Anticipatory Guidance through Online Motivational Interviewing for Mothers on Early Childhood Caries among Young Children of Age 9–24 Months amidst Pandemics: A Nonrandomized Clinical Trial

Early childhood caries (ECC) is a multifactorial disease with known etiologic factors and can be very devastating to the oral and general well-being of a child, including psychological impact on a growing child. The irony is among the different factors responsible for milk that is wholesome nutrition, if fed in a wrong pattern, can be the main factor that helps this type of rampant caries spread within no time, leading to pulp exposures and complicating proceedings. Awareness is the mainstay in prevention, and creating it becomes our sole responsibility as a pediatric dentists. A multidisciplinary approach with the involvement of mothers as a main stakeholder in this front becomes a very promising move, so this project is phase two of interprofessional collaboration involving mothers in prevention;the aim of the study is to create awareness among mothers during COVID lockdown so as to prevent ECC in this COVID pandemic. Materials and methods: A total of 222 mothers with 9–24 months old children were selected and added to the e-groups. The allocated mothers were given a pretest questionnaire and collected back with a photo of their child's oral health, and anticipatory guidance and in-depth interviewing were given to them. Follow-up is done in 2, 4, and 6 months. Awareness is evaluated by pre-and posttest questionnaires. Reversal of the white spot is evaluated through indices, and progression is noted. Statistical analysis: The data was analyzed using Statistical Package for the Social Sciences 13. Result: Pretest and postquestionnaire analysis were done using the Chi-squared test. The test shows the marked raise in knowledge, attitude, and practice of mothers on their children after postintervention, which was given through motivational interviewing (MI). Conclusion: In summary, the MI intervention appeared to improve maternal knowledge but had no effect on oral health behaviors or on the progression of early childhood caries (ECC). © The Author(s). 2023 Open Access.

Resident Perceptions and Confidence Regarding Pediatric Preventive Care

Purpose of Study: Residents have experienced changes in educational structure, format, content, and patient experience due to the COVID-19 pandemic. Resident physicians across the country have reported changes in workload including a decrease in well child checks and immunizations resulting in limited clinical exposure. This study aimed to assess the confidence of first year pediatric residents (interns) in conducting routine preventive screening for children and to identify potential gaps in knowledge among this cohort. Methods Used: We conducted a cross-sectional observation study that included 13 categorical first year pediatric residents. A voluntary, anonymous online survey was administered in September 2022. The survey assessed confidence levels, and perceived comfort regarding common preventive pediatric encounters and screening tools. The survey included 7-questions based on the 4th Edition Bright Future's Guidelines and respondents rated their answers on a 5-point Likert scale. The surveys were distributed anonymously via e-mail using Survey Monkey, a web-based software platform that provided an intuitive interface for validated data capture. Participants were given 2 weeks to complete the survey and reminders were sent via email. Summary of Results: Eight of 13 interns participated for a response rate of 62%. Sixty-three percent of the residents had completed a subinternship in pediatrics. Of our respondents, 75% reported feeling "not at all confident" in executing well child check-ups for children <12months old and 63% reported feeling "very confident" in examining children> 13months old. Regarding the ability to perform a genitourinary examination in children >12years of age, 63% of respondents stated that they were "slightly" or "not at all confident". We asked interns to rate their confidence in providing anticipatory guidance to their patients. Interns perceived being somewhat confident regarding guidance about safe sex, tobacco use, and healthy lifestyles but less confident regarding newborn care, breast feeding and infant nutrition. Nearly 40% reported comfort in recommending and advising parents about the risks and benefits of age appropriate immunizations. We asked residents to report their ability in administering and interpreting screening tools (ASQ, MCAT, EPDS). Interns reported that were able to interpret results but lacked confidence in providing guidance. Conclusion(s): Our study identifies opportunities to bridge experiential knowledge gaps and confidence among pediatric interns who may have had limited clinical exposure to pediatrics following the COVID-19 pandemic. Graduate medical education programs should consider developing tailored educational interventions specifically geared for identified learning gaps to mitigate the challenges posed by the pandemic.

Android-Based Anticipatory Guidance Application for Students in Online Learning

Online learning causes student anxiety during the Covid-19 pandemic. Anticipatory guidance is a form of guidance provided for students to anticipate the occurrence of anxiety. However, the problem is that students in Indonesia consider learning assignments to be the cause of anxiety during online learning. This makes the reason that the importance of guidance for students in preventing anxiety so that online learning can be carried out effectively. The purpose of this research is to build an android-based application to anticipate the occurrence of anxiety for students that is easily accessible and understandable. This research method uses Research & Development (R&D). The subjects in this study were material experts, media experts, and students. The data collection tool used is in the form of a validation sheet to obtain an assessment of the validator or experts. The results show that after design validation by the three material experts an average score of 84.8 was very good and the validation of the three media experts obtained an average score of 72.14 in the good category. Based on the ten student opinions regarding anticipatory guidance on anxiety using an Android-based application, the score was very good in terms of appearance, ease of use of the application and material content related to material clarity, and language. Of the ten students' opinions regarding the android-based application, it gave a proper value to be used as anticipatory guidance on student anxiety during online learning during the COVID-19 pandemic. © 2022 International Journal of Health Sciences.

TREE (Talk Read Engage Encourage) Program: Promoting Positive Parent Child Relationships in Low Income Families with Young Children by Pediatric Providers During Well Child Encounters

Background: Children living in poverty may endure Adverse Childhood Experiences (ACEs) that can affect their cognitive and social-emotional development. Safe and nurturing caregiverchild relationships mitigate many of the deleterious effects of ACEs. Child development research suggests that talking, reading, and playing with young children living in poverty improves their developmental outcomes. Developmental coaching, unlike traditional anticipatory guidance, is an interactive format engaging caregivers through self-reflection, encouraging parents to attempt novel interaction approaches, and strengthening parent self- confidence through positive feedback. This study examined the efficacy of the Grow Your Kids: TREE (Talk Read Engage Encourage) program, an interactive developmental coaching program promoting positive caregiver-child interactions during well-child encounters (ages 0-2) with lowincome families. The TREE program was developed by the Emotional Health Committee of the Maryland Chapter American Academy of Pediatrics. (https://www.mdaap.org/tree/) Methods: The study used a quasi-experimental design in two pediatric training programs in an eastern mid-sized city (residents: intervention n=24, control n=42). A convenience sample (n = 167 families) was recruited (79 intervention;88 control). Data collection included parent STIMQ2 pre/post (4-6 and 9-15 months of age) and pediatric resident report of training impact. The StimQ2 is a structured validated parent measure designed to assess caregiver-child interactions at home. Results: Recruited children were 3-10 months old (both sites), predominantly Black (76% intervention;77% control), and on Medicaid (81% intervention;78% control). Due to COVID-19, follow-up data was obtained from 45% of families (38 intervention;38 control). A significance level of p < .10 was used due to the small sample size. Analyses demonstrated differences in the STIMQ2 total (d = .43;95% CI, -.04 to .89;p = .07) and Parent Verbal Responsivity scales (d = .68;95% CI, .17 to 1.18;p = .009). There was also a significant change over time in the intervention group for reading quality subdimension (d= -.34, 95% CI, -.7 to .03, p=.07), whereas the control group's reading quality decreased. Intervention residents demonstrated significantly greater change in talking to, reading to, and being positive and encouraging with infants and toddlers as well as confidence in fostering interactions, conveying child development, and providing feedback (all p-values = .005 to .09). Conclusion: The TREE program is a feasible, brief, inexpensive, easily replicated and learned, universal developmental coaching intervention delivered by pediatric primary care providers during well child encounters that enhances caregiver-child interactions among low-income families. The study demonstrated increased overall parent-reported caregiver-child interactions, including verbal responsivity and reading behaviors and had a significant effect on pediatric residents' perceptions of their competency in promoting positive caregiver-child interactions. Antagonists' Skin Tones are Darker than Protagonist' Skin Tones in Animated Films. Average weighted grayscale values of protagonist and antagonist skin tones were plotted and arranged into a box and whisker plot. The median grayscale value of antagonists (106.7) was lower than that of protagonists (134.9), indicating that antagonists overall were darker than protagonists. This difference was significant (p<.001). Average grayscale values of protagonist and antagonist skin tones in 91 films were plotted against the year of production. Trend lines and confidence bands were superimposed on these data points. In recent years, the skin tones of both protagonists and antagonists have changed to include darker shades. However, differences between protagonist and antagonist skin tones have remained constant over time, with protagonists consistently having lighter skin tones compared to antagonists.

Pediatrics in the Parking Lot-taking Child Passenger Safety to the Community

Background: Motor vehicle crashes (MVCs) remain the leading cause of death for Kentucky children above age 1. The Nest has four separate non-profit programs that provide respite child care, legal/psychological support services to survivors of intimate partner violence, parenting classes, and crisis assistance to families (toiletries/cleaning-supplies/papergoods/diapers/formula/food/rental-assistance since COVID, serving more than 400 clients per month). Community need for car seats was previously demonstrated by the 57 used seats they distributed in a year. Methods: Standard national Child Passenger Safety (CPS) checkup forms were utilized, with an Excel data base of seats provided/notes of special circumstances/problems with seats/cars. Forms from October 1, 2020 to July 1, 2021 were reviewed for quality improvement at least monthly, with immediate adjustments as necessary. All education and seat installation occurred outdoors during fall months and on all but the coldest winter days. Staff and families were masked, items used were sanitized and meticulous hand washing was done between families due to COVID. New convertible seats from grants were supplemented with individually- purchased harnessed booster seats to serve older children and with current (never-in- crash, not -recalled) donated infant seats. CPS services were conducted in 4 languages (English, French, Spanish and Arabic) with fluent staff or consenting family members as translators, and were offered both by appointment/previous consultation/referral from Family Assistance and as walk-ins requesting help or were observed to have car-seat/booster-sized children. Results: A small program that distributed seats as commodities without instruction or assessment of child/car was revised into a formal CPS fitting station, addressing difficult cars, large families, grandparents raising grandchildren, and resettled international refugees. Approximately 90% of families had annual family incomes of < $20,000/year, many below $10,000. Almost every consult for one child revealed multiple children in need of car seat education or new seats. More than 150 seats were checked in nine months. Types of misuse (in >90%) seen include: no seat, child too loose in seat, seat too loose in car, use of infant seats facing forward for too-big toddlers, premature use of no-back boosters (NBB) for small young children when family has no money for harnessed seats or at the mis-direction of a medical professional. Families that live in high crime areas with car theft are bringing in car seats at night so need lighter weight ones, as do grandparents. Conclusion: Taking CPS to the parking lot of an established non-profit has permitted us to reach more families with great need in a place they trust. Types of misuse have provided a real-world window into the potential optimal timing/messages of CPS within pediatric anticipatory guidance, and families have shown how our anticipatory CPS guidance may need to be adapted to work in the environment that people actually live in.