Clinical Pediatrics

This study evaluated the extent to which the sleep is disrupted by nighttime awakenings in urban children with and without asthma and examined racial/ethnic differences in sleep outcomes. Three hundred and seventy-nine urban children aged 7 to 9 years with (n = 250) and without (n = 129) asthma were included. Participants were 45% Latino, 34% black, and 21% non-Latino white (NLW). Nighttime awakenings were assessed via actigraphy. Asthma status was assessed by a clinically and via self-report. Children with asthma had significantly more awakenings than those without. Latino children with asthma had more and longer awakenings compared to Latino children without asthma; these effects were not observed among black or NLW participants. Poor asthma control was associated with more awakenings. Urban children face higher risks for poor sleep and asthma outcomes. Multicomponent interventions addressing asthma management and culturally tailored sleep hygiene strategies are necessary to improve asthma and sleep outcomes in this highly burdened population.

Caring for children with medical complexity poses significant challenges for parents/caregivers. Outpatient clinical visits are crucial for these children. This qualitative study (2/2022-4/2022) conducted in North Carolina involved semi-structured interviews with 23 caregivers of children with medical complexity (15 English; 8 Spanish) about their in-person visit experiences for their children. The purposive sample included children of Black race, rural residence, age >10 years, telehealth nonusers, and those with ≥10 clinic appointments/year, and Spanish-speaking caregivers. Data were transcribed and analyzed using thematic analysis. Four themes emerged: (1) logistical challenges of in-person visits for caregivers exist; (2) in-person visits negatively affect families and cause caregiver stress; (3) caregivers use personal strategies to optimize in-person visits; and (4) individualized and flexible outpatient care is needed. Health care providers and health systems should consider the unique needs of children with medical complexity and their families, offering choices to minimize challenges caused by in-person visits.

This study evaluated parent perceptions during outpatient pediatric medical visits with presence of medical scribes (virtual or in-person) or no scribe. A national, cross-sectional online survey was completed by 2148 parents of children 0 to 17 years. Parents reported higher visit satisfaction if they were informed of scribe presence (P = .002) and, independently, if asked permission for the provider to work with a scribe (P = .008). Parents reported higher comfort with virtual scribe over in-person scribe presence (P < .001). Parents reported higher visit satisfaction with virtual scribe presence compared with in-person and no scribe (P < .001). Perception of provider communication was not significantly different between virtual, in-person and no scribe presence (P = .615). Findings support increased parent visit satisfaction at pediatric medical visits with virtual scribe presence. Future qualitative studies could explore elements to support positive parent experience for current virtual scribe and future Artificial Intelligence (AI) scribe use.

The current pediatric mental health crisis has resulted in an increase in boarding patients. We sought to understand the role of social factors in final disposition. A single-center retrospective case-control study was conducted. Patients <18 years old presenting for a mental health chief complaint and recommended for inpatient psychiatric treatment were included. Outcomes groups were (1) patients discharged to home or a lower level of care after re-evaluation and (2) patients transferred to an inpatient psychiatric facility. Univariate and multiple logistic regression analyses were conducted. Patient identification as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and questioning and the “+” is intended to signify inclusivity of individuals who are not heterosexual or cisgender) was associated with a lower likelihood of discharge to home or a lower level of care (odds ratio [OR] = 0.39, 95% confidence interval [CI] = 0.18-0.77). We identified additional factors that were associated with final disposition. Further investigation is needed to clarify these associations and to determine the impact of disposition on long-term mental health outcomes.

Pediatric infectious disease (ID) outpatient settings do not routinely screen for household-level psychosocial needs. We assessed the prevalence of health-related social needs (HRSNs), caregiver adverse childhood experiences (ACEs), and neighborhood-level socioeconomic deprivation index (SDI) scores in pediatric ID outpatient settings. We approached English- and Spanish-speaking caregivers of pediatric ID outpatients to complete HRSN and ACE paper questionnaires from August 2023 to August 2024. The SDI scores were identified using geocoded addresses (higher scores indicating more deprivation). We surveyed 306 caregivers regarding HRSNs and ACEs. Caregivers reported anxiety (70%), depression (20%), and food insecurity (10%), with 20% reporting ≥4 ACEs. Median SDI scores were higher for children with reported food insecurity (0.61) compared to those without food insecurity (0.28, P < .001). In addition to general pediatricians, ID clinicians could play a critical role in addressing challenges in ways that could decrease inequities, approaches aided by HRSN and ACE screening and SDI risk stratification.

Metformin use in non-diabetic youth with obesity may improve weight status and reduce comorbidities. This retrospective review of 161 youth with obesity prescribed lifestyle changes and metformin in a pediatric weight management (PWM) program aims to evaluate patient-reported experiences of metformin use and assess the association between metformin use and changes in weight status. The 3 groups (metformin taken ≥6 months, metformin taken <6 months, and metformin ordered not taken) had similar weight status at the start of the evaluation. Youth taking metformin ≥6 months started metformin at an earlier visit and more often had prediabetes and a parent with diabetes. Overall, 57.1% improved weight status (metformin taken ≥6 months, 69.0%; metformin taken <6 months, 59.4%; and metformin ordered not taken, 32.4%; P < .002). Among those who had taken metformin (n = 127), 35.4% reported side effects that did not vary by group status. This study provides perspective on metformin use for pediatric obesity care.

Children with painful disorders of gut–brain interactions (DGBIs) endorse pain-related stigmatization. However, little is known about how stigma may be associated with pain intensity. Consequently, we conducted a cross-sectional study to identify a potential pathway between felt stigma and abdominal pain in youth with DGBIs. 120 youth completed measures of health-related stigma, depressive symptoms, sleep disturbances, and pain severity. As expected, greater felt stigma was significantly correlated with greater depressive symptoms, sleep-related impairments, and abdominal pain. Furthermore, a sequential mediation analysis revealed a significant indirect effect of stigma on abdominal pain via higher depressive symptoms and greater sleep-related impairments. Results suggest potential considerations for modifying current treatments for DGBIs targeting abdominal pain. More specifically, providers should incorporate screening for and addressing felt stigma, sleep-related impairment, and depressive symptoms into their treatment planning. Involving pediatric behavioral health providers may help facilitate this aspect of DGBI intervention.

Health literacy and language impact comprehension of and adherence to written educational materials, including those for gastrostomy tubes (g-tubes). Our objective was to evaluate the readability, understandability, actionability, content, and language availability of a national sample of written g-tube educational materials. We conducted a cross-sectional study of g-tube educational materials from top 20 children’s hospitals (US News and World Report) obtained via a systematic online search and provided by the institutions. We assessed material: (1) readability, (2) understandability and actionability (Patient Education Materials Assessment Tool for Printable Materials, (3) content, and (4) language availability. Mean (standard deviation [SD]) reading grade level was 8.3 (1.9). Mean (SD) understandability and actionability scores were 81.6% (12.1%) and 65.9% (23.2%), respectively. Materials covered a mean (SD) of 46.1% (25.3%) of content items; 20% of institutions provided materials in non-English languages. Future research should examine how to improve educational materials for children with g-tubes.

Excess screen time is an emerging hazard to physical and mental well-being of children. This observational cross-sectional study aimed to assess and compare knowledge regarding screen exposure guidelines among 100 mothers and 150 primigravida antenatal women (AW) using a questionnaire framed based on the Indian Academy of Paediatrics parental guidelines. Only 16% of mothers and none among the AW exhibited good knowledge while 48% of mothers and 79.3% of AW demonstrated poor knowledge (p = .01). Mothers showed higher awareness regarding the minimum permissible age to introduce social media platforms, whereas AW exhibited a higher knowledge regarding ill effects of excess screen use on mental health and physical ill effects like obesity. Women from both groups were unaware of the minimal permissible age to introduce screens and the signs of mobile phone addiction. This emphasizes the need for targeted educational intervention for mothers and AW to promote healthy screen habits among children.

This study investigates the diagnostic efficacy of combining ultrasonography, Pediatric Appendicitis Score (PAS), and C-reactive protein (CRP) for appendicitis in children. We retrospectively analyzed 268 children with acute abdominal pain from 2017 to 2020. Compared with those of any single diagnostic method, the sensitivity and negative predictive value of ultrasonography combined with the pediatric appendicitis score and C-reactive protein were higher in diagnosing acute appendicitis (P < .05). In addition, the sensitivity of ultrasonography combined with C-reactive protein was also greater for diagnosing acute complicated appendicitis (P < .05). Ultrasonography correlated closely with pathological examination findings for appendicitis types (Kappa = 0.888; P < .05). The combined use of ultrasonography, the Pediatric Appendicitis Score, and C-reactive protein enhances the diagnostic accuracy for acute appendicitis. Furthermore, the integration of ultrasonography with C-reactive protein levels may assist in determining the pathological subtype of appendicitis in pediatric patients.

Human coronavirus NL63 (HCoV-NL63) is typically associated with mild upper-respiratory infections, but rare neurological manifestations have been reported. These presentations may closely mimic acute vascular or epileptic events in children. We describe an 8-year-old previously healthy girl who developed vomiting followed by ocular deviation, limb tremors, and brief altered consciousness. On arrival, she was afebrile and hemodynamically stable, with right gaze deviation, miosis, and suspected right hemiparesis. Brain computed tomography (CT) and angiography revealed marked left-hemispheric hypoperfusion consistent with a postictal state. A multiplex respiratory viral panel was positive for HCoV-NL63, while cerebrospinal fluid, microbiological, and toxicological studies were unremarkable. Magnetic resonance imaging (MRI) performed 48 hours later demonstrated complete normalization of perfusion. The patient recovered fully without further seizures. This case highlights a temporal association between HCoV-NL63 infection and transient postictal hemispheric hypoperfusion, underscoring the importance of integrating clinical, radiologic, and virologic data to avoid misdiagnosis of stroke in pediatric patients.