bims-cliped Biomed News
on Clinical pediatrics
Issue of 2026–07–12
forty-one papers selected by
Alyssa M. Portwood, Akron’s Children
  1. The 2026 report mandated by the U.S. congress to assess the NIH support for pediatric research - strategies to enhance NIH-funded pediatric research: Optimizing child health.
  2. Rising Pediatric Button Battery Injuries Despite Safety Efforts: An Analysis of National Injury Data.
  3. Pediatric E-Scooter and Traditional Scooter Injuries: Emergency Department Visits 2015-2024.
  4. Evidence-Based Safe Firearm Storage Counseling in the Pediatric Intensive Care Unit.
  5. Centering Lived Experience: Inclusive Pediatric Care for Children Who Are Deaf and Hard of Hearing and Their Families.
  6. The National Pediatric Readiness Quality Initiative: Empowering Emergency Departments to Improve Pediatric Care.
  7. A Research Agenda for Acute Pediatric Mental and Behavioral Health Emergencies.
  8. Navigating Pediatric Urticaria: Diagnosis and Management for the Busy Pediatrician.
  9. 30-30-60: A Quality Improvement Project on Faster Enteral Feed Advancement and Early Fortification.
  10. Current situation, challenges and future trends of pediatric palliative care from a multi-dimensional perspective: a narrative review.
  11. Location of Crisis Service Delivery for Medicaid-Enrolled Youths With Behavioral Health Conditions.
  12. Using Quality Improvement Methodology to Inform Safe Implementation of Propofol Procedural Sedation in a Pediatric Emergency Department.
  13. What the Salary Rankings Miss About Pediatric Surgery: Readiness, Not Compensation.
  14. Increasing Direct Admissions Safely with an Inclusive Guideline.
  15. Promoting equity for children and adolescents through implementation processes in health and social care: a scoping review.
  16. NO PLACE LIKE HOME: DISCHARGE TIMING AND COSTS FOLLOWING PEDIATRIC GASTROSTOMY TUBE PLACEMENT IN THE UNITED STATES.
  17. Improving Access to Human Milk Through a Breast Pump Program for Hospitalized Infants at a Large, Urban Safety Net Hospital.
  18. Prediabetes in children and adolescents: what do we need to know?
  19. Disease severity and postoperative complications after appendectomy.
  20. Preparing Pediatric Patients for MR Imaging Without Sedation.
  21. Clinical and demographic risk profiles of non-suicidal self-injury among pediatric emergency department presentations: a three-year retrospective study.
  22. Changes in Opioid Prescription Patterns Following Implementation of the Controlled Substance Utilization Review and Evaluation System.
  23. Implementation and evaluation of a quality improvement project to standardize food insecurity screening in a pediatric nephrology clinic.
  24. Skin-to-skin contact in neonatal intensive care units: a narrative review of implementation challenges and strategies within infant- and family-centered care.
  25. High-Acuity Pediatric Home Nursing: Safer Children, Expanded Access.
  26. Adolescents' and Young Adults' Recalled Exposure to E-Cigarette Retail Stores on the Path to School: Association With Past 30-Day Use and Susceptibility to Use.
  27. Optimizing Trauma-Informed Care in Pediatric Health Care: A Call to Action.
  28. Engaging Families in Pediatric Care Management: A Qualitative Study From the North Carolina Integrated Care for Kids Model.
  29. Language barriers are associated with worse outcomes in pediatric foreign body aspiration: A national cohort study.
  30. Prevalence and types of insulin-pump-related skin complications in children and adolescents with type 1 diabetes: A systematic review and meta-analysis.
  31. Pediatric Psoriasis: Comorbidities, Treatment Challenges and Unmet Needs.
  32. The Relationship Between Children with Special Health Care Needs, Chronic Pain, and Unmet Health Care Needs.
  33. Influenza Vaccine Effectiveness Against Pediatric Death in the United States: 2016-2025.
  34. Low-Tech In-Situ Simulation Improves Neonatal Resuscitation Skills in Community Hospitals.
  35. Refractory Chronic Inflammatory Bowel Disease in Childhood and Adolescence: Options in Primary Non-Response or Secondary Treatment Failure.
  36. Pediatric Dermatology Multidisciplinary Clinics: A Survey of Division Leaders.
  37. Factors Affecting Clinical Decision Making for Blood Flow Restriction Training in Pediatric and Adolescent Patients Following Anterior Cruciate Ligament Injury.
  38. Establishing Neonatal Toxicology Testing Protocols to Prioritize Clinical Utility Reduces Racial and Socioeconomic Bias.
  39. Visits to optometrists or ophthalmologists by U.S. school-aged children with autism: Estimates from the 2022-2023 National Survey of Children's Health.
  40. From Early Childhood to Adulthood: Implementing Neuroaffirming Health Care for Autistic Individuals.
  41. Big Thoughts in Little Jars: Memory Days for Families Where a Child has Died.
  1. J Pediatr Nurs. 2026 Jul 06. pii: S0882-5963(26)00289-7. [Epub ahead of print]90 362-365
    The 2026 report mandated by the U.S. congress to assess the NIH support for pediatric research - strategies to enhance NIH-funded pediatric research: Optimizing child health.
    Pamela S Hinds.
       PURPOSE: Physical and mental health symptoms are increasing in children in America and with lifelong adverse consequences. Research is the strongest approach to identifying and addressing the causes of this decrease in child health. The U.S. Congress in 2023 mandated a data-driven report be prepared by a committee of pediatric experts regarding the level of support by the National Institutes of Health (NIH) for pediatric research. The purpose of this article is to describe how the report was prepared and the recommendations made.
    METHOD: The report procedures were overseen by the National Academies of the Sciences, Engineering and Medicine. Eighteen experts in pediatric health and research comprised the consensus committee. Multiple sources of public-facing data were reviewed, and leaders at the NIH were interviewed. Fourteen additional experts reviewed the final report and offered critique comments.
    RESULTS: Though past advances in pediatric health made possible by funding support from the NIH were acknowledged, current barriers to more efficient and effective conduct of pediatric research were identified. Eight recommendations were made to elevate pediatric research within the NIH by altering current structures, creating a culture of child inclusion in research, and providing expanded resources.
    CONCLUSIONS: Gaps in funding for important factors contributing to health and its decline in children exist in funding for pediatric research from the NIH. Addressing these gaps holds the promise of improving health for children in America.
    Keywords:  Child health; National Institutes of Health; Pediatric nursing research implications; Pediatric research; Research funding
    DOI:  https://doi.org/10.1016/j.pedn.2026.06.023
  2. Laryngoscope. 2026 Jul 07.
    Rising Pediatric Button Battery Injuries Despite Safety Efforts: An Analysis of National Injury Data.
    Henry Diamond-Pott, Diana S Shaari, Larissa Iraj, Sara O'Sullivan-Bakshi, Aldo Londino, Stephanie J Wong, Benjamin M Laitman.
       OBJECTIVES: Button battery injuries are emergencies associated with airway and esophageal injury. Despite increased public awareness and recent federal safety legislation, the population-level impact on injury trends remains unclear. This study evaluates national trends in pediatric button battery exposures in the postpandemic era.
    METHODS: The National Electronic Injury Surveillance System was queried for button battery-related ingestions and aspirations presenting to a US emergency department (ED) between January 1, 2020 and December 31, 2024. Cases were identified using product codes and narrative review. Demographics, diagnosis, and disposition were analyzed. Trends and categorical differences were assessed using ANOVA and chi-squared testing, with statistical significance set at p < 0.05.
    RESULTS: A total of 24,891 pediatric button battery exposures were identified between 2020 and 2024. Annual cases increased from 3785 in 2020 to 6424 in 2024, representing a 70% rise (p < 0.001). When adjusted for the US pediatric population, the rate increased from 5.1 to 8.8 per 100,000 children. Children aged 13-24 months represented the largest proportion of cases (50.5%), and males comprised 59.8%. Hospitalizations increased from 807 to 1148, although the proportion of cases requiring admission declined after peaking in 2021. Hospitalization rates differed by age and race, with older children and Black children more likely to be admitted (p < 0.001).
    CONCLUSION: Despite a declining pediatric population, button battery-related ED visits rose sharply from 2020 to 2024. Although hospitalization rates declined proportionally after 2021, the overall injury burden and healthcare utilization increased. Persistent demographic disparities require continued surveillance, prevention strategies, and equitable access to care.
    LEVEL OF EVIDENCE: 3:
    Keywords:  button battery ingestion; health disparities; injury epidemiology; pediatric emergency medicine
    DOI:  https://doi.org/10.1002/lary.70731
  3. Pediatr Emerg Care. 2026 Jul 07.
    Pediatric E-Scooter and Traditional Scooter Injuries: Emergency Department Visits 2015-2024.
    Katherine E Douglas, Alexander W Hirsch, Andrew M Fine, Todd W Lyons.
       OBJECTIVES: Electronic scooters (e-scooters) are increasing in popularity. We sought to compare pediatric e-scooters to traditional scooter injuries, analyze risk factors for non-home disposition, and evaluate injury trends.
    METHODS: We performed a retrospective, cross-sectional study of ED visits for scooter injuries from 2015 to 2024, utilizing the National Electronic Injury Surveillance System, utilizing product codes to identify mechanisms. We compared e-scooter to traditional scooter injuries, and home disposition to non-home disposition (resulting in hospitalization, transfer, or death), using proportion differences and multivariable modeling adjusting for age, sex, and injury characteristics. We described time trends in ED visits for e-scooter injuries.
    RESULTS: We identified 18,254 (population estimate 502,324) ED visits for scooter injuries, of which 3094 [population estimate 91,523 (18.2%)] were e-scooters. E-scooter injuries were more common among males and in older children (age 12 to 18 y). Compared with traditional scooter injuries, e-scooter injuries were more likely to result in admission (adjusted OR: 1.73; 95% CI: 1.2-2.42) and internal injuries (12.1% e-scooter, 9.0% traditional scooter; P < 0.05). E-scooter injuries were associated with increased odds of non-home disposition compared with traditional scooters (adjusted OR: 2.99, 95% CI: 1.66, 5.41). Overall, e-scooter injuries made up an increasing percentage of pediatric ED visits over the study period (annualized OR: 1.22; 95% CI: 1.17-1.28).
    CONCLUSIONS: E-scooter injuries, compared with traditional scooter injuries, are associated with more non-home disposition and specific injury patterns, and are increasing as a proportion of ED injury visits over the past 10 years. These findings inform providers and the public of risks associated with pediatric e-scooter use.
    Keywords:  e-scooter; electric scooter; micromobility devices; trauma
    DOI:  https://doi.org/10.1097/PEC.0000000000003652
  4. Hosp Pediatr. 2026 Jul 09. pii: e2026009463. [Epub ahead of print]
    Evidence-Based Safe Firearm Storage Counseling in the Pediatric Intensive Care Unit.
    Anireddy R Reddy, Sneha Kadiyala, Sanya Tinaikar, Laura Bricklin, Megan Bernstein, Kenya Agarwal, Robert Boyd, Nadir Yehya, Joel Fein, Dorothy Novick, Charlotte Z Woods-Hill.
       INTRODUCTION: Firearm-related injury is the leading cause of death in children in the United States. Safe storage counseling with gun lock distribution is an evidence-based practice to reduce firearm injury; however, it is infrequently employed in the pediatric intensive care unit (PICU), creating a missed opportunity for injury prevention. We assessed caregiver perceptions after implementing safe storage counseling in our PICU, hypothesizing that caregivers would find this practice acceptable and increase intent to safely secure firearms.
    METHODS: With multidisciplinary PICU clinicians and family advisory board input, we created a workflow for universal safe storage counseling and lock distribution. We identified patients with planned discharge or transfer daily and approached those with a caregiver at bedside to provide safe storage counseling, a free cable gun lock, and a postcounseling survey.
    RESULTS: 350 (86%) of 407 caregivers, predominantly mothers, completed the postcounseling survey. This was the first time receiving counseling from a health care clinician for 87% of caregivers; 97% found the PICU an acceptable location. The majority (78%) reported an increased likelihood of asking about safe storage of firearms in other homes where their children spend time, 87% reported they intended to share information received. 30% planned to use the lock provided, and 56% would give the lock to someone else. Others planned to remove a firearm (3%) and/or change their firearm storage practices (17%).
    CONCLUSION: We demonstrated high acceptability and potential impact of a universal approach to safe storage counseling and gun lock distribution in the PICU.
    DOI:  https://doi.org/10.1542/hpeds.2026-009463
  5. Pediatr Ann. 2026 Jul;55(7): e260-e268
    Centering Lived Experience: Inclusive Pediatric Care for Children Who Are Deaf and Hard of Hearing and Their Families.
    Arielle Spellun, Bonnie Crume, Alayna Finley, Jennifer Fleming, Karen Hopkins, Jane Stewart.
      The diversity of experiences of children and individuals who are d/Deaf or hard of hearing (DHH) is broad. Nearly 1 to 2 out of every 1,000 children in the United States, and globally up to 20 out of every 1,000 children, are born DHH, with increasing prevalence as children grow. With proper support that centers early language access, positive identity development, and learning from individuals with lived experience-either as caregivers or as adults who are DHH-all children who are DHH can thrive. Due to the varied needs and backgrounds of children who are DHH, individualized, family-centered, and culturally informed care is essential. In order to best support children who are DHH and their families, primary care clinicians must provide care that is informed by specialists, parents, and individuals with lived experience to ensure children who are DHH are equipped with the resources and interventions necessary to reach their full potential.
    DOI:  https://doi.org/10.3928/19382359-20260318-02
  6. NEJM Catal Innov Care Deliv. 2026 Jul;7(7): CAT250185
    The National Pediatric Readiness Quality Initiative: Empowering Emergency Departments to Improve Pediatric Care.
    Sanyukta Desai, Elizabeth Edgerton, Aaron R Jensen, Katherine Remick.
      Over 80% of all pediatric emergency visits occur in non-pediatric emergency departments (EDs). Continuous quality improvement (QI) is linked to higher pediatric readiness and improved patient outcomes, and, consequently, can lead to a 76% decreased mortality risk for critically ill and injured children. However, fewer than one third of EDs use quality indicators to evaluate and improve pediatric care delivery. Major barriers to QI in non-pediatric EDs include the absence of performance standards; challenges with standardized data collection, analysis, and benchmarking; and limited institutional resources to enhance pediatric emergency care. The authors describe the National Pediatric Readiness Quality Initiative (NPRQI), a free and secure platform that provides ED-based health care teams with real-time, crucial insights into the quality of pediatric emergency care delivery to empower providers to engage in pediatric QI. The NPRQI overcomes the aforementioned barriers to QI by providing (1) the first nationally vetted pediatric quality measures that apply to all types of EDs, including resource-restricted, low-volume EDs; (2) standardized data collection, performance visualization, and benchmarking for participating EDs; and (3) a free, secure web-based direct-to-provider interface for rapid interpretation and action by health care teams. Since its launch in 2023, the NPRQI has engaged more than 100 diverse EDs across 26 states. The NPRQI seeks to transform pediatric emergency care by shortening the time to adoption of and adherence to evidence-derived clinical processes through data transparency and benchmarking. Furthermore, by capturing pediatric care delivery nationally across all types of EDs, the NPRQI is poised to establish the first set of national standards for pediatric emergency care following the model of standards established for stroke and cardiac centers.
    DOI:  https://doi.org/10.1056/CAT.25.0185
  7. Ann Emerg Med. 2026 Jul 10. pii: S0196-0644(26)00320-3. [Epub ahead of print]
    A Research Agenda for Acute Pediatric Mental and Behavioral Health Emergencies.
    Pediatric Emergency Care Applied Research Network Mental Health Working Group
       STUDY OBJECTIVE: To identify high-priority research questions related to emergency care of children with mental and behavioral health conditions and develop a consensus-based research agenda.
    METHODS: We recruited expert partners to participate in a modified Delphi method to develop a consensus-based research agenda. The Pediatric Emergency Care Applied Research Network Mental Health Working Group formulated initial research priorities, informed by literature review. Expert partners modified, added to, and rated proposed research priorities on a 9-point scale across 3 survey rounds. Ratings assessed overall priority, followed by need and urgency, research impact, and family centeredness. Top tier priorities had a median of at least 7 for all 3 domains and a median over 7 in at least 2 domains.
    RESULTS: The 23 expert partners included 4 parents/caregivers and 1 young adult with lived experience, 9 physicians with various training backgrounds, 3 nurses, 3 social workers, 2 out-of-hospital clinicians, and 1 program officer. Of 76 initial research priorities, 41 were dropped and 16 were newly proposed; the expert panel reached consensus on 51 research priorities. Thirty-one top tier research priorities encompassed aspects of out-of-hospital care (eg, training, novel response models), general emergency care and boarding (eg, brief interventions), management of acute agitation (eg, effectiveness of de-escalation methods and medications), suicide prevention (eg, effectiveness of safety planning), and optimal postdischarge follow-up care.
    CONCLUSION: This consensus-based research agenda, which integrates diverse perspectives, informs the need for research to improve identification and management of children at risk of harming themselves or others in the out-of-hospital and emergency department settings.
    Keywords:  Adolescent; Child; Emergency service; Hospital; Mental health
    DOI:  https://doi.org/10.1016/j.annemergmed.2026.05.015
  8. Pediatr Ann. 2026 Jul;55(7): e286-e291
    Navigating Pediatric Urticaria: Diagnosis and Management for the Busy Pediatrician.
    Kristen D Goncalves, Sara M Laule, Heather L Burrows, Sara K McLaughlin.
      Urticaria is a common pediatric skin condition frequently prompting a clinical encounter, unnecessary testing, and subspecialist referrals. Etiology, symptom management, and work-up vary based on the type of urticaria. In this review, we highlight causes of acute and chronic urticaria in children and review pathophysiology and treatment strategies, focusing on new developments. We emphasize practical clinical management strategies for the outpatient pediatrician and discuss indications for work-up and referral.
    DOI:  https://doi.org/10.3928/19382359-20260504-02
  9. Hosp Pediatr. 2026 Jul 08. pii: e2025008954. [Epub ahead of print]
    30-30-60: A Quality Improvement Project on Faster Enteral Feed Advancement and Early Fortification.
    Radhika Maddali, Carmen Alvarez Gell, Eric Basile, Jillian Connors.
       BACKGROUND: Early nutrition for premature infants is a crucial determinant of postnatal growth, neurodevelopment, and survival. Concerns about necrotizing enterocolitis (NEC) have led to delays in the introduction and advancement of enteral feeding. Our quality improvement (QI) project aimed to decrease the time to achieve full enteral feeds and central line duration in infants born between 27 to 32 weeks and 6 days' gestation.
    METHODS: We conducted this QI initiative from August 2023 to December 2024. We designed a simplified feeding guideline, 30-30-60, which involved initiation of enteral feeds at a volume of 30 ml/kg/d, advancement by 30 ml/kg/d, and earlier fortification at 60 ml/kg/d. Statistical control charts were used to study changes over time. We measured days to full enteral feeds and central line days as primary outcomes. Balancing measures were rates of feeding intolerance and usage of donor breast milk. Clinical outcomes (late-onset sepsis, NEC) were also tracked.
    RESULTS: A total of 84 infants were included. The mean time to achieve full enteral feeds decreased by 25.5%, from 11 days to 8.2 days, whereas the mean duration of central line days decreased by 34%, from 8.9 days to 5.9 days. The percentage of infants requiring peripherally inserted central catheter placement decreased by 67%, from 42.9% at baseline to 14%. Episodes of feeding intolerance decreased over time, whereas the donor human milk usage, late-onset sepsis, and NEC rates remained stable.
    CONCLUSIONS: QI methodology was successfully used to implement new feeding guidelines, thereby reducing days to full enteral feeds and central line duration.
    DOI:  https://doi.org/10.1542/hpeds.2025-008954
  10. Transl Pediatr. 2026 Jun 30. 15(6): 250
    Current situation, challenges and future trends of pediatric palliative care from a multi-dimensional perspective: a narrative review.
    Danni Lv, Yang Li, Xiaofei Chen, Yiyao Bao.
       Background and Objective: Pediatric palliative care (PPC) provides holistic support for children and adolescents with life-threatening or life-limiting conditions and their families. This narrative review summarizes PPC concepts, current service models, key implementation challenges, evidence in major practice areas, and future directions, with attention to global differences and the Chinese context.
    Methods: A narrative review was conducted using a targeted PubMed search and supplementary checking of key consensus documents, guidelines, reviews, and organizational reports published from 2010 to 2025. Findings were synthesized thematically rather than quantitatively.
    Key Content and Findings: The review is organized across four domains: foundational concepts and target populations; global service models and regional differences; major challenges involving culture, access, workforce, policy, financing, and ethics; and key practice areas including symptom management, psychosocial-spiritual support, family-centered decision-making, early integration, digital health, and capacity building. PPC has developed rapidly in high-income settings, but access remains uneven, and low-resource regions face persistent barriers related to workforce, essential medicines, reimbursement, and cultural acceptance.
    Conclusions: PPC should be integrated early into serious pediatric illness care while remaining adaptable to local health-system capacity, culture, and family needs. Future progress requires clearer definitions, stronger methods, tiered service models, professional training, equitable access to essential medicines, context-sensitive terminology, and implementation research in underrepresented regions.
    Keywords:  Pediatric palliative care (PPC); end-of-life care; interdisciplinary team; multi-dimensional perspective; palliative care
    DOI:  https://doi.org/10.21037/tp-2026-0343
  11. Psychiatr Serv. 2026 Jul 08. appips20250581
    Location of Crisis Service Delivery for Medicaid-Enrolled Youths With Behavioral Health Conditions.
    Ashley A Foster, Mark Zamani, Jennifer A Hoffmann, Anna M Cushing, Naomi Bardach, Mark I Neuman, Chuan-Mei Lee, Joel Hudgins, Matt Hall, Stephanie K Doupnik.
       OBJECTIVES: National guidelines emphasize the value of community-based behavioral health crisis care for youths, including mobile crisis response and telehealth. This study aimed to assess characteristics associated with receipt of crisis care via mobile or community services and telehealth among Medicaid-enrolled youths.
    METHODS: A retrospective study was conducted of a national sample of youths ages 6-17 years who received crisis services and had data in the 2022 Merative MarketScan Medicaid database. Locations of care included mobile or community, telehealth (i.e., virtual), in-person onsite (e.g., hospitals), and other. Multivariable logistic regression was used to evaluate sociodemographic and clinical factors associated with receipt of crisis services via mobile or community response and via telehealth.
    RESULTS: The sample included 18,993 youths who received behavioral health crisis services in 2022. The most frequent service location was in person onsite (63.0%), followed by mobile or community (29.2%), other (9.3%), and telehealth (9.1%). Compared with results for White youths, the odds of receiving crisis care via mobile or community services were higher for Black youths (adjusted odds ratio [AOR]=1.12) and Hispanic youths (AOR=1.26), and the odds of receiving crisis care via telehealth were higher for Black youths (AOR=1.30) and lower for Hispanic youths (AOR=0.05).
    CONCLUSIONS: Despite recommendations that prioritize community-based behavioral health crisis care, most crisis services occurred in person onsite. Racial-ethnic differences were found in receipt of mobile or community and telehealth crisis care. Future research to investigate facilitators, barriers, and preferences may enable more youths to receive community-based crisis care.
    Keywords:  Adolescent Psychiatry; Adolescents/Adolescence; Child Psychiatry; Community Mental Health Services; Crisis Intervention
    DOI:  https://doi.org/10.1176/appi.ps.20250581
  12. Pediatr Emerg Care. 2026 Jul 07.
    Using Quality Improvement Methodology to Inform Safe Implementation of Propofol Procedural Sedation in a Pediatric Emergency Department.
    Alexandria Wiersma, Nikita Habermehl, Rebecca Helmuth, James Brown, Mark G Roback.
       OBJECTIVES: This study used quality improvement (QI) methodology to safely introduce propofol for use in pediatric procedural sedation across a multisite emergency department (ED) system and to evaluate its impact on length of sedation, length of stay (LOS), and serious adverse events (SAEs).
    METHODS: We conducted a QI initiative across 4 pediatric EDs within a quaternary children's hospital network. A multidisciplinary team used the Define-Measure-Analyze-Improve-Control (DMAIC) framework to develop and implement a standardized propofol sedation protocol for short procedures in low-risk patients. Interventions included protocol development, multidisciplinary education, simulation training, electronic medical record (EMR) order set modifications, and phased site rollout. The primary outcome measure was median length of sedation. Secondary outcomes included ED LOS and proportion of sedations using propofol. The balancing measure was airway-related SAEs. All outcomes were analyzed using statistical process control charts and nonparametric testing.
    RESULTS: During the study period, 2368 children underwent procedural sedation with ketamine (2251) or propofol (117). Median length of sedation for all sedations showed no special cause variation. However, propofol sedation duration was significantly shorter than ketamine across sites (18 to 24 vs. 33 to 52 min; P < 0.001). At the primary site, propofol sedation was shorter than ketamine sedations performed within propofol scope (23 vs. 32.5 min; P < 0.001). ED LOS was shorter for propofol sedations at the primary and secondary sites. SAE rates remained low and stable, with propofol‑associated SAEs occurring in 2.6% of cases. Propofol accounted for 4.9% of all sedations and 20% of sedations among eligible patients.
    CONCLUSIONS: Using QI methodology, propofol was feasibly and safely implemented across a multi‑site pediatric ED system. While the overall length of sedation did not change, propofol use within a defined clinical scope was associated with shorter length of sedation and LOS for selected patients, providing a reproducible framework for implementation.
    Keywords:  deep sedation; feasibility; implementation; procedural sedation; safety
    DOI:  https://doi.org/10.1097/PEC.0000000000003650
  13. Am Surg. 2026 Jul 06. 31348261466122
    What the Salary Rankings Miss About Pediatric Surgery: Readiness, Not Compensation.
    Don K Nakayama.
      Recent Bureau of Labor Statistics reports identifying pediatric surgeons among the highest-paid occupational categories in the United States have placed the specialty in an unfamiliar public frame. Although the ranking is accurate, compensation alone provides an incomplete understanding of the role pediatric surgeons play within modern health care systems. Pediatric surgery developed around conditions that befall children and families without warning. The specialty has traditionally emphasized judgment and stewardship, recognizing that the best course of action is often to avoid surgery altogether. Beyond direct patient care, pediatric surgeons help sustain the clinical and educational missions of children's hospitals. Neonatal and pediatric intensive care units, trauma programs, oncology services, emergency departments, and a range of pediatric subspecialties depend upon immediate access to pediatric surgical expertise. Pediatric surgeons also play central roles in residency education, multidisciplinary care, and hospital leadership. Compared with adult surgical specialties, pediatric surgeons are relatively few in number. Children are healthier than adults, and most never require surgery. Training pathways are prolonged, and maintenance of expertise requires concentrated experience. While compensation systems frequently measure clinical activity through procedural metrics, much of the value provided by pediatric surgeons lies in readiness, availability, and the ability to respond to uncommon but life-threatening conditions. Pediatric surgery is therefore best understood not simply as a procedural specialty but as a foundational capability upon which children's hospitals and the field of children's health care depend.
    Keywords:  Children's hospitals; Medical education; Pediatric surgery; Physician compensation; Surgical readiness
    DOI:  https://doi.org/10.1177/00031348261466122
  14. Pediatrics. 2026 Jul 10. pii: e2025074022. [Epub ahead of print]
    Increasing Direct Admissions Safely with an Inclusive Guideline.
    Lauren M McDaniel, Jessica Jones, Colin Bowles, Amber Hyatt, Erin Sullivan, Corrie E McDaniel.
       BACKGROUND AND OBJECTIVES: Direct admission (DA) to the hospital bypasses the receiving hospital's emergency department (ED) and has been shown to offset ED overload without compromising patient safety. We aimed to increase the proportion of unscheduled admissions admitted directly.
    METHODS: We tracked DA to our children's hospital between January 1, 2021, and October 31, 2025. Interventions included centralization of unscheduled admissions within our Transfer Center, establishment of hospitalist attending oversight, and development of a DA guideline inclusive of all diagnoses, ages, and specialties. Interventions went live May 2023. Our primary outcome was the proportion of unscheduled admissions admitted directly, and our secondary outcome was ED length of stay (LOS) for patients admitted through the ED. Balancing measures included escalations of care within 6 hours, time to first clinical assessment, and hospitalization under 12 hours. We used descriptive statistics and statistical process control to assess the impact of our interventions.
    RESULTS: DA increased from 12% preintervention to 18% postintervention without increasing intensive care transfers. During the same period, there was a sustained shift in ED LOS for admitted patients from 335 to 288 minutes. The median time to initial clinical assessment was 11 minutes faster for DA compared with ED admission (DA: 3 minutes, IQR 0-9 minutes vs ED: 14 minutes, IQR 7-30 minutes; P < .001). ED admissions were more likely to be hospitalized less than 12 hours (DA: 3.0% vs ED: 5.0%, P < .001).
    CONCLUSION: A broadly inclusive DA guideline safely increased DA. Future work may explore adaptation within other health systems.
    DOI:  https://doi.org/10.1542/peds.2025-074022
  15. Syst Rev. 2026 Jul 08.
    Promoting equity for children and adolescents through implementation processes in health and social care: a scoping review.
    Michelle Gooey, Heather Morris, Rebecca Madill, Callie Walsh-Bailey, Ahlia Griffiths, Melissa Savaglio, Claire Blewitt, Amanda O'Connor, Sara Holton, Helia Khalesi, Sofia Grage-Moore, Maria Fernandez, Echezona E Ezeanolue, Allison Metz, Ana Baumann, Helen Skouteris.
       BACKGROUND: Despite the many existing implementation methods, theories, and frameworks, implementation science is insufficiently closing the research-to-practice gap. Bridging this gap is critical to achieving healthy and thriving communities globally, and requires implementation processes that promote equity and reach diverse populations, especially those most in need. The aim of this scoping review was to identify, thematically analyse, categorise, and provide examples of implementation processes described in equity-focused literature, with a focus on health and social care interventions for children and adolescents from birth to 18 years of age.
    METHODS: A comprehensive search of literature was undertaken across six electronic databases (Medline, Embase, Cinahl, Scopus, PsycInfo, and Proquest) and Google Scholar, seeking peer-reviewed articles published in English between January 2018 and April 2024. All articles were double-screened at abstract and full text stage. Implementation processes were identified then thematically analysed.
    RESULTS: A total of 14,374 articles were screened; 80 articles (59 health, 21 social care) were included in the analysis. Seven main themes were identified: (1) foster trusting relationships; (2) dismantle top-down approaches and redistribute power; (3) invest with intention; (4) respect and value community-defined evidence; (5) tailor according to context; (6) broaden perspectives beyond practice norms; and (7) use strengths- and value-based approaches. Twenty-six sub-themes and 140 implementation processes were identified, including examples of how these can be operationalised in practice.
    CONCLUSION: This is the first review of equity-focused implementation processes in health and social care. By offering practical examples of the identified implementation processes, the review synthesises findings from published literature into tangible actions directly relevant to implementation practice. However, while these processes show promise, further research is required as their effectiveness remains largely untested and most evidence is from high-income countries. To promote health and social care equity for all children and adolescents, the evidence-base for effective equitable implementation work must be strengthened by, and reflective of, globally diverse voices and experiences.
    Keywords:  Adolescents; Children; Equity; Health; Implementation; Scoping review; Social care
    DOI:  https://doi.org/10.1186/s13643-026-03176-z
  16. J Pediatr Surg. 2026 Jul 09. pii: S0022-3468(26)00378-7. [Epub ahead of print] 163296
    NO PLACE LIKE HOME: DISCHARGE TIMING AND COSTS FOLLOWING PEDIATRIC GASTROSTOMY TUBE PLACEMENT IN THE UNITED STATES.
    Johanna M Borst, Alexandra Highet, John B Rode, Sahita I Manda, Rayan A Rahmani, Mehul V Raval, Timothy B Lautz.
       BACKGROUND: Despite the proven safety of same-day discharge (SDD) after elective pediatric gastrostomy tube placement in appropriately selected patients, recent United States adoption trends remain unknown. Using a contemporary multicenter cohort, we evaluated the association between SDD and adjusted estimated costs as well as temporal trends and hospital-level variation in SDD.
    METHODS: We conducted a retrospective cohort study of children ≤18 years undergoing elective gastrostomy tube placement between 2016 and 2025 using the Pediatric Health Information System database. Encounters with additional operative procedures were excluded. Discharge was dichotomized as SDD or discharge on postoperative day (POD) 1 or 2. Costs were estimated using generalized linear models, adjusting for patient demographics, medical complexity, illness severity, hospital volume, and year. Temporal trends and hospital-level variation in SDD were evaluated using logistic regression models.
    RESULTS: Among 11,818 children across 46 hospitals, SDD occurred in 1,155 encounters (9.8%). Median costs were lower for SDD than for discharge on POD 1 or 2 ($34,018 [IQR $17,959-$46,770] vs $49,491 [IQR $33,284-$71,159]). In adjusted analyses, SDD was associated with 31% lower costs (cost ratio 0.69, 95% CI 0.58-0.82), about $17,000 per encounter. SDD increased from 4.7% in 2016 to 12.0% in 2025, but adoption remained uneven: the five highest-volume hospitals accounted for 59% of all SDD cases.
    CONCLUSIONS: SDD after pediatric gastrostomy tube placement was associated with substantially lower costs, yet adoption remains limited and uneven across hospitals. Expanding standardized perioperative pathways to facilitate SDD represents an important opportunity to improve value in pediatric surgical care.
    DOI:  https://doi.org/10.1016/j.jpedsurg.2026.163296
  17. J Hum Lact. 2026 Jul 08. 8903344261451914
    Improving Access to Human Milk Through a Breast Pump Program for Hospitalized Infants at a Large, Urban Safety Net Hospital.
    Cynthia Renault, Stacey Fauser, Meghan Solano, Ashlee J Vance.
      Human milk is the optimal source of nutrition for infants, especially those born preterm or requiring neonatal intensive care unit care, offering physiologic and psychological benefits for both infants and lactating parents. Despite its importance, access to high-quality electric breast pumps remains a barrier, particularly for underserved populations. To address this, the Lactation Group (LG) at Henry Ford Hospital, a large urban hospital in Detroit, established a Pump Program providing electric pumps to parents facing financial, insurance, or logistical challenges. In the United States, access to durable medical equipment such as breast pumps often depends on insurance coverage, eligibility, and administrative processes, causing delays for many families. The program offers personal-use pumps for long-term needs and hospital-grade loaner pumps for neonatal intensive care unit families or those with lactation difficulties. Lactation consultants assess eligibility, coordinate with insurers or community programs, and provide hands-on education and emotional support. Since 2015, the Pump Program has served more than 1,400 families, maintaining high demand and positive feedback. It integrates through postpartum and intensive care workflows, ensuring continuity of lactation support during medical complications. By providing the necessary tools and addressing structural inequities, the program enhances access to human milk and promotes equitable infant nutrition. Its success highlights the vital role of hospital-based lactation support and offers a model for other urban hospitals aiming to improve health outcomes for families and infants.
    Keywords:  electric breast pump; high-risk infants; human milk; lactation; neonatal intensive care unit
    DOI:  https://doi.org/10.1177/08903344261451914
  18. Ann Pediatr Endocrinol Metab. 2026 Jun;31(3): 160-167
    Prediabetes in children and adolescents: what do we need to know?
    Kyungmi Jang, Philip S Zeitler.
      Pediatric obesity is a growing global concern because it leads to an increased prevalence of abnormal glucose metabolism, including dysglycemia, prediabetes, and type 2 diabetes. Those conditions are associated with significant cardiovascular risk factors such as dyslipidemia, hypertension, metabolic dysfunction-associated steatotic liver disease, and sleep disturbances. Insulin resistance is a key contributor to the pathophysiology of those conditions, and the physiological reduction in insulin sensitivity during puberty further contributes to their pathogenesis in youth. However, insulin sensitivity improves after puberty, leading to spontaneous normalization of glucose metabolism in most individuals and complicating the concept of prediabetes. Therefore, general population screening for diabetes in youth is not recommended except in certain populations with high prevalence. When prediabetes is identified, lifestyle modification remains the primary intervention because pharmacologic treatments have yet to show efficacy in youth. This review explores the definitions, risk factors, screening recommendations, and management strategies for prediabetes in children and adolescents and highlights the limitations of applying adult-based diagnostic criteria to the pediatric population.
    Keywords:  Dysglycemia; Insulin resistance; Pediatric obesity; Puberty; Type 2 diabetes mellitus
    DOI:  https://doi.org/10.6065/apem.2550222.111
  19. Semin Pediatr Surg. 2026 Jul 09. pii: S1055-8586(26)00084-3. [Epub ahead of print] 151668
    Disease severity and postoperative complications after appendectomy.
    Micah Holloway, Olivia Hime, Courtney J Harris.
      Appendectomy is among the most common emergency operations performed in children and is generally well tolerated. However, postoperative complications remain an important source of morbidity, particularly in patients with complicated appendicitis. Disease severity is a major predictor of adverse postoperative outcomes. Despite this, there is no universal definition for complicated appendicitis. American College of Surgeons' National Surgical Quality Improvement Program in Pediatrics (NSQIP-P) criteria provide a proposed intraoperative framework for severity stratification that may help to improve reporting and comparison of outcomes. The most clinically relevant postoperative complications after pediatric appendectomy include organ-space infection or intra-abdominal abscess, surgical site infection, postoperative ileus, small bowel obstruction, and rare technical complications such as stump leak. Their incidence, presentation, and management vary based on appendicitis severity, operative findings, and postoperative care pathways. Current evidence suggests that severity-based postoperative care, avoidance of unnecessary drain placement, selective imaging, early transition to oral antibiotics when appropriate, and standardized recovery protocols may reduce variation in management and improve outcomes. This review summarizes the most common postoperative complications following pediatric appendectomy, with emphasis on severity stratification, prevention, recognitions, and contemporary management strategies.
    Keywords:  Appendectomy; Intra-abdominal abscess; Pediatric appendicitis; Postoperative complications; Small bowel obstruction; Surgical site infection
    DOI:  https://doi.org/10.1016/j.sempedsurg.2026.151668
  20. Radiol Technol. 2026 Jul-Aug;97(6):97(6): 431-432
    Preparing Pediatric Patients for MR Imaging Without Sedation.
    Amanda J Czech.
      
  21. BMC Pediatr. 2026 Jul 11.
    Clinical and demographic risk profiles of non-suicidal self-injury among pediatric emergency department presentations: a three-year retrospective study.
    Azize Aydemir, Berkan Şahin.
       OBJECTIVE: This study aimed to evaluate the sociodemographic characteristics and clinical profiles of pediatric patients presenting to an emergency department (ED) with non-suicidal self-injury (NSSI).
    METHODS: This retrospective case-control study included 36 children presenting to the ED with NSSI and 50 age- and sex-comparable controls presenting with non-psychiatric complaints between 2019 and 2022. Sociodemographic and clinical data were extracted from hospital records.
    RESULTS: The mean age of the NSSI group was 15.58 ± 1.61 years, and 80.6% of the patients were female. The most frequently reported methods were self-poisoning and self-cutting. The age-at-onset distribution demonstrated a distinct peak at age 15 (52.8%), with a secondary peak at age 10 (22.2%). Logistic regression analysis demonstrated that increasing age was associated with a lower likelihood of NSSI presentation (OR = 0.718), whereas female sex was independently associated with NSSI (OR = 8.090; p < 0.001). The model explained 30.4% of the variance. More than half of the patients were receiving psychotropic medication at the time of ED admission, and a notable proportion had a family history of psychiatric disorders or suicide.
    CONCLUSION: The findings suggest that pediatric NSSI presentations are not isolated events but are frequently accompanied by ongoing psychiatric vulnerability, recurrent emergency department utilization, and psychotropic treatment. The observed age-at-onset pattern, characterized by a peak at age 15 and a secondary peak at age 10, indicates that vulnerability to NSSI may emerge during different developmental periods. Emergency departments represent a critical setting for psychiatric assessment, referral, and continuity of care for vulnerable children and adolescents.
    Keywords:  Adolescents; Children; Emergency department; Gender differences; Non-suicidal self-injury
    DOI:  https://doi.org/10.1186/s12887-026-07327-y
  22. Orthop J Sports Med. 2026 Jul;14(7): 23259671261450619
    Changes in Opioid Prescription Patterns Following Implementation of the Controlled Substance Utilization Review and Evaluation System.
    Amy Steele, Claire E Perrin, Daniel R Massillon, James D Bomar, Eric W Edmonds.
       Background: Drug overdose and poisoning deaths in the pediatric and adolescent population have recently surpassed cancer as the third-leading cause of death, resulting in the opioid epidemic being declared a public health emergency. Federal mandates, such as the Controlled Substance Utilization Review and Evaluation System (CURES) database that followed, were created to improve monitoring of opioid prescriptions. The impact of CURES on pain management for children and adolescents undergoing common arthroscopic procedures has not been assessed.
    Hypothesis: Post-CURES reduction in opioid prescriptions will not result in additional postsurgical triage contacts or additional prescription needs in a pediatric and adolescent cohort undergoing arthroscopic procedures.
    Study Design: Cohort study; Level of evidence, 3.
    Methods: Pediatric and adolescent patients (ages 10-19 years) undergoing common arthroscopic knee and shoulder procedures by a single surgeon at a single, tertiary care pediatric hospital from 2013 through 2023 were reviewed. Demographics, surgical details, and postoperative outcomes were compared across pre- (before 2018) and post-CURES (2018 and later) cohorts defined as before and after implementation of a change in opioid prescription habits that occurred in response to the mandatory reporting in CURES. Primary outcomes included phone calls or messages to the triage nurse related to pain. Secondary outcomes included additional opioid prescriptions required to manage pain.
    Results: The post-CURES cohort (N = 224) was prescribed significantly fewer morphine milligram equivalents (total MMEs prescribed) compared with the pre-CURES cohort (N = 244) (89.4 ± 8.3 vs 444.3 ± 66.0; P < .001). Patients in the post-CURES cohort were more likely to call regarding pain (13% vs 7%; P = .03). However, there were no differences in additional pain prescriptions required (4% pre- vs 4% post-CURES; P≥ .99) to manage pain.
    Conclusion: Despite a nearly 5-fold decrease in total MMEs prescribed, there was no increase in additional pain prescriptions required even though there was a 2-fold increase in messages related to pain to the triage nurse via education and reassurance. The hypothesis was upheld in part, suggesting that effective pain management can be achieved with fewer opioids, but that the postoperative care of adolescents undergoing arthroscopy could be further improved.
    Keywords:  arthroscopic knee procedures; arthroscopic shoulder procedures; opioids; pediatrics; perioperative pain management
    DOI:  https://doi.org/10.1177/23259671261450619
  23. Pediatr Nephrol. 2026 Jul 08.
    Implementation and evaluation of a quality improvement project to standardize food insecurity screening in a pediatric nephrology clinic.
    Eva M Glenn Lecea, Erica Winnicki, Aris Oates, Deborah Franzon, Jennifer Evans, Laura Plantinga, Delphine S Tuot.
       BACKGROUND: Food insecurity is common among children with kidney disease and may worsen health outcomes. Implementation of screening in pediatric subspecialty clinics has not been well described.
    METHODS: Universal in-person screening was developed, implemented, and evaluated at one of the two primary pediatric nephrology clinics within an academic children's hospital in California and compared with a control clinic over a 16-month study period. At the intervention clinic, medical assistants and licensed vocational nurses screened all in-person visits using a two-question tool. The second clinic served as the control and continued usual care, in which selected patients were screened during multidisciplinary visits by a renal nurse, dietitian, or social worker. An interrupted time series analysis assessed changes in screening rates over time, and a difference-in-differences analysis compared trends between the intervention and control clinics. Implementation outcomes were evaluated using the RE-AIM framework.
    RESULTS: After implementation, screening rates in Clinic A (intervention clinic) increased immediately by 33%, followed by a modest but sustained upward trend of 1.0 percentage point per month. Screening completion was maintained, indicating successful integration into the clinic workflow. Staff initially reported discomfort performing screening due to uncertainty about how to respond to positive results; this improved after workflow refinements, including the introduction of a standardized script and the assignment of a nephrology-specific licensed vocational nurse to support follow-up. Caregivers reported high comfort with the screening process.
    CONCLUSIONS: Food insecurity screening was feasible and acceptable in a pediatric nephrology clinic, with clear workflows and defined roles supporting sustainability.
    Keywords:  COM-B; Food insecurity screening; Implementation science; Pediatric nephrology clinic; Quality improvement; RE-AIM
    DOI:  https://doi.org/10.1007/s00467-026-07443-y
  24. Front Pediatr. 2026 ;14 1869554
    Skin-to-skin contact in neonatal intensive care units: a narrative review of implementation challenges and strategies within infant- and family-centered care.
    Alicia Montaner-Ramon, Fatima Camba-Longueira, Josep Perapoch-Lopez.
      Skin-to-skin contact (SSC) is a key component of infant- and family-centered developmental care in neonatal intensive care units (NICU) and is associated with improved clinical and neurodevelopmental outcomes. However, SSC implementation in NICUs remains highly variable, often limited by perceived barriers and uncertainties regarding safety. This review aims to identify these barriers and summarize strategies to support the safe and consistent integration of SSC into routine neonatal care. Current evidence identifies barriers at multiple levels, including clinical factors (extreme prematurity, respiratory support, hemodynamic instability, maternal conditions), organizational constraints (lack of standardized protocols, limited staffing, variability in professional training), and emotional challenges (parental stress, insufficient guidance, and inconsistent support from healthcare professionals). Although concerns about safety-such as accidental device dislodgement or clinical instability-are frequently cited, current evidence does not support withholding SSC when appropriate monitoring, preparation, and positioning are ensured. Recent studies highlight that interventions like multidisciplinary professional training, simulation-based learning, institutional protocols, standardized safety checklists, algorithms for eligibility and structured parental education, are effective to reduce variability and support safe implementation of SSC. These interventions have been associated with increased SSC rates, improved parental engagement, and enhanced alignment with developmental care practices. Addressing these multilevel barriers is essential to promote the safe, equitable, and sustainable implementation of SSC across diverse neonatal care settings.
    Keywords:  infant-and family-centered developmental care; kangaroo mother care; neonatal intensive care; neurodevelopmental care; prematurity; skin to skin contact
    DOI:  https://doi.org/10.3389/fped.2026.1869554
  25. Home Healthc Now. 2026 Jul-Aug 01;44(4):44(4): 264-265
    High-Acuity Pediatric Home Nursing: Safer Children, Expanded Access.
    Susan Ecker Sterner.
      
    DOI:  https://doi.org/10.1097/NHH.0000000000001446
  26. J Adolesc Health. 2026 Jul 09. pii: S1054-139X(26)00155-2. [Epub ahead of print]
    Adolescents' and Young Adults' Recalled Exposure to E-Cigarette Retail Stores on the Path to School: Association With Past 30-Day Use and Susceptibility to Use.
    Myrha Ahsan Qadir, Madison M O'Connell, Lydia A Shrier, Bonnie Halpern-Felsher, Shivani Mathur Gaiha.
       PURPOSE: School-aged youth use e-cigarettes more than any other tobacco product, and e-cigarette marketing exposure near schools remains a concern. However, few studies have examined adolescents' and young adults' (AYAs) exposure to stores selling e-cigarettes along their path to/from school and the association between retailer exposure and AYA e-cigarette use and susceptibility to use.
    METHODS: We conducted a web-based survey of 5,326 United States; 13-24-year-olds. Participants reported e-cigarette use, susceptibility to use e-cigarettes among those who never used, and exposure to retail stores selling e-cigarettes on their school commute. We used age-stratified logistic regression models to examine associations of store exposure (any store, age-restricted/adult-only (21+) stores (e.g., vape shops), store(s) ≤10 minutes) with (1) current (past 30-day) e-cigarette use and (2) susceptibility. Analyses adjusted for age, gender, race and ethnicity, and urbanicity.
    RESULTS: Over one-half (56.7%) of all AYAs were exposed to e-cigarette retail store(s) on their school commute; among participants <21 years, 54.0% were exposed. AYAs with such e-cigarette retail store exposure had elevated odds of current e-cigarette use (adjusted odds ratio [AOR]: 2.15, 95% confidence interval [CI]: 1.86-2.48) and use susceptibility (1.33, 1.14-1.54). Exposure to adult-only stores was associated with current use (3.32, 2.82-3.91) and to stores ≤10 minutes from school was associated with current use (1.30, 1.13-1.51) and susceptibility to use (1.21, 1.03-1.43).
    DISCUSSION: AYAs are frequently exposed to stores selling e-cigarettes on their school commute, which is positively associated with current use and susceptibility to use. Efforts to curb AYA e-cigarette use could focus on environmental factors, such as limiting retail licensing near schools.
    Keywords:  Adolescents; E-cigarettes; Marketing; Point-of-sale; Retail; School; Tobacco; Vaping; Young adults
    DOI:  https://doi.org/10.1016/j.jadohealth.2026.04.014
  27. Hosp Pediatr. 2026 Jul 07. pii: e2025009202. [Epub ahead of print]
    Optimizing Trauma-Informed Care in Pediatric Health Care: A Call to Action.
    Sarah Nelson, Tanesha Johnson, Morgan Mitcheson, Meghan L Marsac.
      
    DOI:  https://doi.org/10.1542/hpeds.2025-009202
  28. Health Serv Res. 2026 Aug;61(4): e70129
    Engaging Families in Pediatric Care Management: A Qualitative Study From the North Carolina Integrated Care for Kids Model.
    Hartlee Lidsky, Eleanor Wertman, Hadiya B Sadiq, Greeshma James, Kimberlin Neblett, Tara Ilsley, Chelsea Swanson, Kori B Flower, Michael Steiner, Carolyn Avery, Rushina Cholera.
       OBJECTIVE: To describe factors influencing caregiver engagement in pediatric care management.
    STUDY SETTING AND DESIGN: This qualitative descriptive study of family engagement was based in the North Carolina Integrated Care for Kids (NC InCK) care management model. NC InCK proactively offers assistance with healthcare coordination and health-related social needs to Medicaid-insured children in five North Carolina counties. Participants were randomly recruited from three cohorts with different levels of engagement (never engaged, briefly engaged, and retained) and participated in semi-structured virtual interviews to understand barriers and facilitators to both enrollment and retention in care management. Cross-cohort themes were identified using rapid qualitative analysis.
    DATA SOURCES AND ANALYTIC SAMPLE: Interviews were conducted between May 2024 and January 2025 with 50 NC InCK-eligible English-speaking families.
    PRINCIPAL FINDINGS: Most participants were mothers (n = 38, 74%) and grandmothers (n = 6, 12%) of non-Hispanic Black children (n = 32, 64%). Initial enrollment facilitators included clear, genuine explanations of care management tailored to family needs. Enrollment obstacles included high caregiver self-reliance, confusion around program scope, and negative prior experiences with social service programs. Retention facilitators included flexible scheduling, convenient communication, and strong interpersonal relationships with care managers. Retention obstacles included competing demands, communication challenges, evolution of family needs, and misalignment between caregiver expectations and services. Post-interview, 32% of briefly engaged and 73% of never engaged participants requested re-enrollment in the NC InCK model.
    CONCLUSIONS: Care management is a fundamental pediatric population health strategy, but low family engagement limits large-scale implementation and impact. Strategies to increase participation include clear messaging and simplified eligibility criteria to effectively convey care management benefits. Strong care manager communication skills are needed to build relationships with caregivers from varied backgrounds. Evolving family needs and bandwidth necessitate flexible care management options rather than a one-size-fits-all model.
    Keywords:  care management; family engagement; pediatrics; value‐based care
    DOI:  https://doi.org/10.1111/1475-6773.70129
  29. Int J Pediatr Otorhinolaryngol. 2026 Jul 01. pii: S0165-5876(26)00216-8. [Epub ahead of print]207 112920
    Language barriers are associated with worse outcomes in pediatric foreign body aspiration: A national cohort study.
    Sara O'Sullivan-Bakshi, Henry Diamond-Pott, Diego F Kaune, Francesca Lanni, Jacob Riordan, Jaime P Doody.
       INTRODUCTION: Foreign body aspiration (FBA) is a serious and potentially life-threatening pediatric emergency. When promptly diagnosed and managed, outcomes are usually favorable, but delayed recognition can result in pneumonia, acute respiratory distress and even death. Prior studies show that language barriers and limited English proficiency (LEP) are associated with delayed diagnosis, increased risk of high-severity aspirations (e.g., nuts), and disparities in perioperative and emergency care. However, few investigations have directly examined the relationship between language barriers and clinical outcomes in pediatric FBA. This study sought to evaluate these associations in a large national cohort.
    METHODS: We conducted a retrospective cohort study using the TriNetX research network. Pediatric patients (<18 years) with an index diagnosis of FBA were included. Exclusion criteria were age ≥18, prior history of FBA, asthma, or neuromuscular disorders. Two cohorts were created: children with FBA and a documented ICD code for acculturation difficulty (language barrier group) and children with FBA without such documentation (control group). Summary statistics were generated, and cohorts were propensity matched via multivariate linear regression based on age, age at index event, gender, race, and ethnicity. Outcomes compared included pneumonia, bronchoscopy, prolonged hospital stay, chest radiograph utilization, acute respiratory distress, dyspnea, and critical care services.
    RESULTS: After propensity score matching for age, age at index event, sex, race, and ethnicity, 880 pediatric patients with foreign body aspiration (FBA) and documented language barriers were compared with 880 matched controls. Patients with language barriers experienced significantly higher rates of pneumonia (39.0% vs 21.8%; OR 2.29, 95% CI 1.86-2.82; p < 0.0001) and prolonged hospital stay (6.93% vs 2.16%; OR 3.38, 95% CI 2.00-5.70; p < 0.0001). Respiratory complications were also more common, including acute respiratory distress (8.64% vs 1.93%; OR 4.80, 95% CI 2.81-8.19; p < 0.0001) and dyspnea (13.1% vs 3.86%; OR 3.74, 95% CI 2.52-5.55; p < 0.0001). Chest radiograph utilization (26.5% vs 14.0%; OR 2.22, 95% CI 1.74-2.82; p < 0.0001) and critical care use (6.93% vs 2.05%; OR 3.57, 95% CI 2.09-6.09; p < 0.0001) were higher among language barrier patients, while bronchoscopy rates were similar between groups (4.21% vs 3.30%; OR 1.29, 95% CI 0.79-2.11; p = 0.32).
    DISCUSSION: This national analysis demonstrates that pediatric patients with language barriers face significantly higher morbidity and resource utilization following FBA. These findings reinforce evidence that LEP contributes to delayed recognition, higher complication rates, and disparities in perioperative and emergency care. In the context of FBA, where timely diagnosis is critical, language barriers may affect survival and recovery. Standardized use of professional interpreters and culturally tailored caregiver education represent actionable strategies to reduce these inequities and potentially improve outcomes in this vulnerable population. To our knowledge, this is the first large-scale national study to directly examine language barriers and pediatric FBA outcomes.
    Keywords:  Bronchoscopy; Foreign body aspiration; Language barriers; Limited English proficiency; Pediatric
    DOI:  https://doi.org/10.1016/j.ijporl.2026.112920
  30. Diabetes Res Clin Pract. 2026 Jul 09. pii: S0168-8227(26)00332-3. [Epub ahead of print] 113412
    Prevalence and types of insulin-pump-related skin complications in children and adolescents with type 1 diabetes: A systematic review and meta-analysis.
    Chuhao Zhang, Ting Yuan, Xiaochun Chen, Yan Zheng, Wei Wu, Junfen Fu, Dan Wang, Guannan Bai, Guanping Dong.
      This systematic review and meta-analysis synthesized evidence on the prevalence and types of diabetes technology-related skin complications in children and adolescents with type 1 diabetes. After removal of a secondary/systematic review that did not contribute primary analyzable data, the revised evidence summary included 13 primary studies. Five studies involving 796 children and adolescents contributed data to the primary meta-analysis of any skin complication. Using a random-effects model, the pooled prevalence was 63.8% (95% CI 47.8%-77.2%), with substantial heterogeneity (I2 = 92.1%). Among specific complications, the pooled prevalence was 36.7% for scarring/insertion marks, 24.1% for lipohypertrophy, 16.6% for eczema/dermatitis-like reactions, 8.6% for infection/folliculitis, and 5.1% for lipoatrophy. The findings indicate that skin complications are common among young users of insulin pumps and related diabetes technologies, but interpretation is limited by inconsistent definitions, outcome ascertainment, and heterogeneous outcome reporting. Future prospective studies using standardized outcome definitions and consistent skin-assessment methods are needed to clarify risk factors and guide regular skin assessment, site-rotation, and skin-care strategies in pediatric type 1 diabetes care.
    Keywords:  Children; Insulin pump therapy; Meta-analysis; Skin; Type 1 diabetes
    DOI:  https://doi.org/10.1016/j.diabres.2026.113412
  31. Dermatol Ther (Heidelb). 2026 Jul 07.
    Pediatric Psoriasis: Comorbidities, Treatment Challenges and Unmet Needs.
    Marc Hernández-Santacana, Pablo Balado-Simó, Miguel Mansilla-Polo, Josep Riera-Monroig.
      Pediatric psoriasis is a chronic, immune-mediated inflammatory disease that frequently begins in childhood or adolescence. Beyond cutaneous involvement, it is associated with a wide spectrum of metabolic, psychological, and inflammatory comorbidities, as well as a marked impairment in health-related quality of life in both patients and their caregivers. This narrative review summarizes current evidence on comorbidities, treatment challenges, unmet needs, and future directions in pediatric psoriasis. Available data indicate an increased risk of overweight and obesity, the clustering of cardiometabolic risk factors, and a high prevalence of psychological and psychiatric comorbidities, including depression, anxiety, and suicidal ideation. Inflammatory comorbidities, particularly psoriatic arthritis, require early recognition to prevent irreversible complications. Therapeutic management of pediatric psoriasis has advanced in recent years with the approval of several biologic therapies supported by pediatric-specific clinical trials. Nevertheless, important challenges remain. These include limited access to biologics, age restrictions, off-label use of conventional systemic therapies, vaccination considerations, and scarcity of long-term safety data, particularly regarding growth, pubertal development, and cumulative drug exposure. Moreover, clear and regularly updated therapeutic algorithms for pediatric patients are still lacking. Despite increasing research activity and ongoing clinical trials, substantial unmet needs persist. These include delays in pediatric drug development, limited evidence beyond plaque psoriasis, insufficient evaluation of extracutaneous outcomes, and poor understanding of the long-term trajectory of comorbidities. Emerging data suggesting immunopathogenic differences between pediatric and adult psoriasis, together with ongoing biomarker research, may inform future personalized approaches. Addressing these gaps will be essential to optimize long-term, patient-centered care for children and adolescents with psoriasis.
    Keywords:  Biologic treatment; Clinical trials; Comorbidities; Pediatric psoriasis; Psoriasis
    DOI:  https://doi.org/10.1007/s13555-026-01846-3
  32. Popul Health Manag. 2026 Jul 08. 19427891261464374
    The Relationship Between Children with Special Health Care Needs, Chronic Pain, and Unmet Health Care Needs.
    Maykala J Williams, Chantel C Burkitt, Rhonda G Cady.
      Children with special health care needs (SHCN) face poorer access to and quality of health care than children without SHCN, leading to greater unmet health care needs. Chronic pain, a common comorbidity of chronic conditions, is associated with greater risk for poor physical and psychological functioning and increased health care utilization. However, little is known about chronic pain in children with SHCN and unmet health care needs in this population. Secondary analysis of the 2022 National Survey of Children's Health (NSCH), a nationally representative survey of youth aged 0-17, was conducted. SHCN status, chronic pain presence, and the presence of and reasons for unmet health care needs were assessed. Models were adjusted for demographic and socioeconomic factors. Among all 52,713 participants, 12,762 (21%) had SHCN, and 2806 (5.5%) reported chronic pain. Children with SHCN experienced a higher prevalence of chronic pain (14.0%) than those without SHCN (3.2%). Greater odds of unmet health care needs were associated with chronic pain; odds further increased among children with both SHCN and chronic pain. Commonly reported barriers to health care included problems getting an appointment, services not available in the area, and the office not being open when the child needed care. Children with SHCN are disproportionately affected by chronic pain, which is strongly associated with increased unmet health care needs. Reported barriers primarily reflected issues with access to and availability of services. Enhancing access to pediatric pain management services may help reduce these disparities and improve health outcomes in this population.
    Keywords:  children with special health care needs; chronic pain; health care access; unmet needs
    DOI:  https://doi.org/10.1177/19427891261464374
  33. Pediatrics. 2026 Jul 06. pii: e2026076453. [Epub ahead of print]
    Influenza Vaccine Effectiveness Against Pediatric Death in the United States: 2016-2025.
    Jerome S Leonard, Katie Reinhart, Peng-Jun Lu, Tammy A Santibanez, Anup Srivastav, Mei-Chuan Hung, Anurag Jain, Alicia Budd, Stacy Huang, Krista Kniss, Ashley M Price, Erin Burns, Sascha Ellington, Brendan Flannery.
       BACKGROUND AND OBJECTIVES: Seasonal influenza vaccination has been shown to reduce the risk of influenza and severe complications among children aged 6 months and older. Since 2010, reported numbers of influenza-associated pediatric deaths among children younger than 18 years have ranged from 37 during the 2011 to 2012 season to 289 during the 2024 to 2025 season. We estimated influenza vaccine effectiveness (VE) against pediatric death from 2016 to 2017 through 2024 to 2025.
    METHODS: We conducted a case-cohort analysis comparing current season influenza vaccination status among reported influenza-associated pediatric deaths with survey estimates of influenza vaccination coverage in pediatric age groups. Underlying medical conditions and current seasonal influenza vaccination were obtained from surveillance case reports. We estimated vaccination odds ratios (OR) and 95% CIs from logistic regression comparing influenza vaccination among children who died with vaccination coverage in comparison cohorts. VE was calculated as (1 - OR) × 100.
    RESULTS: From August 2016 through July 2025, 1234 laboratory-confirmed influenza-associated pediatric deaths were reported among children aged 6 months to 17 years. Of 1086 reported deaths with influenza vaccination information, 124 (23%) of 530 children with underlying medical conditions and 70 (13%) of 556 children without known conditions were fully vaccinated against influenza. Average influenza vaccination coverage in survey cohorts was 49%. VE was 80% (95% CI 75-84) overall, 77% (95% CI 71-82) among children with underlying medical conditions and 87% (95% CI 84-89) among children without known conditions.
    CONCLUSIONS: Influenza vaccination reduced risk of fatal influenza among children with or without known underlying medical conditions.
    DOI:  https://doi.org/10.1542/peds.2026-076453
  34. Hosp Pediatr. 2026 Jul 07. pii: e2026009273. [Epub ahead of print]
    Low-Tech In-Situ Simulation Improves Neonatal Resuscitation Skills in Community Hospitals.
    Melanie D Stempowski, Michael Chaka, Julia Liebner, Chisom Agbim, Sandra P Spencer, Ganga L Srinivas.
       BACKGROUND: Community hospital labor and delivery units manage approximately 40% of US births (1.5 million in 2022), yet face challenges with complex neonatal resuscitation due to infrequent exposure. Multiple high-acuity resuscitations in our community hospitals revealed a need for improvement. Simulation effectively augments Neonatal Resuscitation Program (NRP) training, but many community hospitals lack the necessary resources. Using QI principles, we aimed to create an affordable, sustainable, structured simulation project to improve neonatal resuscitation performance.
    METHODS: Monthly in-situ simulation sessions at 4 community sites used low-technology mannequins rotating through 4 high-acuity, low-occurrence scenarios. NRP performance was tracked longitudinally. In a continuous change model of improvement, we refined our simulation, educated on performance gaps, and remediated latent safety threats (LSTs). Performance scores were analyzed by statistical process control methods. Comparative statistics analyzed change in NRP subset scores, participant self-efficacy, and simulation satisfaction.
    RESULTS: In 65 sessions over 24 months, all clinicians and over 75% of respiratory therapists and nurses participated in at least one session. NRP mean performance scores demonstrated positive special cause variation-clinical scores: 51% to 66%; behavioral scores: 46% to 67%. Confidence increased significantly in all areas except medication and blood administration. Satisfaction with simulation was high (≥4, Likert scale 1-5). We identified 147 LSTs; most were mitigated. Monthly sessions continued after project completion.
    CONCLUSION: This low-cost, sustainable simulation project improved NRP performance and self-efficacy. If widely implemented, this model can foster a culture of simulation-based education, support ongoing improvement, and reduce LSTs in community hospital labor and delivery units.
    DOI:  https://doi.org/10.1542/hpeds.2026-009273
  35. Dtsch Arztebl Int. 2026 Oct 02. pii: arztebl.m2026.0128. [Epub ahead of print]123(20):
    Refractory Chronic Inflammatory Bowel Disease in Childhood and Adolescence: Options in Primary Non-Response or Secondary Treatment Failure.
    Frank Rommel, Christa Bergheim, Ralph Melchior, Thomas Krause, Matthias Zilbauer, Andreas Jenke.
       BACKGROUND: The incidence of inflammatory bowel disease among children and adolescents in Europe is approximately 10 per 100 000 per year. Refractory disease courses are clinically significant and associated with delayed growth and development, recurrent hospitalizations, and the need for surgery. 10-40% of patients have a primary nonresponse to anti-TNFα therapies, and a further 5-20% per year have secondary treatment failure, defined as loss of response after an initial response while on maintenance treatment. The aim of this review is to summarize current treatment options for primary non-response or secondary treatment failure.
    METHOD: This narrative review is based on current guidelines and pertinent publications retrieved by a selective search in the PubMed, Ovid MEDLINE, and Cochrane databases.
    RESULTS: Before switching to another drug class, a standardized reevaluation is essential, incorporating clinical findings, biomarkers, endoscopy and/or imaging, and therapeutic drug monitoring. Following failure of anti-TNFα therapy, ustekinumab (approved for Crohn's disease for patients older than 2 years) and vedolizumab (currently exclusively off-label) represent the best-established options in pediatric care. Reported clinical remission rates are 51% at week 52 for ustekinumab and 32% (Crohn's disease) and 42% (ulcerative colitis) at week 14 for vedolizumab. For IL-23p19 antibodies, Janus kinase inhibitors, and sphingosine-1-phosphate receptor modulators, the available evidence is still derived predominantly from adult studies, with very limited data from pediatric practice. Surgery remains an important option in complicated disease courses.
    CONCLUSION: Given the limited pediatric evidence and the frequent off-label use of newer agents, there is a need for prospective studies, registry data, and structured treatment algorithms to more reliably define the efficacy and long-term safety of treatments for pediatric chronic inflammatory bowel disease. In our view, children and adolescents with refractory inflammatory bowel disease should be managed by an interdisciplinary team in a center with the requisite experience.
    DOI:  https://doi.org/10.3238/arztebl.m2026.0128
  36. Pediatr Dermatol. 2026 Jul 07.
    Pediatric Dermatology Multidisciplinary Clinics: A Survey of Division Leaders.
    Katharina W Horn, Laura E Levin, Kimberly D Morel, Christine T Lauren, Andrew Truong, Maria C Garzon.
      Pediatric dermatologists serve as key members of multidisciplinary clinics (MDCs), during which providers from at least two specialties engage in a visit with a patient. Limited studies have explored the broader landscape of pediatric dermatology MDCs. A total of 39 pediatric dermatology division leaders (59% response rate) from the Society of Pediatric Dermatology completed a survey characterizing the structure, benefits, and challenges of these clinics. Survey results suggested that MDCs provide significant value in inter-specialty learning and complex patient management, but face challenges related to time, space, and financial burden.
    Keywords:  combined clinic; interdisciplinary communication; multidisciplinary clinic; patient care management; patient care team; surveys and questionnaires
    DOI:  https://doi.org/10.1111/pde.70238
  37. Int J Sports Phys Ther. 2026 ;21(7): 617-626
    Factors Affecting Clinical Decision Making for Blood Flow Restriction Training in Pediatric and Adolescent Patients Following Anterior Cruciate Ligament Injury.
    Nicholas Giampetruzzi, Lauren S Butler, Jennifer Prue, Elliot Greenberg.
       Background: Research evaluating the effectiveness of blood flow restriction training (BFRT) in patients post anterior cruciate ligament (ACL) injury is growing, but the application of BFRT within clinical settings remains unknown. Understanding how BFRT is used in the pediatric and adolescent populations and what exercise prescription is followed is necessary to discern if there is concordance between research and clinical practice.
    Hypothesis/Purpose: To describe the influence of patient clinical presentation on BFRT use in pediatric and adolescent patients after anterior cruciate ligament reconstruction.
    Study Design: Cross-sectional survey study.
    Methods: A web-based survey was sent to physical therapists (PTs) who treat pediatric and adolescent patients after ACL injury, via social media and email sent out by rehabilitation continuing education providers. Case vignettes were utilized to understand clinical decisions related to BFRT utilization. Descriptive statistics were utilized to summarize frequency of responses.
    Results: One hundred forty-seven PTs fully completed the survey. Nearly half (55%) of participants indicated they would not use BFRT on younger patients, mostly out of concern for patient tolerance (90%). Pain impacted BFRT application for 71% of participants, with only 19% of clinicians using BFRT with patients reporting pain greater than 6/10. Postoperatively, participants were most likely to initiate BFRT at week 4 with this population (97%), while only 52% of participants indicated that they have defined criteria for discontinuing BFRT.
    Conclusion: Younger age, pain, and time from surgery influenced decision making. There were no consistent criteria utilized to determine proper timing to discontinue use of BFRT. These findings support the need for additional research to identify optimal BFRT application within common clinical scenarios, which will help standardize practice and support clinical decision making when utilizing BFRT in adolescents after ACL reconstruction.
    Level of Evidence: 3.
    Keywords:  adolescents; anterior cruciate ligament; blood flow restriction training; physical therapy
    DOI:  https://doi.org/10.26603/001c.163281
  38. NEJM Catal Innov Care Deliv. 2026 Apr;7(4): CAT250095
    Establishing Neonatal Toxicology Testing Protocols to Prioritize Clinical Utility Reduces Racial and Socioeconomic Bias.
    Sharon Ostfeld-Johns, Elena Aragona, Louis Hart, G Benjamin Carey, Jaspreet Loyal.
      Toxicology testing is frequently performed on newborns with known or suspected prenatal substance exposure, even though research shows that these tests often add no new clinically relevant information to that gathered during pregnancy and are rarely clinically actionable. Yale New Haven Children's Hospital lacked a protocol for newborn toxicology testing. The authors suspected that test-ordering patterns demonstrated clinically inappropriate overuse and racial and socioeconomic discrimination, leading to harm to newborns and families, including unnecessary involvement of child protective services. Their hypothesis was that reduced testing, with continued social support, would lead to no change in newborn outcomes or safety. Prior to implementation, they identified wide disproportionality in testing by race and insurance status as a marker of poverty. Compared with all babies born at Yale New Haven Children's Hospital, Black non-Hispanic newborns and newborns with Medicaid insurance were tested at 2 times and 2.6 times the average frequency, respectively. After implementation, the authors evaluated the protocol's impact on the testing volume and racial and socioeconomic distribution of tests ordered, and tracked outcomes in the institution's newborn population. By the time the protocol went live in January 2022, after extensive discussion and education among staff, testing rates had already decreased from 3.2% to 0.3%. The absolute decrease in testing rates for Black newborns was 6.7% to 0.6%, while that for white newborns was 2.5% to 0.2%. The testing rate for newborns with Medicaid insurance decreased from 8.2% to 0.5%, while the rate for newborns with commercial insurance decreased from 0.4% to 0.1%. There were so few tests ordered after the protocol was in place that differences in testing frequency by race and type of insurance could not be statistically evaluated. These reduced testing rates have persisted since that time, with no further interventions. Importantly, there were no identified hospital readmissions for withdrawal symptoms or adverse events for newborns who had no previously identified prenatal substance exposure before or after the protocol was adopted. This work succeeded due to a close evaluation of the clinical utility of newborn toxicology testing, institutional support, interdisciplinary collaboration, a culture accepting of change, and recognition of quality improvement as a health equity tool.
    DOI:  https://doi.org/10.1056/CAT.25.0095
  39. Optom Vis Sci. 2026 Jul;103(7): e70086
    Visits to optometrists or ophthalmologists by U.S. school-aged children with autism: Estimates from the 2022-2023 National Survey of Children's Health.
    Diane M Gibson.
       PURPOSE: To examine the prevalence and predictors of visits to optometrists or ophthalmologists among U.S. school-aged children with autism.
    METHODS: This study used parent-reported data on children ages 6-17 years residing in U.S. households from the 2022-2023 survey years of the National Survey of Children's Health (n = 68,000). After exclusions for missing data, there were 63,659 children in the full sample and 2653 children in the autism sample. Parents reported whether their child had visited an optometrist or ophthalmologist during the past 2 years. The weighted prevalence of optometrist or ophthalmologist visits was calculated for the autism sample and for the full sample for comparison. Using the autism sample, weighted descriptive statistics and logistic regression models were estimated to examine the associations between visits to an optometrist or ophthalmologist and explanatory variables measuring sociodemographic and contextual characteristics.
    RESULTS: 56.6% (95% confidence interval [CI] 52.5%-60.6%) of the weighted autism sample and 52.6% (95% CI 51.8%-53.4%) of the weighted full sample had visited an optometrist or ophthalmologist in the previous 2 years. Key policy-relevant findings from the regression models are that the likelihood of having visited an optometrist or ophthalmologist was significantly higher for children who had a usual place for preventive care and whose parents had received help coordinating the child's health care, and was substantially and significantly higher for children who had had their vision screened in a primary care, school, or community setting and received a recommendation to follow up with an optometrist or ophthalmologist.
    CONCLUSIONS: The findings suggest that public health efforts should be focused on revising vision screening guidelines to recommend the referral of all school-aged children with autism to an optometrist or ophthalmologist because these revisions would be likely to lead to a considerable increase in the receipt of regular eye care among children with autism.
    DOI:  https://doi.org/10.1002/ovs2.70086
  40. Pediatr Ann. 2026 Jul;55(7): e246-e251
    From Early Childhood to Adulthood: Implementing Neuroaffirming Health Care for Autistic Individuals.
    Kruti Acharya, Sarah C Bauer, Helen Rottier.
      In health care, autism is viewed through the medical model. This approach may lead to adverse health care experiences and outcomes for autistic individuals. In contrast, integrating neurodiversity into care can improve the health care experiences and outcomes of autistic individuals. The authors combine scientific literature, the health care perspectives of autistic people, and clinical experiences to highlight the barriers and needs of individuals who are neurodivergent in health care. The authors present tangible neuroaffirming practices for pediatric medicine, from screening and diagnosis to transition to adulthood. Physicians play a crucial role in advancing accessible, neuroaffirming care. Even small changes in practice meaningfully improve health care experiences for autistic individuals from early childhood to adulthood.
    DOI:  https://doi.org/10.3928/19382359-20260317-01
  41. Clin Child Psychol Psychiatry. 2026 Jul 06. 13591045261464808
    Big Thoughts in Little Jars: Memory Days for Families Where a Child has Died.
    James McParland, Bernadette O'Gorman, Jacqueline Victor, Sara Portnoy.
      The Life Force community paediatric palliative care team offers support to children and young people with complex health needs and their families. The team supports them during their end-of life period, as well as bereavement support after a child has died. This article discusses the development of Memory Days, a yearly event where a child or young person cared for by the team is remembered by their family. The article describes how these Memory Days are set up and facilitated and describes three of the specific memory activities the team has offered. These creative activities are completed in a group setting which affords families who can feel isolated through grief, the opportunity to connect with others and find solidarity. One of the families describes what the days mean to them.
    Keywords:  bereavement work; community health; memory days; paediatric; palliative care; play therapy
    DOI:  https://doi.org/10.1177/13591045261464808
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