Weight change in the first 30 days among infants born less than 2000 grams in Guinea-Bissau and Uganda.

Despite the high prevalence of low birth weight infants in sub-Saharan Africa and the associated poor outcomes, weight change during the newborn period has not been well characterized for this population. We prospectively assessed growth over the first 30 days among 120 infants born < 2000 g (g) in Guinea-Bissau and Uganda, and compared it to a similar cohort of 420 infants born ≥ 2000 g. Among those born < 2000 g, mean birth weight was 1747 ± 164 g, and initial weight loss was 8.25 ± 4.40% of birth weight prior to the initiation of weight gain at a median of 3 (interquartile range 2, 4) days of age. This initial weight loss was more pronounced (8.25 vs 6.06%; p < 0.001) and lasted longer (median 3 vs 2 days; p < 0.001) than for infants born ≥ 2000 g. The initial period of weight loss was an important predictor of growth at 30 days in both cohorts. Infants born < 2000 g on average grew proportionately to their size at birth but did not experience catch-up growth; their weights at 30 days remained much lower than that of infants born ≥ 2000 g and most remained severely underweight. Targeted interventions to optimize early growth should be investigated.

Motor Impairment Referrals to an International Child Development Clinic: It is Not Always Cerebral Palsy.

BACKGROUND: The majority of the estimated 50 to 100 million children living with disability worldwide reside in low- or middle-income countries. As families migrate to avoid humanitarian crises, children with developmental disability and delay warrant particular attention in refugee and international health settings. During transitions, medical documentation may be lost and diagnoses may not be fully understood, contributing to the challenges of determining etiologies of motor impairment. METHODS: Of the first 100 refugee children who were referred to the Child Development Clinic, we identified a subset of children referred for motor impairment or cerebral palsy. Data on their presentation, diagnoses following evaluation, and therapeutic services required was collected by retrospective chart review. RESULTS: Twenty children were referred for motor impairment and cerebral palsy. Average age was 8.9 years; 45% were female. Eight children were eventually diagnosed with cerebral palsy, and 12 had alternate or inconclusive diagnoses. Microcephaly was more common in children diagnosed with cerebral palsy. CONCLUSIONS: The frequent differences between referral and final diagnoses in refugee children referred for cerebral palsy highlights the need for pediatricians' careful examination and diagnostic reasoning upon initial presentation.

Psychometrics of psychosocial behavior items under age 6 years: Evidence from Nebraska, USA.

Because healthy psychosocial development in the first years of life is critical to lifelong well-being, governmental, and nongovernmental organizations are increasingly interested in monitoring psychosocial behaviors among populations of children. In response, the World Health Organization is developing the Global Scales of Early Development Psychosocial Form (GSED PF) to facilitate population-level psychosocial monitoring. Once validated, the GSED PF will be an open-access, caregiver-reported measure of children's psychosocial behaviors that is appropriate for infants and young children. This study examines the psychometric validity evidence from 45 items under consideration for inclusion in the GSED PF. Using data from N = 836 Nebraskan (USA) children aged 180 days to 71 months, results indicate that scores from 44 of the 45 (98%) items exhibit positive evidence of validity and reliability. A bifactor model with one general factor and five specific factors best fit the data, exhibited strong reliability, and acceptable model fit. Criterion associations with known predictors of children's psychosocial behaviors were in the expected direction. These findings suggest that measurement of children's psychosocial behaviors may be feasible, at least in the United States. Data from more culturally and linguistically diverse settings is needed to assess these items for global monitoring.

Debido a que el desarrollo sicosocial en los primeros años de vida es crítico para el bienestar de toda la vida, las organizaciones gubernamentales y no gubernamentales están más y más interesadas en observar vigilantemente las conductas sicosociales en la población infantil. Como respuesta, la Organización Mundial de la Salud está desarrollando el Formulario Sicosocial de las Escalas Globales del Temprano Desarrollo (GSED PF) para facilitar la observación sicosocial alerta al nivel del grupo de población. Una vez que se haya convalidado, el GSED PF será una medida de acceso abierto, que reportará el cuidador, sobre las conductas sicosociales de los niños que son apropiadas para infantes y niños pequeñitos. Este estudio examina la evidencia de la validez sicométrica de 45 puntos bajo consideración para ser incluidos en el GSED PF. Usando datos de N = 836 niños de Nebraska (Estados Unidos), de edad entre 180 días y 71 meses, los resultados indican que los puntajes de 44 de los 45 (98%) puntos muestran evidencia positiva de validez y confiabilidad. Un modelo bifactorial con un factor general y cinco factores específicos, que mejor encaja con los datos, mostró una fuerte confiabilidad y un modelo aceptable que encaja. Las asociaciones de criterio con factores de predicción conocidos acerca de las conductas sicosociales de los niños se encontraban en la dirección esperada. Estos resultados sugieren que la medida de las conductas sicosociales de los niños pudiera ser posible, por lo menos en los Estados Unidos. Se necesitan datos de escenarios más diversos cultural y lingüísticamente para evaluar estos puntos para la estar alerta en la observación global.

Researching COVID to enhance recovery (RECOVER) pregnancy study: Rationale, objectives and design.

IMPORTANCE: Pregnancy induces unique physiologic changes to the immune response and hormonal changes leading to plausible differences in the risk of developing post-acute sequelae of SARS-CoV-2 (PASC), or Long COVID. Exposure to SARS-CoV-2 during pregnancy may also have long-term ramifications for exposed offspring, and it is critical to evaluate the health outcomes of exposed children. The National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC aims to evaluate the long-term sequelae of SARS-CoV-2 infection in various populations. RECOVER-Pregnancy was designed specifically to address long-term outcomes in maternal-child dyads. METHODS: RECOVER-Pregnancy cohort is a combined prospective and retrospective cohort that proposes to enroll 2,300 individuals with a pregnancy during the COVID-19 pandemic and their offspring exposed and unexposed in utero, including single and multiple gestations. Enrollment will occur both in person at 27 sites through the Eunice Kennedy Shriver National Institutes of Health Maternal-Fetal Medicine Units Network and remotely through national recruitment by the study team at the University of California San Francisco (UCSF). Adults with and without SARS-CoV-2 infection during pregnancy are eligible for enrollment in the pregnancy cohort and will follow the protocol for RECOVER-Adult including validated screening tools, laboratory analyses and symptom questionnaires followed by more in-depth phenotyping of PASC on a subset of the overall cohort. Offspring exposed and unexposed in utero to SARS-CoV-2 maternal infection will undergo screening tests for neurodevelopment and other health outcomes at 12, 18, 24, 36 and 48 months of age. Blood specimens will be collected at 24 months of age for SARS-CoV-2 antibody testing, storage and anticipated later analyses proposed by RECOVER and other investigators. DISCUSSION: RECOVER-Pregnancy will address whether having SARS-CoV-2 during pregnancy modifies the risk factors, prevalence, and phenotype of PASC. The pregnancy cohort will also establish whether there are increased risks of adverse long-term outcomes among children exposed in utero. CLINICAL TRIALS.GOV IDENTIFIER: Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT05172011.

Growth and neurodevelopmental outcomes of preterm and low birth weight infants in rural Kenya: a cross-sectional study.

OBJECTIVE: Data on long-term outcomes of preterm (PT) and low birth weight (LBW) infants in countries with high rates of neonatal mortality and childhood stunting are limited, especially from community settings. The current study sought to explore growth and neurodevelopmental outcomes of PT/LBW infants from a rural community-based setting of Kenya up to 18 months adjusted age. DESIGN: Cross-sectional study. SETTING: Migori County, Kenya. PARTICIPANTS: Three hundred and eighty-two PT/LBW infants (50.2% of those identified as eligible) from a cluster randomised control trial evaluating a package of facility-based intrapartum quality of care interventions for newborn survival consented for follow-up. OUTCOME MEASURES: Caregiver interviews and infant health, growth and neurodevelopmental assessments were completed at 6, 12 or 18 months±2 weeks. Data included sociodemographic information, medical history, growth measurements and neurodevelopmental assessment using the Ten Questions Questionnaire, Malawi Developmental Assessment Tool and Hammersmith Infant Neurological Examination. Analyses were descriptive and univariate regression models. No alterations were made to planned data collection. RESULTS: The final sample included 362 PT/LBW infants, of which 56.6% were moderate to late PT infants and 64.4% were LBW. Fewer than 2% of parents identified their child as currently malnourished, but direct measurement revealed higher proportions of stunting and underweight than in national demographic and health survey reports. Overall, 22.7% of caregivers expressed concern about their child's neurodevelopmental status. Neurodevelopmental delays were identified in 8.6% of infants based on one or more standardised tools, and 1.9% showed neurological findings indicative of cerebral palsy. CONCLUSIONS: Malnutrition and neurodevelopmental delays are common among PT/LBW infants in this setting. Close monitoring and access to early intervention programmes are needed to help these vulnerable infants thrive. TRIAL REGISTRATION NUMBER: NCT03112018.

Researching COVID to enhance recovery (RECOVER) pregnancy study: Rationale, objectives and design.

Importance: Pregnancy induces unique physiologic changes to the immune response and hormonal changes leading to plausible differences in the risk of developing post-acute sequelae of SARS-CoV-2 (PASC), or Long COVID. Exposure to SARS-CoV-2 during pregnancy may also have long-term ramifications for exposed offspring, and it is critical to evaluate the health outcomes of exposed children. The National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC aims to evaluate the long-term sequelae of SARS-CoV-2 infection in various populations. RECOVER- Pregnancy was designed specifically to address long-term outcomes in maternal-child dyads. Methods: RECOVER-Pregnancy cohort is a combined prospective and retrospective cohort that proposes to enroll 2,300 individuals with a pregnancy during the COVID-19 pandemic and their offspring exposed and unexposed in utero, including single and multiple gestations. Enrollment will occur both in person at 27 sites through the Eunice Kennedy Shriver National Institutes of Health Maternal-Fetal Medicine Units Network and remotely through national recruitment by the study team at the University of California San Francisco (UCSF). Adults with and without SARS-CoV-2 infection during pregnancy are eligible for enrollment in the pregnancy cohort and will follow the protocol for RECOVER-Adult including validated screening tools, laboratory analyses and symptom questionnaires followed by more in-depth phenotyping of PASC on a subset of the overall cohort. Offspring exposed and unexposed in utero to SARS-CoV-2 maternal infection will undergo screening tests for neurodevelopment and other health outcomes at 12, 18, 24, 36 and 48 months of age. Blood specimens will be collected at 24 months of age for SARS-CoV-2 antibody testing, storage and anticipated later analyses proposed by RECOVER and other investigators. Discussion: RECOVER-Pregnancy will address whether having SARS-CoV-2 during pregnancy modifies the risk factors, prevalence, and phenotype of PASC. The pregnancy cohort will also establish whether there are increased risks of adverse long-term outcomes among children exposed in utero. Registration: NCT05172024.

Expanding Developmental and Behavioral Health Capacity in Pediatric Primary Care.

The Development and Behavior Access Clinic (DBAC) deploys a general pediatrician with brief/intensive training and proctoring by developmental-behavioral pediatricians (DBP) to provide developmental-behavioral (DB) care to children referred with mild/moderate complexity needs as determined by a team of clinical psychologists. This pilot study utilizes visit data, chart review, and surveys to assess wait times, need for subspecialty care, and referring clinician satisfaction. In its first 18 months, DBAC decreased the need for subspecialty DB care, providing initial services for 44% of patients referred for DB pediatric care from the study site; 89% did not require subsequent subspecialty evaluation. Among DBAC participants, average wait times for DB care decreased from a baseline of 218 to 41 calendar days. This pilot study provides a model for building DB clinical skills among interested general pediatricians, decreasing wait times, and building the capacity of primary care settings to address mild-to-moderate complexity DB concerns.

Cognitive Development.

Cognitive development in children begins with brain development. Early life exposures may both positively and negatively influence cognitive development in children. Infants, toddlers, and children learn best in secure, nurturing environments and when attachment to a consistent caregiver is present. Pediatricians can screen for both social determinants of health and developmental milestones at office visits to address barriers to care and promote positive cognitive and learning outcomes. Pediatricians may model developmental stimulation during office visits to talk with an infant/child, asking questions of a child, singing and pointing to pictures in books, and modeling responsive listening. Pediatricians may support caregivers to talk with their children, read to their children, and avoid/reduce screen time. Pediatricians can help point caregivers to resources for parent training, Head Start, and quality preschool programs. School readiness has both pre-academic and socioemotional components and can have long-term effects on a child's school success, health, and quality of life. School readiness depends on both the child and the caregiver being ready for school, taking into account caregiver and child health and mental health and child cognitive development.

Adaptation of Essential Care for Every Baby educational program to improve infant outcomes in the context of Zika.

BACKGROUND: The outbreak and ongoing transmission of Zika virus provided an opportunity to strengthen essential newborn care and early childhood development systems through collaboration with the US Agency for International Development Applying Science to Strengthen and Improve Systems (USAID ASSIST). The objective was to create a system of sustainable training dissemination which improves newborn care-related quality indicators in the context of Zika. METHODS: From 2018-19, USAID ASSIST supported a series of technical assistance visits by the American Academy of Pediatrics (AAP) in four Caribbean countries to strengthen the clinical capacity in care of children potentially affected by Zika through dissemination of Essential Care for Every Baby (ECEB), teaching QI methodology, coaching visits, and development of clinical care guidelines. ECEB was adapted to emphasize physical exam findings related to Zika. The first series of workshops were facilitated by AAP technical advisors and the second series were facilitated by the newly trained local champions. Quality of care was monitored with performance indicators at 134 health facilities. RESULTS: A repeated measures (pre-post) ANOVA was conducted, revealing significant pre-post knowledge gains [F(1) = 197.9, p < 0.001] on knowledge check scores. Certain performance indicators related to ECEB practices demonstrated significant changes and midline shift on the run chart in four countries. CONCLUSION: ECEB can be adapted to incorporate important local practices, causes of neonatal morbidity and mortality, and differing healthcare system structures, which, as one part of a larger technical assistance package, leads to improved performance of health systems.

Impact of posttraumatic stress disorder and depressive symptoms on quality of life in adolescents after general traumatic injury.

Posttraumatic stress disorder (PTSD) and depressive symptoms have been associated with poorer health-related quality of life in adolescents after general traumatic injuries; few studies have examined the broader construct of postinjury quality of life (QOL). We evaluated the impact of traumatic injury on adolescent QOL and examined factors that potentially contribute to poorer outcomes, using the Youth Quality of Life Instrument-Research Version as the outcome measure. Data were collected within 30 days postinjury and 2, 5, and 12 months postinjury. Mixed-model regression (MMR) was used for the main analyses. Participants (N = 204) were drawn from a prospective cohort study of 12-18-year-olds admitted to a Level 1 trauma center (n = 108) and healthy participants from a local cross-sectional study (n = 116); study group participants were significantly older. The initial MMR indicated that female adolescents had significantly lower QOL, B = -2.69, 95% CI [-4.68, -0.70], and were more likely to score above the cutoffs for PTSD (19.1% vs. 2.0%), χ2 (1, N = 381) = 34.6, p < .001, or depression (32.8% vs. 14.0%), χ2 (1, N = 381) = 18.7, p < .001, on post hoc analyses. Adolescents with mental health conditions in the year postinjury had significant QOL deficits without predicted improvements toward baseline, PTSD: B = -10.05, 95% CI [-15.29, -4.81]; depression: B = -18.00, 95% CI [-21.69, -14.31]. These findings highlight the importance of ongoing mental health monitoring and care for adolescents, particularly female adolescents, following traumatic injury even when physical recovery appears complete.

Factors Associated With Trajectories of Externalizing Behavior in Preschoolers.

OBJECTIVE: More media exposure and life stressors are associated with higher levels of externalizing behaviors in young children; however, their joint impact on externalizing behavior trajectory is unknown. This study assessed the relationship of stressful life events (SLE), media exposure, and additional demographic and family variables on the trajectory of externalizing behaviors in preschool-aged children. METHODS: Participants were children ages 3 to 5 years from a large, 18-month duration, randomized control trial to reduce inappropriate media exposure. The sample was recruited from community pediatrics' practices. Intervention and control groups were collapsed, with study arm a covariate. Latent growth modeling (LGM) was conducted, with main outcome of externalizing behaviors at 6, 12, and 18 months after study initiation. Primary exposures of interest were total daily media hours, SLE, intimate partner violence, and harsh parenting. RESULTS: Final analyses included 613 children. LGM without covariates revealed a significant decrease in mean externalizing score between baseline and 18 months. LGM with covariates revealed that individuals with more media exposure exhibited more externalizing behaviors and SLE significantly predicted a slower decline in externalizing behaviors. Externalizing behavior at 18 months was significantly predicted by SLE, child age, white non-Hispanic race, and harsh parenting. CONCLUSIONS: Exposure to a greater number of stressful life events appears to slow the age-appropriate decline in externalizing behaviors for preschool-aged children, while harsh parenting and media exposure are associated with more externalizing behavior. Findings highlight the importance of screening and surveillance in primary care and the need for early intervention efforts targeted to these risks.

Adherence to Child Attention-Deficit/Hyperactivity Disorder Treatment Guidelines in Medical Homes-Results from a National Survey.

OBJECTIVE: Having primary care delivered through a medical home is believed to improve mental health care delivery to children. Children with attention-deficit/hyperactivity disorder (ADHD) are commonly treated in pediatric practices, yet little is known about ADHD treatment patterns in medical homes. Our objective was to assess for treatment variation depending on parent-perceived medical home (PPMH) status. We hypothesized that having a PPMH would be associated with receiving ADHD treatments recommended by clinical guidelines. METHODS: We used the 2016 National Survey of Children's Health-a nationally representative cross-sectional survey of children in the United States. Analyses included an unweighted sample of 4,252, representing 5.4 million children aged 3 to 17 years with parent-reported ADHD. Child characteristics were analyzed using descriptive statistics. Associations between ADHD treatment types and PPMH status were assessed using a multinomial logistic regression, adjusting for child characteristics. RESULTS: Having a PPMH was associated with increased prevalence odds of children's receipt of medications alone for ADHD (vs no treatment). The prevalence odds of receiving behavioral treatment alone (vs medications alone) for ADHD decreased by 43% when children had a PPMH (95% confidence interval, 0.38-0.85, p = 0.01). PPMH status was not associated with a statistically significant difference in prevalence odds of receiving combination treatment (vs medications alone) for pediatric ADHD. CONCLUSION: Having a PPMH was associated with children's receipt of ADHD medications alone, but not behavioral treatments. Our findings suggest that medical homes may need further improvement to ensure that children with ADHD receive treatments as recommended by clinical guidelines.

Parent mediated intervention programmes for children and adolescents with neurodevelopmental disorders in South Asia: A systematic review.

OBJECTIVE: Parent-mediated programmes have been found to be cost effective for addressing the needs of the children and adolescents with Neurodevelopmental Disorders (NDD) in high-income countries. We explored the impact of parent-mediated intervention programmes in South Asia, where the burden of NDD is high. METHODS: A systematic review was conducted using the following databases; PUBMED, MEDLINE, PsycINFO, Google Scholar and Web of Science. Predefined MeSH terms were used, and articles were included if published prior to January 2020. Two independent researchers screened the articles and reviewed data. OUTCOMES MEASURES: The review included studies that targeted children and adolescents between 1 and 18 years of age diagnosed with any of four specific NDDs that are commonly reported in South Asia; Autism Spectrum Disorder (ASD), Intellectual Disability (ID), Attention Deficit Hyperactivity Disorder (ADHD) and Cerebral Palsy (CP). Studies that reported on parent or child outcomes, parent-child interaction, parent knowledge of NDDs, or child activities of daily living were included for full text review. RESULTS: A total of 1585 research articles were retrieved and 23 studies met inclusion criteria, including 9 Randomized Controlled Trials and 14 pre-post intervention studies. Of these, seventeen studies reported effectiveness, and six studies reported feasibility and acceptability of the parent-mediated interventions. Three studies demonstrated improved parent-child interaction, three studies demonstrated improved child communication initiations, five studies reported improved social and communication skills in children, four studies demonstrated improved parental knowledge about how to teach their children, and four studies reported improved motor and cognitive skills, social skills, language development, learning ability, or academic performance in children. CONCLUSION: This systematic review of 23 studies demonstrated improvements in parent and child skills following parent-mediated intervention in South Asia. Additional evaluations of locally customized parent-mediated programmes are needed to support development of feasible interventions for South Asian countries.

Early Child Development Assessments and Their Associations with Long-Term Academic and Economic Outcomes: A Systematic Review.

Developmental screening instruments were designed as diagnostic tools, but there is growing interest in understanding whether select tools can also be used systematically in research to examine intervention impacts on long-term outcomes. As such, this systematic review aims to examine associations between child development assessment tools and educational attainment, academic achievement, or wealth. We included studies identified in PubMed, PsycINFO, and Educational Resources Information Center if they reported an association between at least one tool from a pre-established list and one outcome of interest after age 10. Of 597 studies identified, 11 met inclusion criteria; three examined educational attainment as the outcome of interest, six examined academic achievement, one wealth, and one both educational attainment and wealth. Intelligence tests were utilized in five of the included studies, neuropsychological/executive function or behavior tools were used in five, and one study used tools across the domains. High-quality studies were identified across all three of the domains, but educational attainment and wealth had the greatest proportion of high-quality studies, as compared to academic achievement. Our review demonstrates the potential for certain child development assessment tools to adequately assess long-term outcomes of interest, but additional prospective studies using validated, culturally appropriate tools are needed. PROSPERO registration number: CRD42018092292.

Colocated Developmental-Behavioral Pediatrics in Primary Care: Improved Outcome Across Settings.

OBJECTIVE: We developed a colocation "Rapid Developmental Evaluation" (RDE) model for Developmental-Behavioral Pediatrics (DBP) to evaluate young children for developmental concerns raised during routine developmental surveillance and screening in a pediatric primary care Federally Qualified Health Center (FQHC). In this low-income patient population, we anticipated that colocation would improve patient access to DBP and decrease time from referral to first developmental evaluation and therapeutic services. METHODS: Children were assessed at the FQHC by a DBP pediatrician, who made recommendations for therapeutic services and further diagnostic evaluations. A retrospective chart review over 27 months (N = 151) investigated dates of referral and visit, primary concern, diagnosis, and referral to tertiary DBP center and associated tertiary DBP center dates of service and diagnoses if appropriate. We surveyed primary care clinicians (PCCs) for satisfaction. RESULTS: The DBP pediatrician recommended that 51% of children be referred to the tertiary DBP center for further diagnostic evaluation or routine DBP follow-up. Average wait from referral to an RDE visit was 57 days compared with 137.3 days for the tertiary DBP center. Children referred from RDE to the tertiary DBP center completed visits at a higher rate (77%) than those referred from other sites (54%). RDE-recommended therapeutic services were initiated for 73% of children by the tertiary visit. Fidelity of diagnosis between RDE and the tertiary DBP center was high, as was PCC satisfaction. CONCLUSION: Colocation of a DBP pediatrician in an FQHC primary care pediatrics program decreased time to first developmental assessment and referral for early intervention services for an at-risk, low-income patient population.

Ethical challenges in research with orphans and vulnerable children: a qualitative study of researcher experiences.

BACKGROUND: Orphans and vulnerable children (OVCs) represent a significant population worldwide, enduring poor health and living conditions. Evidence-based interventions are needed. However, without parents, ethical concerns about including OVCs in research persist. The aim of our study was to better understand the ethical challenges facing researchers who work with OVCs. METHODS: We conducted semi-structured interviews with 12 international pediatric researchers working with OVCs in seven countries. We used descriptive content analysis to characterize the ethical rationale for inclusion and associated challenges. RESULTS: Researchers believed research was justified as a necessary means for informing evidence-based interventions to benefit OVCs directly or as a population. Ethical challenges included difficulty identifying OVCs given variation among children living without parents; difficulty identifying guardians among a range of caregivers; concerns about meaningfulness of guardian consent; difficulty assessing risk; and responding to children's many needs. CONCLUSIONS: A range of caregivers bear responsibility to protect OVC's interests in place of parents in research but are often not prepared to do so. This places greater burden on researchers to assess risks and respond to children's needs. Findings suggest that we should improve support and rethink the roles of guardians, researchers and older children in research participation and protection.

Predictors of parental posttraumatic stress disorder symptoms in the year after adolescent traumatic injury.

OBJECTIVES: Parental posttraumatic stress disorder (PTSD) is common after pediatric traumatic injury and may negatively impact parental functioning and quality of life during this key period of the child's early postinjury recovery. This study aimed to evaluate the course and predictors of PTSD in parents during the year after an adolescent traumatic injury. METHODS: This prospective cohort study included a population-based sample of 99 parent-adolescent dyads. Assessment was through structured interview administration of standardized measures. Interviews were conducted within 30 days of injury and 2, 5, and 12 months after injury. Mixed model regression was used to evaluate variables potentially associated with repeated measures of parental PTSD symptoms at the follow-up time points. RESULTS: Twenty-three percent of parents met symptomatic criteria for PTSD at the first postinjury evaluation, as did 15% at 2 months, 7% at 5 months, and 6% at 12 months after the injury. The percentage of parents meeting symptomatic PTSD criteria decreased significantly between the 2-month and 12-month evaluations. Mixed-model regression analyses revealed greater PTSD symptoms within 30 days of injury and a greater number of postinjury parental traumatic and/or stressful life events as significant predictors of parental PTSD. Adolescent factors did not affect the risk of parental PTSD. CONCLUSIONS: A substantial subgroup of parents demonstrate high PTSD symptom levels during the course of the year after an adolescent injury. Given that early modifiable risk factors can be identified, future investigations focusing on screening and intervention are warranted.

Health-related quality of life in children and adolescents following traumatic injury: a review.

This paper comprehensively reviews the published literature investigating health-related quality of life (HRQOL) following general traumatic injury in individuals between birth and 18 years. Studies were not considered if they primarily compared medical treatment options, evaluated physical function but not other aspects of HRQOL, or focused on non-traumatic wounds. Specific injury types (e.g., burn injury) were also not included. A total of 16 studies met criteria. Participants were age 1-18 years, with 12 studies considering children 5 years of age or older. Males were overrepresented. Injury severity averaged mostly in the moderate range. HRQOL deficits were noted in injured samples in all studies except the two with the longest time to follow-up (6-11 years). Some improvement was seen 6 months to 2 years after injury. Factors associated with HRQOL deficits were investigated, with acute and posttraumatic stress disorder symptoms showing the strongest relationship. Research to date in this area is impressive, particularly the number of studies using prospective longitudinal investigations and validated measures. Challenges remain regarding methodologic differences, assessment of preinjury status, retention of participants, and management of missing data. Suggested future directions include extension of follow-up duration, utilization of pediatric self-report when possible, inclusion of younger children, and development of intervention programs.