Children's injuries in legislated types child-care institutions.

BACKGROUND: Severe injuries in child-care institutions are an important social issue. However, no reports on this matter have been made in Japan. This study examined trends in severe injuries at child-care institutions, including the impact of the coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted a serial cross-sectional study and interrupted time-series (ITS) analysis with a linear regression model to assess trends in the incidence rate of severe injuries using Japanese national open data between January or April 2017 and December 2021. Participants were individuals utilizing legislated types child-care institutions. The outcomes were annual and monthly incidence rates of severe injuries in legislated types child-care institutions. RESULTS: The number of legislated types child-care institutions increased from 32,793 facilities in 2017 to 38,666 facilities in 2021, and the number of participants rose from 2,802,228 in 2017 to 3,059,734 in 2021. The annual incidence rate of severe injuries in 2021 was 58.3 cases per 100,000 person-years, which is twofold higher than that in 2017. The ITS for the monthly incidence rate demonstrated an increasing trend before the COVID-19 pandemic. CONCLUSIONS: Before the COVID-19 pandemic, the monthly incidence rate of severe injuries in legislated types child-care institutions increased. The annual incidence rate in Japan may have also increased during the observation period.

Association of perinatal factors with neurodevelopmental referrals in a population-based cohort study in Japan.

Although the causes of neurodevelopmental disorders remain unknown, several environmental risk factors have attracted considerable attention. We conducted a retrospective, longitudinal, population-based cohort study using data from infant health examinations of children born to mothers with pregnancies between April 1, 2014 and March 31, 2016 in Kobe City to identify the perinatal factors associated with neurodevelopmental referrals in 3-year-old children. There were 15,223 and 1283 children in the normal and referral groups, respectively. Neurodevelopmental referrals at the health checkup for 3-year-old children were significantly associated with the lack of social support during pregnancy (adjusted odds ratio [aOR] 1.99, 99% CI 1.14-3.45, p = 0.001), history of psychiatric consultation (aOR 1.56, 99% CI 1.10-2.22, p = 0.001), no social assistance post-delivery (aOR 1.49, 99% CI 1.03-2.16, p = 0.006), Edinburgh Post-natal Depression Scale (EPDS) score ≥ 9 (aOR 1.36, 99% CI 1.01-1.84, p = 0.008), infant gender (male) (aOR 2.51, 99% CI 2.05-3.06, p < 0.001), and cesarean delivery (aOR 1.39, 99% CI 1.11-1.75, p < 0.001). In conclusion, this exploratory study in the general Japanese population identified six perinatal factors associated with neurodevelopmental referrals in 3-year-old children: infant gender (male), cesarean section, maternal history of psychiatric consultation, EPDS score ≥ 9, lack of social support during pregnancy, and no social assistance post-delivery.

[Association of prenatal maternal, prenatal secondhand, and postnatal secondhand smoking exposures with the incidence of asthma/atopic dermatitis in children: An epidemiological study using checkup data of mothers and children in Kobe city].

Objectives　Despite suggested associations among smoking exposures and the prevalence of allergic diseases in children, studies examining the effect of prenatal maternal smoking and secondhand smoking on the occurrence of these diseases in children are limited. Our study aimed to investigate the association between prenatal maternal smoking as well as secondhand smoking and the incidence of asthma or atopic dermatitis in children.Methods　We included checkup data of a total of 53,505 children living in Kobe, Japan, without missing values for exposure or outcome, between April 1, 2004, and March 31, 2013. The exposure variables were prenatal maternal smoking, prenatal secondhand smoking, and postnatal secondhand smoking till 4 months, which were assessed by maternal notification form and exclusively classified into eight categories. The outcome variables were the incidence of asthma or atopic dermatitis in the respective children up to 3 years of age assessed by a checkup questionnaire. The association between the smoking exposures and the development of asthma or atopic dermatitis up to 3 years was examined using a generalized linear mixed model with odds ratios and 95% confidence intervals (CI). Additionally, multiple imputation methods were used for the missing covariates.Results　Of the 53,505 children, 27,210 (50.9%) were males and 26,218 (49.0%) were females. In total, 5,810 (10.9%) children were diagnosed with asthma and 4,964 (9.3%) with atopic dermatitis up to 3 years of their age. Compared to the children born to nonsmoking mothers during pregnancy and those without exposure to postnatal secondhand smoking, the adjusted odds ratio for the incidence of asthma up to 3 years of their age was found to be 2.04 (95% CI: 1.38-3.01) in children exposed to prenatal maternal smoking. Similarly, the adjusted odds ratio for the incidence of asthma in children exposed to maternal secondhand smoking during pregnancy was 1.12 (95% CI: 1.01-1.25) when compared with children who were never exposed to any smoking. Additionally, the adjusted odds ratio increased to 1.86 (95% CI: 1.42-2.44) in children exposed to both prenatal maternal smoking and secondhand smoking. In contrast, no statistical significance was observed among the smoking exposures and the incidence of atopic dermatitis in the children.Conclusions　Our study confirmed that prenatal maternal and secondhand smoking were associated with the incidence of asthma in children. These findings suggest a need to focus on smoking cessation by pregnant women as well as by family members living together to prevent the development of asthma in children.

Association between maternal hypertensive disorders of pregnancy and child neurodevelopment at 3 years of age: a retrospective cohort study.

Hypertensive disorders of pregnancy (HDP) affect up to 10% of women during pregnancy and influence child neurodevelopment, including mental and motor function. We assessed whether HDP, including gestational hypertension, preeclampsia, superimposed preeclampsia, and eclampsia, correlate with motor and mental developmental abnormalities in 3-year-old children, using data obtained between April 2004 and March 2013 through a mandatory population-based health checkup of mothers and children in Kobe city, Japan. The primary outcome was motor and mental developmental abnormalities at 3 years of age; parental-reported questionnaires and physician's medical examinations were evaluated. The association between maternal HDP and child neurodevelopmental abnormality was evaluated using a logistic regression model. Of the 43,854 participating children, 1120 were born to women with HDP and 42,734 were born to women without HDP. The prevalence of motor developmental abnormality was 1.7% in the exposed group and 0.95% in the control group; the prevalence of mental developmental abnormality was 2.41% in the exposed group and 1.22% in the control group. Children born to mothers with HDP did not have an increased risk of motor developmental abnormality at the age of 3 years [adjusted odds ratio (OR) 1.17, 95% confidence interval 0.72-1.91], but had an increased risk of mental developmental abnormality (adjusted OR 1.80, 95% confidence interval 1.21-2.69). Maternal HDP were associated with mental development abnormality in 3-year-old children. These findings may be clinically relevant; mental abnormality in children born to women with HDP could be detected during early stages, which would facilitate early intervention.

Seizure prevalence in children aged up to 3 years: a longitudinal population-based cohort study in Japan.

OBJECTIVE: To investigate the prevalence of seizures/febrile seizures in children up to 3 years of age and examine the effects of gestational age at birth on the risk for febrile seizures. DESIGN: Retrospective longitudinal population-based cohort study. SETTING: Kobe City public health center, Kobe, Japan, from 2010 to 2018. PARTICIPANTS: Children who underwent a medical check-up at 3 years of age. METHODS: Information regarding seizures was collected from the parents of 96 014 children. We identified the occurrence of seizure/febrile seizure in 74 017 children, whose gestational ages at birth were noted. We conducted a multivariate analysis with the parameter, gestational age at birth, to analyse the risk of seizure. We also stratified the samples by sex and birth weight (<2500 g or not) and compared the prevalence of seizure between those with the term and late preterm births. RESULTS: The prevalence of seizure was 12.1% (11.8%-12.3%), 13.2% (12.2%-14.4%), 14.6% (12.4%-17.7%) and 15.7% (10.5%-22.8%) in children born at 37-41, 34-36, 28-33 and 22-27 gestational weeks, respectively. The prevalence of febrile seizures was 9.0% (8.8%-9.2%), 10.5% (9.5%-11.5%), 11.8% (9.7%-14.5%) and 11.2% (6.9%-17.7%) in children born at 37-41, 34-36, 28-33 and 22-27 gestational weeks, respectively. Male was an independent risk factor for seizures (OR: 1.15, 95% CI 1.09 to 1.20; absolute risk increase 0.014, 95% CI 0.010 to 0.019) and febrile seizures (OR: 1.21, 95% CI 1.15 to 1.28; absolute risk increase 0.016, 95% CI 0.012 to 0.020), respectively. Late preterm birth was not associated with an increased risk of seizure/febrile seizure. CONCLUSIONS: Although very preterm birth may increase the risk of seizure/febrile seizure, the risk associated with late preterm birth is considerably small and less than that associated with male.

High Rate of Febrile Seizures in Japanese Children With Occult Bacteremia.

OBJECTIVES: Fever of 39°C or higher and a white blood cell (WBC) count of 15,000/µL or greater are known predictors of occult bacteremia (OB). However, because of a decreasing prevalence of OB, WBC counts have become poor predictors of OB in populations of routinely immunized children. Thus, we aim to evaluate the clinical characteristics of OB in Japanese children and identify potential risk factors for OB. METHODS: We conducted an observational study of children aged 3 to 36 months old with positive blood cultures for Streptococcus pneumoniae or Haemophilus influenzae at an emergency department in a tertiary care children's hospital between April 2002 and December 2015. Patients with significant underlying diseases, a proven source of infection, or toxic appearance, were excluded. RESULTS: Positive blood cultures were recorded in 231 patients; of these, 110 were included in the study (S. pneumoniae, n = 102; H. influenzae, n = 8). Median age was 16 (3-34) months. Patients had a high median body temperature of 39.2 (interquartile range, 38.6-39.9) °C and median WBC of 21,120 (interquartile range, 16,408-24,242)/µL. A high rate of febrile seizures (58 patients, 53%) was observed, with complex febrile seizures accounting for 43% of the episodes. Frequency of febrile seizures was positively associated with age (P = 0.001). CONCLUSIONS: Our study revealed a high rate of children presenting with febrile seizures, especially complex seizures, among children with OB in Japan. A further study is necessary to evaluate the role of febrile seizures as a predictor for OB.

Low plasma D-dimer predicts absence of intracranial injury and skull fracture.

BACKGROUND: Intracranial injury (ICI) is a leading cause of morbidity in children; however, the use of computed tomography (CT) to evaluate ICI has significant risks in children. A recent study suggests D-dimer is associated with ICI. We surveyed the performance of plasma D-dimer in ruling out ICI or skull fracture (SF) in children with head trauma. METHODS: In a cross-sectional study in the Emergency Department (ED) at the National Center for Child Health and Development in Tokyo, Japan we reviewed the medical records of all children age 0-16 years brought to the ED with head trauma from January 2010 to July 2013, who underwent CT based on established clinical criteria and had plasma D-dimer measured. We evaluated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of plasma D-dimer, using abnormal findings on CT (ICI, SF) as the criterion standard. We repeated analysis after stratification by age (<2 years, ≥2 years). RESULTS: Among 364 eligible children (112 children <2 year of age), abnormal findings on CT were demonstrated in 33.8% (123/364). With the cut-off set at 0.5 µg/mL, sensitivity was 100.0% (95% confidence interval [CI]: 95.6-100.0%), specificity 34.0% (95%CI: 28.1-40.4%), PPV 43.6% (95%CI: 37.7-49.6%), NPV 100.0% (95%CI: 93.5-100%). After stratification by age (<2 years and ≥2 years), sensitivity (100.0% and 100.0%) and NPV (100.0% and 100.0%) remained high in both age groups. CONCLUSIONS: Low plasma D-dimer (≤0.5 µg/mL) is useful to limit the use of CT in children by excluding traumatic ICI or SF.

Indication for voiding cystourethrography during first urinary tract infection.

BACKGROUND: There is confusion surrounding the precise indications for voiding cystourethrography (VCUG) during the assessment of vesicoureteral reflex (VUR) after a first febrile urinary tract infection (UTI). The aim of this study was to determine the combination of clinical, laboratory and ultrasonography factors correlating with grades IV-V VUR in young children with a first febrile UTI. METHODS: Children 0-24 months of age who were brought to the emergency department at National Center for Child Health and Development with the diagnosis of first time febrile UTI between March 2004 and May 2011, were enrolled. We compared clinical, laboratory and ultrasonography findings between children with grades IV-V VUR (high-grade VUR) and those with no or grades I-III VUR (normal or low-grade VUR). RESULTS: A total of 231 patients were eligible and 19 had high-grade VUR. Poor clinical appearance, presence of a uropathogen other than Escherichia coli, positive blood culture, hydroureter and thickened renal pelvic wall were all independently associated with high-grade VUR. When one or more of these factors were present, sensitivity, specificity, positive or negative predictive value, and positive or negative likelihood ratio were 94.7%, 69.4%, 23.1%, 99.3%, 3.1 and 0.1, respectively. When none of the factors was present, the proportion of high-grade VUR was 0.7%; if one factor, 11.3%; two factors, 55.6%; three factors, 85.7%. CONCLUSIONS: In the absence of five specific factors during the first febrile UTI episode in young children, VCUG is not necessary to detect high-grade VUR. When more than one factor is present, however, VCUG is indicated.

Childcare Environment and Japanese Children Who Are Overweight in Early Childhood.

BACKGROUND: Maternal employment may affect child care styles and contribute to the increasing prevalence of overweight children. We explored the potential risk factors for becoming overweight during early childhood, especially in the child care environment. METHODS: We conducted a retrospective cohort study using data from health check-up services from 2007 to 2015 in Kobe, Japan. The main outcome was being overweight at age 3 years, which was defined by the International Obesity Task Force cutoffs. Environmental, maternal, and infantile factors were examined as possible risk factors for childhood overweight. RESULTS: Of 31,463 infants, 1315 (4.2%) were classified as overweight at age 3 years. Compared with children who were cared for by their mothers during the day at 4 and 18 months, the adjusted odds ratio (aOR) for becoming overweight for those who were not cared for by their mothers was 1.52: 95% confidence interval (CI), 1.16-1.99. Long sleep duration was associated with lower risk of childhood overweight: aOR, 0.79; 95% CI, 0.66-0.96. CONCLUSION: Less daytime care by mothers and shorter sleep duration were associated with increased risk of becoming overweight during childhood. Further studies are needed to determine on how the effect of those factors may be diminished with respect to childhood overweight.

Pediatric resident perceptions of shift work in ward rotations.

Although the long working hours of physicians are considered to be a social issue, no effective policies such as duty hour regulations have so far been proposed in Japan. We implemented an overnight call shift (OCS) system for ward rotations to improve the working environment for residents in a pediatric residency program. We later conducted a cross-sectional questionnaire asking the residents to compare this system with the traditional overnight call system. Forty-one pediatric residents participated in this survey. The residents felt that the quality of patient care improved (80.4% agreed). Most felt that there was less emphasis on education (26.8%) and more emphasis on service (31.7%). Overall, the residents reported that the OCS was beneficial (90.2%). In conclusion, the pediatric residents considered the OCS system during ward rotations as beneficial. Alternative solutions are vital to balance improvements in resident work conditions with the requirement for a high quality of education.

Limitation of duty hour regulations for pediatric resident wellness: A mixed methods study in Japan.

Duty hour regulations have been placed in residency programs to address mental health concerns and to improve wellness. Here, we elucidate the prevalence of depressive symptoms after implementing an overnight call shift system and the factors associated with burnout or depression among residents.A sequential exploratory mixed methods study was conducted in a tertiary care pediatric and perinatal hospital in Tokyo, Japan. A total of 41 pediatric residents participated in the cross-sectional survey. We determined and compared the prevalence of depressive symptoms and the number of actual working hours before and after implementing the shift system. A follow-up focus-group interview with 4 residents was conducted to explore the factors that may trigger or prevent depression and burnout.Mean working hours significantly decreased from 75.2 hours to 64.9 hours per week. Prevalence of depressive symptoms remained similar before and after implementation of the shift system. Emotional exhaustion and depersonalization from the burnout scale were markedly associated with depression. High workload, stress intolerance, interpersonal difficulties, and generation gaps regarding work-life balance could cause burnout. Stress tolerance, workload monitoring and balancing, appropriate supervision, and peer support could prevent burnout.Although the overnight call shift system was effective in reducing working hours, its effectiveness in managing mental health issues among pediatric residents remains unclear. Resident wellness programs represent an additional strategy and they should be aimed at fostering peer support and improvement of resident-faculty interactions. Such an approach could be beneficial to the relationship between physicians of different generations with conflicting belief structures.

Mentoring the next generation of physician-scientists in Japan: a cross-sectional survey of mentees in six academic medical centers.

BACKGROUND: Physician-scientists play key roles in biomedical research across the globe, yet prior studies have found that it is increasingly difficult to recruit and retain physician-scientists in research careers. Access to quality research mentorship may help to ameliorate this problem in the U.S., but there is virtually no information on mentoring in academic medicine in Japan. We conducted a survey to determine the availability and quality of mentoring relationships for trainee physician-scientists in Japan. METHODS: We surveyed 1700 physician-scientists in post-graduate research training programs in 6 academic medical centers in Japan about mentorship characteristics, mentee perceptions of the mentoring relationship, and attitudes about career development. RESULTS: A total of 683 potential physician-scientist mentees completed the survey. Most reported that they had a departmental mentor (91%) with whom they met at least once a month; 48% reported that they were very satisfied with the mentoring available to them. Mentoring pairs were usually initiated by the mentor (85% of the time); respondents identified translational research skills (55%) and grant writing (50%) as unmet needs. Mentoring concerning long-term career planning was significantly associated with the intention to pursue research careers, however this was also identified by some mentees as an unmet need (35% desired assistance; 15% reported receiving it). CONCLUSIONS: More emphasis and formal training in career mentorship may help to support Japanese physician-scientist mentees to develop a sense of self-efficacy to pursue and stay in research careers.

Trends and variations in infant mortality among 47 prefectures in Japan.

OBJECTIVES: To determine IMR trends and regional variations among 47 prefectures in Japan and to identify associated population-based factors. METHODS: We conducted an ecological study of infant mortality rate (IMR) by analyzing publicly available data from the Ministry of Health, Labour and Welfare of Japan. Outcome measure for trend is the IMR for each of 47 prefectures from 1999 to 2007; for variation, IMRs for 2006 and 2007 in each prefecture were averaged. We considered as covariates prefecture-level variables related to public health, socio-economic status, clinical services and health care facilities. We conducted multivariate statistical analyses to determine covariates most strongly associated with both 1999-2007 IMR trends and 2006-2007 IMR. RESULTS: The mean IMR decreased from 3.42 deaths per 1000 live births (range 2.1 to 5.1) in 1999 to 2.54 (range 1.5 to 4.4) in 2007; reductions were greater in prefectures with higher concentrations of public health nurses (PHNs) and nurses. In 2006-2007, nine prefectures had IMRs ≤ 2.25; eight had IMRs ≥ 3.0. When low-, moderate- and high-IMR prefectures were compared, per capita PHNs, maternal education, centralized water supply and household income were identified as significant covariates. CONCLUSIONS: Both national and prefecture-level IMR in Japan decreased from 1999 to 2007; however, the degree of reduction varied by prefecture. Given that more nurses and PHNs per capita were associated with greater IMR reductions from 1999 to 2007 and more PHNs with lower 2006-2007 IMRs, distribution of preventive health services may play a major role in reducing regional disparities in IMR.

A novel Internet-based blended learning programme providing core competency in clinical research.

RATIONALE, AIMS AND OBJECTIVES: We developed a novel Internet-based blended learning programme that allows busy health care professionals to attain core competency in clinical research. This study details the educational strategies and learning outcomes of the programme. METHOD: This study was conducted at Kyoto University and seven satellite campuses from September 2009 to March 2010. A total of 176 health care professionals who had never attempted to attain core competency in clinical research were enrolled. The participants were supplied with a novel programme comprising the following four strategies: online live lectures at seven satellite campuses, short examinations after each lecture, an Internet-based feedback system and an end-of-course examination. We assessed the proportion of attendance at the lectures as the main outcome. In addition, we evaluated interaction via the feedback system and scores for end-of-course examination. RESULTS: Of the 176 participants, 134 (76%) reported working more than 40 hours per week. The mean proportion of attendance over all 23 lectures was 82%. A total of 156 (89%) participants attended more than 60% of all lectures and were eligible for the end-of-course examination. A total of the participants accessed the feedback system 3564 times and asked 284 questions. No statistically significant differences were noted in the end-of-course scores among medical doctors, pharmacists, registered nurses and other occupations. CONCLUSIONS: We developed an Internet-based blended learning programme providing core competency in clinical research. Most busy health care professionals completed the programme successfully. In addition, the participants could attain the core competency effectively, regardless of their occupation.

Regional variations in prevalence of postpartum depressive symptoms: population-based survey.

The purpose of the present study was to verify that there are regional variations in the detection rate of postpartum depressive symptoms in mothers. A population-based survey of all women who gave birth in Fushimi Ward, Kyoto City during the period 1 December 2008-31 October 2010 was carried out. The Edinburgh Postnatal Depression Scale (EPDS) was completed by 2567 mothers of infants to measure postpartum depressive symptoms. The detection rate of postpartum depressive symptoms was compared between five localities. A significant difference was found between the lowest detection rate of postpartum depressive symptoms (8.4%) and the highest (18.1%; P < 0.001). A significant positive correlation was found between the proportion of houses in the locality receiving public assistance and the detection rate of postpartum depressive symptoms. The detection rate of postpartum depressive symptoms shows regional variations, suggesting a relationship with the poverty rate.

Maternal childrearing anxiety reflects childrearing burden and quality of life.

BACKGROUND: The government of Japan has recently initiated public programs to allay maternal childrearing anxiety. The aim of the present study was to determine the prevalence of childrearing anxiety and describe its relationships with perceived childrearing burden and maternal quality of life (QOL). METHODS: A secondary analysis was done of survey data from 1229 mothers enrolled in the Seiiku Birth Cohort Study at the National Center for Child Health and Development between November 2003 and December 2006. Childrearing anxiety was determined by asking mothers, at infant age 3 months, 'Regarding childrearing, do you have any anxiety or worry?'. Childrearing burden was assessed in specific categories such as physical fatigue, household expenses, and personal time. The validated Japanese translation of the WHOQOL-BREF instrument was used to measure Maternal QOL. RESULTS: Sixty-four percent of mothers reported some and 9% much childrearing anxiety. In total, 73% percent of mothers reported any childrearing anxiety. As childrearing anxiety increased from 'none' to 'some' and 'much', the proportion of mothers who reported any childrearing burden increased from 75% to 99% (P < 0.001). QOL scores in each of four domains (physical, psychological, social relationships, and environment) decreased with increasing level of anxiety (P < 0.001). Primiparity, pregnant with more than a singleton and admission to the neonatal intensive care unit were associated with greater anxiety. CONCLUSIONS: The strong associations between childrearing anxiety and childrearing burden, and between childrearing anxiety and maternal QOL, suggest that childrearing anxiety is an empirically credible and measurable phenomenon.

Can pediatricians accurately identify maternal depression at well-child visits?

BACKGROUND: The feasibility of a two-item screening tool for maternal depression in a pediatric setting was recently reported. We assessed whether the accuracy of pediatrician recognition of maternal depression during the one-month well-child visit could be improved by an educational intervention using the two-item screening tool. METHODS: We conducted an educational intervention for pediatric residents in a suburban hospital in Tokyo, Japan, with outcome measurement before and after. Resident education included knowledge about postpartum depression and its impact on children, use of the two-item screening tool and available management strategies. Sixteen pediatric residents examined 267 mother-infant dyads during well-child visits. Residents documented the presence or absence of postpartum depressive symptoms on medical records. Depressive symptoms were also determined using the Edinburgh Postnatal Depression Scale (EPDS) survey; residents were not aware of the results. Using the EPDS as a "gold standard," improvement in sensitivity and specificity of resident recognition of maternal depressive symptoms was determined. RESULTS: The overall prevalence of postpartum depressive symptoms based on the EPDS was 15.4%. The sensitivity of resident recognition was 8% and specificity 98% before intervention, and 12% and 96% afterwards, respectively. The difference was not statistically significant. Residents indicated fear of maternal stigmatization and mothers' receptiveness to discussing depressive symptoms, as well as lack of time and skills, as major barriers to the identification of maternal depression. CONCLUSIONS: A simple educational intervention using a two-item screening tool did not improve the pediatrician's accuracy in detecting depressive symptoms in mothers. Additional strategies to address perceived barriers may be needed.

Screening for maternal depression in primary care pediatrics.

PURPOSE OF REVIEW: An estimated 10-20% of mothers suffer from postpartum depression. Given its profound impact on both mother and infant and the availability of effective interventions, pediatricians can improve identification and referral of mothers with postpartum depression by screening regularly during well child visits. The purpose of this paper is to review and assess recently developed screening tools. RECENT FINDINGS: Since the development of the Edinburgh Postnatal Depression Scale in 1987, several shorter screening tools have been introduced. Although further innovation to optimize appropriate identification of postpartum depression is critical, these brief tools have been shown to be useful in improving pediatrician recognition of depression in mothers and referral to psychiatric specialists. SUMMARY: Recently developed brief screening tools are recommended for routine use by pediatricians during well child visits to identify mothers who need additional evaluation for depression. Screening should be conducted repeatedly during the first year of child rearing as symptoms of postpartum depression may appear at any time and its progression may help differentiate between mild and more severe forms of depression. Pediatricians can also provide appropriate follow-up of the family.