PediatricsPub Date : 2024-10-21DOI: 10.1542/peds.2024-068955
Gina M Geis,Barbara S Saunders,Paula Hillard,,
{"title":"Examining Permanent Contraception for Children, Adolescents, and Young Adults With Intellectual Developmental Disorder: Ethical, Legal, and Medical Considerations: Clinical Report.","authors":"Gina M Geis,Barbara S Saunders,Paula Hillard,,","doi":"10.1542/peds.2024-068955","DOIUrl":"https://doi.org/10.1542/peds.2024-068955","url":null,"abstract":"There have been significant advances in the medical and surgical options available for contraception and management of menses for individuals, including those with intellectual developmental disorder. This new statement frames the ethical, legal, and medical issues of permanent contraception in children, adolescents, and young adults with intellectual developmental disorder, emphasizing the importance of utilizing long-acting reversible and minimally invasive treatments, whenever possible. The historical use and abuse of permanent contraception is briefly reviewed, providing the foundation for ongoing ethical and legal considerations, including issues of informed consent. The authors then discuss medical decision-making and patient preferences that should be considered and make recommendations to providers who are contemplating permanent contraception therapies in this population.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"67 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PediatricsPub Date : 2024-10-21DOI: 10.1542/peds.2024-068956
Greg Canty,Jennifer King,
{"title":"Safety in Cheerleading: Epidemiology and Recommendations: Policy Statement.","authors":"Greg Canty,Jennifer King,","doi":"10.1542/peds.2024-068956","DOIUrl":"https://doi.org/10.1542/peds.2024-068956","url":null,"abstract":"Participation in cheerleading has continued to increase over the last decade, and the sport has evolved to require a higher level of athleticism. More than 3.5 million youth currently participate, with the vast majority being females between the ages of 6 and 17 years. Cheer occurs in both scholastic and nonscholastic settings; participants may perform to support other interscholastic teams or engage in competitions to showcase their skills against other squads. With the increased athletic demands of the sport and the year-round nature of competition, the number of injuries, including concussions, has risen. The overall injury rate for cheer is fairly low, but average time away from sport after injury is lengthy suggesting injuries can be severe. This policy statement reviews the epidemiology of cheerleading injuries and offers recommendations on how to improve the safety of cheerleading for all youth.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"33 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PediatricsPub Date : 2024-10-18DOI: 10.1542/peds.2023-064838
Charles V Golden,Raymen R Assaf,Ricardo Aguilar,Tatiana Moreno,Heather Huszti,Michelle Fortier,Theodore Heyming,Uma Rao,Louis Ehwerhemuepha,Michael Weiss
{"title":"Age, Adverse Childhood Experiences, and Health Care Utilization.","authors":"Charles V Golden,Raymen R Assaf,Ricardo Aguilar,Tatiana Moreno,Heather Huszti,Michelle Fortier,Theodore Heyming,Uma Rao,Louis Ehwerhemuepha,Michael Weiss","doi":"10.1542/peds.2023-064838","DOIUrl":"https://doi.org/10.1542/peds.2023-064838","url":null,"abstract":"OBJECTIVESTo assess whether the association of adverse childhood experiences (ACEs) with pediatric health care utilization differs by age.METHODSIn this retrospective cohort study, we included patients completing primary care ACEs screening between January 2020 and September 2021. Pediatric ACEs and Related Life Events Screener Part 1 scores were categorized 0, 1 to 3, or ≥4 (none, low, and high, respectively). Two multivariable logistic regression models assessed emergency department (ED) and inpatient utilization across all ages 6 months after screening.RESULTSAmong 37 315 patients, 15.7% visited the ED and 2.5% were hospitalized within 6 months of ACEs screening. Using no ACEs as the reference, infants and toddlers with any ACEs had lower odds of ED and inpatient utilization, whereas older children with any ACEs had higher odds of ED (age-low ACEs: 0.04, P value < .001; age-high ACEs: 0.08, P value < .001) and inpatient (age-low ACEs: 0.06, P value < .001; age-high ACEs: 0.15, P value < .001) utilization and increased each successive year of age.CONCLUSIONSThe association of ACEs with health care utilization is dependent on age and is more complex than previously described. These trends may inform specific therapeutic strategies for pediatric patients by age.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"3 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PediatricsPub Date : 2024-10-17DOI: 10.1542/peds.2024-067248
Ajibike Lapite
{"title":"Cancer, Consents, and Chaos: Navigating Health Literacy at the Time of a New Oncology Diagnosis.","authors":"Ajibike Lapite","doi":"10.1542/peds.2024-067248","DOIUrl":"https://doi.org/10.1542/peds.2024-067248","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"78 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PediatricsPub Date : 2024-10-17DOI: 10.1542/peds.2024-066180
Amy E Caruso Brown,Laura M Beskow,Daniel J Benedetti
{"title":"Legal Involvement in Pediatric Cancer Treatment Refusal: A Qualitative Study.","authors":"Amy E Caruso Brown,Laura M Beskow,Daniel J Benedetti","doi":"10.1542/peds.2024-066180","DOIUrl":"https://doi.org/10.1542/peds.2024-066180","url":null,"abstract":"OBJECTIVESTo characterize the spectrum of legal options considered in cases of treatment refusal, nonadherence, and abandonment (TRNA); clinicians' thought processes regarding legal intervention; and perceived consequences of legal involvement.METHODSWe conducted in-depth, semistructured interviews with 30 pediatric oncologists between May and September of 2019 regarding experiences with TRNA. The interview guide covered types of conflicts encountered; factors and strategies considered in response; effects of TRNA cases, personally and professionally; the role of ethical frameworks and legal requirements; and resources needed to manage TRNA cases. Interviews were transcribed and coded iteratively using thematic analysis.RESULTSParticipants represented a range of institutional sizes, geographic locations, and years in practice. Twenty-five of 30 interviewees discussed legal consideration with regard to TRNA. Most participants first engaged the legal system through child protective service agencies. They considered patient age, treatment efficacy, quality of life (burden of treatment), and prognosis; family resources and social context; and preservation of therapeutic relationships and possible consequences of reporting. Experiences and outcomes of legal involvement varied.CONCLUSIONSClinicians struggle with the tension between obligations to report medical neglect and fears that reporting may result in more harm than benefit to the child in question. We urgently need more dialog between health care professionals and child protective services and legal professionals. Stakeholders from both groups would benefit from a greater understanding of the other's thought processes; clarity regarding the relevant facts; and mutual progress toward creative, evidence-based solutions to working out these complex challenges.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"29 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PediatricsPub Date : 2024-10-16DOI: 10.1542/peds.2024-067195
Anne M Roux,Kyle Chvasta,Kiley J McLean,Meghan Carey,Georgina Perez Liz,Liza Tomczuk,Kristina Lopez,Evva Assing-Murray,Paul T Shattuck,Lindsay L Shea
{"title":"Challenges and Opportunities in Transitioning Autistic Individuals Into Adulthood.","authors":"Anne M Roux,Kyle Chvasta,Kiley J McLean,Meghan Carey,Georgina Perez Liz,Liza Tomczuk,Kristina Lopez,Evva Assing-Murray,Paul T Shattuck,Lindsay L Shea","doi":"10.1542/peds.2024-067195","DOIUrl":"https://doi.org/10.1542/peds.2024-067195","url":null,"abstract":"BACKGROUND AND OBJECTIVESApproximately 1.2 million autistic youth will reach the legal age of adulthood over the next decade. Given dynamic changes in the socioecological context of the transition to adulthood, we produced an updated transitions research agenda reflecting the perspectives of autistic young adults, care partners (parents), and professionals who use autism research.METHODSWe conducted 9 focus groups: 4 young adult, 4 care partner, and 1 professional, with 59 total participants. Young adults were grouped by self-reported identity: (1) racial and ethnic minority, (2) lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other identities, and (3) nonspeaking, in addition to a general group. We selected care partners who supported youth with varying intensity of support needs. We used rapid qualitative inquiry methods to extract key points from answers to semistructured interview questions.RESULTSDelays in diagnosis and transition processes, and placement on wait lists resulted in significant obstacles to successful transitions. Parents assumed a dominant role by coordinating services, navigating systems and identifying opportunities for community participation, and providing direct supports. There was an overarching need for inclusion of autistic people in transitions research and consideration of cultural differences in priorities and values. Participants prioritized investigation of variation in transitions among autistic youth with intersecting identities, navigation support (eg, peer mentors), efficacy of services and supports (eg, transition and employment services), differences in available services by location, and problems within specific benefits programs.CONCLUSIONSResearch should focus on understanding population-level factors of system performance on outcomes and support needs, service delivery among marginalized groups, and transformation of complex service ecosystems.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"155 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PediatricsPub Date : 2024-10-16DOI: 10.1542/peds.2024-066717
Beth Wueste,Tatiana Ndjatou,Weichen Ling,Abena Knight,Ana Clara Mauro,Molly Rideout,Sybil Pentsil
{"title":"Mapping Futures: Early Access to Mentorship Programs in Science and Medicine.","authors":"Beth Wueste,Tatiana Ndjatou,Weichen Ling,Abena Knight,Ana Clara Mauro,Molly Rideout,Sybil Pentsil","doi":"10.1542/peds.2024-066717","DOIUrl":"https://doi.org/10.1542/peds.2024-066717","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"74 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PediatricsPub Date : 2024-10-15DOI: 10.1542/peds.2024-068359
Elisha M Wachman,Hayley Friedman
{"title":"Is Now the Time for Clonidine as a First-Line Agent for Neonatal Opioid Withdrawal Syndrome?","authors":"Elisha M Wachman,Hayley Friedman","doi":"10.1542/peds.2024-068359","DOIUrl":"https://doi.org/10.1542/peds.2024-068359","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"17 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PediatricsPub Date : 2024-10-15DOI: 10.1542/peds.2023-065610
Henrietta S Bada,Philip M Westgate,Thitinart Sithisarn,Kimberly Yolton,Richard Charnigo,Massroor Pourcyrous,Fei Tang,Julia Gibson,Jennifer Shearer-Miller,Peter Giannone,Markos Leggas
{"title":"Clonidine as Monotherapy for Neonatal Opioid Withdrawal Syndrome: A Randomized Trial.","authors":"Henrietta S Bada,Philip M Westgate,Thitinart Sithisarn,Kimberly Yolton,Richard Charnigo,Massroor Pourcyrous,Fei Tang,Julia Gibson,Jennifer Shearer-Miller,Peter Giannone,Markos Leggas","doi":"10.1542/peds.2023-065610","DOIUrl":"https://doi.org/10.1542/peds.2023-065610","url":null,"abstract":"OBJECTIVEWe sought to determine whether clonidine, a non-opioid α-2-adrenergic agonist, would effectively treat neonatal opioid withdrawal syndrome (NOWS).METHODSThis was an intention-to-treat randomized clinical trial. Enrollment criteria included prenatal opioid exposure, age ≤7 days, gestational age ≥35 weeks, no other medical condition, and need for pharmacotherapy. Primary outcomes were length of treatment and neurobehavioral performance.RESULTSA total of 1107 patients were screened for enrollment (645 ineligible, 91 parents or staff unavailable, 216 declined, 155 consented). Of 155 infants, 120 required treatment and were randomized to receive oral clonidine (n = 60) at 1 µg/kg/dose or morphine (n = 60), 0.06 mg/kg/dose, every 3 hours. Infants with no improvement had their doses increased by 25% of the initial dose every 12 to 24 hours. Those without improvement by the fourth dose increase, received adjunct therapy. Length of treatment did not differ between morphine and clonidine, with median (95% confidence interval [CI]) days, respectively, of 15 (13-17) and 17 (15-19), P = .48. More clonidine-treated infants (45%) needed adjunct therapy versus 10% in the morphine group, adjusted odds ratio (95% CI) = 8.85 (2.87-27.31). After treatment completion, the NICU Network Neurobehavioral Scales summary scores did not differ between clonidine-treated and morphine-treated infants.CONCLUSIONSLength of pharmacologic treatment and final neurobehavioral performance were not significantly different between the clonidine- and morphine-treated groups. Clonidine appears to be an effective non-opioid medication to treat NOWS. Future studies are needed to determine the optimal clonidine dosage for a quicker response and obviation of adjunct therapy.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"13 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}