At the peak of respiratory virus season, bronchiolitis is one of the most common presentations in infants and young toddlers. The characteristic wheeze and prolonged duration of illness can be distressing for parents, who may lack the practical knowledge of how to effectively implement supportive care. When the mainstay of treatment is supportive care without any single curative intervention, you need to be able to discuss the etiology, management, and anticipatory guidance on a level that the parents can understand. This episode introduces the idea of capacity-building family-centered care and takes a granular, detailed approach to improving family understanding and home care education so that you can facilitate better evidence-based care in the unrestricted environment of the home. By arming parents with the knowledge and skills needed to care for their infant at home and the clear, objective return criteria, you’re providing family-centered care and reducing unnecessary visits.    Instagram: @thepedsnppodcast Show notes and references thepedsnp.com Disclaimer   References Justice NA, Le JK. Bronchiolitis. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441959/ Rha, B., Curns, A. T., Lively, J. Y., Campbell, A. P., Englund, J. A., Boom, J. A., Azimi, P. H., Weinberg, G. A., Staat, M. A., Selvarangan, R., Halasa, N. B., McNeal, M. M., Klein, E. J., Harrison, C. J., Williams, J. V., Szilagyi, P. G., Singer, M. N., Sahni, L. C., Figueroa-Downing, D., McDaniel, D., … Gerber, S. I. (2020). Respiratory Syncytial Virus-Associated Hospitalizations Among Young Children: 2015-2016. Pediatrics, 146(1), e20193611. https://doi.org/10.1542/peds.2019-3611 Suh, M., Movva, N., Jiang, X., Bylsma, L. C., Reichert, H., Fryzek, J. P., & Nelson, C. B. (2022). Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009-2019: A Study of the National (Nationwide) Inpatient Sample. The Journal of infectious diseases, 226(Suppl 2), S154–S163. https://doi.org/10.1093/infdis/jiac120

In the eighth and final episode of the Health Equity in Pediatrics podcast series, the epilogue begins with my inspiration for the series, shares some parting sentiments, and discusses the results and conclusions of the cross-sectional study published in the special DEIB edition of Journal of Pediatric Health Care (March/April 2024). I’ll rewind to my childhood and walk you down the cobblestone brick paths of my hometown, the book that changed my perspective, and the words that helped a podcast create allies. I’ll share the results of the international series and post-survey cross-sectional study. The conclusions will fuel your soul about the series’ impact on listeners and implications for DEI education standardization. Now that you’ve listened, you can be confident that you can make a difference in the equitable care experienced by your patients. After touring the country talking about podcasting and health equity in pediatrics, I’m headed for one last stop in Denver. You’re invited to join me on March 13 at the NAPNAP national conference session 117 for “Scholarly Podcasting 101” where you can learn about quality standards and technology in podcasting, help decide the future of The Peds NP, and envision your own podcast. Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant.  For more information, please community.napnap.org/northcarolinachapter References Carson, R.A., Sobolewski, B., & Bowen, F. (2024). Evaluating a health equity podcast for provider practice change: A cross-sectional study. Journal of Pediatric Health Care, in press. Kapur, G. (2021). To drink from the well: The struggle for equality at the nation’s oldest public university. Blair/Carolina Wren Press.

Nirsevimab is the new FDA-approved monoclonal antibody RSV vaccine for the prevention of severe lower respiratory illness in infants. In this episode, we discuss the current recommendations on who gets the vaccine and when, how to use a lens of health equity to approach the current vaccine shortages, and how to discuss safety and efficacy with vaccine hesitant parents. Now that nirsevimab is on the routine infant immunization schedule, it’s extremely important and pediatric providers understand the recommendations and science behind the monoclonal antibody to help vaccine acceptance that will undoubtedly reduce bronchiolitis hospitalization. Instagram: @thepedsnppodcast Show notes and references thepedsnp.com Disclaimer   References: CDC Health Alert Network. (2023). Limited availability of nirsevimab in the United States—Interim CDC recommendations to protect infants from Respiratory Syncytial Virus (RSV) during the 2023–2024 respiratory virus season. Emergency Preparedness and Response. https://emergency.cdc.gov/han/2023/han00499.asp?c Centers for Disease Control and Prevention. (2023). Frequently asked questions about RSV immunization with monoclonal antibody for children 19 months and younger. Vaccines and Preventable Diseases. https://www.cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html Centers for Disease Control and Prevention. (2022). Vaccines for Children Program. https://www.cdc.gov/vaccines/programs/vfc/index.html Centers for Disease Control and Prevention. (2023). General best practice guidelines for immunization. Vaccine Recommendations and the Guidelines of the ACIP. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html Jones, J. M., Fleming-Dutra, K. E., Prill, M. M., Roper, L. E., Brooks, O., Sánchez, P. J., Kotton, C. N., Mahon, B. E., Meyer, S., Long, S. S., & McMorrow, M. L. (2023). Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR. Morbidity and mortality weekly report, 72(34), 920–925. https://doi.org/10.15585/mmwr.mm7234a4 Hill, D., & Parga-Belinkie, J. (Host). (2023, August 29). Immunizations special: RSV, Covid, pneumococcal disease, influenza (No. 170) [Audio podcast episode]. In Pediatrics on call. American Academy of Pediatrics. www.aap.org/podcast Rha, B., Curns, A. T., Lively, J. Y., Campbell, A. P., Englund, J. A., Boom, J. A., Azimi, P. H., Weinberg, G. A., Staat, M. A., Selvarangan, R., Halasa, N. B., McNeal, M. M., Klein, E. J., Harrison, C. J., Williams, J. V., Szilagyi, P. G., Singer, M. N., Sahni, L. C., Figueroa-Downing, D., McDaniel, D., … Gerber, S. I. (2020). Respiratory Syncytial Virus-Associated Hospitalizations Among Young Children: 2015-2016. Pediatrics, 146(1), e20193611. https://doi.org/10.1542/peds.2019-3611 Suh, M., Movva, N., Jiang, X., Bylsma, L. C., Reichert, H., Fryzek, J. P., & Nelson, C. B. (2022). Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009-2019: A Study of the National (Nationwide) Inpatient Sample. The Journal of infectious diseases, 226(Suppl 2), S154–S163. https://doi.org/10.1093/infdis/jiac120

Mental health is one of the greatest health risks encountered by children and adolescents in today’s world.  Stigma can be one of the biggest barriers to children being evaluated and treated for mental health problems, particularly in communities that are marginalized.  In the final episode of the miniseries on Health Equity in Children, we bring mental health into your everyday conversations to diminish stigma and give mental health the time it deserves to help your patients grow up happy and healthy. Want to make a bigger difference in health equity? Complete an anonymous survey here after you listen to the episode or visit www.thepedsnp.com and click the “Complete a Survey” button at the top of the page. The responses will provide greater insight into how podcasts impact education and behavior through microlearning of health equity concepts. After you complete a survey, you’ll receive a separate link to enter your email to a raffle for a $15 Amazon gift card.  Winners will be chosen at random and notified by email one week after the original publication date. This raffle was made possible by grant funding from the sources below.  Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant.  For more information, please community.napnap.org/northcarolinachapter. References Bureau of Health Workforce, Health Resources and Services Administration, U. S. Department of Health & Human Services. (2019). Designated health professional shortage areas statistics. Retrieved from https://bhw.hrsa.gov/shortage-designa tion/hpsa-criteria Cotton, N. K., & Shim, R. S. (2022). Social Determinants of Health, Structural Racism, and the Impact on Child and Adolescent Mental Health. Journal of the American Academy of Child and Adolescent Psychiatry, 61(11), 1385–1389. https://doi.org/10.1016/j.jaac.2022.04.020 Cross, T. L. (1989). Towards a culturally competent system of care: A monograph on effective services for minority children who are severely emotionally disturbed. Harris, T. B., Udoetuk, S. C., Webb, S., Tatem, A., Nutile, L. M., & Al-Mateen, C. S. (2020). Achieving Mental Health Equity: Children and Adolescents. The Psychiatric clinics of North America, 43(3), 471–485. https://doi.org/10.1016/j.psc.2020.06.001 Nápoles-Springer, A. M., Santoyo, J., Houston, K., Pérez-Stable, E. J., & Stewart, A. L. (2005). Patients' perceptions of cultural factors affecting the quality of their medical encounters. Health expectations : an international journal of public participation in health care and health policy, 8(1), 4–17. https://doi.org/10.1111/j.1369-7625.2004.00298.x National Association of Pediatric Nurse Practitioners, Developmental and Behavioral Health Special Interest Group, Frye, L., Van Cleve, S., Heighway, S., & Johnson-Smith, A. (2020). NAPNAP position statement on the integration of mental health care in pediatric primary care settings. Journal of Pediatric Health Care, 34(5), p. 514-517, https://doi.org/10.1016/j.pedhc.2020.04.013 Pumariega, A. J., Rothe, E., Mian, A., Carlisle, L., Toppelberg, C., Harris, T., Gogineni, R. R., Webb, S., Smith, J., & American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI) (2013). Practice parameter for cultural competence in child and adolescent psychiatric practice. Journal of the American Academy of Child and Adolescent Psychiatry, 52(10), 1101–1115. https://doi.org/10.1016/j.jaac.2013.06.019 Song, J., Mailick, M. R., & Greenberg, J. S. (2018). Health of parents of individuals with developmental disorders or mental health problems: Impacts of stigma. Social science & medicine (1982), 217, 152–158. https://doi.org/10.1016/j.socscimed.2018.09.044 Telesia, L., Kaushik, A., & Kyriakopoulos, M. (2020). The role of stigma in children and adolescents with mental health difficulties. Current opinion in psychiatry, 33(6), 571–576. https://doi.org/10.1097/YCO.0000000000000644 Waid, J., & Kelly, M. (2020). Supporting family engagement with child and adolescent mental health services: A scoping review. Health & social care in the community, 28(5), 1333–1342. https://doi.org/10.1111/hsc.12947 Walter, H. J., Vernacchio, L., Trudell, E. K., Bromberg, J., Goodman, E., Barton, J., Young, G. J., DeMaso, D. R., & Focht, G. (2019). Five-Year Outcomes of Behavioral Health Integration in Pediatric Primary Care. Pediatrics, 144(1), e20183243. https://doi.org/10.1542/peds.2018-3243

It’s good advice for any pediatric provider to never assume anything.  In the sixth episode of the series on Health Equity in Children, we understand how not making assumptions is a best practice for pediatric providers from the evaluation and management of LGBTQ patients, to communicating with diverse families, and serving as an ally in health promotion.   Want to make a bigger difference in health equity? Complete an anonymous survey here after you listen to the episode or visit www.thepedsnp.com and click the “Complete a Survey” button at the top of the page. The responses will provide greater insight into how podcasts impact education and behavior through microlearning of health equity concepts. After you complete a survey, you’ll receive a separate link to enter your email to a raffle for a $15 Amazon gift card.  Winners will be chosen at random and notified by email one week after the original publication date. This raffle was made possible by grant funding from the sources below.  Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant.  For more information, please community.napnap.org/northcarolinachapter. References Brown, C., Frohard-Dourlent, H., Wood, B. A., Saewyc, E., Eisenberg, M. E., & Porta, C. M. (2020). "It makes such a difference": An examination of how LGBTQ youth talk about personal gender pronouns. Journal of the American Association of Nurse Practitioners, 32(1), 70–80. https://doi.org/10.1097/JXX.0000000000000217 Centers for Disease Control and Prevention. (2019). Health disparities among LTGBQ youth. Adolescent and School Health. https://www.cdc.gov/healthyyouth/disparities/health-disparities-among-lgbtq-youth.htm Coulter-Thompson, E. I., Matthews, D. D., Applegate, J., Broder-Fingert, S., & Dubé, K. (2023). Health Care Bias and Discrimination Experienced by Lesbian, Gay, Bisexual, Transgender, and Queer Parents of Children With Developmental Disabilities: A Qualitative Inquiry in the United States. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 37(1), 5–16. https://doi.org/10.1016/j.pedhc.2022.09.004 Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., Lowry, R., Chyen, D., Whittle, L., Thornton, J., Lim, C., Bradford, D., Yamakawa, Y., Leon, M., Brener, N., & Ethier, K. A. (2018). Youth Risk Behavior Surveillance - United States, 2017. Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), 67(8), 1–114. https://doi.org/10.15585/mmwr.ss6708a1 Kyriakou, A., Nicolaides, N. C., & Skordis, N. (2020). Current approach to the clinical care of adolescents with gender dysphoria. Acta bio-medica : Atenei Parmensis, 91(1), 165–175. https://doi.org/10.23750/abm.v91i1.9244 National Association of Pediatric Nurse Practitioners, Evans, S.C., Derouin, A.L., Fuller, M.G., Heighway, S., & Schapiro, N.A. (2018). NAPNAP position statement on health risks and needs of lesbian, gay, bisexual, transgender, and questioning youth. The Journal of Pediatric Health Care, 33(2), p. A12-A14. doi: https://doi.org/10.1016/j.pedhc.2018.12.005 Roth, L. T., Friedman, S., Gordon, R., & Catallozzi, M. (2020). Rainbows and "Ready for Residency": Integrating LGBTQ Health Into Medical Education. MedEdPORTAL : the journal of teaching and learning resources, 16, 11013. https://doi.org/10.15766/mep_2374-8265.11013 Simons, L. K., Leibowitz, S. F., & Hidalgo, M. A. (2014). Understanding gender variance in children and adolescents. Pediatric annals, 43(6), e126–e131. https://doi.org/10.3928/00904481-20140522-07

The seminal publication of the AAP’s Guideline on the Evaluation and Treatment of Children and Adolescents with Obesity serves as the source of our fifth episode in the series on Health Equity in Children.  The best practices for managing obesity go beyond discussions of beauty and body image to include systemic racism, obesity as a chronic disease, and the reckoning that children and adolescents with obesity are people first. Want to make a bigger difference in health equity? Complete an anonymous survey here after you listen to the episode or visit www.thepedsnp.com and click the “Complete a Survey” button at the top of the page. The responses will provide greater insight into how podcasts impact education and behavior through microlearning of health equity concepts. After you complete a survey, you’ll receive a separate link to enter your email to a raffle for a $15 Amazon gift card.  Winners will be chosen at random and notified by email one week after the original publication date. This raffle was made possible by grant funding from the sources below.  Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant.  For more information, please community.napnap.org/northcarolinachapter. References Bell, C. N., Kerr, J., & Young, J. L. (2019). Associations between Obesity, Obesogenic Environments, and Structural Racism Vary by County-Level Racial Composition. International journal of environmental research and public health, 16(5), 861. https://doi.org/10.3390/ijerph16050861 Centers for Disease Control and Prevention. (2022). Inclusive communication principles. Gateway to Health Communication. https://www.cdc.gov/healthcommunication/Key_Principles.html Gmeiner, M. S., & Warschburger, P. (2020). Intrapersonal predictors of weight bias internalization among elementary school children: a prospective analysis. BMC pediatrics, 20(1), 408. https://doi.org/10.1186/s12887-020-02264-w Hadjiyannakis, S., Ibrahim, Q., Li, J., Ball, G. D. C., Buchholz, A., Hamilton, J. K., Zenlea, I., Ho, J., Legault, L., Laberge, A. M., Thabane, L., Tremblay, M., & Morrison, K. M. (2019). Obesity class versus the Edmonton Obesity Staging System for Pediatrics to define health risk in childhood obesity: results from the CANPWR cross-sectional study. The Lancet. Child & adolescent health, 3(6), 398–407. https://doi.org/10.1016/S2352-4642(19)30056-2 Hampl, S. E., Hassink, S. G., Skinner, A. C., Armstrong, S. C., Barlow, S. E., Bolling, C. F., Avila Edwards, K. C., Eneli, I., Hamre, R., Joseph, M. M., Lunsford, D., Mendonca, E., Michalsky, M. P., Mirza, N., Ochoa, E. R., Sharifi, M., Staiano, A. E., Weedn, A. E., Flinn, S. K., Lindros, J., … Okechukwu, K. (2023). Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics, 151(2), e2022060640. https://doi.org/10.1542/peds.2022-060640 Haqq, A. M., Kebbe, M., Tan, Q., Manco, M., & Salas, X. R. (2021). Complexity and Stigma of Pediatric Obesity. Childhood obesity (Print), 17(4), 229–240. https://doi.org/10.1089/chi.2021.0003 Puhl, R. M., & Himmelstein, M. S. (2018). Adolescent preferences for weight terminology used by health care providers. Pediatric obesity, 13(9), 533–540. https://doi.org/10.1111/ijpo.12275 Puhl, R. M., Peterson, J. L., & Luedicke, J. (2011). Parental perceptions of weight terminology that providers use with youth. Pediatrics, 128(4), e786–e793. https://doi.org/10.1542/peds.2010-3841 Yan J, Liu L, Zhu Y, Huang G, Wang PP. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health. 2014 Dec 13;14:1267. doi: 10.1186/1471-2458-14-1267. PMID: 25495402; PMCID: PMC4301835.

The fourth episode in our Health Equity in Pediatrics series highlights one of the simplest individual actions a provider can take to be an ally in health equity: Say your patients’ names correctly.  Saying a person’s name correctly validates their identity, family, culture, and heritage.  Whether the name is difficult to pronounce or varies from the name given at birth, providers can use simple tools to correctly pronounce names and address their patients in a way that honors both the patient and their caregivers.  Together we can answer William Shakespeare’s question, “What’s in a name?” with a lens of health equity. Want to make a bigger difference in health equity? Complete an anonymous survey here after you listen to the episode or visit www.thepedsnp.com and click the “Complete a Survey” button at the top of the page. The responses will provide greater insight into how podcasts impact education and behavior through microlearning of health equity concepts. After you complete a survey, you’ll receive a separate link to enter your email to a raffle for a $15 Amazon gift card.  Winners will be chosen at random and notified by email one week after the original publication date. This raffle was made possible by grant funding from the sources below.  Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant.  For more information, please community.napnap.org/northcarolinachapter. References Dali, S., Atasuntseva, A., Shankar, M., Ayeroff, E., Holmes, M., Johnson, C., Terkawi, A. S., Beadle, B., Chang, J., Boyd, K., & Dunn, T. (2022). Say My Name: Understanding the Power of Names, Correct Pronunciation, and Personal Narratives. MedEdPORTAL : the journal of teaching and learning resources, 18, 11284. https://doi.org/10.15766/mep_2374-8265.11284 Keister, A. (2022). Can I still use sir and ma’am? When should I use Mr., Mrs., Ms., and Mx? What to do when you don’t know someone’s gender. The Diversity Movement. Retreived from https://thediversitymovement.com/sir-maam-mr-mrs-ms-mx-what-to-do-when-you-dont-know-someones-gender/ Lebensohn-Chialvo F. (2021). That's not my name. Families, systems & health : the journal of collaborative family healthcare, 39(1), 163–164. https://doi.org/10.1037/fsh0000588

The third episode in the Health Equity in Pediatrics series focuses on microaggressions, which are subtle slights, snubs, and digs that are seemingly innocent, innocuous, and naïve at first glance.  But their roots in harmful stereotypes and assumptions are psychologically disparaging and invalidating to the people from marginalized groups they offend. They reflect implicit bias that is unconsciously embedded into language and behavior.  As an ally, interrupting microaggressions can be a challenge that requires curiosity to confront.  The decision to interrupt is individual and complex, but this episode will provide allies with the skills to intervene through role play in several scenarios.   Want to make a bigger difference in health equity? Complete an anonymous survey here after you listen to the episode or visit www.thepedsnp.com and click the “Complete a Survey” button at the top of the page. The responses will provide greater insight into how podcasts impact education and behavior through microlearning of health equity concepts. After you complete a survey, you’ll receive a separate link to enter your email to a raffle for a $15 Amazon gift card.  Winners will be chosen at random and notified by email one week after the original publication date. This raffle was made possible by grant funding from the sources below.  Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant.  For more information, please community.napnap.org/northcarolinachapter. References: Acholonu, R. G., Cook, T. E., Roswell, R. O., & Greene, R. E. (2020). Interrupting Microaggressions in Health Care Settings: A Guide for Teaching Medical Students. MedEdPORTAL : The journal of teaching and learning resources, 16, 10969. https://doi.org/10.15766/mep_2374-8265.10969 FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC medical ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8 Kanter, J. (2020). Microaggressions aren’t just innocent blunders– research links them with racial bias. The Conversation. https://theconversation.com/microaggressions-arent-just-innocent-blunders-research-links-them-with-racial-bias-145894 Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: implications for clinical practice. The American psychologist, 62(4), 271–286. https://doi.org/10.1037/0003-066X.62.4.271 Sue, D. W., Alsaidi, S., Awad, M. N., Glaeser, E., Calle, C. Z., & Mendez, N. (2019). Disarming racial microaggressions: Microintervention strategies for targets, White allies, and bystanders. The American psychologist, 74(1), 128–142. https://doi.org/10.1037/amp0000296 Turner, J., Higgins, R., & Childs, E. (2021). Microaggression and Implicit Bias. The American Surgeon, 87(11), 1727–1731. https://doi.org/10.1177/00031348211023418

In the second episode of the Health Equity in Pediatrics series, we explore implicit bias as unconscious attitudes and stereotypes held against a group that may even be contrary to one’s stated beliefs. Identifying your implicit bias is a best practice that can enable you to limit its impact on your behavior and prevent harm from altered clinical decision making that is based on preconceived notions.  In this episode, we discuss examples of how implicit bias can impact health care in children and the skills that provider’s can hone to combat its influence. Want to make a bigger difference in health equity? Complete an anonymous survey here after you listen to the episode or visit www.thepedsnp.com and click the “Complete a Survey” button at the top of the page. The responses will provide greater insight into how podcasts impact education and behavior through microlearning of health equity concepts. After you complete a survey, you’ll receive a separate link to enter your email to a raffle for a $15 Amazon gift card.  Winners will be chosen at random and notified by email one week after the original publication date. This raffle was made possible by grant funding from the sources below.  Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant.  For more information, please community.napnap.org/northcarolinachapter. References: FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC medical ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8 Gonzalez, C. M., Lypson, M. L., & Sukhera, J. (2021). Twelve tips for teaching implicit bias recognition and management. Medical teacher, 43(12), 1368–1373. https://doi.org/10.1080/0142159X.2021.1879378 Goyal, M. K., Johnson, T. J., Chamberlain, J. M., Cook, L., Webb, M., Drendel, A. L., Alessandrini, E., Bajaj, L., Lorch, S., Grundmeier, R. W., Alpern, E. R., & PEDIATRIC EMERGENCY CARE APPLIED RESEARCH NETWORK (PECARN) (2020). Racial and Ethnic Differences in Emergency Department Pain Management of Children With Fractures. Pediatrics, 145(5), e20193370. https://doi.org/10.1542/peds.2019-3370 Greenwald, A. G., Dasgupta, N., Dovidio, J. F., Kang, J., Moss-Racusin, C. A., & Teachman, B. A. (2022). Implicit-Bias Remedies: Treating Discriminatory Bias as a Public-Health Problem. Psychological science in the public interest : a journal of the American Psychological Society, 23(1), 7–40. https://doi.org/10.1177/15291006211070781 Jindal, M., Trent, M., & Mistry, K. B. (2022). The Intersection of Race, Racism, and Child and Adolescent Health. Pediatrics in review, 43(8), 415–425. https://doi.org/10.1542/pir.2020-004366 Mossey J. M. (2011). Defining racial and ethnic disparities in pain management. Clinical orthopaedics and related research, 469(7), 1859–1870. https://doi.org/10.1007/s11999-011-1770-9 Pediatric Nursing Certification Board. (2022). Pediatric Nursing Workforce Report 2022: A Demographic Profile of 53,000 PNCB-Certified Nursing Professionals. https://pncb.org/ sites/default/files/resources/PNCB_2022_Pediatric_Nursing_Workforce_Demographic_ Report.pdf Project Implicit. (2011). Take a test. https://implicit.harvard.edu/implicit/takeatest.html Raphael, J. L., & Oyeku, S. O. (2020). Implicit Bias in Pediatrics: An Emerging Focus in Health Equity Research. Pediatrics, 145(5), e20200512. https://doi.org/10.1542/peds.2020-0512 Sabin J. A. (2022). Tackling Implicit Bias in Health Care. The New England journal of medicine, 387(2), 105–107. https://doi.org/10.1056/NEJMp2201180 Smiley, R. A., Ruttinger, C., Oliveira, C. M., Hudson, L. R., Allgeyer, R., Reneau, K. A., Silvestre, J. H., & Alexander, M. (2021). The 2020 National Nursing Workforce Survey. Journal of Nursing Regulation, 12(1). https://doi.org/10.1016/s2155-8256(21)00027-2. U.S. Equal Employment Opportunity Commission. (2023). Religious garb and grooming in the workplace: Rights and responsibilities. https://www.eeoc.gov/laws/guidance/religious-garb-and-grooming-workplace-rights-and-responsibilities#_ftn17

Welcome to the Health Equity in Pediatrics series!  In the first installment of our series, we define health equity and review some communities often affected by health disparities that limit a person’s opportunity to be as healthy as possible.  While health equity can seem like a seismic public health crisis that is too big for one person to tackle, each episode in this series will give listeners tangible best practices that can be implemented immediately to provide more equitable care in your workplace.  As you learn to view every patient encounter through a lens of health equity, you’ll be able to apply these concepts to the evaluation and management of the diverse children for whom you care and improve their journey toward health. When you become a partner in the health equity care plan, rather than just an authority in health care, you bring practicality to your recommendations and interventions that augment the expert knowledge you share.  In this episode we will apply these concepts to a challenging example with a historical precedent that will shape how you understand the approach to overcoming obstacles on the journey to health equity. Want to make a bigger difference in health equity? Complete an anonymous survey here after you listen to the episode or visit www.thepedsnp.com and click the “Complete a Survey” button at the top of the page. The responses will provide greater insight into how podcasts impact education and behavior through microlearning of health equity concepts. After you complete a survey, you’ll receive a separate link to enter your email to a raffle for a $15 Amazon gift card.  Winners will be chosen at random and notified by email one week after the original publication date. This raffle was made possible by grant funding from the sources below.  Disclaimer: This series was supported by the North Carolina Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP) Dr. Rasheeda Monroe Health Equity grant whose mission is to support research and quality improvement aimed at improving health equity among infants, children, and adolescents. The content of this episode reflects my views and does not necessarily represent, nor is an endorsement of, NC NAPNAP or the Dr. Rasheeda Monroe Health Equity grant.  For more information, please community.napnap.org/northcarolinachapter. References: American Psychological Association. (2022). Racial and ethnic identity. https://apastyle.apa.org/style-grammar-guidelines/bias-free-language/racial-ethnic-minorities Braveman, P., Arkin, E., Orleans, T., Proctor, D., & Plough, A. (2017). What is health equity? Achieving health equity. The Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html Centers for Disease Control and Prevention. (2022, August 2). Health equity guiding principles for inclusive communication. https://www.cdc.gov/healthcommunication/Health_Equity.html Duke Health. (2020). Weight management for children and teens. Duke Health. https://www.dukehealth.org/pediatric-treatments/childhood-obesity Jindal, M., Trent, M., & Mistry, K. B. (2022). The Intersection of Race, Racism, and Child and Adolescent Health. Pediatrics in review, 43(8), 415–425. https://doi.org/10.1542/pir.2020-004366 Pediatric Nursing Certification Board. (2022). Pediatric Nursing Workforce Report 2022: A Demographic Profile of 53,000 PNCB-Certified Nursing Professionals. https://pncb.org/ sites/default/files/resources/PNCB_2022_Pediatric_Nursing_Workforce_Demographic_ Report.pdf Zippia. (2022, September 9). Family nurse practitioner demographics and statistics in the US. https://www.zippia.com/family-nurse-practitioner-jobs/demographics/

Got milk? The answer is complicated.  While plant-based beverages are accused of posing as animal by-product imposters, the FDA claims that consumers know the difference.  But most parents don't recognize that plant-based milks lack the same micro and macronutrient profile as cow's milk or soy milk.  This leaves pediatric providers with the very important job of assessing nutrition and guiding parents on what beverages their infants and toddlers should be drinking.

Just because you can, doesn't mean you should.  In the depths of respiratory virus season, providers often order unnecessary tests that won't alter the course of treatment for the child presenting with upper respiratory symptoms.  This episode covers 5 common pathogens, the indications to test a child presenting with symptoms, and how to talk to families requesting tests.   References: Centers for Disease Control and Prevention (2022). Influenza antiviral medications: Summary for clinicians. Retrieved from https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#Table1 Frost, H. M., & Hersh, A. L. (2022). Rethinking Our Approach to Management of Acute Otitis Media. JAMA pediatrics, 176(5), 439–440. https://doi.org/10.1001/jamapediatrics.2021.6575 Giovanni Piedimonte, Miriam K. Perez; Respiratory Syncytial Virus Infection and Bronchiolitis. Pediatr Rev December 2014; 35 (12): 519–530. https://doi.org/10.1542/pir.35-12-519 Liu, J. W., Lin, S. H., Wang, L. C., Chiu, H. Y., & Lee, J. A. (2021). Comparison of Antiviral Agents for Seasonal Influenza Outcomes in Healthy Adults and Children: A Systematic Review and Network Meta-analysis. JAMA network open, 4(8), e2119151. https://doi.org/10.1001/jamanetworkopen.2021.19151 Parikh R, Mathai A, Parikh S, Chandra Sekhar G, Thomas R. Understanding and using sensitivity, specificity and predictive values. Indian J Ophthalmol. 2008 Jan-Feb;56(1):45-50. doi: 10.4103/0301-4738.37595. PMID: 18158403; PMCID: PMC2636062. Spencer D. Johnson, Jennifer S. Harthan, Tammy Than, Mary K. Migneco, Ellen Shorter, Meredith M. Whiteside, Christina E. Morettin, Christian K. Olson, Crystal A. Rosemann, Mathew S. Margolis, Leonard W. Haertter, Julia B. Huecker, Bojana Rodic-Polic, Richard S. Buller, Gregory A. Storch, Mae O. Gordon, Andrew T. E. Hartwick; Predictive Accuracy and Densitometric Analysis of Point-of-Care Immunoassay for Adenoviral Conjunctivitis. Trans. Vis. Sci. Tech. 2021;10(9):30. doi: https://doi.org/10.1167/tvst.10.9.30. Stanford T. Shulman, Alan L. Bisno, Herbert W. Clegg, Michael A. Gerber, Edward L. Kaplan, Grace Lee, Judith M. Martin, Chris Van Beneden, Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 55, Issue 10, 15 November 2012, Pages e86–e102, https://doi.org/10.1093/cid/cis629 Stanford Medicine. (2022). Common cold in children. Retrieved from https://www.stanfordchildrens.org/en/topic/default?id=upper-respiratory-infection-uri-or-common-cold-90-P02966 Walsh, P. S., Schnadower, D., Zhang, Y., Ramgopal, S., Shah, S. S., & Wilson, P. M. (2022). Association of Early Oseltamivir With Improved Outcomes in Hospitalized Children With Influenza, 2007-2020. JAMA pediatrics, 176(11), e223261. https://doi.org/10.1001/jamapediatrics.2022.3261 World Health Organization. (2019). WHO launches new global influenza strategy. https://www.who.int/news-room/detail/11-03-2019-who-launches-new-global-influenza-strategy

Not all bacterial infections need an antibiotic.  It may sound hard to believe, but if we all followed the AAP guidelines on the management of otitis media in children and actually used a watch-and-wait approach in appropriate patients, upwards of 75% of the antibiotics prescribed for otitis media could be avoided.  Why? Because the microbiology of AOM has changed, but our prescribing practices haven't.  This episode is a great guideline refresher and microbiology update while learning how to talk parents into partnership on watchful waiting.    References: American Academy of Pediatrics. (2019). Chapter quality network improving antibiotic prescribing for children: Change package. Retrieved from https://downloads.aap.org/DOCCSA/CQN%20ABX%20Change%20Package%20Final%20October%202019.pdf Frost, H. M., & Hersh, A. L. (2022). Rethinking Our Approach to Management of Acute Otitis Media. JAMA pediatrics, 176(5), 439–440. https://doi.org/10.1001/jamapediatrics.2021.6575 Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., Joffe, M. D., Miller, D. T., Rosenfeld, R. M., Sevilla, X. D., Schwartz, R. H., Thomas, P. A., & Tunkel, D. E. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964–e999. https://doi.org/10.1542/peds.2012-3488 Sanchez, G.V., Fleming-Dutra, K.E., Roberts, R.M., & Hicks, L.A. (2016). Core elements of outpatient antibiotic stewardship. MMRW Recomm Rep., 65(6), p. 1-12. doi: 10.15585/mmrw.rr.6506a1 Smolinski, N. E., Antonelli, P. J., & Winterstein, A. G. (2022). Watchful Waiting for Acute Otitis Media. Pediatrics, 150(1), e2021055613. https://doi.org/10.1542/peds.2021-055613 Sun, D., McCarthy, T. J., & Liberman, D. B. (2017). Cost-Effectiveness of Watchful Waiting in Acute Otitis Media. Pediatrics, 139(4), e20163086. https://doi.org/10.1542/peds.2016-3086 Venekamp, R. P., Sanders, S. L., Glasziou, P. P., Del Mar, C. B., & Rovers, M. M. (2015). Antibiotics for acute otitis media in children. The Cochrane database of systematic reviews, 2015(6), CD000219. https://doi.org/10.1002/14651858.CD000219.pub4

If you've been looking for a New Year's Resolution to make a real difference in your practice, stop prescribing diphenhydramine.  Despite being a common over-the-counter medication, its potent anticholinergic side effects and sedation make it a poor choice for children.  Review the common misuses for the drug and practical, evidence-based alternatives to help get diphenhydramine out of your prescribing practice in 2023.   References: Bachur RG, Monuteaux MC, Neuman MI. A comparison of acute treatment regimens for migraine in the emergency department. Pediatrics 2015;135:232-238. Brady, K.B. (2020). 'Benadryl challenge": What pediatricians need to know. AAP News. Retrieved from https://publications.aap.org/aapnews/news/6210/Benadryl-Challenge-What-pediatricians-need-to-know Chehab, H., Fischer, P. R., & Christenson, J. C. (2021). Preparing Children for International Travel. Pediatrics in Review, 42(4), 189–202. https://doi.org/10.1542/pir.2018-0353 Ghossein N, Kang M, Lakhkar AD. Anticholinergic Medications. [Updated 2022 May 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555893/ Green, J.L., Wang, G.S., Reynolds, K.M., Banner, W., Bond, G.R., Kauffman, R.E., Palmer, R.B., Paul, I.M., Dart, R.C. (2017). Safety profile of cough and cold medication use in pediatrics. Pediatrics, 139(6), e20163070. doi: 10.1542/peds.2016-3070 Guthrie, C.C., & Nathani, Y. (2019). Acute treatment of pediatric migraine. Pediatric Emergency Medicine Reports. Relias Media. Retrieved https://www.reliasmedia.com/articles/144150-acute-treatment-of-pediatric-migraine Palmer, R. B., Reynolds, K. M., Banner, W., Bond, G. R., Kauffman, R. E., Paul, I. M., Green, J. L., & Dart, R. C. (2020). Adverse events associated with diphenhydramine in children, 2008-2015. Clinical toxicology (Philadelphia, Pa.), 58(2), 99–106. https://doi.org/10.1080/15563650.2019.1609683 Paul, I.M., Yoder, K.E., Crowell, K.R., Shaffer, M.L., McMillan, H.S., Carlson, L.C., Dilworth, D.A., Berlin, C.M. (2004). Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents. Pediatrics, 114(1), e85-e90. doi: 10.1542/peds.114.1.e85 Shaker, M. S., Wallace, D. V., Golden, D. B. K., Oppenheimer, J., Bernstein, J. A., Campbell, R. L., Dinakar, C., Ellis, A., Greenhawt, M., Khan, D. A., Lang, D. M., Lang, E. S., Lieberman, J. A., Portnoy, J., Rank, M. A., Stukus, D. R., Wang, J., Collaborators, Riblet, N., Bobrownicki, A. M. P., … Wang, J. (2020). Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. The Journal of allergy and clinical immunology, 145(4), 1082–1123. https://doi.org/10.1016/j.jaci.2020.01.017 Stern J, Pozun A. Pediatric Procedural Sedation. [Updated 2022 Sep 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572100/ Trottier ED, Bailey B, Lucas N, Lortie A. Prochlorperazine in children with migraine: A look at its effectiveness and rate of akathisia. Am J Emerg Med 2012;30:456-463

In the last case study in our series on Cognitive Bias in Healthcare, attribution error (among others) of an adolescent female with foot burning reveals how two more best practices for avoiding cognitive bias can help providers think metacognitively.  Review all 8 best practices and start to implement them to reduce diagnostic error. References: Marshall, T.L., Rinke, M.L., Olson, A.P.J., Brady, P.W. (2022). Diagnostic error in pediatrics: A narrative review. Pediatrics, 149 (Supplement 3): e2020045948D. 10.1542/peds.2020-045948D The Canadian Medical Protection Authority. Common cognitive biases: Influences on decision making. Good Practices Guide. https://www.cmpa-acpm.ca/serve/docs/ela/goodpracticesguide/pages/human_factors/Cognitive_biases/common_cognitive_biases-e.html Yale, S. C., Cohen, S. S., Kliegman, R. M., & Bordini, B. J. (2022). A pause in pediatrics: implementation of a pediatric diagnostic time-out. Diagnosis (Berlin, Germany), 9(3), 348–351. https://doi.org/10.1515/dx-2022-0010

The next case study in our series on cognitive bias in healthcare follows an obese adolescent female with arm and neck pain who felt unheard during the 4 prior emergency room visits that week.  Listen as the differential diagnosis takes on a completely different angle and the pressure of making the diagnosis goes sky high!  We will unpack additional forms of cognitive bias and 2 more best practices for avoiding diagnostic error in the clinical setting.   References: Hulens, M., Rasschaert, R., Vansant, G., Stalmans, I., Bruyninckx, F., & Dankaerts, W. (2018). The link between idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome: exploration of a shared pathophysiology. Journal of pain research, 11, 3129–3140. https://doi.org/10.2147/JPR.S186878 Mondragon J, Klovenski V. Pseudotumor Cerebri. [Updated 2022 Sep 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536924/ Norris, D., Clark, M. S., & Shipley, S. (2016). The Mental Status Examination. American family physician, 94(8), 635–641. Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity reviews : an official journal of the International Association for the Study of Obesity, 16(4), 319–326. https://doi.org/10.1111/obr.12266 The Canadian Medical Protection Authority. Common cognitive biases: Influences on decision making. Good Practices Guide. https://www.cmpa-acpm.ca/serve/docs/ela/goodpracticesguide/pages/human_factors/Cognitive_biases/common_cognitive_biases-e.html Villines, Z. (2021). What to know about obesity discrimination in health care. Medical News Today. https://www.medicalnewstoday.com/articles/obesity-discrimination-in-healthcare

In the first case study of our mini-series on Cognitive Bias in Health Care, we meet a 4 month old female referred to the emergency department for constipation.  Spoiler alert: We know it's not constipation... so we explore how her presentation and physical exam clash with the initial medical decision making.  Try to spot the cognitive bias and test yourself on building a differential diagnosis.  Lastly, we explore 4 best practice techniques to help you avoid bias in the first place.   References Abimanyi-Ochom, J., Bohingamu Mudiyanselage, S., Catchpool, M., Firipis, M., Wanni Arachchige Dona, S., & Watts, J. J. (2019). Strategies to reduce diagnostic errors: a systematic review. BMC medical informatics and decision making, 19(1), 174. https://doi.org/10.1186/s12911-019-0901-1 Benninga, M. A., Faure, C., Hyman, P. E., St James Roberts, I., Schechter, N. L., & Nurko, S. (2016). Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology, S0016-5085(16)00182-7. https://doi.org/10.1053/j.gastro.2016.02.016 Bolick, B.N., Reuter-Rice, K., Madden, M.A., & Severin, P.A. (2021). Pediatric Acute Care: A Guide for Interprofessional Practice (2nd ed). Elsevier. Centers for Disease Control and Prevention. (2021). Botulism: Diagnosis and treatment. https://www.cdc.gov/botulism/testing-treatment.html Committee on Diagnostic Error in Health Care; Board on Health Care Services; Institute of Medicine; The National Academies of Sciences, Engineering, and Medicine; Balogh EP, Miller BT, Ball JR, editors. Improving Diagnosis in Health Care. Washington (DC): National Academies Press (US); 2015 Dec 29. 3, Overview of Diagnostic Error in Health Care. Available from: https://www.ncbi.nlm.nih.gov/books/NBK338594/ Ely, J. W., & Graber, M. A. (2015). Checklists to prevent diagnostic errors: a pilot randomized controlled trial. Diagnosis (Berlin, Germany), 2(3), 163–169. https://doi.org/10.1515/dx-2015-0008 Graber, M. L., Sorensen, A. V., Biswas, J., Modi, V., Wackett, A., Johnson, S., Lenfestey, N., Meyer, A. N., & Singh, H. (2014). Developing checklists to prevent diagnostic error in Emergency Room settings. Diagnosis (Berlin, Germany), 1(3), 223–231. https://doi.org/10.1515/dx-2014-0019 Marshall, T.L., Rinke, M.L., Olson, A.P.J., Brady, P.W. (2022). Diagnostic error in pediatrics: A narrative review. Pediatrics, 149 (Supplement 3): e2020045948D. 10.1542/peds.2020-045948D O’Hagan, T., Fennell, J., Tan, K., Ding, D., & Thomas-Jones, I. (2019). Cognitive bias in the clinical decision making of doctors. Future Healthcare Journal, 6(1), s113. Tabbers, M. M., DiLorenzo, C., Berger, M. Y., Faure, C., Langendam, M. W., Nurko, S., Staiano, A., Vandenplas, Y., Benninga, M. A., European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, & North American Society for Pediatric Gastroenterology. (2014). Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of Pediatric Gastroenterology and Nutrition, 58(2), 258–274. https://doi.org/10.1097/MPG.0000000000000266 The Canadian Medical Protection Authority. Common cognitive biases: Influences on decision making. Good Practices Guide. https://www.cmpa-acpm.ca/serve/docs/ela/goodpracticesguide/pages/human_factors/Cognitive_biases/common_cognitive_biases-e.html Zabidi-Hussin Z. A. (2016). Practical way of creating differential diagnoses through an expanded VITAMINSABCDEK mnemonic. Advances in medical education and practice, 7, 247–248. https://doi.org/10.2147/AMEP.S106507

There are many factors that contribute to the way we perceive and interpret information... and lots of ways that our brains skew our perspectives that can lead to cognitive bias.  The second episode in our Cognitive Bias in Healthcare mini-series discusses the features of information delivery that impact our decision-making and how our brains distort them to cause diagnostic error.   References: Arokszallasi, T., Balogh, E., Csiba, L., Fekete, I., Fekete, K., & Olah, L.. (2019). Acute alcohol intoxication may cause delay in stroke treatment – case reports. BMC Neurology, 19, 14. https://doi.org/10.1186/s12883-019-1241-6 Berkwitt, A., & Grossman, M. (2014). Cognitive bias in inpatient pediatrics. Hospital pediatrics, 4(3), 190–193. https://doi.org/10.1542/hpeds.2014-0002 Clark, B. W., Derakhshan, A., & Desai, S. V. (2018). Diagnostic Errors and the Bedside Clinical Examination. The Medical clinics of North America, 102(3), 453–464. https://doi.org/10.1016/j.mcna.2017.12.007 Croskerry, P., Singhal, G., & Mamede, S. (2013). Cognitive debiasing 2: impediments to and strategies for change. BMJ quality & safety, 22 Suppl 2(Suppl 2), ii65–ii72. https://doi.org/10.1136/bmjqs-2012-001713 Galvani, A. P., Parpia, A. S., Foster, E. M., Singer, B. H., & Fitzpatrick, M. C. (2020). Improving the prognosis of health care in the USA. Lancet (London, England), 395(10223), 524–533. https://doi.org/10.1016/S0140-6736(19)33019-3 Mamede, S., Splinter, T.A.W., Gog, T., Rikers, R., & Schmidt, H.G. (2012). Exploring the role of salient distracting clinical features in the emergence of diagnostic errors and the mechanisms through which reflection counteracts mistakes. BMJ Quality & Safety, 21, p. 295-300. doi:10.1136/bmjqs-2011-000518 Marshall, T.L., Rinke, M.L., Olson, A.P.J., Brady, P.W. (2022). Diagnostic error in pediatrics: A narrative review. Pediatrics, 149 (Supplement 3): e2020045948D. 10.1542/peds.2020-045948D

This episode is the first installment on a new mini series on cognitive bias in pediatric healthcare.  We begin by discussing what cognitive bias is, how it becomes diagnostic error, and the impact on healthcare in America.  Begin to think about how you think and explore the interesting ways our brains use mental shortcuts to arrive at an answer. References: Balogh, E. P., Miller, B. T., Ball, J. R., Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine, & The National Academies of Sciences, Engineering, and Medicine (Eds.). (2015). Improving Diagnosis in Health Care. National Academies Press (US). Berkwitt, A., & Grossman, M. (2014). Cognitive bias in inpatient pediatrics. Hospital pediatrics, 4(3), 190–193. https://doi.org/10.1542/hpeds.2014-0002 Bordini, B. J., Stephany, A., & Kliegman, R. (2017). Overcoming Diagnostic Errors in Medical Practice. The Journal of pediatrics, 185, 19–25.e1. https://doi.org/10.1016/j.jpeds.2017.02.065 Carberry, A. R., Hanson, K., Flannery, A., Fischer, M., Gehlbach, J., Diamond, C., & Wald, E. R. (2018). Diagnostic Error in Pediatric Cancer. Clinical pediatrics, 57(1), 11–18. https://doi.org/10.1177/0009922816687325 CRICO. (2014). Malpractice risks in the diagnostic process. Retrieved from https://www.rmf.harvard.edu/Malpractice-Data/Annual-Benchmark-Reports/Risks-in-the-Diagnostic-Process Institute of Medicine (US) Committee on Quality of Health Care in America. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press (US). Institute of Medicine (US) Committee on Quality of Health Care in America, Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To Err is Human: Building a Safer Health System. National Academies Press (US). National Geographic Kids. (No date). 10 facts about great white sharks! Retrieved from https://www.natgeokids.com/uk/discover/animals/sea-life/great-white-sharks/ Royce, C.S., Hayes, M.M., & Schwartzstein, R.M. (2019). Teaching critical thinking: A case for instruction in cogntitive biases to reduce diagnostic errors and improve patient safety.

Developmental surveillance and screening work best to identify delays when used together.  The AAP and CDC teamed up to create a standardized developmental milestone checklist in order to improve the longitudinal monitoring of pediatric milestones at home by caregivers.  This episode reviews their publication and discusses what went into the checklist, its strengths, and areas for further research.   View the CDC's website for the full checklist and read the article here. References: CDC. (2022). Developmental surveillance resources for healthcare providers. Retrieved from https://www.cdc.gov/ncbddd/actearly/hcp/index.html. Zubler JM, Wiggins LD, Macias MM, et al. Evidence-InformedMilestones for Developmental Surveillance Tools. Pediatrics. 2022;149(3):e2021052138