Academic Pediatrics最新文献

{"title":"From Course to Clinical Practice: A Mixed-Methods Evaluation of a Longitudinal POCUS Curriculum for Community Pediatricians.","authors":"Hadas Katz-Dana, Ayelet Shles, Ortal Erez-Granat, Hadas Yechiam, Dania Takagi, Ehud Rosenbloom, Nir Friedman","doi":"10.1016/j.acap.2026.103445","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103445","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS) is increasingly used in emergency and adult primary care, yet its integration into pediatric community pediatrics remains limited. Barriers include limited training opportunities, insufficient hands-on practice, and inconsistent access to ultrasound devices. This study evaluated self-reported POCUS use, confidence, perceived practice impact, and barriers 12 months after completion of a longitudinal POCUS training program tailored for community pediatricians.</p><p><strong>Methods: </strong>This mixed-methods study included 65 community pediatricians who completed a two-day introductory POCUS course followed by four supervised scanning shifts in a pediatric emergency department. Participants were required to commit to ultrasound device access prior to enrollment. Twelve months after course completion, participants completed an anonymous survey assessing POCUS use frequency, self-reported confidence across 19 applications, perceived clinical impact, and barriers.</p><p><strong>Results: </strong>Fifty-two of 65 pediatricians (80%) completed the 12-month follow-up survey. 23/52 (44%) reported using POCUS at least weekly, while 20/52 (38%) reported rare use. Lung and soft-tissue applications were most used and associated with the highest confidence. Participants reported increased diagnostic confidence (39/52, 75%), improved communication with families (41/52, 79%), and enhanced patient satisfaction (46/52, 88%). 34/52 (65%) perceived reduced reliance on chest radiography and 31/52 (59%) reported faster decision-making. Device availability was strongly associated with ongoing use. Major barriers included limited refresher training, lack of feedback on image quality, and extended visit duration.</p><p><strong>Conclusion: </strong>A longitudinal POCUS curriculum may support meaningful integration of POCUS into community pediatric practice. Reliable device access and ongoing supervised practice are essential for sustaining long-term adoption.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103445"},"PeriodicalIF":2.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change in Travel Distance for Pediatric Mental Health Admissions in Illinois, 2016 to 2024.","authors":"Alexandria Vangelatos, Emily Lynott, Jennifer Hoffmann, Anna M Cushing, Joe Feinglass","doi":"10.1016/j.acap.2026.103450","DOIUrl":"10.1016/j.acap.2026.103450","url":null,"abstract":"<p><strong>Objective: </strong>This study analyzes changes in distance travelled by Illinois youth ages 5-17 between 2016 and 2024 for mental health hospitalizations at Illinois hospitals.</p><p><strong>Methods: </strong>We obtained records for admissions with a mental health principal diagnosis in each year. Patient and hospital zip codes were used to estimate distance. We present bivariate and multivariable analyses of change in distance between years by patient and hospital characteristics.</p><p><strong>Results: </strong>There were 22,516 youth mental health admissions in 2016 to 101 hospitals and 18,316 in 2024 to only 56 hospitals. Hospitalizations of youth who travelled ≥50 miles increased from 15.7% in 2016 to 21.9% in 2024 (p<0.001). Youth who were younger, non-Hispanic White, covered by Medicaid and those from 'downstate' Illinois counties had the longest travel distances. Travel distance ≥50 miles for youth hospitalized for depression increased from 15.4% in 2016 to 23.8% in 2024. As compared to 2016, the adjusted odds of youth having to travel more than 50 or 100 miles in 2024 were 1.76 (95% CI=1.36-2.28) and 2.05 (95%CI=1.30-3.24) respectively.</p><p><strong>Discussion: </strong>By 2024, more than one in five children traveled ≥50 miles and one in ten traveled ≥100 miles to access mental health hospital care. The odds of travel ≥100 miles more than doubled between 2016 and 2024. The increase in travel distance appears to be related to a large reduction in admissions to community hospitals with a small number of 2016 admissions, with a corresponding trend towards hospitalizations at a small number of specialty behavioral health hospitals.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103450"},"PeriodicalIF":2.8,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What We Are Watching For.","authors":"Alexandra Kilinsky","doi":"10.1016/j.acap.2026.103441","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103441","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103441"},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DIAGNOSING THE TRAINEE IN DIFFICULTY.","authors":"Andrew Arndt, Gabrielle Berger","doi":"10.1016/j.acap.2026.103440","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103440","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103440"},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing the Science of School Readiness - New Evidence and Evolving Frameworks.","authors":"Reem M Ghandour, Ashley H Hirai, Katherine Paschall, Kristin A Moore","doi":"10.1016/j.acap.2026.103449","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103449","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103449"},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Do I Need Help?\": A Qualitative Study of Interns on a Pediatrics Night Float Rotation.","authors":"Beth Links Torwekar, Megan Durham, Gayatri Boddupalli Madduri, Margaret Robinson, Judith L Bowen","doi":"10.1016/j.acap.2026.103448","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103448","url":null,"abstract":"<p><strong>Objective: </strong>Nighttime clinical work comprises a substantial portion of inpatient training, yet interns often make decisions without supervisors physically present and must actively initiate requests for input. How interns decide to seek support from attendings is not well understood. We aimed to explore interns' help-seeking behaviors from attendings during clinical decision-making at night.</p><p><strong>Methods: </strong>Twelve pediatric and family medicine interns participated in semi-structured interviews and shared 19 stories about help-seeking during nighttime clinical encounters at a tertiary children's hospital between February 2020 and August 2021. The research team analyzed the narratives using an inductive approach. Vygotsky's Zone of Proximal Development served as a conceptual lens to explore moments when learners recognized the limits of their independent decision-making.</p><p><strong>Results: </strong>Three patterns of help-seeking behavior were identified along a continuum: (1) \"I need help now,\" (2) \"Do I need help?\" and (3) \"I should wait to get help.\" Interns sought help earlier when patient acuity was higher or when they felt less certain in their clinical decision-making. In contrast, reluctance to wake attendings and a desire to preserve opportunities for independence often delayed help-seeking.</p><p><strong>Conclusions: </strong>Interns' help-seeking behavior is a fluid, relational process shaped by the unique structural, cultural, and interpersonal dynamics of the overnight environment. Future faculty development should emphasize normalizing help-seeking to promote learning in this clinical setting.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103448"},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatrician Preparedness and Referrals to Resources for Children in Immigrant Families.","authors":"Julia Rosenberg, William H Burr, Chloe A Somberg, William L Cull, Karla Fredricks","doi":"10.1016/j.acap.2026.103447","DOIUrl":"10.1016/j.acap.2026.103447","url":null,"abstract":"<p><strong>Objective: </strong>To identify characteristics associated with (1) pediatrician preparedness to provide care for children in immigrant families (CIF) and (2) referrals to resources for health-related social needs (HRSNs).</p><p><strong>Methods: </strong>We analyzed the 2023 American Academy of Pediatrics Periodic Survey to assess association of pediatrician and practice characteristics with (1) preparedness to care for CIF and (2) referrals for six types of HRSNs (social services, federal/state programs, early childhood development, health insurance, legal/immigration-related services, adult English language programs). After bivariate analyses identified significant modifiable practice characteristics, we conducted multivariable analyses to determine associations with: (1) pediatrician preparedness, (2) providing referrals for HRSNs, and (3) individual types of referrals.</p><p><strong>Results: </strong>Of 488 respondents (response rate 33%), only 49% reported feeling moderately/very prepared to care for CIF, despite having 26% CIF (on average) in their practices. Modifiable practice factors were: offering written materials in the patient's primary language, hiring bilingual/multilingual staff, having professional interpreters, and having care coordination. Factors associated with higher number of referral types were: written materials in primary language (estimated marginal mean referrals 2.94 vs 2.07, p<0.001), bilingual/multilingual staff (3.04 vs 2.46, p<0.001) and care coordination (2.85 vs 2.40, p<0.01). Modifiable characteristics were also independently associated with specific referrals, particularly to federal/state programs and social services. Factors associated with improved pediatrician preparedness were bilingual/multilingual staff [aOR 1.92 (95%CI 1.17,3.17)] and care coordination [aOR 1.89 (95%CI 1.10,3.23)].</p><p><strong>Conclusions: </strong>Ensuring adequate linguistic support and dedicated care coordination may strengthen pediatrician preparedness, facilitate HRSN referrals and, ultimately, improve quality of care for CIF.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103447"},"PeriodicalIF":2.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An ACEs Life Course Health Development Framework to Guide Prevention and Mitigation.","authors":"Jane Kinsey, Shirley Ann Russ, Adam Schickedanz, Neal Halfon","doi":"10.1016/j.acap.2026.103444","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103444","url":null,"abstract":"<p><p>Prevention of Adverse Childhood Experiences (ACEs) and mitigation of their impacts on lifelong health and wellbeing are public health priorities. Current prevention and mitigation efforts lack a comprehensive, actionable and widely adopted conceptual framework to guide research, policy and practice. To address this shortcoming we propose an ACEs Life Course Health Development (ACEs LCHD) framework that integrates Bronfenbrenner's Bioecological Model, the Family Stress Model, the Stress Continuum and other relational development theories. A life course framework is especially pertinent because it explains and specifies mechanisms linking early life adversity and later life physical and mental health challenges. It incorporates intergenerational and historic cultural factors including parents' own life histories that can play a powerful role in either perpetuating and compounding or resisting adversity. It demonstrates how ACEs occur in the context of developmental ecosystems - multi-layered family, community and societal milieu in which children live, learn, play and grow. Strengths and vulnerabilities in each level of these ecosystems across the life course can either buffer or amplify the effects of adversity. Unlike previous ACEs or trauma informed frameworks, the ACEs LCHD framework unites developmental timing, intergenerational influences and ecological context within one integrative systems approach. It points to four action-step priorities: (1) Create developmental ecosystems maps and apply a complex systems science approach to their analysis; (2) Address root causes and mitigate the impact of ACEs on health development trajectories; (3) Identify and act on leverage points; and (4) Enable collaborative action. Child health providers cannot do all this alone but can contribute to local cross-sector coalitions to co-develop interdisciplinary multi-level action, advocate for trauma informed practice and connect children and families to evidence-based interventions to prevent and mitigate ACEs.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103444"},"PeriodicalIF":2.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Common and costly conditions among children in United States Emergency Departments.","authors":"Sriram Ramgopal, Chris A Rees, Alexandra T Geanacopoulos, Daniel J Shapiro, Kelly R Bergmann, Elizabeth M Keating, Frank Gonzalez, Mohamed Eltorki, Pradip P Chaudhari, Timothy T Phamduy, Oluwakemi Badaki-Makun, Mark I Neuman","doi":"10.1016/j.acap.2026.103442","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103442","url":null,"abstract":"<p><strong>Objectives: </strong>To identify the most common and costly diagnoses among children presenting to US emergency departments (EDs) and to assess whether the distribution of these diagnoses and the associated resource utilization, including costs, vary according to hospital type.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional study of children (<18 years) using the 2023 Nationwide Emergency Department Sample. We categorized the principal diagnoses using the Diagnosis Grouping System. We estimated costs by applying hospital-specific cost-to-charge ratios to ED charges. We identified the most common and costly DGS subgroups, overall and by hospital urbanicity and teaching status.</p><p><strong>Results: </strong>We identified 23,956,458 encounters. Most children were seen at metropolitan teaching EDs (55.6%), with smaller percentages seen at pediatric EDs (14.8%), metropolitan non-teaching EDs (14.8%), and non-metropolitan EDs (14.9%). The most common diagnosis subgroups were viral illnesses (6.6%), infectious nose and sinus disorders (6.5%), infectious respiratory diseases (6.2%), lacerations, amputations, and uninfected foreign bodies (5.3%), and infectious mouth and throat disorders (5.2%). Pediatric EDs encountered relatively more medical conditions, whereas non-metropolitan and metropolitan non-teaching hospitals had higher rankings for infectious mouth and throat disorders, strains and sprains, and abdominal pain. Total care costs were $10.4B. Costliest conditions were infectious respiratory diseases ($0.6B), fractures and dislocations ($0.6B), viral illnesses ($0.6B), abdominal pain ($0.5B), and psychiatric and behavioral diseases ($0.5B).</p><p><strong>Conclusion: </strong>Common and costly pediatric ED diagnoses are dominated by infectious and respiratory conditions, with variation in case mix and resource utilization across hospital types. These findings have implications for pediatric readiness and low-value care initiatives.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103442"},"PeriodicalIF":2.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Childhood Medicaid Pays for Itself: The Lifelong and Intergenerational Returns of Early Coverage.","authors":"Janet Currie, Zia Kinzy, Anna Malinovskaya","doi":"10.1016/j.acap.2026.103426","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103426","url":null,"abstract":"<p><p>We review recent evidence on longer-term effects of Medicaid coverage during the prenatal period and in childhood and ask whether the benefits of these investments outweigh their costs. Included studies were published since 2015, follow cohorts for at least 10 years, and estimate the impacts of prenatal or childhood Medicaid eligibility on adult health, mortality, education, income, crime, and/or intergenerational outcomes. Reported effects are standardized to percent changes per additional year of eligibility and are incorporated into a Marginal Value of Public Funds (MVPF) framework to compare benefits with government costs. Greater Medicaid eligibility in utero and during childhood is consistently associated with lower rates of adult disability, chronic disease, hospitalizations, and mortality. Benefits extend beyond health to higher educational attainment, improved employment and earnings in adulthood, and reduced criminal involvement. Emerging evidence also points to intergenerational gains, with improved birth outcomes in the next generation. The longer-term reductions in public spending attributable to the effects of Medicaid on improved health and economic outcomes exceed the direct cost of expanded eligibility. Hence, prenatal and childhood Medicaid \"pays for itself\" by generating additional benefits for individuals and society. Overall, early-life Medicaid coverage generates durable improvements in longevity, health, human capital, and economic productivity while reducing crime and intergenerational disadvantage. These findings underscore Medicaid's role as both a public health investment and a fiscal bargain. Planned Medicaid cutbacks risk reversing decades of progress and will likely impose significant financial and social costs.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103426"},"PeriodicalIF":2.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}