Clinical Pediatrics

Pediatric residency clinics caring for underserved populations are often staffed with varying levels of social and legal resources, though their effects on residents’ knowledge and practice have not been studied.

To examine the effects of clinic-based social and legal resources on resident knowledge and screening patterns for social determinants of health.

A cross-sectional study of residents from 3 continuity clinics with different social and legal resources was performed. Resident surveys assessing their knowledge and screening practices, and direct observation of social history taking was compared.

Forty resident surveys revealed that those from clinics with more social and legal resources had greater confidence in their knowledge, screened more frequently, and spent more time taking social histories as assessed on direct observation.

Residents who practiced in continuity clinics with increased social and legal resources were more confident in their knowledge and screened for social determinants of health more frequently.

To determine whether pulmonary follow-up affects rates of rehospitalization and visitations to emergency departments (EDs) in preterm infants with bronchopulmonary dysplasia (BPD).

In this retrospective cohort study, the authors identified all preterm infants born at ≤32 weeks’ gestation with at least one outpatient visit to a pulmonary follow-up clinic at Children’s Hospital Boston or a high-risk primary neurodevelopmental follow-up clinic for preterm infants. ED visits and rehospitalizations were identified through electronic medical records.

Infants with pulmonary follow-up compared with infants without pulmonary follow-up were, respectively, younger (mean gestational age 26.3 ± 2.3 vs 28.3 ± 2.3 weeks, P < .0001), smaller at birth (birth weight <1200 g, 87.6% vs 57.2%, P < .0001), and needed more supplemental oxygen (55.7% vs 2.6%, P < .0001) and diuretics (65.8% vs 4.7%, P < .001) at the time of discharge from the neonatal intensive care unit. Although rates of rehospitalization were higher in infants with pulmonary follow-up, rates of visits to an ED for respiratory causes were not statistically significant. After controlling for baseline differences in both groups, the rates of rehospitalization or ED visits were the same for both groups.

Despite differences in lung disease status in infants with and without pulmonary follow-up, the rates of health care utilization were the same in both groups. Pulmonary follow-up may decrease the expected higher rates of ED visits and hospitalizations in preterm infants with more severe lung disease.

A substantial percentage of emergency department (ED) patients return within 72 hours of their initial evaluation. Quality reviews typically demonstrate that most revisits do not seem to be directly related to problematic care provided on the first evaluation. We examined the possibility that return visits are related to nonmedical issues on the first visit, most notably patient discharge education.

We prospectively surveyed a convenience sample of caregivers in a pediatric ED to determine why they returned with their children within 72 hours of their initial ED visit.

All patients who returned within 72 hours of a previous visit were identified and prospectively interviewed using a survey instrument with nominal (multiple choice) and brief descriptive responses.

Caregivers of 124 children were prospectively surveyed; 93 children (75%) returned because their symptoms had not improved or worsened. Only 50 (53%) had contacted their primary medical doctor (PMD) prior to the second visit; of these, 14 (28%) could not get an appointment, and 32 (64%) were told to return to the ED. Discharge instructions were felt to be informative by 94% (n = 86) of caregivers with the same number (94%) reported being satisfied with the first ED physician. Twenty-nine children (30%) were admitted on the second visit.

Among children who are discharged from the emergency department and return within 72 hours, most caregivers are satisfied with the care and instructions provided on their first visits. Though most patients have a PMD, many do not call them prior to their return ED visit, and those who do either cannot schedule an appointment or are told to return to the ED. The majority of patients return for clinical progression of illness.

To determine parental rankings of known factors related to early-childhood obesity and compare reports between parents of healthy weight and overweight children.

Parents of 2- to 5-year-old children seeking well-child care ranked card-sort statements including risks, barriers, and motivating factors for achieving a healthy weight child. Frequencies and means of ranked factors are reported and compared.

Of the 150 participants, few parents (7.4%) considered low levels of physical activity a top risk factor compared with other known risks. Inability to control the food choices of alternate caregivers was the greatest perceived barrier to achieving a healthy child weight (34%). There were no differences in rankings by child weight groups.

Low-income parents of preschoolers are aware of high-risk feeding behaviors, but few recognize the risk of inactivity in their young child. Innovations that promote adequate physical activity and engage influential caregivers during counseling are necessary.

To determine which anthropometric measure best correlates with change in fat mass (FM) over time.

The authors performed a retrospective cohort study of 76 obese patients (mean body mass index [BMI] 38 kg/m² and mean age 13 years) presenting to an obesity clinic between 2005 and 2010. For each patient, during 2 visits, FM was measured by bioelectrical impedance analysis and the following measures obtained: BMI, waist circumference, hip circumference, and neck circumference. Correlation coefficients and linear regression analyses were calculated to examine the relationship between each measure and FM.

Change in BMI correlated better with change in FM than any other measure and had the strongest effect on change in FM (P < .01, R² = .887). The best regression model included BMI only (R² = .891); without BMI, the model was significantly worse (R² = .521).

In the clinical management of obese children, BMI is an adequate measure of change in FM.

Participants’ perceptions may be associated with the high attrition rates reported by weight management programs.

To explore participants’ perceptions of a weight management program.

Semistructured interviews were performed (spring 2010) with past participants of the Michigan Pediatric Outpatient Weight Evaluation and Reduction program. Transcripts were reviewed and themes identified.

Parents (38) and adolescents (25) were interviewed separately; similar themes emerged. Theme 1: Support/encouragement—Participants emphasized the importance of a supportive environment with a positive, compassionate approach from providers. Theme 2: Exercise—Fun, achievable activities were a valued means of making exercise enjoyable and building self-efficacy. Theme 3: Nutrition—Hands on demonstrations and tangible suggestions were preferred over activities such as self-monitoring. Theme 4: Behavioral factors—Participants valued the opportunity to hear their peers’ experiences. However, individual/family sessions addressing their personal concerns were also viewed as important.

Beyond program content, participants valued a supportive environment emphasizing health over habitus.