bims-cliped 2026-08-30 papers

bims-cliped

Biomed News

on Clinical pediatrics

Issue of 2026–08–30
thirty papers selected by
Alyssa M. Portwood, Akron’s Children

Factors associated with medication administration errors in hospitalized pediatric patients: A scoping review.
Improving Antibiotic Management for Pediatric Patients Diagnosed With Presumed Urinary Tract Infections in the Pediatric Emergency Department.
Patient Portal Use and Care Utilization Among Hospitalized Children.
Patient and Family Experience in the Pediatric Emergency Department: Association With Real-Time Crowding Monitoring and Operational Factors.
Timely care for tiny lives: quality improvement for golden hour management bundle.
Improving Success Rates in Infant Lumbar Punctures: A Quality Improvement Initiative Using Ultrasound Guidance.
Vaccination of children with inborn errors of metabolism: safety, immunogenicity, and practical implications.
Streamlining the Interfacility Transfer Referral Process for Pediatric Seizures: A Quality Improvement Project.
2025 Practice-changing articles in trauma, emergency general surgery, pediatric trauma, and surgical critical care: an EAST narrative review.
Cost Implication of a Community-Based Pediatric Palliative Care Program.
Suicide Screening, Evaluation, and Management: A Trauma-Informed Approach for Primary Care.
The Pediatric Hospitalist: A Survey of What We Do and Where We Are Going.
Beginning Restorative Activities Very Early: A Quality Improvement Project to Advance ABCDEF Bundle Practice in a Pediatric Oncology Intensive Care Unit.
How Rapid Cycle Deliberate Practice Compares to Traditional Simulation: A Qualitative Investigation of Pediatric Resident Perceptions.
Adolescent Menstrual Health Equity.
A Comparative Analysis of US State Pediatric Dental Moderate Enteral Sedation Regulations.
Hope in Pediatric Palliative Care: A Systematic Review.
Reframing Patient and Parental Experience in Pediatric Healthcare: Medical Gaslighting as a Diagnostic Safety Vulnerability.
Understanding Parental Behaviours Related to Infant Sleep Environment: A Qualitative Study.
Are Pediatric GLP-1 Receptor Agonist Cutaneous Adverse Events Being Overlooked? Emerging Age-Specific Patterns and Their Implications for Dermatologists.
ICE Activity Tied to Disruptions in Pediatric Care.
Comparison of Basketball-Related Injuries at US Emergency Departments Between High School-Aged and College-Aged Athletes: A 10-Year NEISS Analysis, 2015-2024.
Intracapsular tonsillectomy/tonsillotomy for severe pediatric obstructive sleep apnea A PRISMA-based systematic review and exploratory meta-analytic synthesis of full-text articles.
Inpatient Palliative Care for Pediatric Neurologic and Neuromuscular Illnesses in the U.S.-A National Perspective.
Continuing Trend of Increased Operative Treatment of Clavicle Fractures in Pediatric Patients in the United States Despite a Lack of Supporting Evidence in the Literature.
Exploring the Social, Emotional, and Physical Consequences of Hidradenitis Suppurativa in Pediatric Patients: A Scoping Review.
Sleep Health in School-Aged Children: A Qualitative Study of Community-Based Pediatric Providers' Perspectives and Practices.
Naloxone Access in Schools: A National Survey of School Nurses in the United States.
Household Vaccination Status and Attitudes toward Pediatric COVID-19 Vaccination: A Survey at Four New Jersey Clinic-Based Pediatric Practices.
Temporal Trends in Geographic Distribution of PICUs in the United States 2001-2023.

Ther Adv Drug Saf. 2026 ;17 20420986261478390

Factors associated with medication administration errors in hospitalized pediatric patients: A scoping review.

Claudia Lorena Motta Robayo, Jonathan Martínez Pinto, Bryan Tabango Goyes, Laura Varela Chagüendo, Eduardo Duque Grisales, Ricardo Ballesteros-Ramírez.

   Background: Medication errors are a leading preventable cause of harm in hospitalized children. The pediatric population is particularly vulnerable due to weight-based dosing requirements, developmental pharmacokinetic variability, and limited capacity for self-advocacy.
Objectives: To map and synthesize the available evidence on factors associated with the occurrence of medication administration errors in hospitalized pediatric patients.
Eligibility Criteria: Studies addressing administration phase medication errors (per the National Coordinating Council for Medication Error Reporting and Prevention, NCC MERP) in hospitalized children aged 0 to 18 years, published in English, Spanish, or Portuguese, using quantitative, qualitative, or mixed methods designs.
Sources of Evidence: Nine electronic databases were searched from inception to July 2026 using English, Spanish, and Portuguese (DeCS) terms, supplemented by hand searching of reference lists.
Charting Methods: The review followed the Joanna Briggs Institute (JBI) methodology; data were charted with the JBI standardized instrument and synthesized narratively with thematic analysis.
Results: Of 1,012 records, 25 studies met the inclusion criteria. Incorrect dosing was the most prevalent error type (18 studies, 72%). Neonates and infants were the most vulnerable group, and PICU and NICU the highest-risk settings, although a direct observation study reported that 37% of administrations on general wards involved an error. Human factors, particularly knowledge deficits, were the most frequently reported contributors (13 studies, 52%). Five complementary mitigation strategies were identified: professional education, dual verification, unified non-punitive reporting, technology, and interprofessional communication.
Conclusions: Medication administration errors in pediatric inpatients are driven by a multilayered interplay of human, environmental, communicative, and medication related factors. Effective prevention demands integrated, systems-based approaches combining education, technology, standardized protocols, and a non-punitive safety culture.

Keywords:  drug administration; drug safety; medication errors; nursing; patient safety; pediatrics

DOI:  https://doi.org/10.1177/20420986261478390
Pediatr Emerg Care. 2026 Aug 28.

Improving Antibiotic Management for Pediatric Patients Diagnosed With Presumed Urinary Tract Infections in the Pediatric Emergency Department.

Sejal M Bhavsar, Catherine Hahn, Kaitlyn Philips, Hailey Connolly, Katharine Clouser, Nisha Polavarapu, Caroline Black, Megan Jolin, Ashley Kourgialis, Pooja Shah.

   OBJECTIVES: The objective of this quality improvement (QI) study was to increase appropriate antibiotic management for presumed urinary tract infection (UTI) based on urine culture results for patients discharged from the pediatric emergency department (ED) to 90% (from a baseline of 61%) over 12 months.
METHODS: Pediatric patients discharged from our pediatric ED from February 2024 to January 2025 with the diagnosis of cystitis, pyelonephritis, or UTI were included in our study. We excluded patients with chronic urologic or renal anomalies, immunocompromised status, or those on antibiotics before ED presentation. The primary outcome was the percentage of patients appropriately managed based on urine culture results. Interventions tested using Plan, Do, Study, Act cycles included provider education, individualized antimicrobial stewardship program (ASP) feedback, clinical guideline creation and implementation, and electronic health record (EHR) enhancements. Our balancing measure was ED revisit within 7 days with persistent UTI symptoms.
RESULTS: A total of 355 encounters were included in the intervention period. Mean percentage of patients appropriately managed increased from 61% to 92%. Immediately following our education of the ED team, we observed special cause variation and shifted our centerline. Our second shift was attributed to the implementation of a guideline and EHR enhancements. Guideline adherence was 98%. Four patients (1.1%) returned to the ED within 7 days with persistent UTI symptoms but were found to have other diagnoses.
CONCLUSIONS: This QI project demonstrated that provider education, guideline implementation, and individualized ASP feedback can improve antibiotic management of pediatric patients with UTI discharged from the pediatric ED.

Keywords:  ASP; QI; UTI; pediatric UTI

DOI:  https://doi.org/10.1097/PEC.0000000000003688
Hosp Pediatr. 2026 Aug 27. pii: e2026009398. [Epub ahead of print]

Patient Portal Use and Care Utilization Among Hospitalized Children.

Michael J Luke, Yinlu Zhu, Courtney B Wolk, Stephanie G Menko, Danielle Capriola, Kate Fuller, Philip V Scribano, Christopher P Bonafide, Aditi Vasan.

OBJECTIVE: Patient portals allow patients and caregivers to better engage with health care. Disparities in portal use among high-risk populations, like hospitalized children, could limit their benefits. Additionally, little is known about the association between pediatric portal usage and acute care utilization.
PATIENTS AND METHODS: We conducted a cross-sectional analysis to identify disparities in portal activation and use among patients admitted to 2 children's hospitals from 2022 to 2024. We described unadjusted patterns of portal use and then used multivariable regression to examine the association between portal activation and use before, during, and after hospitalization and patient-level factors, household-level factors, and population-level factors, as well as critical care admissions, hospital length of stay (LOS), and 30-day readmissions.
RESULTS: Among 40 371 hospitalized patients, 93% had activated portal accounts. Patients who identified as non-Hispanic Black, were publicly insured, had a household language other than English, and lived in lower-opportunity neighborhoods had significantly lower odds of portal activation and use before, during, and after hospitalization. Patients with portal use before hospitalization had decreased odds of critical care admission (odds ratio, 0.64; 95% CI, 0.58-0.70) and shorter LOS (incident rate ratio, 0.74; 95% CI, 0.69-0.79), with no difference in readmissions.
CONCLUSIONS: Despite high rates of portal activation in our sample, we observed persistent disparities in portal activation and use. Associations between portal activity and acute care utilization are complex and merit further investigation. Efforts to promote equitable portal usage among hospitalized children should focus on families who are publicly insured, prefer languages other than English, and live in lower-opportunity neighborhoods.

DOI: https://doi.org/10.1542/hpeds.2026-009398
J Patient Exp. 2026 ;13 23743735261481135

Patient and Family Experience in the Pediatric Emergency Department: Association With Real-Time Crowding Monitoring and Operational Factors.

Rebecca C Spegele, Adam A Vukovic, Michael C Ponti-Zins, Yin Zhang, Elena Duma, Nathan Timm, Benjamin Kerrey, Kevin M Overmann.

  Emergency department (ED) crowding is associated with many types of medical errors and mortality. The association of ED crowding and patient and family experience (PFE) is largely unknown. The study objective was to determine the association between crowding in pediatric EDs (PEDs), operational factors, and PFE scores. This was a retrospective analysis of the association between PED crowding (main exposure as measured by PEDOCS, a validated real-time crowding score) and PFE survey scores (main outcome), for 10,876 patient encounters in two PEDs over 18 months. Multivariable regression was used to determine the association of PEDOCS and relevant covariates with PFE. The PEDs were busy but not overcrowded for 83% of encounters. PED crowding was independently associated with worse PFE. Pairwise comparisons showed PEDOCS-measured crowding was independently associated with worse PFE. The greatest reduction in PFE occurred as the PEDs progressed from "busy" to "extremely busy." Covariates including acuity, arrival time, and patient age were also associated with worse PFE scores. Further work to develop targeted interventions using real-time crowding measures may improve PFE in PEDs.

Keywords:  emergency medicine; patient experience; patient-reported experience measures; pediatrics; wait times

DOI:  https://doi.org/10.1177/23743735261481135
BMJ Open Qual. 2026 Aug 26. pii: e003924. [Epub ahead of print]15(3):

Timely care for tiny lives: quality improvement for golden hour management bundle.

Sonali Tanpure, Atul Londhe, Laxmikant Deshmukh, Amol Joshi, John Biswas.

   BACKGROUND: Preterm babies face a high risk of hypothermia, respiratory distress and hypoglycaemia soon after birth. The golden hour-the first 60 min of life-has been shown to improve outcomes with evidence-based, timely interventions. An audit in our neonatal intensive care unit (NICU) in central India showed that only 7.7% of preterms received the golden hour management bundle (GHMB).
METHODS: This quasi-experimental study was conducted between May 2023 and May 2025 in inborn preterms <34 weeks. A multidisciplinary team used process mining and root cause analysis to identify delays in GHMB. Multiple plan-do-study-act (PDSA) cycles were conducted, including revised delivery room transfer policies, dedicated resident role allocation, thermal care practices, ventilator and consumables buffer stock and preprepared intravenous cannula trays. Data were collected prospectively and analysed using time-motion analysis and statistical process control charts.
RESULTS: A total of 294 preterms were studied. The median time to complete GHMB decreased from 107 min at baseline to 55 min in the sustainability phase (p<0.001). The percentage of preterms receiving GHMB rose from 7.7% to 71.7%. The rate of moderate hypothermia at admission decreased from 100% to 12.1%. Timely intravenous fluid administration improved from 12.5% to 80.4%, and medications within the first hour increased from 4.1% to 71%.
CONCLUSION: Process mining helped identify and reduce rate-limiting steps as well as reorganise and reassign tasks, thereby improving the proportion of preterms receiving GHMB.

Keywords:  Nurses; PDSA; Patient Care Bundles; Quality improvement

DOI:  https://doi.org/10.1136/bmjoq-2025-003924
Qual Manag Health Care. 2026 Aug 04.

Improving Success Rates in Infant Lumbar Punctures: A Quality Improvement Initiative Using Ultrasound Guidance.

Alyssa Goodman, Danielle Paulin, Esther Son, Michael Oravec.

  Infant lumbar punctures (LPs) are common procedures in the pediatric emergency department, yet first-attempt success remains challenging. Point-of-care ultrasound improves landmark identification and has been associated with higher LP success rates. We implemented a quality improvement project aiming to reduce multiple LP attempts in children younger than 24 months from 55% to 30% over 1 year through an ultrasound-guided LP education program. The intervention included an online module, hands-on simulation, competency assessment, and Plan-Do-Study-Act cycles. Chart review of 167 patient encounters compared baseline and postintervention outcomes. Multiple-attempt LPs decreased from 55.1% to 43.5%, traumatic LPs declined from 47.0% to 35.6%, overall LP success increased from 84.7% to 85.5%, and ultrasound-guided LP use rose from 5.1% to 14.5%. Although limited sample size prevented statistical significance, integrating phantom simulation and static ultrasound guidance into infant-specific training shows promise for reducing procedural attempts and traumatic LPs while improving patient, family, and clinician experiences.

Keywords:  lumbar puncture; pediatrics; point-of-care ultrasound; quality improvement; ultrasound; ultrasound guidance

DOI:  https://doi.org/10.1097/QMH.0000000000000564
Eur J Pediatr. 2026 Aug 27. pii: 694. [Epub ahead of print]185(9):

Vaccination of children with inborn errors of metabolism: safety, immunogenicity, and practical implications.

Patryk Lipiński, Maria Jaczewska, Teresa Jackowska.

  Children with inborn errors of metabolism (IEMs) are vulnerable to infection-induced catabolism and metabolic decompensation, yet vaccination may be delayed because of concerns that fever or reduced intake after immunization could produce similar effects. This review evaluates vaccine safety, immunogenicity, effectiveness, and practical precautions in pediatric IEMs. PubMed/MEDLINE and Embase were searched from inception to 30 June 2026 using predefined terms for IEMs, vaccination, and pediatric populations. Google Scholar and the reference lists of relevant publications were searched as supplementary sources. Primary evidence synthesis was restricted to pediatric studies or separately extractable pediatric results. Mixed-age studies without separable pediatric outcomes were retained only as contextual evidence and were explicitly identified. Study selection and data extraction were performed independently by two reviewers, and findings were synthesized narratively. Pediatric evidence, predominantly from small observational studies, did not identify a consistent signal of increased serious adverse events or metabolic decompensation after vaccination of clinically stable children with IEMs. Limited pediatric studies reported measurable humoral responses, but the evidence is insufficient for many individual disorders and does not establish clinical effectiveness. Published guidance generally favors age-appropriate vaccination, with precautions individualized to metabolic stability, catabolic risk, immune dysfunction, comorbidities, treatment, and vaccine excipients.
CONCLUSION: Available pediatric evidence is limited but generally reassuring for vaccination of clinically stable children with IEMs. Current guidance supports vaccination according to national schedules unless a vaccine-specific contraindication is present. Decisions concerning live vaccines, serological testing, additional doses, and peri-vaccination measures should be individualized according to the complete immune and metabolic phenotype.
WHAT IS KNOWN: • Infections can precipitate metabolic decompensation in children with IEMs, but vaccination is often delayed because of safety concerns. • Evidence on vaccine immunogenicity and disease-specific precautions remains limited.
WHAT IS NEW: • Direct pediatric evidence is limited and heterogeneous but has not identified a consistent safety signal after vaccination of clinically stable children with IEMs. • This review separates pediatric findings from mixed-age contextual evidence and translates published guidance into phenotype-based practical considerations, while highlighting the low certainty of the evidence.

Keywords:  Children; Immunogenicity; Inborn errors of metabolism; Metabolic decompensation; Vaccination

DOI:  https://doi.org/10.1007/s00431-026-07359-7
Pediatr Emerg Care. 2026 Aug 28.

Streamlining the Interfacility Transfer Referral Process for Pediatric Seizures: A Quality Improvement Project.

Jeffrey Naples, Theodore Pavlantos, Erin Pitchure, Andrea Pacheco, Philip Burt, Stephen Steiner, Michael T Bigham, Prabi Rajbhandari.

   OBJECTIVES: As pediatric specialty care is highly regionalized, children's hospital transfer centers are essential for facilitating timely access to subspecialty care. Seizures are a common diagnosis for transfer requests, but the lack of a standardized triage process leads to inefficient and potentially inappropriate referral decisions. For this QI initiative, our aim was to implement standardized triage guidelines to improve identification of the appropriate subspecialist for children referred with seizures.
METHODS: In 2024, a multidisciplinary team of transfer center staff, neurologists, and medical control physicians (MCPs) used the Model for Improvement framework. MCPs are pediatric intensivists who oversee transfer and patient care decisions during interfacility referrals. Key interventions included standardizing the seizure referral pathway and optimizing the electronic health record. The primary outcome was seizure guideline utilization. The secondary outcome was neurology consult-only encounters, and the process measure was the proportion of referrals directed to neurology. The balancing measure was a 24-hour ED revisit after consult-only management.
RESULTS: Guideline utilization increased from 0% to 100% within 6 months and was sustained thereafter. Neurology consult-only referrals increased from 31% to 58% while referrals directed to neurology increased from 56% to 85%. No patients managed with consult-only returned to their community ED within 24 hours.
CONCLUSIONS: Implementation of a standardized seizure referral pathway improved access to pediatric neurology expertise while reducing potentially avoidable interfacility transfers.

Keywords:  interfacility; neurology; potentially avoidable transfers; quality improvement; seizure; transfer center; transport

DOI:  https://doi.org/10.1097/PEC.0000000000003685
Trauma Surg Acute Care Open. 2026 ;11(3): e002374

2025 Practice-changing articles in trauma, emergency general surgery, pediatric trauma, and surgical critical care: an EAST narrative review.

Allyson M Hynes, Brian K Yorkgitis, Colleen Trevino, Crisanto Torres, James P Byrne.

  Trauma, acute care surgery, and surgical critical care clinicians routinely manage patients in whom small differences in timing, technique, and patient selection can meaningfully influence outcomes. Each year, emerging literature refines clinical decision-making across trauma surgery, emergency general surgery, pediatric trauma, and surgical critical care. A narrative review of the literature was conducted with primary emphasis on studies published in 2025. Selected high-impact articles from 2024 were included when they directly informed contemporary practice. Articles were identified through a structured review of the tables of contents of 17 high-impact general medical, surgical, trauma, and critical care journals and were supplemented by key articles known to the author group based on subject-matter expertise. The search was conducted between June 3, 2025, and December 31, 2025, and was limited to English-language publications. Priority was given to randomized clinical trials and large multicenter observational studies, with additional consideration of methodological rigor, citation impact, and journal-recognized distinctions. Thirteen studies were included, encompassing randomized trials, multicenter cohorts, and observational studies. These investigations addressed critical decision points across the continuum of care, including early resuscitation strategies, timing of life-saving interventions, analgesia and sedation, ventilator management, infection prevention, transfusion timing, perioperative antibiotics, diagnostic imaging strategies in older adults, and diagnostic and management pathways in pediatric trauma. Recent literature supports incremental refinement of trauma, acute care surgery, and surgical critical care practice, emphasizing selective application of established interventions, appropriate timing, and patient-centered decision-making. Collectively, these studies advance a more deliberate, evidence-informed approach to care across trauma surgery, emergency general surgery, pediatric trauma, and surgical critical care. Level of evidence Narrative review.

Keywords:  Emergency Treatment; critical care; general surgery; pediatrics

DOI:  https://doi.org/10.1136/tsaco-2026-002374
J Palliat Med. 2026 Aug 27. 10966218261481230

Cost Implication of a Community-Based Pediatric Palliative Care Program.

Ying Elaine Wang, Wenyun Yang, Megan Young, Kerri Padgett, Elaine Gabovitch, Ning Zhang, Jianying Zhang, Scot T Bateman.

   BACKGROUND: Massachusetts' Pediatric Palliative Care Network (PPCN) program provides community-based pediatric palliative care (CBPPC) to children with life-limiting conditions and their families. PPCN offers comprehensive clinical services, integrative therapies, and case management.
OBJECTIVES: This study explores whether PPCN can maintain or reduce health care utilization and costs.
DESIGN: PPCN children were compared with a propensity score matched group. Bivariate and regression analyses were conducted to compare outcomes between these two groups based on program data, Medicaid claims data, and vital records from 2015 to 2021.
SETTING/SUBJECTS: A sample of 126 deceased PPCN and non-PPCN children, respectively.
MEASUREMENTS: Chief outcomes included service use (inpatient/outpatient service, hospice, telehealth, length of stay), place of death, clinical symptoms, psycho-social well-being proxies, and health care cost.
RESULTS: Compared to 126 non-PPCN children, PPCN children had similar inpatient hospital admissions, emergency department visits, outpatient visits, hospice use, and telehealth use, but the length of stay was shorter. PPCN children were less likely to have intensive care unit admissions Adjusted Odds Ratio (aOR = 0.19, 95% Confidence Interval (CI): [0.06, 0.65]) with similar clinical symptoms and less ventilator use (aOR = 0.79, 95% CI: [0.78, 0.80]). A 20.6-point higher percent of PPCN children died at home (p < 0.001). PPCN children with neoplasm (n = 37), both neoplasm and genetic disease conditions (n = 11), or who died at home (n = 50) incurred at least 10% less cost, inclusive of program cost, than non-PPCN children (n = 37, 11, and 24).
CONCLUSIONS: CBPPC maintains or reduces health care utilization and costs for children at the end of life. It potentially saves costs for those with the most complex medical conditions or having died at home, which indicates the potential cost-effectiveness of PPCN because of its proven effect to improve quality of life for program children and their caregivers.

Keywords:  children with life-limiting conditions; community-based pediatric palliative care; cost; health care utilization

DOI:  https://doi.org/10.1177/10966218261481230
Pediatr Ann. 2026 Aug;55(8): e318-e322

Suicide Screening, Evaluation, and Management: A Trauma-Informed Approach for Primary Care.

Katherine Amano, Brooks Keeshin, Shannon Chaplo.

Suicidality, defined as suicidal ideation and suicidal behaviors, is unfortunately common. As many as 1 in 5 adolescents report having had serious thoughts of suicide in the past year, and suicide is a leading cause of mortality among adolescents. Guidelines from the American Academy of Pediatrics recommend universal screening for suicide risk in primary care, and evidence suggests that clinicians can take an active role in assessment and management of youth who are suicidal. Although trauma exposure and traumatic stress are potent risk factors for suicidality in adolescents, a trauma-informed approach is not well integrated into tools used for suicide detection, risk stratification, and safety planning. This article will provide clinical guidance on adopting a trauma-informed approach to suicide prevention in the primary care setting.

DOI: https://doi.org/10.3928/19382359-20260615-02
Hosp Pediatr. 2026 Aug 24. pii: e2025009175. [Epub ahead of print]

The Pediatric Hospitalist: A Survey of What We Do and Where We Are Going.

Kelsey Jackson, H Barrett Fromme, Elizabeth Nguyen, Kristen Wroblewski, Thomas B Mike.

BACKGROUND: Pediatric hospital medicine (PHM) is undergoing structural transitions, including the discontinuation of the practice pathway to board certification and changes to pediatric resident training, decreasing inpatient exposure. In this context, understanding the composition, roles, and sustainability of the current PHM workforce is critical. This study describes (1) the scope of clinical and nonclinical roles of pediatric hospitalists, (2) factors correlating with differences in teaching, scholarship, and leadership roles, and (3) workforce sustainability.
METHODS: A cross-sectional survey, adapted from the 2021 PHM workforce survey, was distributed from July to September 2024 to individual emails obtained from societal lists and a list of division/group leaders. Participants identifying as a physician or advanced practice provider currently practicing PHM were included. Trainees were excluded.
RESULTS: The survey was sent to 2932 individuals and 1060 responded (response rate 36.2%). Participants were from all US geographic regions and worked in various employment models. Most respondents worked full time (88.6%) and provided direct patient care (99.6%). Respondents engaged in nonclinical activities, including teaching (92.9%), research and scholarship (62.3%), and administration (53.6%), although participation varied by employment model, academic appointment, board status, gender, and career stage. Many planned to decrease clinical time (43.8%) and night or evening shifts (36.5%).
CONCLUSION: PHM is characterized by broad professional engagement, yet nonclinical responsibilities and perceptions of sustainability vary. As certification and training structures evolve, continued workforce planning and monitoring will be important to support the workforce.

DOI: https://doi.org/10.1542/hpeds.2025-009175
Pediatr Rep. 2026 Jul 22. pii: 99. [Epub ahead of print]18(4):

Beginning Restorative Activities Very Early: A Quality Improvement Project to Advance ABCDEF Bundle Practice in a Pediatric Oncology Intensive Care Unit.

Elizabeth Christian, Sarah Williams, Sara Tyson Husband, Amanda Brown, Mohammad Sabobeh, Sarah Schwartzberg, Eliza Hendrix, Sherry Locket, Deni Trone, Jennifer Featherston, Shankari Kalyanasundaram, Shilpa Gorantla, Maham Alam, Zhongheng Cai, Haitao Pan, Saad Ghafoor.

  Background/Objectives: Children with cancer admitted to the pediatric intensive care unit (PICU) are at increased risk for post-intensive care syndrome (PICS-p) due to prolonged immobility, deep sedation, and severe illness. The ABCDEF bundle offers a framework for enhancing ICU care and patient recovery, but implementing all components in pediatric oncology patients is challenging. This study assesses the development and implementation of the BRAVE (Beginning Restorative Activities Very Early) initiative, specifically BRAVE2, to integrate the comprehensive ABCDEF bundle and a nurse-led mobility program, in collaboration with rehabilitation specialists, within a pediatric oncology intensive care unit. Methods: BRAVE2 was a quality improvement project conducted in a single pediatric ICU from 2022 to 2023. We analyzed ICU data to assess patient demographics, frequency of physical and occupational therapy (PT/OT) consultations, time to initial mobilization, and delirium screening rates (CAPD score of 9 or higher) for patients with ICU stays over 48 h. BRAVE2 addressed all elements of the ABCDEF bundle, including regular pain assessments, evaluation of spontaneous breathing readiness, sedation adjustments, delirium screening, early mobilization, and family engagement. Outcomes were monitored using statistical process control methods. Results: Of 140 patients, 117 (84%) remained in the ICU for more than 48 h. The delirium screening rate was 15.5%, consistently below the target of 30%. PT/OT consultations within 72 h occurred in 80.7% of patients, and early mobilization in 49.7% of patients, both below the 80% goal. However, 90.4% of patients with tracked mobility were able to ambulate during their ICU stay. No mobility-related safety incidents were reported. Conclusions: Rolling out a full ICU liberation plan in a pediatric oncology ICU is possible, and implementing a comprehensive one is feasible and sustainable despite challenges. Although therapist-led early mobilization did not meet targets, incorporating nurse-led mobility strategies and routine delirium screening has established a scalable model to enhance ICU care and support long-term recovery for these patients.

Keywords:  delirium; early mobility; pediatric intensive care unit; quality improvement

DOI:  https://doi.org/10.3390/pediatric18040099
Pediatr Emerg Care. 2026 Aug 28.

How Rapid Cycle Deliberate Practice Compares to Traditional Simulation: A Qualitative Investigation of Pediatric Resident Perceptions.

Margaret E Tashjian, Jason M Woods, Michelle E Kiger, Jonathan R Higgins, Mairead Dillon, Shannon M Flood.

   OBJECTIVES: Rapid cycle deliberate practice (RCDP) is a type of within-simulation debriefing that alternates between specific practice and targeted feedback. While RCDP has become increasingly used in conjunction with traditional debriefing, little is known about specific contexts in which RCDP might be most useful. Therefore, our objective was to explore learners' perceptions of RCDP versus traditional simulation, with focus on differences in learning and psychological safety.
METHODS: Pediatric residents at a large pediatric residency program attended simulation trainings with both RCDP and traditional simulations as a part of their pre-established simulation curricula. Graduating residents in the 2024 to 2025 class were invited to participate in semi-structured interviews exploring their experiences with each type of simulation. Transcripts were analyzed via an inductive thematic analysis.
RESULTS: Fifteen interviews yielded 2 major themes: (1) Residents identified unique roles for RCDP and traditional simulation. Subthemes included each style teaches different skills, allows for practice with varying cognitive loads, and progresses towards more realistic scenarios. (2) Residents valued the psychological safety of RCDP but also recognized growth through discomfort in traditional simulation. Subthemes for the second major theme included that psychological safety of RCDP is achieved through breaks and repeated practice, and the value of growth through discomfort.
CONCLUSIONS: Both styles of simulation are valuable in curricula but might be best utilized in specific contexts. Educators should intentionally choose a simulation style with special consideration of a simulation's learning objectives and participants' experience.

Keywords:  learner perception; rapid cycle deliberate practice; simulation

DOI:  https://doi.org/10.1097/PEC.0000000000003682
Pediatr Ann. 2026 Aug;55(8): e296-e299

Adolescent Menstrual Health Equity.

Bako Orionzi.

Menstrual poverty (ie, the systemic lack of access to menstrual hygiene products, education, and sanitation) represents a profound barrier to health equity. This article examines the physical, psychological, and socioeconomic toll of period poverty, with a particular focus on adolescent, as well as transgender and gender-diverse, populations who face unique structural vulnerabilities. While state-level legislation expanding product access in public schools has proliferated, critical implementation deficits remain regarding comprehensive education and physical infrastructure. At the local level, evaluations reveal that administrative friction and structural barriers continue to marginalize underserved cohorts. To dismantle these inequities, pediatric primary care and adolescent medicine clinicians must play a transformative role. By operationalizing menstruation as the fifth vital sign through clinical screening, establishing cost-free distribution networks, and engaging in legislative advocacy (eg, lobbying for sales tax elimination, expanding federal assistance frameworks), clinicians can lead the movement toward comprehensive menstrual health equity.

DOI: https://doi.org/10.3928/19382359-20260609-03
Pediatr Dent. 2026 Jul 15. 48(4): 280-299

A Comparative Analysis of US State Pediatric Dental Moderate Enteral Sedation Regulations.

Alyssa Moy, Travis Nelson, Stephen Wilson, Thomas Tanbonliong.

Purpose: To compare moderate enteral sedation regulations across the 50 US states and evaluate alignment with the American Academy of Pediatrics/American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA) guidelines. Methods: An online review of all state dental sedation laws was conducted from January to June 2025. Extracted variables include permit type, renewal interval, site visit, and education requirements. State regulations were compared with the AAPD Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures and the ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students.Results: Forty-eight states (96%) require a permit to administer moderate enteral sedation. The most common renewal interval is 2 years (58%), and two-thirds of states require 1 to 5 annual continuing education hours. Twenty states (40%) require a pediatric endorsement. Nearly all states (98%) mandate advanced life-support training for pediatric patients. More than half (64%) require an initial site visit, and 50% require regular emergency drills. Educational standards vary, though 60 didactic hours and 20 cases are most common. Most states (86%) require Basic Life Support (BLS) for monitoring personnel, and 56% require at least 2 individuals during procedures. Conclusions: Despite increased alignment with published sedation guidelines in recent decades, significant variability persists among state permit definitions and requirements. These findings highlight the need for standardized, evidence-based state dental practice acts that clearly define sedation depths, routes, and training requirements.
Children (Basel). 2026 Aug 21. pii: 1117. [Epub ahead of print]13(8):

Hope in Pediatric Palliative Care: A Systematic Review.

Hana Benešová, Miroslava Janoušková, Martin Loučka.

  Context: Previous studies and reviews in adult patients have shown that hope is an important coping mechanism in patients with serious health problems. Although there are individual studies in pediatric patients, there is a lack of a systematic review of how hope manifests and how it can be supported in children with life-threatening illnesses and their families. Objectives: This systematic review aims to identify the key factors that are associated with the experience of hope in pediatric palliative care. It examines how hope is fostered or diminished in children with life-limiting illnesses, their parents, and other family members. Methods: A systematic search was conducted across major medical databases for studies published between 1990 and 2024. Thematic analysis was used to identify factors associated with hope. The quality of the included studies was critically appraised. Results: Out of 1373 identified records, 105 studies met the inclusion criteria. Most studies were qualitative in design and met a high proportion of the applicable criteria in their respective design-specific appraisal tools. Factors associated with increased hope included open and empathetic communication, trusting relationships with healthcare providers, strong social and family support, spiritual and religious faith, effective symptom management, involvement in care decisions, and access to practical resources. Conversely, reduced hope was associated with poor communication, social isolation, uncontrolled symptoms, uncertainty, caregiver distress, financial strain, and negative healthcare experiences. These factors were consistent across cultural and diagnostic contexts, with some variation in emphasis. Conclusions: Hope in pediatric palliative care is associated with relational, psychological, spiritual, and systemic factors. Many of these are modifiable. A family-centered and multidisciplinary approach is essential to sustaining hope in pediatric palliative contexts.

Keywords:  adolescent; child; hope; infant; palliative care; parents; pediatrics; siblings

DOI:  https://doi.org/10.3390/children13081117
Children (Basel). 2026 Jul 24. pii: 981. [Epub ahead of print]13(8):

Reframing Patient and Parental Experience in Pediatric Healthcare: Medical Gaslighting as a Diagnostic Safety Vulnerability.

Susmitha Nagula, Nasreen Ahmed, Kryss Shane, Anthony D Slonim.

  Medical gaslighting has emerged as a widely used term describing situations in which patients or caregivers perceive that their symptoms are minimized, dismissed, or prematurely attributed to psychological causes without adequate clinical evaluation. Although the term has gained prominence through patient narratives and public discourse, many of the underlying mechanisms correspond to well-established contributors to diagnostic error, including cognitive bias, communication failures, and diagnostic overshadowing. In pediatric care, these challenges are amplified because clinicians frequently rely upon caregiver-mediated histories while children may have a limited ability to communicate evolving symptoms. This narrative review examines medical gaslighting through the framework of diagnostic safety and explores how epistemic injustice, cognitive bias, and failures in information gathering and interpretation may contribute to delayed, missed, or incorrect diagnoses. Relevant literature was identified through a structured narrative review of publications addressing diagnostic error, cognitive bias, epistemic injustice, diagnostic safety, and pediatric communication. The literature was synthesized conceptually to develop an integrated framework linking patient experiences with established diagnostic safety models. We propose that reframing medical gaslighting as a diagnostic safety vulnerability rather than an allegation of clinician misconduct provides opportunities for measurable quality improvement through enhanced communication, structured reassessment, cognitive debiasing strategies, and integration of patient- and caregiver-reported information into diagnostic reasoning.

Keywords:  cognitive bias; diagnostic error; diagnostic reasoning; diagnostic safety; epistemic injustice; medical gaslighting; patient safety; pediatric diagnosis

DOI:  https://doi.org/10.3390/children13080981
Child Care Health Dev. 2026 Sep;52(5): e70337

Understanding Parental Behaviours Related to Infant Sleep Environment: A Qualitative Study.

Jennifer N Smith, Julie C Johnstone, Sanjay Mahant, Michelle Shouldice.

   INTRODUCTION: Sudden unexplained death in infants is responsible for a significant proportion of infant deaths. Despite broad dissemination of Canadian Paediatric Society and American Academy of Paediatrics safe sleep recommendations, studies demonstrate significant caregiver nonadherence. Few studies have examined caregiver reasons for low uptake of recommendations.
OBJECTIVES: Our study aimed to explore parental perceptions, beliefs and influences regarding safe infant sleep environment and factors contributing to parental behaviour related to sleep environment.
METHODS: A qualitative study utilizing grounded theory methodology was conducted with in-depth individual interviews of parents of infants less than 6 months admitted to a large paediatric hospital in Toronto, Canada. Data collection occurred from November 2017 to January 2018 until saturation of themes. Interview transcripts were analysed for recurrent and emergent themes and a coding structure was developed.
RESULTS: Interviews with 14 caregivers were completed. Caregivers described a range of sleep locations and environments. Decisional conflict was a dominant theme that emerged, as caregivers reported multiple factors simultaneously affecting decision-making about sleep location and often acting in opposition with one another. Factors influencing decision-making were categorized into the following themes: (1) safety, (2) feasibility and family logistics and (3) perception of infant preference and developmental needs. Information sources regarding sleep choices typically included family, friends, healthcare providers and media.
CONCLUSION: These results can inform healthcare providers counselling about safe sleep recommendations and public health interventions aimed at increasing adherence to safe sleep recommendations and reducing preventable infant deaths.

Keywords:  infant sleep; paediatrics; safe sleep; sudden infant death

DOI:  https://doi.org/10.1111/cch.70337
Pediatr Dermatol. 2026 Aug 28.

Are Pediatric GLP-1 Receptor Agonist Cutaneous Adverse Events Being Overlooked? Emerging Age-Specific Patterns and Their Implications for Dermatologists.

Margaret F Cote, Vikash S Oza, Seth J Orlow.

  Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) use in children is rapidly expanding, though in contrast to adults, morphologic data on dermatologic adverse events (AEs) in pediatric patients remain sparse, underscoring the need for further focused investigation. We review and synthesize the existing literature on dermatologic AEs of GLP-1 RAs in children in comparison to adults, to summarize current evidence, identify knowledge gaps, and highlight areas for future research. Available reports suggest that rash, urticaria, and alopecia may occur with greater frequency in children on injectable GLP-1 RAs compared with adults, while facial lipodystrophy has been more often described in adults. However, pediatric dermatologic AE data are not as robust as adult data, reducing the ability for direct comparisons. Based on this initial investigation, dermatologic AEs of GLP-1 RAs are seemingly under-described in children and may have important differences compared with adult dermatologic AEs.

Keywords:  adolescent; adverse drug event; dermatology; glucagon‐like peptide‐1 receptor agonists; pediatrics

DOI:  https://doi.org/10.1111/pde.70340
JAMA. 2026 Aug 28.

ICE Activity Tied to Disruptions in Pediatric Care.

Samantha Anderer.

DOI: https://doi.org/10.1001/jama.2026.12067
Orthop J Sports Med. 2026 Aug;14(8): 23259671261476937

Comparison of Basketball-Related Injuries at US Emergency Departments Between High School-Aged and College-Aged Athletes: A 10-Year NEISS Analysis, 2015-2024.

John R Tyler, Mark Gamadia, Nata Parnes, Hunter Czajkowski, Mitchell J Christiansen, Mary K Mulcahey.

   Background: Basketball is widely played in the United States, yet contemporary comparisons of basketball-related injuries between high school- and college-aged athletes using nationally representative emergency department (ED) data remain limited.
Purpose: To compare basketball-related injury epidemiology between high school- and college-aged athletes and characterize the burden of these injuries on US EDs.
Study Design: Descriptive epidemiological study.
Methods: The National Electronic Injury Surveillance System (NEISS) was queried for basketball-related injuries in athletes aged 14 to 23 years from 2015 to 2024. Patients aged 14 to 18 years were categorized as high school-aged and those aged 19 to 23 years as college-aged. Weighted national estimates were calculated using NEISS sampling weights. US Census Bureau annual population estimates were summed across ages 14 to 18 years and 19 to 23 years to determine the population at risk for each group and calculate incidence rates (IRs) per 100,000 person-years. IR ratios (IRRs) with 95% CIs were used to compare age groups by overall incidence, injury pattern, and ED disposition.
Results: A total of 61,279 basketball-related injuries among athletes aged 14 to 23 years were documented in the NEISS database, corresponding to an estimated 2,023,859 injuries treated in US EDs between 2015 and 2024. High school-aged athletes had a higher overall injury incidence than college-aged athletes (686.67 vs 252.63 per 100,000 person-years; IRR, 2.72; 95% CI, 2.67-2.77). Both groups showed a sharp decline in injury incidence in 2020, corresponding with the onset of the COVID-19 pandemic. The ankle (26.8%), knee (11.8%), finger (10.3%), and head (8.6%) were the most frequently injured body regions. High school-aged athletes had significantly higher rates of injuries to the head (IRR, 4.88; 95% CI, 4.52-5.27), lower arm (IRR, 5.02; 95% CI, 4.18-6.04), wrist (IRR, 4.12; 95% CI, 3.71-4.58), elbow (IRR, 4.12; 95% CI, 3.54-4.80), and finger (IRR, 3.64; 95% CI, 3.42-3.87), as well as higher rates of concussion (IRR, 6.64; 95% CI, 5.81-7.58), fractures (IRR, 3.43; 95% CI, 3.25-3.61), and strains and sprains (IRR, 2.73; 95% CI, 2.65-2.81). Treated-and-discharged injuries accounted for 97.6% of ED visits among high school-aged athletes and 96.8% among college-aged athletes; however, high school-aged athletes had higher rates of transfer or admission (IRR, 7.61; 95% CI, 5.26-10.99) and observation (IRR, 5.49; 95% CI, 3.06-9.84).
Conclusion: Our study showed that from 2015 to 2024, high school-aged athletes had substantially higher IRs than college-aged athletes for basketball-related ED injuries across most body regions, diagnoses, and ED dispositions. These findings support targeted injury prevention strategies at the high school level and highlight the burden basketball injuries place on US EDs.

Keywords:  National Electronic Injury Surveillance System; basketball; college athletes; epidemiology; high school athletes

DOI:  https://doi.org/10.1177/23259671261476937
Int J Pediatr Otorhinolaryngol. 2026 Aug 25. pii: S0165-5876(26)00287-9. [Epub ahead of print]209 112991

Intracapsular tonsillectomy/tonsillotomy for severe pediatric obstructive sleep apnea A PRISMA-based systematic review and exploratory meta-analytic synthesis of full-text articles.

Sara Torretta, Giulia De Lucia, Anna Cozzi, Kevin De Mari, Ludovica Battilocchi.

   BACKGROUND: Intracapsular tonsillectomy/tonsillotomy combined with adenoidectomy has been increasingly adopted for pediatric obstructive sleep apnea (OSA) because it reduces postoperative pain, dysphagia, and hemorrhage while preserving respiratory efficacy. However, its role in severe pediatric OSA remains debated.
OBJECTIVE: To evaluate the effectiveness and safety of intracapsular tonsillectomy/tonsillotomy combined with adenoidectomy in children with severe OSA, focusing on polysomnographic (PSG) improvement, residual disease, need for additional treatment, revision/completion tonsillectomy, nocturnal ventilation, and postoperative complications.
METHODS: A PRISMA 2020-compliant, PICO-based systematic review was conducted. Thirty-six records were identified through title and abstract screening. After the initial screening, 11 studies were excluded and 25 full-text articles were assessed for eligibility. Studies involving syndromic or cleft populations, procedures other than intracapsular tonsil surgery, or lacking PSG-based outcomes were excluded. Fourteen studies were included in the qualitative synthesis, and 11 provided extractable pre- and postoperative apnea-hypopnea index/obstructive apnea-hypopnea index (AHI/OAHI) data for quantitative analysis.
RESULTS: Intracapsular or partial tonsil surgery consistently reduced respiratory event burden (p < 0.001). In children with severe OSA, the sample-size-weighted reduction in AHI/OAHI was 16.5 events/hour (95% confidence interval [CI], 14.2-18.8). The weighted mean preoperative AHI/OAHI was 19.6 events/hour (95% CI, 18.7-20.5), decreasing to 3.0 events/hour (95% CI, 2.6-3.4) postoperatively. Reported postoperative bleeding rates were very low in intracapsular cohorts. Rates of tonsillar regrowth and revision surgery ranged from approximately 2% to 15%, depending on follow-up duration and surgical technique.
CONCLUSIONS: In appropriately selected children with severe OSA, intracapsular tonsillectomy/tonsillotomy combined with adenoidectomy provides substantial PSG improvement while maintaining a favorable postoperative morbidity profile. The principal trade-off is the need for long-term surveillance for residual OSA and tonsillar regrowth. No intracapsular surgical technique or instrument has demonstrated clear superiority, although all commonly used approaches achieved clinically meaningful improvements.

Keywords:  Apnea; Children; OSA; Tonsillectomy; Tonsillotomy

DOI:  https://doi.org/10.1016/j.ijporl.2026.112991
Children (Basel). 2026 Aug 13. pii: 1072. [Epub ahead of print]13(8):

Inpatient Palliative Care for Pediatric Neurologic and Neuromuscular Illnesses in the U.S.-A National Perspective.

Zahra Mojtahedi, Pearl C Kim, Yonsu Kim, Ji W Yoo, Jay J Shen.

   BACKGROUND: Pediatric neurologic and neuromuscular illnesses, often progressive and debilitating, require comprehensive medical management focused on enhancing quality of life. Despite the benefits of palliative care in managing symptoms and providing psychological support, there is limited knowledge on its associated factors and utilization for pediatric neurologic and neuromuscular illnesses in hospital settings.
METHODS: This study analyzed the National Inpatient Sample (NIS) database, covering hospitalizations of children under 18 years with neurologic and neuromuscular diagnoses from 2016 to 2020, to examine associations of palliative care with sociodemographic, clinical, and hospital factors.
RESULTS: Out of 139,598 pediatric patients, 4273 (3.1%) received palliative care. Palliative care recipients were younger (mean age 5.3 vs. 6.4 years), had more diagnoses (17.8 vs. 10.9) and procedures (4.0 vs. 2.4), higher illness severity scores (3.4 vs. 2.6), longer LOS (18.7 vs. 9.9 days), and higher hospital charges ($332,559 vs. $150,727). In-hospital mortality was significantly higher among palliative care recipients (32.9% vs. 2.4%). The utilization of palliative care increased annually (OR = 1.08, 95% CI [1.05, 1.11]). Black patients had lower odds (OR = 0.90, 95% CI [0.81, 1.00]). Higher severity scores (OR = 2.09, 95% CI [1.99, 2.20]) were positively associated with palliative care. Smaller hospitals and urban nonteaching hospitals were inversely associated with palliative care utilization.
CONCLUSIONS: Palliative care utilization for pediatric neurologic and neuromuscular illnesses remains low, with significant disparities based on sociodemographic and hospital-related factors. Enhanced awareness and integration of palliative care in pediatric practice, especially in underutilized settings, are crucial for improving outcomes and quality of life for these patients.

Keywords:  disability; inpatient; neurologic; neuromuscular; palliative care; pediatric

DOI:  https://doi.org/10.3390/children13081072
Children (Basel). 2026 Aug 14. pii: 1075. [Epub ahead of print]13(8):

Continuing Trend of Increased Operative Treatment of Clavicle Fractures in Pediatric Patients in the United States Despite a Lack of Supporting Evidence in the Literature.

Mahara Mohseni, Jad Lawand, Alireza Mirahmadi, Rohit Siddabattula, David Momtaz, Kaveh Momenzadeh, Abdullah Ghali, Mohammad Javad Shariyate, Pooya Hosseinzadeh.

  Introduction: Pediatric clavicle fractures are among the most common fractures in this age group. Current research supports the efficacy of nonoperative treatment for these injuries in pediatric patients. Our study seeks to examine the current trends in the management of these fractures and determine whether they align with the existing evidence-based guidelines. Methods: A retrospective analysis of pediatric patients with clavicle fractures between 1 January 2014 and 31 December 2024 was analyzed. A retrospective query was performed using the TriNetX Research Network. Patients were dichotomized into two groups based on open reduction internal fixation and nonoperative or closed treatment codes over this period, performing subgroup analyses by sex, race, and age. Results: We evaluated 78,251 patients between 10 and 18 years with clavicle fractures from 2014 to 2024, of whom 3546 underwent open reduction and internal fixation (ORIF). ORIF utilization increased from 1.62% in 2014 to 5.89% in 2024, representing a 263.6% increase from the 2014 baseline. Males consistently underwent ORIF more often than females. Adolescents (15-18 years) had substantially higher and faster-rising ORIF rates than younger patients (10-14 years), increasing from 3.4% to 12.4% versus 0.8% to 2.5% between 2014 and 2024 (APC 7.5% vs. 0%, p = 0.001). White patients had higher ORIF rates than African American patients, although some disparities narrowed over time. Conclusions: Despite limited supporting evidence, current trends demonstrate a substantial increase in the surgical management of pediatric clavicle fractures, with operative treatment rising by 263.6% by 2024. This increase in ORIF procedures may expose patients to potentially avoidable risks, including infection, anesthesia-related complications, implant-related issues, and prolonged recovery, without clearly established benefits in many cases.

Keywords:  adolescent; clavicle; fracture; pediatric

DOI:  https://doi.org/10.3390/children13081075
Pediatr Rep. 2026 Aug 04. pii: 103. [Epub ahead of print]18(4):

Exploring the Social, Emotional, and Physical Consequences of Hidradenitis Suppurativa in Pediatric Patients: A Scoping Review.

Kathryn Lotharius, Kendell Lewis, Clarissa Portocarrero, Megha Srivastav, Silvia Zervos, Rebecca Urbonas, Michelle Knecht, Lea Sacca.

  There remains a widespread lack of knowledge regarding hidradenitis suppurativa (HS) among physicians in the United States, impeding timely diagnosis and implementation of comprehensive treatment interventions. Despite the presence of supporting communities for affected adolescents and their caretakers, the overall awareness of HS remains low, and a greater consensus on the treatment of HS is needed. Current research highlights the lack of standardized pediatric guidelines for treatment of HS largely due to the varied nature of the disease and limited efficacy of current therapies. Our study aims to explore the relationship between the chronic skin condition HS and social-emotional concerns, mental health, and physical health issues in US children and adolescents. Using the Arksey and O'Malley framework and PRISMA-ScR reporting, we searched PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and Embase for U.S. studies (2015-2025) on pediatric HS (<18 years) and social-emotional, mental health, or quality-of-life outcomes. Recommendations were synthesized, and study quality was appraised with CASP checklist methods and rigor. Ten studies (2020-2025) met inclusion criteria. Pediatric HS was associated with depression, anxiety, social withdrawal, shame, low self-esteem, and reduced quality of life. Physical comorbidities increased psychosocial burden. Socioeconomic and racial disparities worsened outcomes and access to care. Studies emphasized early diagnosis, routine screening, multidisciplinary management, and disparity-focused interventions. Findings may inform clinical practice and guide research initiatives aimed at improving outcomes for children and adolescents with HS.

Keywords:  children; emotional consequences; hidradenitis suppurativa (HS); mental health; social impact

DOI:  https://doi.org/10.3390/pediatric18040103
Clin Pediatr (Phila). 2026 Aug 27. 99228261478510

Sleep Health in School-Aged Children: A Qualitative Study of Community-Based Pediatric Providers' Perspectives and Practices.

Jessica Page, Grace Wang, Gillian Heckler, Rebecca Robbins, Judith Owens.

  Despite its importance for general health, sleep health is inconsistently addressed in pediatric primary care, particularly in minority and low-income school-aged children. This study aimed to (1) explore providers' knowledge, perspectives, and practices related to sleep health in this population and (2) identify opportunities for improving education in clinical settings. Semi-structured interviews were developed and conducted with 12 pediatric providers from 3 community health care centers. Major themes were classified as (1) practitioner sleep health beliefs, (2) screening/anticipatory guidance, (3) caregiver and (4) provider barriers to supporting healthy sleep, and (5) educational recommendations. Results suggest that community-based pediatric providers recognize sleep health as a critical component of child well-being but also describe gaps in their knowledge, obstacles in clinical practice, and real-world challenges for caregivers, especially in resource-limited communities. The findings underscore the importance of advancing provider sleep health education and promoting evidence-based guidelines to help reduce sleep health disparities.

Keywords:  anticipatory guidance; pediatric providers; recommendations; screening; sleep health

DOI:  https://doi.org/10.1177/00099228261478510
Subst Use. 2026 Jan-Dec;20:20 29768357261478395

Naloxone Access in Schools: A National Survey of School Nurses in the United States.

Jessica B Calihan, Maria Christina Herrera, Samara Jinks-Chang, J Deanna Wilson, Catherine C McDonald, Nadia Dowshen, Chlo-Anne Bobrowski, E Jennifer Edelman, Sarah M Bagley.

   Objectives: To describe naloxone availability, accessibility, barriers and facilitators to naloxone availability in United States-based schools.
Methods: In May and September 2024, we conducted an optional, cross-sectional national survey of K-12 school nurse members of the National Association of School Nurses. The anonymous emailed survey assessed: (a) nurse demographics, (b) school and community characteristics, (c) school naloxone availability and accessibility, (d) related barriers and facilitators, and (e) available naloxone trainings.
Results: Respondents included n=462 school nurses (response rate 23%) from 44 states. The majority reported their school(s) stocked naloxone (90%); many (18%) reported prior naloxone administration on campus. A third (37%) reported restrictions on who can access/administer naloxone. Few schools (6%) provided student naloxone training. Nurses reported experience with prior school (11% respondents) and/or community overdose (44%).
Conclusions: In this exploratory national survey, most school nurses reported that their K-12 school(s) stocked naloxone. However, many schools limit who can access and administer naloxone, and few provide training to students. There is an urgent need to improve naloxone availability and accessibility to optimize access to this potentially life-saving treatment.

Keywords:  United States schools; health policy; naloxone; overdose prevention; school nurses

DOI:  https://doi.org/10.1177/29768357261478395
Behav Med. 2026 Aug 27. 1-11

Household Vaccination Status and Attitudes toward Pediatric COVID-19 Vaccination: A Survey at Four New Jersey Clinic-Based Pediatric Practices.

Bozena J Katic, Aspasia Katragkou, Uzma N Hasan, Jessica Alvitres, Manisha Gurumurthy, Charles Li, Joseph V Schwab, Sunanda Gaur, Alan S Weller, Cecilia DiPentima, Mary Kennedy, Claudia Rohan, Benjamin Richlin, Dorothy Chu, Isaura Otero, Christian Suarez, Akhil Patel, Pauline Thomas, Stephen Friedman.

  Despite the documented safety and efficacy of the COVID-19 vaccination, parental pediatric vaccine hesitancy is common. Little is known about the concerns and beliefs held by caregivers that impact COVID vaccination decision-making on behalf of their minor children, as underlying attitudes toward pediatric COVID-19 vaccination have not been well described. Unvaccinated children and their caregivers underwent antibody testing and completed an electronic survey at four clinic-based practices in Northern and Central New Jersey from August 2022 to June 2023. Caregivers were grouped into four attitudinal classes based on how safe, effective, useful, and necessary they believed COVID-19 vaccination were. Caregivers in the lowest vaccine acceptance classes (1 and 2) were significantly less likely to plan to vaccinate their children compared to those in the higher classes (3 and 4) (8.9% and 5.6% vs. 30.4% and 61%). Those in Class 2 were significantly less likely to have at least one adult household member fully vaccinated or boosted against COVID-19 than those in higher classes and marginally more likely to be from households where at least one adult had been diagnosed with COVID-19 in the past year than those in Class 3 (52% vs. 40%). The majority of caregivers viewed their pediatrician as a trusted source of information (89%). Caregiver attitudes toward vaccination are associated with household vaccination status and family COVID-19 infection history. Pediatricians play an important role in aiding vaccine uptake among children. Educational efforts should target differing caregiver profiles to address vaccine hesitancy and make future pediatric vaccine programming more successful.

Keywords:  COVID-19; pediatric vaccine; pediatrician; vaccine hesitancy

DOI:  https://doi.org/10.1080/08964289.2026.2702949
Pediatr Crit Care Med. 2026 Aug 26.

Temporal Trends in Geographic Distribution of PICUs in the United States 2001-2023.

Eleanor Gradidge, Abigail Shih, Kaeli Samson, Christina Cifra, Robin Klein, Adrienne G Randolph.

   OBJECTIVES: To identify and describe changes in the geographic distribution of PICUs across the United States from 2001 to 2023.
DESIGN: Cross-sectional study over three time points using geographic methods to calculate distances to the nearest PICU, change in distances to the nearest PICU over time, and changes in rates of access by census tract.
SETTING: U.S. PICUs.
PARTICIPANTS: None.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: The primary outcome was the distance from a given U.S. census tract center to the nearest PICU. Distances were grouped by U.S. census regions and divisions. Most PICUs were located in urban areas. The median distance from census tract centers to the nearest PICU was 12.5 miles (interquartile range [IQR], 4.5-37.1 miles), 12.8 miles (IQR, 4.9-36.2 miles), and 13.3 miles (IQR, 5.2-36.0 miles) for 2001, 2016, and 2023, respectively. In all years, PICUs were localized to a single city in Arkansas, Nebraska, and Oregon, and there were no PICUs in Wyoming. In 2023, the median distance to a PICU from the nearest census tract was 7.4 miles in the Middle Atlantic division (NJ, NY, and PA) and 30.1 miles in the East South Central division (AL, KY, MS, and TN). The distance to a PICU was shorter for coastal regions compared with large areas of the Mountain and Pacific divisions.
CONCLUSIONS: The geographic distribution of PICUs across the U.S. varied over time, with PICU beds remaining concentrated in urban areas, whereas rural areas were farther from the nearest PICU. This results in inequitable access for critically ill children, particularly in the western U.S. Understanding the variation in geographic access to PICUs is an essential step toward ensuring equitable access to life-saving care for all children.

Keywords:  disaster planning; geospatial; inpatient pediatrics; pediatric intensive care unit; rural healthcare

DOI:  https://doi.org/10.1097/PCC.0000000000004022