Parenting Stress, Community Support, and Unmet Health Care Needs of Children in the US.

OBJECTIVES: In 2018, approximately 2.3 million children in the United States had unmet healthcare needs (UHCN). To date, studies examining associations between UHCN and parent stress and support have had limited generalizability. This study aimed to investigate the relationship between children's UHCN and parenting stress and support using a nationally representative sample. Additionally, this study aimed to assess associations between unmet mental health needs and these parental well-being measures. METHODS: Households with children ages 0-17 and complete data on UHCN in the combined 2016, 2017, 2018, and 2019 cohorts of the National Survey of Children's Health (NSCH) met inclusion criteria. Logistic regressions were used to evaluate associations between overall UHCN and outcome measures of parental coping, aggravation, emotional support, and neighborhood support. Associations between mental UHCN and these outcome measures were analyzed in a subset limited to children with mental health conditions. Regressions were adjusted for potential confounders, including demographics, household income, medical home status, and health insurance (adequacy/type). RESULTS: In our sample of 131,299 children, overall UHCN were associated with poorer parental coping (aOR = 5.35, 95% CI: [3.60, 7.95]), greater parental aggravation (aOR = 3.35, 95% CI: [2.73, 4.12]), and non-supportive neighborhood (aOR = 2.22, 95% CI: [1.86, 2.65]). Mental UHCN were similarly associated with parental coping and aggravation and neighborhood support in the mental health subset. CONCLUSIONS FOR PRACTICE: Healthcare professionals must address the needs of children with UHCN and collaborate with community organizations and child advocates to promote coordinated and comprehensive care and adequately support caregivers.

The COVID-19 pandemic and its potential enduring impact on children.

PURPOSE OF REVIEW: The COVID-19 pandemic has ushered in great and rapid change in our society. Although children are somewhat less likely to get infected or have severe symptoms from COVID-19, they are being adversely affected by this global public health emergency in many direct and indirect ways. This review focuses on the major areas in which children and adolescents are suffering, and how pediatricians can anticipate and optimize child healthcare and support as the COVID-19 pandemic and its aftermath continues. RECENT FINDINGS: This review provides preliminary insights into the physical, psychological, educational, developmental, behavioral, and social health implications of the pandemic on the pediatric population, highlighting both the pandemic's current and potential future impact on children. SUMMARY: The COVID-19 pandemic has and will likely continue to adversely affect many different aspects of children's health and well-being. It is important for pediatricians to be aware of these consequences of COVID-19 and take steps to help their patients now and in the future. Because the virus continues to ravage many parts of the world, continued research is needed to identify and evaluate any additional COVID-related challenges and concerns that adversely impact the growth and development of children.

Health care provider support and factors associated with breastfeeding beyond infancy: A cross-national study.

BACKGROUND: Breastfeeding beyond infancy (12 months) remains atypical in the United States, United Kingdom, Canada, and Australia, and the role of health care providers is unclear. The objective of this study was to compare women's perceptions of provider support and other factors affecting breastfeeding beyond infancy across countries, among women who had each successfully breastfed at least one child that long. METHODS: Women completed an online questionnaire distributed via La Leche League, USA (2013), about sources and ratings of support for breastfeeding for their oldest child who was breastfed at least 12 months and participant demographics. Multivariable log-binomial regression was used to compare ratings of health care provider support and the importance of 13 factors by country. RESULTS: Some similarities and many differences were observed across countries in support received from providers, whereas modest or no differences were observed in the importance women placed on factors like health benefits and enjoyment of breastfeeding. Of 59 581 women, less than half discussed their decision to breastfeed beyond infancy with their child's provider. United Kingdom women rated their comfort in discussing breastfeeding beyond 12 months with their providers and the support received as lower than United States women. Canadian women gave lower ratings than United States women, but inconsistently. Australian women rarely differed from United States women in their responses. Providers' recommendations were not important to the decision to breastfeed beyond infancy, especially for United Kingdom women. DISCUSSION: Rates of breastfeeding beyond infancy are low in these countries; improving provider support may help achieve global breastfeeding goals.

Wandering behavior in children with autism spectrum disorder and other developmental disabilities.

PURPOSE OF REVIEW: Approximately one in four children with autism spectrum disorder (ASD) 'elope' or wander away from supervision each year; however, many caregivers do not receive adequate information on how to address wandering behavior. The purpose of this review is to summarize the available research on elopement frequency, wandering patterns, and interventions to provide pediatricians and other childcare professionals with appropriate strategies to address wandering behavior. RECENT FINDINGS: Despite the high prevalence of wandering by children with ASD or other developmental disabilities, there is relatively limited research in this area. Recent research has identified common patterns and factors associated with risk of elopement and elopement frequency. SUMMARY: Pediatricians should counsel families on the common issues and intervention strategies related to elopement. By increasing awareness of wandering in children with ASD, caregivers can feel better prepared to make informed decisions regarding their child's wellbeing and safety.

Clinical correlates of laterality among school-age children in the United States.

Researchers have long been interested in whether lateral preference is associated with giftedness, season of birth, and/or ADHD constructs (short attention span, high level of activity, and impulsivity). The objective of this study was to examine these associations in a large, longitudinal sample of U.S. children (National Collaborative Perinatal Project (CPP), 1959-1973). Children born to women in this pregnancy cohort underwent a neonatal exam and an exam at age 7 years to assess lateral preference of the hand and eye, IQ on the Wechsler Intelligence Scale for Children (WISC), and ADHD symptoms. Children with perinatal/neonatal risk factors for neurologic impairment or early signs of neurological abnormality were excluded from our analyses. The final sample included 25,385 children. Associations between laterality and IQ were examined using linear and logistic regression models adjusted for sex, race, and socioeconomic status. Associations between laterality and ADHD symptoms and between season of birth and laterality were estimated using multivariable logistic regression. In this large, longitudinal study of neurologically healthy children, modest associations were observed between hand/eye preference and IQ and hyperactivity only.

Common parenting misconceptions regarding infant care: setting the record straight for parents (and some pediatricians).

PURPOSE OF REVIEW: First-time parents often turn to friends and family for advice regarding feeding, sleeping, bathing, diapering and toilet training, and childhood illnesses. Unfortunately, parents may at times be given incorrect and potentially dangerous advice as several widely embraced parenting practices are no longer deemed appropriate. In addition, young children are cared for by family and friends - many of whom are older and may still subscribe to outdated parenting practices.Parents and grandparents are not the only ones who subscribe to child care myths and misconceptions. Pediatricians also believe in the effectiveness of some outdated child care practices. Although some of these parenting myths are relatively benign, others may indeed pose a significant health risk or safety hazard to a young child. The purpose of this article is to review 10 commonly held myths or misconceptions regarding infant care. RECENT FINDINGS: In this review article, we not only highlight many of the studies that document which outdated health beliefs are still endorsed by parents and/or pediatricians, but also review the specific health risks associated with these parenting myths or misconceptions. SUMMARY: It is important that pediatricians educate parents and other primary caregivers about the potential risks of following outdated parenting practices.

Pharmacological cognitive enhancement in pediatrics.

PURPOSE OF REVIEW: Given the pervasiveness of psychotropic medication in the youth population and an increasingly competitive culture regarding educational performance, children, teenagers, and/or their parents may increasingly seek psychotropic substances in an effort to enhance a student's cognitive abilities and/or academic performance. Physicians must become aware of this very important and clinically relevant issue and work to ensure that medications remain in the hands of patients seeking wellness and not enhancement. RECENT FINDINGS: The current article highlights findings on the pervasiveness of stimulant misuse and diversion in youth, the motivations and effects of stimulant use, health and legal consequences associated with use, and physician perceptions and preventive practices. Ethical concerns regarding pharmacological cognitive enhancement in pediatrics are also outlined - including coercion for nonusers, inequities in access, and threats to an individual's sense of self with regard to authenticity and autonomy. SUMMARY: Pharmacological cognitive enhancement in pediatrics will become a larger, clinically relevant issue in the coming years. Physicians who care for children and adolescents must become more aware of this issue. Given the myriad health, legal, and ethical concerns, clinicians should discourage use of pharmaceuticals for enhancement purposes in the pediatric population.

Grandparents raising grandchildren: a primer for pediatricians.

PURPOSE OF REVIEW: To provide clinicians with a review of key considerations relating to the physical and behavioral well-being of children raised by their grandparents. RECENT FINDINGS: As the number of children being raised by their grandparents in the United States steadily increases, the needs of these families require greater attention. These children and their custodial grandparents face unique health, social, legal, and financial challenges. Children being raised by their grandparents are at higher risk for developmental and behavioral problems because of prior or current adverse family environments. Moreover, there is evidence that custodial grandparents may experience negative health, social, and financial outcomes that may constrain their ability to provide the best care for their grandchildren. SUMMARY: Pediatricians should not only be aware of the medical and developmental status of children who are being reared by their grandparents, but also assess the needs, abilities, and potential limitations of these custodial grandparents. In addition to providing useful parenting advice and direct support to custodial grandparents, pediatricians should refer these families as needed to local grandparenting groups, social service agencies, experienced legal counsel, and relevant national organizations for support and guidance.

Leaving the nest: anticipatory guidance for the college-bound youth.

PURPOSE OF REVIEW: The number of students enrolling in college is on the rise; however, the number of students dropping out is increasing as well. Given that the transition to attending college poses challenges with independent academic functioning, social adjustment, health behaviors, and lifestyle choices, the purpose of this review is to describe some of the issues that these students will encounter so that pediatricians can help teens who are going to college successfully transition to their new academic, social, and living environment. RECENT FINDINGS: Students who have the opportunity to go to college must successfully balance their scholastic commitments and their personal development outside the classroom. Their newfound independence poses several other challenges - obtaining adequate sleep, proper nutrition, and regular exercise as well as risks related to alcohol use, drug use, and sexual activity. SUMMARY: Pediatricians can play an important role by counseling college-bound teens about these common issues, perils and pitfalls. With anticipatory counseling focused on these concerns, pediatricians can help foster the personal growth and social/intellectual development of teenagers to better prepare them for success in college and then later in life.

Health implications of new-age technologies: a systematic review.

INTRODUCTION: New-age technologies are ubiquitous in the lives of adolescents. Recent trends in media use suggest that adolescents are spending more time than ever engaging with technologies, and are able to do so in virtually all settings at any time. Given that new-age technologies are so heavily integrated within the daily life of adolescents, the health risks and benefits they offer must be closely examined. EVIDENCE ACQUISITION: In this systematic review, we present recent literature related to the implications of new-age technologies on adolescent health. A total of 94 articles published since 2006 were collected using PubMed and Google Scholar on the most popular new-age technologies among adolescents: the internet, television, cell phones, and video games. EVIDENCE SYNTHESIS: The current body of research highlights several health risks related to these technologies. Nearly all have the potential for addiction, which can result in other symptoms and impair one's daily life. Excessive use can affect several components of health, such as quality of sleep, body composition, and mental well-being, and certain practices (viewing pornography, sexting) can lead to risky sexual behaviors. However, the technologies discussed in the present review also have tremendous potential to promote adolescent health. CONCLUSIONS: Pediatricians must educate parents and patients on how to safely use technology to minimize the potentially harmful outcomes.

Long-term neurodevelopmental benefits of breastfeeding.

PURPOSE OF REVIEW: The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of an infant#$#apos;s life, with continuation of breastfeeding for at least a year or as mutually desired by mother and child. A robust body of research literature documenting the short-term medical, developmental, and emotional benefits of breastfeeding for infants and toddlers supports this position. This article reviews the neurodevelopmental benefits of breastfeeding as it relates to preschool and school-age children, with particular emphasis on cognitive development, attention-deficit/hyperactivity disorder, and autism spectrum disorder. RECENT FINDINGS: The majority of research studies examining breastfeeding and long-term neurodevelopmental outcomes suggest that children who breastfeed for longer than 6 months have better cognitive outcomes, lower risk of developing attention-deficit/hyperactivity disorder, and lower risk of being diagnosed with autism spectrum disorder. SUMMARY: Pediatricians play a critical role in educating and counseling families about infant nutrition and feeding. Along with the many positive short-term medical effects that breastfeeding confers, physicians should be aware of the growing body of research suggesting that there are also significant long-term neurodevelopmental benefits of breastfeeding.

Teen victimization: prevalence and consequences of traditional and cyberbullying.

PURPOSE OF REVIEW: In recent years, there has been increased recognition that the experiences of youth who have endured bullying cannot be ignored or dismissed as harmless acts by 'kids being kids'. The present article reviews several key risks and consequences of bullying for adolescent victims. RECENT FINDINGS: Bullying victimization has been linked with a number of adverse health and social outcomes, including mental health issues, weapon-carrying, substance abuse, academic problems, and other adverse consequences - some of which may persist into adulthood. Recent findings on cyberbullying, in particular, highlight the real-life consequences of virtual victimization. SUMMARY: Pediatricians play a critical role in identifying and supporting victims of bullying and counseling parents about surveillance and intervention strategies.

What we do not know about ADHD yet.

PURPOSE OF REVIEW: This article provides an overview of current controversies in attention-deficit/hyperactivity disorder (ADHD) research, with an emphasis on recent findings that are directly relevant to clinical practice. RECENT FINDINGS: Over the past few years, a number of studies have added key evidence to ongoing debates about the epidemiology, nosology, and treatment of ADHD. Although the causes of the rising prevalence of ADHD in the USA are still not fully understood, recent research suggests that environmental factors and changes to the diagnostic criteria may have played a role. In addition, there continues to be controversy surrounding the clinical diagnosis of ADHD and newly recognized, related conditions such as sluggish cognitive tempo. Recent studies have also challenged previous assumptions about the long-term effects of stimulant treatment on growth, academic achievement, and substance use. Moreover, although most complementary and alternative therapies for ADHD appear to be ineffective, there is emerging evidence supporting the value of fatty acid supplementation. Although these findings are promising, more research is needed on all fronts. SUMMARY: Although research has shed light on unanswered questions about the epidemiology, nosology, and treatment of ADHD, much is still not known. An understanding of the most important current controversies in ADHD research may aid pediatricians in clinical decision making and allow them to counsel patients more effectively.

Pearls, perils, and pitfalls in the assessment and treatment of attention-deficit/hyperactivity disorder in adolescents.

PURPOSE OF REVIEW: To provide clinicians with an updated overview of key considerations related to the clinical assessment and management of attention-deficit/hyperactivity disorder (ADHD) in adolescents. RECENT FINDINGS: The American Psychiatric Association's recently revised Diagnostic and Statistical Manual of Mental Disorders-5 included significant changes regarding diagnostic criteria for ADHD in adolescents. The American Academy of Pediatrics (AAP) also recently revised their Clinical Practice Guidelines for ADHD; whereas prior guidelines were focused on children aged 6-12, the new guidelines extend up to age 17. An understanding of these revised diagnostic criteria and clinical guidelines is essential for pediatricians and others who care for adolescents. In addition to providing an updated review of the clinical approach to assessment and treatment of ADHD in adolescents, recent findings are briefly described relating to common comorbidities, psychosocial risks, and long-term outcome. SUMMARY: Diagnosis and treatment of adolescents with ADHD present unique challenges and obstacles. Clinicians need to be careful and deliberate in their evaluation of a teenager with recent-onset symptoms suggestive of ADHD, giving consideration to other conditions that could mimic ADHD and screening for common comorbid conditions. In terms of treatment of adolescents, the AAP recommends medication as the first-line intervention, noting that stimulants have a much broader evidence base and larger effect size than nonstimulants. Although clinicians now have a multitude of medication formulations to choose among, they must also be vigilant to the potential for stimulant misuse and diversion.

Health implications of new age technologies for adolescents: a review of the research.

PURPOSE OF REVIEW: Within the past 20 years, there have been profound advances in personal technology. Although adolescents have embraced the Internet, video games and smart phones, with their extraordinary potential for education, entertainment and connecting with peers, respectively, there is a 'dark side' to these new age technologies. This article identifies many of the adverse physical, psychological, developmental and emotional consequences of our new age technologies. RECENT FINDINGS: As Internet access has become easier, faster and more ubiquitous, there is increased evidence of its potential for direct and indirect harm to teens. Sexually explicit material is now indiscriminately available to youth, and studies have linked pornography with a number of negative health effects. Internet addiction is a problem even among teenagers who do not view pornography online. The rise of the Internet and social media sites now makes it easier for a student to bully a peer, and adolescents represent the majority of cyberbullying victims These technologies not only carry increased morbidity but also mortality, with increased suicides due to cyberbullying and motor vehicle deaths due to texting while driving. SUMMARY: Paediatricians play a critical role in educating adolescents and their parents about the risks associated with new age technologies.

Autism spectrum disorders: a pediatric overview and update.

PURPOSE OF REVIEW: To provide an updated overview of autism spectrum disorders (ASDs), with particular attention to the pediatrician's role in assessing and managing patients with ASDs. RECENT FINDINGS: Clinical perspectives on ASDs continue to evolve. The prevalence of ASDs in the United States continues to rise, and pediatricians are being tasked with the responsibility for universal screening. Further changes in its epidemiology will undoubtedly result from anticipated changes in the diagnostic criteria put forth in the upcoming revision to the Diagnostic and Statistical Manual (5th edition). Although there have been considerable advances in identifying a genetic cause in many more cases, the cause remains elusive in most cases. Recent studies of concordant twins suggest there is a stronger environmental component than previously believed. Research suggests earlier diagnosis may be feasible in some cases, and a new treatment approach has been shown to be effective in very young children. Although there have not been any large-scale advances in the medical treatment, some isolated successes have been reported and other promising therapies are now being investigated. SUMMARY: Clinical guidelines for ASDs are evolving, with updated diagnostic criteria expected and revised recommendations for evaluation also imminent. This article provides pediatricians with a clinical overview of ASD - with an emphasis on the clinical considerations relating to screening, evaluation, and management.

Associations Between Bullying and Condition Severity Among Youth With Chronic Health Conditions.

PURPOSE: Children with chronic conditions are at increased risk of bullying involvement. In addition to examining associations between chronic health conditions and both victimization and perpetration, this study investigated whether condition severity is associated with bullying involvement. METHODS: A secondary analysis of the 2018-2019 National Survey of Children's Health was performed. Children ages six-17 (n = 42,716) were classified as perpetrators (if bullied others ≥one-two times/month), victims-only (if victimized ≥one-two times/month and not a perpetrator) or uninvolved in bullying (neither perpetrator nor victim-only). Survey-weighted multinomial logistic regressions were used to investigate associations between bullying involvement and 13 chronic medical and developmental/mental health conditions. For children with conditions associated with being a victim and/or perpetrator, multinomial logistic regressions were used to further investigate associations between condition severity and victimization or perpetration. RESULTS: All 13 conditions were associated with higher odds of victimization. Seven developmental/mental health conditions were associated with higher odds of perpetration. Condition severity was associated with at least one domain of bullying involvement for one chronic medical and six developmental/mental health conditions. Notably, among children with attention-deficit/hyperactivity disorder, learning disability, or anxiety, condition severity was associated with higher odds of being a victim or bully/bully-victim. DISCUSSION: Condition severity may be a risk-factor for bullying involvement for many developmental/mental health conditions. Future condition-specific analyses are needed that directly examine bullying involvement among children with varying severity of individual conditions like attention-deficit/hyperactivity disorder, learning disability, and anxiety, using a clear operational definition for bullying, objective measures of condition severity, and multiple informants of bullying involvement.

Sports Team Participation and Vaping Among High School Students: 2015-2019.

BACKGROUND AND OBJECTIVES: Electronic vapor products (EVPs) have gained popularity among adolescents despite the health risks. This study aimed to evaluate whether sports team participation, a well-established protective factor against cigarette use, is similarly associated with decreased EVP use. METHODS: This cross-sectional study analyzed the 2015-2019 Youth Risk Behavior Survey cohorts. Survey-weighted logistic regressions investigated associations between sports team participation and past 30-day exclusive cigarette use, exclusive EVP use, and dual cigarette/EVP use among US high school students, adjusting for sex, grade, and survey year. RESULTS: The analytic cohort included 16 790 sports team participants (1.7% exclusive cigarette users, 18.3% exclusive EVP users, 5.5% dual users) and 13 972 nonparticipants (3.1% exclusive cigarette users, 13.4% exclusive EVP users, 7.6% dual users). Sports team participation was associated with lower odds of cigarette use (adjusted odds ratio [aOR], 0.58; 95% confidence interval [CI], 0.48-0.71) and dual use (aOR, 0.74; 95% CI, 0.63-0.88) and higher odds of EVP use (aOR, 1.39; 95% CI, 1.25-1.54). Among exclusive cigarette users and exclusive EVP users, sports team participation was associated with lower odds of frequent (≥20 days in the past month) than intermittent (1-19 days in the past month) cigarette use (aOR, 0.30; 95% CI, 0.19-0.49) and EVP use (aOR, 0.74; 95% CI, 0.61-0.91), respectively. CONCLUSIONS: Our findings suggest that risk profiles for cigarette and EVP use differ with respect to sports team participation. Given the health risks associated with EVP use, aggressive efforts must be taken to educate student athletes about the health risks of EVP use.

Complementary and alternative therapies for children and adolescents with ADHD.

PURPOSE OF REVIEW: To provide a comprehensive review of complementary and alternative medicine (CAM) treatments for children and adolescents with attention deficit hyperactivity disorder (ADHD). RECENT FINDINGS: Many parents of children with ADHD are reluctant to pursue medication options and unable to access behavioral counseling. CAM therapies are often appealing to families and studies show that a large percentage of children with ADHD are treated with one or more CAM therapy. Most research studies evaluating CAM therapies are methodologically flawed, and often times there are inconsistencies across either study design or results. Although the American Academy of Pediatrics does not recommend any CAM therapies for ADHD, essential fatty acid supplementation is likely well tolerated and modestly effective. SUMMARY: Most complementary and alternative treatments do not have adequate research to recommend their use in children with ADHD. Physicians should be aware of the many CAM treatment options and the research surrounding them in order to provide their patients with the most current and accurate information available.

Impact of Medication on Performance of Household Chores by Children with ADHD.

OBJECTIVE: To investigate associations between ADHD medication and household chore performance by children with ADHD. METHODS: A parent questionnaire collected information about the adequacy and quality of their child's performance of two self-care and six family-care chores. Parent perceptions of ADHD medication effect duration were used to identify children with after-school medication benefits (ASMB). Mann-Whitney U tests compared children with and without ASMB across measures of chore performance. RESULTS: A total of 565 parents of children with ADHD that regularly take medication completed the questionnaire. Children with ASMB were more likely to meet parental expectations for five of eight household chores and were more likely to be able to independently complete both self-care and family-care chores than those without ASMB. No differences were noted regarding their need for reminders or assistance with chores. CONCLUSION: Improvement in chore performance may be an additional consideration with respect to medication selection for children with ADHD.