Journal of Pediatric Health Care - Articles in Press

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.

Understanding Certification, Licensure, and Credentialing: A Guide For the New Nurse Practitioner - Corrected Proof

Kristin Hittle — 2010-01-18

The novice pediatric nurse practitioner (PNP) faces daunting tasks upon the completion of graduate education prior to beginning a new PNP position. Understanding the process of PNP certification, licensure, and credentialing often is not well understood at the time of graduation and can cause new practitioners much anguish. The intent of this article is to clarify the concepts and enhance the knowledge of new PNPs who are preparing to take the first steps in their professional career.

In Search of Quality Health Information - Corrected Proof

Jennifer P. D'Auria — 2010-01-18

Jennifer D'Auria, PhD, RN, CPNP

Window Safety Devices - Corrected Proof

Mikki Meadows-Oliver — 2010-01-18

Juanita Conkin Dale, PhD, RN, CPNP-PC

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.

Confidentiality and Access to Adolescent Health Care Services - Corrected Proof

Naomi A. Schapiro — 2010-01-07

Karen G. Duderstadt, PhD, RN, CPNP

The Meaning of Cost for Families of Children With Congenital Heart Disease - Corrected Proof

Jean Anne Connor, Nancy E. Kline, Sandra Mott, Sion Kim Harris, Kathy J. Jenkins — 2010-01-06

Abstract: Introduction: The purpose of this study was to describe the cost burden of congenital heart disease (CHD) and the associated social impact as experienced by families.Method: Qualitative methods were used to collect and interpret data. Semi-structured interviews were conducted with parents of children with various degrees of CHD complexity and socioeconomic status currently admitted for congenital heart surgery at a large tertiary care regional center.Results: The meaning of cost burden as defined by participants resulted in the emergence of two major categories, lifestyle change and uncertainty. Cost was described beyond monetary terms, and as a result, data in each category were further clustered into three underlying subcategories labeled financial, emotional, and family burden. The child's disease complexity and parent's socioeconomic status seem to be linked to higher levels of stress experienced in terms of finances, emotional drain, and family member burden. Prenatal diagnosis was noted to trigger early discussion of financial uncertainty, often resulting in altered personal spending prior to birth.Discussion: The cost experienced by parents of children with complex CHD was described as both life-changing and uncertain. Informing families of these types of additional stressors may allow issues of finances to be considered early in the overall preparation of caring for a child with complex CHD.

Tired From Mowing the Lawn - Corrected Proof

Rosalynn Bravo — 2009-12-31

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

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.

Diagnosing Asthma in Young Children: Current Research & Recommendations - Corrected Proof

Tamar Friedman — 2009-11-09

Abstract: Asthma is the leading pediatric chronic illness in the United States, and there has been a steady increase in the incidence of asthma in children younger than 6 years of age. Early intervention for asthma decreases morbidity, controls health care costs, and may even preserve lung function. Asthma is difficult to diagnose in young children and is under-diagnosed in this population. It is important for primary care nurse practitioners to diagnose asthma in young children in a timely manner so that therapy can be initiated. This article reviews current recommendations for diagnosing asthma in young children and highlights new and promising diagnostic tools for asthma.

Starting HIV-positive Babies on Antiretroviral Treatment: Perspectives of Mothers in Soweto, South Africa - Corrected Proof

Ray Lazarus, Helen Struthers, Avy Violari — 2009-10-26

Abstract: Introduction: Timely and effective initiation of antiretroviral treatment for babies infected with the human immunodeficiency virus (HIV) is critical. Mothers' perspectives on the health care and treatment of their HIV-positive babies could affect how they engage with health care.Method: A convenience sample of HIV-positive mothers was interviewed using qualitative methods. Thematic analysis was used to identify themes significant for participants as well as those relevant to health service provision.Results: These mothers seemed relatively well-informed and positive regarding their baby's care and treatment, but their understanding and practice was influenced by their own experience, observations, and fears, as well as the views of others. Having a baby on antiretroviral treatment improved their own health care motivation, but the daily reminder that it provided of the baby's status and still possible death and the prospect of their own death constituted a heavy emotional burden.Discussion: The study highlights the complexity, ambiguity, and interlocking nature of the mothers' understandings, attitudes, and concerns. This contrasts with the often fairly one-dimensional nature of communication by health care providers and highlights the need to engage more comprehensively with mothers.

A Mentoring Program for the Promotion of Sexual Health Among Korean Adolescents - Corrected Proof

YunHee Shin, Lynn Rew — 2009-10-12

Abstract: The purpose of this pilot study was to develop a mentoring program for the promotion of sexual health among Korean adolescents and to explore the effects of the program. A nonequivalent control group pre-test–post-test design was used. The mentoring intervention was conducted by eight nursing students who participated in the program as mentors using various methods such as formal group sessions and informal individual contacts. At the 12-week post-intervention, the interaction between time and group was statistically significant on both sexual knowledge and sexual attitude of the 17 adolescent mentees. The mentoring program demonstrated potential as a developmentally appropriate intervention for the sexual health promotion of adolescents and promises to enable nursing students to gain confidence in their professional capability.

Parental Anxiety Associated With Kawasaki Disease in Previously Healthy Children - Corrected Proof

2009-09-18

Abstract: Objective: The objective of this study was to explore the lived experience of parents of children diagnosed with Kawasaki disease (KD) and to identify factors associated with increased levels of parental anxiety.Study design: Three focus groups were conducted including 25 parents of 17 patients with KD, seven (41%) of whom had coronary artery complications. A conceptual model was developed to depict parental experiences and illustrate the key issues related to heightened anxiety.Results: Themes identified included anxiety related to the child's sudden illness and delay in obtaining a correct diagnosis because of the lack of health care providers’ awareness and knowledge regarding KD. Parents were frustrated by the lack of information available in lay language and the limited scientific knowledge regarding the long-term consequences of the disease. Parents also reported positive transformations and different perspective toward challenges in life. However, the parents of children with coronary artery complications expressed persistent anxiety even years after the acute phase of the illness due to the uncertainty of the long-term prognosis.Conclusions: There remains a critical need for richly textured research data on the perspective and experience of families of children with KD.

Fathers' Perspectives on Parenting a Child With a Craniofacial Anomaly - Corrected Proof

Tovah P. Klein, Alice W. Pope, Erlene Tan — 2009-09-18

Abstract: Introduction: Although research on healthy children indicates that fathers exert specific and beneficial influences on children's development, there is little research on fathers of children with chronic medical challenges, and none on fathers of children with craniofacial anomalies (CFA). This exploratory study aimed to obtain preliminary information about fathers' experiences of parenting a child with CFA.Method: Structured telephone interviews were conducted with a volunteer sample of nine fathers of children with CFA. Interviews were summarized using percentages of responses for questions using a rating-scale format, and with excerpts of narratives from open-ended questions.Results: Most fathers (90%) felt highly optimistic about their children's potential for happiness and life success, although a smaller percentage also expressed worry (21% a lot; 33% some) and concern (11% a lot; 44% some). All fathers described positive attributes in their children. Fathers tended to support their children's peer relationships through encouraging and organizing activities with friends.Discussion: Fathers' focus on children's effective engagement in the world is consistent with findings on fathering of healthy children. Findings provide hypotheses for future research on fathers' role in the positive development of children with CFA.

Including the Perspective of the Adolescent in Palliative Care Preferences - Corrected Proof

2009-09-14

Abstract: Improving communication with an adolescent with a life-limiting or life-threatening disease is key to providing comprehensive care and support. A pediatric hospital in the Midwest uses a communication tool (CCCT) to facilitate conversations about the adolescent's wishes, beliefs, values, preferences and goals. Information gathered in a CCCT conversation becomes a key intervention to providing compassionate, appropriate care that is directed toward quality of life consistent with the adolescent's and family's goals.

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.

Individual, Interpersonal, & Relationship Factors Predicting Hormonal & Condom Use Consistency Among Adolescent Girls - Corrected Proof

2009-08-07

Abstract: Introduction: Few existing studies have considered influences of adolescents' sexual partners on contraceptive consistency. This study examines the influence of personal characteristics, partner characteristics, and relationship factors on consistency of contraceptive use among an ethnically diverse sample of adolescent girls at high risk for pregnancy and sexually transmitted diseases.Method: Data are from 110 sexually active 13- to 17-year-old girls participating in a clinic-based intervention study aimed at reducing sexual risk behaviors. Personal characteristics were assessed at baseline (T1), and partner and relationship characteristics were assessed at 12 months (T2).Results: Multivariate analyses revealed that T2 hormonal contraceptive consistency was predicted by T1 hormonal consistency, girls' desire to use birth control, having the same sexual partner at T1 and T2, perceived partner support for birth control, and communication with partner about sexual risk. T2 condom use consistency was negatively predicted by emergency contraceptive use history and perceived partner support for birth control.Discussion: Findings underscore the importance of nurses addressing both personal and relationship factors in their efforts to promote consistent contraceptive use among sexually active adolescent girls.

Preliminary Examination of a New Mental Health Screener in a Pediatric Sample - Corrected Proof

Cynthia M. Hartung, Elizabeth K. Lefler — 2009-07-30

Abstract: Introduction: Approximately 80% of children with mental health problems do not receive services. It has been recommended that mental health screening be conducted during pediatric visits (Huffman & Nichols, 2004).Methods: The Primary Care Mental Health Screener (PCMHS) was designed to screen for DSM-IV disorders (APA, 1994) in children. The PCMHS was completed by 328 parents of 3- to 12-year-olds.Results: The long-form showed adequate to excellent internal consistency across three age groups and eight subscales with one exception (depression in preschoolers). Next, data were used to shorten the screener without compromising internal consistency, resulting in a 32-item short-form.Discussion: The long-form of the PCMHS is a promising mental health screener. The internal consistency of the proposed short-form should be examined with a separate sample. Additional research is needed to improve the reliability of the PCMHS for 3- to 5-year-olds and, in general, to examine the validity of this screener.

When Size Matters: A Clinical Review of Pathological Micropenis - Corrected Proof

Shirley Tsang — 2009-07-24

Abstract: Micropenis is a significantly small penis with normal internal male genitalia. Micropenis is usually diagnosed shortly after birth, and the cause should be established; in addition, it should be differentiated from other associated syndromes. The role of the pediatric nurse practitioner is to diagnose the micropenis, guide the parents through the options of management, and support all involved through the selected treatment, whether hormonal or surgical. Patients affected with micropenis will need long-term management from their pediatric nurse practitioners, as well as follow-up by endocrinologists, urologists, pediatric surgeons (if surgery is chosen as the treatment), psychologists, and social workers. The need of more long-term research on patients with micropenis also is discussed.

A Pilot Study Comparing Two Developmental Screening Tools for Use With Homeless Children - Corrected Proof

Sheau-Huey Chiu, Marguerite A. DiMarco — 2009-07-21

Abstract: Homelessness and poverty can present serious health issues for children, including those associated with developmental delays. Early identification and intervention may decrease risk associated with delayed development. Parent-completed measures have been used to help screen for children's development, but little is known about how they may enhance early detection with homeless children. The primary aims of this pilot study were to describe growth and developmental characteristics of homeless children and to compare a parent-completed measure with professionally-conducted developmental screening results. A prospective, comparative study was conducted with 20 homeless mothers and their 21 children. Health professionals used the Denver Developmental Screening Test II, identifying nine children with possible language delay. Mothers completed the Ages and Stages Questionnaires and identified three areas of concern: fine motor (n = 9), communication/language (n = 4), and problem solving (n = 4). The percentage agreement between these two tools was strongest in gross motor (95%) and personal social development (95%) but weakest in language development (67%). While it is essential for all children, developmental screening is particularly crucial for homeless children because of increased risks related to poverty and homelessness. Nurses and nurse practitioners are in a unique position to assess applicability of such instruments and to provide critically needed interventions for these children.

Bruises in Children: Normal or Child Abuse? - Corrected Proof

Tomika S. Harris — 2009-06-29

Abstract: Bruises in active children are common and often are considered “normal” childhood injuries. However, bruises also may be the result of physical abuse or other conditions. The evaluation of a child with bruising should include a thorough history and physical examination to determine the cause. When abuse is suspected, prompt reporting is necessary to protect the child from further injury. This article provides information intended to assist nurse practitioners and other pediatric health care providers in their decision making when assessing a child with bruises.

Identification of Suicide Risk Among Rural Youth: Implications for the Use of HEADSS - Corrected Proof

Virginia Sue Biddle, L. Kathleen Sekula, Rick Zoucha, Kathryn R. Puskar — 2009-06-24

Abstract: Introduction: Nurse practitioners have the power to assess psychosocial risk and detect and prevent suicide, a problem plaguing rural areas of the United States. Suicide risk assessment can be completed using the Home, Education, Activities, Drug use and abuse, Sexual behavior, and Suicidality and depression (HEADSS) interview instrument. The purpose of this study was to determine if HEADSS is appropriate for guiding suicide risk assessment of rural adolescents.Method: High school students in Southwestern Pennsylvania completed qualitative questions from the Child Behavior Checklist and Coping Response Inventory as part of the Intervention to Promote Mental Health in Rural Youth. Qualitative content analysis was performed.Results: Prominent themes identified by participants included academic performance, relationships, dislikes about school, friends, death, mental health, and the future. Several minor themes concerned safety. Most known risk factors for suicide were concerns of participants.Discussion: The expansion of HEADSS to include death and safety should be considered. The modified version—HEADDSSS—can be used to guide suicide risk assessment of youth in rural Pennsylvania, ensuring both thoroughness of assessment and safety.

Strengthening PNP Curricula in Mental/Behavioral Health and Evidence-based Practice - Corrected Proof

2009-05-22

Abstract: Introduction: The incidence of mental health/behavioral and developmental problems in children and teens is escalating. However, many primary care providers report inadequate skills to accurately screen, identify, and manage these problems using an evidence-based approach to care. Additionally, educational programs that prepare pediatric nurse practitioners (PNPs) have been slow to incorporate this content into their curriculums.Methods: The purpose of this project was to implement and evaluate a strengthened curriculum in 20 PNP programs from across the United States that focused on: (a) health promotion strategies for optimal mental/behavioral health and developmental outcomes in children, and (b) screening and evidence-based interventions for these problems. An outcomes evaluation was conducted with faculty and graduating students from the participating programs along with faculty and students from 13 PNP programs who did not participate in the project.Results: Participating schools varied in the speed at which components of the strengthened curriculum were incorporated into their programs. Over the course of the project, faculty from participating programs increased their own knowledge in the targeted areas and reported that their students were better prepared to assess and manage these problems using an evidence-based approach. Although reports of screening for certain problems were higher in the graduating students from the participating schools than the non-participating schools, the overall use of screening tools by students in clinical practice was low.Discussion: There is a need for educational programs to strengthen their curricula and clinical experiences to prepare students to screen for, accurately identify, prevent, and provide early evidence-based interventions for children and teens with mental health/behavioral and developmental problems. This project can serve as a national model for curriculum change.

On Hitting Children: A Review of Corporal Punishment in the United States - Corrected Proof

Michele Knox — 2009-05-22

Abstract: Research has clearly demonstrated associations between corporal punishment of children and maladaptive behavior patterns such as aggression and delinquency. Hitting children is an act of violence and a clear violation of children's human rights. In this article, the position of the United States on corporal punishment of children is discussed. Professional and international progress on ending corporal punishment is explained, and the relationship between corporal punishment and child abuse is discussed. An appeal is made for prevention efforts such as parent education and removal of social sanctions for hitting children that may hold significant promise for preventing child maltreatment.

Socioeconomic Factors and Home Allergen Exposure in Children With Asthma - Corrected Proof

Wendy J. Ungar, Shannon F. Cope, Anita Kozyrskyj, J. Michael Paterson — 2009-05-22

Abstract: Introduction: The objective of this study was to determine the association between sociodemographic factors and the elimination of allergen sources from homes of asthmatic children.Method: In a cross-sectional analysis of data from 845 asthmatic children, multiple linear regression investigated the association between socioeconomic factors and failure to reduce allergen sources (i.e., stuffed toys, pets, carpeting, curtains, and cushions); failure to use linen covers; and not laundering linens weekly in hot water. Logistic regression assessed the relationship between socioeconomic status and exposure to environmental tobacco smoke.Results: Mother's employment status was significantly associated with the quality of the home environment (P = .0002). Homemakers demonstrated fewer poor practices (3.1) compared with full-time or part-time employed mothers (3.6). Children whose mothers reported no post-secondary education were more likely to have environmental tobacco smoke exposure compared with those who had a post-secondary CE education or higher (OR 2.4, 95% CI 1.7, 3.5).Discussion: Children whose mothers worked at home and were better educated were at reduced risk for exposure to sources of indoor allergens.

Role of the Pediatric Nurse Practitioner in Promoting Breastfeeding for Late Preterm Infants in Primary Care Settings - Corrected Proof

Azza H. Ahmed — 2009-05-22

Abstract: The preterm birth rate has been increasing steadily during the past two decades. Up to two thirds of this increase has been attributed to the increasing rate of late preterm births (34 to < 37 gestational weeks). The advantages of breastfeeding for premature infants appear to be even greater than for term infants; however, establishing breastfeeding in late-preterm infants is frequently more problematic. Because of their immaturity, late preterm infants may have less stamina; difficulty with latch, suck, and swallow; temperature instability; increased vulnerability to infection; hyperbilirubinemia, and more respiratory problems than the full-term infant. Late preterm infants usually are treated as full term and discharged within 48 hours of birth, so pediatric nurse practitioners in primary care settings play a critical role in promoting breastfeeding through early assessment and detection of breastfeeding difficulties and by providing anticipatory guidance related to breastfeeding and follow-up. The purpose of this article is to describe the developmental and physiologic immaturity of late preterm infants and to highlight the role of pediatric nurse practitioners in primary care settings in supporting and promoting breastfeeding for late preterm infants.

The Voices of Children: Stories About Hospitalization - Corrected Proof

Margaret E. Wilson, Mary E. Megel, Laura Enenbach, Kimberly L. Carlson — 2009-03-18

Abstract: Introduction: The study explored children's views of hospitalization through their own voices.Method: In this secondary analysis, 93 children aged 5 to 9 years told stories about hospitalization using a set of drawings of children in the hospital. Children were recruited in the hospital and in the community. Themes were identified through qualitative analysis.Results: Children's stories focused on being alone and feeling scared, mad, and sad. These children wanted protection. Children in the stories were not always facing scary events. They were simply not at home and feeling bored, lonely, and sad. They wanted companions. Children displayed awareness of both good and bad outcomes. The hospital was a unique environment that could be fun as well as threatening.Discussion: Children's views of hospitalization were not invariably negative. The themes of hospitalized and never-hospitalized children were different only in degree of detail.

A Normal Ano-Genital Exam: Sexual Abuse or Not? - Corrected Proof

Gail Hornor — 2008-12-19

Abstract: Sexual abuse is a problem of epidemic proportions in the United States. Pediatric nurse practitioners (PNPs) are at the forefront of providing care to children and families. The PNP is in a unique position to educate patients and families regarding sexual abuse and dispel common myths associated with sexual abuse. One such myth is that a normal ano-genital examination is synonymous with the absence of sexual abuse. This article will provide primary care providers, including PNPs, with a framework for understanding why a normal ano-genital examination does not negate the possibility of sexual abuse/assault. Normal ano-genital anatomy, changes that occur with puberty, and physical properties related to the genitalia and anus will be discussed. Photos will provide visualization of both normal variants of the pre-pubertal hymen and genitalia as well as changes that occur with puberty. Implications for practice for PNPs will be discussed.