Pediatricians` attitudes, practices, and perceived barriers to school readiness

BACKGROUND

School readiness (SR) has been adopted by the American Academy of Pediatrics (AAP) as a component of health supervision, but the medical community`s role is unknown. We evaluated the pediatricians` attitudes, practices, and perceived barriers to SR.

METHODS

This multicenter, cross-sectional descriptive study was performed among 787 general pediatricians, pediatric residents, subspecialists, and subspecialty fellows. A 41-item survey was administered.

RESULTS

Forty-nine point two percent of the pediatricians defined SR as a multidimensional issue, as outlined by the AAP, whereas 50.8% defined it as the child`s set of skills or passing the SR tests. Three-quarters of pediatricians believed that SR assessment tests are necessary before starting school, and children who do not appear ready should wait a year. To promote SR, the rates of usually fostering at least four of the five `Rs` (reading, rhyming, routines, rewarding, relationships) and integrating developmental surveillance into daily practice were 37.8% and 23.8%, respectively. Only 2.2% of pediatricians usually inquired about eight adverse childhood experiences (ACEs), and 68.9% did not usually ask about any. Usually fostering at least four of the five `Rs` was associated with usually integrating developmental surveillance (p < 0.001), usually inquiring about each ACE (p < 0.001), and being perceived as responsible for promoting SR (p < 0.01). Training on SR during pediatric residency was 2.7%. Time constraints and insufficient knowledge were the most common barriers.

CONCLUSIONS

Pediatricians were not familiar with the concept of SR and had some misconceptions. There is a need for additional training regarding pediatricians` roles in promoting SR along with addressing multiple, modifiable barriers within the health system. < strong > Supplementary: < a href="https://www.turkishjournalpediatrics.org/uploads/2573-supplementary.pdf" target=`_blank` > Supplementary Appendix < /a > < /strong >.

Serum spexin levels are not associated with size at birth but are associated with metabolic syndrome components in prepubertal children born at term

BACKGROUND

Babies born small for gestational age (SGA) are at risk of obesity and metabolic syndrome (MetS). Spexin (SPX) is a novel peptide implicated in food intake and obesity. Spexin levels are lower in obese subjects. This study investigated the potential association of SPX and some obesity related peptides such as leptin and active ghrelin with size at birth and MetS components in prepubertal children born term and either SGA or appropriate for GA (AGA). Secondary aim was to identify whether any of the investigated peptides were associated with MetS components.

METHODS

We conducted a cross-sectional study of 37 consecutive (median age: 5.6 y) SGA- and 50 (median age: 5.9 y) AGA-born children. Clinical evaluations were performed using standard methods. Several biochemical variables (SPX, total leptin, and active ghrelin levels) were analyzed. Age-dependent cut-off values were used to define MetS components, including excess adiposity, hypertension, insulin resistance, and dyslipidemia. The associations between the assessed clinical and laboratory variables and MetS components were investigated.

RESULTS

Children born SGA had higher frequencies of MetS components than AGA-born peers (p < 0.01). None of the investigated peptides were different between children born SGA and AGA after correcting for body mass index (p > 0.05 for all). Serum SPX levels were lower in children with at least one metS component than those without MetS components (p = 0.018).

CONCLUSIONS

Size at birth had no association with serum SPX. Serum SPX levels are decreased in prepubertal children with MetS components.

Routine Pediatric Vaccination During Pandemic: Attitudes of Parents

Objective

To examine the effects of a pandemic on children’s routine vaccination between 0 months and 24 months and to determine the affecting factors on vaccination during the pandemic.

Materials and Methods

Our study was conducted between July 17, 2020, and August 1, 2020, among 513 mothers whose children were aged between 0 months and 24 months old. A total of 21 questions were asked to participants’ sociodemographic characteristics and attitudes and behaviors towards pediatric vaccines during the pandemic.

Results

The rate of vaccination for children was 82.8% (n = 425), unvaccinated children was 3.9% (n = 1). 13.3% (n = 68) of vaccinated children had “delayed” vaccination. 76.2% (n = 391) of the participants stated “they were concerned about COVID-19 infection’’ while visiting a healthcare center for vaccination. The 3 most common affecting factors for vaccination; 43.9% (n = 340 ) “pediatric vaccines are vital and must be administered,” 23.6% (n = 183) they had vaccine appointment and have been informed “vaccination service would continue as usual,” 22.7% (n = 176 ) have been informed that “required precautions have been taken”. It was found that reasons for not to be vaccinated in the pandemic; 63.2% (n = 12) “fear of COVID-19,” 15.8% (n = 3) “quarantined as the whole family” and 10.5% (n = 2) “vaccine hesitancy.”

Conclusion

Healthcare providers should inform parents that vaccination is vital, and vaccination must always be administered on time during a pandemic. During a pandemic, continuing appointments for vaccination services, calling to inform the parents that required precautions to minimize the spread of infection have already been taken, and alleviating parents’ concerns would prevent vaccination rates from decreasing in this period.

Associations of Size at Birth and Metabolic Syndrome Antecedents With Serum Spexin Levels in Prepubertal Children

Background: Spexin is a novel peptide implicated in food intake and obesity. The primary aim of this study was to analyze whether serum spexin levels, along with total leptin and active ghrelin levels were different in prepubertal children born small for gestational age(SGA) and appropriate for gestational(AGA). Secondary aims were to analyze whether serum spexin, leptin and active ghrelin levels correlated with metabolic syndrome(MS)antecedents according to the Dietary and lifestyle-induced health effects in children and infants (IDEFICS)study. Subjects and Methods: We conducted a cross-sectional study on prepubertal37SGA- (median:5.6yr)and50prepubertalAGA-born children(median:5.9yr). Anthropometric data, homeostasis model assessment of insulin resistance(HOMAIR),plasma lipids, serum spexin, total leptin and active ghrelin levels were analyzed. Associations of serum spexin levels with MS antecedents according to the IDEFICS study were investigated. Results: Children bornSGA had higher body mass index and waist circumference than AGA-born peers(p <0.05). Serum total leptin levels were higher in SGA-born children than in AGA-born peers (p<0.05). Plasma active ghrelin and spexin levels were not different between the subgroups(p>0.05). Children bornSGA had higher MS risk scores than AGA-born peers(p <0.05). Small for gestational age- born children had higher plasma glucose,insulin and HOMA-IR than AGA-born peers(p<0.05). In children born SGA, the number of subjects with excess adiposity (N_SGA=18(43.9%)andN_AGA=7(14%),p=0.016)and insulin resistance(N_SGA=14(34%) andN_AGA=6(12%),p=0.035)was higher than in AGA-born peers. There was no significant difference in frequency of dyslipidemia between the subgroups(p=0.19). The frequency of children with more than one MS antecedent was higher in SGA-born children than in AGA-born peers(Chi-Square p <0.01). Metabolic syndrome risk score according to IDEFICS was higher in SGA born children than in AGA-born peers(2.2±1.8vs1.1±1.8;p=0.008). Serum spexin levels were lower in children with MS antecedents than those without MS antecedents in both AGA -and SGA-born children[Serum spexin levels in AGA-born children with and without MS antecedents: 48,5pg/mL(25-75%IQR:19.8-93.8pg/mL)and143pg/mL(25-75%IQR:104-211pg/mL),p<0.001;respectively, serum spexin levels inSGAborn children with and without MS antecedents: 31,0pg/mL(25-75%IQR:16.5-47.0 pg/mL) and79.5pg/mL(25-75% IQR:49.5-274.8pg/mL),p=0,0016;respectively]. In the whole study group, the most important factor associated with excess adiposity was history of being born SGA(OddsRatio=91.3[95%CI:2.2-374;p=0.017]

Conclusions: Serum spexin levels were not different inSGA- and AGA-born children. Serum spexin levels were reduced in children with MS antecedents independent of size at birth.

Evaluation of retinal neurovascular structures by optical coherence tomography and optical coherence tomography angiography in children and adolescents with type 1 diabetes mellitus without clinical sign of diabetic retinopathy

BACKGROUND

The aim of the study was to investigate whether retinal neurovascular structural impairment in children and adolescents with type 1 diabetes mellitus (T1D) without clinical signs of diabetic retinopathy (DR) could be detected early via optical coherence tomography (OCT) and OCT angiography (OCTA).

METHODS

In the current prospective, cross-sectional, observational clinical study children and adolescents with T1D without DR were evaluated between December 2018 and May 2019. Retinal neurovascular structures in the macular and optic disc regions were examined in detail and quantitatively assessed using OCT and OCTA. Data from subjects with T1D were compared with data from healthy controls. Whether retinal neurovascular structural changes were significantly associated with puberty stage, diabetes duration, and HbA1c level was also investigated.

RESULTS

The T1D group included 110 eyes and the control group included 84 eyes. In the T1D group the mean inside disc vessel density (VD) was significantly lower than that of the control group (p < 0.001), as was the mean superior temporal disc VD (p < 0.043). Puberty stage was significantly associated with retinal thickness, parafoveal superficial capillary plexus VD, and peripapillary retinal nerve fiber layer thickness (p < 0.05). Diabetes duration and HbA1c level was significantly correlated with retinal layer thickness, foveal avascular zone diameter, and superficial and deep capillary plexus VDs.

CONCLUSION

In children and adolescents with T1D without clinical signs of DR, the VD of the disc region is affected earlier than the macular region. In these patients, early neurovascular impairment can be detected non-invasively via OCT and OCTA.

Addressing early childhood development and developmental difficulties in Turkey: a training programfor developmental pediatrics units

INTRODUCTION

Addressing early childhood development (ECD) and developmental difficulties (DDs) in low and middle-income countries (LMICs) requires applicable and sustainable programs. Seven years after its implementation in 2010, we evaluated the Developmental Pediatrics Unit (DPU) Training Program in pediatric referral centers in Turkey.

POPULATION AND METHODS

We applied crosssectional design and quantitative/qualitative methods to assess services, training, research and advocacy of the DPUs.

RESULTS

Five of six established DPUs sustained clinical services, training, research, and advocacy. A total of 23,710 children (9085 new cases in 2017) had been referred mainly for perinatal risks and chronic illness, all centers contributed with similar proportions of children. Staff motivation and endurance, hospital administrator support, and client satisfaction facilitated the program; whereas invisibility within the performance based healthcare system was a barrier.

CONCLUSIONS

In Turkey and possibly other LMICs, the DPU Training Program is applicable and sustainable if health system barriers are addressed.

Recommending immunizations to adolescents in Turkey: a study of the knowledge, attitude, and practices of physicians

Introduction: The aim of this study was to determine the knowledge, attitudes, and practices of family physicians and pediatricians in regard to adolescent immunization.Methods: The study was conducted from March to May 2017. A total of 665 physicians participated. Participants were asked 31 questions about their personal sociodemographic characteristics and their knowledge, attitudes, and practices around adolescent immunization.Results: The study sample consisted of 348 family physicians (52.3% of the sample) and 317 pediatricians (47.7%). The results showed that 5.4% of family physicians and 10.4% of pediatricians thought that they had enough knowledge about adolescent immunization (p < .01). Overall, 15.8% of family physicians and 12.7% of pediatricians provided adolescents with information about vaccines 'always/most of the time'. A variety of reasons for not providing information about adolescent vaccines was provided, including 'inability to allocate time' (50.2% of family physicians, 69.3% of pediatricians); 'forgetfulness' (34.8% of family physicians, 28.5% of pediatricians); 'lack of knowledge about vaccines' (34.1% of family physicians, 27.4% of pediatricians); and 'no need to immunize adolescents' (15.7% of family physicians, 6.5% of pediatricians) (p < .01). HPV immunization was recommended only to girls by 30.5% of family physicians and 38.8% of pediatricians (p < .01). The percentages of family physicians and pediatricians not recommending that adolescents be immunized with the Tdap vaccine were 53.4% and 42.6%, respectively (p = .016). Meningococcal immunization was not recommended by 20.7% of family physicians and 11.4% of pediatricians (p < .01), and influenza immunization was not recommended by 10.3% of family physicians and 8.2% of pediatricians (p < .01).Conclusion: Family physicians and pediatricians in Turkey have low rates of recommendation of immunization to adolescents. Reasons for not recommending immunization include an inability to allocate time, forgetfulness, and lack of knowledge about vaccines. We conclude that educational programs should be used to improve knowledge of adolescent immunization among family physicians and pediatricians.

Vitamin D levels of 12-24-month-old healthy children in Turkey who received vitamin D supplementation until the age of one year

INTRODUCTION

The aim of this study was to evaluate vitamin D levels between 12-24 monthold healthy children supplemented with vitamin D (400 IU/day) during the first year.

METHODS

Descriptive-sectional study conducted between June 2015, and May 2016, in Istanbul (latitude 41ºN). Children aged 12-24 months followed up by the well-child clinic who had vitamin D supplementation in the first year were included in the study. The levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone and 25-hydroxyvitamin D [25(OH)D] were measured. Vitamin D status was defined as >20 ng/mL: sufficiency, 15-20 ng/mL: insufficiency and <15 ng/mL: deficiency.

RESULTS

The study was completed with 197 children. 26.9 % of children (n = 53) went on receiving supplementation after one year (mean dose 491 ± 267 IU/day). The mean 25(OH)D level was 38.0 ± 13.9 ng/mL. It was found that regular vitamin D intake under one year of age (p = 0.008) and continued support after one year of age (p = 0.042) increased level of 25(OH)D in children aged 12-24 months. Vitamin D deficiency was found in 4.1 % and vitamin D insufficiency in 7.1 %. Mother's education (p = 0.009) and use of formula (p = 0.012) were protective factors in relation to development of vitamin D deficiency or insufficiency.

CONCLUSIONS

The level of 25(OH)D was sufficient in 88.8 % of children aged 12-24 months receiving 400 IU/day vitamin D supplementation in the first year. Vitamin D supplementation could not be required in healthy children aged 12- 24 months who received properly vitamin D supplementation in the first year.

Maternal Characteristics and Obstetric and Neonatal Outcomes of Singleton Pregnancies Among Adolescents

Background

Adolescent pregnancy remains a global public health issue with serious implications on maternal and child health, particularly in developing countries The aim of this study was to investigate maternal characteristics and obstetric and neonatal outcomes of singleton pregnancies among adolescents.

Material/Methods

A total of 241 adolescent women who gave birth to singletons between January 2015 and December 2015 at our hospital were included in this descriptive cross-sectional study. Data on maternal sociodemographic and obstetric characteristics as well as neonatal outcome were recorded.

Results

Primary school education (66.0%), lack of regular antenatal care (69.7%), religious (36.7%) and consanguineous (37.0) marriage, Southeastern Anatolia hometown (34.9%) and Eastern Anatolia hometown (21.2%) were noted in most of the adolescent pregnancies, while 95% were desired pregnancies within marriage. Pregnancy complications were noted in 19.5% (preeclampsia in 5.8%) and cesarean delivery was performed in 44.8% of adolescent pregnancies. Preterm delivery rate was 27.0% (20.3% were in >34 weeks). Overall, 13.3% of neonates were admitted to neonatal intensive care unit (NICU) in the postpartum period (prematurity in 28.1%), while 25.3% were re-admitted to NICU admission in the post-discharge 1-month (hyperbilirubinemia in 55.7%). Adolescent pregnancies were associated considerably high rates of fetal distress at birth (28.7%), preterm delivery (26.9%), and re-admission to NICU after hospital discharge (25.3%).

Conclusions

In conclusion, our findings indicate that along with considerably high rates of poor antenatal care, maternal anemia and cesarean delivery, adolescent pregnancies were also associated with high rates for fetal distress at birth, preterm delivery, and NICU re-admission within post-discharge 1-month.

Does Food Allergy Require Any Change in Measles-Mumps-Rubella Vaccination?

OBJECTIVES

To determine the allergic reactions that develop after Measles and Measles-Mumps-Rubella (MMR) vaccination, and whether any delay in the timing of vaccination occurs in children with food allergy.

METHODS

Children with food allergy who were admitted to the Şişli Hamidiye Etfal Training and Research Hospital Healthy Child Clinic between 1st January 2015 and 30th June 2018 for Measles or MMR vaccination were studied retrospectively. Their age, delayed days of vaccination, the types of allergic food, the results of the specific IgE and skin tests, and any reaction after the vaccination were recorded.

RESULTS

During the study period, 159 patients were vaccinated and 170 doses of Measles or MMR vaccine were administered. Children allergic to egg were 50.3%, allergic to egg and milk were 25.8%, and 13.2% had multiple food allergy including egg. The rate of post-vaccination reactions in the patients with food allergy was 1.76%. Minor reaction was observed in three patients and no anaphylaxis was seen in any patient. Delayed days of vaccination in the patients referred by another center were greater than followed-up by present clinic (p < 0.001).

CONCLUSIONS

Any serious allergic reaction was not observed in this study. Food allergy does not necessitate modification of routine vaccination. Anaphylaxis may develop in any vaccinated child regardless of whether he/she has food allergy or not. Therefore, vaccines should be administered in a healthcare facility that can treat anaphylaxis.

How should we give vitamin D supplementation? evaluation of the pediatricians' knowledge in Turkey

Background

We aimed to determine the knowledge and attitudes of Turkish pediatricians concerning vitamin D supplement.

Methods

The study was planned cross-sectional to be carried out between April–May 2015 in Turkey. A questionnaire form that determined the participants’ opinions and practices concerning vitamin D supplement was completed via face-to-face interview.

Results

A total of 107 pediatricians (49.3%) and 110 pediatric residents (50.7%) participated in the study. Of the physicians, 85.2% recommended vitamin D supplement for all infants and children regardless of diet, 13.4% recommended for the infants which are solely breastfed. Vitamin D supplement is recommended at a dose of 400 IU/day by 88.8% of pediatricians and by 90% of pediatric residents. Of the pediatricians and pediatric residents, 72% and 68.2%, respectively commence vitamin D supplement when the newborn is 15 days old. The rates of recommending vitamin D supplement until the age of one and two years were higher among pediatricians (48.6% and 41.1%, respectively) than pediatric residents (40.9% and 32.7%, respectively). The rate of starting vitamin D supplement for fontanelle closure was significantly higher among pediatric residents (15.5%) than pediatricians (3.7%) (p = 0.002). It was determined that the rate of prescribing vitamin D supplement until fontanelle closure was higher among pediatric residents (18.2%) than pediatricians (0.9%).

Conclusions

The present study suggest that the knowledge of pediatricians about recommendation of vitamin D needs to be enhanced by education programs in addition to free vitamin D supplement provided by the Ministry of Health.