Telehealth has become a cornerstone of modern pediatric care, offering continuity, access and efficiency across a wide range of clinical settings. Initially a supplementary model, its rapid expansion during the COVID-19 pandemic accelerated innovation in virtual care delivery. Post-pandemic, pediatric telehealth remains a vital tool for improving access to behavioral health, chronic disease management and preventive care, particularly in underserved communities. However, variability in policy, equity gaps and reimbursement barriers continue to challenge sustainability. This review summarizes policy, lessons learned, best practices and strategic directions for telehealth integration in pediatric practice, integrating artificial intelligence and advocating for systemic policy reform to sustain long-term use and address social determinants of health.
There has been increased use of telemedicine in clinical practice, but telemedicine curricula are not standard in pediatric residency training. We developed a 2-case, Virtual Objective Structured Clinical Exam (VOSCE) for pediatric residents with telemedicine learning objectives. Resident competency was assessed using a behaviorally anchored checklist, and residents completed a pre/post self-assessment. Less than half of the residents met mastery for the following behaviors: confirmation of patient identifiers, optimization of technical aspects and partnering with the patient to perform a physical exam. Resident self-assessment improved after participating in the VOSCE but remained low in key domains such as virtual physical exam and mental health issue identification and guidance. Most pediatric residents have not mastered all the skills needed for a successful telemedicine encounter. Incorporating a curriculum focused on telemedicine best practices into residency training is highly merited.
Pediatric myocarditis presents with heterogeneous clinical manifestations and may progress to severe cardiac dysfunction requiring advanced life support. This retrospective study included 78 children with clinically suspected myocarditis treated between January 2021 and December 2024. Children were stratified by left ventricular ejection fraction (LVEF) at admission and further analyzed according to the use of extracorporeal membrane oxygenation (ECMO). Children with LVEF <50% more frequently presented with gastrointestinal symptoms, shock, arrhythmias, organ dysfunction, and higher rates of pediatric intensive care unit (PICU) admission and ECMO support. Left ventricular ejection fraction <50%, arrhythmia, younger age, hypoalbuminemia, elevated lactate and myocardial injury biomarkers were associated with ECMO support. Reduced LVEF in pediatric myocarditis is associated with a higher risk of organ dysfunction and a greater need for advanced life support; ECMO support correlates with markers of myocardial injury and systemic hypoperfusion. These findings may help clinicians recognize high-risk patients early and guide timely escalation of life-support therapies.
We evaluated the appropriateness of cefdinir prescribing in an integrated health care system. We performed a cross-sectional analysis of cefdinir prescribing for children aged 0 to 17 years old from 2005 to 2020 with acute otitis media, sinusitis, streptococcal pharyngitis, community-acquired pneumonia, urinary tract infection, and viral respiratory tract infections. The percentage of potentially inappropriate prescriptions was compared by location, provider specialty, and provider type using the chi-square test. A total of 93 748 cefdinir prescriptions were prescribed to pediatric patients, with 53 642 (57%) deemed as potentially inappropriate. Encounters in emergency and urgent care settings were more likely than ambulatory settings to be associated with inappropriate prescribing of cefdinir (P < .001). Non-pediatric-trained providers were responsible for 46.8% of the potentially inappropriate cefdinir prescriptions and were more likely to prescribe potentially inappropriate cefdinir prescriptions compared with pediatric-trained providers (P < .001). Advanced practice providers were more likely than physician providers to prescribe potentially inappropriate cefdinir prescriptions (P < .001).
Safe water is essential for children to comply with healthy beverage consumption recommendations. Tap water generates varying degrees of concern, including safety, health, taste, and so on. Perceptions of water quality may influence other beverages consumed, such as sugar-sweetened beverages (SSBs). To assess the association between tap water perceptions and SSB and juice consumption, parents of 4- to 6-year-old children completed surveys. The associations between tap water concerns and SSB and juice consumption were separately assessed via chi-square tests and multinomial logit models (adjusted for child sex, household income, and parent anxiety). Children (N = 221) were racially and socioeconomically diverse. One-quarter (27%) of parents expressed some concern about tap water; their children had higher risk of consuming SSB 3+ times a day (relative risk ratio [RRR] = 6.7; 95% CI = 1.4-33.1) and sometimes consuming SSB (RRR = 3.4, 95% CI = 1.1-10.8) compared with those without concerns. In conclusion, tap water concerns may contribute to increased SSB consumption among young children.
This poem captures the transformative journey of pregnancy, from the initial shock of discovery on an ordinary day to a profound shift in identity. It celebrates the simultaneous birth of a child and a mother, honoring the courage required to navigate the wait through doubt and hope.
Bright Futures Parent and Patient Handouts from the American Academy of Pediatrics are widely used after pediatric well-child visits, yet their content has not been systematically evaluated. We assessed all fourth-edition handouts using standard readability formulas for readability and the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) for understandability and actionability. Patient Handouts averaged a 4th-grade level (ages 7-8), 5th-grade level (ages 9-10), and 6th- to 7th-grade level (age 11+). Parent Handouts ranged from about 5th to nearly 7th grade. The PEMAT-P scores across all 23 handouts showed high understandability (92.3%) but lower actionability (60%). Overall, Bright Futures Handouts appear readable and understandable, supporting their use in pediatric practice, although opportunities remain to improve actionability. When clinicians create or evaluate patient education materials, attention to plain language, straightforward delivery, visual aids, and checklists helps improve readability, understandability, and actionability. These strategies may support more effective patient education and promote pediatric health outcomes.
This poem captures the transformative journey of pregnancy, from the initial shock of discovery on an ordinary day to a profound shift in identity. It celebrates the simultaneous birth of a child and a mother, honoring the courage required to navigate the wait through doubt and hope.
Upper gastrointestinal involvement beyond the duodenum in pediatric celiac disease (CD) remains undercharacterized. We conducted a single-center retrospective analysis of children who underwent esophagogastroduodenoscopy, comparing CD cases with non-CD controls. Biopsies were graded using the modified Marsh-Oberhuber and Sydney systems; Helicobacter pylori was assessed by histology and rapid urease testing. Outcomes were esophagitis, gastritis subtypes, H pylori infection, peptic ulcers, and, in CD, associations with Marsh stage. Among 996 procedures, 260 (26.1%) had CD. Gastritis was common in both groups, with chronic active gastritis most frequent. Chronic lymphocytic gastritis was more prevalent in CD (P < .05), while H pylori infection was lower (39.6% vs 50.3%; P < .05). Peptic ulcers were more frequent in CD, predominantly in the duodenal bulb (P < .001). Esophagitis showed an inverse relationship with Marsh stage (P < .05). These findings delineate distinct upper gastrointestinal features in pediatric CD and may support a more comprehensive evaluation of the upper gastrointestinal tract during diagnostic endoscopy.
This study evaluated CXC motif chemokine 5 (CXCL5) and C-C motif chemokine ligand 20 (CCL20) as predictors of azithromycin failure in pediatric Mycoplasma pneumoniae pneumonia (MPP). Procalcitonin (PCT), CXCL5, CCL20, interleukin-6 (IL-6), and C-reactive protein (CRP) were assayed in 318 patients and 100 controls. Favorable outcome was symptomatic remission with >50% radiological absorption; poor outcome was persistent/worsening symptoms, no radiological absorption or progression, or complications requiring additional intervention. Patients were stratified by 7-day outcomes (poor, n = 62; favorable, n = 256). Multivariable logistic regression and receiver operating characteristic analysis showed prolonged fever, higher clinical pulmonary infection score (CPIS), and elevated PCT, lactate dehydrogenase, CXCL5, and CCL20 predicted poor prognosis ( P < .05). Procalcitonin, CXCL5, and CCL20 area under the curve (AUC) were 0.755, 0.714, and 0.745, respectively; combined AUC was 0.863. Pretreatment CXCL5 and CCL20 positively correlated with CPIS, IL-6, and CRP ( P < .05). CXCL5 and CCL20 are robust additive biomarkers for azithromycin-refractory MPP.
Health care disparities stemming from language discordance have been well established, leading to increased morbidity and mortality. We sought to examine the effect of patient preferred language on time to rapid response activation and subsequent intensive care utilization. We sought to evaluate the association between patient preferred language and time to rapid response (RR) activation, intensive care unit (ICU) transfer rate, and intensive care utilization in a quaternary pediatric hospital. We conducted a retrospective observational study of pediatric patients with rapid response activation from January 2020 to June 2023. Demographic and clinical data, including time to rapid response, ICU transfers, and use of mechanical ventilation, non-invasive ventilation, and vasoactive support, were analyzed. Statistical comparisons were performed between English-speaking and language other than English (LOE) patients, with subgroup analyses for Spanish-speaking patients. Of 374 unique patients, 25% were using LOE. Time to rapid response activation was not significantly different between language groups. However, Spanish-speaking patients were more likely to be transferred to the ICU (P = .0047) and had longer hospital stays (10 vs 7 days, P = .0425). While language preference did not impact time to rapid response activation, Spanish-speaking patients had increased ICU transfers and prolonged hospital stays. These findings highlight the need for improved language-concordant care to mitigate disparities in pediatric critical care outcomes.
Recognition of wheezing by parents of children with asthma is often difficult, potentially delaying care and worsening exacerbations. We evaluated whether caregiver report of wheezing at presentation was associated with hospital outcomes. Using chart review of 732 pediatric asthma admissions over 3 years, symptom and demographic data were extracted from the electronic health record, and regression models examined length of stay (LOS) and pediatric intensive care unit (PICU) admission. Wheezing was reported in 45% of cases and was linked to a 10% shorter LOS (IRR 0.9, 95% CI 0.82-0.99, P = .04). Commonly reported symptoms included shortness of breath (89%), cough (79%), and congestion (47%). Longer LOS was associated with older age (IRR 1.04, 95% CI 1.03-1.06, P < .001) and female sex (IRR 1.14, 95% CI 1.03-1.26, P = .01). No variables predicted PICU admission. These findings suggest under-recognition of wheezing by caregivers may contribute to longer hospitalizations and greater exacerbation severity.
Hospitalized children experience educational disruption and reduced motivation during prolonged admissions. Despite the availability of in-hospital schools, many cannot participate due to illness severity or isolation precautions. This pragmatic, randomized crossover trial evaluated whether bedside virtual reality (VR) lessons improve intrinsic motivation among inpatients aged 5 to 25 years unable to attend the hospital school. Participants completed both VR-based educational sessions and standard of care (SOC) conditions on consecutive days. The primary outcome was intrinsic motivation, with secondary outcomes including educational self-efficacy, well-being, self-esteem, and parental experience. Of 156 enrolled patients, 100 were analyzed (mean age 11.5 [SD = 4.1 years]; 43.9% female). Intrinsic motivation scores were higher in the VR condition than SOC (P = .0048), and parental satisfaction was also greater (P = .0008). Bedside VR education represents a feasible, acceptable, and scalable adjunct to inpatient learning, supporting intrinsic motivation and caregiver satisfaction during hospitalization.Trial Registration: ClinicalTrials.gov NCT05725395, date first registered November 22, 2022.
Pediatric invasive Group A Streptococcus (iGAS) infections two years before, during, and a year after the Coronavirus Disease 2019 (COVID-19) pandemic were analyzed in an urban hospital in the Northeastern United States. Invasive GAS was diagnosed in 38 patients. There were as many infected children post-COVID as in the prior 4.5 years combined. The post-pandemic surge was most striking in late spring. The median age was youngest during the post-pandemic year at 2.3 years. During and after the pandemic, about half the children had concurrent virus detection, and two-thirds had no known chronic comorbidities, highlighting Streptococcus pyogenes’ potential for significant morbidity in healthy and young children. The spectrum of iGAS disease manifestations was similar among the 3 time periods, with soft tissue infections predominating overall. Of post-pandemic GAS isolates, 67% were emm 1 and 33% were emm 12. Preventive efforts of this grave disease at all ages should continue.
