bims-cliped Biomed News
on Clinical pediatrics
Issue of 2026–06–21
37 papers selected by
Alyssa M. Portwood, Akron’s Children
  1. The Emergency Department Is Not the System: Youth Mental Health and the Need for a Continuum of Care.
  2. Improving Naloxone and Buprenorphine Provision in the Pediatric Emergency Department Through Education and Chief Complaint-Triggered Screening.
  3. Impact of an Attending-Only Pediatric Hospital Medicine Service on Patient Throughput.
  4. How to Build a Pediatric Behavioral Health Crisis Intervention Program.
  5. Appendicitis as a model for pediatric surgical quality improvement and standardization.
  6. Pediatric Hospital-Based Postdischarge Telemedicine Follow-Up Programs: A Scoping Review.
  7. Enhancing Safety in Pediatric Airway Management: An Integrative Review for Perioperative Settings.
  8. Assessing school nurses' knowledge and comfort in caring for children returning to school after pediatric critical illness.
  9. Bridging the Gap: Implementing Race-Conscious Clinical Guidance in Pediatrics.
  10. A 100-Day Workout Quality Improvement Project to Improve Value for the Care of Mental Health Conditions in a Pediatric Emergency Department.
  11. Demographic Shifts in Pediatric Emergency Department Visits for Homelessness During State and Federal Policy Changes.
  12. Missed outpatient appointments: Who's missing out and Why?
  13. PCT-Anchored Machine Learning for Pre-Culture Identification of Gram-Negative Sepsis in Children: A Four-Site Study.
  14. Pediatric cervical spine injury: emergency department management.
  15. ACR Appropriateness Criteria® Gastrointestinal Bleeding-Child.
  16. Addressing Racial and Ethnic Inequities in Pediatric Pain Management in Emergent Settings.
  17. Medical Home Screening Tool Development and Validation Among a Sample of Infants and Young Children.
  18. The Critical Subspecialist Gap in Pediatric Dermatology: Trends in Fellowship Data From 2009 to 2023.
  19. Primary Care Pediatrician Assessment of Access Barriers and Local Supply of Pediatric Subspecialists.
  20. Before the Race Even Starts: Early Intervention to Prevent Long-Term Late Effects From Childhood Cancer Therapies.
  21. Exploring the neurobiological markers of suicidal behaviors in pediatric population: a narrative review.
  22. Evaluation of a Pediatric Teaching Program: A Qualitative, Ethnographic Study.
  23. Values in the Neonatal ICU: Insights into Caregiver Priorities.
  24. Perspectives on artificial intelligence supported firearm access screening and storage counseling in pediatric emergency care.
  25. Tailoring screening algorithms for a large health system: Autism screening as a case example.
  26. Value-Based Care for Acute Pediatric Seizure Management: Operational Models, Quality Metrics, Barriers, and Financial Strategy.
  27. Don't Skip A Beat: Deliberate Practice and Mastery Learning of Pediatric Electrocardiograms.
  28. Restraint care in the pediatric intensive care unit: a qualitative investigation of nurses' perspectives and experiences.
  29. Quality improvement strategies for preventing tracheostomy-related pressure injuries in children: a systematic review and meta-analysis.
  30. Venous Intervention in Children: Current Practice and Controversies.
  31. Family sport commitments in a professionalized landscape: An exploration of parental pressures and beliefs.
  32. A Crisis Care Continuum for Children and Adolescents: The Boston Medical Center Model.
  33. CPT Codes for Pediatric Orthopaedics.
  34. Trauma Center Type and Outcomes After Pediatric Blunt Pancreatic Injury: A National Trauma Data Bank Analysis.
  35. From FOB to PICU: military trauma systems that changed pediatrics.
  36. Hypodermoclysis for Fluid Administration in Hospitalized Pediatric Patients: A Scoping Review.
  37. Advances in the treatment of pediatric hidradenitis suppurativa: emerging therapies and future directions.
  1. Child Adolesc Psychiatr Clin N Am. 2026 Jul;pii: S1056-4993(26)00013-1. [Epub ahead of print]35(3): 417-427
    The Emergency Department Is Not the System: Youth Mental Health and the Need for a Continuum of Care.
    Mollie C Marr, K Ron-Li Liaw, Lisa M Horowitz, Laura E Love, Jennifer Havens.
      The dramatic rise in pediatric mental health visits to emergency departments that started in the 1990s continues, reflecting an ongoing youth mental health crisis. There is an urgent need for a comprehensive care continuum with accessible outpatient services capable of identifying and supporting the mental health needs of children regardless of acuity, payor, and geographic setting. A fully realized child mental health continuum of care meets children where they are; adequately funds services from the outpatient clinic to the inpatient unit; delivers evidence-based treatments targeted to reduce mental health symptoms; and supports the development of a skilled behavioral health workforce.
    Keywords:  Child and adolescent; Continuum of care; Suicide; Workforce; Youth mental health crisis
    DOI:  https://doi.org/10.1016/j.chc.2026.03.002
  2. Pediatr Emerg Care. 2026 Jun 16.
    Improving Naloxone and Buprenorphine Provision in the Pediatric Emergency Department Through Education and Chief Complaint-Triggered Screening.
    Chris Buresh, Ron Kaplan, Sarah Lowry, Stephen Sandelich, Lori Rutman.
       OBJECTIVE: Opioid use disorder (OUD) among US adolescents represents a public health crisis, with overdose deaths becoming a leading cause of mortality. Despite their efficacy, naloxone and buprenorphine remain underutilized. The pediatric emergency department (PED) presents an intervention opportunity, as many adolescents with OUD present there before fatal overdoses. This quality improvement initiative examined the use of education and hybrid screening to improve the provision of naloxone and buprenorphine in the PED.
    METHODS: A multifaceted OUD screening and treatment protocol was implemented in a PED using Best Practice Alerts (BPA) triggered by specific chief complaints (CC), alerting providers to the need for additional screening. Components included provider education, formulary changes, and clinical pathways. Data from adolescent encounters over 45 months were analyzed, comparing naloxone and buprenorphine prescribing rates before and after implementation. Secondary analyses examined demographics, insurance, and psychiatric comorbidities.
    RESULTS: During the study, 63 adolescents initiated buprenorphine, and 246 received naloxone. Among patients with BPA-qualifying CCs, naloxone dispensing increased from 3.89% to 11.39% and buprenorphine prescribing increased from 1.04% to 2.46%. Postimplementation, Black/African American adolescents and those with government insurance received more medications than peers, and overall naloxone prescribing increased from 0.4% to 0.79% of all visits. Patients triggering the BPA experienced longer ED stays regardless of medication receipt, with no increase in return visits.
    CONCLUSIONS: Electronic screening alerts coupled with provider education increased the provision of medications for adolescents at risk for opioid-related harm. The intervention is achievable in a PED without increasing return visits.
    Keywords:  adolescent; buprenorphine; chief complaint based screening; emergency department; naloxone; opioid use disorder
    DOI:  https://doi.org/10.1097/PEC.0000000000003640
  3. Hosp Pediatr. 2026 Jun 18. pii: e2025008761. [Epub ahead of print]
    Impact of an Attending-Only Pediatric Hospital Medicine Service on Patient Throughput.
    Rebekah S Shaw, Jodi Ehrmann, Harlan McCaffery, Zarina S Norton, Monisha Sachdev, Maria S Skoczylas, Emily Jacobson.
       OBJECTIVE: Children's hospitals face increasing patient volumes, prolonged length of stay (LOS), and constrained inpatient capacity. In response, our institution implemented Pediatric Hospital Medicine (PHM) service changes, including reduced teaching service (TS) patient caps and the addition of an attending-only service (AOS). We evaluated the association between the implementation of a PHM AOS and hospital throughput and discharge timeliness.
    METHODS: We conducted a retrospective review of 8294 PHM admissions at a single quaternary care pediatric hospital from October 2021 through December 2023. Monthly aggregate data were compared 1 year before and after AOS implementation in November 2022. Primary outcomes were discharge before 11 am and LOS. Secondary outcomes included all-cause return to the emergency department (ED) within 7 days of discharge and all-cause unscheduled readmission within 30 days. Outcomes were compared preimplementation vs postimplementation and between TS and AOS using 2-sample t-tests and chi-square tests.
    RESULTS: There was no overall difference in discharge before 11:00 am for all PHM patients preimplementation vs postimplementation (8.0% vs 8.8%; P = .17). A greater proportion of patients had early discharge on the AOS compared with TS (12.25% vs 8.38%; P = .008). LOS did not differ by service or time period. There were no differences in postdischarge ED visits or readmissions.
    CONCLUSION: The creation of a PHM AOS had no impact on overall patient early discharges or LOS but was associated with earlier discharges on the AOS without adversely affecting readmissions. More work is needed to assess other interventions to improve overall hospital throughput.
    DOI:  https://doi.org/10.1542/hpeds.2025-008761
  4. Child Adolesc Psychiatr Clin N Am. 2026 Jul;pii: S1056-4993(26)00021-0. [Epub ahead of print]35(3): 429-438
    How to Build a Pediatric Behavioral Health Crisis Intervention Program.
    Jonathon W Wanta, Bhavana Muppavarapu, Rebecca Marshall, Moshe Bitterman, Khushbu Shah.
      While emergency departments are a vital safety net for all patients, they often fail to meet the unique care needs of pediatric patients presenting with behavioral health emergencies. In response, increasing attention has been directed toward pediatric crisis intervention programs that divert unnecessary emergency department visits and link youth in crisis to more appropriate services. This article outlines key factors to consider in designing a pediatric behavioral health crisis intervention program and presents a practical decision-making framework to guide program selection and implementation.
    Keywords:  Continuum of care; Crisis intervention program; Emergency department diversion; Pediatric mental health crisis care
    DOI:  https://doi.org/10.1016/j.chc.2026.03.010
  5. Semin Pediatr Surg. 2026 Jun 07. pii: S1055-8586(26)00079-X. [Epub ahead of print] 151663
    Appendicitis as a model for pediatric surgical quality improvement and standardization.
    Johanna M Borst, Mehul V Raval.
      Appendicitis serves as a model for pathway-driven quality improvement (QI) in pediatric surgical care. The high case volume, predictable clinical trajectory, and measurable outcomes associated with acute appendicitis care facilitate identification of unwarranted practice variation and allow standardization to be feasible at scale. Starting in the mid-2010s, several QI initiatives transformed appendicitis management in children. This review highlights four QI efforts in pediatric appendicitis management including the shift of diagnostic imaging from routine computed tomography to ultrasound-first strategies, improved opioid stewardship, de-implementation of low-value practices such as routine total parenteral nutrition utilization, and generation of severity-guided clinical practice guidelines that decreased postoperative antibiotic durations. Across these domains, improvement followed a consistent progression through phases of documented variation, evidence consolidation, structured local implementation, guideline alignment, and eventually sustained monitoring of guideline-based practices. Continued progress will require ongoing development of pediatric-specific evidence, dissemination of evidence-based practices into broader practice settings, and focused efforts to ensure equitable implementation across populations. QI efforts for appendicitis serve as a transferable blueprint for value-based and safety-focused pediatric care, demonstrating that unwarranted variation can be reduced when evidence-based practices are embedded into structured clinical guidelines, process metrics and outcomes are measured transparently, and principles are reinforced through coordinated dissemination.
    Keywords:  Antibiotic stewardship; Clinical practice guidelines; De-implementation; Pediatric appendicitis; Quality improvement; Standardized care
    DOI:  https://doi.org/10.1016/j.sempedsurg.2026.151663
  6. Hosp Pediatr. 2026 Jun 17. pii: e2025009034. [Epub ahead of print]
    Pediatric Hospital-Based Postdischarge Telemedicine Follow-Up Programs: A Scoping Review.
    Zachary J Tabb, Tom Harrod, Kavita Parikh, Jordan Tyris.
       CONTEXT: Children discharged from the inpatient setting are at risk for postdischarge health issues. Postdischarge telemedicine follow-up programs (health care visits conducted via phone or video) might address these issues, but their focus, structure, and outcomes have not been collectively studied.
    OBJECTIVE: To conduct a scoping review reporting on hospital-based postdischarge telemedicine follow-up program design, evaluation, and ability to address postdischarge issues and unplanned health care reutilization.
    DATA SOURCES: PubMed, CINAHL, Scopus, Web of Science, preprints, and gray literature were systematically searched.
    STUDY SELECTION: Articles in English that investigated hospital-based postdischarge telemedicine programs for pediatric patients younger than 22 years, not part of a bundle, were included.
    DATA EXTRACTION: Data on program and study characteristics and outcomes were extracted and synthesized.
    RESULTS: Of 3407 unique studies identified, 17 were included. Most programs (n = 13, 76%) used phone call follow-up rather than video, and most (n = 13, 76%) follow-up occurred within 4 days. Prevalence of postdischarge issues identified ranged from 2.9% to 85% (median 23.8%, IQR 18.6%, 64.3%), predominantly related to appointments, medications, and clinical concerns. One phone call follow-up observational study showed a reduction in 14-day emergency department (ED) reutilization, but no other studies found reductions in 7-, 14-, or 30-day ED revisit or readmission rates.
    CONCLUSIONS: This scoping review found that hospital-based postdischarge telemedicine follow-up programs are acceptable to families and successfully identify wide-ranging postdischarge issues that affect patient safety. However, evidence to date does not demonstrate an effect on reducing health care reutilization.
    DOI:  https://doi.org/10.1542/hpeds.2025-009034
  7. J Perianesth Nurs. 2026 Jun 19. pii: S1089-9472(26)00182-6. [Epub ahead of print]
    Enhancing Safety in Pediatric Airway Management: An Integrative Review for Perioperative Settings.
    Rebecca A Motykiewicz, Jennifer R Majumdar, Tito D Tubog.
       PURPOSE: Pediatric airway management presents unique challenges that require specialized knowledge, preparation, and coordinated teamwork. This integrative review synthesizes current evidence to guide perioperative teams, particularly Certified Registered Nurse Anesthetists (CRNAs) and perioperative nurses, in promoting safety and readiness when caring for pediatric patients.
    DESIGN: A structured literature review was conducted using PubMed, CINAHL, Embase, Cochrane Library, and Scopus. Studies were included if they addressed pediatric airway management techniques, education, or safety outcomes relevant to anesthesia and perioperative practice. Evidence was appraised using the Johns Hopkins Nursing Evidence-Based Practice framework.
    METHODS: Thirty-nine studies met the inclusion criteria and were analyzed for key themes in anatomy and physiology, complication prevention, equipment selection, and difficult airway management. Additional focus was placed on educational strategies such as simulation and continuing professional development.
    FINDINGS: The literature emphasizes that most perioperative pediatric adverse events are respiratory in nature and often preventable through early recognition, proper equipment preparation, and interdisciplinary communication. Evidence supports the use of video laryngoscopy, apneic oxygenation, and structured team training to improve outcomes. Simulation-based education enhances confidence, technical skills, and crisis response among CRNAs and perioperative staff.
    CONCLUSIONS: Effective pediatric airway management requires both technical expertise and interprofessional collaboration. Regular review of pediatric airway anatomy, evidence-based algorithms, and structured team training can significantly enhance safety and provider confidence.
    Keywords:  airway management; airway obstruction; laryngoscopy; nurse anesthetists; patient safety; pediatric anesthesia (paediatric anesthesia); video-assisted
    DOI:  https://doi.org/10.1016/j.jopan.2026.05.032
  8. J Pediatr Nurs. 2026 Jun 16. pii: S0882-5963(26)00255-1. [Epub ahead of print]90 193-198
    Assessing school nurses' knowledge and comfort in caring for children returning to school after pediatric critical illness.
    Julia A Heneghan, Mallory A Perry, Cynthia Samuel, Erin Carlton.
       BACKGROUND: Approximately 125,000 school-age children are admitted to pediatric intensive care units (PICUs) in the United States annually. These children are at risk for post-intensive care syndrome in pediatrics (PICS-p) as they reintegrate into their communities. School nurses are uniquely positioned to care for children recovering from critical illness, yet little is known about their comfort and knowledge in post-PICU care.
    METHODS: We conducted an online survey of United States-based school nurses. Surveying school nurse demographics, clinical characteristics of the children they cared for, post-PICU clinical information received, and their comfort and knowledge of caring for children post-PICU.
    RESULTS: Seventy-nine (N = 79) school nurses completed the survey. More than half of nurses (54%) cared for a child who was hospitalized in the PICU during the prior academic year. Over a third (35%) did not receive any discharge summary/written instructions, and only 21% spoke with the child's medical provider before returning to school. While most felt comfortable caring for a recovering child, less than 5% were aware of PICS-p. Most school nurses (91%) expressed interest in learning more about PICS-p, specifically the framework (81%), which includes physical, cognitive, social, emotional, and family impact domains, and screening of at-risk children (53%).
    CONCLUSIONS: Most school nurses are unfamiliar with PICS-p. There are opportunities to improve processes to ensure school nurses receive adequate discharge information and education on PICS-p.
    IMPLICATIONS FOR PRACTICE: Increased awareness regarding PICS-p and its recovery implications may improve school nurses ability to support children upon return to school following PICU hospitalization.
    Keywords:  Critical care outcomes; Intensive care units, pediatric; Pediatric nursing; Postintensive care syndrome; School nursing
    DOI:  https://doi.org/10.1016/j.pedn.2026.05.049
  9. Pediatrics. 2026 Jun 17.
    Bridging the Gap: Implementing Race-Conscious Clinical Guidance in Pediatrics.
    Robert H Rosen, Joseph L Wright, Courtney A Gilliam.
      Pediatric clinical guidelines and algorithms have frequently included race as a risk factor to be considered in clinical decision-making. This practice, commonly known as "race-based medicine" or "race correction", substitutes race as a flawed proxy for socioeconomic status and genetic ancestry. The American Academy of Pediatrics has called for the elimination of race-based medicine and endorsed "race-conscious medicine" as a preferable alternative. Race-conscious medicine embraces race-neutral clinical tools and supports efforts to tackle the structural barriers to health that cause racial disparities. We aimed to assess recent progress and identify ongoing barriers in the implementation of race-conscious medicine in pediatrics. First, we review the role of medical societies and the research community in generating race-conscious alternatives to race correctiosn, while noting that many pediatric tools continue to include race in ways that may negatively impact equity. Second, we discuss the role of healthcare organizations in implementing race-conscious guidance locally, drawing upon specific local and regional efforts to reveal organizational, cultural, technical, and financial factors that may facilitate or impede success. Third, we identify medical education governing bodies as essential in integrating the principles of race-conscious medicine into every stage of medical education. Fourth, we highlight the need for third-party clinical algorithm platforms and biomedical device manufacturers to provide access to race-conscious tools through their products. Finally, we highlight the role of the policy and regulatory landscape in accelerating or slowing the rate of progress, and the importance of patient engagement and redress of historical harms.
    DOI:  https://doi.org/10.1542/peds.2026-076070f
  10. Pediatr Emerg Care. 2026 Jun 15.
    A 100-Day Workout Quality Improvement Project to Improve Value for the Care of Mental Health Conditions in a Pediatric Emergency Department.
    Claudia Vega Castellvi, Vincenzo Maniaci, Nicole Czubkowski, Indira Sukie, Mindy Shikiar, Mario Reyes, Beatriz Franyie Ladd, Americo Padilla, Jennifer Cordo, Veronica Etinger.
       BACKGROUND: The escalating mental health crisis among children has led to increased visits to the emergency department. Routine laboratory testing in children with behavioral and mental health (BMH) concerns is a common practice but rarely identifies clinically meaningful abnormalities.
    OBJECTIVE: We aimed to reduce low-value care for patients requiring admission to our inpatient psychiatry unit by decreasing unnecessary testing and costs by 25%.
    METHODS: We conducted a "100-day workout quality initiative" which used Lean Six Sigma methodology to implement an evidenced-based clinical pathway.
    RESULTS: After implementation, routine laboratory testing decreased from 96% to 20.8%. Overall costs associated with psychiatry admission in our institution decreased by 10%, with no adverse impact on clinical outcomes.
    CONCLUSIONS: This approach demonstrates a sustainable model for reducing low-value care in the emergency department setting for patients with BMH complaints.
    Keywords:  clinical pathway; lean six sigma; low-value care; mental health; utilization
    DOI:  https://doi.org/10.1097/PEC.0000000000003639
  11. J Pediatr. 2026 Jun 15. pii: S0022-3476(26)00224-6. [Epub ahead of print] 115196
    Demographic Shifts in Pediatric Emergency Department Visits for Homelessness During State and Federal Policy Changes.
    Kendall J Donohue, Jonathan M Gabbay, Genevieve G Guyol, Lawrence Chang, Clara C Belenky, Amanda M Stewart.
       OBJECTIVE: To evaluate trends, demographics, and visit characteristics in pediatric emergency department (ED) visits for homelessness in relation to state and federal policies before and during the COVID-19 pandemic.
    STUDY DESIGN: We conducted a retrospective cohort study of pediatric ED visits for homelessness from 2019-2021 at an urban tertiary care children's hospital. Visit rates were analyzed in relation to the 2019 repeal of a restrictive shelter eligibility state policy and the implementation and expiration of state and federal COVID-19 eviction moratoria. Demographic and clinical characteristics were compared before and during the pandemic.
    RESULTS: Among 1,045 visits, the rate of pediatric ED visits for homelessness per 1,000 total visits declined modestly after the 2019 policy repeal, then spiked in January 2021 following the end of COVID-19 eviction moratoria. During the pandemic, children presenting for homelessness were more likely to be Hispanic (72.5% vs 53.4%, P<0.001), have Spanish-speaking caregivers (59.1% vs 40.1%, P<0.001), and have chronic medical conditions (25.2% vs 14.6%, P<0.001), compared with before the pandemic. Families were less likely to have eviction as the reason for their homelessness (6.2% vs 11.4%, P=0.010) during the pandemic, and were more likely to cite loss of job or income (11.2% vs 4.9%, P=0.001).
    CONCLUSIONS: Pediatric ED visits for homelessness persisted throughout the pandemic, with notable demographic shifts and changing causes of homelessness. These findings demonstrate the inequitable impact of the pandemic on different groups of children, underscore the limitations of temporary housing protections, and highlight the need for durable, equity-driven housing policies.
    DOI:  https://doi.org/10.1016/j.jpeds.2026.115196
  12. J Pediatr Urol. 2026 Jun 06. pii: S1477-5131(26)00339-6. [Epub ahead of print] 106060
    Missed outpatient appointments: Who's missing out and Why?
    Emma A Harwood, Daniel Lassman, Evelyn James, Bruce Ndebanje, Ethan Griffin, Lily C Wang.
       INTRODUCTION: Missed outpatient appointments ("no-shows") negatively affect healthcare access, efficiency, and patient outcomes and may be particularly impactful in pediatric subspecialty care. Pediatric urology services are often centralized, requiring families to travel long distances and coordinate care around caregiver availability and competing responsibilities. Limited data directly compare predictors of missed appointments between pediatric and adult urology populations or incorporate patient- and caregiver-reported reasons for nonattendance.
    MATERIALS AND METHODS: We conducted an Institutional Review Board-approved retrospective review of all outpatient urology appointments scheduled at a single center between January and December 2024. This practice serves as the sole provider of pediatric urology care for a predominantly rural state. Demographic, socioeconomic, and visit-level variables were extracted from the electronic health record. Multivariable logistic regression was used to identify predictors of no-show visits in the full cohort and in pediatric and adult subgroups. Additionally, telephone interviews were conducted with pediatric caregivers and adult patients who missed appointments between March and September 2024 to assess patient- and family-reported barriers to attendance.
    RESULTS: A total of 10,106 visits were analyzed, including 2031 pediatric visits. Pediatric patients had a higher no-show rate than adults (7% vs. 4%) and were significantly more likely to miss appointments overall (odds ratio [OR] 1.67, p < 0.001). Across all patients, governmental insurance, lack of insurance, non-English language preference, non-white race, and new patient visits were associated with increased odds of no-show. In pediatric-specific analyses, male gender, lower Childhood Opportunity Index, and follow-up visit status were significant predictors of nonattendance. Among 72 interview respondents, the most commonly reported reasons for missed visits were forgetting the appointment, transportation barriers, and competing family or childcare obligations, with caregivers of pediatric patients significantly more likely to cite family-related barriers.
    CONCLUSIONS: Pediatric urology patients experience higher no-show rates than adults, driven by socioeconomic disadvantage, geographic barriers, and family-level responsibilities. Interventions addressing communication, transportation challenges, and structural access barriers may improve appointment adherence and access to pediatric urology care, particularly in rural settings.
    Keywords:  Access to care; Caregiver barriers; Missed appointments; No-show visits; Pediatric urology; Rural health
    DOI:  https://doi.org/10.1016/j.jpurol.2026.106060
  13. Shock. 2026 Jun 22.
    PCT-Anchored Machine Learning for Pre-Culture Identification of Gram-Negative Sepsis in Children: A Four-Site Study.
    Tom Velez, Maya Dewan, Oluwakemi Badaki-Makun, Danielle Hirsch, Danielle Claire Mercurio, Holly Depinet, Rishikesan Kamaleswaran, Jocelyn Grunwell, Maria Triantafyllou, Nora Wolff, Fehima Abdelrahman, Charles Macias, Ioannis Koutroulis.
       OBJECTIVE: Procalcitonin (PCT) has moderate accuracy for bacteremia detection but is infrequently used in pediatric emergency departments, partly due to poor sensitivity when applied as a standalone threshold and guideline recommendations against its isolated use. We evaluated whether a machine learning (ML) approach that contextualizes PCT with additional clinical features has the potential to improve detection of gram-negative bacteremic organ dysfunction in children prior to culture results.
    METHODS: We conducted a retrospective analysis of 431 pediatric encounters across four sites where blood culture and PCT were co-ordered. Blood culture results were classified as gram-negative bloodstream infection (BSI), gram-positive BSI, contaminant, or negative using a priority-based NLP algorithm applied to free-text result strings. The primary outcome was gram-negative BSI with concurrent organ dysfunction ascertained by Phoenix-8 criteria excluding the immunologic domain. We evaluated PCT alone, a four-feature adult sepsis-aligned benchmarking model, and candidate multi-feature combinations identified through systematic univariate screening, using Random Forest (RF) and penalized logistic regression (LASSO) as co-primary algorithms with nested repeated stratified cross-validation and permutation importance analysis. Model discrimination was compared using paired fold-level AUROC testing and calibration was assessed using Platt scaling.
    RESULTS: Among 431 encounters with a numeric PCT result, 20 (4.6%) met the primary outcome of gram-negative BSI with Phoenix-8 organ dysfunction. PCT alone achieved AUROC 0.762. A four-feature adult sepsis-aligned model achieved AUROC 0.862; respiratory rate and systolic blood pressure contributed negligibly. Systematic screening identified platelet count and creatinine as optimal co-features; the three-feature model (PCT, platelet count, creatinine) achieved AUROC 0.884 (BCa 95% CI 0.871-0.982), consistent across RF and LASSO (0.874), with Brier score 0.038 below the null model (0.044), and positive likelihood ratio 12.56 (number needed to assess of 2.6).
    CONCLUSIONS: PCT alone showed limited performance. Embedding PCT within a 3-feature ML model improved discrimination over PCT alone (delta AUROC 0.122, p<0.001), with consistent performance across RF and LASSO. Unlike adult models, pediatric prediction relied on renal dysfunction (creatinine) rather than hemodynamics. These findings are hypothesis-generating and require prospective validation in adequately powered cohorts before clinical implementation.
    Keywords:  bacteremia; machine learning; organ dysfunction; pediatric emergency; platelet; procalcitonin; sepsis
    DOI:  https://doi.org/10.1097/SHK.0000000000002895
  14. Pediatr Emerg Med Pract. 2026 Jun 15. 23(Suppl 1): 1-42
    Pediatric cervical spine injury: emergency department management.
    Andrew Dixon, C Jenner Lakusta.
      Although they are rare, pediatric cervical spine injuries can be severe and life-threatening. To detect these injuries while avoiding further harm, emergency clinicians must recognize high-risk signs and mechanisms and consider physiology based on patient age. This review presents evidence-based recommendations for prehospital management, imaging decisions, and emergency department management of pediatric cervical spine injuries.
  15. J Am Coll Radiol. 2026 Jun 05. pii: S1546-1440(26)00232-2. [Epub ahead of print]
    ACR Appropriateness Criteria® Gastrointestinal Bleeding-Child.
    Expert Panel on Pediatric Imaging
      Gastrointestinal (GI) bleeding is a relatively common presenting complaint in pediatric practices and may arise from either the upper or lower GI tract. Many common causes of GI bleed are benign and self-limited, often requiring only supportive care with no imaging necessary. When indicated, the goal of imaging is to diagnose and localize the source of bleeding to help guide timely, targeted interventions. Abdominal radiography is often the initial imaging study obtained for patients presenting with GI bleeding. Although it is usually unable to precisely localize the site of bleeding, it may provide clues to the diagnosis. Nuclear medicine imaging studies including pertechnetate (Meckel scan) and tagged red blood cell studies can help localize the site of bleeding, occasionally providing a specific diagnosis. CT angiography of the abdomen and pelvis may be appropriate in many scenarios; however, in unstable patients CT angiography is usually appropriate as initial imaging. Visceral angiography may also be used. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
    Keywords:  AUC; Appropriate Use Criteria; Appropriateness Criteria; CT angiography (CTA); Meckel diverticulum; gastrointestinal bleeding (GIB); hematemesis; melena; pertechnetate scan
    DOI:  https://doi.org/10.1016/j.jacr.2026.05.001
  16. Pediatrics. 2026 Jun 17.
    Addressing Racial and Ethnic Inequities in Pediatric Pain Management in Emergent Settings.
    Jessica Hippolyte, Caleb Ward, Monika K Goyal, Sylvia Owusu-Ansah, Marshall Washick, Joseph L Wright.
      Pain is among the most common reasons children seek care in emergent settings, including emergency medical services (EMS) and emergency departments (EDs). Despite well-established guidelines for pediatric pain management, racial and ethnic inequities persist. The drivers of these inequities are multi-factorial. This review synthesizes the current literature on racial and ethnic inequities in pediatric pain management across the continuum of emergent care settings and highlights actionable strategies and research priorities to advance equitable pain care. Despite the known benefits of prehospital analgesia, children from minoritized racial and ethnic groups are less likely to receive analgesia, including opioids, and less likely to experience pain relief (also referred to as oligoanalgesia). Evidence regarding disparities in discharge prescribing is mixed. While identifying disparities is an essential first step, meaningful progress requires understanding the root causes and implementing multi-factorial, equity-centered interventions. Potential strategies include standardizing clinical processes to minimize variability, using equity-informed pain assessment tools and clinical guidelines, centering patient and family lived experiences, leveraging quality improvement methodologies, and re-examining clinician education to mitigate bias and improve pediatric pain care. Equity-focused research and interventions, coupled with advocacy, policy reform, and community partnerships, are essential to move the field beyond awareness toward sustainable and equitable delivery of pediatric pain care in emergent settings.
    DOI:  https://doi.org/10.1542/peds.2026-076070e
  17. Child Care Health Dev. 2026 Jul;52(4): e70302
    Medical Home Screening Tool Development and Validation Among a Sample of Infants and Young Children.
    Caitlin Bradley, Stacey Cook, Cheryl Toole, Laura Berbert, Alexandra Cole, Michele DeGrazia.
       BACKGROUND: Medical home (MH) is a financially viable, all-inclusive primary care model that can enhance communication, improve care coordination and support patients, families and healthcare providers. No standard screening tool exists for use by hospital-based healthcare providers to identify children with medical complexity (CMC), which can result in inconsistent MH referrals. The purpose of this research was to develop and validate a screening tool for use in identifying CMC who would benefit most from early MH referrals prior to hospital discharge home.
    METHODS: This mixed-methods research utilized e-Delphi methodology and retrospective chart review to develop and validate a screening tool for MH referrals.
    RESULTS: Twenty-three nurses, nurse practitioners, physicians, social workers and case managers participated in four e-Delphi rounds to develop the Pediatric Medical Home Screening Tool (PMHST). The PMHST consists of four sections and 20 criteria. Reliability testing of the PMHST revealed 82% agreement with medical complexity categorization of infants and young children.
    CONCLUSION: The PMHST may enhance future care transitions, improve quality of care and reduce the risks of safety events. The PMHST was validated in a sample of infants and young children and will be tested with a broader sample of children in the future.
    Keywords:  children and youth with special healthcare needs; children with medical complexity; discharge; medical home; transitions in care
    DOI:  https://doi.org/10.1111/cch.70302
  18. Pediatr Dermatol. 2026 Jun 14.
    The Critical Subspecialist Gap in Pediatric Dermatology: Trends in Fellowship Data From 2009 to 2023.
    Christina Druskovich, Yvonne E Chiu, Esteban Fernandez-Faith, Kimberly A Horii, Harper Price.
       BACKGROUND: The field of pediatric dermatology continues to experience a critical workforce shortage, which negatively impacts specialized care for children with dermatologic conditions.
    OBJECTIVE: To analyze pediatric dermatology fellowship applicant data and match rate trends from 2009 to 2023, board certification of new pediatric dermatologists from 2010 to 2023, and assess workforce trends and identify potential challenges in the pipeline of pediatric dermatologists.
    METHODS: This retrospective study examined data provided by the Society of Pediatric Dermatology and San Francisco Match for pediatric dermatology fellowships from 2009 to 2023 and board certification information from the American Board of Dermatology.
    RESULTS: Our analysis revealed a limited number of board-eligible fellowship applicants despite the availability of multiple fellowship programs, with an average of 32% of programs failing to match fellows. Board certification rates varied, with an increase over time in non-board-eligible fellow applicants. The geographic distribution of fellowship-trained pediatric dermatologists showed regional disparities.
    LIMITATIONS: Some pediatric dermatology fellows may enter fellowship outside of the official match process, not captured in the data. We used a public search engine for practice data, and it is possible that misclassification occurred.
    CONCLUSION: In recent decades, the dire need for pediatric dermatologists has exceeded the available workforce, with numerous fellowship programs remaining unfilled.
    Keywords:  dermatology subspecialty; fellowship match rate; fellowship programs; pediatric dermatology; pediatric dermatology fellowship
    DOI:  https://doi.org/10.1111/pde.70286
  19. Acad Pediatr. 2026 Jun 13. pii: S1876-2859(26)00124-5. [Epub ahead of print] 103342
    Primary Care Pediatrician Assessment of Access Barriers and Local Supply of Pediatric Subspecialists.
    William L Cull, William H Burr, Chloe A Somberg, Lynn M Olson.
       OBJECTIVE: We aimed to examine primary care pediatricians' experiences with availability of pediatric subspecialists in their practice area. We further aimed to compare the experiences of pediatricians in rural and nonrural areas.
    METHODS: We analyzed weighted 2024 data from 471 primary care pediatrician respondents to the AAP Periodic Survey, a national survey of AAP members. Questions focused on barriers to subspecialty care and availability of specific subspecialties. Responses were analyzed descriptively for the overall sample, and chi-squares tests were used to compare responses for pediatricians from rural and nonrural areas.
    RESULTS: Primary care pediatricians reported that for patients needing subspecialty care, moderate or significant barriers included long waiting times for appointments (88%), too few pediatric subspecialists (72%), and long travel times to subspecialists (53%). Respondents identified many specific subspecialty areas as having a shortage (% of pediatricians choosing "too few"): child/adolescent psychiatry (97%), developmental-behavioral pediatrics (96%), pediatric dermatology (76%), child abuse pediatrics (76%), and pediatric rheumatology (75%) Rural pediatricians were significantly more likely than those from nonrural areas to report shortages for 20 of the 28 subspecialty areas.
    CONCLUSION: Primary care pediatricians provide an important perspective concerning the subspecialty care needs of their patients, and they report shortages for many subspecialty areas. The shortages are more pronounced in rural areas.
    Keywords:  primary care pediatrics; subspecialty referral; workforce
    DOI:  https://doi.org/10.1016/j.acap.2026.103342
  20. Am Soc Clin Oncol Educ Book. 2026 Jun;46(3): e517242
    Before the Race Even Starts: Early Intervention to Prevent Long-Term Late Effects From Childhood Cancer Therapies.
    Etan Orgel, Karen C Burns, Joshua Gorlick, Lisa S Kahalley.
      Increasing treatment intensity has improved survival rates for children with cancer, resulting in an increasing population burdened with late effects from treatment. The Children's Oncology Group Survivorship Guidelines provide a compendium of late effects with recommendations for risk-adapted surveillance based on treatment components and intensity. However, many late effects from therapy are permanent; alternative strategies are therefore necessary to prevent their debilitating impact on the quality of life for childhood cancer survivors. Prevention of late effects via early intervention is an increasingly vital component of pediatric cancer therapy. In this review, we highlight three common and debilitating late effects amenable to this strategy: oncofertility and fertility preservation, cisplatin-induced ototoxicity (hearing loss) and otoprotection, and radiation-induced neurocognitive deficits and cognitive-sparing approaches. For each toxicity, current practice, knowledge gaps, and future directions are discussed.
    DOI:  https://doi.org/10.1200/EDBK-26-517242
  21. Front Pediatr. 2026 ;14 1738009
    Exploring the neurobiological markers of suicidal behaviors in pediatric population: a narrative review.
    Mona Salehi, Mahdieh Saeidi, Man Amanat, Tala Barias, Urenna Anyeji, Omar Alzein, Sasidhar Gunturu.
       Background: Suicide is the second leading cause of death among children and adolescents, with rates of pediatric suicidal behavior rising substantially over the past two decades. The neurobiology of suicide has been extensively studied in adults, yet pediatric-specific evidence remains limited and the extent to which adult findings can be extrapolated to youth is unclear. This review synthesizes current evidence on the neurobiological correlates of suicidal ideation, suicide attempt, and death by suicide in pediatric and adolescent populations across neurological, genetic, epigenetic, inflammatory, metabolic, and endocrine domains.
    Methods: A literature search was conducted in PubMed, Embase, PsycINFO, and Google Scholar for peer-reviewed, English-language human studies. Priority was given to pediatric and adolescent samples, with adult data included where pediatric evidence was lacking. Studies were grouped by biological domain and by suicidal phenotype.
    Results: Suicidal ideation, suicide attempt, and death by suicide showed partially distinct biological signatures rather than lying on a single continuum of severity. Different markers, most notably cortisol regulation and stress-related DNA methylation, differed in direction between pediatric and adult cohorts, indicating that adult biomarker data cannot be directly extrapolated to youth. Findings converged on a developmental cascade in which genetic liability and early-life adversity influence the hypothalamic-pituitary-adrenal axis, with downstream effects on epigenetic regulation, neuroinflammation, neurochemistry, and frontolimbic circuitry.
    Conclusions: Pediatric suicidal behavior reflects developmentally distinct biological processes that cannot be inferred from adult findings. Advancing the field will require longitudinal, multimodal pediatric studies that disaggregate suicidal phenotypes, span the pubertal transition, and apply age-stratified reference ranges, supporting biologically informed stratification and mechanism-targeted intervention.
    Keywords:  neurobiologic basis; pediatric; suicidal attempt; suicidal idea; suicide
    DOI:  https://doi.org/10.3389/fped.2026.1738009
  22. Hosp Pediatr. 2026 Jun 15. pii: e2025008998. [Epub ahead of print]
    Evaluation of a Pediatric Teaching Program: A Qualitative, Ethnographic Study.
    Kimberly O'Hara, Kathleen Brimsek, Lauren Anderson, Francesca Moisson, Lee Engelbreth, Jessica Landry, Janice Hanson.
       OBJECTIVE: A local needs assessment demonstrated deficits in direct observations, teaching, and written evaluations, which are required by training programs and accrediting bodies. We developed the Teaching Excellence Among Medical Providers (TEAM) Program to fill this gap and enhance the educational experience of learners and faculty in pediatric hospital medicine. Our objective was to evaluate this program's impact on our educational culture using a focused ethnographic approach.
    PATIENTS AND METHODS: Informed by self-regulated learning theory, TEAM was created at our freestanding children's hospital in 2019. We conducted this qualitative study involving interviews of learners and faculty and field observations of TEAM shifts. We coded transcripts and field notes, organizing codes into themes through iterative group discussion until achieving information power. Prior research has described culture in medical education using 3 lenses: organizational, identity, and practice; we organized our analyzed data using these 3 cultural perspectives as a framework.
    RESULTS: Between May 2023 and August 2024, we completed 25 1:1 interviews and 10 field observations. Data analysis revealed 6 themes, each categorized in 1 of 3 cultural lenses. Our themes highlighted that TEAM represents shared values within our institution and increases cohesion and mentorship (organizational); fosters professional identify formation and a growth mindset (identity); and affects the workings of the clinical team while providing an appreciated, additional perspective (practice).
    CONCLUSIONS: TEAM has had a positive impact on our institution's educational culture through 3 unique lenses, as participants described prioritization of education, a professional development opportunity, and valuable support for the clinical team.
    DOI:  https://doi.org/10.1542/hpeds.2025-008998
  23. J Pediatr. 2026 Jun 15. pii: S0022-3476(26)00226-X. [Epub ahead of print] 115198
    Values in the Neonatal ICU: Insights into Caregiver Priorities.
    Kathryn E Cyrus, Amy M Creel, Zhide Fang, Ashley K Autrey, Jeffrey W Surcouf.
       OBJECTIVE: To identify and prioritize caregiver values related to high-quality care for infants hospitalized in the neonatal intensive care unit (NICU) and to examine variation in these values by caregiver and clinical characteristics.
    STUDY DESIGN: Sixteen domains of high-value NICU care were adapted for the neonatal, critical care setting from the National Consensus Project's Guidelines for Quality Palliative Care, neonatology literature, and a stakeholder panel. Using a discrete choice experiment, we recruited caregivers to provide their ratings of the most and least valued NICU care domains.
    RESULTS: Forty-five caregivers of 39 infants participated. Overall, caregivers ranked "Care team members have the necessary education and training to provide high quality care for infants and families," as most important with domains relating to communication and symptom management also ranked highly. Cultural, spiritual, and religious aspects of care were among the lowest ranked. Differences in highest ranked values were also noted based on the patient's length of stay, clinical status, and caregiver's relationship to the patient.
    CONCLUSIONS: Among caregivers of infants in the NICU, values emphasizing care team knowledge, communication, and symptom management were consistently prioritized. Identification of caregiver priorities during NICU hospitalization may help clinicians better understand the perspectives that shape families' experiences of care and support efforts toward value-concordant communication and shared decision-making.
    Keywords:  NICU; caregiver values; discrete choice experiment; parental insight; shared decision making
    DOI:  https://doi.org/10.1016/j.jpeds.2026.115198
  24. Am J Emerg Med. 2026 Jun 08. pii: S0735-6757(26)00282-2. [Epub ahead of print]108 95-101
    Perspectives on artificial intelligence supported firearm access screening and storage counseling in pediatric emergency care.
    Joanna S Cohen, Alannah Clarke, Aubrey DeVinney, Paul Nestadt, Oluwakemi Badaki-Makun.
       BACKGROUND: Lethal means counseling in the emergency department (ED) is associated with increased firearm safe storage, and ED based screening and counseling programs can identify and create opportunities for intervention for at risk youth; however, implementation in pediatric EDs remains inconsistent. While artificial intelligence (AI) tools may help address barriers, little is known about providers perspectives on AI tools for firearm screening and safe storage counseling.
    OBJECTIVES: Assess Pediatric Emergency Medicine (PEM) physicians' attitudes toward firearm screening and counseling, perceived barriers to implementation, and acceptability of AI enabled strategies to support firearm injury prevention in the pediatric ED.
    METHODS: We conducted a national, cross-sectional survey of PEM physicians. The survey assessed current screening practices, perceived barriers, and attitudes toward AI powered tools. Descriptive statistics summarized quantitative responses, and qualitative thematic analysis was performed on open-ended responses.
    RESULTS: Of 687 eligible physicians, 296 responded (43.1%), with 274 (39.9%) completing the survey. Most respondents endorsed the importance of firearm access screening and counseling. Commonly reported barriers included limited time, lack of standardized protocols, unclear role responsibility, insufficient training, and limited resources. More than half of respondents reported prior exposure to AI tools, and many expressed openness to AI assisted approaches, particularly for identifying patients for screening, providing counseling language, and facilitating documentation. Concerns focused on workflow burden, accuracy, and patient safety.
    CONCLUSIONS: PEM physicians recognize firearm screening and counseling as important, but face implementation barriers. Clinician centered, workflow integrated AI tools may offer a promising strategy to enhance firearm injury prevention in pediatric emergency care.
    Keywords:  Artificial intelligence; Firearm screening; Safe storage
    DOI:  https://doi.org/10.1016/j.ajem.2026.06.009
  25. Acad Pediatr. 2026 Jun 15. pii: S1876-2859(26)00132-4. [Epub ahead of print] 103350
    Tailoring screening algorithms for a large health system: Autism screening as a case example.
    R Christopher Sheldrick, J L Hooker, M Davignon, J Sakimura, Y Qian, L A Croen.
       OBJECTIVES: When healthcare systems develop algorithms to implement national screening guidelines, they must choose which information to incorporate (e.g., primary screening, secondary screening, and results from prior visits), whether to follow recommended screening thresholds (i.e., cut scores), and if not, how to set them. Our objective was to analyze electronic medical record (EMR) data to inform these choices.
    STUDY DESIGN: Retrospective analyses utilized EMR from 33,490 families of children 4 years of age and under enrolled in Kaiser Permanente Northern California. Given prior screening results, we analyzed how each child in the dataset would have been classified by several potential screening algorithms that differed with respect to information used and screening thresholds. Outcomes considered several perspectives, including population health, specialty care, primary care, and individual families.
    RESULTS: Analyses supported a screening algorithm that: (a) includes all sources of screening information, (b) recommends evaluation for children with an estimated chance of receiving an autism diagnosis by 4 years of ≥50%, and (c) recommends active monitoring for children with an estimated probability of autism of ≥3.3% (but <50%). If implemented with fidelity, this algorithm could result in the direct referral of 1.8% of children, achieving 34.2% sensitivity and 62.1% positive predictive value before requiring further clinical decision-making. Tradeoffs with other potential screening algorithms are considered.
    CONCLUSIONS: Based on results, we recommend that health systems use EMR data to consider tradeoffs between potential algorithms when implementing or refining screening protocols. We also recommend replication over time to account for secular changes.
    Keywords:  Autism; pediatrics; primary care; screening
    DOI:  https://doi.org/10.1016/j.acap.2026.103350
  26. Pediatr Neurol. 2026 May 29. pii: S0887-8994(26)00167-0. [Epub ahead of print]181 101-106
    Value-Based Care for Acute Pediatric Seizure Management: Operational Models, Quality Metrics, Barriers, and Financial Strategy.
    Matthew Chase Lustig.
      Acute pediatric seizure care spans the emergency department, inpatient ward, intensive care unit, and early outpatient follow-up, and it shapes throughput, admission decisions, neurodiagnostic use, discharge reliability, and downstream utilization. The literature on value in pediatric neurology remains limited, and broad operational frameworks risk drifting toward speculation unless they are anchored to common, measurable clinical problems. Acute seizure care is the clearest current example; it is high-volume, resource-intensive, time-sensitive, and supported by a maturing literature on quality measures, pathway redesign, diagnostic stewardship, patient-reported outcomes, and access barriers. This topical review describes a framework in which value is created through five process levers - timely specialist evaluation, protocolized acute management, diagnostic stewardship, reliable discharge and transition planning, and structured outcome measurement - and assessed across the following four outcome domains: clinical, patient and family, operational, and financial. The review also addresses common barriers to implementation, including insurance constraints, limited outpatient electroencephalography and magnetic resonance imaging capacity, magnetic resonance imaging sedation bottlenecks, delayed neurology follow-up, referral failures, workforce turnover, and inequitable access after discharge. Finally, the review proposes an implementation roadmap anchored to the Consolidated Framework for Implementation Research and outlines how the same analytic approach may later be adapted to other inpatient pediatric neurology presentations.
    Keywords:  Epilepsy; Hospital operations; Pediatric neurology; Quality improvement; Seizures; Value-based care
    DOI:  https://doi.org/10.1016/j.pediatrneurol.2026.05.019
  27. J Pediatr. 2026 Jun 16. pii: S0022-3476(26)00220-9. [Epub ahead of print] 115192
    Don't Skip A Beat: Deliberate Practice and Mastery Learning of Pediatric Electrocardiograms.
    K Boutis, M Pusic, Y Etoom, S Patel, R Johri, R Pecaric, Ea Stephenson.
       OBJECTIVES: To develop an online pediatric electrocardiogram (ECG) educational intervention, d to examine pediatricians' diagnostic skill development as they progressed to achieve a performance-based standard, and to determine the frequency of pediatric ECG findings at highest risk for diagnostic error.
    METHODS: This multicenter, prospective cohort study included a convenience sample of pediatricians. There were 400 cases in the intervention, and for each case, participants first determined whether an actionable abnormality was present or absent. If present, participants categorized abnormalities as rate/rhythm, anatomical/technical, or Q-wave/repolarization, and selected the most appropriate specific diagnosis from a drop-down list of options. Immediate feedback was provided after each case, and practice continued until a minimal passing standard was achieved.
    RESULTS: A total of 345 pediatricians performed 46,649 pediatric ECG case interpretations. Initial accuracy was 82.1% in identifying ECG with actionable findings, 70.9% for correct categorization of actionable findings, and 45.2% for selecting most actionable specific diagnosis. There were learning gains for each of these diagnostic tasks: +14.6% (95% CI 13.1, 15.8), +15.0% (95% CI 13.2, 16.8), and +19.8% (95% CI 17.5, 22.1), respectively. Furthermore, 65% achieved the minimal passing standard in a median of 325 cases (IQR 198, 496) or 6.5 hours (IQR 3.4, 10.0) of practice. Among the 46,649 case interpretations, 7,675 (16.5%) were incorrect interpretations. ECG findings consistent with ventricular hypertrophy, Brugada sign, prolonged QTc, and ischemia/pericarditis were among the most challenging diagnoses.
    CONCLUSION: Structured practice with feedback can feasibly improve pediatrician ECG interpretation skills and derive data to identify ECG findings prone to diagnostic error.
    Keywords:  Children; Electrocardiogram; Medical Education
    DOI:  https://doi.org/10.1016/j.jpeds.2026.115192
  28. Front Pediatr. 2026 ;14 1825957
    Restraint care in the pediatric intensive care unit: a qualitative investigation of nurses' perspectives and experiences.
    Xiaowen Dai, Qingqing Liu, Shuyi Ma, Li Wei.
       Background: Restraint use in pediatric intensive care units (PICUs), while essential for preventing unplanned extubation, presents ethical and practical challenges. Nurses, as primary implementers, often face psychological tensions arising from their dual role as caregivers and enforcers of safety. Yet, their subjective experiences remain underexplored.
    Methods: A descriptive phenomenological design was employed. Purposive sampling recruited 16 PICU nurses from a tertiary children's hospital in Jiangsu, China, between March and June 2025. Semi-structured, face-to-face interviews (30-60 min) were conducted and analyzed using Colaizzi's method. Ethical approval was obtained, and triangulation ensured rigor. Sample size was determined by data saturation.
    Results: Sixteen PICU nurses participated. Five core themes emerged: (1) ethical tensions in balancing patient safety with respect for autonomy; (2) practical difficulties due to ill-fitting restraint tools and technical demands; (3) nurse-family communication breakdowns from emotional resistance and information asymmetry; (4) cumulative psychological strain, including vicarious trauma and diminished professional identity; (5) institutional needs for clear protocols, targeted training, and staffing support. Practice gaps included inconsistent emergency assessments, incomplete family consent, poor site-monitoring compliance, and lack of pediatric-specific tools.
    Conclusion: PICU nurses face multifaceted challenges in restraint care. Improvements require standardized pediatric guidelines, communication-focused training, non-restraint alternatives, and enhanced institutional support.
    Keywords:  care; nurse; pediatric intensive care unit; physical restraint; qualitative research
    DOI:  https://doi.org/10.3389/fped.2026.1825957
  29. Front Pediatr. 2026 ;14 1829526
    Quality improvement strategies for preventing tracheostomy-related pressure injuries in children: a systematic review and meta-analysis.
    Yanan Wang, Chunli Wang, Shifen Zhai, Hua Wang, Wei Chi, Xudong He, Ziqian Wang.
       Background: Children with tracheostomies represent a high-risk population for medical device-related pressure injuries (MDRPI) due to prolonged cannulation, immature skin, limited mobility, and exposure to secretions, consistent with NPIAP/EPUAP definitions. The development of pressure injuries not only prolongs hospitalization and escalates healthcare costs but may also precipitate severe infectious complications. Although diverse preventive strategies have been implemented in clinical settings, evidence-based synthesis specifically targeting the pediatric population remains scarce, and the comparative effectiveness of these interventions continues to be debated.
    Objective: To systematically evaluate the efficacy of interventions for preventing pressure injuries in tracheostomized children and to compare, through meta-analysis, the impact of different preventive measures (including securement methods and dressing types) on pressure injury incidence and severity, thereby furnishing an evidence base for clinical nursing practice.
    Methods: A comprehensive computerized search of Chinese and international databases was conducted to identify clinical studies examining preventive interventions for pressure injuries in children (aged ≤18 years) with tracheostomies. Meta-analyses of pressure injury incidence were performed using R software and STATA.
    Results: A total of 6 studies encompassing 736 participants were included. Direct Bayesian meta-analysis of three studies comparing Velcro® ties with conventional twill ties showed a reduction in adverse event risk favoring the Velcro® group (OR = 0.26, 95% CrI 0.07-0.94), with a continuity correction of 0.5 applied for zero events. Bayesian network meta-analysis comparing Mepilex®, Mepilex® Ag, and standard care revealed that, relative to control, the OR for Mepilex® was 0.83 (95% CrI: 0.02-21.48) and for Mepilex® Ag was 0.32 (95% CrI: 0.003-11.37). Node-splitting analyses indicated no significant inconsistency between direct and indirect evidence (all p > 0.05). The OR for Mepilex® Ag compared to Mepilex® was 0.37 (95%CI: 0.01-11.11), with none achieving statistical significance. SUCRA rankings indicated that Mepilex® Ag demonstrated the highest probability of being the optimal intervention (SUCRA = 97.6%), followed by standard care (SUCRA = 52.2%) and Mepilex® (SUCRA = 0.1%). These findings suggest that Mepilex® Ag had a higher cumulative probability across rank distributions compared with other interventions; however, none of the pairwise comparisons were statistically significant, and credible intervals were wide, indicating substantial uncertainty. The SUCRA ranking should be interpreted as indicative rather than definitive.
    Conclusion: This systematic review and meta-analysis provides preliminary evidence supporting the potential value of silver-containing foam dressings and Velcro®-type securement devices in preventing tracheostomy-related pressure injuries among pediatric patients. However, the certainty of evidence remains moderate, constrained by the limited number of available studies, variable methodological quality, and substantial heterogeneity. Clinical decision-makers should integrate individual patient characteristics, resource availability, and cost-effectiveness considerations when selecting appropriate preventive regimens. High-quality randomized controlled trials and real-world studies are urgently warranted to establish standardized clinical practice guidelines for preventing tracheostomy-related pressure injuries in children, ultimately improving outcomes for this vulnerable population.
    Systematic Review Registration: INPLASY202650137 (INPLASY.COM, DOI: 10.37766/inplasy2026.5.0137).
    Keywords:  medical device-related pressure injury (MDRPI); mepilex; mepilex silver; pediatrics; tracheostomy; velcro tie
    DOI:  https://doi.org/10.3389/fped.2026.1829526
  30. Cardiovasc Intervent Radiol. 2026 Jun 16.
    Venous Intervention in Children: Current Practice and Controversies.
    Kishore Minhas, Aaron Stirling, Aparna Annam, Anne E Gill.
      Although anticoagulation remains the cornerstone of treatment for pediatric deep vein thrombosis, there is increased utility of endovascular interventions including catheter-directed thrombolysis, mechanical thrombectomy, and pharmacomechanical thrombectomy in severe cases. Chronic venous occlusion and venous compression syndromes, including May-Thurner, venous thoracic outlet, and Nutcracker syndromes, present additional challenges and, where clinically indicated, often require angioplasty with or without venous stenting. Venous stenting in children shows promise but raises concerns about vessel growth and reintervention. Pediatric-specific data remain limited, and interventions must account for patient size, skeletal maturity, and long-term outcomes. Pediatric venous interventions lag behind adult practice, underscoring the need for specialized expertise and further research. A multidisciplinary, individualized approach is essential to optimize outcomes and minimize complications in children.
    DOI:  https://doi.org/10.1007/s00270-026-04501-8
  31. Psychol Sport Exerc. 2026 Jun 15. pii: S1469-0292(26)00134-2. [Epub ahead of print]86 103193
    Family sport commitments in a professionalized landscape: An exploration of parental pressures and beliefs.
    Katherine N Alexander, Daniel J M Fleming, Stephanie L K Fuller, Ayomiposi O Aribasoye, Emily S DeLisle, Ece Ibanoglu, Jordan A Blazo, Travis E Dorsch, Tom Farrey, Jon Solomon, Jennfer Brown Lerner.
      Youth sport in the United States has become increasingly professionalized, heightening pressure on parents and caregivers to invest substantial time and financial resources in their child's sport participation. Despite widespread concern that pressures to specialize and optimistic beliefs about a child's athletic potential drive such investments, few empirical studies have examined these relationships. Guided by Eccles's expectancy-value model, this exploratory study examined whether perceived pressures to specialize and parental beliefs about a child's sport potential predict parental commitments to youth sport. Parents and caregivers (N = 1229) completed an online survey assessing perceived pressures to specialize (from children, parents, club coaches, school coaches, and society), beliefs about their child's sport potential and sport commitments (financial spending, days per week, and months per year). Three multiple regression models were fit to examine the independent contributions of pressures and perceived potential to each investment outcome. Findings suggest that perceived pressure from club coaches significantly predicted greater financial spending, while perceived pressure from school coaches predicted more days per week spent in sport. Contrary to theoretical expectations, parental belief in child potential did not predict greater financial investment. These results suggest that families' youth sport investments may be more structurally determined by sport system demands than shaped by parental beliefs alone. Scholars should consider contextual factors in future models of family decision-making. Additionally, coaches and youth sport organizations should offer education to help parents navigate decisions without undue pressure.
    Keywords:  Expectancy value theory; Sport investment; Sport parents; Sport specialization; Youth sport
    DOI:  https://doi.org/10.1016/j.psychsport.2026.103193
  32. Child Adolesc Psychiatr Clin N Am. 2026 Jul;pii: S1056-4993(26)00019-2. [Epub ahead of print]35(3): 557-571
    A Crisis Care Continuum for Children and Adolescents: The Boston Medical Center Model.
    Alison Duncan, Tasha Ferguson, Tim Lash, Rachel Oblath.
      Children and adolescents experiencing behavioral health crises and their families often rely on emergency systems, including 911, law enforcement, and emergency medical services. Health care systems are increasingly partnering with emergency systems to ensure that youth and families are connected with urgent behavioral health care in the community, avoiding unnecessary emergency department visits and interactions with law enforcement. This article describes the pediatric behavioral health crisis care continuum developed at Boston Medical Center, the largest safety-net hospital in New England, and situates this model within the existing evidence base on youth crisis response.
    Keywords:  Adolescent psychiatry; Behavioral health continuum; Community psychiatry child; Emergency psychiatry
    DOI:  https://doi.org/10.1016/j.chc.2026.03.008
  33. J Pediatr Soc North Am. 2026 Aug;16 100386
    CPT Codes for Pediatric Orthopaedics.
    R Dale Blasier, Kevin Neal.
      CPT codes are essential for standardizing medical services, billing, and reimbursement, and for ensuring clear communication among providers, insurers, and patients. The purpose of this review is to examine the history of the 33 most frequently reported CPT codes (as recorded by pediatric Orthopaedic fellowships), their shortcomings, and the challenges currently facing the pediatric orthopedist. None of the pediatric Orthopaedic CPT codes have been reviewed since 2007. Many codes lack vignettes that describe the typical work performed by the clinician. Several codes have not been assigned an RVU value in 30 years (and none have been reviewed in the last 17 years). Therefore, it is unknown whether the current wRVU for each of these codes is accurate. The number of designated inpatient visits for many pediatric Orthopaedic codes is likely inaccurate. The Pediatric Orthopaedic Society of North America could take responsibility for overseeing CPT codes used by pediatric Orthopaedic surgeons. This could be done by establishing a committee of experts to review the existing codes and make recommendations regarding code development, revision, or deletion.
    Key Concepts: (1)There are CPT codes which are unique and important to pediatric orthopaedics.(2)These CPT codes have not recently been reviewed and may be out of date.
    Keywords:  CPT Codes; Coding for pediatric orthopedic procedures; Current Procedural Terminology
    DOI:  https://doi.org/10.1016/j.jposna.2026.100386
  34. J Surg Res. 2026 Jun 13. pii: S0022-4804(26)00309-4. [Epub ahead of print]325 1-9
    Trauma Center Type and Outcomes After Pediatric Blunt Pancreatic Injury: A National Trauma Data Bank Analysis.
    Rawan Sharma, Richard Herman, Christopher Blewett, Connie Rossini, Shin Miyata.
       INTRODUCTION: The management of blunt pancreatic trauma in pediatric patients has evolved with the establishment of designated pediatric trauma centers. Given that pancreatic injuries frequently occur alongside other major injuries, studies specifically assessing outcomes remain limited. We compared outcomes for children with blunt pancreatic injury treated at pediatric versus nonpediatric trauma centers.
    METHODS: Using the National Trauma Data Bank (2017-2023), we identified trauma patients aged ≤18 y with blunt pancreatic injury. Patients transferred out and those with severe nonabdominal injuries (AIS ≥3) were excluded. Outcomes included pancreas repair or resection, pancreatic duct procedures, hemorrhage control laparotomy, blood product transfusion, computed tomography (CT) utilization, in-hospital complications, discharge home, and hospital length of stay. Data were analyzed using multivariable regression and severity-adjusted models to evaluate clinical outcomes in children with blunt pancreatic injury.
    RESULTS: Among 1387 children, 802 (58%) were treated at pediatric trauma centers. After adjustment, treatment at pediatric trauma centers was associated with lower odds of pancreas repair/resection (adjusted odds ratio [aOR] 0.60), lower CT abdomen/pelvis utilization (aOR 0.68), fewer in-hospital complications (aOR 0.59), and a higher likelihood of discharge home (aOR 3.97). Hospital length of stay was also shorter among children treated at pediatric trauma centers. Pancreatic duct procedures did not differ by center type. In severity-stratified analyses, these associations were most apparent in lower-grade injuries, where pediatric trauma centers were associated with lower odds of operative intervention, complications, transfusion, hemorrhage control laparotomy, and CT utilization. In the restricted cohort excluding hollow viscus or mesenteric injury, the main findings were preserved.
    CONCLUSIONS: In pediatric blunt pancreatic injury, treatment at pediatric trauma centers was associated with a more favorable pattern of short-term outcomes and resource utilization. The observed associations may support early pediatric trauma center involvement for selected children with suspected blunt pancreatic injury.
    Keywords:  Blunt pancreatic trauma; National Trauma Data Bank; Nonpediatric trauma centers; Pediatric trauma centers
    DOI:  https://doi.org/10.1016/j.jss.2026.05.018
  35. Semin Pediatr Surg. 2026 Jun 11. pii: S1055-8586(26)00081-8. [Epub ahead of print] 151665
    From FOB to PICU: military trauma systems that changed pediatrics.
    Sara Bibbens, Matthew Borgman.
      The U.S. Department of Defense Joint Trauma System (JTS) has transformed battlefield trauma care through data-driven performance improvement, standardized guidelines, and continuous feedback. Lessons learned from pediatric wartime casualties in Iraq and Afghanistan, spanning more than two decades, have extended beyond combat, influencing how civilian pediatric trauma and disaster systems prepare for and manage mass-casualty incidents (MCIs). This manuscript examines the historical development of military trauma systems, the evaluation of Critical Care Air Transport Teams (CCATT), and the translation of Combat Casualty Care (CCC) principles, such as tourniquet use, tranexamic acid (TXA), and balanced transfusion, into civilian pediatric practice. These innovations demonstrate how military-derived frameworks continue to shape pediatric preparedness, trauma resuscitation, and disaster response across both prehospital and hospital domains.
    Keywords:  Critical care air transport teams (CCATT); Joint trauma systems (JTS); Military medicine; Pediatric trauma; Pediatric wartime care
    DOI:  https://doi.org/10.1016/j.sempedsurg.2026.151665
  36. Pediatr Emerg Care. 2026 Jun 22.
    Hypodermoclysis for Fluid Administration in Hospitalized Pediatric Patients: A Scoping Review.
    Mariana de Siqueira Silva, Beatriz Bernava Sarinho, Thamires Da Silva Feres, Yasmin Fortunato Teixeira, Sandra Cristina Brassica, Inajara Rotta, Marília Berlofa Visacri.
       OBJECTIVE: Hypodermoclysis is an alternative for hydrating children with difficult venous access. This study aimed to map the literature on its use for fluid administration in neonates, infants, and children up to 12 years old in hospital settings.
    METHODS: A scoping review was conducted on December 4, 2024, and updated on July 25, 2025, in PubMed, Scopus, Web of Science, and CINAHL. Primary studies on hospitalized children (0 to 12 y) receiving fluids through hypodermoclysis were included. Two reviewers independently screened the articles.
    RESULTS: Ten studies, published between 1950 and 2025, were conducted in emergency, inpatient, and palliative care settings. The most used fluid was 0.9% sodium chloride; hyaluronidase was used in 8 studies. Outcomes most frequently assessed were safety (n=8), efficacy/effectiveness (n=4), and ease of use/comfort/satisfaction (n=3). The data demonstrate that hypodermoclysis is safe, with expected local adverse effects related to subcutaneous administration and rare severe local or systemic adverse effects. Moreover, dehydrated patients were successfully treated using this technique. The studies also indicate that hypodermoclysis is simple to perform, well accepted by health care professionals, facilitates parenteral rehydration with fewer needle insertions, and is satisfactory to caregivers.
    CONCLUSION: Hypodermoclysis appears to be a safe, effective, and well-accepted option for pediatric dehydration. Its incorporation into pediatric clinical protocols may reduce the need for repeated venipuncture and associated distress, thereby improving patient comfort and family satisfaction.
    Keywords:  child; dehydration; emergency treatment; hospitals; hypodermoclysis; neonate; pediatrics; solutions; subcutaneous infusion
    DOI:  https://doi.org/10.1097/PEC.0000000000003646
  37. Curr Opin Pediatr. 2026 Jun 09.
    Advances in the treatment of pediatric hidradenitis suppurativa: emerging therapies and future directions.
    Anastasia Chajecki, Colleen H Cotton.
       PURPOSE OF REVIEW: Hidradenitis suppurativa is a chronic inflammatory skin disease causing recurrent abscesses, tunnels, and scarring. Despite significant disease burden in children and adolescents, treatment data for this population remains limited. This review summarizes the most recent developments in pediatric hidradenitis suppurativa management.
    RECENT FINDINGS: The 2025 North American clinical practice guidelines for the medical management of hidradenitis suppurativa in special populations included key consensus-based treatment recommendations for pediatric hidradenitis suppurativa. Although antibiotics remain the mainstay of treatment for acute flares, adult data support the use of intravenous ertapenem as a rescue therapy for severe, recalcitrant hidradenitis suppurativa. Hormonal therapies, including spironolactone and combined oral contraceptives, should be considered in postmenarchal women. Metabolic therapies, particularly metformin and GLP-1 receptor agonists, are newer adjunctive options for patients with comorbid obesity and insulin resistance. Secukinumab was recently approved for moderate-to-severe hidradenitis suppurativa in adolescents at least 12 years, and clinical trials for multiple other biologic therapies for pediatric hidradenitis suppurativa are underway.
    SUMMARY: Patients with pediatric hidradenitis suppurativa require individualized management approaches that consider their unique comorbidities and stages of development. Clinicians should integrate the 2025 North American guidelines into clinical practice, recognize, and co-manage comorbidities when appropriate, and counsel patients on approved and emerging biologic options.
    Keywords:  adolescent; hidradenitis suppurativa; multidisciplinary care; systemic therapy
    DOI:  https://doi.org/10.1097/MOP.0000000000001590
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