Screen Exposure During Daily Routines and a Young Child's Risk for Having Social-Emotional Delay.

This cross-sectional study assessed associations between social-emotional development in young children and their number of daily routines involving an electronic screen. We hypothesized children with poor social-emotional development have a significant portion of daily routines occurring with a screen. Two hundred and ten female caregivers of typically developing children 12 to 36 months old completed the Ages and Stages Questionnaire: Social-Emotional (ASQ: SE) and a media diary. Caregivers completed the diary for 1 day around 10 daily routines (Waking Up, Diapering/Toileting, Dressing, Breakfast, Lunch, Naptime, Playtime, Dinner, Bath, and Bedtime). Median number of daily routines occurring with a screen for children at risk and not at risk for social-emotional delay (as defined by the ASQ: SE) was 7 versus 5. Children at risk for social-emotional delay were 5.8 times more likely to have ≥5 routines occurring with a screen as compared to children not at risk for delay (χ12 = 9.28, N = 210, P = .002; 95% confidence interval = 1.66-20.39).

Pediatrician identification of child behavior problems: the roles of parenting factors and cross-practice differences.

While most primary care pediatricians acknowledge the importance of identifying child behavior problems, fewer than 2% of children with a diagnosable psychological disorder are referred for mental health care in any given year. The present study examined the potential role of parental characteristics (parental affect, parenting style, and parenting self-efficacy) in pediatrician identification of child behavior problems, and determined whether these relationships differed across practices. Parents of 831 children between 2 and 16 years completed questionnaires regarding demographic information, their child's behavior, their affect, their parenting style, and their parenting self-efficacy. Pediatricians completed a brief questionnaire following visits in four community-based primary care practices in the Midwest. Logistic regressions controlling for child behavior and demographic predictors of pediatrician identification found that an authoritarian parenting style, in which parents yell or strongly negatively react to problem behavior, was negatively associated with likelihood of identification in the overall sample. However, the variables that were predictive of pediatrician identification differed depending on the specific practice. Parental characteristics can aid in understanding which children are likely to be identified by their pediatrician as having behavioral problems. The finding that practices differed on which variables were associated with pediatrician identification suggests the need to potentially individualize interventions to certain physicians and practices to improve identification of child behavior problems in primary care.

Peering into the future: pediatrics in a changing world.

Over the last decade, health care has experienced continuous, capricious, and ever-accelerating change. In response, the American Academy of Pediatrics convened the Vision of Pediatrics (VOP) 2020 Task Force in 2008. This task force was charged with identifying forces that affect child and adolescent health and the implications for the field of pediatrics. It determined that shifts in demographics, socioeconomics, health status, health care delivery, and scientific advances mandate creative responses to these current trends. Eight megatrends were identified as foci for the profession to address over the coming decade. Given the unpredictable speed and direction of change, the VOP 2020 Task Force concluded that our profession needs to adopt an ongoing process to prepare for and lead change. The task force proposed that pediatric clinicians, practices, organizations, and interest groups embark on a continual process of preparing, envisioning, engaging, and reshaping (PEER) change. This PEER cycle involves (1) preparing our capacity to actively participate in change efforts, (2) envisioning possible futures and potential strategies through ongoing conversations, (3) engaging change strategies to lead any prioritized changes, and (4) reshaping our futures on the basis of results of any change strategies and novel trends in the field. By illustrating this process as a cycle of inquiry and action, we deliberately capture the continuous aspects of successful change processes that attempt to peer into a multiplicity of futures to anticipate and lead change.

Pediatrics in the year 2020 and beyond: preparing for plausible futures.

Although the future of pediatrics is uncertain, the organizations that lead pediatrics, and the professionals who practice within it, have embraced the notion that the pediatric community must anticipate and lead change to ultimately improve the health of children and adolescents. In an attempt to proactively prepare for a variety of conceivable futures, the board of directors of the American Academy of Pediatrics established the Vision of Pediatrics 2020 Task Force in 2008. This group was charged to think broadly about the future of pediatrics, to gather input on key trends that are influencing the future, to create likely scenarios of the future, and to recommend strategies to best prepare pediatric clinicians and pediatric organizations for a range of potential futures. The work of this task force led to the development of 8 "megatrends" that were identified as highly likely to have a profound influence on the future of pediatrics. A separate list of "wild-card" scenarios was created of trends with the potential to have a substantial influence but are less likely to occur. The process of scenario-planning was used to consider the effects of the 8 megatrends on pediatrics in the year 2020 and beyond. Consideration of these possible scenarios affords the opportunity to determine potential future pediatric needs, to identify potential solutions to address those needs, and, ultimately, to proactively prepare the profession to thrive if these or other future scenarios become realities.

Role of the medical home in family-centered early intervention services.

There is growing evidence that early intervention services have a positive influence on the developmental outcome of children with established disabilities as well as those who are considered to be "at risk" of disabilities. Various federal and state laws now mandate the establishment of community-based, coordinated, multidisciplinary, family-centered programs that are accessible to children and families. The medical home, in close collaboration with the family and the early intervention team, can play a critical role in ensuring that at-risk children receive appropriate clinical and developmental early intervention services. The purpose of this statement is to assist the pediatric health care professional in assuming a proactive role with the interdisciplinary team that provides early intervention services.