Introduction Prior research has linked health-related social needs (HRSNs) with poor pediatric health outcomes. Studies have demonstrated the implementation of HRSN screening in lower-acuity settings, but few have been conducted in pediatric intensive care units (PICUs). Our primary aim was to increase HRSN screening from 4% to 75% between February 2024 and May 2025. Our secondary aim was to increase referral rates for community health workers (CHW) from 0% to 75% for those with unmet HRSNs. Methods A multidisciplinary team used quality improvement (QI) methodology to implement interventions in a 26-bed PICU at an urban, tertiary-care children's hospital. The study included all patients admitted to the PICU. We implemented six interventions over multiple plan-do-study-act cycles to optimize screening and CHW resource navigation workflow. Results Data collection included sociodemographic characteristics and monthly HRSN screening completion, positive screens, and CHW referral rates. During our intervention period, there were 1,256 direct admits to the PICU. By the end of the study period, an average of 76% of patients had a completed HRSN screen, just over our anticipated goal. The mean HRSN screening increased from a baseline of 17.9% to 76.5. Among screened patients, 27.7% reported ≥1 unmet HRSN, with a mean CHW referral rate of 64%. Conclusions A multidisciplinary team approach and use of QI methodology led to an increase in monthly HRSN screenings in our PICU. Next steps will focus on increasing CHW referral rates and connecting patients with resources for unmet HRSNs.
Objectives Many surveys report less than optimum knowledge, attitude, and practice (KAP) of dental imaging for patient and operator safety. This study aimed to assess the KAP for diagnostic imaging among dentists in light of global practices and recent recommendations. Methods A cross-sectional survey was conducted using a structured questionnaire that was electronically distributed through dental social media platforms between March 1st and June 30th, 2022. Forty-seven questions evaluating demographics, knowledge, practice, and attitude were included. The survey targeted Egyptian dentists practicing in Egypt. Results Two hundred and twenty-eight dentists of different specialties responded. Fifty-nine percent of the dentists were not familiar with the ALARA principle. Fifty-three percent never use lead aprons. Dentists (16.6%) who practiced in facilities with cone-beam computerized tomography (CBCTs) showed significantly (p = 0.000) higher knowledge scores (7.89 ± 2.63) than those who didn't have CBCTs (6.16 ± 2.67). There was no statistical difference in training received (p = 0.345) between the different specialties. Most dentists (79.4%) were interested in increasing their knowledge of radiation safety. Conclusions Within the limitations of this study, there is a need to educate dentists on radiation hazards, child-sized imaging protocols, and how to implement the ALARA principle. Training materials freely available on reliable websites should be disseminated. Regulations should include auditing referrals and periodic calibration of X-ray units.
OBJECTIVE: To evaluate the efficacy and safety of glucagon-like peptide-1 (GLP-1) receptor agonists in the treatment of obesity among children and adolescents. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared GLP-1 receptor agonists with placebo in children and adolescents with obesity. Literature retrieval, study selection, and data extraction were performed according to the PRISMA guidelines. Pooled mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using RevMan 5.3 software. RESULTS: Fourteen RCTs comprising 1349 participants were included, with 810 patients assigned to GLP-1 receptor agonist treatment (liraglutide [n = 317], exenatide [n = 125], semaglutide [n = 265], dulaglutide [n = 103]) and 539 to placebo. Compared with placebo, GLP-1 receptor agonists significantly reduced body weight (MD = -4.50; 95% CI: -6.40 to -2.60; P < 0.0001), body mass index (BMI) (MD = -1.65; 95% CI: -2.05 to -1.26; P < 0.00001), hemoglobin A1c (HbA1c) (MD = -0.34%; 95% CI: -0.63 to -0.05; P = 0.02), and fasting blood glucose (MD = -0.21; 95% CI: -0.41 to -0.01; P = 0.04). The overall incidence of adverse events was similar between groups, with no significant difference in serious adverse events. However, gastrointestinal adverse events were more frequent in the GLP-1 receptor agonist group. CONCLUSIONS: GLP-1 receptor agonists are effective in reducing weight and improving glycemic parameters in children and adolescents with obesity, with an acceptable safety profile. Variations in efficacy may exist among different agents within the drug class. CLINICAL TRIAL NUMBER: Not applicable.
Introduction Obtaining clean-catch urine (CCU) samples from non-continent infants is a common clinical challenge due to low urine volume and irregular urination. Non-invasive stimulation techniques, such as the bladder stimulation technique (BST) and the Quick-Wee method, have been proposed to improve success rates and reduce contamination. However, the supporting evidence remains inconsistent, and no multicentre randomised trials have directly compared the effectiveness and safety of Quick-Wee, BST and standard CCU. Methods and analysis The study will enrol 342 infants aged 1-12 months requiring urinalysis, recruited from paediatric wards across three tertiary hospitals in China. Eligible participants will be randomly assigned in a 1:1:1 ratio to one of three intervention groups: BST, Quick-Wee or standard CCU. The primary endpoint is the success rate of urine collection within 5 min of intervention. Secondary endpoints include time to urination, 5 min urination rate, infant discomfort scores, parental and clinician satisfaction, and urine contamination rates. Safety will be evaluated by monitoring the incidence of adverse events. Ethics and dissemination This study was approved by the Biomedical Ethics Review Committee of West China Hospital, Sichuan University (No. 114/2025). Written informed consent will be obtained from all participants' parents prior to enrolment. Study findings will be published in peer-reviewed journals and presented at relevant conferences. Individual participant data will be kept strictly confidential and securely stored in compliance with data protection regulations. Trial registration number ChiCTR2500098691.
Purpose Traditional preoperative fasting guidance (6-4-2) aims to reduce aspiration risk but frequently produces prolonged fasting and discomfort in children. We evaluated whether progressively liberalizing the clear-liquid fasting policy reduces fasting time and improves the perioperative experience. Methods We conducted a prospective, four-phase interventional quality-improvement study at a tertiary hospital in rural Kenya (11/2021-12/2022). Phase 0 followed standard 6-4-2 guidelines; Phase 1 shortened clear-liquid fasting to 1 h; Phase 2 permitted a fixed volume of water until transfer to theatre; Phase 3, unrestricted water. The primary outcome was clear-liquid fasting time. Secondary outcomes were thirst, hunger, parental satisfaction, preoperative anxiety, and aspiration events. Results Among 253 children, median clear-liquid fasting time decreased: 14.0 h (Phase 0) to 1.7 h (Phase 3) (p < 0.001). Anxiety decreased significantly (mYPAS 35.4 to 22.9; p < 0.001) and thirst declined. Parental satisfaction was higher but did not reach statistical significance (8.0 to 9.0; p = 0.06). One confirmed aspiration occurred in Phase 1 (7.2-h fasting time). Conclusion Reducing preoperative fasting improved comfort and lowered anxiety. No increase in clinically significant aspiration events was observed, although the study was not powered for rare events. An unrestricted clear-liquid protocol appears feasible and beneficial.
Fragile X syndrome (FXS) is the most common inherited cause of intellectual disability and autism spectrum disorder, resulting from CGG trinucleotide repeat expansion in the FMR1 gene and consequent absence of Fragile X Messenger Ribonucleoprotein (FMRP). Current management remains symptomatic, and adeno-associated virus (AAV)-mediated gene therapy represents a promising treatment and perhaps a curative avenue. However, community perspectives on gene therapy in FXS have not been assessed. FXS is a non-lethal neurodevelopmental condition with a normal life expectancy. Caregivers weighing gene therapy for a child with FXS must balance the potential benefits of FMRP restoration against the uncertainties and risks of an investigational gene therapy in the absence of life-threatening urgency. Whether and to what degree FXS caregivers are willing to consider gene therapy under these circumstances is therefore a meaningful and non-trivial question, and one that has not previously been examined. We report findings from two sequential cross-sectional surveys examining community and caregiver knowledge, attitudes, concerns, and information preferences regarding gene therapy for FXS. The initial survey (Survey One) was an 8-item online survey completed by 351 FXS community members. A follow-up survey (Survey Two) was a 26-item online, REDCap-based instrument completed by 56 parents/caregivers recruited through clinics and the National Fragile X International Conference. Both surveys demonstrated strongly positive attitudes toward gene therapy: 94% of Survey One community members indicated they would consider gene therapy for FXS, while 84% of Survey Two caregivers agreed or strongly agreed they were hopeful about gene therapy success, and an equal 84% indicated they would consider gene therapy if available. The primary concern across both surveys was side effects and risks, followed by effectiveness, timeline, and cost. Improving quality of life was the leading motivator (69%), and intellectual and developmental disability was the symptom caregivers most wanted a future therapy to address (57%). Physicians, genetic counselors, and geneticists were identified as the preferred sources for gene therapy education. These findings reveal that surveyed caregivers express high motivation and broadly positive attitudes toward gene therapy, while highlighting specific educational needs that may inform informed consent processes and clinical trial design for future FXS gene therapy development. These results represent the perspectives of surveyed caregivers and may not generalize to the broader FXS community.
Background and aims Caregiver-mediated interventions are commonly used by Speech and Language Therapists to support early language development. Developmental Language Disorder (DLD) is associated with reduced quality of life throughout the lifespan. Understanding factors that predict intervention success is essential for developing appropriate, cost-effective therapy provision for the approximately 12% of preschool children who present with early markers for Developmental Language Disorder (DLD). This systematic review and meta-analysis examined the effectiveness of caregiver-mediated spoken language interventions for under-fives at risk of DLD, and factors influencing intervention effectiveness. Methods A systematic review following PRISMA guidelines was conducted. Five electronic databases were searched to identify experimental studies comparing caregiver-mediated spoken language interventions to control conditions in under-fives presenting with risk factors for DLD. Risk factors included prematurity, socioeconomic factors, caregiver language development concerns, and formal or informal language screening or assessment scores. Twenty-six experimental studies with 1407 child participants were included in qualitative synthesis. Meta-analysis was performed on nine Randomised Controlled Trials involving 947 children. Results Effectiveness was examined for outcomes including child language gains, child wellbeing, inclusion and attainment. Meta-analysis indicated a significant effect of caregiver-mediated spoken language interventions on language outcomes compared to treatment-as-usual, non-language intervention or waitlist control conditions. Non-language outcomes were evaluated via qualitative synthesis. Interventions significantly improved language development trajectories for under-fives presenting with risk factors or early markers for DLD. Conclusion and implications This review contributes to the growing evidence base demonstrating that caregiver-mediated interventions can positively impact language development and wellbeing outcomes for children under five at risk of DLD. These findings support the implementation of caregiver-mediated environmental language interventions in clinical practice to maximise accessibility and cost-effectiveness while delivering optimal outcomes for vulnerable populations. What this paper adds What is already known on this subject Previous research on caregiver-mediated spoken language interventions has highlighted gaps in the evidence regarding the impact of risk factors, demographic characteristics, dosage and intervention components on child language outcomes. Developmental Language Disorder has relatively high population prevalence, estimated at 7%. Prevalence is associated with risk factors including low household socioeconomic status (SES), prematurity and late language emergence. In contrast to its prevalence, there is low public and professional awareness of DLD and a low diagnostic rate. Therefore, a strengthened evidence base and additional insights into the factors affecting success of family-based interventions is important in order to increase the effectiveness of service provision and care planning for this underserved population. Timely and effective intervention with young children presenting with early markers for DLD has the potential to offer lifelong improvement to their wellbeing, inclusion and attainment outcomes. Recent systematic reviews of the effectiveness of caregiver-mediated language interventions had differences in population age range and diagnostic inclusion criteria. What this paper adds to existing knowledge Our review examines the effectiveness of caregiver-mediated early spoken language interventions on child language, attainment and wellbeing, and on caregiver self-efficacy and adherence to language support strategies. Our population was children under five presenting with risk factors for Developmental Language Disorder, in the absence of other neurodevelopmental or genetic conditions such as intellectual disability or autism. This review adds depth and detail to the evidence base supporting the effectiveness of caregiver-mediated spoken language interventions in improving outcomes for this population of young children, and factors that influence their success. What are the potential or actual clinical implications of this work? The high prevalence of Developmental Language Disorder, estimated at around 7% of the population, and the strong association with risk factors including low SES, prematurity and late language emergence, coupled with the low awareness of DLD and low diagnostic rate, mean that a strengthened evidence base and additional insights into the factors affecting success of family-based interventions can increase the effectiveness of service provision and care planning for this population. Timely and effective intervention in this group of young children has the potential to improve wellbeing and attainment outcomes across the lifespan. This review contributes to our understanding of how to implement cost-effective, socially valid and maximally engaging partnership working with families of young children at risk for DLD.
Johnstone-Cooke V, Rutherford M, Sheripkanova A et al.
Latinx populations in the United States experience a disproportionate burden of mental and behavioral health challenges and face significant barriers to care, often relying on emergency departments during crises. The study explores the social determinants of mental health shaping emergency department experiences of Latinx children with mental and behavioral health conditions and their care partners. This study draws on a subset of participants from a larger, multiethnic qualitative study by focusing specifically on Latinx children (ages 6-18; n = 4) and their care partners (n = 5). In-depth interviews were conducted with children selecting arts-based techniques (e.g., photo elicitation and drawing). Data were analyzed using the World Health Organization Commission on Social Determinants of Health framework, combining inductive coding with categorization into structural and intermediary determinants. Findings demonstrate how structural determinants (e.g., immigration-related barriers, insurance, and socioeconomic position) interact with intermediary determinants (e.g., psychosocial stress, material hardship, and health system factors) to shape care-seeking, including delays in accessing services and reliance on emergency departments. Cultural influences emerged primarily through individual- and family-level beliefs and did not operate in isolation; rather, their influence was embedded within broader social contexts marked by varying levels of social cohesion and social capital. Overall, the study highlights mental and behavioral health crisis care as a system-mediated, ongoing process rather than a discrete event. While findings reflect a small, context-specific sample, they underscore the need for integrated, culturally and linguistically responsive, and structurally informed interventions, such as the inclusion of bilingual community health workers, to improve access and continuity of care for Latinx families. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Background Migraine in children and adolescents not only impacts academic pursuits and family life but also have secondary psychological effects. Determining the role of acute medication for migraine treatment in this population can reduce the burden associated with migraine. This network meta-analysis aimed to identify the relative efficacy and safety of acute migraine drug in children and adolescents migraine populations. Methods The Cochrane Register of Controlled Trials and MEDLINE via PubMed and Embase databases were searched from inception to August 2025, only published studies in English. Double-blind randomized clinical trials evaluating the currently available acute treatments for childhood and adolescent migraines were included. The primary efficacy endpoint was pain freedom at 2 hours. Secondary efficacy endpoints included the proportion of participants with pain relief at 2 hours, pain freedom from two to 24 h, and the proportion using rescue drugs after 2 hours and up to 24 h. Adverse events (AEs) were also evaluated. Results The analysis included 30 studies (involving 8,914 participants and 13 pharmacological interventions). All treatments included demonstrated higher odds ratios (ORs) compared with the placebo for pain freedom at 2 hours. Dihydroergotamine was associated with the highest ORs, but its confidence interval included null values. Sumatriptan/naproxen sodium, ibuprofen, zolmitriptan nasal spray, sumatriptan nasal spray, and rizatriptan showed statistical significance. Sumatriptan/naproxen sodium yielded the highest odds (OR: 2.91, 95% CI: 1.87-4.53), followed by ibuprofen (OR: 2.88, 95% CI: 1.47-5.64), and rizatriptan showed the lowest (OR: 1.51, 95% CI: 1.23-1.86). Only sumatriptan/naproxen sodium was associated with a significantly higher OR compared with placebo for pain freedom from two to 24 h (OR: 2.31, 95% CI: 1.31-4.07). Ibuprofen exhibited the highest effect size for pain relief at 2 hours (OR: 3.21, 95% CI: 1.10-9.34). None of the included drugs was found to reduce the use of rescue drugs from two to 24 h. Zolmitriptan was associated with the highest risk of AEs among all treatments. Acetaminophen appears to have the lowest risk of adverse events, comparable to that of a placebo. Conclusion Ibuprofen can effectively relieve symptoms, characterized by a favorable benefit-risk profile. Sumatriptan and zolmitriptan nasal sprays also exhibited robust efficacy, specifically among populations with prominent nausea and vomiting. Sumatriptan/naproxen sodium merits consideration, especially in patients exhibiting an inadequate response to monotherapy. Dihydroergotamine demonstrated potential benefits in refractory and chronic migraine; however, high-quality studies are warranted to validate these findings.
Introduction Multiple studies have noted significant rates of emotional and developmental concerns in children, coupled with inconsistent rates of engagement with related services. Such inconsistency can lead to a range of negative outcomes. Our project aimed to increase the number of children who completed the intake process following referral to the Child Development Center from 57% to 80% by the end of the second quarter of 2022. Methods The project team identified barriers to referral adherence and developed targeted interventions to address them. Plan-Do-Study-Act cycles included interventions such as moving the intake process to a phone call, direct outreach to families, enhancing education on Child Development Center services, and increasing communication with referring providers. We used control charts to assess the impact of interventions. Results Completed intakes increased from 57% to 85% within 2 months and remained between 83% and 89% for the rest of the study. Referral completion rates for children younger than 5 rose from 45% to 75% or higher. The referral completion rate did not vary by ethnicity, race, or insurance type. Although increased referral completion rate led to increased wait times for appointments, 83% of patients who completed an initial intake followed through with an appointment at the Center. Conclusions We used a quality improvement methodology to increase the percentage of patients who completed an initial intake following referral to the Center. The use of a phone intake option and consistent seeking of feedback and collaboration with all stakeholders involved in the project contributed to its success.
