a universal anxiety screening program in the pediatric primary care setting,” Dr Malik said.
The screening intervention took place in a single Penn State Health Children’s Hospital primary care practice in Hershey, Pa., that typically received 37,000 visits a year from 12,500 patients. The practice has 19 attending physicians, 4 nurse practitioners, and 21 residents.
Providers asked patients aged 11-18 years to fill out a nine-question Generalized Anxiety Disorder subscale of the Screen for Child Anxiety Related Disorders (SCARED) during their well-child visits from April 2017 to March 2018. Two-thirds of the patients had private insurance, 80% were white and 8% were black; 10% were Hispanic.
Providers had access to the screening results after nurses transcribed them into electronic medical records. The researchers used EMRs to determine how many patients completed a SCARED at their well-child visit and how many screened positive for anxiety, defined as a score of at least 9/18.
Then the providers compared the prevalence of anxiety 1 year after implementing the routine screening with the prevalence of teens with an ICD-10 anxiety diagnosis within the 36 months before the screening was implemented. The practice’s prevalence of adolescent anxiety was 13.3% 1 year after implementing universal anxiety screening, compared with 9.6% in the previous 3 years (P less than .0001).
Among 2,276 well-child visits for adolescents during the study period, 80% completed a SCARED. Of those who completed the screening, 17% screened positive. The physicians identified 70% of those patients with positive screens (214/306) as having anxiety, and 82% of those patients (n = 176) were diagnosed with anxiety.
About half of those diagnosed with anxiety (n = 93) received one or more interventions: 77 received referrals for counseling, 15 received psychiatric referrals, and 20 were prescribed new anxiety medication.
“We did find that a universal screening program for anxiety is very useful to implement in the primary care setting, and it’s also really effective at identifying adolescents with anxiety symptoms,” Dr. Malik said.
The study’s generalizability is limited by its implementation at a single academic center with integrated behavioral health, and the use of the SCARED, a portion of the GAD scale, is not considered a standard of care.
The researchers used no external funding, and they had no disclosures.
BALTIMORE – according to a new study.
The findings suggest that implementing a universal anxiety screening for teen patients is feasible and improves detection of patients with anxiety.
“Our providers were able to act on these positive screens and are able to catch a really serious entry-level condition that may have otherwise been missed,” presenter Sarah Malik, MD, a resident at Penn State Children’s Hospital, told attendees at the Pediatric Academic Societies annual meeting. “Hopefully, this will make a really meaningful difference in these kids’ lives, which is, of course, what we all want.”
An estimated 32% of U.S. teens have anxiety, according to the National Institute of Mental Health, and “8.3% of adolescents with anxiety have severe impairment defined by DSM4 criteria,” according to the study’s background information. Yet neither the American Academy of Pediatrics nor the U.S. Preventive Services Task Force has issued recommendations regarding screening for anxiety in teens.
“For this reason, we developed a study in which we implemented and measured the effect of a universal anxiety screening program in the pediatric primary care setting,” Dr Malik said.
The screening intervention took place in a single Penn State Health Children’s Hospital primary care practice in Hershey, Pa., that typically received 37,000 visits a year from 12,500 patients. The practice has 19 attending physicians, 4 nurse practitioners, and 21 residents.
Providers asked patients aged 11-18 years to fill out a nine-question Generalized Anxiety Disorder subscale of the Screen for Child Anxiety Related Disorders (SCARED) during their well-child visits from April 2017 to March 2018. Two-thirds of the patients had private insurance, 80% were white and 8% were black; 10% were Hispanic.
Providers had access to the screening results after nurses transcribed them into electronic medical records. The researchers used EMRs to determine how many patients completed a SCARED at their well-child visit and how many screened positive for anxiety, defined as a score of at least 9/18.
Then the providers compared the prevalence of anxiety 1 year after implementing the routine screening with the prevalence of teens with an ICD-10 anxiety diagnosis within the 36 months before the screening was implemented. The practice’s prevalence of adolescent anxiety was 13.3% 1 year after implementing universal anxiety screening, compared with 9.6% in the previous 3 years (P less than .0001).
Among 2,276 well-child visits for adolescents during the study period, 80% completed a SCARED. Of those who completed the screening, 17% screened positive. The physicians identified 70% of those patients with positive screens (214/306) as having anxiety, and 82% of those patients (n = 176) were diagnosed with anxiety.
About half of those diagnosed with anxiety (n = 93) received one or more interventions: 77 received referrals for counseling, 15 received psychiatric referrals, and 20 were prescribed new anxiety medication.
“We did find that a universal screening program for anxiety is very useful to implement in the primary care setting, and it’s also really effective at identifying adolescents with anxiety symptoms,” Dr. Malik said.
The study’s generalizability is limited by its implementation at a single academic center with integrated behavioral health, and the use of the SCARED, a portion of the GAD scale, is not considered a standard of care.
The researchers used no external funding, and they had no disclosures.
REPORTING FROM PAS 2019
Key clinical point: Universal anxiety screening for adolescents is feasible and effective in pediatric primary care.
Major finding: Adolescent anxiety diagnoses increased from 9.6% to 13.3% 1 year after university screening (P less than .0001).
Study details: The findings are based on assessment of a universal anxiety screening program implemented at a single academic pediatric primary care practice, involving 2,276 well visits between April 2017 and March 2018 for patients aged 11-18 years.
Disclosures: The researchers used no external funding, and they had no disclosures.
No benefit to infants from e-books over board books
BALTIMORE – Despite the greater portability and seeming convenience of electronic tablets or smartphones, compared with giving them physical board books, according to preliminary findings.
James Guevara, MD, MPH, professor of pediatrics at the Children’s Hospital of Philadelphia, presented his findings at the annual meeting of Pediatric Academic Societies in a session focused on the changing nature of children’s digital media use as digital natives.
The session chair, Danielle C. Erkoboni, MD, of the University of Pennsylvania, Philadelphia, opened the session with a review of research to date regarding children’s frequency of digital use and relative benefits of independent and shared reading, both with traditional books and e-books.
Nearly all U.S. children (98%) live in homes with mobile devices, and about a third of U.S. children (35%) use those devices, according to a 2017 Common Sense Media Report. The same survey found that children aged under 2 years get an average 42 minutes a day of overall screen time, but children in low-income households get twice as much screen time as those in middle- and upper-income homes.
Research into e-books exists for preschoolers, showing that animated pictures and sounds directly matching an e-book’s story text can potentially promote language memory, but that too many interactive features or other bells and whistles can overwhelm children and contribute to poor vocabulary development and comprehension.
Researchers also have found that parent reading of e-books has greater benefits for children than children listening to an e-book’s audio narration. However, little to no research has looked into e-reading for infants and toddlers, a gap especially relevant for physicians who participate in the Reach Out and Read program.
Dr Guevara’s study enrolled 100 Medicaid-eligible children aged 5-7 months from three participating practices in a single geographic area. Only English- or Spanish-speaking parents who owned a smartphone or tablet participated.
At the children’s 6-month well visit, the clinicians gave parents information about the importance of early parent-child reading. Then parents received Dr. Seuss’s “Hop on Pop” as either an e-book download (n = 45) or a physical board book (n = 54). The parents similarly received “Barnyard Dance” at the 9-month visit and “Goodnight Moon” at the 12-month visit.
No significant differences between the two groups existed in terms of race/ethnicity, parent age, household income, education level, marital status or the total number of adults or children in the household. Maternal depression rates (based on the Edinburgh Postnatal Depression Scale), Adverse Childhood Experience scale scores, health literacy scores (Short Assessment of Health Literacy) and scores on the StimQ home cognitive environment assessment also were similar at baseline between the two groups.
The children were assessed with the StimQ Infant measure at 7-8 months and 10-11 months, and then with the StimQ Toddler and Bayley Scale of Infant and Toddler Development (BSID-III) at 13-15 months. At the final check-up, 37 parents remained in the e-book group and 43 parents remained in the board book group.
A similar proportion of parents in both groups reported reading to their children, and parents in both groups said they read an average of 5 days a week to their child.
However, parents who received the e-books had read an average 18 books at the final follow-up, compared with an average of 31 books among parents who received the board books (P = .039).
No significant differences in children’s StimQ scores or any of the BSID-III scores (cognitive, language, motor) existed between those who received e-books versus those who received board books.
The study results showed the feasibility of promoting literacy by providing e-books to parents of older infants, but doing so did not appear to confer any advantage over providing families with traditional, physical board books. Further, language development among children in both groups remained below average, albeit not statistically different from one another.
“Pediatric clinicians should exercise caution in recommending e-books to parents of young children.” Dr Guevara said. “Additional strategies beyond clinic-based literacy promotion are needed to enhance language development among poor children.”
The research was funded by the Vanguard Strong Start for Kids Program. Dr. Guevara reported no disclosures.
BALTIMORE – Despite the greater portability and seeming convenience of electronic tablets or smartphones, compared with giving them physical board books, according to preliminary findings.
James Guevara, MD, MPH, professor of pediatrics at the Children’s Hospital of Philadelphia, presented his findings at the annual meeting of Pediatric Academic Societies in a session focused on the changing nature of children’s digital media use as digital natives.
The session chair, Danielle C. Erkoboni, MD, of the University of Pennsylvania, Philadelphia, opened the session with a review of research to date regarding children’s frequency of digital use and relative benefits of independent and shared reading, both with traditional books and e-books.
Nearly all U.S. children (98%) live in homes with mobile devices, and about a third of U.S. children (35%) use those devices, according to a 2017 Common Sense Media Report. The same survey found that children aged under 2 years get an average 42 minutes a day of overall screen time, but children in low-income households get twice as much screen time as those in middle- and upper-income homes.
Research into e-books exists for preschoolers, showing that animated pictures and sounds directly matching an e-book’s story text can potentially promote language memory, but that too many interactive features or other bells and whistles can overwhelm children and contribute to poor vocabulary development and comprehension.
Researchers also have found that parent reading of e-books has greater benefits for children than children listening to an e-book’s audio narration. However, little to no research has looked into e-reading for infants and toddlers, a gap especially relevant for physicians who participate in the Reach Out and Read program.
Dr Guevara’s study enrolled 100 Medicaid-eligible children aged 5-7 months from three participating practices in a single geographic area. Only English- or Spanish-speaking parents who owned a smartphone or tablet participated.
At the children’s 6-month well visit, the clinicians gave parents information about the importance of early parent-child reading. Then parents received Dr. Seuss’s “Hop on Pop” as either an e-book download (n = 45) or a physical board book (n = 54). The parents similarly received “Barnyard Dance” at the 9-month visit and “Goodnight Moon” at the 12-month visit.
No significant differences between the two groups existed in terms of race/ethnicity, parent age, household income, education level, marital status or the total number of adults or children in the household. Maternal depression rates (based on the Edinburgh Postnatal Depression Scale), Adverse Childhood Experience scale scores, health literacy scores (Short Assessment of Health Literacy) and scores on the StimQ home cognitive environment assessment also were similar at baseline between the two groups.
The children were assessed with the StimQ Infant measure at 7-8 months and 10-11 months, and then with the StimQ Toddler and Bayley Scale of Infant and Toddler Development (BSID-III) at 13-15 months. At the final check-up, 37 parents remained in the e-book group and 43 parents remained in the board book group.
A similar proportion of parents in both groups reported reading to their children, and parents in both groups said they read an average of 5 days a week to their child.
However, parents who received the e-books had read an average 18 books at the final follow-up, compared with an average of 31 books among parents who received the board books (P = .039).
No significant differences in children’s StimQ scores or any of the BSID-III scores (cognitive, language, motor) existed between those who received e-books versus those who received board books.
The study results showed the feasibility of promoting literacy by providing e-books to parents of older infants, but doing so did not appear to confer any advantage over providing families with traditional, physical board books. Further, language development among children in both groups remained below average, albeit not statistically different from one another.
“Pediatric clinicians should exercise caution in recommending e-books to parents of young children.” Dr Guevara said. “Additional strategies beyond clinic-based literacy promotion are needed to enhance language development among poor children.”
The research was funded by the Vanguard Strong Start for Kids Program. Dr. Guevara reported no disclosures.
BALTIMORE – Despite the greater portability and seeming convenience of electronic tablets or smartphones, compared with giving them physical board books, according to preliminary findings.
James Guevara, MD, MPH, professor of pediatrics at the Children’s Hospital of Philadelphia, presented his findings at the annual meeting of Pediatric Academic Societies in a session focused on the changing nature of children’s digital media use as digital natives.
The session chair, Danielle C. Erkoboni, MD, of the University of Pennsylvania, Philadelphia, opened the session with a review of research to date regarding children’s frequency of digital use and relative benefits of independent and shared reading, both with traditional books and e-books.
Nearly all U.S. children (98%) live in homes with mobile devices, and about a third of U.S. children (35%) use those devices, according to a 2017 Common Sense Media Report. The same survey found that children aged under 2 years get an average 42 minutes a day of overall screen time, but children in low-income households get twice as much screen time as those in middle- and upper-income homes.
Research into e-books exists for preschoolers, showing that animated pictures and sounds directly matching an e-book’s story text can potentially promote language memory, but that too many interactive features or other bells and whistles can overwhelm children and contribute to poor vocabulary development and comprehension.
Researchers also have found that parent reading of e-books has greater benefits for children than children listening to an e-book’s audio narration. However, little to no research has looked into e-reading for infants and toddlers, a gap especially relevant for physicians who participate in the Reach Out and Read program.
Dr Guevara’s study enrolled 100 Medicaid-eligible children aged 5-7 months from three participating practices in a single geographic area. Only English- or Spanish-speaking parents who owned a smartphone or tablet participated.
At the children’s 6-month well visit, the clinicians gave parents information about the importance of early parent-child reading. Then parents received Dr. Seuss’s “Hop on Pop” as either an e-book download (n = 45) or a physical board book (n = 54). The parents similarly received “Barnyard Dance” at the 9-month visit and “Goodnight Moon” at the 12-month visit.
No significant differences between the two groups existed in terms of race/ethnicity, parent age, household income, education level, marital status or the total number of adults or children in the household. Maternal depression rates (based on the Edinburgh Postnatal Depression Scale), Adverse Childhood Experience scale scores, health literacy scores (Short Assessment of Health Literacy) and scores on the StimQ home cognitive environment assessment also were similar at baseline between the two groups.
The children were assessed with the StimQ Infant measure at 7-8 months and 10-11 months, and then with the StimQ Toddler and Bayley Scale of Infant and Toddler Development (BSID-III) at 13-15 months. At the final check-up, 37 parents remained in the e-book group and 43 parents remained in the board book group.
A similar proportion of parents in both groups reported reading to their children, and parents in both groups said they read an average of 5 days a week to their child.
However, parents who received the e-books had read an average 18 books at the final follow-up, compared with an average of 31 books among parents who received the board books (P = .039).
No significant differences in children’s StimQ scores or any of the BSID-III scores (cognitive, language, motor) existed between those who received e-books versus those who received board books.
The study results showed the feasibility of promoting literacy by providing e-books to parents of older infants, but doing so did not appear to confer any advantage over providing families with traditional, physical board books. Further, language development among children in both groups remained below average, albeit not statistically different from one another.
“Pediatric clinicians should exercise caution in recommending e-books to parents of young children.” Dr Guevara said. “Additional strategies beyond clinic-based literacy promotion are needed to enhance language development among poor children.”
The research was funded by the Vanguard Strong Start for Kids Program. Dr. Guevara reported no disclosures.
REPORTING FROM PAS 2019
Parents’ smartphone addiction linked to children’s overuse of the devices
BALTIMORE – according to a new study. The findings suggest that excessive smartphone use also is associated with the stress of parenting.
“We really need to start raising awareness among parents that their behaviors possibly have an association with their children’s [behaviors] as well,” lead author Korena S. Klimczak of Old Dominion University, Norfolk, Va., said in an interview at the annual meeting of the Pediatric Academic Societies.
“I think a lot of parents are not really considering how their smartphone use might be possibly influencing their children,” Ms. Klimczak said. “I think that’s an area pediatricians can start to target as they see parents using the smartphone in the room or passing the phone off to their child in the room.”
Previous research already has linked excessive smartphone use with problematic parenting. Parents distracted by their phones tend to communicate less with their children in the moment, and parents with smartphone addiction symptoms are “less likely to actively mediate their child’s smartphone use,” Ms. Klimczak and her associates noted.
For this study, the researchers recruited 355 parents of children aged 6 months to 5 years from an urban Southeastern academic pediatric hospital clinic. Most of the participating parents were black (72%) and most were mothers (79%).
During a well-child visit, the parents filled out the Smartphone Addiction Scale (SAS), the Parental Stress Scale (PSS) and a 16-item survey on their demographics and their children’s smartphone use. The SAS provided a binary variable (yes/no) on whether parents were addicted to their phones.
Starting when the children were between 12 and 17 months old, parents reported their children’s increasing ability to open or turn on a smartphone. Forty percent of parents reported that their children could turn on phones at this age, and the proportion steadily rose to 79% for children aged 4-5 years (P less than .001).
About one-third of children could start applications on their parents’ phones at age 12-17 months, but more than half were watching videos on their parents’ phones at that age. By the time children were aged 18-24 months, 73% of parents reported that the toddlers could open applications on the phones.
Among parents with a smartphone addiction as defined by the SAS, 59% reported finding it difficult to take their phones away from their children, compared with about half as many parents (26%) without a smartphone addiction (P = .001).
That finding appeared to carry over into their children spending more time on their smartphones as well. Among parents with a smartphone addiction, 22% reported that their children spent more than 2 hours a day on their smartphones, compared with 4% of parents without a smartphone addiction (P = .012). Past research suggests that spending that much time on mobile phones can be an obstacle to emotional and cognitive development, Ms. Klimczak said.
The proportion of children who spent time on their parents’ phones for 5-30 minutes, 30-60 minutes, or 1-2 hours was otherwise relatively similar between parents with and without smartphone addiction.
“There were some possible behavioral issues involved with smartphone addiction in parents as well,” she said, given how much more difficulty these parents had with taking phones away from their children. These parents “were more likely to use corporal punishment as well,” she added.
When faced with a hypothetical situation in which the child broke the parent’s phone, parents with high levels of parental stress were “significantly more likely to discipline their child through either spanking or yelling” the researchers reported, and a positive correlation between parental stress and smartphone addiction existed as well (r = .352, P less than .001).
Ms. Klimczak acknowledged that pediatricians already have a lot of ground to cover in each well-child visit, and monitoring parents’ cell phone use does not necessarily need to be a formal screening measure.
“I think as you see the behavior, you can point it out and maybe gently bring it up,” she said. Pediatricians who notice parents focused on their phones or passing their phones to their children can ask parents at that moment: “I see you using your phone ...” or “I see you’re letting your child use the phone. How often do you let them use the phone [each] day?” Ms. Klimczak said. Gently asking those questions may at least get the parents to think about the issues.
She also recommended incorporating awareness of smartphone addiction and child use of phones into parent education programs in addition to information about safe sleep, breastfeeding, and similar topics. “With how prevalent smartphone use is today, I think it’s at least something to bring up and make them conscious of.”
Ms. Klimczak had no financial disclosures.
BALTIMORE – according to a new study. The findings suggest that excessive smartphone use also is associated with the stress of parenting.
“We really need to start raising awareness among parents that their behaviors possibly have an association with their children’s [behaviors] as well,” lead author Korena S. Klimczak of Old Dominion University, Norfolk, Va., said in an interview at the annual meeting of the Pediatric Academic Societies.
“I think a lot of parents are not really considering how their smartphone use might be possibly influencing their children,” Ms. Klimczak said. “I think that’s an area pediatricians can start to target as they see parents using the smartphone in the room or passing the phone off to their child in the room.”
Previous research already has linked excessive smartphone use with problematic parenting. Parents distracted by their phones tend to communicate less with their children in the moment, and parents with smartphone addiction symptoms are “less likely to actively mediate their child’s smartphone use,” Ms. Klimczak and her associates noted.
For this study, the researchers recruited 355 parents of children aged 6 months to 5 years from an urban Southeastern academic pediatric hospital clinic. Most of the participating parents were black (72%) and most were mothers (79%).
During a well-child visit, the parents filled out the Smartphone Addiction Scale (SAS), the Parental Stress Scale (PSS) and a 16-item survey on their demographics and their children’s smartphone use. The SAS provided a binary variable (yes/no) on whether parents were addicted to their phones.
Starting when the children were between 12 and 17 months old, parents reported their children’s increasing ability to open or turn on a smartphone. Forty percent of parents reported that their children could turn on phones at this age, and the proportion steadily rose to 79% for children aged 4-5 years (P less than .001).
About one-third of children could start applications on their parents’ phones at age 12-17 months, but more than half were watching videos on their parents’ phones at that age. By the time children were aged 18-24 months, 73% of parents reported that the toddlers could open applications on the phones.
Among parents with a smartphone addiction as defined by the SAS, 59% reported finding it difficult to take their phones away from their children, compared with about half as many parents (26%) without a smartphone addiction (P = .001).
That finding appeared to carry over into their children spending more time on their smartphones as well. Among parents with a smartphone addiction, 22% reported that their children spent more than 2 hours a day on their smartphones, compared with 4% of parents without a smartphone addiction (P = .012). Past research suggests that spending that much time on mobile phones can be an obstacle to emotional and cognitive development, Ms. Klimczak said.
The proportion of children who spent time on their parents’ phones for 5-30 minutes, 30-60 minutes, or 1-2 hours was otherwise relatively similar between parents with and without smartphone addiction.
“There were some possible behavioral issues involved with smartphone addiction in parents as well,” she said, given how much more difficulty these parents had with taking phones away from their children. These parents “were more likely to use corporal punishment as well,” she added.
When faced with a hypothetical situation in which the child broke the parent’s phone, parents with high levels of parental stress were “significantly more likely to discipline their child through either spanking or yelling” the researchers reported, and a positive correlation between parental stress and smartphone addiction existed as well (r = .352, P less than .001).
Ms. Klimczak acknowledged that pediatricians already have a lot of ground to cover in each well-child visit, and monitoring parents’ cell phone use does not necessarily need to be a formal screening measure.
“I think as you see the behavior, you can point it out and maybe gently bring it up,” she said. Pediatricians who notice parents focused on their phones or passing their phones to their children can ask parents at that moment: “I see you using your phone ...” or “I see you’re letting your child use the phone. How often do you let them use the phone [each] day?” Ms. Klimczak said. Gently asking those questions may at least get the parents to think about the issues.
She also recommended incorporating awareness of smartphone addiction and child use of phones into parent education programs in addition to information about safe sleep, breastfeeding, and similar topics. “With how prevalent smartphone use is today, I think it’s at least something to bring up and make them conscious of.”
Ms. Klimczak had no financial disclosures.
BALTIMORE – according to a new study. The findings suggest that excessive smartphone use also is associated with the stress of parenting.
“We really need to start raising awareness among parents that their behaviors possibly have an association with their children’s [behaviors] as well,” lead author Korena S. Klimczak of Old Dominion University, Norfolk, Va., said in an interview at the annual meeting of the Pediatric Academic Societies.
“I think a lot of parents are not really considering how their smartphone use might be possibly influencing their children,” Ms. Klimczak said. “I think that’s an area pediatricians can start to target as they see parents using the smartphone in the room or passing the phone off to their child in the room.”
Previous research already has linked excessive smartphone use with problematic parenting. Parents distracted by their phones tend to communicate less with their children in the moment, and parents with smartphone addiction symptoms are “less likely to actively mediate their child’s smartphone use,” Ms. Klimczak and her associates noted.
For this study, the researchers recruited 355 parents of children aged 6 months to 5 years from an urban Southeastern academic pediatric hospital clinic. Most of the participating parents were black (72%) and most were mothers (79%).
During a well-child visit, the parents filled out the Smartphone Addiction Scale (SAS), the Parental Stress Scale (PSS) and a 16-item survey on their demographics and their children’s smartphone use. The SAS provided a binary variable (yes/no) on whether parents were addicted to their phones.
Starting when the children were between 12 and 17 months old, parents reported their children’s increasing ability to open or turn on a smartphone. Forty percent of parents reported that their children could turn on phones at this age, and the proportion steadily rose to 79% for children aged 4-5 years (P less than .001).
About one-third of children could start applications on their parents’ phones at age 12-17 months, but more than half were watching videos on their parents’ phones at that age. By the time children were aged 18-24 months, 73% of parents reported that the toddlers could open applications on the phones.
Among parents with a smartphone addiction as defined by the SAS, 59% reported finding it difficult to take their phones away from their children, compared with about half as many parents (26%) without a smartphone addiction (P = .001).
That finding appeared to carry over into their children spending more time on their smartphones as well. Among parents with a smartphone addiction, 22% reported that their children spent more than 2 hours a day on their smartphones, compared with 4% of parents without a smartphone addiction (P = .012). Past research suggests that spending that much time on mobile phones can be an obstacle to emotional and cognitive development, Ms. Klimczak said.
The proportion of children who spent time on their parents’ phones for 5-30 minutes, 30-60 minutes, or 1-2 hours was otherwise relatively similar between parents with and without smartphone addiction.
“There were some possible behavioral issues involved with smartphone addiction in parents as well,” she said, given how much more difficulty these parents had with taking phones away from their children. These parents “were more likely to use corporal punishment as well,” she added.
When faced with a hypothetical situation in which the child broke the parent’s phone, parents with high levels of parental stress were “significantly more likely to discipline their child through either spanking or yelling” the researchers reported, and a positive correlation between parental stress and smartphone addiction existed as well (r = .352, P less than .001).
Ms. Klimczak acknowledged that pediatricians already have a lot of ground to cover in each well-child visit, and monitoring parents’ cell phone use does not necessarily need to be a formal screening measure.
“I think as you see the behavior, you can point it out and maybe gently bring it up,” she said. Pediatricians who notice parents focused on their phones or passing their phones to their children can ask parents at that moment: “I see you using your phone ...” or “I see you’re letting your child use the phone. How often do you let them use the phone [each] day?” Ms. Klimczak said. Gently asking those questions may at least get the parents to think about the issues.
She also recommended incorporating awareness of smartphone addiction and child use of phones into parent education programs in addition to information about safe sleep, breastfeeding, and similar topics. “With how prevalent smartphone use is today, I think it’s at least something to bring up and make them conscious of.”
Ms. Klimczak had no financial disclosures.
REPORTING FROM PAS 2019
Zika knowledge, preparedness low among U.S. pediatricians
BALTIMORE – U.S. pediatricians feel comfortable providing patients with preventive information and travel advice related to Zika, but few feel prepared when it comes to testing and management of infants exposed prenatally to Zika infections, a study found.
“Areas where pediatricians were less likely to report preparedness included recommending testing, providing data to the Centers for Disease Control and Prevention’s Zika Pregnancy Registry, managing infants exposed to Zika prenatally, and informing parents of social services for Zika-infected infants,” senior author Amy J. Houtrow, MD, MPH, PhD, and colleagues reported at the Pediatric Academic Societies annual meeting.
“Results indicate that additional education efforts are needed to grow the overall Zika knowledge of pediatricians and boost preparedness, particularly around recommending Zika testing and providing data to CDC,” they concluded.
But these findings are not surprising given how rare congenital Zika virus syndrome is, explained Dr. Houtrow, an associate professor of physical medicine and rehabilitation and pediatrics at the University of Pittsburgh.
“For most rare conditions, pediatricians report better general than specific knowledge,” Dr. Houtrow said in an interview. “We expect pediatricians have a broad range of knowledge for a multitude of conditions and to be well versed in the care of infants and children with common conditions, coupled with the ability to access knowledge and expertise about rarer conditions such as congenital Zika syndrome.”
Dr. Houtrow and associates drew their findings from the 2018 AAP Periodic Survey of Fellows, which includes both primary care physicians and neonatologists. The survey’s response rate was 42%, with 672 of 1,599 surveys returned, but the researchers limited their analysis to 576 postresidency respondents who were providing direct patient care.
Overall, 39% of physicians reported being knowledgeable about Zika virus, and 47% said they wanted to learn more. More than half of responding doctors (57%) reported feeling moderately or very prepared when it came to informing patients of preventive measures to reduce risk of Zika infection, and nearly half (49%) felt confident about giving patients travel advice.
However, physicians’ preparedness gradually dropped for clinical situations requiring more direct experience with Zika. For example, 37% felt moderately or very prepared to provide clinical referrals for infant patients with an infection, and 33% felt prepared to talk with pregnant women about the risks of birth defects from Zika infection.
Just one in five physicians (22%) felt prepared for recommending Zika virus testing, and 16% felt prepared about providing data to the CDC’s U.S. Zika Pregnancy Registry or managing infants who had been prenatally exposed to Zika infection. Only 15% felt they had the preparedness to tell parents about social services for Zika-affected infants.
Preparedness did not differ by gender, specialty, practice setting, hours worked per week, or population density (urban, rural and suburban). However, differences did appear based on respondents’ age and U.S. region.
Older doctors reported greater knowledge about Zika than younger doctors. Compared with those aged 39 years or younger, those aged 40-49 and 50-59 reported feeling more knowledgeable (adjusted odds ratio, 1.74 and 1.72, respectively; P less than .05). The odds of feeling more knowledgeable was nearly triple among those aged at least 60 years, compared with those under 40 (aOR, 2.92; P less than .001).
Those practicing in the Northeast United States (aOR, 2.19; P less than .01) and in the South (aOR, 1.74; P less than .05) also reported feeling more knowledgeable than those in the West or Midwest.
“This makes sense because infants with a history of prenatal exposure to the Zika Virus are more likely to be seen in practices with more immigrants from the Caribbean and Latin America,” Dr. Houtrow said in an interview.
“ but the urgency of the need for education about Zika virus has diminished because the rates of new congenital Zika syndrome have dropped,” she continued.
Study limitations include the inability to generalize the findings beyond U.S. members of the AAP and the possibility that nonrespondents differed from respondents in terms of Zika knowledge and preparedness.
The research was funded by the AAP and CDC.
BALTIMORE – U.S. pediatricians feel comfortable providing patients with preventive information and travel advice related to Zika, but few feel prepared when it comes to testing and management of infants exposed prenatally to Zika infections, a study found.
“Areas where pediatricians were less likely to report preparedness included recommending testing, providing data to the Centers for Disease Control and Prevention’s Zika Pregnancy Registry, managing infants exposed to Zika prenatally, and informing parents of social services for Zika-infected infants,” senior author Amy J. Houtrow, MD, MPH, PhD, and colleagues reported at the Pediatric Academic Societies annual meeting.
“Results indicate that additional education efforts are needed to grow the overall Zika knowledge of pediatricians and boost preparedness, particularly around recommending Zika testing and providing data to CDC,” they concluded.
But these findings are not surprising given how rare congenital Zika virus syndrome is, explained Dr. Houtrow, an associate professor of physical medicine and rehabilitation and pediatrics at the University of Pittsburgh.
“For most rare conditions, pediatricians report better general than specific knowledge,” Dr. Houtrow said in an interview. “We expect pediatricians have a broad range of knowledge for a multitude of conditions and to be well versed in the care of infants and children with common conditions, coupled with the ability to access knowledge and expertise about rarer conditions such as congenital Zika syndrome.”
Dr. Houtrow and associates drew their findings from the 2018 AAP Periodic Survey of Fellows, which includes both primary care physicians and neonatologists. The survey’s response rate was 42%, with 672 of 1,599 surveys returned, but the researchers limited their analysis to 576 postresidency respondents who were providing direct patient care.
Overall, 39% of physicians reported being knowledgeable about Zika virus, and 47% said they wanted to learn more. More than half of responding doctors (57%) reported feeling moderately or very prepared when it came to informing patients of preventive measures to reduce risk of Zika infection, and nearly half (49%) felt confident about giving patients travel advice.
However, physicians’ preparedness gradually dropped for clinical situations requiring more direct experience with Zika. For example, 37% felt moderately or very prepared to provide clinical referrals for infant patients with an infection, and 33% felt prepared to talk with pregnant women about the risks of birth defects from Zika infection.
Just one in five physicians (22%) felt prepared for recommending Zika virus testing, and 16% felt prepared about providing data to the CDC’s U.S. Zika Pregnancy Registry or managing infants who had been prenatally exposed to Zika infection. Only 15% felt they had the preparedness to tell parents about social services for Zika-affected infants.
Preparedness did not differ by gender, specialty, practice setting, hours worked per week, or population density (urban, rural and suburban). However, differences did appear based on respondents’ age and U.S. region.
Older doctors reported greater knowledge about Zika than younger doctors. Compared with those aged 39 years or younger, those aged 40-49 and 50-59 reported feeling more knowledgeable (adjusted odds ratio, 1.74 and 1.72, respectively; P less than .05). The odds of feeling more knowledgeable was nearly triple among those aged at least 60 years, compared with those under 40 (aOR, 2.92; P less than .001).
Those practicing in the Northeast United States (aOR, 2.19; P less than .01) and in the South (aOR, 1.74; P less than .05) also reported feeling more knowledgeable than those in the West or Midwest.
“This makes sense because infants with a history of prenatal exposure to the Zika Virus are more likely to be seen in practices with more immigrants from the Caribbean and Latin America,” Dr. Houtrow said in an interview.
“ but the urgency of the need for education about Zika virus has diminished because the rates of new congenital Zika syndrome have dropped,” she continued.
Study limitations include the inability to generalize the findings beyond U.S. members of the AAP and the possibility that nonrespondents differed from respondents in terms of Zika knowledge and preparedness.
The research was funded by the AAP and CDC.
BALTIMORE – U.S. pediatricians feel comfortable providing patients with preventive information and travel advice related to Zika, but few feel prepared when it comes to testing and management of infants exposed prenatally to Zika infections, a study found.
“Areas where pediatricians were less likely to report preparedness included recommending testing, providing data to the Centers for Disease Control and Prevention’s Zika Pregnancy Registry, managing infants exposed to Zika prenatally, and informing parents of social services for Zika-infected infants,” senior author Amy J. Houtrow, MD, MPH, PhD, and colleagues reported at the Pediatric Academic Societies annual meeting.
“Results indicate that additional education efforts are needed to grow the overall Zika knowledge of pediatricians and boost preparedness, particularly around recommending Zika testing and providing data to CDC,” they concluded.
But these findings are not surprising given how rare congenital Zika virus syndrome is, explained Dr. Houtrow, an associate professor of physical medicine and rehabilitation and pediatrics at the University of Pittsburgh.
“For most rare conditions, pediatricians report better general than specific knowledge,” Dr. Houtrow said in an interview. “We expect pediatricians have a broad range of knowledge for a multitude of conditions and to be well versed in the care of infants and children with common conditions, coupled with the ability to access knowledge and expertise about rarer conditions such as congenital Zika syndrome.”
Dr. Houtrow and associates drew their findings from the 2018 AAP Periodic Survey of Fellows, which includes both primary care physicians and neonatologists. The survey’s response rate was 42%, with 672 of 1,599 surveys returned, but the researchers limited their analysis to 576 postresidency respondents who were providing direct patient care.
Overall, 39% of physicians reported being knowledgeable about Zika virus, and 47% said they wanted to learn more. More than half of responding doctors (57%) reported feeling moderately or very prepared when it came to informing patients of preventive measures to reduce risk of Zika infection, and nearly half (49%) felt confident about giving patients travel advice.
However, physicians’ preparedness gradually dropped for clinical situations requiring more direct experience with Zika. For example, 37% felt moderately or very prepared to provide clinical referrals for infant patients with an infection, and 33% felt prepared to talk with pregnant women about the risks of birth defects from Zika infection.
Just one in five physicians (22%) felt prepared for recommending Zika virus testing, and 16% felt prepared about providing data to the CDC’s U.S. Zika Pregnancy Registry or managing infants who had been prenatally exposed to Zika infection. Only 15% felt they had the preparedness to tell parents about social services for Zika-affected infants.
Preparedness did not differ by gender, specialty, practice setting, hours worked per week, or population density (urban, rural and suburban). However, differences did appear based on respondents’ age and U.S. region.
Older doctors reported greater knowledge about Zika than younger doctors. Compared with those aged 39 years or younger, those aged 40-49 and 50-59 reported feeling more knowledgeable (adjusted odds ratio, 1.74 and 1.72, respectively; P less than .05). The odds of feeling more knowledgeable was nearly triple among those aged at least 60 years, compared with those under 40 (aOR, 2.92; P less than .001).
Those practicing in the Northeast United States (aOR, 2.19; P less than .01) and in the South (aOR, 1.74; P less than .05) also reported feeling more knowledgeable than those in the West or Midwest.
“This makes sense because infants with a history of prenatal exposure to the Zika Virus are more likely to be seen in practices with more immigrants from the Caribbean and Latin America,” Dr. Houtrow said in an interview.
“ but the urgency of the need for education about Zika virus has diminished because the rates of new congenital Zika syndrome have dropped,” she continued.
Study limitations include the inability to generalize the findings beyond U.S. members of the AAP and the possibility that nonrespondents differed from respondents in terms of Zika knowledge and preparedness.
The research was funded by the AAP and CDC.
REPORTING FROM PAS 2019
Neurodevelopmental concerns may emerge later in Zika-exposed infants
BALTIMORE – Most infants prenatally exposed to Zika showed relatively normal neurodevelopment if their fetal MRI and birth head circumference were normal, but others with similarly initial normal measures appeared to struggle with social cognition and mobility as they got older, according to a new study.
“I think we need to be cautious with saying that these children are normal when these normal-appearing children may not be doing as well as we think,” lead author Sarah Mulkey, MD, of Children’s National Health System and George Washington University, Washington, said in an interview. “While most children are showing fairly normal development, there are some children who are … becoming more abnormal over time.”
Dr. Mulkey shared her findings at the Pediatric Academic Societies annual meeting. She and her colleagues had previously published a prospective study of 82 Zika-exposed infants’ fetal brain MRIs. In their new study, they followed up with the 78 Colombian infants from that study whose fetal neuroimaging and birth head circumstance had been normal.
The researchers used the Alberta Infant Motor Scale (AIMS) and the Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA) to evaluate 72 of the children, 34 of whom underwent assessment twice. Forty of the children were an average 5.7 months old when evaluated, and 66 were an average 13.5 months old.
As the children got older, their overall WIDEA z-score and their subscores in the social cognition domain and especially in the mobility domain trended downward. Three of the children had AIMS scores two standard deviations below normal, but the rest fell within the normal range.
Their WIDEA communication z-score hovered relatively close to the norm, but self-care also showed a very slight slope downward, albeit not as substantially as in the social cognition and mobility domains.
The younger a child is, the fewer skills they generally show related to neurocognitive development, Dr. Mulkey explained. But as they grow older and are expected to show more skills, it becomes more apparent where gaps and delays might exist.
“We can see that there are a lot of kids doing well, but some of these kids certainly are not,” she said. “Until children have a long time to develop, you really can’t see these changes unless you follow them long-term.”
The researchers also looked separately at a subgroup of 19 children (26%) whose cranial ultrasounds showed mild nonspecific findings. These findings – such as lenticulostriate vasculopathy, choroid plexus cysts, subependymal cysts and calcifications – do not usually indicate any problems, but they appeared in a quarter of this population, considerably more than the approximately 5% typically seen in the general population, Dr. Mulkey said.
Though the findings did not reach significance, infants in this subgroup tended to have a lower WIDEA mobility z-scores (P = .054) and lower AIMS scores (P = .26) than the Zika-exposed infants with normal cranial ultrasounds.
“Mild nonspecific cranial ultrasound findings may represent a mild injury” related to exposure to their mother’s Zika infection during pregnancy, the researchers suggested. “It may be a risk factor for the lower mobility outcome,” Dr. Mulkey said.
The researchers hope to continue later follow-ups as the children age.
The research was funded by the Thrasher Research Fund. Dr. Mulkey had no conflicts of interest.
BALTIMORE – Most infants prenatally exposed to Zika showed relatively normal neurodevelopment if their fetal MRI and birth head circumference were normal, but others with similarly initial normal measures appeared to struggle with social cognition and mobility as they got older, according to a new study.
“I think we need to be cautious with saying that these children are normal when these normal-appearing children may not be doing as well as we think,” lead author Sarah Mulkey, MD, of Children’s National Health System and George Washington University, Washington, said in an interview. “While most children are showing fairly normal development, there are some children who are … becoming more abnormal over time.”
Dr. Mulkey shared her findings at the Pediatric Academic Societies annual meeting. She and her colleagues had previously published a prospective study of 82 Zika-exposed infants’ fetal brain MRIs. In their new study, they followed up with the 78 Colombian infants from that study whose fetal neuroimaging and birth head circumstance had been normal.
The researchers used the Alberta Infant Motor Scale (AIMS) and the Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA) to evaluate 72 of the children, 34 of whom underwent assessment twice. Forty of the children were an average 5.7 months old when evaluated, and 66 were an average 13.5 months old.
As the children got older, their overall WIDEA z-score and their subscores in the social cognition domain and especially in the mobility domain trended downward. Three of the children had AIMS scores two standard deviations below normal, but the rest fell within the normal range.
Their WIDEA communication z-score hovered relatively close to the norm, but self-care also showed a very slight slope downward, albeit not as substantially as in the social cognition and mobility domains.
The younger a child is, the fewer skills they generally show related to neurocognitive development, Dr. Mulkey explained. But as they grow older and are expected to show more skills, it becomes more apparent where gaps and delays might exist.
“We can see that there are a lot of kids doing well, but some of these kids certainly are not,” she said. “Until children have a long time to develop, you really can’t see these changes unless you follow them long-term.”
The researchers also looked separately at a subgroup of 19 children (26%) whose cranial ultrasounds showed mild nonspecific findings. These findings – such as lenticulostriate vasculopathy, choroid plexus cysts, subependymal cysts and calcifications – do not usually indicate any problems, but they appeared in a quarter of this population, considerably more than the approximately 5% typically seen in the general population, Dr. Mulkey said.
Though the findings did not reach significance, infants in this subgroup tended to have a lower WIDEA mobility z-scores (P = .054) and lower AIMS scores (P = .26) than the Zika-exposed infants with normal cranial ultrasounds.
“Mild nonspecific cranial ultrasound findings may represent a mild injury” related to exposure to their mother’s Zika infection during pregnancy, the researchers suggested. “It may be a risk factor for the lower mobility outcome,” Dr. Mulkey said.
The researchers hope to continue later follow-ups as the children age.
The research was funded by the Thrasher Research Fund. Dr. Mulkey had no conflicts of interest.
BALTIMORE – Most infants prenatally exposed to Zika showed relatively normal neurodevelopment if their fetal MRI and birth head circumference were normal, but others with similarly initial normal measures appeared to struggle with social cognition and mobility as they got older, according to a new study.
“I think we need to be cautious with saying that these children are normal when these normal-appearing children may not be doing as well as we think,” lead author Sarah Mulkey, MD, of Children’s National Health System and George Washington University, Washington, said in an interview. “While most children are showing fairly normal development, there are some children who are … becoming more abnormal over time.”
Dr. Mulkey shared her findings at the Pediatric Academic Societies annual meeting. She and her colleagues had previously published a prospective study of 82 Zika-exposed infants’ fetal brain MRIs. In their new study, they followed up with the 78 Colombian infants from that study whose fetal neuroimaging and birth head circumstance had been normal.
The researchers used the Alberta Infant Motor Scale (AIMS) and the Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA) to evaluate 72 of the children, 34 of whom underwent assessment twice. Forty of the children were an average 5.7 months old when evaluated, and 66 were an average 13.5 months old.
As the children got older, their overall WIDEA z-score and their subscores in the social cognition domain and especially in the mobility domain trended downward. Three of the children had AIMS scores two standard deviations below normal, but the rest fell within the normal range.
Their WIDEA communication z-score hovered relatively close to the norm, but self-care also showed a very slight slope downward, albeit not as substantially as in the social cognition and mobility domains.
The younger a child is, the fewer skills they generally show related to neurocognitive development, Dr. Mulkey explained. But as they grow older and are expected to show more skills, it becomes more apparent where gaps and delays might exist.
“We can see that there are a lot of kids doing well, but some of these kids certainly are not,” she said. “Until children have a long time to develop, you really can’t see these changes unless you follow them long-term.”
The researchers also looked separately at a subgroup of 19 children (26%) whose cranial ultrasounds showed mild nonspecific findings. These findings – such as lenticulostriate vasculopathy, choroid plexus cysts, subependymal cysts and calcifications – do not usually indicate any problems, but they appeared in a quarter of this population, considerably more than the approximately 5% typically seen in the general population, Dr. Mulkey said.
Though the findings did not reach significance, infants in this subgroup tended to have a lower WIDEA mobility z-scores (P = .054) and lower AIMS scores (P = .26) than the Zika-exposed infants with normal cranial ultrasounds.
“Mild nonspecific cranial ultrasound findings may represent a mild injury” related to exposure to their mother’s Zika infection during pregnancy, the researchers suggested. “It may be a risk factor for the lower mobility outcome,” Dr. Mulkey said.
The researchers hope to continue later follow-ups as the children age.
The research was funded by the Thrasher Research Fund. Dr. Mulkey had no conflicts of interest.
REPORTING FROM PAS 2019
Key clinical point: .
Major finding: Zika-exposed infants with normal fetal MRI neuroimaging showed increasingly lower mobility and social cognition skills as they approached their first birthday.
Study details: The findings are based on neurodevelopmental assessments of 72 Zika-exposed Colombian children at 4-18 months old.
Disclosures: The research was funded by the Thrasher Research Fund. Dr. Mulkey had no conflicts of interest.