Journal of Pediatric Health Care - Articles in Press

Passport to Health: An Innovative Tool to Enhance Healthy Lifestyle Choices - Corrected Proof

Elizabeth Vaczy, Brenda Seaman, Kathleen Peterson-Sweeney, Carol Hondorf — 2010-09-01

Abstract: Obesity in children and adolescents has become an epidemic in the United States. The ramifications of obesity at a young age are longstanding and affect physical health, emotional health, and the economics of the health care industry. The Strong Pediatric Practice at Golisano Children's Hospital is a large inner-city practice serving more than 14,000 urban children and adolescents, the majority living below the poverty level. The Obesity Task Force, which comprises four nurse practitioners, two nurses, a nutritionist, and one physician, developed and implemented the “Passport to Health” tool in an attempt to encourage providers to assess and work with families around the issues of weight and activity, a need that was identified through chart audits. The Passport to Health supports the policy statements on prevention of overweight and obesity by the Centers for Disease Control and Prevention, National Association of Pediatric Nurse Practitioners, and American Academy of Pediatrics. Quality assurance standards for managed care that mandate body mass index (BMI) assessment and nutrition counseling in all children and adolescents also is supported by this tool. The Passport to Health also provides the same message as a current community initiative in the Rochester area that has received widespread media coverage. This tool includes a visual color-coded indicator of the child's BMI status and a synopsis of specific healthy eating and activity goals, and it permits an individualized goal to be established. The Passport to Health translates information that the provider knows about the BMI status into information that the family and child can embrace and understand. Chart audits as well as exit interviews have demonstrated that use of the Passport to Health has increased the assessment, identification, and counseling by providers in relation to healthy eating and activity. Chart audits found that nurse practitioners embraced this practice change more readily than did other providers. We also found that the use of the Passport to Health has increased the involvement of the child and adolescent in discussions about weight and activity status. Recommendations to encourage future practice changes have been established and will be implemented. The changes include intensive education with providers who were less likely to utilize the Passport to Health tool. The Passport to Health could be implemented easily in any pediatric practice setting.

Heat-related Illness Risk With Methylphenidate Use - Corrected Proof

Melanie M. Thoenes — 2010-09-01

A 15-year-old White boy who was seen in a school-based health clinic reported having muscle cramps and a headache and feeling hot, dizzy, and nauseated. Prior to the visit, he ran three laps around the track on a day with an ambient temperature of 29.4°C (85°F) and a humidity level of 74%. He also reported that he had difficulty walking after the third lap. He reported that he had experienced a similar episode during a soccer game when he was 13 years old. He denied drinking caffeinated beverages or using illicit drugs but was taking a prescribed 10-mg dose of methylphenidate (Ritalin) twice a day for his attention deficit hyperactivity disorder (ADHD). He reported that his last dose of methylphenidate was taken 4 hours before he became ill. He said that he ate breakfast before coming to school but did not drink water or other fluids before exercising. He reported that he does not routinely exercise.

A Primary Care Healthy Choices Intervention Program for Overweight and Obese School-age Children and Their Parents - Corrected Proof

Diana Jacobson, Bernadette Mazurek Melnyk — 2010-08-23

Abstract: Introduction: The escalating crisis of childhood overweight and obesity creates an urgent demand for evidence-based interventions that can be used by primary care providers. Therefore, the purpose of this study was to test the feasibility, acceptability, and preliminary efficacy of a theory-based Healthy Choices Intervention (HCI) Program with 15 9-12 year old overweight and obese children and their parents in a primary care setting.Methods: A 1-group, 7-week pre-test/post-test study design was used. Outcome measures included: body mass index (BMI) percentile, physical activity and nutrition knowledge, beliefs, choices and behaviors, anxiety, depression, self-concept, and social competence.Results: Children and parents found the HCI to be useful and informative. Positive effects of the HCI for the children included decreased BMI percentile, increased knowledge, beliefs, choices and behaviors, and self-control. Positive effects of the intervention for the parents included increased knowledge, beliefs, behaviors, and decreased anxiety.Discussion: This study provides evidence to support the feasibility, acceptability, and preliminary effects of the HCI with overweight and obese school-age children and their parents within a primary care setting.

Emerging Issues Regarding Pediatric Nurse Practitioner Education in Acute and Primary Care - Corrected Proof

2010-08-16

The climate of health care in the United States continues to be tumultuous, with widespread calls for change. Concerns about health care costs are matched by public demands for quality, safety, efficiency, and appropriate access for all (). Nurse practitioners (NPs) are increasingly recognized as providing a level of care comparable to physicians (), prompting the design of new models of care delivery that integrate NPs. This growing recognition of effectiveness has given rise to a myriad of new NP positions in diverse settings ranging from community-based to high-acuity critical care. Nursing educators are challenged to effectively deliver NP educational programs to meet the demand for highly skilled advanced practice registered nurses (APRNs).

The Experiences of School-age Children with a Tracheostomy - Corrected Proof

Regena Spratling, Ptlene Minick, Myra Carmon — 2010-08-13

Abstract: Purpose: The purpose of this study was to explore the school-age child’s perspective about living with a tracheostomy.Design and methods: A qualitative design using phenomenological methods was used to describe and interpret the lived experiences of school-age children with a tracheostomy.Results: The perceptions of five children were explored, and three themes emerged: “I’m the only one,” “friends are helpful,” and “just tell them.”Conclusions: Data indicated that encouraging friendships with other children enhances the well-being of the child with a tracheostomy. In addition, data suggested that when schoolmates understand the experiences of children with tracheostomies, they are supportive of the child. Nurse practitioners are in a unique position to assist the child with a tracheostomy in the development of peer networks.

Screening for Depression and Help-seeking in Postpartum Women During Well-baby Pediatric Visits: An Integrated Review - Corrected Proof

Terri L. Liberto — 2010-08-12

Abstract: Purpose: The purposes of this integrated review are to examine the literature on screening for depression and help-seeking behaviors by postpartum women during pediatric well-baby visits; to identify gaps in the literature relating to depression and help-seeking behaviors; and to discuss implications for practice and future research.Method: An extensive search of primary source documents was conducted in Academic Search Premier, CINAHL, MEDLINE, Mental Measurements Yearbook, PsycINFO, PsycARTICLES, and Women’s Studies International using the key words postpartum, postpartum depression (PPD), help seeking, and pediatric setting or pediatrician. Thirty-five articles relevant to help seeking, PPD, and screening in the pediatric setting were included in this review. Research studies included both quantitative and qualitative articles.Results: PPD affects 10% to 15% of all women after birth. Postpartum women generally do not seek help for depression. Untreated PPD has significant adverse affects on parenting, maternal bonding, and the infant’s emotional and behavioral development. Interaction with the woman’s obstetric provider ends shortly after the baby’s birth. However, interactions with the pediatric office are initiated and continue throughout the infant’s first two years of life.Discussion: Early recognition of PPD and appropriate treatment are imperative for positive maternal-infant outcomes. A majority of women do not seek help for depression from any source. Because mothers have routine interactions with pediatric office staff during the first few years after giving birth, pediatric nurse practitioners and pediatricians have the perfect opportunity to screen and educate women regarding symptoms, treatment, and available resources for PPD.

Interpersonal Violence: Secondary Analysis of the Keep Your Children/Yourself Safe and Secure (KySS) Data - Corrected Proof

Linda Lewin, Gregory Graham — 2010-08-12

Abstract: Introduction: The purpose of the secondary analysis was to determine agreement of parents and children to the interpersonal violence (IPV) items on the Keep Your Children/Yourself Safe and Secure (KySS) survey to assess mental health concerns.Methods: A comparative, descriptive design was used to determine the level of agreement between parent/child dyads on the 15 attitude/knowledge and worry items related to IPV (n = 563 dyads).Results: Single mother/son and 10- to 12-year-olds had less agreement than other dyad combinations and child age groups. Six of the 10 knowledge/attitude items had significant differences, including multigenerational occurrence of sexual abuse, the effect of harsh parenting, witnessing domestic violence, and incidence of physical abuse. The least agreement was on sexual abuse, incidence of physical abuse, and outcome of strict parenting (P < .001). Parents had greater worry about the parent/child relationship than did the children (P < .001).Discussion: Parents and clinicians may not realize how different their understanding of IPV is from that of children. Identifying items of least agreement can inform parents and clinicians in targeting violence education and prevention.

Uptake of the Human Papillomavirus Vaccine: A Review of the Literature and Report of a Quality Assurance Project - Corrected Proof

Brenda Cassidy, Elizabeth A. Schlenk — 2010-08-05

Abstract: Purpose: The aims of this study were to review predictors of knowledge about human papillomavirus (HPV), HPV vaccine, and factors related to HPV vaccine uptake and report a quality assurance project that evaluated HPV vaccine uptake and three-dose completion rates.Methods: The setting was a small private urban pediatric practice. Chart review was used to describe HPV vaccine uptake and dose completion rates in 2007. The convenience sample included 189 girls aged 12 to 21 years with HPV vaccine uptake.Results: During 2007, 153 girls aged 12 to 17 years and 42 girls aged 18 to 21 years were seen at well child care visits. HPV vaccine uptake was 72% (n = 110) for the younger group and 79% (n = 33) for the older group. There was no significant difference in HPV vaccine uptake by group. One quarter (24%, n = 46) received the HPV vaccine dose at an episodic visit. The dose completion rate was 64% (n = 120).Discussion: HPV vaccine uptake and dose completion rates were higher than rates reported by the Centers for Disease Control and Prevention. Effective strategies are needed to promote HPV vaccine uptake and dose completion.

Juvenile Dermatomyositis: A Case Study - Corrected Proof

Michelle Schneider, Kathleen Murphy — 2010-08-05

Andrea Kline Tilford, MS, RN, CPNP-PC/AC, CCRN, FCCM

Shared Medical Appointments: Facilitating Care for Children With Asthma and Their Caregivers - Corrected Proof

Constance L. Wall-Haas, Pamela Kulbok, John Kirchgessner, Virginia Rovnyak — 2010-07-23

Abstract: As important members of the health care team, patients and caregivers must be empowered to recognize their asthma status and to act accordingly. Education about asthma, complications, and successful management of asthma provide the best way to empower children and their caregivers. A Shared Medical Appointment (SMA) is a unique health care delivery approach that integrates disease management and patient education. The SMA described here is a 90-minute group appointment for four to nine patients who share a diagnosis of asthma, bronchospasm, or wheeze and their caregivers. The appointment includes a brief individual examination, health education delivered to the group, and the opportunity for interaction between group members. Because a supporting theoretic framework is not identified in the original design proposals for the SMA model or in the literature on its use, for the purposes of this project, Social Cognitive Theory is identified as the theoretical framework that best explains and reinforces the benefits of the SMA. The theoretic framework is important to direct the development and continued success of this treatment model. This project report describes the first nurse practitioner-led SMA as a tool for improving quality of care and service for children with asthma and their caregivers.

Factors That Influence the Likelihood of Hiring a Health Care Advocate for a Chronically Ill Child - Corrected Proof

Elaina A. Vasserman-Stokes, Terry A. Cronan, Melody S. Sadler — 2010-07-22

Abstract: Introduction: In response to the increasing complexity of the health care system, the field of health care advocacy has emerged. However, little is known about variables that may influence a person’s likelihood of hiring a health care advocate (HCA) for their chronically ill child.Methods: Severity (high or low) and probability of mortality (high or low) of a child’s chronic illness and the child’s age (1, 7, or 13 years) were manipulated using vignettes. The dependent variable was a composite score of the eight items used to measure the participants’ likelihood of hiring an HCA.Results: Participants (N = 1052) were more likely to hire an HCA for a child who was 1 year old than for a child who was 13 years old. Participants were more likely to hire an HCA for a child whose chronic illness was low rather than high in severity and whose chronic illness was high rather than low in probability of mortality.Discussion: Use of an HCA may increase patient satisfaction, decrease medical errors, and enhance pediatric health outcomes.

Outpatient Management of Community-associated Methicillin-resistant Staphylococcus aureus Skin and Soft Tissue Infection - Corrected Proof

Melissa NeVille-Swensen, Margaret Clayton — 2010-07-20

Abstract: During the past decade, there has been a dramatic increase in the number of patients presenting with skin and soft tissue infections in the outpatient setting. The predominant causative bacterium for these infections has recently been identified as community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). It is estimated that nearly 80% of infections caused by CA-MRSA manifest as skin and soft tissue infections which are of mild to modest severity. However, invasive disease and fatal illness has been reported among otherwise healthy adults and children. The rapid evolution of CA-MRSA presents a unique challenge for pediatric health care providers. As such, it is critical to raise awareness regarding the epidemiology, microbiology, and evidence-based treatment options for treating skin and soft tissue infections in the age of CA-MRSA. The aims of this article include discussion regarding the epidemiology, microbiology, and evidence-based management of CA-MRSA as well as publication of a more relevant one-page evidence-based treatment flow diagram and antimicrobial prescribing table for health care providers practicing in the ambulatory care setting.

Characteristics of HIV-infected Mothers Associated With Increased Risk of Poor Mother-infant Interactions and Infant Outcomes - Corrected Proof

Krista Lee Oswalt, Fred J. Biasini — 2010-07-16

Abstract: Introduction: The current study aimed to investigate the relationship between individual and familial characteristics of HIV-infected mothers and their psychological health as it relates to parenting as well as their parenting beliefs/abilities.Method: A descriptive correlational design was used. Seventeen HIV-infected mothers and their infants were recruited from a university clinic in Alabama. Assessments were gathered at the infant’s pediatric clinic appointments (approximately 6 weeks after delivery) and included a demographic questionnaire, the Beck Depression Inventory-II, the Maternal Confidence Questionnaire, the Parenting Stress Index–Short Form, and the Questionnaire about Physical Contact.Results: Dysfunctional parent-child interactions significantly correlated with maternal confidence, parent stress, and overall feeling about physical contact. Difficult child temperament correlated with overall and current feelings of physical contact and parent stress. Significant correlations were found between parent distress, parent stress, and maternal depression.Discussion: Beyond the need to assist HIV-infected mothers with stress and depression, an intervention is needed to facilitate optimal parent-child interactions and improve both child psychosocial and cognitive outcomes.

Coping Patterns in Latino Families of Children With Asthma - Corrected Proof

Adrienne Garro — 2010-07-12

Abstract: Introduction: Using the Coping Health Inventory for Parents (CHIP), this study examined coping behaviors in 26 Latino parents of children with asthma.Methods: Correlations and t tests were used to look at variables related to the parents' coping patterns and to compare their frequency of usage of these patterns.Results: The parents in this study were most likely to cope with their child's asthma by making active attempts to understand this condition, doing activities with family members, and maintaining an optimistic perspective. Child and family variables were not significantly associated with parents' usage of coping patterns.Discussion: These results shed light on coping in Latino families of children with asthma and contribute to a growing framework of research and practice regarding health problems in this population. The aforementioned results can enhance health care professionals' understanding of the experiences of these families and help develop and expand culturally sensitive interventions to positively affect their health and psychological needs.

Care Coordination in the Spina Bifida Clinic Setting: Current Practice and Future Directions - Corrected Proof

Jennifer Brustrom, Judy Thibadeau, Lisa John, Jaime Liesmann, Shyanika Rose — 2010-07-12

Abstract: Introduction: Although the potential benefits of care coordination are widely recognized, little is known about care coordination in the multidisciplinary spina bifida clinic setting. This study examined several aspects of care coordination in this environment.Method: We conducted semi-structured interviews with clinic staff (n = 43) and focus groups with caregivers (n = 38) at seven spina bifida clinics in the United States.Results: Clinic staff described several primary goals of care coordination, including coordinating multiple services during one visit to ease the burden on families. Although the structure of care coordination varied across the clinics, several clinics had a dedicated care coordinator. Barriers and facilitators to care coordination included staffing issues, clinic day logistics, community resources, and family-related concerns. Despite challenges associated with care coordination processes, clinic staff and caregivers alike believed that care coordination is beneficial.Discussion: Study findings suggest ways that care might be coordinated optimally in spina bifida clinics. A synthesis of these findings for clinics interested in implementing care coordination or improving the care coordination services they currently offer is provided.

A National Survey of the Primary and Acute Care Pediatric Nurse Practitioner Educational Preparation - Corrected Proof

2010-07-12

Abstract: Introduction: The past decade has been marked by a gradual expansion of the traditional primary care role of the pediatric nurse practitioner (PNP) into practice arenas that call for more acute and critical care of children. The purpose of the study was to explore the educational programming needs of dual (combined) track PNP programs that prepare graduates to provide care to children and adolescents across the continuum of health and illness.Method: A two-phase, exploratory, mixed method design was utilized. An electronic survey was completed by 65% of PNP program directors in the country. Semi-structured telephone interviews were conducted with hospital-based PNPs who were practicing in roles that met a range of health care needs across the primary and acute care continuum.Results: Primary care and acute care programs have more common than unique elements, and the vast majority of clinical competencies are common to both types of program. Only three competencies appear to be unique to acute care programs.Discussion: The Association of Faculties of Pediatric Nurse Practitioner Programs should utilize existing evidence and develop guidelines for dual PNP programs that focus on the provision of care to children across a wide continuum of health and illness.

Uveitis Presenting With Decreased Vision and Leukocoria - Corrected Proof

Sanjeev Tuli, Nausheen Khuddus, Sonal S. Tuli — 2010-07-12

Andrea Kline Tilford, MS, RN, CPNP-PC/AC, CCRN, FCCM

Sources, Locations, and Predictors of Environmental Tobacco Smoke Exposure Among Young Children From Inner-city Families - Corrected Proof

Xinguang Chen, Bonita Stanton, John Hopper, Nikhil Khankari — 2010-07-12

Abstract: Introduction: The purpose of this study was to determine the levels, sources, and locations of and influential factors for exposure to environmental tobacco smoke (ETS) among pediatric patients from inner-city families.Method: Descriptive and associative analysis of ETS exposure in children 6 to 10 years of age was performed with survey data collected at Children's Hospital of Michigan through mothers' report and children's urine cotinine.Results: The sample included 397 participants, 82.4% of whom were African American. Urine cotinine levels were correlated with reported ETS exposure and 71% of children with urine cotinine levels >10 ng/mL. The mean duration of ETS exposure was 14.3 minutes (SD = 11.0) in the past week and 58.9 minutes (SD = 50.8) in the past month. Smoking parents (∼30%), grandparents (∼30%), and non-family members (∼28%) were the major ETS sources, and relatives' homes (∼40%), the children's own homes (∼24%), automobiles (∼15%), and friends' homes (∼11%) were the main ETS locations. Child ETS exposure was inversely correlated with having a non-single mother, maternal education, income, use of prenatal preventive care, and satisfactory parenting.Discussion: ETS exposure in inner-city children was prevalent. Findings of this study may aid pediatric practitioners and public health workers in providing targeted interventions.

Living With Juvenile Arthritis: Adolescents' Challenges and Experiences - Corrected Proof

2010-07-09

Abstract: Introduction: The objective of this study was to identify challenges that teens experience while living with juvenile arthritis (JA) from the perspective of youth and young adults with JA.Method: Focus group interviews were conducted with youth (aged 14-21 years) and young adults (aged 22-29 years) with JA using a semi-structured interview protocol that included questions about the challenges adolescents experience while living with arthritis.Results: Challenges of living with JA were identified in the areas of (a) health care, (b) relationships, (c) school, (d) physical, and (e) individual. However, distinct perspectives emerged between youth and young adult participants. For youth, challenges were situated in present time and focused heavily on interpersonal situations. Alternatively, young adults reported challenges that illuminated their experiences of movement from adolescence into young adulthood (e.g., independently managing their JA and disclosure to dating partners).Discussion: Findings from this study display complex and multifaceted experiences that teens face while living with arthritis. Experiences associated with arthritis were not limited to being described as health care–related challenges; rather, arthritis permeates multiple contexts in adolescents' lives.

A Survey of NAPNAP Members’ Clinical and Professional Research Priorities - Corrected Proof

2010-06-21

Abstract: Introduction: The purpose of this methodological article is to describe the development, implementation, and analysis of the survey used to determine NAPNAP members' ranking of research priorities, to describe the top priorities ranked by participants, and to determine if priorities differed by area of practice (primary, acute, or specialty care) or participant age.Method: A cross-sectional descriptive design with an online survey was used. Completed by 324 NAPNAP members, the survey consisted of a demographic section and 90 statements in two domains: Clinical Priorities and Professional Role Priorities.Results: Survey respondents strongly supported the top priorities with an average overall mean score of 4.0 or above on a 5-point Likert scale. Only three of the top 10 clinical and professional priorities differed by area of practice. No clinical priorities and only three professional priorities differed by age.Discussion: The survey results were used to develop the NAPNAP Research Agenda. Both the survey results and the agenda can provide guidance for the NAPNAP Board, committees and interests groups as they develop initiatives and programs.

Intranasal Fentanyl for Pain Management in Children: A Systematic Review of the Literature - Corrected Proof

Shawna Mudd — 2010-06-18

Abstract: Intranasally administered fentanyl (INF) has been studied as an alternate route of delivery for pain relief in children. The purpose of this systematic review is to evaluate the available research evidence on the use of INF in the pediatric population. A search was conducted of PubMed, ISI, Scopus, Popline, CINAHL, and Embase for research studies evaluating INF in this population (0-18 years of age). The studies were graded on the strength of the evidence and the results reviewed. All of the reviewed studies showed similar or improved pain scores when compared with other opioids and administration methods. No severe adverse outcomes were reported. Current evidence suggests that INF is a safe and effective method of pain management for children in a variety of clinical settings.

Toxoplasmosis: Diagnosis, Treatment, and Prevention in Congenitally Exposed Infants - Corrected Proof

Alyson Kaye — 2010-06-14

Abstract: Toxoplasmosis is a rare disease caused by the obligate intracellular protozoan parasite, Toxoplasma gondii. Most persons with toxoplasmosis in the United States are asymptomatic, but if a woman is infected during pregnancy, the parasite can cross the placenta and cause congenital toxoplasmosis in the fetus. The severity of congenital toxoplasmosis depends on when in the pregnancy the mother is exposed, but it can cause ocular and central nervous system disease as well as lead to growth failure and hearing and vision abnormalities. Congenital toxoplasmosis is treated with a combination of pyrimethamine, sulfadiazine, and leucovorin. It is important for pediatric nurse practitioners to be aware of the clinical presentation and treatment of congenital toxoplasmosis.

Improving Asthma Care for African American Children by Increasing National Asthma Guideline Adherence - Corrected Proof

Karen Rance, Mary O'Laughlen, Stanislaus Ting — 2010-06-14

Abstract: Introduction: Children, particularly African American children, bear a disproportionate burden of asthma and are at highest risk for associated morbidity and mortality. The under-utilization of the National Asthma Education and Prevention Program (NAEPP) guidelines across all demographics and the under-use of inhaled corticosteroids (ICS) as controller therapy in these children are well documented. The primary aim of this study was to increase health care provider (HCP) adherence to the NAEPP guidelines by means of a guideline reminder tool, the Multi-colored Simplified Asthma Guideline Reminder, consequently increasing the prescription of ICS in this population.Method: This study had a pre-experimental design with descriptive analysis.Results: The Multi-colored Simplified Asthma Guideline Reminder was effective in increasing HCP adherence to the NAEPP guidelines as evidenced by increased use of ICS as controller therapy.Discussion: Despite the increasing prevalence and burden of asthma in African American children, the associated prescriptive use of ICS has not increased substantially in the past decade. The greatest obstacle in the scope of improving asthma outcomes is the under-use of ICS by HCPs.

Evidence-based Care Management of the Late Preterm Infant - Corrected Proof

Ana Souto, Miriam Pudel, Donna Hallas — 2010-06-10

Jo Ann Serota, MSN, RN, CPNP

Mothers With Positive or Negative Depression Screens Evaluate a Maternal Resource Guide - Corrected Proof

2010-06-10

Abstract: Introduction: Social isolation is common in mothers with high depressive symptoms. This study tested the hypothesis that a maternal resource guide that provided mothers with links to community human service agencies would be deemed more helpful by mothers with positive depression screens (PDS) compared with mothers with negative depression screens (NDS).Method: This investigation was a cross-sectional survey study of a convenience sample from a primary care practice–based research network, the Southwestern Ohio Ambulatory Research Network (SOAR-Net). English-speaking mothers who took their child(ren) to SOAR-Net practices were eligible to participate in the study. Data were collected between May 2006 and March 2009. A total of 1048 mothers completed the survey, and 234 mothers refused to participate.Results: Mothers were more likely to report that “This guide is helpful to me” if they were single (odds ratio [OR] = 4.05; 95% confidence interval [CI]: 2.77-5.94), their child had public health insurance (OR = 3.59; 95% CI: 2.39-5.40), or they had PDS (OR = 3.57; 95% CI: 2.13-5.98). After adjusting for a number of demographic variables, PDS continued to be significantly associated with “This guide is helpful to me” (adjusted OR = 2.68; 95% CI: 1.58-4.56).Discussion: Mothers with PDS were more likely to report that the maternal resource guide would be personally helpful compared with mothers with NDS.

Parents’ Perceptions of Their Children's Weight, Eating Habits, and Physical Activities at Home and at School - Corrected Proof

2010-06-10

Abstract: Introduction: Parental perceptions of their young children's weight and habits may play an important role in determining whether children develop and maintain healthy lifestyles. This study was conducted to determine perceptions of parents of third-grade children in an urban school setting regarding their children's weight, eating habits, and physical activities.Methods: Parents anonymously completed surveys about their child's weight, eating habits, and daily activities. The survey also asked about how schools could encourage healthy eating and increased physical activity.Results: Overall, 26% of the parents perceived their child to be overweight and expressed concern, but 40% of these parents believed that overweight is a condition that will be outgrown. Parents who reported eating more than eight meals per week with their child were less likely to report their child as overweight and more likely to believe that their child's physical activity level was appropriate.Discussion: Most parents of third-grade students demonstrated concern regarding their child's weight and perceive obesity as a problem. Parents support school interventions such as nutrition education and fitness classes.

Children's Perceptions of Influenza Illness and Preferences for Influenza Vaccine - Corrected Proof

2010-05-31

Abstract: Introduction: In this qualitative study we explored children's perceptions of influenza, preferences for influenza vaccines, and ability to understand “risk” of vaccine adverse effects and different attributes between injectable and intranasal vaccines.Method: In-person, semi-structured interviews were conducted among 28 U.S. children aged 6 through 12 years.Results: Many children understood the concept of influenza illness and believed vaccination was important. Efficacy, adverse effects, and mode of administration affected their preferences for influenza vaccines. Children 8 years of age and older were able to consider multiple attributes when selecting between hypothetical vaccines, and their responses were consistent with their previously stated preferences for individual attributes. Most children would prefer a nasal spray over a shot vaccine when all other vaccine attributes were equal.Discussion: Efficacy, adverse effects, and mode of administration were important factors in children's preferences for influenza vaccine. Children as young as 8 years of age appeared to understand vaccine “risk” and were able to consider multiple attributes simultaneously when choosing between vaccine alternatives.

Rickets: A Preventable Growth Delay - Corrected Proof

Maureen Kelly LeFevre — 2010-05-17

Jo Ann Serota, MSN, RN, CPNP

Back Pain in Children: A Holistic Approach to Diagnosis and Management - Corrected Proof

Christina Jackson, Kristen McLaughlin, Beverly Teti — 2010-05-10

Abstract: Back pain is a relatively common complaint presenting to the primary care practitioner and is addressed with increasing frequency in the pediatric literature. Back pain is not uncommon in adolescents and often is symptomatic of a relatively benign musculoskeletal etiology. Back pain in children less than 10 years of age and most especially less than 4 years of age can signal a more alarming underlying condition. Evaluation requires a complete history including psychosocial and cultural considerations. Additionally a thorough clinical examination, strategic lab work and judicious imaging are imperative. Management and appropriate referral is specific to the underlying disease process. A holistic, individualized plan of care with inherent involvement of the child and parent/caregiver is essential to ensure safety and enhance outcomes.

A Review of Attachment Theory in the Context of Adolescent Parenting - Corrected Proof

Serena Cherry Flaherty, Lois S. Sadler — 2010-05-04

Abstract: The purpose of this article is to review attachment theory and relate the attachment perspective to adolescent mothers and their children. Attachment theory explains positive maternal-infant attachment as a dyadic relationship between the infant and mother that provides the infant with a secure base from which to explore the world. With respect to cognitive, social, and behavioral domains, securely attached infants tend to have more favorable long-term outcomes, while insecurely attached infants are more likely to have adverse outcomes. Adolescent parenthood can disrupt normal adolescent development, and this disruption influences development of the emotional and cognitive capacities necessary for maternal behaviors that foster secure attachment. However, it appears that if specialized supports are in place to facilitate the process of developing attachment, infants of adolescent mothers can obtain higher rates of secure attachment than normative samples in this population.

Transition of Chronically Ill Youth to Adult Health Care: Experience of Youth With Hemoglobinopathy - Corrected Proof

Rosalind Bryant, Anne Young, Sandra Cesario, Brenda Binder — 2010-05-04

Abstract: Introduction: The purpose of this study was to describe the transition experience, expectations, and concerns of chronically ill youth with hemoglobinopathy (CIYH) (e.g., sickle cell disease) who have transitioned to adult health care.Method: A descriptive phenomenological study was used to explore the transition experience of CIYH through interviews. A purposive sample of 14 CIYH aged 19 to 25 years were recruited from a large southwestern medical center. The Colaizzi method was used to analyze the CIYH's meaning of the transition experience.Results: Themes identified were: Reactions to adult care transition (“I don't want to go”), concerns about transition experience (“What's going to happen to me?”), pushed into transitioning to adult care (“Facing the music”), and transitioned to adult care (“Accepting that I had to leave”).Discussion: The findings revealed CIYH's adjustment process, which may facilitate the design of effective interventions to provide uninterrupted medical care as the CIYH transitions to adult health care.

Adolescent Early Death Perception: Links to Behavioral and Life Outcomes in Young Adulthood - Corrected Proof

2010-05-04

Abstract: Introduction: The purpose of this study was to examine the relationship between changes in adolescent perception of risk for early death over time and behavioral and life outcomes in young adulthood.Methods: This is a secondary data analysis of 7202 respondents participating in waves 1(1995), 2 (1996), and 3 (2001-2002) of the in-home interviews from the National Longitudinal Study of Adolescent Health. Linear and logistic regression models were used to determine the predictive ability of adolescent early death perception at waves 1 and 2 on young adult outcomes of health risk, human capital, and prosocial development, and fitness at wave 3.Results: Nearly one in four youth (23%) expressed perceived risk of premature death at some point in time; 6% of youth persisted in this outlook. Perceived risk of premature death during adolescence was linked to poor health and productivity on multiple levels in young adulthood.Discussion: Adolescent perceived risk for premature death portends poor outcomes in young adulthood. Findings support incorporating screening questions on adolescents' mortality beliefs into psychosocial assessments and interviews.

Growth Hormone Use in Children: Necessary or Designer Therapy? - Corrected Proof

Laurie Anne Ferguson — 2010-04-28

Abstract: Society often rewards the beautiful, the smart, and the intelligent. The possibility that children with idiopathic short stature (ISS) will sustain psychological damage as a result of ridicule from their peers is a concern. The desire for children to become tall adults provides a difficult quandary for parents and caregivers. Growth hormone (GH) treatment in children requires subcutaneous injections six to seven times weekly. The cost of treating with GH can be more than $52,000, and many third-party payers do not cover the cost of GH treatment. Research to date would indicate that while the administration of GH may improve final adult height in children with ISS, children treated with GH will remain short when compared with peers. More research is needed to study whether the administration of GH is beneficial for children with ISS. This article will discuss ISS and the use of GH in children.

Correlates Among Healthy Lifestyle Cognitive Beliefs, Healthy Lifestyle Choices, Social Support, and Healthy Behaviors in Adolescents: Implications for Behavioral Change Strategies and Future Research - Corrected Proof

Stephanie A. Kelly, Bernadette M. Melnyk, Diana L. Jacobson, Judith A. O'Haver — 2010-04-23

Abstract: Introduction: The foundation for healthy lifestyle behaviors begins in childhood. As such, the relationships among cognitive beliefs, healthy lifestyle choices, and healthy lifestyle behaviors in adolescents have been explored. The purpose of this study was to assess the relationships among cognitive variables, social support, and healthy lifestyle behaviors in adolescents.Method: A descriptive correlational design was used for this study. Students from two high schools in the Southwest United States were recruited to participate (N = 404).Results: Significant correlations existed among cognitive variables, social support, behavioral skills, and health lifestyle behaviors.Discussion: This study demonstrated that cognitive beliefs about leading a healthy lifestyle, including attitudes and intended choices, are related to physical activity as well as the intake of fruits and vegetables. In working with adolescents on healthy lifestyle behavior change, it is important to implement strategies to strengthen their cognitive beliefs about their ability to make healthy choices and engage in healthy lifestyle behaviors. Strengthening these beliefs should lessen their perception that these behaviors are difficult to perform, which ultimately should result in healthy behaviors.

Health-related Quality of Life in Children and Adolescents With Sickle Cell Disease - Corrected Proof

2010-04-05

Abstract: Objective: To assess health-related quality of life (HRQOL) in children and adolescents with sickle cell disease (SCD).Design, Setting, and Participants: The PedsQL 4.0 Generic Scales, a multidimensional self-report instrument that has been shown to be valid and reliable for use in children and adolescents with chronic illness, consists of 23 items that assess physical, emotional, social, and school functioning. Questionnaires were administered to 124 children and adolescents (ages 8 to 18 years, child self-report) with SCD (100 sickle cell anemia, 24 sickle β zero thalassemia) and their parents (parent-proxy report). Summary scores for children's and parents' ratings of overall HRQOL and psychosocial health and subscale scores for physical, emotional, social, and school functioning were compared with published data for healthy children. Both summary and subscale scores for children with SCD also were compared with those of their parents.Results: Children with SCD and their parents rated overall HRQOL and all sub-domains of HRQOL lower than did healthy children and their parents (P < .001). Children with SCD rated their own HRQOL significantly better than their parents did for overall HRQOL and all sub-domains (P <.001) except emotional functioning (P = .06).Conclusions: Children with SCD and their parents perceived overall HRQOL and all HRQOL sub-domains to be lower than scores reported in healthy children. Therefore, successful therapeutic efforts to improve HRQOL could represent important advances in the health of children with SCD.

The Birds, the Bees and the HPVs: What Drives Mothers’ Intentions to Use the HPV Vaccination as a Chance to Talk About Sex? - Corrected Proof

2010-04-05

Abstract: Parent-child communication about sex is a way to protect adolescents from engaging in risky behavior. The human papillomavirus vaccine provides mothers with a teachable moment to communicate about sex. This study examines mothers' intentions to talk about sex in conjunction with the vaccination of daughters ages 9 to 15 years, using the Theory of Planned Behavior as a framework. A random sample of mothers was surveyed (N = 217). Findings indicated that mothers' intentions were driven by attitudes, subjective norms, and the age at which they intended to vaccinate. Efforts to encourage vaccination should concentrate on strengthening mothers' attitudes about the value of talking about sex and highlight referent persons who support communication about sex.

Recognizing and Diagnosing Abdominal Migraines - Corrected Proof

Debbie M. Popovich, Denise M. Schentrup, Allison L. McAlhany — 2010-02-05

Abstract: Abdominal migraine affects 1% to 4% of children and is a variant of migraine headaches. Onset is seen most often between the ages of 7 to 12 years, with girls affected more often than boys. Presenting symptoms include acute incapacitating non-colicky periumbilical abdominal pain that lasts for 1 or more hours. Pallor, anorexia, nausea, vomiting, photophobia, or headache may be associated with the episodes, and a family history of migraine headaches often is noted. The diagnostic process begins with a thorough history and physical examination and often follows a series of exclusions or elimination of other organic causes. Limited research exists regarding treatment options, but they may include pharmacologic intervention and prevention based on lifestyle modifications.

Coping Skills Training in a Telephone Health Coaching Program for Youth at Risk for Type 2 Diabetes - Corrected Proof

2010-02-05

Abstract: Introduction: The purpose of this article is to describe components of a health coaching intervention based on coping skills training delivered via telephone. This intervention was provided to urban adolescents at risk for type 2 diabetes mellitus (T2DM), reinforcing a school-based curriculum designed to promote a healthy lifestyle and prevent T2DM.Method: Health coaching via telephone was provided to at-risk urban youth enrolled in a study of an intervention to reduce risk for T2DM. Vignettes are used to describe the use of several coping skills in this high-risk youth population.Results: A variety of vignettes illustrate how telephone health coaching reinforced lifestyle changes in students by incorporating coping skills training.Discussion: Given the benefits and the challenges of the telephone health coaching intervention, several suggestions for others who plan to use a similar method are described.

Adolescents' Perception of Asthma Symptoms and Health Care Utilization - Corrected Proof

Hyekyun Rhee, Michael J. Belyea, & Jill S. Halterman — 2010-02-01

Abstract: Introduction: Pediatric asthma is accountable for a substantial use of health care services. The purpose of this study was to systemically examine the extent to which inaccurate perception of asthma symptoms is associated with the use of health care services.Methods: This exploratory study included 126 adolescents with asthma who were between 13 and 20 years of age. Subjects were classified as having inaccurate symptom perception (IG); well-controlled accurate symptom perception (WCA); and poorly controlled accurate symptom perception (PCA). These groups were compared with respect to health care utilization, including emergency department (ED) visits, hospitalization, and office visits and school absenteeism in the past 3 months.Results: More adolescents in the IG group had at least one hospitalization compared with adolescents in the PCA or WCA groups (23.1% vs. 11.1% vs. 2.6%, respectively). A similar trend was seen for ED visits. Compared with the WCA group, adolescents in the IG group were nearly nine times more likely to have been hospitalized, 3.4 times more likely to have visited an ED, and four times more likely to have missed school days.Discussion: Adolescents with inaccurate symptom perception are more likely to have hospitalizations, ED visits, and missed days from school compared with those who have accurate perceptions. The findings underscore the importance of screening for perceptual accuracy of asthma symptoms and call for interventions promoting accurate symptom assessment in adolescents with asthma to ensure appropriate care.

Development of a Protocol for Transitioning Adolescents With HIV Infection to Adult Care - Corrected Proof

2010-02-01

Abstract: As HIV infection in childhood and adolescence has evolved from a terminal to a chronic illness, new challenges are posed for both medical and psychosocial teams serving these clients. Although specialized programs for transition to adult care have been reported for persons with cystic fibrosis, diabetes mellitus, sickle cell disease, and other chronic illnesses, there are few published reports of integral programs designed to transition adolescents who were infected with HIV during the adolescent period to adult HIV services. This article describes a model of transition from a University-based, federally funded adolescent HIV program to adult HIV services, addresses barriers to transition, and provides strategies and recommendations for improving adherence to the transition process.

Fathers' Coping Mechanisms Related to Parenting a Chronically Ill Child: Implications for Advanced Practice Nurses - Corrected Proof

Brenda Broger, Mary Beth Zeni — 2010-01-29

Abstract: Introduction: The presence of a father has been positively associated with outcomes in several aspects of a child's life. This descriptive study investigated coping methods used by fathers of chronically ill children, fathers' perceived severity of the child's illness, and demographic differences related to coping mechanisms.Method: A sample of 54 fathers of chronically ill children completed measurements of demographics, coping processes, and severity levels of their child's chronic condition. Data were analyzed with SPSS 14.0 using parametric and nonparametric tests to examine relationships and coping behaviors used by fathers in northwest Florida.Results: A majority of fathers used an emotion-focused coping process with a religious dimension. No association was found between perceived level of severity of their child's illness and eight subscales used to measure coping methods; however, statistical significance was found between the age and marital status of fathers with seven of the subscales. Married and older fathers more often used “positive” coping mechanisms than did younger, unmarried fathers.Discussion: The findings emphasize the need for practitioners, clinicians, and educators to assess, support, and provide appropriate resources to fathers in order to promote positive effective coping and increase the level of involvement in the child's life.

Perceptions of Parenting Children With Type 1 Diabetes Diagnosed in Early Childhood - Corrected Proof

Arlene Smaldone, Marilyn D. Ritholz — 2010-01-18

Abstract: Introduction: The purpose of this study was to explore perceptions of psychosocial adaptations in parenting young children with type 1 diabetes (T1DM) from diagnosis through childhood.Method: Fourteen parents of 11 children with T1DM who were diagnosed at age 5 years or younger participated in semi-structured interviews. Data were analyzed using content analysis.Results: Three significant themes were identified. In the theme “Diagnostic Experiences: Frustrations, Fears, and Doubts,” parents described inadequate diagnostic experiences with pediatricians where concerns were minimized and diagnosis was sometimes delayed. Although hospitalization occurred abruptly, communication with specialists was more satisfactory. In the theme “Adapting to Diabetes,” parents described isolation in caring for their child's T1DM. Family and friends had minimal understanding of T1DM care. Support groups lessened mothers' isolation, but fathers were less positive about this experience. Parental adaptation was more effective when responsibility for diabetes decision making was shared. All parents reported never mastering diabetes management. The theme “Negotiating Developmental Transitions” revealed that normative childhood events were stressful, requiring that parents balance concerns to foster their child's participation.Conclusions: Pediatric providers can improve diagnostic and treatment experiences for parents of children with T1DM by recognizing feelings of isolation and lack of mastery, providing attentive communication, encouraging parental teamwork, and offering ongoing anticipatory guidance.

Early Intervention in Pediatrics Offices for Emerging Disruptive Behavior in Toddlers - Corrected Proof

Jannette McMenamy, R. Christopher Sheldrick, Ellen C. Perrin — 2010-01-07

Abstract: Background: This study provides preliminary data about a parenting intervention for families of preschoolers with early attention deficit hyperactivity disorder/oppositional defiant disorder symptoms carried out in two diverse primary care pediatric offices.Method: Parents of toddlers completed behavioral screening questionnaires at well-child visits. Eligible parents participated in a 10-week parenting education group using the Incredible Years program. Mothers completed several outcome measures at three time points: before participating in the group, immediately after the group ended, and 6 months thereafter. These measures assessed changes in parenting practices, parenting stress, and child symptoms. Parent and provider satisfaction also were assessed.Results: Mothers reported improvements in parenting skills and a decrease in stress. They also reported a decrease in child aggression and an increase in compliance. Mothers and providers reported high levels of satisfaction.Conclusions: Results support the benefits and feasibility of providing parenting education groups to parents of toddlers in pediatric practice settings.

Survey of Insulin Site Rotation in Youth With Type 1 Diabetes Mellitus - Corrected Proof

Susana R. Patton, Sally Eder, Jennifer Schwab, Christine M. Sisson — 2010-01-07

Abstract: Objective: Injection site rotation is an important component of insulin administration and is helpful in preventing lipodystrophy in type 1 diabetes (T1DM). We examined the number of injection/infusion sites (sites) used by youth with T1DM and their perceived barriers to using new sites for insulin.Methods: Two hundred and one youth with T1DM completed a 24-item survey about site rotation practices and barriers to site rotation during a routine diabetes appointment.Results: Fifteen percent of youth reported using at least four distinct sites in their rotation plan, while 22% reported using only one site. A negative correlation was found between number of sites used and the number of perceived barriers endorsed by youth on multiple daily injections. Fear of pain was the most common barrier endorsed by youth.Conclusion: Many youth with T1DM may not adhere to an adequate site rotation plan. Regular assessment of insulin sites and counseling regarding adequate site rotation is needed when managing diabetes in youth. Relaxation and distraction may help to reduce youths' fear of pain when rotating to new insulin sites.

Baby Lost and Found: Mothers' Experiences of Infants Who Cry Persistently - Corrected Proof

2009-12-31

Abstract: Introduction: The purpose of this study was to describe mothers' experiences of parenting an irritable infant. Although “colic” is regarded as a “self-limiting” condition that usually disappears by 3 to 4 months of age, the entire family is affected by the infant's crying; no definitive cause or cure has been identified.Method: Sample and setting: Twelve middle-class married mothers (mean age=27.6 years) of irritable infants were interviewed. The women responded to open-ended questions, beginning with a description of the “typical day” with the infant. All interviews were tape recorded, transcribed verbatim, and entered into the AtlasTi qualitative analysis program. Grounded theory methods were used to analyze the data. Transcripts were read repeatedly to verify coding and emerging concepts.Results: The basic social psychological problem was the loss of the perceived baby and competence as a mother. The psychosocial process was the search for the baby and sense of self as mother. Processes involved cycles of hope and despair and trial and error as mothers became more isolated.Discussion: Implications for practitioners include support and listening to mothers during this difficult period.

Child Sexual Abuse: Consequences and Implications - Corrected Proof

Gail Hornor — 2009-08-31

Abstract: Sexual abuse is a problem of epidemic proportions in the United States. Given the sheer numbers of sexually abused children, it is vital for pediatric nurse practitioners to understand both short-term and long-term consequences of sexual abuse. Understanding consequences of sexual abuse can assist the pediatric nurse practitioner in anticipating the physical and mental health needs of patients and also may assist in the identification of sexual abuse victims. Sexual abuse typically does not occur in isolation. Implications for practice will be discussed.