American Academy of Pediatrics Recommended Cardiac Screening Questions in Preparticipation Physical Evaluation Forms.

To evaluate the utilization of the American Academy of Pediatrics' (AAP) cardiovascular screening questions within preparticipation physical evaluation forms from the 50 state high school athletic associations. We found that fewer than one-half of state forms incorporated all 10 AAP questions; moreover, a subset failed to adhere to criteria recommended by either the AAP or American Heart Association.

[Interpretation of 2023 American Heart Association and American Academy of Pediatrics focused update on neonatal resuscitation guidelines]. / 2023美国心脏协会与美国儿科学会新生儿复苏指南要点更新解读.

In November 2023, the American Heart Association and the American Academy of Pediatrics jointly released key updates to the neonatal resuscitation guidelines based on new clinical evidence. This update serves as an important supplement to the "Neonatal resuscitation: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care". The aim of this paper is to outline the key updates and provide guidance on umbilical cord management and the selection of positive pressure ventilation equipment and its additional interfaces in neonatal resuscitation.

Prospective study of thyroid function in the first year of life in infants with Down syndrome.

Current American Academy of Pediatrics (AAP) Guidelines recommend monitoring thyroid function in infants with Down syndrome (DS) at birth, 6 and 12 months, and annually thereafter. This study aimed to determine whether these guidelines are optimal for early diagnosis and treatment of (subclinical) hypothyroidism. Enrolled infants with DS less than age 7 months, born at ≥ 30 weeks gestation to monitor thyroid function test (TFT). A filter paper (FP) blood sample was analyzed for TSH and total T4 at ages 2 and 4 weeks and monthly thereafter until 12 months. Subjects with abnormal FP sample and confirmatory serum TFT for hypothyroidism promptly started treatment. Subjects with thyroid dysfunction identified had thyroid antibodies measured at diagnosis and 12 months. Descriptive statistics determined average time to diagnosis of abnormal TFT. Sixteen (30%) of 54 subjects were diagnosed with a thyroid disorder, the majority with subclinical hypothyroidism (SH) and 1 with hyperthyroidism. Diagnosis occurred in 6 (11%), 9 (17%), and 12 (22.2%) infants in the first 30, 60, and 90 days of life (DOL), respectively. Eight infants had an abnormal NBS and half were diagnosed with a thyroid disorder by DOL 8 and the remainder prior to 4 months. Among subjects with a normal NBS, four were diagnosed at a mean of 104 days and three at a mean of 101 days prior to the 6-month and 12-month routine screens, respectively.  Conclusion: Based on current AAP guidelines, thyroid disorder diagnosis would have been delayed in nearly 20% of the subjects. An additional TFT screen at 1 and 3 months can lead to earlier diagnosis and treatment. What is Known: • Current American Academy of Pediatrics (AAP) Guidelines recommend thyroid function tests (TFT) in infants with Down syndrome (DS) at birth and 6 and 12 months. • Peer- reviewed retrospective studies report an increased incidence of hypothyroidism in infants with DS undetected by the newborn screen (NBS) and prior to 6 months. What is New: • This prospective study monitored TFT in infants with DS at age 2 weeks and monthly throughout the first year of life. • The findings in this study support additional TFT screens at 1 and 3 months in infants with DS.

The NRP 8th Edition: Innovation in Education.

The American Academy of Pediatrics/American Heart Association Neonatal Resuscitation Program® (NRP®) 8th-Edition materials were released in June 2021 and must be in use by January 1, 2022. Ongoing international review and consensus of resuscitation science since 2015 has yielded no major changes in practice. However, the NRP Steering Committee revised several practices in the interest of patient safety and educational efficiency. The NRP 8th Edition offers NRP Essentials and NRP Advanced levels of learning and 2 recommended Provider Course formats. In most hospitals, NRP Essentials and NRP Advanced will be taught using instructor-led Provider Courses. Resuscitation Quality Improvement® (RQI® for NRP®), a self-directed learning program that uses low-dose, high-frequency quarterly learning and skills sessions, may be used in hospitals that already use RQI for life support education.

What is the best age to circumcise? A medical and ethical analysis.

Circumcision is often claimed to be simpler, safer and more cost-effective when performed in the neonatal period as opposed to later in life, with a greater benefit-to-risk ratio. In the first part of this paper, we critically examine the evidence base for these claims, and find that it is not as robust as is commonly assumed. In the second part, we demonstrate that, even if one simply grants these claims for the sake of argument, it still does not follow that neonatal circumcision is ethically permissible absent urgent medical necessity. Based on a careful consideration of the relevant evidence, arguments and counterarguments, we conclude that medically unnecessary penile circumcision-like other medically unnecessary genital procedures, such as 'cosmetic' labiaplasty-should not be performed on individuals who are too young (or otherwise unable) to provide meaningful consent to the procedure.

Can absence of pyuria exclude urinary tract infection in febrile infants? About 2011 AAP guidelines on UTI.

BACKGROUND: The aim of this study was to describe clinical and laboratory characteristics of urinary tract infection (UTI) without significant pyuria in young children aged 2-24 months. METHODS: The subjects consisted of infants and young children with febrile UTI treated at Pusan National University Children's Hospital, Korea. Group A included 283 patients with definite UTI who fulfilled the revised American Academy of Pediatrics diagnostic criteria, and group B included 19 patients with presumed UTI who had significant culture of uropathogens without pyuria, bacteriuria or other focus of infection. RESULTS: Duration of fever before hospital visit in group B was significantly shorter than in group A (17.7 ± 14.0 vs 34.5 ± 30.7 h). Most patients in group B (17/19, 89.5%) came to the hospital within 24 h of onset of fever. Acute scintigraphic lesions were found in 47.8% of patients in group A and 50% in group B. Underlying urological abnormalities such as vesicoureteral reflux and obstructive uropathy were found in 24.5% of patients in group A and in 33.3% of patients in group B (P = 0.74). CONCLUSIONS: Clinicians cannot exclude UTI on the absence of pyuria in young children aged 2-24 months.

Pediatric Care Online: A Pediatric Point-of-Care Tool.

Pediatric Care Online is the American Academy of Pediatrics' point-of-care tool designed for health care providers. Pediatric Care Online builds on content from Red Book Online and Pediatric Patient Education and features Quick Reference topic pages for more than 250 pediatric health care topics. The multitude of resources available within Pediatric Care Online will be reviewed in this column, and a sample search will be used to illustrate the type of information available within this point-of-care pediatric resource.

The US pediatric nephrology workforce: a report commissioned by the American Academy of Pediatrics.

The US pediatric nephrology workforce is poorly characterized. This report describes clinical and nonclinical activities, motivations and disincentives to a career in pediatric nephrology, future workforce needs, trainee recruitment, and possible explanations for personnel shortages. An e-mail survey was sent in 2013 to all identified US-trained or -practicing pediatric nephrologists. Of 504 respondents, 51% are men, 66% are US graduates, and 73% work in an academic setting. About 20% of trained pediatric nephrologists no longer practice pediatric nephrology. Among the 384 respondents practicing pediatric nephrology full or part-time in the United States, the mean work week was 56.1±14.3 hours, with time divided between patient care (59%), administration (13%), teaching (10%), clinical research (9%), basic research (6%), and other medical activities (3%). Most (>85%) care for dialysis and transplantation patients. The median number of weeks annually on call is 16, and 29% work with one or no partner. One-third of US pediatric nephrologists (n=126) plan to reduce or stop clinical nephrology practice in the next 5 years, and 53% plan to fully or partially retire. Almost half the division chiefs (47%) report inadequate physician staffing. Ongoing efforts to monitor and address pediatric nephrology workforce issues are needed.

Experience, knowledge, and opinions about childhood genetic testing in Batten disease.

BACKGROUND AND OBJECTIVES: Policies for genetic testing in children (GTIC) focus on medical or psychosocial benefit to the child, discouraging or prohibiting carrier testing, and advising caution regarding pre-symptomatic diagnosis if no treatment exists. This study sought to understand parents' perspectives on these issues and determine their experiences and knowledge related to genetic testing for Batten disease - a set of inherited neurodegenerative diseases of childhood onset for which no disease modifying therapies yet exist. METHODS: Parents of children with Batten disease completed a survey of their knowledge of genetics, experience with genetic testing, and opinions regarding GTIC. RESULTS: 54% had sought genetic testing for non-affected family members, including predictive diagnosis of healthy, at-risk children. Participation in any genetic counseling was associated with greater knowledge on questions about genetics. The majority of parents felt it was better to know ahead of time that a child would develop Batten disease, believed that this knowledge would not alter how they related to their child, and that parents should have the final say in deciding whether to obtain GTIC. CONCLUSIONS: Parents of children with an inherited disease are knowledgeable about genetics and wish to establish predictive or carrier status of at-risk children.

New Validated Tool to Diagnose Breastfeeding Dysfunction.

BACKGROUND: Breastfeeding behaviors and experiences exist on a continuum. What differentiates normal from dysfunctional is defined by frequency and severity. No current validated tool addresses the subjective experience of dyads with a predictive score that can be followed over time. RESEARCH AIM: To create and validate a self-report tool to assess breastfeeding and evaluate its ability to predict risk of breastfeeding dysfunction. METHODS: This study used a cross-sectional design to determine the validity of a novel instrument to assess breastfeeding dysfunction. We gave the initial questionnaire to 2085 breastfeeding dyads. We assessed content validity by comparison with other tools. We used exploratory factor analysis with varimax rotation for concept identification and Cronbach's alpha for internal consistency. We employed logistic regression to assess the tool's ability to differentiate between normal breastfeeding and breastfeeding dysfunction. RESULTS: Factor analysis mapped 17 questions to four concepts to create a score (FLIP; flow, latch, injury [to the nipple], and post-feed behavior). Internal consistency and reliability of the scores in these concepts were acceptable (Cronbach's alpha ≥ 0.087 for all measures). A logistic regression model that controlled for infant age, with a breastfeeding dysfunction risk classification threshold of 60%, yielded a correct classification of 88.7%, with 93.1% sensitivity, 64.6% specificity, and a 6.5% false positive rate. CONCLUSIONS: The FLIP score was determined to be a valid and reliable instrument for quantifying the severity of breastfeeding dysfunction in children under 1 year old. Further studies will assess its usefulness in the management of breastfeeding dysfunction.

The birth of pediatric urology in the United States: From pioneers to subcertification.

INTRODUCTION: Pediatric urology is a subspecialty of urology that emerged from a culture in which children with urological disorders were cared for by general urologists and general pediatric surgeons. The development of pediatric urology as a subspecialty was years in the making, highlighted by individuals who recognized that children with urological conditions were not just "small adults," but required special experience and training. Subspecialization was initiated by persistent visionaries who recognized the need for a trained cadre of experts to provide better care for children. It took the coordinated effort of all subgroups and leaderships in pediatric urology to push these efforts over the goal line. The focus of this review is to highlight certain individuals who played major roles in this vision and to document the efforts of many to coordinate the pathways to sub-specialization. METHODS: The careers of Meredith F. Campbell and Frank B. Bicknell were researched to identify their rationale and roles in developing pediatric urology as a distinct medical specialty in the United States. In addition, the minutes of the meetings of the Pediatric Urology Advisory Council (PUAC) with the American Board of Urology (ABU) were reviewed. The origins of the Society for Pediatric Urology (SPU) and the American Academy of Pediatrics Section of Urology (AAP-SOU) were researched. The contributions of each to the certification of pediatric urology as a distinct subspecialty was delineated. RESULTS: Campbell was Chair of Urology at the New York University (NYU) School of Medicine and wrote prolifically about pediatric urology. He published one of the first practical textbooks in pediatric urology, almost completely self-written, in 1937. Bicknell, a general urologist in Michigan on the faculty at Wayne State University School of Medicine, led the initiative to create the Society for Pediatric Urology (SPU) that first met at the 1951 annual American Urological Association (AUA) meeting in Chicago and included nine attendees. Subsequently, John Lattimer (College of Physicians and Surgeons at Columbia University) organized a well-attended meeting of urologists interested in pediatrics at the 1964 annual AAP meeting in New York City. This led to the formation of the AAP Section on Urology. Integral to the justification for the development of a subspecialty was evidence of a published corpus of content. In addition to published textbooks devoted exclusively to pediatric urology, this was further fulfilled by the AAP Section on Urology Pediatric Supplement to the Journal of Urology, first published in 1986, and later with the Journal of Pediatric Urology in 2005. The SPU and the AAP Section on Urology came together to form the Pediatric Urology Advisory Council (PUAC) in 2000, which worked with the ABU to create subspecialty certification in pediatric urology with an independent exam, first administered in 2008 to 176 applicants. CONCLUSION: The metaphor "We have stood on the shoulders of giants" is apt for pediatric urology: Meredith Campbell, Frank Bicknell, David Innes Williams (Hospital for Sick Children, London), and J. Herbert Johnston (Alder Hay Hospital, Liverpool) come to mind among the first generation of pediatric urology pioneers, and others among their colleagues also had significant impact. Clearly this is a story of persistence and attention to detail on the part of those giants and those who followed. Pediatric urology became a distinct discipline after the SPU and AAP-SOU came together to create a robust cohort of pediatric urologists who through education and negotiation were able to help the ABU and the American Board of Medical Specialties (ABMS) recognize that subspecialization would lead to better care for children with urologic disorders. This benchmark set a high bar for future subspecialization in urology and other fields.

Pediatric primary care provider practices, knowledge, and attitudes of human immunodeficiency virus screening among adolescents.

OBJECTIVES: To evaluate pediatric primary care provider (PCP) HIV screening practices, knowledge, and attitudes. STUDY DESIGN: Anonymous cross-sectional, internet-based survey of pediatric PCPs from 29 primary care practices. Survey items assessed current HIV screening practices and knowledge, attitudes, and perceived barriers towards screening. Provider demographics and practice characteristics were analyzed for associations with screening through logistic regression. RESULTS: Of 190 PCPs, there were 101 evaluable responses (response rate: 53.2%). PCPs reported a screening rate for HIV of 39.6% ("most" or "all of the time") during routine adolescent visits compared with violence (60.4%), substance abuse (92.1%), and depression (94.1%) (P < .001). Less than 10% of PCPs correctly answered questions related to Centers for Disease Control and Prevention and state HIV screening recommendations. Of 20 potential HIV screening barriers assessed, mean number of reported barriers was 4.8 (SD ± 2.9); with most concerns related to confidentiality, time for counseling, and follow-up. In a multivariable model, the only factor significantly associated with HIV screening "most" or "all of the time" during routine adolescent visits was urban practice site (aOR 9.8, 95% CI 2.9, 32.9). Provider type, sex, years since training, HIV screening guideline knowledge, and endorsing ≤5 barriers were not associated with HIV screening. CONCLUSIONS: Although providers practicing in urban areas were more likely to report screening adolescents for HIV than those in suburban areas, overall self-reported screening rates were low, and several barriers were identified commonly. Future interventions should target increasing providers' knowledge and addressing concerns about confidentiality, requirements and counseling time, and follow-up of results.

Hyponatremia in children with bronchiolitis admitted to the pediatric intensive care unit is associated with worse outcomes.

OBJECTIVE: To characterize the relationship between hyponatremia (serum sodium <135 mEq/L) and clinical outcomes in children ages 1 month to 2 years admitted to the pediatric intensive care unit (PICU) with bronchiolitis. STUDY DESIGN: Single-center retrospective cohort study comprising children who were admitted to the PICU between January 2009 and April 2011. Serum sodium concentrations, collected within the first 2 hours after admission to the PICU, were recorded and associations with clinical outcomes were calculated. Quantitative data are presented as mean ± SD or percentage. Student t-test, Fisher exact test, and χ(2) analyses were performed as appropriate. Subjects were excluded if they were previously diagnosed with chronic disease that would affect initial serum sodium concentration. RESULTS: Children with bronchiolitis were enrolled (n = 102; age = 10.7 ± 6.7 months). Twenty-three patients (22%) were diagnosed with hyponatremia within 2 hours of admission. Mortality (13% vs 0%; P = .011), ventilator time (8.41 ± 2 days vs 4.11 ± 2 days; P = .001), duration of stay in the PICU (10.63 ± 2.5 days vs 5.82 ± 2.09 days; P = .007), and noninvasive ventilator support (65% vs 24%; P = .007) were significantly different between subjects with hyponatremia vs those without. There were no differences in the number of patients with seizures, bronchodilator use, steroid use, intubation requirement, oxygen use at discharge, or hospital readmission. CONCLUSIONS: Pediatric patients diagnosed with bronchiolitis who present with a serum sodium concentration less than 135 mEq/L within 2 hours of admission to the PICU fare worse than their cohorts with normonatremia. A prospective study to evaluate the effects of hyponatremia appears justified.

Pediatric global health education: correlation of website information and curriculum.

OBJECTIVE: Web sites describing residency programs are initial sources of information for applicants. The correlation of global health content on pediatric residency program Web sites with reported curricula is unknown. To determine the accuracy of global health education, information on program Web sites was compared with queried program content responses. STUDY DESIGN: The Fellowship and Residency Electronic Interactive Database was used to assess pediatric residency programs' Web sites for global health education, applying American Academy of Pediatrics consensus guidelines. The authors developed a questionnaire using these consensus guidelines and contacted each program to assess Web site findings, and χ(2) tests were used to compare data from these 2 sources. RESULTS: Of 194 programs, 177 had operational Web sites, of which 98 participated in the questionnaire (55%). Ninety-three of 177 programs (53%) reported global health education on Web sites, whereas 80 of 98 programs (82%) reported global health education through direct questioning (P < .001). Results include provision of resident salaries during global health elective (Web site 5% vs questionnaire 98%, P < .001), mandatory training before global health elective (8% vs 20%, P = .02), presence of global health elective curriculum (24% vs 75%, P < .001), postexperience debriefing (16% vs 29%, P = .05), and bidirectional resident exchange (2% vs 13%, P = .01). CONCLUSIONS: Results indicate continued expansion of pediatric global health education, but significant differences exist between information on Web sites and data obtained through direct questioning. Accurate representation of global health opportunities would allow for more informed decision-making among prospective applicants. Findings also suggest substantial variability in global health curricula that needs to be addressed through improved planning and cooperation among training programs.

Young physicians' recall about pediatric training in ethics and professionalism and its practical utility.

OBJECTIVE: To assess the adequacy of ethics and professionalism education in residency by examining the recollections of young pediatricians in practice. STUDY DESIGN: We surveyed a random sample of members of the American Academy of Pediatrics Section on Young Physicians between February and June 2012. RESULTS: The majority of young pediatricians reported that ethics and professionalism were taught ad hoc in their training programs. Compared with physicians in practice for >5 years, those in practice for ≤ 5 years were significantly more likely to report having had an organized curriculum (72 of 181 [40%] vs 27 of 113 [24%]; P < .01) and that the ethics and professionalism training in their program was adequate (124 of 180 [69%] vs 62 of 113 [55%]). Of the topics encountered in practice by at least two-thirds of pediatricians, more than two-thirds of the respondents stated that residency training adequately prepared them to address issues of consent, privacy, truth-telling, and child abuse/neglect, but less than one-third felt adequately prepared to address conduct on social media and requests for prescriptions by family, friends, and colleagues outside of clinical encounters. CONCLUSION: The majority of recent graduates from pediatric training programs described themselves as competent to address the ethical and professionalism issues faced in practice, but nonetheless reported gaps in their education. As pediatric residency programs adopt more structured curricula for ethics and professionalism education, issues commonly faced by practitioners should be incorporated.

Urinary tract infections caused by community-acquired extended-spectrum ß-lactamase-producing and nonproducing bacteria: a comparative study.

OBJECTIVE: To study the clinical characteristics and associated risk factors of urinary tract infections (UTIs) caused by community-acquired extended-spectrum ß-lactamase (CA-ESBL)-producing Enterobacteriaceae. STUDY DESIGN: A case-control study at a large community hospital in northern Israel, comparing children who had UTI due to CA-ESBL (n = 25) and CA non-ESBL (n = 125) in 2008-2011. Data were collected from medical charts, telephonic questionnaires administered to all participants, and groups were compared. RESULTS: During the study period, the yearly incidence of CA-ESBL UTI increased significantly. There were no significant differences between the CA-ESBL and CA non-ESBL groups in demographics and clinical outcome. Compared with CA non-ESBL UTI, children with CA-ESBL UTI had a longer hospital stay (5.9 ± 3.3 vs 3.9 ± 2.3 days; P = .003) and higher rates of recent hospitalization (28% vs 4%; P = .001), previous UTI (40% vs 13%; P = .003), urinary tract anomalies (32% vs 5%; P < .001), UTI prophylaxis with cephalexin (32% vs 2%; P < .005), and aminoglycoside resistance. In a multivariate analysis, UTI prophylaxis (OR 12.5 [CI 2.7-58]), recent hospitalization (OR 4.8 [CI 1.1-21]), and Klebsiella spp. UTI (OR 4.7 [CI 1.3-17]), were risk factors for CA-ESBL UTI. CONCLUSIONS: Children prescribed UTI prophylaxis (due to urinary tract anomalies or recurrent UTI) with cephalexin and those with previous hospitalizations are at increased risk for CA-ESBL UTI. Although not associated with higher rates of complications, the multidrug resistant phenotype of CA-ESBL isolates poses a challenge in choosing appropriate empiric and definitive therapy and prolongs hospital stay.

Pediatric providers' attitudes toward retail clinics.

OBJECTIVE: To describe pediatric primary care providers' attitudes toward retail clinics and their experiences of retail clinics use by their patients. STUDY DESIGN: A 51-item, self-administered survey from 4 pediatric practice-based research networks from the midwestern US, which gauged providers' attitudes toward and perceptions of their patients' interactions with retail clinics, and changes to office practice to better compete. RESULTS: A total of 226 providers participated (50% response). Providers believed that retail clinics were a business threat (80%) and disrupted continuity of chronic disease management (54%). Few (20%) agreed that retail clinics provided care within recommended clinical guidelines. Most (91%) reported that they provided additional care after a retail clinic visit (median 1-2 times per week), and 37% felt this resulted from suboptimal care at retail clinics "most or all of the time." Few (15%) reported being notified by the retail clinic within 24 hours of a patient visit. Those reporting prompt communication were less likely to report suboptimal retail clinic care (OR 0.20, 95% CI 0.10-0.42) or disruption in continuity of care (OR 0.32, 95% CI 0.15-0.71). Thirty-six percent reported changes to office practice to compete with retail clinics (most commonly adjusting or extending office hours), and change was more likely if retail clinics were perceived as a threat (OR 3.70, 95% CI 1.56-8.76); 30% planned to make changes in the near future. CONCLUSIONS: Based on the perceived business threat, pediatric providers are making changes to their practice to compete with retail clinics. Improved communication between the clinic and providers may improve collaboration.

The correlates of preschoolers' compliance with screen recommendations exist across multiple domains.

OBJECTIVE: To investigate the individual, social and physical environment correlates of preschool children's compliance with Australian/Canadian and American Academy of Pediatrics (AAP) screen recommendations. METHOD: An Ecological Model (EM) was used to identify constructs potentially associated with children's screen time. In 2008-2009, parents in Melbourne, Australia, reported their child's screen time and on a range of potential correlates. Children (n = 935; 54% boys, mean age 4.54 ± 0.70 years) were assessed as meeting or not meeting each of the screen recommendations. Logistic regression assessed bivariable and multivariable associations. RESULTS: In total, 15 explanatory variables, across the three domains of the EM were associated with boys' and/or girls' compliance with either Australian/Canadian or AAP recommendations. Correlates varied by sex and recommendation. Maternal television viewing time was the only consistent correlate for both boys' and girls' compliance with both recommendations. No demographic groups were identified as being less likely to comply with screen recommendations. CONCLUSION: Public health programs should take account of the sex-specific nature of correlates of preschool children's screen time. Preschool children across all demographic groups need support to engage in less screen use. Parents may benefit from education and parenting skills to minimize potentially harmful effects of excessive screen time for their child.

Photoprotection: part II. Sunscreen: development, efficacy, and controversies.

In addition to the naturally occurring, physical, and systemic photoprotective agents reviewed in part I, topical ultraviolet radiation filters are an important cornerstone of photoprotection. Sunscreen development, efficacy, testing, and controversies are reviewed in part II of this continuing medical education article.

Maternal Postpartum Depression Screening and Referral in a Latinx Immigrant Population: A Quality Improvement Study.

Postpartum depression (PPD) is the most underdiagnosed obstetric complication in the United States. Left undiagnosed and untreated, PPD can have lasting effects on the infant and the mother. A quality improvement project was conducted to improve rates of screening and referrals with postpartum Latinx immigrant mothers. Community health workers were designated to assist with PPD screening and referral for behavioral health services, at a pediatric patient-centered medical home, using a referral process algorithm (Byatt, N., Biebel, K. & Straus, J. Postpartum Depression Screening Algorithm for Pediatric Providers During Well-Child Visits, MCPAP for Moms: Promoting maternal mental health during and after pregnancy, N/A (2014)). Using chi analysis of pre and post implementation findings, results demonstrated a 21% increase in screening of eligible postpartum mothers. Referrals for behavioral health services also increased from 9 to 22% of patients that screened positive. Community Health Workers were an asset in increasing screening and referral practices for PPD in a Latinx immigrant population. Further research efforts will assist to remove further barriers to PPD screening and treatment.