Urban Teen Perspectives on Gun Violence: a Mixed Methods Study.

We aimed to explore perspectives of teenagers on their exposure to gun violence (GV), their knowledge and attitudes towards firearm injury prevention (FIP) efforts, and how to counsel them about FIP. Teens from two single-sex Bronx Catholic high schools participated in videoconferencing focus groups. Participants completed an online survey collecting demographic information and Likert-scale scoring of attitudes towards GV. Quantitative data was analyzed with descriptive statistics. Focus group discussions were recorded and transcribed. Using Dedoose, two investigators independently coded data and achieved consensus using content analysis. Six focus groups (3 from each school, n = 28 participants) were held from October-November 2020. A total of 27 participants completed the survey. Eighty-one percent of respondents agreed "Doctors should talk to teens about gun safety." During focus groups, participants reported personal, community, and entertainment media exposure to GV. GV elicited many emotions, including fear and frustration. Teens identified factors contributing to GV that should be addressed, including poverty, racism, and mental illness. Most had not received prior FIP education and desired more information from trusted adults. They preferred discussions over written materials and information given over time. Teens were open to doctors counseling on FIP during healthcare visits and suggested including screening questions on surveys, conversations during healthcare maintenance visits, and classroom talks by physicians. Bronx teens are exposed to and distressed by community GV. They desired more FIP education, including physician counseling during healthcare visits. Next steps are to create and test FIP guidance for adolescents.

A Parent Survey Assessing Association of Exposure to Gun Violence, Beliefs, and Physician Counseling.

OBJECTIVES: The study objectives are to assess associations between hospitalized children's parental exposure to gun violence (GV) and parental beliefs about guns and gun safety; secondarily, the authors aim to describe parental views on the pediatrician's role in firearm injury prevention (FIP) counseling. METHODS: Parents residing with children <20 years old hospitalized at a quaternary care hospital in a large city were eligible. Researchers administered verbal surveys between March 2017 and July 2019. We analyzed data (Wilcoxon rank-sum, χ2, or Fisher's exact tests, as appropriate) to compare the characteristics of those with exposure to GV and those without, and to assess associations of those with and without GV exposure with various beliefs. RESULTS: Enrollment included 225 parents or guardians. Although 75.5% agreed pediatricians should talk to parents about safe gun storage, 8.9% reported FIP counseling by their child's doctor. There were no substantial differences in characteristics between those with GV exposure versus those without. The study revealed that 60.0% of participants reported hearing gunshots, and 41.8% had a friend/relative who had been shot; only 29.8% reported neither. There were no differences between groups in gun-related beliefs regardless of exposure. CONCLUSIONS: In this population, there was no association between exposure to GV and gun-related beliefs. Most parents are receptive to FIP counseling, yet few have discussed FIP with their pediatrician despite high exposure to GV in this community. Nearly all parents agreed with the use of gunlocks and stricter laws for background checks. Regardless of exposure to GV, parents agreed with safe gun storage and support strengthening gun safety laws.

A Randomized Controlled Trial for Parents of Hospitalized Children: Keeping Kids Safe From Guns.

OBJECTIVES: To assess an educational intervention (BeSMART) for parents of hospitalized children on behaviors, beliefs, and knowledge about firearm safety. METHODS: A randomized controlled, 3-arm preintervention and postintervention study compared BeSMART video and handout interventions (with and without physician review) to tobacco smoke videos and handouts (control) on parental behaviors, beliefs, and knowledge. Eligibility criteria included parents and/or guardians residing with hospitalized children aged <20 years. The primary outcome was a change in parent-reported frequency of asking about guns in homes visited by their children preintervention to 1 month after intervention. Secondary outcomes were parent-reported likelihood of asking about guns in others' homes immediately postintervention and change in firearm safety beliefs and/or knowledge in the intervention versus control group, analyzed with analysis of variance. McNemar's and paired t tests compared changes within groups, and generalized estimating equations compared change between groups for the primary outcome. RESULTS: A total of 225 participants enrolled. Both intervention and control groups revealed significant increase mean in parent-reported Likert score of frequency of asking about guns within groups preintervention to 1 month after intervention (BeSMART: 1.5 to 2.3, P = .04; BeSMART + physician review: 1.4 to 1.9, P = .03; control: 1.4 to 2.3, P = .01). Change between groups was not significant (P = .81). Immediately postintervention, intervention groups reported higher likelihood of asking about guns (P < .001). Study groups revealed no significant differences in beliefs. Firearm safety knowledge increased significantly in the intervention groups. CONCLUSIONS: BeSMART firearm injury prevention intervention in a hospital setting increased parental knowledge regarding firearm safety. Immediately postintervention, BeSMART groups reported higher likelihood of asking about guns in others' homes compared with controls. At 1 month after intervention, all groups reported increased frequency asking about guns. Future investigations are needed to understand the duration of intervention impact.

Nutritional Rickets Due to Severe Food Selectivity in Autism Spectrum Disorder.

OBJECTIVE: Studies have detected differences in various measures of bone health between individuals with autism spectrum disorder (ASD) and their peers. However, these measures do not amount to direct clinical evidence of increased orthopedic pathology in this population. Some of the most compelling evidence to this effect comes from case reports of nutritional rickets in children with ASD. We report on 1 such case that, to our knowledge, is the first report of nutritional rickets in ASD necessitating corrective surgery. METHODS: Case report, review of relevant literature, and implications for further research. RESULTS: An 11-year-old girl with ASD was admitted for postoperative medical comanagement after successful repair of bilateral genu valgum (knock knees). On admission, the patient's mother reported that the patient was a "picky eater." No cause had been determined preoperatively, although the deformity had developed at 10 years of age, thereby qualifying as pathologic. The medical team considered rickets because of the patient's limited diet. Subsequent laboratory work demonstrated hypocalcemia, vitamin D deficiency, and secondary hyperparathyroidism. The patient was diagnosed with nutritional rickets due to inadequate vitamin D intake, a consequence of severe food selectivity associated with ASD. CONCLUSION: This case exemplifies the extreme orthopedic and metabolic complications that can result from food selectivity in children with ASD, pointing to the need for further research into the prevalence and causes of orthopedic pathology and nutritional rickets in this population. The case also underscores the need for evidence-based guidelines to prevent orthopedic pathology in children with ASD.

Engagement and Leadership in Firearm-Related Violence Prevention: The Role of the Pediatric Hospitalist.

Gun violence is a US public health crisis. Approximately 7000 children are hospitalized each year because of firearm-related injuries. As pediatric hospitalists, we are poised to address this crisis, whether we care directly for patients who are victims of gun violence. In this article, we aim to provide practical tools and opportunities for pediatric hospitalists to address the epidemic of gun safety and gun violence prevention, including specifics related to the inpatient setting. We provide a framework to act within 4 domains: clinical care, advocacy, education and research.

3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Bronchiolitis, the most common reason for hospitalization in children younger than 1 year in the United States, has no proven therapies effective beyond supportive care. We aimed to investigate the effect of nebulized 3% hypertonic saline (HS) compared with nebulized normal saline (NS) on length of stay (LOS) in infants hospitalized with bronchiolitis. METHODS: We conducted a prospective, randomized, double-blind, controlled trial in an urban tertiary care children's hospital in 227 infants younger than 12 months old admitted with a diagnosis of bronchiolitis (190 completed the study); 113 infants were randomized to HS (93 completed the study), and 114 to NS (97 completed the study). Subjects received 4 mL nebulized 3% HS or 4 mL 0.9% NS every 4 hours from enrollment until hospital discharge. The primary outcome was median LOS. Secondary outcomes were total adverse events, subdivided as clinical worsening and readmissions. RESULTS: Patient characteristics were similar in groups. In intention-to-treat analysis, median LOS (interquartile range) of HS and NS groups was 2.1 (1.2-4.6) vs 2.1 days (1.2-3.8), respectively, P = .73. We confirmed findings with per-protocol analysis, HS and NS groups with 2.0 (1.3-3.3) and 2.0 days (1.2-3.0), respectively, P = .96. Seven-day readmission rate for HS and NS groups were 4.3% and 3.1%, respectively, P = .77. Clinical worsening events were similar between groups (9% vs 8%, P = .97). CONCLUSIONS: Among infants admitted to the hospital with bronchiolitis, treatment with nebulized 3% HS compared with NS had no difference in LOS or 7-day readmission rates.