Objective: Children with prematurity and complex medical histories are at increased risk for tube dependence, feeding aversion, and aspiration, which can interfere with completing a video fluoroscopic swallow study (VFSS) making it challenging to target broader feeding goals. This case report describes a bolus fading intervention designed to establish consistent oral intake and prepare a tube-dependent child for VFSS. Methods: An 18-month-old child born at 26 weeks’ gestation with severe bronchopulmonary dysplasia, a prior failed VFSS, and 100% gastrostomy-tube dependence participated in an intensive interdisciplinary home-based feeding program. A single-case reversal design evaluated a bolus fading treatment that included noncontingent reinforcement and escape extinction (initially), along with procedures to increase mouth clean. Bolus sizes increased systematically from empty spoon to full spoon while the clinician monitored clinical signs of aspiration. Caregiver acceptability was assessed using a questionnaire. Results: Baseline responding showed no acceptance and high inappropriate mealtime behavior. During treatment, acceptance increased, inappropriate mealtime behavior decreased to near zero, and mouth cleans improved after targeted modifications. During the VFSS, the child accepted thin liquids by spoon without inappropriate mealtime behavior, and the hospital speech-language pathologist confirmed safe swallowing. Caregivers indicated high acceptability. Conclusions: Bolus fading effectively prepared a tube-dependent child to participate in the VFSS, making it possible to determine swallow safety and progress toward broader feeding treatment goals. Implications for Impact Statement Our findings highlight how individualized behavioral interventions can make swallow studies more successful for children who struggle with feeding, improving both the assessment process and ultimately treatment outcomes.
Objective: In a field where standards of care for subspecialty pediatric psychology services have become increasingly operationalized, the pediatric psychology consultation/liaison (C/L) service can vary substantially as a function of the hospital system in which the service resides. We explore the potential benefits of pediatric psychology C/L services integrated with psychiatry on an inpatient consult service (Integrated) versus existing as a standalone service embedded in pediatrics (Standalone). Methods: Data from two similarly sized children’s hospitals in academic medical centers in different regions of the United States were compared (Standalone and Integrated C/L services). Variables included total number of consults seen and nature of consult request for psychology, psychiatry, or both services (psychiatry and psychology). The Standalone C/L service also included data prior to, and following, the onboarding of a fully dedicated psychologist in C/L services. Results: Across both models of C/L, the nature of referrals placed by inpatient medical teams reflected that pediatric psychology C/L provided a specialization separate from psychiatry, as evidenced by different presenting consult concerns. The Standalone C/L service also observed an increase in referrals placed to their service following the onboarding of a full-time psychologist in C/L services. Conclusions: Data suggest that pediatric psychology C/L services are desirable and sustainable regardless of whether they exist as a standalone or integrated model. Implications for Impact Statement The results of the study indicate that pediatric psychology C/L services hold similar value whether they are integrated within inpatient psychiatry C/L services or standalone services in pediatrics.
Objective: Inequities in accessing waitlisting for liver and kidney transplantation among pediatric and adult populations are well-documented, with disparities related to race, ethnicity, and socioeconomic status consistently present in both settings. Historically, studies examining barriers to transplant waitlisting have focused mainly on patient and family demographics. However, due to the complexity and subjectivity of pretransplant evaluations, other factors (e.g., provider biases) likely influence waitlisting decisions. This topical review brings awareness to how provider biases toward race, ethnicity, and socioeconomic status may impact access to pediatric liver and kidney transplant waitlisting. Methods: Searches using keywords such as ethnic and racial minorities, waiting lists, transplantation, poverty, and pediatrics were conducted in https://inPubMed.gov , CINAHL Complete (EBSCO), PsychINFO (EBSCO), https://Embase.com , https://Scopus.com , and Web of Science databases with no relevant findings including provider bias in pediatric liver or kidney transplant. A second search in only PubMed with no limit by age produced four relevant articles between 2004 and 2023. Results: Provider biases within the pretransplantation evaluation and waitlisting processes have been explored in adult populations and are starting to be explored in some pediatric subspecialties, though gaps remain in pediatric liver and kidney transplantation. Conclusions: Pediatric kidney and liver transplant waitlisting may be impacted by provider biases throughout the evaluation process. More research is needed to determine areas of susceptibility and how to reduce bias throughout the subjective processes of transplant evaluation. We provide recommendations for how pediatric psychologists can use their skillsets to decrease bias and advance equity in pediatric liver and kidney transplantation settings.
Maternal depression negatively impacts parenting practices and child development. Many mothers of young children screen positive for depression in our clinics. The objective of this quality improvement initiative was to use the SQUIRE 2.0 framework to evaluate a quality improvement initiative that focused on the integration of a brief parenting intervention in two family medicine clinic's routine depression screening. Patients who were caregivers of young children and who screened positive for depressive symptoms but did not endorse suicidality were invited to receive parenting tips via automated text, a few learning materials (e.g., books, blocks), and monthly support phone calls over a 5-month period. Though initially intended to include caregivers regardless of sex or identified gender, only caregivers who self-identified as females participated. Outcome measures included the Patient Health Questionnaire-2 and -9 (depression symptoms) and portions of the Family Map Inventories (parenting-practices). Sixty-two percent of participating patients completed pre- and postintervention surveys. Following intervention participation, patients' depression symptoms significantly decreased and their self-reported positive parenting practices (e.g., use of routines, parent-child play, positive guidance) significantly increased. Leveraging technology to improve parenting practices and mental health among parents of young children expanded access to support services and was effective in our setting.
Objective The purpose of this study is to understand baseline psychological functioning and protective factors for transmasculine, transfeminine, and gender expansive youth seeking services at a gender affirming outpatient clinic. This study also examines differences between these groups.Method 137 TGE youth aged 12-21 completed the Behavior Assessment Scale for Children, Third Edition. Of the 137 participants, 82 (59.4%) identified as transmasculine, 26 (18.8%) identified as transfeminine, and 29 (21.0%) identified as non-binary/gender expansive. Additionally, a majority (79.6%) identified as White. Several analyses were conducted to explore baseline psychological functioning across different groups and look at the impact of psychotherapy and the current political climate.Results Results showed no significant differences between gender identity groups for depression, anxiety, hyperactivity, attention problems, relations with parents, interpersonal relationships, self-esteem, self-reliance, external locus of control, and ego strength. For all variables except anxiety and self-esteem, participants scored in the average range. There was not a significant difference by identity in access to psychotherapy or treatment access on psychological functioning psychological functioning. We also found no significant differences between psychological functioning and sociopolitical events. However, gender identity moderated the relationship between self-esteem and attention problems.Conclusions These results suggest that there are few differences found between groups of TGE youth regarding mental health symptoms in this sample. The results suggest additional research is needed to understand what screening measures are appropriate for use with TGE youth and provides evidence that not all clinical samples of TGE youth are experiencing clinically significant mental health symptoms.
