Faculty Bibliography

OBJECTIVE: Determine maternal and infant characteristics associated with adding cereal into the bottle. DESIGN: Secondary data analysis. PARTICIPANTS: Study participants were immigrant, low-income, urban mother-infant dyads (n = 216; 91% Hispanic, 19% US-born) enrolled in a randomized controlled trial entitled the Bellevue Project for Early Language, Literacy and Education Success. MAIN OUTCOME MEASURES: Maternal characteristics (age, marital status, ethnicity, primary language, country of origin, education, work status, income, depressive symptoms, and concern about infant's future weight) and infant characteristics (gender, first born, and difficult temperament). ANALYSIS: Fisher exact test, chi-square test, and simultaneous multiple logistic regression of significant (P < .05) variables identified in unadjusted analyses. RESULTS: Twenty-seven percent of mothers added cereal into the bottle. After adjusting for confounding variables identified in bivariate analyses, mothers who were single (P = .02), had moderate to severe depressive symptoms (P = .01) and perceived their infant had a difficult temperament (P = .03) were more likely to add cereal into the bottle. Conversely, mothers who expressed concern about their infants becoming overweight were less likely to add cereal (P = .02). CONCLUSIONS AND IMPLICATIONS: Health care providers should screen for adding cereal in infant bottles. Further research is needed to investigate the impact of adding cereal into the bottle on weight trajectories over time. Causal associations also need to be identified to effectively prevent this practice.

OBJECTIVE: Some experts recommend eliminating "teaspoon" and "tablespoon" terms from pediatric medication dosing instructions, as they may inadvertently encourage use of nonstandard tools (i.e. kitchen spoons), which are associated with dosing errors. We examined whether use of "teaspoon" or "tsp" on prescription labels affects parents' choice of dosing tools, and the role of health literacy and language. METHODS: Analysis of data collected as part of a controlled experiment (SAFE Rx for Kids study), which randomized English/Spanish-speaking parents (n=2110) of children <8 years old to 1 of 5 groups which varied in unit of measurement pairings on medication labels/dosing tools. Outcome assessed was parent self-reported choice of dosing tool. Parent health literacy measured using the Newest Vital Sign. RESULTS: 77.0% had limited health literacy (36.0% low, 41.0% marginal); 35.0% completed assessments in Spanish. Overall, 27.7% who viewed labels containing either "tsp" or "teaspoon" units (alone or with "mL") chose nonstandard dosing tools (i.e. kitchen teaspoon, kitchen tablespoon), compared to 8.3% who viewed "mL"-only labels (AOR=4.4[95%CI: 3.3-5.8]). Odds varied based on whether "teaspoon" was spelled out or abbreviated ("teaspoon"-alone: AOR=5.3[3.8-7.3]); "teaspoon" with mL: AOR=4.7[3.3-6.5]; "tsp" with mL (AOR=3.3[2.4-4.7]); p<0.001)). Similar findings were noted across health literacy and language groups. CONCLUSIONS: Use of teaspoon units ("teaspoon" or "tsp) on prescription labels is associated with increased likelihood of parent choice of nonstandard dosing tools. Future studies may be helpful to examine the real-world impact of eliminating teaspoon units from medication labels, and identify additional strategies to promote the safe use of pediatric liquid medications.

BACKGROUND AND OBJECTIVES: Poorly designed labels and packaging are key contributors to medication errors. To identify attributes of labels and dosing tools that could be improved, we examined the extent to which dosing error rates are affected by tool characteristics (ie, type, marking complexity) and discordance between units of measurement on labels and dosing tools; along with differences by health literacy and language. METHODS: Randomized controlled experiment in 3 urban pediatric clinics. English- or Spanish-speaking parents (n = 2110) of children 20% deviation; large error defined as > 2 times the dose). RESULTS: A total of 84.4% of parents made >/=1 dosing error (21.0% >/=1 large error). More errors were seen with cups than syringes (adjusted odds ratio = 4.6; 95% confidence interval, 4.2-5.1) across health literacy and language groups (P < .001 for interactions), especially for smaller doses. No differences in error rates were seen between the 2 syringe types. Use of a teaspoon-only label (with a milliliter and teaspoon tool) was associated with more errors than when milliliter-only labels and tools were used (adjusted odds ratio = 1.2; 95% confidence interval, 1.01-1.4). CONCLUSIONS: Recommending oral syringes over cups, particularly for smaller doses, should be part of a comprehensive pediatric labeling and dosing strategy to reduce medication errors.

Parental engagement is critical to children's educational achievement. Before and during elementary school, it is crucial for parents to be involved in their children's education in order to foster development and achievement. Hispanic parents' immigrant status, coupled with a lack of English proficiency, means that they often find themselves of low socioeconomic status (SES). Being low SES also means that parents possess fewer resources for engaging with their children. The current study seeks to understand low-income, primarily Hispanic mothers' perceptions of their roles in their first grade children's education. Mothers were interviewed regarding parenting confidence related to teaching their children, and responses were analyzed using qualitative research methods. Mothers in this study associated their roles in their children's education with two primary areas: helping their children to learn, and raising their children to be well-behaved and respectful. The main barrier to parental confidence in these roles appeared to be mothers' lack of English proficiency. This is consistent with previous research demonstrating that Hispanic parents maintain the perception of a lack of proficiency in English as a significant barrier to parental involvement in their children's education in the United States. Future interventions with teachers and parents may benefit from these findings in consideration of the optimal ways to involve parent related to their perceived personal strengths regarding parental engagement.

BACKGROUND: One in five US children live in poverty, which adversely affects health and development. While there are existing curricular resources on advocacy, a gap exists pediatric training on the specific links between poverty, health and advocacy for children. The APA Taskforce on Child Poverty formed the multidisciplinary Child Poverty Education Subcommittee (CPES) to address this curricular need. DESIGN/METHODS: CPES members were recruited from key stakeholders in the child health and medical education communities. The CPES first identified the key domains of a novel child poverty curriculum not well addressed in current curricula. Utilizing the principles of backward design, the CPES drafted goals and objectives and built interactive learning modules targeted to those objectives. Work was done asynchronously in small workgroups with group discussion and consensus building through virtual, telephone, and face-to-face interactions. RESULTS: Four curricular domains were identified: epidemiology, pathophysiology, social determinants of health, and leadership and taking action. Each domain contains two learning goals with 3-4 objectives per goal. The final curriculum consists of four interactive modules, one per domain, structured utilizing the flipped-classroom modelwith a brief amount of pre-work, a 1 hour face-to-face session, and additional in-depth follow-up activities for the advanced learner. Facilitator guides accompany each module to allow standardization and dissemination of the educational components. CONCLUSIONS: A national curriculum on child poverty is crucial for future pediatricians as they care for children at a time of increasing wealth inequity, child health disparities and known negative impacts of poverty on health. This curriculum addresses current gaps in pediatric education in a flexible and customizable structure to allow for easy dissemination across programs and learner levels

OBJECTIVE: Child sleep problems are prevalent and have been linked to poor behavior, worse school performance, and obesity. Low health literacy (HL) is associated with suboptimal parenting practices and worse health outcomes, but the relationship between parent HL and child sleep-related issues is not known. We examined the association between parent HL and child sleep-related issues. DESIGN/METHODS: Cross-sectional analysis of data from caregivers enrolled in a cluster randomized trial of a primary care-based child obesity prevention program in 4 pediatric clinics. Parent HL assessed using the Short Test of Functional HL in Adults. At the 9-month well-child visit, sleep-related factors were assessed: presence of TV in room where child sleeps, regular naptimes and bedtimes (>5 days/week), low daytime and nighttime sleep duration (>1SD below mean based on national data). Adjusted logistic regression analyses performed. RESULTS: 557 caregivers of 9-month olds enrolled (49.7% Hispanic, 26.9% Black, 56.2% <$20K annual income); 49.6% reported having a TV in the room where their child sleeps; 26.6% did not have regular naptimes/bedtimes. Median (IQR) sleep duration was 2.3(1.5-3.0) hours (daytime), 9.0(8.0-10.0) hours (night) (30.2% low daytime; 20.3% low night sleep duration). Children of parents with low HL were more likely to have a bedroom TV (66.7 v. 47.7%, p=0.01; AOR=2.2[95%CI: 1.1-4.3]) and low nighttime sleep (37.0 v. 18.5%, p=0.002; AOR=2.4[1.2-4.8]). CONCLUSIONS: Low parent HL is associated with TV in the bedroom and low night sleep duration. Additional study is needed to further explore these associations and intervention strategies to address child sleep problems.