PEDIATRICS recent issues

Abusive Head Trauma in Day Care Centers

BACKGROUND:

Abusive head trauma (AHT) warrants particular attention in terms of prevention. One of the key questions asked is how often AHT occurs in infant day care centers compared with private parental or nonparental homes. To investigate this, we studied the caretaking arrangement and child’s location at the time of injury in a cohort of cases involving AHT from the courts.

METHODS:

This multicenter retrospective study covering an 18-year period included all medical and court records of 323 children (2.5 months to 3 years) with AHT, confirmed by the authors acting as medical experts. All markers for abuse and forensic written reports were analyzed by using a standardized data collection tool. The usual child care arrangement and the child’s location at the time of injury were noted. The percentage of day care centers found in the study was compared to the expected rate in the French population (19.5%) by using the 2 test.

RESULTS:

In 317 AHT cases (98.5%), the assault occurred in a private home (4 in other indoor settings and 1 with missing data). In only 1 case, shaking occurred in a day care center when the nurse was alone with the infant for a few minutes. In 317 cases (98.5%), the usual child care arrangement was by a single adult in charge of 1 or more children.

CONCLUSIONS:

The fact that AHT is an unusual occurrence in day care centers could help social service agencies make decisions in terms of prevention. Recent government policies regarding stay-at-home orders during a pandemic have given this issue new relevance.

The Intertwined Histories of Resident Education and Pediatric Hospital Medicine in the US

The histories of pediatric resident education and pediatric hospital medicine (PHM) are intertwined. PHM, now a new subspecialty, is generally considered to have emerged from the hospitalist movement in the late 1990s but is actually what some influential pediatricians in the 19th century envisioned for pediatrics in the United States, comparable to the British model. The prime focus of resident education during the 20th century remained hospital care, even during the years of national concern regarding the need for more primary care physicians. Various changes in resident education have contributed to the rise of PHM as a subspecialty. Requirements for subspecialty certification in PHM have implications for general residency training in pediatrics.

Quantitative SARS-CoV-2 Serology in Children With Multisystem Inflammatory Syndrome (MIS-C)

OBJECTIVES:

We aimed to measure severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological responses in children hospitalized with multisystem inflammatory syndrome in children (MIS-C) compared with those with coronavirus disease 2019 (COVID-19), those with Kawasaki disease (KD), and hospitalized pediatric controls.

METHODS:

From March 17, 2020, to May 26, 2020, we prospectively identified hospitalized children with MIS-C (n = 10), symptomatic COVID-19 (n = 10), and KD (n = 5) and hospitalized controls (n = 4) at Children’s Healthcare of Atlanta. With institutional review board approval, we obtained prospective and residual blood samples from these children and measured SARS-CoV-2 spike receptor-binding domain (RBD) immunoglobulin M and immunoglobulin G (IgG), full-length spike IgG, and nucleocapsid protein antibodies using quantitative enzyme-linked immunosorbent assays and SARS-CoV-2 neutralizing antibodies using live-virus focus-reduction neutralization assays. We statistically compared the log-transformed antibody titers among groups and performed linear regression analyses.

RESULTS:

All children with MIS-C had high titers of SARS-CoV-2 RBD IgG antibodies, which correlated with full-length spike IgG antibodies (R2 = 0.956; P < .001), nucleocapsid protein antibodies (R2 = 0.846; P < .001), and neutralizing antibodies (R2 = 0.667; P < .001). Children with MIS-C had significantly higher SARS-CoV-2 RBD IgG antibody titers (geometric mean titer 6800; 95% confidence interval 3495–13 231) than children with COVID-19 (geometric mean titer 626; 95% confidence interval 251–1563; P < .001), children with KD (geometric mean titer 124; 95% confidence interval 91–170; P < .001), and hospitalized controls (geometric mean titer 85; P < .001). All children with MIS-C also had detectable RBD immunoglobulin M antibodies, indicating recent SARS-CoV-2 infection. RBD IgG titers correlated with the erythrocyte sedimentation rate (R2 = 0.512; P < .046) and with hospital (R2 = 0.548; P = .014) and ICU lengths of stay (R2 = 0.590; P = .010).

CONCLUSIONS:

Quantitative SARS-CoV-2 serology may have a role in establishing the diagnosis of MIS-C, distinguishing it from similar clinical entities, and stratifying risk for adverse outcomes.

COVID-19 and Parent Intention to Vaccinate Their Children Against Influenza

OBJECTIVES:

Evaluate if the coronavirus disease 2019 (COVID-19) pandemic influences parents’ intentions to have their children receive the 2020–2021 seasonal influenza vaccination.

METHODS:

In May 2020, we recruited 2164 US parents and guardians of children ages 6 months to 5 years to complete a brief online survey that examined parental behavior and decision-making in response to experimental stimuli and real-world events. We estimated a multivariate multinomial logistic regression (controlling for key demographics) to assess the relationship between a child’s 2019–2020 influenza vaccination status and the COVID-19 pandemic’s influence on a parent’s intentions for their child’s 2020–2021 influenza vaccination.

RESULTS:

Changes in vaccination intentions significantly differed between parents whose children received the 2019–2020 influenza vaccine compared with those whose children did not (P < .001). Specifically, among parents whose children did not receive the 2019–2020 vaccine, 34% (95% confidence interval [CI]: 30%–37%) reported that the COVID-19 pandemic made them less likely to have their child receive the 2020–2021 vaccine. Among those whose children did receive the 2019–2020 vaccine, this figure was just 24% (95% CI: 22%–27%). Conversely, only 21% (95% CI: 18%–24%) of parents whose children did not receive the 2019–2020 vaccine reported that the COVID-19 pandemic made them more likely to have their child receive the 2020–2021 vaccine, compared with 39% (95% CI: 36%–41%) of parents whose children did receive the 2019–2020 vaccine.

CONCLUSIONS:

The COVID-19 pandemic alone does not appear sufficient to encourage the uptake of pediatric seasonal influenza vaccination. Instead, the COVID-19 pandemic may exacerbate polarity in vaccination uptake.

Pediatrician Guidance in Supporting Families of Children Who Are Adopted, Fostered, or in Kinship Care

The child welfare system strives to provide children and adolescents in foster care with a safe, nurturing environment through kinship and nonkinship foster care placement with the goal of either reunification with birth parents or adoption. Pediatricians can support families who care for children and adolescents who are fostered and adopted while attending to children’s medical needs and helping each child attain their developmental potential. Although this report primarily focuses on children in the US child welfare system, private and internationally adopted children often have similar needs.

Fluoride Use in Caries Prevention in the Primary Care Setting

Dental caries remains the most common chronic disease of childhood in the United States. Caries is a largely preventable condition, and fluoride has proven effectiveness in caries prevention. This clinical report aims to clarify the use of available fluoride modalities for caries prevention in the primary care setting and to assist pediatricians in using fluoride to achieve maximum protection against dental caries, while minimizing the likelihood of enamel fluorosis. Fluoride varnish application is now considered the standard of care in pediatric primary care. This report highlights administration, billing, and payment information regarding the fluoride varnish procedure.

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