De-escalation of the Agitated Pediatric Patient: A Standardized Patient Case for Pediatric Residents.

Introduction: Over the past 5 years, pediatric mental health emergencies requiring emergency safety evaluations and inpatient boarding of pediatric patients requiring psychiatric admission have increased. Pediatric trainees must learn to effectively and safely de-escalate a patient with agitated or aggressive behavior, as mental health patients take up a larger proportion of their patient population. This standardized patient case addresses gaps in knowledge and skills to ameliorate the care of children and adolescents with behavioral crises in the hospital. Methods: Resident learners were presented with a teenage patient admitted to the hospital and awaiting inpatient psychiatric placement for suicidal ideation who became acutely agitated with aggressive behaviors. Learners were expected to attempt to verbally de-escalate the patient and select an appropriate pharmacologic agent for decreasing agitation in the patient. A standardized debrief was conducted with the assistance of child and adolescent mental health experts. Results: Twenty-two learners participated in this activity. Residents' confidence in their management skills of the acutely agitated pediatric patient significantly increased after completion of the activity. Seventy-three percent of learners felt confident or very confident in their de-escalation skills at the end of the case, and 86% agreed that the case improved their confidence in managing acute agitation scenarios on the inpatient wards. Discussion: This case led to overall increased self-efficacy in caring for the acutely agitated pediatric patient. Future iterations may include multidisciplinary learners of various skill levels and evaluating changes in patient-centered outcomes, such as restraint use, after implementation of the case.

The Health Effects of Video Games in Children and Adolescents.

Play has always been an essential part of childhood, but it looks different for modern children, who increasingly engage in virtual play. More than 90% of children older than 2 years play video games, and three-quarters of American households own a video game console. Children 8 to 17 years of age spend an average of 1.5 to 2 hours daily playing video games. Recent developments framed by decades of research have provided insight into how games influence children's physical health, mental health, social behaviors, and cognitive development. Anticipatory guidance surrounding media use is often centered on screen time, but pediatricians should have some knowledge of the unique benefits and risks associated with this nearly ubiquitous activity. In light of the recent addition of gaming disorder to the International Classification of Diseases, 11th Revision, this review includes a discussion of the epidemiology, clinical features, and diagnosis of gaming disorder, including the use of existing screening tools. As games become more popular while ever-increasing in scope and complexity, this review aims to educate the modern pediatric provider about what is known, what is uncertain, and how to use this knowledge in the management of both healthy and unhealthy video gaming in children.

Dietary inflammation and cardiometabolic health in adolescents.

BACKGROUND: The Children's Dietary Inflammatory Index (C-DII) has been validated to characterize the inflammatory potential of an individual child's diet. OBJECTIVE: To determine the association between C-DII and markers of cardiometabolic risk (adiposity, blood pressure [BP], lipids, albuminuria, glomerular hyperfiltration) in adolescents. METHODS: Participants aged 12-18 enrolled in NHANES from 2005 to 2014 who completed a 24-hour dietary recall were included in this cross-sectional study. Regression models adjusted for age, sex, race and height examined associations of C-DII quartiles stratified by weight status. RESULTS: Among adolescents (mean age 15 years), the average C-DII score was 0.86 (SE 0.04). When comparing C-DII quartile 4 (most pro-inflammatory) to quartile 1 (most anti-inflammatory), there was a positive association with albuminuria (OR 1.44, 95% CI 1.02, 2.03). After stratifying by weight status, C-DII quartile was found to be significantly associated with albuminuria (OR 4.27, 95% CI 1.83, 9.92) and dyslipidemia (OR 1.87, 95% CI 1.15, 3.03) in adolescents who were overweight. Among adolescents with obesity, C-DII quartile was associated with higher SBP (ß = 5.07, 95% CI 2.55-7.59) and lower DBP (ß = -4.14, 95% CI -6.74, -1.54). CONCLUSION: Consuming a pro-inflammatory diet in adolescence was associated with alterations in albuminuria, lipid and BP measures.