bims-cliped 2026-08-02 papers

bims-cliped

Biomed News

on Clinical pediatrics

Issue of 2026–08–02
35 papers selected by
Alyssa M. Portwood, Akron’s Children

Improving Rates of Routine Vaccinations in Adolescents at an Academic Children's Hospital.
Diagnostic Stewardship of Respiratory Cultures Using Clinical Decision Support in the PICU.
Improving Pediatric Emergency Department Lethal Means Safety Documentation Rates for Adolescents with Mental Health Concerns.
Advancing Pediatric Stroke Readiness: Engaging Healthcare Systems to Optimize Care Delivery.
Fertile Ground for Collaboration: A survey of pediatric surgeons on pediatric and adolescent gynecologic care.
Pediatricians' perceptions of children with disabilities and their health care.
Gender-Affirming Care for Youth: Compassionate Care in a Hostile Environment.
PICU Move! Improving Early Mobilization in a Large Pediatric Intensive Care Unit.
Maximizing Efficiency: A Quality Improvement Project to Improve Inpatient Flow to the Operating Room.
Community health workers as providers of pediatric behavioral healthcare: a scoping review and call to action for pediatric psychologists.
Physician-Generated Advocacy Letters for Individualized Education Programs.
Hydromorphone in Pediatric Pain Management: Pharmacology, Clinical Applications, and Safety Considerations-A Narrative Review.
A Systematic Review of Pediatric-Specific Risk Factors for Nosocomial Infections in Pediatric Intensive Care Units, 2005-2024.
Small Patients, Big Risk: The Physiologically Difficult Airway in Infants and Children.
Promoting Early Relational Health in Primary Care: A Scoping Review of Interventions and Evidence Gaps.
Improving Time to Antibiotic Administration in Open Fractures.
Vitamin D in pediatrics: the need for precision medicine-based guidelines for screening, monitoring, and supplementation.
Enhancing Pediatric Obesity Management through Quality Improvement: A Hybrid Approach to Intensive Health Behavior and Lifestyle Treatment in Primary Care.
Pediatric Trauma Education in the United States: A Nationwide Clinician Needs Assessment.
Non-Pharmacological and Non-Optical Interventions for Myopia Prevention and Control in Children: A Systematic Review and Meta-Analysis.
21‑Valent Pneumococcal Conjugate Vaccine V116 (CAPVAXIVE®): Pediatric First Approval.
What Parents Need to Know About Head Injury and Concussions.
Introducing the ZIPP Scale: Addressing a Gap in Pediatric Pain Assessment.
Improving Communication Around Discharge Readiness at a Satellite Children's Hospital: A Single-site Improvement Initiative.
Quality Improvement Project to Reduce Wait Time for Pediatric Gastrointestinal Procedures.
Recent Updates in the Management of Anaphylaxis: The Role of the Pediatrician.
The Development of Parental Knowledge of Their Child in NNU and PICU: An Exploratory Qualitative Study of Parents' Experiences.
Barriers and Facilitators to Naloxone Access for Adolescents: A Narrative Review.
Physician Knowledge and Comfort Identifying Pediatric Speech Sound Development Concerns.
Screening for Depression at Adolescent Well-Child Visits: Who Is Screened and What Happens Afterwards?
Something Doesn't Look Right: Recognizing and Managing Limb-Length Discrepancy.
Staying Put: A Single Institution Quality Improvement Initiative to Reduce Early Gastrostomy Tube Dislodgement in Children.
Use of Ketamine and Esketamine in the Pediatric Population: Current Evidence and Clinical Applications.
Implementation of Universal Child Abuse Screening Tool (U-CAST): Real-world implementation of a standardized electronic health record-based child physical abuse screening in the pediatric emergency department.
Pediatric Oncology Clinical Trial Participation Among Families From Historically Marginalized Groups.

Pediatr Qual Saf. 2026 Jul-Aug;11(4):11(4): e902

Improving Rates of Routine Vaccinations in Adolescents at an Academic Children's Hospital.

Maria G Biancarelli, Hannah Rauchle, Kathleen Waddicor, Benjamin Ethier, Sara F Forman, Gabriela Vargas, Joshua Borus.

Introduction: This project sought to increase the vaccination completion rate to 95% in an adolescent medicine practice. We aimed to increase the percentage of individuals who were up to date on their meningococcal, human papillomavirus, and tetanus, diphtheria, and pertussis vaccinations to 80% and to verify that these efforts led to more equitable care.
Methods: We used the Model for Improvement. After a current-state analysis, the team implemented a bundled intervention that included obtaining missing records, notifying providers about patients who needed vaccinations, and providing electronic medical record alerts when vaccinations were due. Patients received vaccine education, and nurses offered a numbing spray to mitigate needle-related vaccine hesitancy.
Results: Statistical process control charts showed a shift in the percentage of complete vaccination records from 88% to 95%. There was a mean shift for the combined meningococcal, human papillomavirus, and tetanus, diphtheria, and pertussis completion percentage from 70% to 76%. All race and payer subgroups improved with the interventions. Racial disparity analysis for the completion percentage pre- and postintervention showed that there were 2 disparities observed between the reference group, Hispanic patients, and other racial groups. No disparities were observed between publicly and privately insured patients before or after the interventions.
Conclusions: The bundled intervention was associated with higher rates of vaccine documentation and administration. The highly engaged nursing staff and innovative technology drove success.

DOI: https://doi.org/10.1097/pq9.0000000000000902
JAMA Netw Open. 2026 Jul 01. 9(7): e2626547

Diagnostic Stewardship of Respiratory Cultures Using Clinical Decision Support in the PICU.

BrighT STAR Respiratory Authorship Group

Importance: Endotracheal aspirate culture (EAC) practices for evaluation of ventilator-associated infections (VAI) vary widely across pediatric hospitals, and overuse can contribute to overdiagnosis and overtreatment for VAI. Diagnostic stewardship strategies to optimize EAC testing practices may reduce overtesting and unnecessary antibiotic treatment.
Objective: To evaluate the association of diagnostic stewardship of EACs using clinical decision support with culture rates, antibiotic use, and patient outcomes across a multicenter collaborative of pediatric intensive care units (PICUs).
Design, Setting, and Participants: This was a multicenter cohort study with a pre-post study design among the BrighT STAR (Testing Stewardship for Antibiotic Reduction) Quality Improvement (QI) Collaborative involving PICUs across the US between 2019 and 2023. Data were collected from the participating sites and from the Children's Hospital Association Pediatric Health Information System and were analyzed from August to December 2025.
Exposure: Participating PICUs conducted local QI programs focused on optimizing EAC practices, facilitated by the BrighT STAR collaborative.
Main Outcomes and Measures: The primary outcome was the monthly rate of EACs per 100 ventilator-days. Secondary outcomes included rates of antibiotic initiations and antibiotic days of therapy, bronchoalveolar lavage cultures, readmissions, length of stay, ventilation duration, ventilation-free days, sepsis, and septic shock. Analysis included adjustment for seasonality.
Results: Across 15 sites (median [IQR] unit size, 30 [25-38] beds), the study captured 106 967 ventilator-days preimplementation and 92 167 ventilator-days postimplementation. Comparing 24 months in the preimplementation period with the 18 months in the postimplementation period, the mean monthly EAC rate declined by 16% from a preimplementation to postimplementation rate of 7.80 to 6.55 cultures per 100 ventilator-days (relative rate [RR], 0.84; 95% CI, 0.78-0.90). The rate of antibiotic initiations remained stable (RR, 0.98; 95% CI, 0.89-1.08), as well as the antibiotic days of therapy rate (RR, 1.03; 95% CI, 0.95-1.11). There were no significant changes in the rates of bronchoalveolar lavage cultures, PICU length of stay, PICU or hospital readmissions, sepsis, septic shock, ventilation duration, or ventilator-free days.
Conclusions and Relevance: In this multicenter cohort study, diagnostic stewardship of EACs using clinical decision support led by multidisciplinary teams was associated with reduced EAC use in the PICU without safety concerns. Future work will determine optimal implementation strategies, assess sustainability and the cost impact of EAC stewardship.

DOI: https://doi.org/10.1001/jamanetworkopen.2026.26547
Pediatr Qual Saf. 2026 Jul-Aug;11(4):11(4): e903

Improving Pediatric Emergency Department Lethal Means Safety Documentation Rates for Adolescents with Mental Health Concerns.

Cassandra L Stegall, Ana-Maria McGill, John Fanton, Paul C Mullan.

Introduction: Lethal means safety counseling (LMSC) is recommended for children presenting to the emergency department (ED) for a mental health (MH) evaluation. Currently, no gold-standard guidelines exist for documenting LMSC in the ED.
Methods: This quality improvement project was conducted in the ED of a tertiary children's hospital. Baseline data were analyzed for access to any LMSC documentation (ALD) for "firearms/guns," "sharps," or "medication," and for complete LMSC documentation (CLD) if access to all 3 types was documented. The first intervention period added open-ended screening questions about access to lethal means to the MH-licensed clinical social worker note template. Intervention period 2 implemented an electronic health record "PowerForm" in Cerner PowerChart. We aimed to increase ALD and CLD to exceed 75% and 50%, respectively, during a 6-month period, with sustained success. Statistical process control p-charts with standardized special-cause rules were used to determine performance over time.
Results: Baseline ALD and CLD rates were 3% and 1%, respectively. During intervention 1, the ALD and CLD rates increased to 81% and 68%, respectively, with special-cause variation noted for both rates. During intervention 2, ALD increased to 90%, but CLD rates did not change significantly (66%). For intervention 2, the documentation of firearm/gun access (90%) was higher than documentation of access to sharps (68%) or medication (69%).
Conclusions: We achieved a significant increase in ALD and CLD for MH evaluations in our ED. Lessons learned may generalize to other ED settings.

DOI: https://doi.org/10.1097/pq9.0000000000000903
Stroke. 2026 Aug;57(8): 2555-2564

Advancing Pediatric Stroke Readiness: Engaging Healthcare Systems to Optimize Care Delivery.

with the Texas Governor’s EMS and Trauma Advisory Council (GETAC) Pediatric Stroke Task Force

  Stroke is less common in children than in adults, yet equally devastating. Nevertheless, children with symptoms of acute stroke commonly present to community hospitals or adult stroke centers where experience and institutional protocols for pediatric stroke diagnosis and management may be limited. Despite advances in pediatric stroke awareness and the implementation of stroke pathways in many children's hospitals, significant gaps remain in the timely recognition, diagnosis, and management of pediatric stroke. A key contributing factor is the lack of system-level infrastructure to guide pediatric acute stroke care. This special report examines the challenges and barriers to achieving Pediatric Stroke Readiness at a national level in the United States and presents 5 engagement case studies highlighting efforts to establish processes and networks for pediatric stroke management across diverse care settings. The cases emphasize the development and implementation of systems of care in which pediatric stroke centers collaborate with first responders, community hospitals, and adult stroke centers to improve the delivery of acute stroke care for children. The strategies underscore different engagement approaches and identify opportunities for future research and quality improvement. These case studies also illustrate educational materials and clinical pathways that may serve as resources for others pursuing similar initiatives.

Keywords:  United States; child; emergency medical services; hospitals, community; stroke

DOI:  https://doi.org/10.1161/STROKEAHA.126.055126
J Pediatr Adolesc Gynecol. 2026 Jul 26. pii: S1083-3188(26)00461-4. [Epub ahead of print]

Fertile Ground for Collaboration: A survey of pediatric surgeons on pediatric and adolescent gynecologic care.

Avanthi S Ajjarapu, Michele Gifford, Kenneth W Gow, Jennifer E Dietrich.

   BACKGROUND: Pediatric and Adolescent Gynecology (PAG) emerged to bridge gaps between pediatrics and adult gynecology, while pediatric surgeons currently provide most operative gynecologic care for young patients. The goal of this survey was to understand pediatric surgical subspecialty perspectives on access to PAG services, perceived management patterns for common gynecologic conditions, and to assess opportunities for collaborative clinical and surgical care with PAG providers METHODS: A voluntary, anonymous, eight-question descriptive survey was distributed to members of the American Academy of Pediatrics Section on Surgery (SOSu) and Section on Urology (SOU). Survey questions assessed perceived PAG access, consultation patterns, coverage, and condition-specific management by subspecialty. Quantitative data were summarized descriptively, and qualitative free-text responses were analyzed thematically.
RESULTS: Of 701 AAP SOSu and SOU members surveyed, 136 responded (19.4%). 63% reported access to PAG. PAG was perceived as primarily providing consultations (96%) and multidisciplinary support (58%). Pediatric surgeons self identified as the primary managers of most acute and congenital conditions. PAG was associated with endometriosis, ectopic pregnancy, and miscarriage management. Care for fertility preservation and Tuboovarian abscess/pelvic inflammatory disease(TOA/PID) were mixed. Free-text responses emphasized PAG's focused expertise and multidisciplinary value, with concerns regarding limited availability.
CONCLUSIONS: This survey describes pediatric surgical subspecialty perspectives on pediatric and adult gynecologic care and access to PAG services. While pediatric surgeons manage many common gynecologic conditions, PAG providers serve as consultants, participate in multidisciplinary clinics, and offer specialized reproductive tract expertise. These findings highlight the importance of pediatric surgery while underscoring the value of expanding PAG within a collaborative model to meet evolving patient needs.

Keywords:  Endometriosis; Fertility preservation; Health Services Accessibility; Müllerian anomalies; Ovarian torsion; Pediatric and Adolescent Gynecology; Pediatric surgery; Practice Patterns; Subspecialty Care; Surveys and Questionnaires; Workforce Distribution; multidisciplinary care

DOI:  https://doi.org/10.1016/j.jpag.2026.07.012
Health Aff Sch. 2026 Jul;4(7): qxag152

Pediatricians' perceptions of children with disabilities and their health care.

Carolyn C Foster, William Howard Burr, Chloe Somberg, Stefanie G Ames, Lucas Bruton, Elizabeth J Bleed, Garey Noritz, Dennis Z Kuo, Amy Houtrow.

   Introduction: Because existing data are limited, we conducted a nationally representative survey to better understand American pediatricians' views on caring for children with disabilities.
Methods: The American Academy of Pediatrics (AAP) 2023 Periodic Survey asked members about their attitudes and perceptions in the care of children with disabilities (33.0% response rate, data weighted to account for nonresponse bias). Descriptive and bivariate statistics were performed; multivariable logistic regressions examined responses adjusting for demographic characteristics.
Results: Among 463 pediatrician-respondents, 98% strongly/somewhat agreed their practice welcomed patients with disability, but 81% strongly/somewhat agreed that the health care system often treats patients with disability unfairly. While 86% of pediatricians strongly agreed that understanding the needs of patients with disability was valuable to them, only 27% were very confident in their ability to provide the same quality of care to patients with disability as those without disability. Pediatricians who were the most confident in their ability to provide the same quality of care to patients with disability were more than twice as likely to welcome them into their practice.
Conclusion: Results indicate needed improvements in pediatric training and the health care system to reduce bias against disability and improve pediatricians' confidence in caring for children with disability.

Keywords:  ableism; children with disabilities; health policy; medical education; pediatrics

DOI:  https://doi.org/10.1093/haschl/qxag152
Nurs Clin North Am. 2026 Sep;pii: S0029-6465(26)00016-2. [Epub ahead of print]61(3): 369-387

Gender-Affirming Care for Youth: Compassionate Care in a Hostile Environment.

Michelle Forcier.

  Gender diversity can be a part of some children and adolescents' experience of gender identity formation. This article will provide an overview of some 40 years of evidence regarding gender development and care of transgender and gender diverse youth. Gender affirmation is a safe, effective way to support youth who may experience gender diversity and nontraditional gender identities. Gender affirmation is a tool for parents and providers to better guide and support youth through this developmental process. There are safe, effective, and reversible options for gender-affirming care for gender-diverse youth.

Keywords:  Gender affirmation; Gender and sexual minoritized youth; Gender development; Gender diversity; Gender-affirming hormones; Gender-diverse youth (TGDY); Hormone blockers; Transgender

DOI:  https://doi.org/10.1016/j.cnur.2026.04.002
Pediatr Qual Saf. 2026 Jul-Aug;11(4):11(4): e899

PICU Move! Improving Early Mobilization in a Large Pediatric Intensive Care Unit.

Jacqueline Zedalis, Katrina Budzynski, Meghan Burkhardt, Amanda Manzi, Susan Phillips, Aubree Little, Riane Goodwin, Vitoria Moreno-Costa, Kumaran Senthil.

Introduction: Guidelines support early mobilization in the pediatric intensive care unit (PICU). In our 75-bed PICU, we implemented "PICU Move!," a standardized early mobilization protocol using "Critical Care Illness Levels" (CCILs) that specify mobilization goals based on patients' medical status.
Methods: We used systems-based interventions (electronic health record order sets and workflows, opt-out therapy consultations, and progressive mobilization equipment) and person-based interventions (education, mobility champions, simulations, and mobility rounds). Process measures were CCIL ordering compliance, early mobilization goal compliance, and the proportion of admissions with a length of stay (LOS) ≥ 72 hours that included consultations with physical therapy (PT) and occupational therapy (OT). Outcome measures included time to first registered nurse activity documentation (all admissions and admissions with LOS ≥72 h) and admissions with LOS ≥72 hours with multiple PT/OT contacts. Balancing measures included safety event reports related to early mobilization activities, unplanned extubations, and falls.
Results: During the intervention period (July 2023-December 2024), median monthly CCIL compliance was 95.9%, and early mobilization goal compliance was 49.4%. Compared to baseline, the average monthly proportion of admissions with LOS ≥72 hours with PT or OT consultation increased from 38.8% to 82.6% and from 34.3% to 81.2%, respectively. Multiple PT and OT contacts increased from 40.9% to 81.7% and from 37.7% to 70.8%, respectively. Time to first activity decreased from 21.6 to 19.6 hours (all admissions) and from 67.9 to 59.1 hours (admissions with LOS ≥72 h). There were no documented safety events related to early mobilization activities.
Conclusions: In a large PICU, systems-based interventions, supplemented by person-based interventions, safely reduced time to first activity and increased the number of repeated PT/OT contacts.

DOI: https://doi.org/10.1097/pq9.0000000000000899
Pediatr Qual Saf. 2026 Jul-Aug;11(4):11(4): e904

Maximizing Efficiency: A Quality Improvement Project to Improve Inpatient Flow to the Operating Room.

Amber M Franz, Christina M Street, Colin D Crook, Pamela L Christensen, Eno Chen, Rosemary E Walkup, Elena J Raney, Lauren A Burnett, Lizabeth D Martin.

Introduction: Half a million pediatric inpatients undergo surgery each year. At a large, tertiary-care academic pediatric hospital, the time required to transition inpatients from the acute care units to the preoperative zones was lengthy and unreliable, resulting in costly operating room (OR) delays.
Methods: In 2024, the perioperative microsystem quality improvement team aimed to improve preoperative efficiency by 10% for nonintensive care unit inpatients undergoing nonemergent surgery in the main hospital ORs. The primary outcome measure was the time from the OR's phone call for the inpatient to completion of preoperative nursing tasks, as documented in the electronic health record. The Institute for Healthcare Improvement model framework guided the work. Multiple Plan-Do-Study-Act cycles aimed to improve communication among acute care unit, OR, and preoperative staff. Data were displayed as statistical process control charts.
Results: Mean time from calling for the inpatient to preoperative task completion improved from 48.2 minutes at baseline to 43.7 minutes (4.5 min, 9.3% improvement), with a sustained downward shift of the centerline on statistical process control analysis. After the second intervention, process variability also decreased relative to baseline and persisted after implementation.
Conclusions: Multiple Plan-Do-Study-Act cycles focused on inpatient-to-OR readiness led to more than 9% improvement in patient flow, enhanced communication between groups, increased awareness of preoperative preparation tasks, and improved trust in OR readiness signals to the preoperative zones. Further study is needed to determine whether similar interventions would be effective at improving efficiency at other hospitals.

DOI: https://doi.org/10.1097/pq9.0000000000000904
J Pediatr Psychol. 2026 Jul 25. pii: jsag051. [Epub ahead of print]

Community health workers as providers of pediatric behavioral healthcare: a scoping review and call to action for pediatric psychologists.

Erin M Rodríguez, Jendayi Dillard-Cooke, Spencer Westcott, Hadi Fareed, Ricardo Garay.

   OBJECTIVE: Community health workers (CHWs) are uniquely positioned to provide community-based, culturally responsive, and accessible healthcare to pediatric populations. We conducted a scoping review of the literature to describe how CHWs have been involved in pediatric health intervention research in the United States.
METHODS: We searched the databases PubMed, PsycInfo, Medline, CINAHL, and Medic Latina for peer-reviewed intervention studies published in English from 2003 to 2025. Additional inclusion criteria were that CHWs were involved in some aspect of intervention delivery; the intervention impacted a child's physical, behavioral, or mental health concern or behavior; the study provided quantitative outcome data, and the intervention was implemented in the United States. We extracted information on (1) the characteristics of interventions CHWs have delivered, (2) the extent to which CHWs are providing interventions with psychotherapeutic content, (3) the training and supervision received by CHWs, and (4) the match between intervention components and CHW roles/competencies.
RESULTS: We identified 11,361 articles from our search, of which 151 articles met inclusion criteria. Interventions addressed a range of pediatric health conditions and prevention/promotion outcomes, and 35 interventions included psychotherapeutic components. Most studies provided minimal information about CHW training and supervision, and CHWs' roles in most studies were limited to providing health education and outreach, despite the wide range of competencies CHWs have in providing care.
CONCLUSIONS: We call for pediatric psychologists to advocate for CHWs as members of multidisciplinary healthcare teams and collaborate with CHWs in research and practice for children and families.

Keywords:  community health worker; intervention; lay health worker; supervision; training

DOI:  https://doi.org/10.1093/jpepsy/jsag051
J Sch Health. 2026 Aug;96(8): e70206

Physician-Generated Advocacy Letters for Individualized Education Programs.

Yonit Lax, Nickie Uwoghiren, Colin Matthews, Michael Silver.

   BACKGROUND: Pediatricians can advocate for families seeking special educational services by writing a letter to schools and advocating for an individualized education program (IEP) evaluation or additional services.
CONTRIBUTIONS TO PRACTICE: An electronic health record-based health-related social needs screening (HRSN) tool and referral model was implemented in 3 urban, hospital-based pediatric primary care sites. Caregivers of school-aged children who completed HRSN screening, reported unmet educational needs for their child, and received an IEP letter were surveyed. Of these caregivers, 73.7% presented the letter to the school, and 61.9% of those caregivers reported that the school initiated an evaluation or provided a new service.
IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Families with educational concerns who gave letters to their child's school reported that the process led to school action, such as IEP evaluation or receipt of services. This supports screening for unmet educational needs, standardizing letter templates in the EHR for pediatric providers, and strengthening collaborations between pediatric providers and schools.
CONCLUSIONS: Integrating the IEP letter template into the electronic health record allows for a timely social care intervention, providing families with a simple way to advocate for special education services.

Keywords:  advocacy; pediatrics; social determinants of health; special education

DOI:  https://doi.org/10.1111/josh.70206
Healthcare (Basel). 2026 Jul 22. pii: 2228. [Epub ahead of print]14(14):

Hydromorphone in Pediatric Pain Management: Pharmacology, Clinical Applications, and Safety Considerations-A Narrative Review.

Alessandro Vittori, Cecilia Di Fabio, Ilaria Mascilini, Elisa Francia, Sara Pescatore, Corrado Cecchetti, Giuliano Marchetti, Franco Marinangeli, Teresa Grimaldi Capitello, Marco Cascella.

  Background: Pain is one of the most common and challenging clinical problems in pediatric care, affecting up to three-quarters of hospitalized children. Hydromorphone has gained increasing clinical interest as an alternative opioid in pediatric settings, although evidence supporting its use remains limited. Methods: A narrative literature review was conducted in accordance with SANRA recommendations using PubMed, Embase, and the Cochrane Library to identify studies evaluating hydromorphone use in pediatric and adolescent patients across perioperative, postoperative, intensive care unit (ICU), and emergency settings. Results: Available evidence suggests that hydromorphone may provide effective analgesia in pediatric patients across multiple clinical contexts, including postoperative pain control, patient-controlled analgesia, analgosedation in the ICU, and acute pain management in the emergency department. However, the available data are largely derived from small, heterogeneous, and predominantly retrospective studies, often limited to single-center experiences. Conclusions: Hydromorphone may represent a useful alternative opioid for pediatric pain management and analgosedation, particularly when morphine is ineffective or poorly tolerated. Nevertheless, the current evidence base is limited, heterogeneous, and largely observational, precluding robust conclusions regarding its comparative effectiveness and safety. Further well-designed pediatric studies are required to better define its role in clinical practice.

Keywords:  addiction; analgosedation; children; chronic pain; hydromorphone; morphine; opioid; pain; pediatric anesthesia; pediatric pain

DOI:  https://doi.org/10.3390/healthcare14142228
J Hosp Infect. 2026 Jul 28. pii: S0195-6701(26)00309-9. [Epub ahead of print]

A Systematic Review of Pediatric-Specific Risk Factors for Nosocomial Infections in Pediatric Intensive Care Units, 2005-2024.

Lingying Wang, Mei Feng, Yulan Luo, Chunxia Wang, Heng Wang, Yuan Zhang, Xiuling Huang, Minjie Huang, Yongming Tian.

   BACKGROUND: Children admitted to the pediatric intensive care unit (PICU) are at markedly high risk of nosocomial infections (NIs, also termed hospital-acquired infections [HAIs]), which correlate with elevated mortality, extended hospital stays, and amplified healthcare burdens. Children exhibit distinct immunological and physiological traits compared with adult patients, highlighting an urgent need for pediatric-specific evidence to guide infection prevention. The latest existing systematic review on this topic was published in 2009, failing to cover emerging multidrug-resistant infections (MDRIs) and modern pediatric critical care management practices. This systematic review aimed to synthesize two decades of evidence on pediatric-specific risk factors for PICU-onset nosocomial infections, encompassing all-site NIs, ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CA-UTIs), and bloodstream infections (BSIs)-with central line-associated bloodstream infections (CLABSIs) as the predominant subtype-to deliver updated evidence supporting targeted infection control strategies.
METHODS: We performed a comprehensive electronic literature search across six databases: PubMed, Embase, Web of Science, CNKI, VIP, and Wanfang, covering publications released between January 2005 and December 2024. Two independent reviewers completed literature screening, data extraction, and methodological quality assessment in accordance with pre-established inclusion and exclusion criteria. All eligible observational studies investigating risk factors for NIs in PICU populations were included for qualitative synthesis.
RESULTS: Overall, 24 observational studies involving 74,960 hospitalized children (2,863 of whom developed NIs) were incorporated into this review. Consistent risk factors for all-site PICU NIs comprised younger age, prolonged PICU length of stay, invasive procedures, parenteral nutrition, glucocorticoid administration, and high admission illness severity (quantified via the PRISM III or PCIS scoring systems). For VAP, independent risk factors were prolonged mechanical ventilation duration, reintubation, and pre-existing lung disease or baseline pneumonia before ventilation initiation. Indwelling urinary catheters constituted a core risk factor for catheter-associated UTIs. Risk factors predictive of MDRIs included administration of two or more antimicrobial agents, coma, parenteral nutrition, and extended mechanical ventilation.
CONCLUSION: PICU-onset NIs stem from multiple modifiable risk exposures: invasive medical devices, extended intensive care hospitalization, parenteral nutrition, glucocorticoid therapy, and inappropriate overprescription of antimicrobials. Implementation of PICU-tailored infection control bundles and stratified surveillance for high-risk children is critical to reduce NI incidence. Large, standardized multicenter prospective cohorts are warranted to harmonize infection diagnostic criteria and develop optimized pediatric-specific guidelines for NI prevention.
SYSTEMATIC REVIEW REGISTRATION: The review protocol was prospectively registered on PROSPERO (Registration No. CRD42025635030).

Keywords:  Nosocomial Infection; Pediatric Intensive Care Unit; Risk Factor

DOI:  https://doi.org/10.1016/j.jhin.2026.07.024
Pediatr Emerg Care. 2026 Aug 01. 42(8): 640-650

Small Patients, Big Risk: The Physiologically Difficult Airway in Infants and Children.

Garrett S Pacheco.

  The pediatric airway presents significant physiological challenges that make children particularly susceptible to adverse events during intubation. These vulnerabilities place them at increased risk for cardiovascular collapse and cardiac arrest during airway procedures. Hypoxemia and hypotension are the most frequent adverse events in this population. To reduce these risks, strategies to enhance preoxygenation and apneic oxygenation, as well as optimizing hemodynamic status before intubation, are critical to improving the safety of pediatric emergency airway management. This review highlights the concept of the physiologically difficult airway in children, outlines risk factors associated with physiological deterioration, and proposes interventions to mitigate these risks.

Keywords:  adverse events; hemodynamic instability; hypoxemia; pediatric; peri-intubation cardiac arrest; physiologically difficult airway

DOI:  https://doi.org/10.1097/PEC.0000000000003583
Acad Pediatr. 2026 Jul 30. pii: S1876-2859(26)00200-7. [Epub ahead of print] 103418

Promoting Early Relational Health in Primary Care: A Scoping Review of Interventions and Evidence Gaps.

Sarah Behrens, Stephen Lauer, Brenda J Salley.

   BACKGROUND: Early relational health - the quality of caregiver-child interactions - is foundational for socio-emotional development and long-term wellbeing. The American Academy of Pediatrics has called for a paradigm shift toward relationship-centered care in pediatric primary care, yet a gap remains between this vision and real-world implementation.
OBJECTIVES: To map early relational health interventions implemented in pediatric primary care, summarize reported outcomes and identify implementation strategies, barriers, and facilitators.
DATA SOURCES: PubMed, CINAHL, and PsycINFO were searched for studies published between 2014 and 2024, supplemented by backward citation searching.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: A scoping review methodology following PRISMA-ScR guidelines was used. Data were charted and synthesized using descriptive and thematic analysis.
RESULTS: Eighteen studies met inclusion criteria. Interventions were delivered in clinic, home, or hybrid settings and were commonly integrated into routine workflows. Reported outcomes included improvements in caregiver responsiveness, parenting self-efficacy, and child language and socio-emotional development. Implementation strategies included staff training, workflow integration, fidelity monitoring, and community partnerships. Key facilitators were contextual responsiveness, strong relational supports, and alignment with clinical processes. Barriers included small or homogeneous samples, reliance on parent-report outcomes, short follow-up periods, and resource constraints.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Early relational health interventions are feasible and show promise in pediatric primary care when embedded into routine care and adapted to context. Addressing methodological and implementation challenges is essential to advancing relationship-centered pediatric practice.
SCOPING REVIEW REGISTRATION: Open Science Framework (OSF) DOI: https://doi.org/10.17605/OSF.IO/ZCGVA.

Keywords:  Early relational health; caregiver–child interaction; implementation science; pediatric primary care; scoping review

DOI:  https://doi.org/10.1016/j.acap.2026.103418
Pediatr Qual Saf. 2026 Jul-Aug;11(4):11(4): e890

Improving Time to Antibiotic Administration in Open Fractures.

Fiona A Fimmel, Emily M Rheaume, Kelly S Falcone, Vincent R Alexander, Sean Bartlett, Laurie H Johnson, Adam A Vukovic.

Introduction: Timely antibiotic treatment for pediatric open long-bone fractures is associated with a reduced risk of infection. National guidelines recommend administering intravenous antibiotics within 60 minutes of presentation to the emergency department (ED). Historically, this study's level 1 pediatric trauma center has not met this benchmark. The objective of this study was to improve antibiotic administration time for pediatric patients with open long-bone fractures from a baseline of 113 to 60 minutes or less.
Methods: A multidisciplinary team used serial Plan-Do-Study-Act cycles to implement and refine ED processes. Key interventions included targeted education for stakeholders, an updated order set with standardized antibiotic recommendations, modification of the existing orthopedic triage workflow, and quality review of eligible cases with feedback provided to treatment teams. Data were analyzed using X-moving range control charts to identify signals of change. The primary outcome measure was the time to appropriate antibiotic administration after arrival at the ED. Use of the newly introduced order set was tracked as a process measure, and time to analgesic and fracture reduction were balancing measures.
Results: Data collected from September 2020 to March 2025 included 111 patients, 60 of whom were seen postintervention (starting in April 2023). Time to antibiotic administration improved from 113 to 36 minutes. There was a modest improvement in order set usage. Balancing measure times were not negatively impacted.
Conclusions: The use of an iterative multimodal quality improvement package reduced the time to antibiotic administration and improved adherence to evidence-based protocols for the initial treatment of pediatric open long-bone fractures.

DOI: https://doi.org/10.1097/pq9.0000000000000890
Curr Opin Pediatr. 2026 Jul 28.

Vitamin D in pediatrics: the need for precision medicine-based guidelines for screening, monitoring, and supplementation.

Benjamin Udoka Nwosu.

   PURPOSE OF REVIEW: About 7.6 million children and adolescents in the United States have vitamin D deficiency. There are significant consequences from low vitamin D states, including epigenetic modifications in utero that lead to diseases later in life. Current vitamin D guidelines are inadequate because they focus solely on the skeletal benefits of vitamin D, excluding its extra-skeletal functions.
RECENT FINDINGS: Recent randomized controlled trials and large, long-term studies demonstrate the extra-skeletal benefits of vitamin D in type 1 diabetes, prediabetes, multiple sclerosis, telomere erosion, and cardiovascular health at higher serum 25-hydroxyvitamin D [25(OH)D] compared with the current recommended thresholds. These data call for a revision of current guidelines for vitamin D screening and supplementation.
SUMMARY: Vitamin D is vital for health due to its skeletal and extra-skeletal functions. Extra-skeletal functions are less well known among medical personnel and the public. Thus, most of the world's population, especially children, have sustained suboptimal serum concentrations of 25(OH)D, which exert negative impacts on health across the lifespan. This Review provides the data and rationale for a comprehensive revision of vitamin D guidelines for fetuses, infants, children, and adolescents, using a precision medicine-based approach to address their skeletal and extra-skeletal needs.

Keywords:  bone health; guidelines; screening; supplementation; vitamin D

DOI:  https://doi.org/10.1097/MOP.0000000000001599
Pediatr Qual Saf. 2026 Jul-Aug;11(4):11(4): e892

Enhancing Pediatric Obesity Management through Quality Improvement: A Hybrid Approach to Intensive Health Behavior and Lifestyle Treatment in Primary Care.

Emily T Skrocki, Cristian Sarabia, Shengh Xiong, Ayelet Talmi.

Introduction: Intensive health behavior and lifestyle treatment (IHBLT) programs can improve weight and reduce comorbidities for children with obesity, but implementation in primary care remains limited. Baseline performance at our institution showed low referral volume, limited participation, and insufficient treatment intensity, indicating gaps in program reach and adoption.
Methods: Utilizing the model for improvement, we led a quality improvement initiative in a large urban academic primary care clinic to increase IHBLT referrals, participation, and treatment intensity. Sequential plan-do-study-act cycles tested provider education, standardized and culturally tailored materials, a hybrid in-person-and-virtual program structure, and engagement strategies. We tracked three process measures: referrals, participation, and program intensity. We tracked outcomes using individuals-moving-range (X-mR) statistical process control charts.
Results: Statistical process control analysis demonstrated that program participation and intervention intensity met Provost criteria for a sustained shift, whereas referral volume demonstrated primarily common-cause variation. Improvements in participation and intervention intensity were maintained over time, with centerlines recalculated to reflect updated process performance. Moving range charts indicated stable variation across all measures.
Conclusions: An iterative, context-responsive system redesign improved the delivery of evidence-based pediatric obesity treatment in our primary care setting. The hybrid IHBLT model, combining in-person visits and technology-supported touchpoints, was associated with sustained gains in participation and treatment intensity, whereas referral volume remained stable. This pragmatic approach leverages existing resources and offers a feasible pathway for primary care clinics seeking to implement guideline-concordant IHBLT while addressing common logistical and equity-related barriers.

DOI: https://doi.org/10.1097/pq9.0000000000000892
Pediatr Emerg Care. 2026 Jul 29.

Pediatric Trauma Education in the United States: A Nationwide Clinician Needs Assessment.

Elizabeth M Brigham, Kyndra Holm, Denise B Klinkner, Zachary Kochy, Catherine A McGaughey, Gary W Nace, Dana M Schwartz, Patrick C Bonasso.

   OBJECTIVE: Standardized training and education are priorities for improving system-level quality and outcomes for pediatric trauma patients. The objective of this study is to identify common educational needs of pediatric trauma clinicians in the United States and the gaps in currently available education courses, to inform future curriculum development.
METHODS: An anonymous, IRB-approved, 30-item cross-sectional survey was developed and distributed to pediatric trauma clinicians via e-mail. Demographic and quantitative data were analyzed with descriptive statistics. Open-ended responses were analyzed using reflexive thematic analysis.
RESULTS: Two hundred four surveys were analyzed. Respondents were faculty physicians (40.7%), nurses (23.5%), trauma program managers (18.6%), advanced practice providers (11.3%), EMS (4.4%), and trainee physicians (1.5%) representing thirty-seven states. 70% worked at a pediatric trauma center. 65% had taken the ATLS course, but only 50% felt that the course prepared them to care for pediatric trauma patients. 97% had taken PALS, but only 45% felt the course prepared them for pediatric trauma care. Respondents ranked comfort with specific pediatric trauma skills. Confidence was lowest for chest tube placement (mean=5.7/10) and dosing intubation medications (6.1/10). Confidence was highest for tourniquet placement (8.2/10) and assigning a GCS to a school-aged child or teen (8.1/10). Qualitative themes included: (1) Neither ATLS nor PALS provide comprehensive pediatric trauma education; (2) Comfort with pediatric trauma comes from experience rather than course completion; (3) There is a desire for additional pediatric-specific education, and (4) Multiple specific topics were identified as educational needs.
CONCLUSION: ATLS and PALS alone do not meet the need for comprehensive pediatric trauma education in the United States. Experience is most helpful for proficiency, putting low-volume centers at a disadvantage. Pediatric-specific trauma education is desired, including simulation-based courses and app-based reference materials. Pediatric procedural skills, age-specific assessment and physiology, and evidence-based best practices should be targeted.

Keywords:  education; pediatric trauma; simulation

DOI:  https://doi.org/10.1097/PEC.0000000000003666
Children (Basel). 2026 Jul 10. pii: 915. [Epub ahead of print]13(7):

Non-Pharmacological and Non-Optical Interventions for Myopia Prevention and Control in Children: A Systematic Review and Meta-Analysis.

Claudia Domínguez-Morras, Miren Paniagua García, Isabel Castro Garrido, Javier Moreno-Montañés, Alejandro Fernandez-Montero, Laura Moreno-Galarraga.

   BACKGROUND: Myopia is projected to affect 50% of the global population by 2050. Its progression increases the risk of severe ocular pathologies, making it imperative to validate safe and effective non-pharmacological prevention interventions.
AIM: To evaluate the clinical efficacy of low-level red-light therapy (RLRL) and nutritional supplementation in preventing and controlling myopia progression in children and adolescents.
METHODS: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420261301596). Randomized clinical trials in pediatric populations (aged 0-18 years) were included. The primary quantitative outcome measures for myopia were axial length (AL) and spherical equivalent (SE). Risk of bias (RoB 2) and heterogeneity (I2) were assessed.
RESULTS: 18 articles were included (n = 2438). RLRL demonstrated a significant reduction in axial elongation (mean difference (MD): -0.26 mm; 95% CI: -0.34 to -0.18) and a protective effect on refractive progression (MD: +0.60 D; 95% CI: 0.42 to 0.78), although with high heterogeneity (I2 > 97%). Nutritional supplementation exhibited a modest, non-significant effect on axial length (-0.22 mm; 95% CI: -0.44 to 0.00), acting primarily as functional support.
CONCLUSIONS: RLRL slows ocular elongation and myopia progression. Recent studies provide reassuring evidence regarding its long-term safety when recommended treatment protocols are followed. However, the high heterogeneity among studies, the need for standardized treatment discontinuation strategies, and the limited long-term evidence in geographically and ethnically diverse pediatric populations warrant further investigation. Current evidence is insufficient to demonstrate a consistent clinically meaningful effect of nutritional supplementation on axial elongation.

Keywords:  axial length; children; dietary supplements; low-level light therapy; myopia; photobiomodulation; prevention and control; spherical equivalent

DOI:  https://doi.org/10.3390/children13070915
Paediatr Drugs. 2026 Jul 27.

21‑Valent Pneumococcal Conjugate Vaccine V116 (CAPVAXIVE®): Pediatric First Approval.

Matt Shirley.

The 21‑valent pneumococcal conjugate vaccine (PCV) V116 (CAPVAXIVE®), developed by Merck & Co., has been approved in the USA since June 2024 for active immunization for the prevention of pneumonia and invasive disease caused by Streptococcus pneumoniae in adults, with subsequent approvals in adults in the EU and a range of other countries. With the inclusion of eight S. pneumoniae serotypes that are not included in other currently licensed pneumococcal vaccines, V116 was designed to target residual pneumococcal disease in adults. Noting that some of the unique serotypes in V116 are responsible for significant pneumococcal disease in children and adolescents, the potential value of V116 in also complementing existing pediatric pneumococcal vaccination regimens has been explored. Supported by phase III clinical evaluation in children and adolescents with an increased risk of pneumococcal disease, in March 2026, V116 received its first pediatric approval, in the EU, for active immunization for the prevention of invasive disease and pneumonia caused by S. pneumoniae in children and adolescents 2 to < 18 years of age who previously completed a primary pediatric pneumococcal vaccination regimen. Subsequently, in June 2026, the US approval for V116 was extended to include use in individuals 2-17 years of age who are at increased risk for pneumococcal disease. This article summarizes the milestones in the development of V116 leading to these first pediatric approvals for active immunization for the prevention of invasive disease and pneumonia caused by S. pneumoniae.

DOI: https://doi.org/10.1007/s40272-026-00764-3
JAMA Pediatr. 2026 Jul 27.

What Parents Need to Know About Head Injury and Concussions.

Maria Isabel Angulo, Miguel Barajas, Lindsay A Thompson.

DOI: https://doi.org/10.1001/jamapediatrics.2026.2821
Pain Manag Nurs. 2026 Jul 30. pii: S1524-9042(26)00249-3. [Epub ahead of print]

Introducing the ZIPP Scale: Addressing a Gap in Pediatric Pain Assessment.

Chrysanthe Patestos.

   BACKGROUND: Accurate assessment of pain in young children remains a persistent challenge, as many existing self-report tools demonstrate limitations in children under 6 years of age. Developmentally appropriate measures are needed to support reliable pain evaluation in this population.
PURPOSE: This article presents the theoretical rationale, structure, and intended administration of the Zoographic Indicator for Pediatric Pain (ZIPP) Scale, a new tool proposed to address this gap in pediatric pain assessment by utilizing concepts commonly understood by children as young as two years old. Proposed procedures for formal psychometric testing of the tool are outlined. The ZIPP Scale is introduced as an early-stage instrument requiring validation prior to use in clinical care.
CONCLUSIONS: The ZIPP Scale introduces a developmentally responsive approach to pediatric pain assessment, advancing conceptual and methodological development in the evaluation of pain in young children, with potential to enhance quality of life for children and their families.

Keywords:  Chronic pain; Nursing assessment; Pain management; Palliative care

DOI:  https://doi.org/10.1016/j.pmn.2026.07.013
Pediatr Qual Saf. 2026 Jul-Aug;11(4):11(4): e897

Improving Communication Around Discharge Readiness at a Satellite Children's Hospital: A Single-site Improvement Initiative.

Brittany B Hubbell, Stephanie Allen, Yamini Kuchipudi, Emily Schmidlin, Deanna Verdin, Madison Archer, Jennifer Albrecht, Eric Mailloux, Christine M White, Angela M Statile, Lisa E Herrmann.

Introduction: Discharge efficiency enhances hospital throughput, enabling timely, appropriate care while improving patient/caregiver experience and provider satisfaction. Prior efforts at our institution focused on implementing a discharge workflow based on the early identification of medical discharge goals. However, our satellite hospital team lacked consistent nurse-driven discharge activation when patients met these goals, which could delay the identification of discharge readiness. We aimed to increase the percentage of patients for whom nurses identified discharge readiness and activated the discharge process from 28% to 60% within 6 months.
Methods: A multidisciplinary team applied quality improvement methods to identify key drivers and implement targeted interventions. Interventions included process education, structured communication during rounds, targeted feedback and email reminders, scheduled rounding times, and use of conditional discharge orders. We tracked the primary measure, the percentage of patients with nurse-driven discharge activation, using a statistical process control chart. Secondary measures included the percentage of patients with nurse-documented discharge readiness, the percentage of patients discharged within 2 hours of meeting medical discharge goals, and hospital length of stay. We monitored 7-day readmission rates as a balancing measure.
Results: The mean percentage of patients with nurse-driven discharge activation increased to 67% and remained above this level for more than 8 months. The percentage of patients with nurse-documented discharge readiness improved from 71% to 86%; the mean percentage of patients discharged within 2 hours of nurse-identified readiness increased from 85% to 89%. Length of stay and 7-day readmission rates were unchanged.
Conclusions: Through multidisciplinary efforts to improve process transparency and collaborative communication frameworks, we enhanced nurse-driven discharge activation at a satellite children's hospital.

DOI: https://doi.org/10.1097/pq9.0000000000000897
Pediatr Qual Saf. 2026 Jul-Aug;11(4):11(4): e900

Quality Improvement Project to Reduce Wait Time for Pediatric Gastrointestinal Procedures.

Jennifer M Colombo, Nicholas A Clark, Laura E Shroyer, Dustin J Hahn, Jonathan Patterson, Kenneth J Sam.

Introduction: Delays in care can lead to poor health outcomes and suboptimal patient and family experiences. We aimed to reduce the average wait time for gastrointestinal endoscopic procedures (procedure request to procedure completion) from 145 to 15 days (a 90% reduction) within 4 months (November 2023 to March 2024).
Methods: A3 problem-solving methodology was used. The primary intervention was a multiday, multidisciplinary improvement workshop. Outcome measures included (1) procedure request date to procedure completion date, and (2) favorable patient satisfaction score for timeliness of access to care. Process measures included (1) procedure request date to date procedure scheduled by staff, and (2) date procedure scheduled by staff to procedure completion date. The balancing measure was the number of procedures scheduled per weekday. Control charts assessed the impact of interventions.
Results: Following the primary intervention (October 2023), special cause improvement was seen for all but the balancing measure. Outcome measure 1 achieved a sustained reduction in mean monthly wait time from 145 to 26.4 days (an 82% reduction), whereas outcome measure 2 achieved sustained improvement in patient satisfaction from 39.7% to 50.2% (a 26.4% relative improvement). Process measures 1 and 2 had sustained reductions from 56.5 to 14.7 days (a 74% reduction) and 89.1 to 20.7 days (a 77% reduction), respectively. The balancing measure also remained unchanged at a monthly average of 11.7 procedures scheduled per weekday.
Conclusions: Using A3 problem-solving methodology, we achieved an 82% sustained reduction in endoscopic procedure wait times with a concurrent 26.4% improvement in patient satisfaction. Procedures are now routinely completed within 1 month of the request date.

DOI: https://doi.org/10.1097/pq9.0000000000000900
J Pediatr Clin Pract. 2026 Oct;21 200223

Recent Updates in the Management of Anaphylaxis: The Role of the Pediatrician.

Jonathan M Spergel, Anna Nowak-Wegrzyn, Joel Brooks, Suzanne Kochis.

  Anaphylaxis is a rapid-onset, potentially life-threatening systemic allergic reaction that remains a significant clinical concern in pediatric practice. Food allergies are the most common trigger in children, and a substantial proportion of affected patients experience severe reactions. This review provides a practical, evidence-based framework for the diagnosis and management of IgE-mediated allergy in the pediatric setting, emphasizing recognition, treatment, and preparedness. Anaphylaxis is a clinical diagnosis based on established criteria, with age-specific presentations that may complicate recognition, particularly in infants and young children. Epinephrine is the cornerstone of treatment and the only therapy capable of reversing life-threatening respiratory and cardiovascular manifestations. Early epinephrine administration improves outcomes, yet real-world use remains suboptimal due to barriers such as needle aversion, device complexity, and access challenges. Pediatricians play a critical role in identifying at-risk patients, prescribing epinephrine, and reinforcing preparedness through education and individualized action plans across care settings. Integrating evolving therapeutic options with established best practices may help to address persistent gaps in care and improve outcomes for children at risk of anaphylaxis.

Keywords:  IgE-mediated allergy; anaphylaxis; epinephrine; food allergy

DOI:  https://doi.org/10.1016/j.jpedcp.2026.200223
Nurs Crit Care. 2026 Jul;31(4): e70593

The Development of Parental Knowledge of Their Child in NNU and PICU: An Exploratory Qualitative Study of Parents' Experiences.

Sarah E Seaton, Ashleigh E Butler, Joseph C Manning, Lucy K Smith, Katie Gallagher, Nicola Mackintosh.

   BACKGROUND: Advancements in neonatal and paediatric intensive care have improved survival of children born very preterm or with complex health conditions. However, many of these children will subsequently require admission to paediatric intensive care. How families navigate experiences and knowledge across these different admissions remains poorly understood.
AIM: To explore the experiences of parents with a child admitted to both a neonatal unit (NNU) and a paediatric intensive care unit (PICU) with a focus on the development of parental knowledge.
STUDY DESIGN: We conducted an exploratory qualitative study. Semi-structured interviews were conducted with 18 parents of 15 children who experienced admission to both NNU and PICU. Participants were recruited via national charities and interviewed remotely. Data were analysed using inductive content analysis, focussing on parents' temporal experiences.
FINDINGS: Parents described knowing their child as a dynamic state evolving throughout the NNU to the PICU. In the NNU, parents initially learned to know their child through hands-on care, often facilitated by staff, though physical and emotional barriers sometimes hindered bonding. Discharge from NNU was a key transition moment, with some parents feeling confident while others felt uncertain about managing their child's healthcare needs at home without the support of staff and medical equipment. At PICU admission, parents brought experiential knowledge, the value of which was not always recognised by healthcare professionals. This lack of acknowledgement sometimes led to missed opportunities for provision of safe care. During PICU stays, parents wanted their expertise respected and integrated into care, particularly for children requiring ongoing specialist care, which was often provided by families, outside of PICU.
CONCLUSIONS: Parental knowledge of their child, and their previous experiences, is vital to support safe care delivery but sometimes overlooked. Recognising parents as expert and equal partners in care can potentially improve safety, communication and family-centred practice.
RELEVANCE FOR CLINICAL PRACTICE: Neonatal and paediatric healthcare teams should actively acknowledge and incorporate parental expertise during and when transitioning between NNU and PICU. Parents' experiences provide additional insights, which provide opportunities for better care. Improved communication across neonatal and paediatric services may enhance outcomes and parental confidence.

Keywords:  neonatal care; paediatric intensive care; parent experience; qualitative research

DOI:  https://doi.org/10.1111/nicc.70593
Subst Use. 2026 Jan-Dec;20:20 29768357261472425

Barriers and Facilitators to Naloxone Access for Adolescents: A Narrative Review.

Cristian R Ramos, Kathleen H Krause, Veronica M Joseph, Darja Beinenson, Samantha C Patton, Katharine Torrey, Mansi Chaubey, Joseph E Mathias, Janet R Cummings, Justine W Welsh.

   Background: Disproportionately high mortality rates from opioid overdose among adolescents have emerged as a major public health concern in the United States (U.S.). Among available interventions, naloxone, an opioid receptor antagonist, continues to be recognized for its effectiveness in reversing opioid overdose. However, access to naloxone among adolescents remains scarce, underscoring potential gaps in overdose prevention for this population.
Methods: This narrative review examines current literature to identify barriers and facilitators that influence naloxone availability and uptake among adolescents. The review includes young adult (up to age 30) data when it overlaps with adolescent literature. The review followed the SANRA checklist criteria and utilized the Cochrane, MEDLINE-PubMed, and Google Scholar databases for relevant studies from 2012-2026.
Key Findings: Barriers to naloxone access are multifactorial, including cost-related constraints, inconsistent implementation of over-the-counter dispensing practices, limited awareness of dispensing policies, and stigma towards people who use drugs. Structural and individual factors found to assist in the facilitation of naloxone access include policy changes enabling non-prescription dispensing, pharmacy standing orders, and laws that permit independent minor consent for substance use treatment. However, disparities in naloxone availability and use persist, and implementation of such policies is inconsistent across settings.
Recommendations: Accordingly, legislation that promotes naloxone availability and educational initiatives designed to increase knowledge and acceptance of its use in diverse settings may be important, as evidence supports its association with reduced overdose mortality. Additional efforts are warranted to improve naloxone availability and use among adolescents, including expansion of clinician prescribing practices, reduction of costs at the point-of-dispense, and greater distribution of the medication for patients leaving treatment facilities.

Keywords:  adolescents; naloxone; overdose; substance use; youth

DOI:  https://doi.org/10.1177/29768357261472425
Acad Pediatr. 2026 Jul 28. pii: S1876-2859(26)00195-6. [Epub ahead of print] 103413

Physician Knowledge and Comfort Identifying Pediatric Speech Sound Development Concerns.

Marisha Speights.

   OBJECTIVE: Physicians who provide pediatric care play an important role in early identification of developmental communication concerns, yet little is known about their comfort, knowledge, and screening practices related to pediatric speech sound disorders (SSDs). This study examined physicians' perspectives on universal screening, comfort screening speech sound concerns relative to language concerns, characteristics associated with comfort, self-rated knowledge across child linguistic profiles, speech sound screening tool use, and perceived training needs.
METHODS: U.S.-licensed physicians who provide pediatric care completed a national survey assessing universal screening perspectives, comfort screening speech and language concerns, knowledge of speech sound development, screening tool use, and training needs. Descriptive analyses summarized survey responses. Ordinal mixed-effects and logistic regression models examined differences in comfort and knowledge, and physician characteristics associated with comfort screening speech sound concerns.
RESULTS: Most physicians endorsed universal screening for speech and language development. Physicians reported greater comfort screening language concerns than speech sound concerns. Self-rated knowledge varied across child linguistic profiles, with the lowest knowledge reported for bilingual/multilingual children exposed to English after another language. Physicians reported limited use of speech sound-specific screening tools, and more than 70% endorsed additional training related to speech sound disorders.
CONCLUSIONS: Physicians who provide pediatric care support early identification but report domain-specific gaps in comfort and preparation for screening SSDs. Strengthening physician knowledge, practical screening supports, decision tools, and cross-disciplinary collaboration may improve physician comfort identifying pediatric speech sound concerns.

Keywords:  language diversity; pediatricians; screening; speech sound disorders

DOI:  https://doi.org/10.1016/j.acap.2026.103413
J Pediatr. 2026 Jul 29. pii: S0022-3476(26)00290-8. [Epub ahead of print] 115262

Screening for Depression at Adolescent Well-Child Visits: Who Is Screened and What Happens Afterwards?

Kevin Petranu, Joseph Chase, Ashley Mchugh, Cheryl Lefaiver, Michael Fendrich.

OBJECTIVES: To evaluate the frequency in which depression screenings were administered at yearly adolescent well visits between 2019 - 2022, and to examine how often primary care providers initiated a depression-related follow-up action for youth who screened "high" for depression.
STUDY DESIGN: We examined electronic health record (EHR) data between 2019 - 2022 for youth patients ages 12 - 17 (N = 53,283) at Advocate Health - Midwest. Depression screening and related data were collected from each patient's index well visit, and depression-related follow-up data were collected within the first 6 months after the index well visit.
RESULTS: Depression screenings were completed at 86.7% of well visits, and patients who were screened were more likely to receive follow-up care compared with those who were not (adjusted OR = 1.33, 95% CI [4.56, 5.87]). There were significant differences in depression screening rates and follow-up care, based on age, race and ethnicity, and insurance type.
CONCLUSIONS: Depression screening rates were high year-over-year, which may be attributed to the automated depression screening system embedded within the healthcare system's EHR. There is still a need to improve the equity of screening practices, particularly for historically marginalized groups, as screening for depression is a crucial step in connecting at-risk youth with follow-up care.

DOI: https://doi.org/10.1016/j.jpeds.2026.115262
Pediatr Rev. 2026 Aug 01. 47(8): 439-449

Something Doesn't Look Right: Recognizing and Managing Limb-Length Discrepancy.

D'Arcy Marsh, Mohamed Said, Catherine Mackey, Eric Fornari.

Leg length discrepancy (LLD) is a frequently encountered yet often underrecognized musculoskeletal condition in children. Minor differences in leg length are common and typically benign; however, more significant discrepancies may reflect underlying congenital, developmental, or acquired pathology. Because many children adapt well, these discrepancies can remain unnoticed until gait changes, pain, or functional limitations appear. Early recognition is essential, as management depends on the child's remaining growth and the underlying cause. Epidemiologic studies suggest that up to 90% of children have some degree of asymmetry, but clinically significant LLD is rare. Despite this, many pediatricians report uncertainty about how to distinguish true from apparent discrepancies and when to refer for orthopedic evaluation. The optimal approach involves routine screening during well-child visits, accurate physical examination, and timely referral when progressive or symptomatic differences are detected. This review summarizes the causes, evaluation, and management of pediatric LLD and provides practical guidance to help pediatricians recognize red flags, interpret imaging, and counsel families effectively.

DOI: https://doi.org/10.1542/pir.2025-006863
J Pediatr Surg. 2026 Jul 29. pii: S0022-3468(26)00417-3. [Epub ahead of print] 163335

Staying Put: A Single Institution Quality Improvement Initiative to Reduce Early Gastrostomy Tube Dislodgement in Children.

Alexa G Turpin, Molly Haislip, Kristen Delin, Kathleen Kiesel, Brett Kestecher, Judith Guidash, Loren Berman.

   PURPOSE: Gastrostomy tube (GT) placement is one of the most common surgical procedures performed in children. Early GT dislodgement is a potentially preventable complication associated with high morbidity, increased healthcare utilization, and need for early instrumentation or re-operation. This quality improvement initiative aimed to reduce the rate of early GT dislodgement from 14.3% to 7% within 12 months.
METHODS: After identifying a high rate of early GT dislodgements, a team of multidisciplinary stakeholders developed a quality improvement initiative to reduce early dislodgements, defined as any dislodgement within 60 days of surgery. The intervention included: 1) standardization of post-operative GT dressing; 2) robust family education focusing on common GT problems, GT dressings and securement, and instructions for management if dislodgement occurs; 3) nursing education and hands-on demonstration; and 4) creation of a post-operative order set, including the new dressing order and instructions to disconnect the extension tubing when not in use. Process measures included adherence to post-operative dressings and completion of family education. The outcome measure was GT dislodgement rate.
RESULTS: Since Go-Live, there has been 100% compliance with completion of family education. Compliance with standard post-operative dressing initially lagged, but has been 100% since February 2025, with the exception of October 2025. At 1.5 years post-implementation, the rate of early dislodgements was not trending in the desired direction, so we identified patients at higher risk for dislodgement based on demographic factors. All high-risk patients are contacted via telephone two weeks post-operatively to check in and reinforce family education. The rate of early dislodgement has decreased from 14.8% to 4.3%.
CONCLUSION: Interventions including hospital-wide post-operative protocols, standardized dressings, high-quality parent education, and targeted efforts for high-risk patients can reduce rates of early GT dislodgement in children and related morbidity.

Keywords:  dislodgement; gastrostomy tube; quality improvement

DOI:  https://doi.org/10.1016/j.jpedsurg.2026.163335
Focus (Am Psychiatr Publ). 2026 Apr;24(2): 127-139

Use of Ketamine and Esketamine in the Pediatric Population: Current Evidence and Clinical Applications.

Thomas Kun Pak, Stephen Kimatian, Graham Emslie, Emine Rabia Ayvaci.

  Ketamine is a well-established anesthetic agent that is gaining increasing recognition for its diverse therapeutic applications, including the management of chronic pain, refractory status epilepticus, major depressive disorder, and suicidality. Although it has been used clinically since the 1960s, multiple clinical trials with ketamine and esketamine in adults and pediatric populations are ongoing. There has been recent growing interest in ketamine and esketamine for psychiatric conditions in children and adolescents. The clinical use of ketamine is complex, in part because of the numerous available formulations and administration routes. Ketamine has different bioavailability depending on the route of administration: intravenous (100%), intramuscular (64%-93% in adults, 41% in pediatric populations), intranasal (43%-48% in adults, 50% in pediatric populations), sublingual (29%-32%), rectal (25%-30%), epidural (77%), and oral (17%-18%), which is due to extensive first-pass hepatic metabolism. Differences in dosing also produce distinct clinical effects. The challenges associated with ketamine use are further magnified in pediatric populations, for which developmental stage, pharmacokinetics, and neurodevelopmental factors play critical roles in guiding safe and effective treatment. In this review, the authors summarize the pharmacodynamics, pharmacokinetics, adverse effects and contraindications, and clinical applications of ketamine and esketamine among adult and pediatric populations.

Keywords:  Child/Adolescent Psychiatry; Pharmacokinetics/Pharmacodynamics; Pharmacotherapy See Also Specific Medication Classes

DOI:  https://doi.org/10.1176/appi.focus.20250040
Child Abuse Negl. 2026 Jul 27. pii: S0145-2134(26)00354-6. [Epub ahead of print]179 108234

Implementation of Universal Child Abuse Screening Tool (U-CAST): Real-world implementation of a standardized electronic health record-based child physical abuse screening in the pediatric emergency department.

Morgan Knowlton, Elizabeth Cauley, Brooke Hammond, Moon Lee, Melissa K Egge, Elena Harnish, Stephanie D Chao.

   BACKGROUND: Universal screening tools can help detect child physical abuse. Epic released an electronic health record-embedded universal child physical abuse screening tool (U-CAST) that can quickly be implemented by any institution that uses Epic.
OBJECTIVE: We evaluated the first year of implementation of an adapted U-CAST in the pediatric emergency department at an academic hospital.
PARTICIPANTS AND SETTING: All patients less than four years of age who arrived in the pediatric emergency department were screened using a four-question tool embedded into the electronic health record.
METHODS: A screen was positive if at least one question was answered "yes". For positive screens, a Best Practice Advisory prompted the attending to document low risk, order specialty consultation, or indicate they were not the responsible physician. The Suspected Child Abuse and Neglect (SCAN) team reviewed all positive screens.
RESULTS: From May 28, 2024 to May 27, 2025, 11,326 screenings were initiated; 10,634 (93.9%) were completed and 198 (1.7%) were positive. Thirty-eight positive screens were associated with Child Protective Services (CPS) reports for concern of child physical abuse (true positives). Eight CPS reports for concern of child physical abuse occurred after negative or incomplete screens. Demographic proportions were similar across screening stages. Implementation achieved a 97% corrected completion rate and an 83% sensitivity for CPS reports for concern for child physical abuse.
CONCLUSIONS: The successful implementation in the first year is promising evidence for the adoption of U-CAST among pediatric emergency departments. We will continue to monitor sustainability beyond the first year.

Keywords:  Child physical abuse; Clinical decision support tool; Electronic health record; Universal screening

DOI:  https://doi.org/10.1016/j.chiabu.2026.108234
JAMA Netw Open. 2026 Jul 01. 9(7): e2626538

Pediatric Oncology Clinical Trial Participation Among Families From Historically Marginalized Groups.

Puja J Umaretiya, Morgan A Paul, Ariana Valenzuela, Alexandria Hawkins, Anna C Revette, Brett Nava-Coulter, Ijeoma Julie Eche-Ugwu, Jennifer M Snaman, Rahela Aziz-Bose, Colleen A Kelly, Gabriella Nguyen, Sandi L Pruitt, Joanne Wolfe, Kira Bona.

Importance: Perspectives of families from historically marginalized groups regarding pediatric oncology clinical trial participation are not well-represented in the literature.
Objective: To describe clinician- and parent-perceived facilitators and barriers to clinical trial participation.
Design, Setting, and Participants: This single-center cross-sectional study with an explanatory sequential mixed-methods design enrolled parents of Black and Hispanic children with cancer as well as pediatric oncology clinicians from a large pediatric cancer center in Boston, Massachusetts. Parent participants completed single-time point surveys, and a subset, purposively sampled based on self-identified race and ethnicity, language, and household material hardship (HMH; ie, food, housing, transportation, or utility insecurity), completed semistructured interviews from September to December 2021. Clinicians completed semistructured interviews from February to March 2022. Data were analyzed from April 2022 to October 2025.
Main Outcomes and Measures: Key factors influencing clinical trial participation in pediatric oncology among parents from historically marginalized groups. Quantitative data were summarized descriptively. Interview transcripts were analyzed using thematic analysis and integrated along key domains.
Results: A total of 60 parents completed the questionnaire; self-identified race and ethnicity included 5 Hispanic Black (8%), 10 Hispanic White (17%), 21 Hispanic other (35%), 21 non-Hispanic Black (35%), and 3 non-Hispanic White (5%) parents; most were mothers (51 [85%]). Twenty parents participated in interviews. Fifteen clinicians (10 [67%] female participants; 10 [67%] with ≥10 years caring for children with cancer) were interviewed, including 12 (80%) attendings and 3 (20%) advanced practice practitioners; most identified as non-Hispanic White (14 [93%]). Most families experienced HMH (44 [73%]) and reported high trust in their oncology team (mean [SD] score, 4.63 [0.65] of 5.00). Qualitatively, parents and clinicians aligned in identifying altruism and trustworthiness as facilitators to trial participation, while the informed consent discussion, non-English language preference, trial materials, and study requirements were participation barriers. Unlike clinicians, parents did not identify HMH or the experimental nature of trials as significant barriers to participation. Parents identified the desire for representation as a facilitator to participation, and clinicians identified gatekeeping as a barrier.
Conclusions and Relevance: In this cross-sectional study of pediatric oncology families from historically marginalized groups and clinicians, clinician- and parent-perceived barriers identified opportunities to increase equitable trial participation. Next steps include standardization of trial eligibility screening and systematic HMH screening and support to reduce gatekeeping.

DOI: https://doi.org/10.1001/jamanetworkopen.2026.26538