Dental Caries: Early Intervention and the Role of the Pediatrician.

Despite improvements in oral morbidity levels and access to care among the pediatric population, there are still major disparities in the United States. Results of national surveys have documented a decrease in the number of children receiving either a dental examination or a cleaning. This finding is particularly concerning for toddlers and infants, as early preventive dental visits and the establishment of a dental home is cost-effective and leads to enhanced oral health outcomes over the life span. Many infants and toddlers do not visit a dentist, suggesting that the recommendations of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to establish a dental home are not appropriately adopted.

Individual Medical Emergencies Occurring at School.

Children and adults may face emergency medical situations because of injuries, complications of chronic health conditions, or unexpected major illnesses that occur in schools. The American Academy of Pediatrics published a policy statement in 2001 titled "Guidelines for Emergency Medical Care in Schools," and in 2008, published its revision, "Medical Emergencies Occurring at School." Those statements focused on the preparedness of schools to address individual student emergencies. The increase in the number of children with special health care needs and chronic medical conditions attending schools, together with the added challenges faced by school districts to ensure that schools have access to on-site, licensed health care professionals on an ongoing basis, have contributed to added risks that medical and nonmedical personnel face in dealing with medical emergencies in schools. This newly revised policy statement serves as an update of the statement published in 2008 and reaffirmed in 2017, and intends to increase pediatricians' awareness of schools' roles in preparing for individual student emergencies and provide recommendations for the medical home and school physicians on how to assist and support school personnel. This statement does not address schoolwide or communitywide emergencies that might occur as a result of natural or man-made disasters.

Use of Pediatric Health Information System database to study the trends in the incidence, management, etiology, and outcomes due to pediatric acute liver failure in the United States from 2008 to 2013.

Data were collected of children admitted with ALF to 16 US pediatric liver transplant centers from 2008 to 2013 using the PHIS for a retrospective analysis of PALF trends. Patient data linked to the principal diagnosis code for acute necrosis of the liver (570.00) were analyzed for the following: demographics, regional differences, changes over time, pharmaceutical trends, procedural trends, associated diagnoses, and patient outcomes. In 52.5% of 583 patients who met the selection criteria for PALF, the etiology remained undetermined. Acetaminophen toxicity (18.7%) was the most common identifiable etiology, and hepatic encephalopathy (38.6%) was the most common complication. Mortality was lower than previously reported; 95.4% survived and 73.2% survived without a liver transplant. Acute respiratory failure (OR = 3.4, p = 0.035), acute kidney injury (OR = 3.6, p = 0.003), and cerebral edema (OR = 3.6, p = 0.02) were independently associated with increased risk of mortality. The use of N-acetylcysteine in non-acetaminophen-related ALF, the use of intracranial pressure monitoring, and the proportion of sepsis decreased significantly during the study period. The PHIS database can be a useful tool to study the future trends of PALF patients.

Pediatric Residents' Knowledge and Comfort With Oral Health Bright Futures Concepts: A CORNET Study.

OBJECTIVE: Training residents in oral health helps eliminate disparities and improves access. The American Academy of Pediatrics Bright Futures Guidelines curriculum is used as a training guide. We assessed knowledge, confidence, and perceived barriers to incorporating Bright Futures oral health concepts into well-child care for children below 3 years in a national sample of pediatric residents. METHODS: A sample of postgraduate year 1 and 2 residents from CORNET sites completed demographic, Bright Futures oral health concepts confidence and knowledge cross-sectional surveys before any intervention. Measures were tested for reliability using Cronbach's alpha coefficient. RESULTS: One hundred sixty-three residents from 28 CORNET sites completed the surveys. One third reported no prior training in oral health. Time (42%) and knowledge (33%) led the perceived barriers to addressing these concepts in well visits. Although 63% rated their confidence as excellent in identifying tooth decay risk factors, a significant percentage rated their oral health risk assessment skills as poor or neutral (64%) and identifying caries at examination (53%). Only 49% conveyed oral health messages during encounters and 80% correctly scored 75% or higher on knowledge questions. CONCLUSIONS: This cross-sectional study shows that residents from a wide geographic range have high self-reported oral health knowledge but low perceived skills and competency in clinical implementation. Lack of time and knowledge in identifying caries led the perceived barriers. Barriers are addressed by implementing oral health curricula that promote competence and skill-development. This study helps programs effectively implement Bright Futures concepts to train graduates to incorporate oral health in well visits.

Two perspectives on the educational and administrative roles of the pediatric chief resident.

PURPOSE: To investigate pediatric chief residents' responsibilities and determine how chief residents and program directors view the scope of the chief resident's role. SURVEY: We distributed a 20-item survey to program directors and chief residents at all US pediatric residency programs. Questions pertained to activities performed and the level of importance of administrative, clinical, and educational activities. The survey also investigated motivating factors to become chief resident, future career plans, and level of job satisfaction. RESULTS: We received responses from 127 program directors and 101 chief residents. Of the chief residents, 98% (99/101) felt administrative tasks were very/somewhat important, followed by education, service, and research. Significantly more program directors than chief residents felt chiefs' overall workload was well balanced. Program directors gave higher ratings than chief residents on chief's ability to develop clinical skills (79% [95/121] versus 61% [61/100]) and manage stress and burnout (86% [104/121] versus 72% [72/100]). Future career plans for chief residents in decreasing order included fellowship, outpatient practice, academic practice, and working as a hospitalist. The most significant problems reported by the chief residents were lack of administrative support and lack of time spent in educational/clinical activities. CONCLUSIONS: The chief resident role is primarily administrative, but program directors and chiefs feel teaching and clinical responsibilities also are important. Although the 2 groups agreed in many areas, program directors underestimated the administrative demands placed on the chief residents, and our findings suggest the chief resident role may be more fulfilling if the balance was shifted somewhat toward teaching and clinical responsibilities.

Is it more than just constipation?

We report an infant presenting with constipation, whose history and physical examination initiated the investigation that led to the diagnosis of the Currarino triad in the proband and 2 other family members.