Routine screening for adverse childhood experiences (ACEs) still doesn't make sense.

When a serious health or social problem is identified as both prevalent and in need of attention, a common response is to propose that various systems implement routine identification, such as universal screening. However, these well-intentioned responses often fail to consider the key requirements necessary to determine whether benefits outweigh harms. Unfortunately, this continues to be the case for calls to implement routine screening for Adverse Childhood Experiences (ACEs). Persistent evidence gaps for this type of screening include the lack of any randomized controlled trials demonstrating that ACEs screening programs lead to any benefits. Rather than being informed by established screening principles, the calls to proceed with ACEs screening appear to rely on the assumption that simply identifying risk factors can lead to beneficial outcomes that outweigh any risk of harms. This may reflect a gap in understanding that patterns identified at the population level (e.g., that more ACEs are associated with more health and social problems) cannot be directly translated to practices at the level of the individual. This commentary does not question the importance of ACEs; rather it identifies that directing limited resources to screening approaches for which there is no evidence that benefits outweigh harms is problematic. Instead, we advocate for the investment in high-quality trials of prevention interventions to determine where best to direct limited resources to reduce the occurrence of ACEs, and for the prioritization of evidence-based treatment services for those with existing health and social conditions, whether or not they are attributed to ACEs.

Do parenting behaviors intended as discipline vary by household religious affiliation in Cameroon?

BACKGROUND: Religious affiliation may account for some variance in parenting behaviors used for disciplinary intent. However, most reported studies of this relationship are limited to high-income countries focused on Christianity. OBJECTIVE: This study aimed to determine whether parenting behaviors vary by religion in a low- and middle-income country between Protestant, Catholic, and Muslim groups. It was hypothesized that Protestant households would have higher odds of select parenting behaviors. PARTICIPANTS & SETTINGS: Data from the 2014 Cameroonian Multiple Indicator Cluster Survey, containing a nationally representative household sample, were used. METHODS: Adult caregivers in selected households with a child aged 1-14 years of age participated in interviews containing a standardized disciplinary measure asking about the exposure of one randomly selected child to a series of parent behaviors in the preceding month. RESULTS: Of the 4978 households, 41.6 % were Catholic, 30.9 % Protestant and 27.6 % Muslim. Spanking was the most common of the six types of physical punishments across groups with no association with household religion. In contrast, children in Protestant households had higher odds of being hit with an object compared to the other two groups, but only for younger children. Children in Protestant households also had higher odds of exposure to a combined approach, i.e., use of physical, psychological, and non-violent parent behaviors. CONCLUSIONS: This study advances the examination of the potential influence of household religion on parenting behavior, however further inquiry is needed to examine these patterns in other settings with additional indices of religiosity and disciplinary beliefs.

Service Use Patterns by Children With Down Syndrome in a Canadian Region.

Children with Down syndrome require services from different sectors over time to optimize health and development, however, there is little information on longitudinal, cross-sector service use. Parents of children with Down syndrome attending a Canadian children's hospital participated in semistructured interviews covering life-time multiple sector service use. Five key service patterns were identified: (1) primary care physicians playing a circumscribed role; (2) a marked shift in public habilitative service receipt from development agencies in the preschool years to exclusive school delivery after school entry; (3) families obtaining private services to address gaps from public sector services; (4) a prominent role for parents to identify additional services; and (5) service variability as a function of timing and severity of medical comorbidity.

A mixed method inquiry of early complementary feeding of infants in the Dominican Republic.

Exclusive breastfeeding (EBF) is infrequent and decreasing over time in the Dominican Republic. This study aimed to identify patterns of, and women's rationale for, early complementary feeding. Mothers of children under 12 months of age living in a low-resource peri-urban community had three opportunities to contribute: (i) responding to feeding questions embedded in a standardized questionnaire used at a well-baby clinic (n = 101), (ii) participating in focus groups (n = 31), and (iii) engaging in home-based, semi-structured individual interviews (n = 25). Quantitative questionnaire data were analyzed to identify feeding practices as a function of child age. Textual data from the individual interviews and focus groups were systematically reviewed and coded to identify key constructs through a qualitative descriptive approach. The majority (>86%) of mothers reported breastfeeding at all monthly age bands up to six months. However, EBF was rare, with more than half reporting use of other milks and other foods by the infants' second and fifth month, respectively. Overarching themes to explain early complementary feeding from the qualitative data can be broadly captured by the complementary perceptions that there are problems with relying on breastfeeding alone and that there are benefits to early complementary feeding in the early months of an infant's life. EBF was experienced as (A) insufficient, (B) not always available, (C) sometimes not safe, (D) having potentially negative effects on the mother, and (E) bringing challenges. Complementary feeding was identified as helpful in addressing each of these concerns. Although mothers typically endorsed breastmilk as the preferable and best option for infant feeding, this did not translate into EBF and was not presented as contradictory to the use and perceived benefits of early complementary feeds.

Arguments for Keeping Child & Adolescent Psychiatry Focused on Persons Under 18 Years of Age.

Child and adolescent psychiatrists and their associations are grappling with the idea of restructuring their subspecialty to including transitional age youth (TAY), sometimes operationalized as persons 18-25 years of age. This consideration is currently before the Canadian Academy of Child and Adolescent Psychiatry (CACAP). This essay identifies several concerning and potentially harmful consequences of widening the age range of child and adolescent psychiatry. A key concern is the consequential and substantial increase in the population mandate which will significantly dilute already strained and limited child and adolescent psychiatry resources. Furthermore, the nature of some of the needs of TAY may preferentially divert resources away from younger patients. The change in age range will also disrupt existing partnerships which facilitate multidisciplinary care and needed efficiencies for the child and adolescent population, such as close working ties with pediatrics and schools. This is not to say that there may not be merit in child and adolescent psychiatrists contributing to the care of TAY, just as our members already contribute to other areas of mental health outside our immediate mandate. However, to advance such a mandate change, a threshold of evidence of a net beneficial impact including a systematic evaluation of potential harms and opportunity costs is needed. Unfortunately, such an assessment has not yet occurred and therefore a mandate and name change is premature. We recommend a much more deliberate evaluation of the role child and adolescent psychiatrists and their associations might play in contributing to the needs of TAY.

Les psychiatres pour enfants et adolescents et leurs associations sont aux prises avec l'idée de restructurer leur surspécialité en y incluant des jeunes d'âge transitionnel (JAT), parfois concrétisés comme étant des personnes de 18 à 25 ans. L'idée est présentement prise en considération par l'Académie canadienne de psychiatrie de l'enfant et de l'adolescent (ACPEA). Le présent essai identifie plusieurs conséquences préoccupantes et éventuellement nuisibles d'élargir le groupe d'âge de la psychiatrie de l'enfant et de l'adolescent. Une préoccupation essentielle est l'augmentation conséquente et substantielle du mandat dans la population, qui diluera significativement les ressources déjà grevées et limitées de la psychiatrie de l'enfant et de l'adolescent. En outre, la nature de certains besoins des JAT peut détourner préférentiellement des ressources des patients plus jeunes. Le changement de groupe d'âge dérangera aussi les partenariats existants qui facilitent les soins multidisciplinaires et les efficacités nécessaires pour la population des enfants et adolescents, comme des liens de travail étroits avec des pédiatres et des écoles. Cela ne veut pas dire qu'il ne puisse pas y avoir de mérite à ce que des psychiatres pour enfants et adolescents contribuent aux soins des JAT, tout comme nos membres contribuent déjà à d'autres domaines de la santé mentale, hors de notre mandat immédiat. Cependant, pour mettre de l'avant un tel changement de mandat, il faut un niveau de preuve d'un effet bénéfique net, notamment une évaluation systématique des dommages potentiels et des coûts de renonciation. Malheureusement, cette évaluation n'a pas encore eu lieu et par conséquent, un changement de mandat et de nom est prématuré. Nous recommandons une évaluation beaucoup plus consciente du rôle que peuvent jouer les psychiatres pour enfants et adolescents et leurs associations dans la contribution aux besoins des JAT.

Limited Reduction in Anemia in Children in a Low-Income Community Offered Iron Treatment Despite a Quality Improvement Initiative.

This study aimed to determine whether better hematological outcomes were attained in young anemic (hemoglobin <11.0g/dl) children following a quality improvements initiative (QII) of a basic anemia screening and iron treatment approach in a low-income community. Pre-post changes in two anemic cohorts, one before (cohort A, n=115) and one after (Cohort B, n=106) a QII, were determined using data from a well-baby clinic in the Dominican Republic. More anemic children in Cohort B had documented anemia resolution than Cohort A, 16.0 versus 7.0%, respectively. For the subgroups with post treatment hemoglobin results, Cohort B (n=65) had a larger pre-post hemoglobin increase than Cohort A (n=62), 0.88 (SD 1.04) versus 0.43 (SD 0.96) g/dl, respectively. However, not all the parameters were significantly better for Cohort B and most children remained anemic in both cohorts post treatment. Determination of more effective service interventions to address childhood anemia in low-resource settings is needed.

Cross-sector service use patterns among children with developmental disabilities in a district in Canada.

BACKGROUND: There is a lack of information about cross-sector service use by children with developmental disabilities despite their need for services from multiple sectors. METHODS: Responses to service use questions from a parent-completed survey on school-aged children who attended clinics specific for those with developmental disabilities at a Canadian children's hospital were examined. RESULTS: School meetings were the most common of three professional meeting types attended in the last 12 months (64.9%) for the sample of 205 children. Recreational services were the most common of five service types received in the same time period (79.0%). Using ordinal logistic regression models, a higher number of behavioural difficulties was the only variable consistently related to indices of more meeting types (school, physician, other) attended and more service types received (recreation, respite, etc.). CONCLUSIONS: The service relationship with behavioural problems, and not socio-demographic variables, is consistent with a needs-based oriented delivery system.