Category Archives: Pediatrics

Pediatrics

Let’s talk about childhood injury prevention | Hub – The Hub at Johns Hopkins

By Annika Weder

Unintentional injuries are a leading cause of suffering and mortality in young children, and doctors agree that many of these injury-related deaths are preventable. To address this, the American Academy of Pediatrics designed The Injury Prevention Program, or TIPP. Launched in 1983, TIPP helps pediatricians implement injury prevention counseling for parents by providing anticipatory guidance based on child development schedules including what new skills children are learning at each age, potential dangers parents should look out for, and what preventative steps they should be taking.

Despite TIPP's widespread use, until recently, no formal evaluation had been done to investigate whether TIPP effectively prevents injuries. A new study led by Eliana Perrin, Bloomberg Distinguished Professor of Primary Care in the Department of Pediatrics in the School of Medicine and in the School of Nursing, showed that the program dramatically reduces injuries in young children. The study was published April 1 in Pediatrics.

Image caption: Eliana Perrin

Image credit: Johns Hopkins School of Medicine

Perrin, whose research typically focuses on childhood obesity, says this research began by chance, when TIPP was used as the attention control for a study she was involved in on obesity prevention, the Greenlight Intervention Study. When her site was randomized into the TIPP arm instead of the obesity prevention arm, Perrin says she was determined to "make lemonade out of lemons."

"We decided to turn this cluster randomized trial of our obesity prevention program on its head and look at how effective the control was," Perrin says. "Thanks to the Centers for Disease Control and Prevention and the National Institute of Child Health and Human Development partnering to support the study of this injury prevention piece, we were able to do a rigorous job of looking at how effective TIPP is at preventing injuries in young children. And, as it turns out, it was very effective."

The study involved a cluster-randomized trial at four academic medical centerstwo implemented TIPP screening and counseling materials at all well-child checks for ages two to 24 months, and two centers implemented obesity prevention. A total of 781 parent-infant pairs were enrolled in the study. The majority of parents were Hispanic (51%) or Black (28%), and most were insured by Medicaid (87%). Over a period of four years, parents were asked to report the number of injuries since the previous visit at the recommended well-child checks at two, four, six, nine, 12, 15, 18, and 24 months of age as well as whether the injuries were serious enough to require medical attention. Injuries include cuts, burns, falls, choking, unintentional ingestions, drownings, and motor vehicle crashes.

Unsurprisingly, both the number of injuries and the number of injuries requiring medical attention increased with age, with injuries recorded in only 3% of children at two months of age, and in 40% of children at 24 months of age. By far the most common cause of injury reported was falls, followed by "other" in second place and burns in third. Choking, motor vehicle crashes, poisonings, and near drownings were much less common.

What was unexpected, however, was the magnitude of the impact TIPP had on reducing reported injuries. Children who were enrolled in sites with the injury prevention program had significantly reduced parent-reported injuries compared to children at the control sites. The estimated risk of reporting injuries averaged across all ages from four months to 24 months was 30% in the control group and only 14% in the group where TIPP was used. So, the TIPP intervention was associated with a more than 50% reduction in the risk of reporting at least one injury compared to the control group.

Eliana Perrin

Bloomberg Distinguished Professor of Primary Care

"Honestly, we were surprised by the results," says Perrin. "TIPP is a pretty simple program. There's not a lot of bells or whistles. It's just bread-and-butter developmentally guided injury prevention anticipatory guidance for parents. It reminds us pediatric providers to say to parents, 'hey, in the next two months, your baby will be reaching and grabbing things, so you might want to make sure that hot coffee and the table cloth it's on are out of reach from your baby.' When we were teaching the residents to use this program, we really thought, this is so rote! So, we were not expecting the effect we saw."

This study highlights the effectiveness of primary care-based injury prevention approaches, and has important public health implications, as the rate of injury reduction could have a significant effect if TIPP were implemented widely. "We hope this paper will encourage providers to spend time counseling about injury," Perrin says. "We also hope more will adopt The Injury Prevention Program into their practice because this anticipatory guidance for parents really helps prevent injuries for young children."

Looking forward, the researchers aim to investigate the mechanisms by which TIPP leads to a reduction in injuries, as well as to investigate TIPP's impact on serious injury prevention.

"We hope to next look at whether TIPP prevents serious injuries," says Perrin. "We also hope to look at whether we can enhance TIPP to be even better and best ways to implement this program into busy practice since providers are so strapped for time."

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Let's talk about childhood injury prevention | Hub - The Hub at Johns Hopkins

Pediatrics

More young people with depression, anxiety in Virginia | Headlines – InsideNoVa

An analysis of hospital data shows statewide emergency department visits among patients under 18 for mental health treatment have increased in recent years.

When looking at data spanning the first quarter of 2020 through the second quarter of 2023, the Virginia Hospital & Healthcare Association found that emergency department visits with anxiety and depression diagnoses increased in pediatric patients.

According to a news release from the association, the first quarter of 2023 saw the highest volume recorded, with numbers surpassing pre-pandemic levels.

On average, hospitals in the Virginia saw approximately 3,054 pediatric emergency department visits for anxiety and depression each quarter.

Two-thirds of the diagnoses were related to unspecified anxiety disorder (33%) and single episodes of unspecified major depressive disorders (33%).

About 69% of the visits were female patients. The data follows statistics seen in Northern Virginia.

Last year, a report from the Community Foundation of Northern Virginia found that youth in Northern Virginia have experienced high rates of clinical depression, anxiety and feelings of hopelessness or sadness. It also showed that girls and students in the LGBTQ community felt persistent sadness at twice the rate of their peers.

To address the increase, the report made several recommendations including, focusing on mental health outreach to at-risk youth and expanding the number of trusting, supportive adults in a teenager's life.

The statewide increase in emergency room visits also follows a trend seen nationwide. Last summer, the joint paper from the American Academy of Pediatrics, American College of Emergency Physicians and Emergency Nurses Association, said emergency rooms have been overwhelmed by a surge in mental health emergencies.

The organizations called for systemic changes and more resources, saying strategies to address challenging circumstances that affect prehospital services, the surrounding community and, ultimately, patient care are needed.

Two-thirds of the diagnoses were related to unspecified anxiety disorder (33%) and single episodes of unspecified major depressive disorders (33%).

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More young people with depression, anxiety in Virginia | Headlines - InsideNoVa

Pediatrics

Public perceptions of families affected by pediatric cancer and educational work in pediatric oncology | Pediatric … – Nature.com

Steliarova-Foucher, E. et al. International incidence of childhood cancer, 2001-10: a population-based registry study. Lancet Oncol. 18, 719731 (2017).

Article PubMed PubMed Central Google Scholar

Ward, Z. J., Yeh, J. M., Bhakta, N., Frazier, A. L. & Atun, R. Estimating the total incidence of global childhood cancer: a simulation-based analysis. Lancet Oncol. 20, 483493 (2019).

Article PubMed Google Scholar

WHO. CureAll framework: WHO global initiative for childhood cancer: increasing access, advancing quality, saving lives https://apps.who.int/iris/handle/10665/347370 (2021).

Allemani, C. et al. Global surveillance of cancer survival 19952009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 385, 9771010 (2015).

Article PubMed Google Scholar

Coven, S. L., Stanek, J. R., Hollingsworth, E. & Finlay, J. L. Delays in diagnosis for children with newly diagnosed central nervous system tumors. Neurooncol. Pract. 5, 227233 (2018).

PubMed PubMed Central Google Scholar

Qaddoumi, I., Merchant, T. E., Boop, F. A. & Gajjar, A. Diagnostic delay in children with central nervous system tumors and the need to improve education. J. Neurooncol. 145, 591592 (2019).

Article PubMed PubMed Central Google Scholar

Kozlova, N. V. & Androsova, T. V. Socio-psychological support of cancer patients. Bull. Tomsk State Univ. 335, 142147 (2010).

Google Scholar

Cejtlin, G. Y., Guseva, M. A., Antonov, A. I. & Rumyancev, A. G. Medical and social problems of families with a child with cancer, and ways to solve them in the practice of pediatric oncology. Pediatrics 96, 173181 (2017).

Google Scholar

Pahl, D. A., Wieder, M. S. & Steinberg, D. M. Social isolation and connection in adolescents with cancer and survivors of childhood cancer: a systematic review. J. Adolesc. 87, 1527 (2021).

Article PubMed Google Scholar

Yoshida, K. & Matsui, Y. A pilot study for the development and evaluation of an educational program to reduce stigma toward cancer and cancer survivors: focusing on dating and marriage after cancer diagnosis. J. Cancer Educ. 37, 806811 (2022).

Article PubMed Google Scholar

Graetz, D. E., Garza, M., RodriguezGalindo, C. & Mack, J. W. Pediatric cancer communication in low- and middle-income countries: a scoping review. Cancer 126, 50305039 (2020).

Article PubMed Google Scholar

Daher, M. Cultural beliefs and values in cancer patients. Ann. Oncol. 23(Suppl 3), 6669 (2012).

Article PubMed Google Scholar

Janin, M. M. H., Ellis, S. J., Wakefield, C. E. & Fardell, J. E. Talking about cancer among adolescent and young adult cancer patients and survivors: a systematic review. J. Adolesc. Young-. Adult Oncol. 7, 515524 (2018).

Article PubMed Google Scholar

Vrinten, C., Gallagher, A., Waller, J. & Marlow, L. A. Cancer stigma and cancer screening attendance: a population based survey in England. BMC Cancer 19, 566 (2019).

Article PubMed PubMed Central Google Scholar

Nahata, L. et al. Romantic relationships and physical intimacy among survivors of childhood cancer. J. Adolesc. Young-. Adult Oncol. 9, 359366 (2020).

Article PubMed PubMed Central Google Scholar

Mader, L., Michel, G. & Roser, K. Unemployment following childhood cancer. Dtsch Arztebl Int. 114, 805812 (2017).

PubMed PubMed Central Google Scholar

Kaul, P., Kumar, R., Singh, M. P. & Garg, P. K. Social taboos: a formidable challenge in cancer care. BMJ Case Rep. 14, e236095 (2021).

Article PubMed PubMed Central Google Scholar

Gevandova, M. G. I believe that everything will work out and my child will live like everyone else: parents ideas about the future of a child who has had an oncological disease. Soc. Med. 1, 3541 (2021).

Article Google Scholar

Marklew, R. E., Jackson, A. A., Wiseman, M. J. & Wootton, S. A. ICONIC: an international task force supporting collaboration in nutrition and cancer globally. Trends Food Sci. Technol. 30, 310 (2022).

Article Google Scholar

Newman, H. et al. Impact of poverty and neighborhood opportunity on outcomes for children treated with CD19-directed CAR T-cell therapy. Blood 141, 609619 (2023).

Article CAS PubMed Google Scholar

Zapata-Tarrs, M. et al. Patient and health service factors associated with delays in cancer treatment for children without social security in Mexico. Pediatr. Blood Cancer 67, e28331 (2022).

Article Google Scholar

Krver, S., Kinghorn, A., Negin, J., Shea-Perry, M. & Martiniuk, A. L. Assessing the experience of social support for parents who attended Camp Trilliums pediatric oncology family program. J. Psychosoc. Oncol. 35, 116 (2017).

Article PubMed Google Scholar

Guseva, M. A. Family stress and possibilities of psychological and social adaptation of the family in pediatric oncology. Soc. Med. 16, 1822 (2017).

Article Google Scholar

Reshetnikov, A., Gevandova, M., Prisyazhnaya, N. & Vyatkina, N. The role of parents in their childs cancer diagnosis, treatment, rehabilitation, and socialization. Indian J. Pediatr. 91, 3034 (2024).

Reshetnikov, A. V., Gevandova, M. G. & Prisyazhnaya, N. V. Peculiarities of legal regulation of oncological care for children in Russia and abroad. Med. Bull. North. Cauc. 14, 412417 (2019).

Google Scholar

Park, M., Choi, E. K., Lyu, C. J., Han, J. W. & Hahn, S. M. Family resilience factors affecting family adaptation of children with cancer: a cross-sectional study. Eur. J. Oncol. Nurs. 56, 102078 (2022).

Article PubMed Google Scholar

Tonorezos, E. S. et al. Long-term care for people treated for cancer during childhood and adolescence. Lancet 399, 15611572 (2022).

Article PubMed PubMed Central Google Scholar

Weller, L. J. R., Cavers, D. G. & Rowa-Dewar, N. Parents perceptions and experiences of physical activity in childhood cancer survivors in Singapore: a qualitative study. Singapore Med. J. https://doi.org/10.4103/singaporemedj.SMJ-2022-122 (2023). Epub ahead of print.

Shanmugavadivel, S. et al. 156 Even now as a Mum, I dont know what just viral means: parental perceptions of childhood cancer, the ChIP study. Arch. Dis. Child. 108(Suppl 2), A285A286 (2023).

Google Scholar

Ochoa, C. Y. et al. Barriers and facilitators of Hispanic/Latino parents caregiving for a childhood cancer survivor: a qualitative study. Cancer Causes Control 34, 151160 (2023).

Article PubMed Google Scholar

Wechsler, A. M. & SnchezIglesias, I. Psychological adjustment of children with cancer as compared with healthy children: a meta-analysis. Eur. J. Cancer Care 22, 314325 (2013).

Article CAS Google Scholar

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Pediatrics

The pediatrician, the resident, the strawberry monster, and the zebra – VUMC News – VUMC Reporter

There is a saying in the world of medicine: when working toward a diagnosis, think horses, not zebras.

In other words, if you see a symptom that could be something common or could be something rare, proceed first on the theory that the common is what youre seeing. If you hear hoofbeats, its probably a horse, not a zebra.

This does not mean that zebras do not exist.

Gerald Hickson, MD, the founding director of the Vanderbilt Health Center for Patient and Professional Advocacy, was a young resident physician in Pediatrics at Vanderbilt in the early 1980s, and one of the older pediatricians he thinks it was likely William Buck Donald, MD passed along some hard-earned advice about a common clinical finding: blood in the stool.

Donald, a 1947 graduate of the Vanderbilt School of Medicine, who had been on the faculty since 1960, was the director of the Pediatric Ambulatory Care Unit located, as all VUMC clinics were those days, in the building we now call Medical Center North. He spent his days seeing to the cornucopia of ailments the children of Nashville could bring to his door.

I remember being taught theneed to check stool for occult and not-so-occult blood, Hickson said. That is, blood that is hidden and blood that is visible.

Here comes the zebra how about blood that is not blood at all?

In the 1970s a new breakfast cereal came on the market called Franken Berry, which was sugary and had a lot of artificial strawberry-like flavors and artificial colors. It was marketed by General Mills along with another monster-themed cereal, represented by the cartoon vampire Count Chocula.

Franken Berry (the character) was depicted on the box as basically what would happen if Frankensteins monster was crossed with a giant strawberry.

Franken Berry (the cereal) was sold in grocery stores all over the country, including in one location a stones throw from VUMCs walk-in pediatrics clinic: the H.G. Hill supermarket that once stood where a small park and Vanderbilt Stallworth Rehabilitation Hospital are now.

Among the food dyes in use at that time were FD&C Red Nos. 2 and 3, and these were in the original formulation of Franken Berry. It was fairly quickly discovered that these colors are not absorbed by the body, and resulted in children who were especially fond of the cereal having pink stools and showing up at pediatrics clinics, often in the company of freaked out parents.

A 1972 report in the journal Pediatrics by a physician at the University of Maryland tells of a case of a 12-year-old whose terrified mother brought him to the hospital suspecting internal bleeding, and the resulting research that solved the mystery. The child had pink poop, but otherwise seemed fine, even after four days of hospitalization and many tests. The mystery was solved when, upon close questioning about his diet, his mom mentioned his fondness for this new cereal, Franken Berry. The children in this family were really fond of Franken Berry; it turned out his sister was pooping pink, too.

They were not alone, as evidenced by the fact that Donald felt the need to teach VUMC residents about the phenomenon several years later.

Franken Berry still haunts the cereal aisle, but not the colons of its young fans. Its current pink hue is achieved without the dyes that caused the problems in the 1970s.

Amazingly, this isnt even the only time unnaturally hued breakfast foods have led to similar outcomes. Another monster-themed cereal introduced in the 1970s, the faux-blueberry flavored Boo Berry, used a blue food dye that somehow turned stools green. And Smurfberry Crunch, introduced by Post in 1982, produced blue poop in some children who ate it.

Hickson recalled his own experience with a patient who showed up, not with blue stools but with blue hands a concerning symptom of a lack of oxygen saturation but who turned out to be fine.

The girl had been sent by her school because of a concern that the blue on her hands meant a problem with her heart.

When I walked into her exam room, she looked good, Hickson recalled. The diagnosis was made when I found that an alcohol pad removed what turned out to be blue dye from a new pair of blue jeans.

You just never know, he said. You see a lot of strange things in practice.

Research sources: Gerald Hickson; James Thweatt, VUMC Archives; Pediatrics; Smithsonian; Atlas Obscura.

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The pediatrician, the resident, the strawberry monster, and the zebra - VUMC News - VUMC Reporter

Pediatrics

Receptor targeting to identify medications for pediatric mental health concerns – Contemporary Pediatrics

In this Contemporary Pediatrics video interview, Joanne M. Howard, MSN, MA, RN, CPNP-PC, PMHS & Anne Craig, MSN, RN, CPNP-PC, of C.S. Mott Children's Hospital, Ann Arbor, Michigan, highlight their session titled "Pediatric Psychopharmacology: Understanding Receptor Targets to Identify Medications That May Work Best for Children and Teens," presented at the 2024 NAPNAP National Conference.

Their session explored psychopharmacologic agents used in the pediatric population, with a focus on their interactions with receptor targets in the brain and body.

"[We wanted to] take a deeper dive into the medication management for pediatric mental health disorders and empower our [colleagues] out there in the community to maybe be more comfortable or knowledgable about managing things like depression, anxiety, aggressive behaviors, or ADHD," said Howard.

"We gave an overview of what neurotransmitters are, and then focused on the neurotransmitters monoamines that are implicated in psychopathology or development of many psychiatric disorders," added Craig. "We wanted to approach it from what [a particular] medication is targeting, what receptors, and how does that translate into a clinical effect."

Click here for more NAPNAP coverage.

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Receptor targeting to identify medications for pediatric mental health concerns - Contemporary Pediatrics

Pediatrics

Hypoglossal nerve stimulation offers hope for pediatric Down syndrome patients with OSA – News-Medical.Net

While Obstructive Sleep Apnea (OSA) affects about five percent of the general pediatric population, 80 percent of children with Down syndrome experience OSA. Continual OSA results in poor health, including disruptions to cognitive development and functioning, leading physician-researchers from Mass General Brigham to investigate better methods to treat these patients as early as possible to maximize their health outcomes.

In a new case study published April 11 in Pediatrics, they report on a 4-year-old boy with Down syndrome and OSA who underwent a procedure to implant a hypoglossal nerve stimulation device, and experienced improvements thereafter.

Currently, adenoidectomies and tonsillectomies are among first-line treatments for pediatric OSA, however they are not always effective for children with Down syndrome because OSA can recur. Additionally, continuous positive airway pressure (CPAP) treatment, which streams compressed air into airways during sleep, is often not tolerated by children with Down syndrome due to sensory sensitivities.

The hypoglossal nerve stimulation device by Inspire has been an option increasingly used to treat OSA in adults since its 2014 FDA-approval. The device detects when the airway is blocked and sends an electrical pulse to the hypoglossal nerve that controls the tongue, causing it to move forward in the mouth, thereby opening the airway. Positive treatment data in adults first led lead study author Christopher Hartnick, MD, director of Pediatric Otolaryngology at Mass Eye and Ear, to wonder whether the treatment may help his patients with Down syndrome whose lives were impacted by OSA. With Mass General Brigham colleague Brian Skotko, MD, MPP, the Emma Campbell Endowed Chair on Down Syndrome at Massachusetts General Hospital, they organized a clinical trial looking at the safety and effectiveness of the procedure in children between the ages of 10 and 22 with Down syndrome. Results of a 42-patient trial showing the benefits and safety of the procedure were published in 2022, leading to FDA approval for the device for adolescents with Down syndrome over the age of 13 nearly a year later.

These results spurred the researchers to examine whether the procedure could benefit younger children who are impacted by the physical and neurocognitive effects of OSA during pivotal developmental years.

Hartnick and Skotko identified a patient candidate, 4-year-old Theodore "Theo" Scott of Knoxville, Tenn., who had been on CPAP therapy since he was 1 year old.

After Hartnick and his team had extensive discussions about potential risks with colleagues in other medical specialties and Theo's parents, Rachel and Andrew Scott, a surgery took place in May 2023. The surgery was successful without complications, and the procedure was modified to allow for Theo's continued growth.

After one month, Theo experienced an improvement in sleep, and his obstructive apnea-hypopnea index (a measure of apnea severity) decreased by 40 percent. Additional follow-up care will take place for Theo to monitor effects of the procedure on neurocognition and surveillance of the device as he grows.

"The most significant change we have seen is the amount of sleep Theo is now getting, routinely over 10 hours a night versus what we experienced with CPAP where he would pull his mask off up to fifteen times a night. Theo sleeping through the night has also benefitted us as parents since we would need to get up and assist him, and we could each feel the toll poor sleep was taking on our health," Rachel and Andrew Scott said in a statement. "We have also noticed Theo wakes up more easily in the morning and has a longer attention span than before the surgery, and his language development has accelerated from one-word statements to multiple word sentences. This procedure has absolutely been a game-changing intervention in Theo's life and in our family's."

Hartnick and Skotko are currently leading an NIH-sponsored 4-year trial examining the impact of upper airway stimulation on neurocognition and language in young patients with Down syndrome.

Children with Down syndrome are disproportionally affected by obstructive sleep apnea and often don't benefit from traditional interventions, and research shows this impacts their cognitive development and IQ scores. The potential long-term impact on neurocognition was a major driver of our team and the family's shared decision-making to pursue this treatment, and this case suggests it may be a possible option for some families."

Christopher Hartnick, MD,Director of Pediatric Otolaryngology at Mass Eye and Ear

"In our Down Syndrome Program, I see first-hand how frustrated families become when their child with Down syndrome runs out of options to treat significant sleep apnea," said Skotko. "Theo now opens up a new frontier for research and potential clinical care."

Source:

Journal reference:

Wasserman, I.,et al.(2024) Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea in a Young Child With Down Syndrome. Pediatrics. doi.org/10.1542/peds.2023-063330.

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Hypoglossal nerve stimulation offers hope for pediatric Down syndrome patients with OSA - News-Medical.Net

Pediatrics

Efforts to reduce wait times for developmental evaluations – Baylor College of Medicine | BCM

In the state of Texas, there are over 500,000 children and adults with IDD (intellectual or developmental disabilities inclusive of autism spectrum disorder (ASD), intellectual disability, and related conditions). Additionally, thousands more have learning and/or attention difficulties (ADHD, dyslexia, etc.).

Children referred to a developmental-behavioral pediatrician often wait well over a year for a developmental evaluation. This delay in assessment is even more problematic in light of evidence that has demonstrated the importance of early recognition and intervention in achieving optimal outcomes for children with developmental diagnoses such as autism or intellectual disability.

This problem is not unique to Texas. There are just over 700 board-certified developmental-behavioral pediatricians nationally (compared to nearly 3,000 pediatric cardiologists in 2021, for example) and wait times are similar for developmental pediatrics clinics nationwide. This problem does not end after childhood. In fact, even fewer physicians providing primary care for adults have received training in healthcare transition or adult care for individuals with intellectual and developmental disabilities (IDD) and autism.

The Maternal Child Health Bureau (MCHB), a branch of the Health and Resource Services Administration (HRSA), has responded to this workforce crisis by offering a select number of Developmental-Behavioral Pediatrics (DBP) Training Grants to academic medical institutions across the nation. For the first time, Baylor College of Medicine is the recipient of a DBP training grant as of July 2023.

Project directors Dr. Holly Harris, assistant professor of pediatrics in the section of developmental and behavioral pediatrics, and Dr. Jordan Kemere, assistant professor of internal medicine in the section of transition medicine, were awarded just over 1.3 million to be distributed over the 5-year grant cycle. The majority of the activities for the DBP Training Grant are housed at the Meyer Center for Developmental Pediatrics and Autism at Texas Childrens Hospital, in addition to the Transition Medicine Clinic at Baylor and Texas Childrens. DBP trainees and faculty also interface with the Harris Health System to provide developmental evaluations to children at the Pasadena Pediatric and Adolescent Health Center.

The grant objectives are to train the next generation of leaders in DBP, to provide continuing education and technical assistance to providers and agencies caring for individuals with IDD/autism, and ultimately increase access to care.

This funding will allow Baylor to expand its DBP Fellowship program by increasing the number of incoming trainees and by facilitating more robust recruitment activities. The funding also supports a novel one-year Transition Lifespan Fellowship, a nationally unique offering that trains a physician specifically in healthcare transition and lifespan care for individuals with IDD and autism, a priority within the Autism Cares Act of 2019 and HRSA/MCHBs Blueprint for change.

Along with training subspecialists, the grant funding also supports a unique training opportunity for primary care pediatricians (PCPs) interested in honing their skills in developmental assessment. This training enables a pediatrician to confidently diagnose and provide appropriate recommendations for straightforward cases of developmental conditions, such as autism or intellectual disability, in the medical home. Not only are children and families able to work with a provider with whom they have had continuity of care, but they also are able to immediately access appropriate interventions without waiting for a specialist assessment. Thus far, there has been overwhelming interest in this position from primary care pediatricians across the Houston area.

The grant faculty are also planning to conduct needs assessments of local community agencies to determine how to best support individuals in the community who are providing care for individuals with IDD and autism. Surveys with underserved populations, including Spanish-speaking families and transition-aged youth, are also underway. These will allow us to understand the needs of our population better so that we can construct our educational offerings accordingly. The DBP workforce crisis will clearly take time to address, but investigators at Baylor are excited to play a part in moving the needle through education and, ultimately, increased access to care for individuals and families of individuals with IDD.

By Dr. Holly Harris, assistant professor of pediatrics, program director, developmental-behavioral pediatrics fellowship at Texas Childrens Hospital/Baylor College of Medicine and Dr. Kathryn Jordan Kemere, assistant professor of medicine transition medicine at Baylor College of Medicine

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Efforts to reduce wait times for developmental evaluations - Baylor College of Medicine | BCM

Pediatrics

Nasal oxidative stress mediating the effects of colder temperature exposure on pediatric asthma symptoms | Pediatric … – Nature.com

Barrett, C. et al. Eat or Heat: Fuel Poverty and Childhood Respiratory Health. Lancet Respir. Med. 10, 229 (2022).

Article PubMed Google Scholar

Hyrks-Palmu, H. et al. Cold Weather Increases Respiratory Symptoms and Functional Disability Especially among Patients with Asthma and Allergic Rhinitis. Sci. Rep. 8, 18 (2018).

Article Google Scholar

He, L. et al. Associations between Personal Apparent Temperature Exposures and Asthma Symptoms in Children with Asthma. PLoS One 18, e0293603 (2023).

Article CAS PubMed PubMed Central Google Scholar

Xu, Z. et al. Extreme Temperatures and Emergency Department Admissions for Childhood Asthma in Brisbane, Australia. Occup. Environ. Med. 70, 730735 (2013).

Article PubMed Google Scholar

Chen, Y. et al. Associations between Ambient Temperature and Adult Asthma Hospitalizations in Beijing, China: A Time-Stratified Case-Crossover Study. Respir. Res. 23, 112 (2022).

Article Google Scholar

Cohen, J., Agel, L., Barlow, M., Garfinkel, C. I. & White, I. Linking Arctic Variability and Change with Extreme Winter Weather in the United States. Science 373, 11161121 (2021).

Article PubMed Google Scholar

Nadeem, A., Raj, H. G. & Chhabra, S. K. Increased Oxidative Stress in Acute Exacerbations of Asthma. J. Asthma 42, 4550 (2005).

Article CAS PubMed Google Scholar

Strauss, R. H., McFadden, E. Jr, Ingram, R. Jr, Jaeger, J. J. & Stearns, D. R. Enhancement of Exercise-Induced Asthma by Cold Air. N. Engl. J. Med. 297, 743747 (1977).

Article CAS PubMed Google Scholar

Kaminsky, D. A., Bates, J. H. & Irvin, C. G. Effects of Cool, Dry Air Stimulation on Peripheral Lung Mechanics in Asthma. Am. J. Respir. Crit. Care Med. 162, 179186 (2000).

Article CAS PubMed Google Scholar

Deng, L. et al. High and Low Temperatures Aggravate Airway Inflammation of Asthma: Evidence in a Mouse Model. Environ. Pollut. 256, 113433 (2020).

Article CAS PubMed Google Scholar

Holguin, F. Oxidative Stress in Airway Diseases. Ann. Am. Thorac. Soc. 10, S150S157 (2013).

Article PubMed Google Scholar

DAmato, M. et al. The Impact of Cold on the Respiratory Tract and Its Consequences to Respiratory Health. Clin. Transl. Allergy 8, 18 (2018).

Article Google Scholar

Zeng, M. et al. Local and Systemic Oxidative Stress and Glucocorticoid Receptor Levels in Chronic Obstructive Pulmonary Disease Patients. Can. Respir. J. 20, 3541 (2013).

Article PubMed PubMed Central Google Scholar

He, L. et al. Malondialdehyde in Nasal Fluid: A Biomarker for Monitoring Asthma Control in Relation to Air Pollution Exposure. Environ. Sci. Technol. 54, 1140511413 (2020).

Article CAS PubMed Google Scholar

Cui, X. et al. Association between Bedroom Particulate Matter Filtration and Changes in Airway Pathophysiology in Children with Asthma. JAMA Pediatrics 174, 533542 (2020).

Article PubMed PubMed Central Google Scholar

He, L. et al. Associations of Personal Exposure to Air Pollutants with Airway Mechanics in Children with Asthma. Environ. Int. 138, 105647 (2020).

Article CAS PubMed Google Scholar

Ilyasova, D., Scarbrough, P. & Spasojevic, I. Urinary Biomarkers of Oxidative Status. Clin. Chim. Acta 413, 14461453 (2012).

Article PubMed PubMed Central Google Scholar

Khoubnasabjafari, M., Ansarin, K. & Jouyban, A. Salivary Malondialdehyde as an Oxidative Stress Biomarker in Oral and Systemic Diseases. J. Dent. Res. Dent. Clin. Dent. Prospects 10, 71 (2016).

Article PubMed PubMed Central Google Scholar

Gong, J. et al. Malondialdehyde in Exhaled Breath Condensate and Urine as a Biomarker of Air Pollution Induced Oxidative Stress. J. Exposure Sci. Environ. Epidemiol. 23, 322 (2013).

Article CAS Google Scholar

Valavanidis, A., Vlachogianni, T. & Fiotakis, C. 8-Hydroxy-2-Deoxyguanosine (8-Ohdg): A Critical Biomarker of Oxidative Stress and Carcinogenesis. J. Environ. Sci. Health Part C. 27, 120139 (2009).

Article CAS Google Scholar

He, L. et al. Effects of Personal Air Pollutant Exposure on Oxidative Stress: Potential Confounding by Natural Variation in Melatonin Levels. Int. J. Hyg. Environ. Health 223, 116123 (2020).

Article CAS PubMed Google Scholar

He, L., Liu, X. L. & Zhang, J. J. Simultaneous Quantification of Urinary 6Sulfatoxymelatonin and 8Hydroxy2Deoxyguanosine Using Liquid Chromatography-Tandem Mass Spectrometry. J. Chromatogr. B 1095, 119126 (2018).

Article CAS Google Scholar

Liu, A. H. et al. Development and Cross-Sectional Validation of the Childhood Asthma Control Test. J. Allergy Clin. Immunol. 119, 817825 (2007).

Article PubMed Google Scholar

Koolen, B. et al. Comparing Global Initiative for Asthma (Gina) Criteria with the Childhood Asthma Control Test (C-Act) and Asthma Control Test (Act). Eur. Respir. J. 38, 561566 (2011).

Article CAS PubMed Google Scholar

Schoemann, A. M., Boulton, A. J. & Short, S. D. Determining Power and Sample Size for Simple and Complex Mediation Models. Soc. Psychological Personal. Sci. 8, 379386 (2017).

Article Google Scholar

Cruz, A. A., Naclerio, R. M., Proud, D. & Togias, A. Epithelial Shedding Is Associated with Nasal Reactions to Cold, Dry Air. J. Allergy Clin. Immunol. 117, 13511358 (2006).

Article PubMed Google Scholar

Huang, D. et al. Cold Exposure Impairs Extracellular Vesicle SwarmMediated Nasal Antiviral Immunity. J. Allergy Clin. Immunol. 151, 509525.e508 (2023).

Article CAS PubMed Google Scholar

Lester, S. N. & Li, K. Toll-Like Receptors in Antiviral Innate Immunity. J. Mol. Biol. 426, 12461264 (2014).

Article CAS PubMed Google Scholar

Novak, N., Haberstok, J., Bieber, T. & Allam, J.-P. The Immune Privilege of the Oral Mucosa. Trends Mol. Med. 14, 191198 (2008).

Article CAS PubMed Google Scholar

Lin, Z., Sun, L., Li, L. & Jiang, S. Nasal Mucosa Is Much More Susceptible Than Oral Mucosa to Infection of SarsCov2 Omicron Subvariants: Wearing Nasal Masks Where Facial Masks Cannot Be Used. J. Med. Virol. 95, e28577 (2023).

Article CAS PubMed Google Scholar

Blagojevic, D. P., Grubor-Lajsic, G. N. & Spasic, M. B. Cold Defence Responses: The Role of Oxidative Stress. Front. Biosci. Scholar 3, 416427 (2011).

Article Google Scholar

Saadeh, C., Saadeh, C., Cross, B., Gaylor, M. & Griffith, M. Advantage of Impulse Oscillometry over Spirometry to Diagnose Chronic Obstructive Pulmonary Disease and Monitor Pulmonary Responses to Bronchodilators: An Observational Study. SAGE Open. Medicine 3, 2050312115578957 (2015).

Google Scholar

Guan, W.-j et al. Impulse Oscillometry in Adults with Bronchiectasis. Ann. Am. Thorac. Soc. 12, 657665 (2015).

Article PubMed Google Scholar

Nadeem, A. et al. Proteinase Activated Receptor2Mediated Dual Oxidase2 upRegulation Is Involved in Enhanced Airway Reactivity and Inflammation in a Mouse Model of Allergic Asthma. Immunology 145, 391403 (2015).

Article CAS PubMed PubMed Central Google Scholar

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Nasal oxidative stress mediating the effects of colder temperature exposure on pediatric asthma symptoms | Pediatric ... - Nature.com

Pediatrics

Week in review: A new dermatology case study, and a new treatment for severe asthma – Contemporary Pediatrics

Thank you for visiting the Contemporary Pediatrics website. Take a look at some of our top stories from last week (Monday, April 8, to Friday, April 12, 2024), and click on each link to read and watch anything you may have missed.

1.) Young woman with tick bites presents with erythematous papules, headaches, and fatigue

A young woman with no significant past medical history returns from hiking with several white-spotted ticks and experiences erythematous papules, rashes, headaches, and fatigue. Whats the diagnosis?

Click here for the full case, differential diagnosis, and case diagnosis.

2.) FDA approves benralizumab for children aged 6 to 11 years with severe asthma

The FDA approval of benralizumab for patients ages 6 to 11 with asthma follows the conclusions of the phase 3 TATE study. Click here for full FDA approval details.

3.) FDA approves dolutegravir/lamivudine to treat HIV infection in adolescents

The indication is approved for those with no antiretroviral (ARV) treatment history or to replace current ARV regimen in those, "are virologically suppressed (HIV-1 RNA less than 50 copies/mL) on a stable ARV regimen with no history of treatment failure and no known substitutions associated with resistance to the individual components of [dolutegravir/lamivudine]," ViiV stated.

Click here for full approval details.

4.) Does vitamin C among pregnant smokers improve airway function trajectory in offspring?

"Our findings provide evidence for a direct association between maternal smoking during pregnancy and wheeze occurrence," wrote the authors.

Click here for the full article.

5.) Does acetaminophen intake during pregnancy influence childrens risk of neurodevelopmental disorders?

A recently published study in JAMA sought to determine if there is a link between acetaminophen use during pregnancy and childrens risk of developing autism, ADHD, or intellectual disabilities.

Click here for the full article.

Read more:

Week in review: A new dermatology case study, and a new treatment for severe asthma - Contemporary Pediatrics