<p><strong>OBJECTIVE: </strong>Overuse of diagnostic tests is of particular concern for pediatric academic medical centers. Our objective was to measure variation in testing based on proportion of hospitalization during the day versus night and the association between attending in-house coverage on the teaching service and test utilization for hospitalized pediatric patients.</p>

<p><strong>METHODS: </strong>Electronic health record data from 11,567 hospitalizations to a large, Northeastern, academic pediatric hospital were collected between January 2007 and December 2010. The patient-level dataset included orders for laboratory and imaging tests, information about who placed the order, and the timing of the order. Using a cross-sectional effect modification analysis, we estimated the difference in test utilization attributable to attending in-house coverage.</p>

<p><strong>RESULTS: </strong>We found that admission to the teaching service was independently associated with higher utilization of laboratory and imaging tests. However, the number of orders was 0.76 lower (95% confidence interval:-1.31 to -0.21, P = .006) per 10% increase in the proportion in the share of the hospitalization that occurred during daytime hours on the teaching services, which is attributable to direct attending supervision.</p>

<p><strong>CONCLUSIONS: </strong>Direct attending care of hospitalized pediatric patients at night was associated with slightly lower diagnostic test utilization.</p>

<p><strong>OBJECTIVES: </strong>The American Academy of Pediatrics recommends that all pediatricians screen for social determinants of health to identify families in need and connect them to available resources. We examined pediatric residents' screening practices for social needs in different clinical settings and explored the influence of electronic health record (EHR) prompts on screening.</p>

<p><strong>METHODS: </strong>In this cross-sectional study, pediatric residents participated in a brief electronic survey assessing (1) screening practices for unmet social needs and (2) perceived barriers to and facilitators of routine screening in the inpatient and outpatient settings. The differences in screening by care setting were assessed by using Fisher's exact test. Mixed-effects logistic regression was used to examine the association between EHR prompts and resident screening practices.</p>

<p><strong>RESULTS: </strong>Ninety-two pediatric residents (64% of the residency program) responded to the survey. Respondents reported significantly higher rates of social needs screening in the outpatient as compared with the inpatient setting (98% vs 37%; &lt; .001). Residents cited time constraints, lack of knowledge about available resources, and discomfort with screening questions as barriers to screening in both settings. Residents were more likely to screen for social needs when screening questions were embedded in the EHR (odds ratio = 9.6; 95% confidence interval: 6.7-13.9).</p>

<p><strong>CONCLUSIONS: </strong>Pediatric residents were more likely to screen for unmet social needs in the outpatient than in the inpatient setting despite reporting similar barriers to screening in both settings. EHR-based social needs screening templates could be used to increase rates of screening and reach additional families in need.</p>

<p>Families' access to local food-insecurity (FI) resources differs. This study examines how health system and public data may be combined to identify limitations in community resources designed to address FI. We conducted a retrospective cohort study using electronic health record (EHR) data from nine practices that screened families for FI. Electronic health record data included demographic and clinical characteristics. Publicly available data included local socioeconomic and food resource information. We calculated the distance from each household to the nearest food pantry and determined the percentage of families who might have difficulty accessing resources. We demonstrate how health systems could merge these data sources to map where food-insecure families live, describe families' access to local resources, and identify regions where gaps in services exist. Health systems could use this approach to support households with FI and advocate for additional services in areas lacking resources in order to target population health efforts.</p>

<p><strong>CONTEXT: </strong>Parents may experience psychological distress when a child is acutely hospitalized, which can negatively affect child outcomes. Interventions designed to support parents' coping have the potential to mitigate this distress.</p>

<p><strong>OBJECTIVE: </strong>To describe interventions designed to provide coping support to parents of hospitalized children and conduct a meta-analysis of coping support intervention outcomes (parent anxiety, depression, and stress).</p>

<p><strong>DATA SOURCES: </strong>We searched Pubmed, Embase, PsycINFO, Psychiatry Online, and Cumulative Index to Nursing and Allied Health Literature from 1985 to 2016 for English-language articles including the concepts "pediatric," "hospitalization," "parents," and "coping support intervention."</p>

<p><strong>STUDY SELECTION: </strong>Two authors reviewed titles and abstracts to identify studies meeting inclusion criteria and reviewed full text if a determination was not possible using the title and abstract. References of studies meeting inclusion criteria were reviewed to identify additional articles for inclusion.</p>

<p><strong>DATA EXTRACTION: </strong>Two authors abstracted data and assessed risk of bias by using a structured instrument.</p>

<p><strong>RESULTS: </strong>Initial searches yielded 3450 abstracts for possible inclusion. Thirty-two studies met criteria for inclusion in the systematic review and 12 studies met criteria for inclusion in the meta-analysis. The most commonly measured outcomes were parent depression, anxiety, and stress symptoms. In meta-analysis, combined intervention effects significantly reduced parent anxiety and stress but not depression. Heterogeneity among included studies was high.</p>

<p><strong>LIMITATIONS: </strong>Most included studies were conducted at single centers with small sample sizes.</p>

<p><strong>CONCLUSIONS: </strong>Coping support interventions can alleviate parents' psychological distress during children's hospitalization. More evidence is needed to determine if such interventions benefit children.</p>

<p><strong>BACKGROUND: </strong>National organizations recommend pediatricians screen for food insecurity (FI). Although there has been growing research in urban practices, little research has addressed FI screening in suburban practices. We evaluated the feasibility, acceptability, and impact of screening in suburban practices.</p>

<p><strong>METHODS: </strong>We conducted a mixed methods study that implemented FI screening in 6 suburban pediatric primary care practices. We included all children presenting for either a 2-, 15-, or 36-month well-child visit (N = 5645). Families who screened positive were eligible to be referred to our community partner that worked to connect families to the Supplemental Nutrition Assistance Program. We conducted focus groups with clinicians to determine their perceptions of screening and suggestions for improvement.</p>

<p><strong>RESULTS: </strong>Of the 5645 children eligible, 4371 (77.4%) were screened, of which 122 (2.8%) screened positive for FI (range: 0.9%-5.9% across practices). Of the 122 food-insecure families, only 1 received new Supplemental Nutrition Assistance Program benefits. In focus groups, 3 themes emerged: (1) Time and workflow were not barriers to screening, but concerns about embarrassing families and being unable to provide adequate resources were; (2) Clinicians reported that parents felt the screening showed caring, which reinforced clinicians' continued screening; (3) Clinicians suggested implementing screening before the visit.</p>

<p><strong>CONCLUSIONS: </strong>We found it is feasible and acceptable for clinicians to screen for FI in suburban practices, but the referral method used in this study was ineffective in assisting families in obtaining benefits. Better approaches to connect families to local resources may be needed to maximize the effectiveness of screening in suburban settings.</p>

<p><strong>BACKGROUND: </strong>Food insecurity (FI) remains a major public health problem. With the rise in suburban poverty, a greater understanding of parents' experiences of FI in suburban settings is needed to effectively screen and address FI in suburban practices.</p>

<p><strong>METHODS: </strong>We conducted 23 semistructured interviews with parents of children &lt;4 years of age who presented for well-child care in 6 suburban pediatric practices and screened positive for FI. In the interviews, we elicited parents' perceptions of screening for FI, how FI impacted the family, and recommendations for how practices could more effectively address FI. All interviews were audio recorded and transcribed. We used a modified grounded theory approach to code the interviews inductively and identified emerging themes through an iterative process. Interviews continued until thematic saturation was achieved.</p>

<p><strong>RESULTS: </strong>Of the 23 parents interviewed, all were women, with 39% white and 39% African American. Three primary themes emerged: Parents expressed initial surprise at screening followed by comfort discussing their unmet food needs; parents experience shame, frustration, and helplessness regarding FI, but discussing FI with their clinician helped alleviate these feelings; parents suggested practices could help them more directly access food resources, which, depending on income, may not be available to them through government programs.</p>

<p><strong>CONCLUSIONS: </strong>Although most parents were comfortable discussing FI, they felt it was important for clinicians to acknowledge their frustrations with FI and facilitate access to a range of food resources.</p>

<p>The adverse effects of poverty on health have been well documented. In response, pediatric clinicians have become increasingly focused on mitigating these effects on children’s health. In March 2016, the American Academy of Pediatrics (AAP) released the first-ever policy statement on poverty, calling for pediatricians to screen and address poverty and related social determinants of health (SDH). Recent research has developed an evidence base for strategies to address SDH in urban practices. Notably, poverty has grown by 66% in suburban communities over the past decade, double the rate in cities.However, comparatively little information is available for pediatricians on how to address poverty in the suburbs, where almost half of US pediatricians practice and where differences in infrastructure and resources may limit the generalizability of strategies successfully implemented in urban practices. This Perspective addresses barriers to and opportunities for pediatricians to better support suburban poor families.</p>

<p>Building on prior research, this study tested two theories: (1) differences in child health care utilization can predict household food insecurity (FI), and (2) FI is associated with subsequent increased acute health care use. We conducted a prospective cohort study of 3,335 children screened for FI at three-year well-child visits in three urban practices, evaluating their acute care use one year before and after FI screening. Prior to screening, food-insecure participants had fewer acute primary care visits, but there were no differences in emergency department visits or hospitalizations. Overall, child demographic characteristics and health care use were no better than chance in predicting household FI. For those who screened positive, there were no differences in subsequent acute care use. This study suggests that the risk of FI among three-year olds cannot be reliably predicted based on acute health care use patterns, and FI may not be associated with subsequent acute health care use.</p>

<p>Many states have enacted laws to improve school nutrition. We tested whether stronger state nutrition laws are associated with subsequently decreased obesity. We conducted a retrospective national multi-year panel data study (analyzed 2014-2016 at the Children's Hospital of Philadelphia). The predictors were 2010 laws regarding 9 nutrition categories from the Classification of Laws Associated with School Students, which grades the strength of state laws (none, weak, or strong). The outcome was weight status (healthy weight, overweight, or obese) in elementary, middle, and high school from the 2011/2012 National Survey of Children's Health. We tested the association between the strength of laws and weight using multinomial logistic regression. To further evaluate our main results, we conducted state-level longitudinal analyses testing the association between competitive food and beverage laws on the change in obesity from 2003-2011. In main analyses of 40,177 children ages 10-17years, we found strong state laws restricting the sale of competitive food and beverages in elementary school (OR: 0.68; 95% CI: 0.48, 0.96) and strong advertising laws across all grades (OR: 0.63; 95% CI: 0.46, 0.86) were associated with reduced odds of obesity. In longitudinal analyses, states with strong competitive food and beverage laws from 2003-2010 had small but significant decreases in obesity, compared to states with no laws. Although further research is needed to determine the causal effect of these laws, this study suggests that strong state laws limiting the sale and advertising of unhealthy foods and beverages in schools are associated with decreased obesity rates.</p>

<p><strong>OBJECTIVE: </strong>To examine differences in expectations when a resident should contact a supervising physician in several hospital-based, after-hours clinical circumstances.</p>

<p><strong>STUDY DESIGN: </strong>We developed 34 scenarios collectively considered the most common or serious issues encountered by on-call residents, and incorporated them into a survey of pediatric residents, fellows, and attendings. For each scenario, participants were asked whether the resident should talk to the attending/fellow immediately or delay communication until the next day. ORs comparing attendings/fellows and residents were calculated, and subgroup analyses were performed examining differences among the study populations.</p>

<p><strong>RESULTS: </strong>A total of 112 participants completed the survey (91% response rate). In 17 of the 34 scenarios (50%), more attendings/fellows than residents asked for immediate communication (OR &gt;1; P&nbsp;&lt;&nbsp;.05). Most discrepant scenarios were in uncertain areas in which residents may feel comfortable managing the issue without supervisory input or, alternatively, fail to recognize an evolving matter or a deteriorating clinical status. In subgroup analyses, residents were homogeneous in their responses; however, responses of fellows and junior faculty differed from those of senior faculty in 7 of the 34 scenarios, with senior attendings more likely desiring immediate communication.</p>

<p><strong>CONCLUSION: </strong>We found differences in expectations of when a pediatric resident should contact a supervising physician after hours not only between residents and attendings/fellows, but among attendings themselves. These differences could lead to medical errors, miscommunication, and inconsistent supervision for overnight residents.</p>