Attitudes and perceived barriers to firearm safety anticipatory guidance by pediatricians: a statewide perspective.

BACKGROUND: Firearms are the second leading cause of injury-related death in American children. Safe storage of firearms is associated with a significantly decreased odds of firearm-related death, however more than half of US firearm owners store at least one firearm unlocked or accessible to a minor. While guidance by primary care providers has been shown to improve storage practices, firearm safety counseling occurs infrequently in the primary care setting. The primary objective of this study was to describe pediatricians' perceived barriers to providing firearm safety education to families in the pediatric primary care setting. Secondary objectives included identifying pediatric provider attitudes and current practices around firearm counseling. METHODS: This was a cross-sectional survey of pediatric primary care providers in Ohio. Participants were recruited from the Ohio AAP email list over a 3-month period. Only pediatric primary care providers in Ohio were included; subspecialists, residents and non-practicing physicians were excluded. Participants completed an anonymous online survey detailing practice patterns around and barriers to providing firearm safety counseling. Three follow-up emails were sent to pediatricians that failed to initially respond. Response frequencies were calculated using Microsoft Excel. RESULTS: Two hundred eighty-nine pediatricians completed the survey and 149 met inclusion criteria for analysis. One hundred seven (72%) respondents agreed that it is the responsibility of the pediatric primary care provider to discuss safe storage. Counseling, however, occurred infrequently with 119 (80%) of respondents performing firearm safety education at fewer than half of well child visits. The most commonly cited barriers to providing counseling were lack of time during office visits, lack of education and few resources to provide to families. A majority, 82 of pediatric providers (55%), agreed they would counsel more if given additional training, with 110 (74%) conveying they would distribute firearm safety devices to families if these were available in their practice. CONCLUSION: Ohio pediatricians agree that it is the responsibility of the primary care provider to discuss firearm safety. However, counseling occurs infrequently in the primary care setting due to a lack of time, provider education and available resources. Improving access to resources for primary care pediatricians will be critical in helping educate families in order to protect their children through improved storage practices.

Prevention of Drowning.

Drowning is a leading cause of injury-related death in children. In 2018, almost 900 US children younger than 20 years died of drowning. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in prevention of drowning.

Coming Together to Save Babies: Our Institution's Quality Improvement Collaborative to Improve Infant Safe Sleep Practices.

Many hospitalized infants are not observed in an American Academy of Pediatrics-recommended safe sleep environment, which can translate to unsafe sleep practices at home. We implemented this collaborative to reduce our county's sleep-related death rate by improving infant safe sleep practices in the freestanding children's hospital setting and increasing safe sleep screening and education in our clinics and emergency departments (EDs). METHODS: Physicians from our institution's primary care clinics, EDs, neonatal intensive care units, and general inpatient units created and led multidisciplinary safe sleep teams. Teams have used standardized data tools to collect information on infant patient ages and sleep position and environment, both in the hospital and at home. Based on audit data, teams have implemented multiple Plan-Do-Study-Act cycles during this collaborative. We have calculated changes in safe sleep practices in the hospital and changes in screening and education on safe sleep behaviors over time. RESULTS: Our teams have significantly increased compliance with safe sleep practices in the inpatient and neonatal intensive care unit settings (P < 0.01). We have also increased screening and education on appropriate safe sleep behaviors by ED and primary care providers (P < 0.01). Our county's sleep-related death rate has not significantly decreased during the collaborative. CONCLUSIONS: Our collaborative has increased American Academy of Pediatrics-recommended safe sleep practices in our institution, and we decreased sleep-related deaths in our primary care network. We have created stronger ties to our community partners working to decrease infant mortality rates. More efforts will be needed, both within and outside of our institution, to lower our community's sleep-related death rate.

Personalising Safe Sleep Messaging for Infant Caregivers in the United States.

The purpose of our study was to better understand why parents/caregivers might not practice safe sleep behaviours. In autumn 2016, we conducted 'pulse' interviews with 124 parents/caregivers of children under the age of one year at a variety of local community events, festivals and meetings in cities with high infant mortality rates around the Midwestern US state of Ohio. Through an inductive approach, pulse interviews were analysed using thematic coding and an iterative process which followed for further clarification of themes (Qualitative Research in Psychology, 2006, 3, 77; BMC Medical Research Methodology, 2013, 13, 117). The six major themes of underlying reasons why parents/caregivers might not practice safe sleep behaviours that were identified in our coding process included the following: (a) culture and family tradition, (b) knowledge about safe sleep practices, (c) resource access, (d) stressed out parents, (f) lack of support and (g) fear for safety of baby. Using the descriptive findings from the pulse interviews, qualitative themes and key informant validation feedback, we developed four diverse fictional characters or personas of parents/caregivers who are most likely to practice unsafe sleep behaviours. These personas are characteristic scenarios which imitate parent and caregiver experiences with unsafe sleep behaviours. The personas are currently being used to influence development of health promotion and education programs personalised for parents/caregivers of infants less than one year to encourage safe sleep practices.

The EASE Project Revisited: Improving Safe Sleep Practices in Ohio Birthing and Children's Hospitals.

Literature has shown hospitalized infants are not often observed in recommended safe sleep environments. Our objective was to implement a quality improvement program to improve compliance with appropriate safe sleep practices in both children's and birthing hospitals. Hospitalists from both settings were recruited to join an Ohio American Academy of Pediatrics collaborative to increase admitted infant safe sleep behaviors. Participants used a standardized tool to audit infants' sleep environments. Each site implemented 3 PDSA (Plan-Do-Study-Act) cycles to improve safe sleep behaviors. A total of 37.0% of infants in children's hospitals were observed to follow the current American Academy of Pediatrics recommendations at baseline; compliance improved to 59.6% at the project's end (P < .01). Compliance at birthing centers was 59.3% and increased to 72.5% (P < .01) at the collaborative's conclusion. This study demonstrates that a quality improvement program in different hospital settings can improve safe sleep practices. Infants in birthing centers were more commonly observed in appropriate sleep environments than infants in children's hospitals.

Prevention of Drowning.

Drowning is a leading cause of injury-related death in children. In 2017, drowning claimed the lives of almost 1000 US children younger than 20 years. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in the prevention of drowning.

Septic Arthritis, Osteomyelitis, and Pyomyositis in a Previously Healthy Infant.

Septic arthritis of the shoulder is rare in the pediatric population. In younger children and infants, it can be very difficult to diagnose. Septic arthritis of the shoulder is more commonly associated with concurrent osteomyelitis when compared to septic arthritis of the lower extremity. We describe a case of a 9-month-old patient with septic arthritis, osteomyelitis, and pyomyositis of the shoulder, and a discussion of diagnosis and management of pediatric bone and joint infection in the emergency department setting.

Rare-Earth Magnet Ingestion-Related Injuries in the Pediatric Population: A Review.

Foreign-body ingestions are common among children and usually resolve with limited, if any, treatment. The ingestion of rare-earth magnets, however, commonly results in serious injury or death. These dangerous high-powered magnets can be found in the United States in a variety of consumer products, including magnetic toy sets designed for children and adults. The ingestion of one of such magnet is unlikely to cause significant harm. However, if multiple magnets are ingested, or if a magnet is ingested along with a metal object, the magnets are powerful enough to attract each other through the walls of the intestine, potentially resulting in significant internal damage. Rare-earth magnet ingestion cases are difficult to diagnose and the symptoms are not easy to differentiate from other causes of gastrointestinal illness or pain. However, delays in medical treatment can lead to serious injury or death. This review article describes the epidemiology of rare-earth magnet ingestion-related injuries and provides recommendations for diagnosis and treatment. Federal regulatory efforts related to rare-earth magnets and other prevention strategies are also discussed.

The EASE Quality Improvement Project: Improving Safe Sleep Practices in Ohio Children's Hospitals.

BACKGROUND: Despite American Academy of Pediatrics (AAP) recommendations, many hospitalized infants are not observed in the appropriate safe sleep environment. Caregivers tend to model sleep patterns observed in a hospital setting. This project assessed the change in infant safe sleep practices within 6 children's hospitals after the implementation of a statewide quality improvement program. METHODS: The AAP recruited hospitalists from each of the state's children's hospitals and asked them to form "safe sleep teams" within their institutions. Teams used a standardized data tool to collect information on the infant's age and sleep position/environment. They collected baseline data and then weekly for the duration of the 12-month project. Teams were required to implement at least 3 Plan-Do-Study-Act cycles. We calculated changes in safe sleep practices over time. Providers received Maintenance of Certification Part IV credit for participation. RESULTS: Teams collected 5343 audits at all participating sites. At baseline, only 279 (32.6%) of 856 of the sleeping infants were observed to follow AAP recommendations, compared with 110 (58.2%) of 189 (P < .001) at the project's conclusion. The presence of empty cribs was the greatest improvement (38.1% to 67.2%) (P < .001). Removing loose blankets (77.8% to 50.0%) (P < .001) was the most common change made. Audits also showed an increase in education of families about safe sleep practices from 48.2% to 75.4% (P < .001). CONCLUSIONS: Multifactorial interventions by hospitalist teams in a multi-institutional program within 1 state's children's hospitals improved observed infant safe sleep behaviors and family report of safe sleep education. These behavior changes may lead to more appropriate safe sleep practices at home.